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The transition from the apartheid rule to a new democracy in South Africa has been accompanied by a vision of a national health care system that is based on the principles of universal primary health care. This vision opens up access to provision of mental health to everyone. This means that nurses, as gate-keepers of primary health care, have had to be trained in identification and management of minor mental health problems that are presented in their community clinics as well as health centres. For the current study, the need for such training was identified by an intern psychologist placed in one of the clinics in the area of KwaDedangendlale Valley of a Thousand Hills. His work in the area alerted him to the shortcomings of the nurses in both identification and management of what was perceived to be mental health problems. These shortcomings included the nurses' inability to identity and hence properly refer patients who needed the intervention of a professional mental health specialist. From this, a training programme which also included a reorientation process to deal with negative attitudes that are usually levied against the mentally ill was undertaken. Reorientation in this context was based on the assumption that prior to training nurses had a particular world view or position towards the provision of health care, which was identified to be biomedical and this training sought to re-orientate them towards the provision of a more holistic care which is inclusive of psycho social aspect of functioning The follow up to that training and reorientation programme was an evaluation component. This sought to ascertain whether after training, nurses were better equipped to identify and manage mental health problems. Further to that, the researcher sought to identify whether their attitudes had improved, such that they would be willing to deal with patients who presented with minor psychiatric problems. The objective of the current study is to present results of the evaluation component that was undertaken after training. This evaluation took into consideration both the process undertaken during training and the outcome of the reorientation process itself. Process evaluation focused on what makes a programme successful or unsuccessful. This included how the training was undertaken, i.e. manner of instruction etc. Outcome evaluation focused on establishing how good the programme was and whether it managed to provide desired outcomes i.e. change in nurses' attitudes. The Physician's Belief Scale (Ashworth, Williamson & Montano, 1984) was used for both the pre and post evaluation of the nurses' attitudes. The results revealed that before training, nurses had limited knowledge of mental health problems and as a consequence of this limited knowledge they developed negative attitudes towards provision of mental health care. One of the unexpected results of the study was the response of one of the groups of the nurses trained to the integrative manner of instruction. Their response highlighted the importance of understanding the influence of the padagogy on knowledge transmission and acquisition. Nurses reported to be accustomed to harsh pedagogical methods, used during formal nursing training. This kind of pedagogy was viewed as disempowering, as well as somewhat disrespectful, and hence, the much as the friendly and warm atmosphere presented by the facilitators in the current study was viewed as a welcomed change and an empowering process. Most importantly, one was also alerted to the importance of providing ongoing support to health care professionals after being trained. As Petersen (2000) has cautioned that should there be no additional mentoring or support, nurses would be likely to revert to their usuaVold styles of dealing with their patients' problems, given that the training does not necessarily change their environments. They would still be pressured to see large numbers of patients within a limited time period. And because of this, it becomes easier to just prescribing medication than to explore issues that are psychological in nature. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

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Assessment of clinical learning is imperative in order to ensure that those who become registered nurses are safe and competent practitioners. Assessment of clinical skills requires evaluation of the development of appropriate knowledge, skills and attitudes. Literature however reveals that the measurement of clinical skills performance continues to pose a challenge for nurse educators, the debate around the best assessment method in clinical learning, as well as, validity and reliability in assessing clinical learning is ongoing. This study was therefore aimed at exploring and describing current practices in assessment of clinical learning in a nursing diploma programme in Kigali Health Institute in Rwanda. The study was a quantitative descriptive exploratory design. Data were collected through the use of questionnaires. Nurse educators, students and external examiners were asked to report on the assessment strategies commonly used in Kigali Health Institute, their views about assessment strategies, and the strengths and weaknesses of clinical assessment strategies used in a nursing diploma programme in assessing practical competences of nursing students. The total number of participants who returned questionnaires in this study was 117. The results of this study revealed the commonly used assessment strategies included OSCEs (100%), case presentations (66%), direct observations (38%), standardized patients (31 %) and reflective diaries (2%). Furthermore, assessments were based on clinical learning outcomes. Assessments were conducted formatively and summatively to ensure validity in assessments and to ensure that a variety of clinical learning areas were assessed. Although there was no documented structured process of conducting clinical assessments, the findings revealed that the process included a number of phases; planning, preparation, implementation and evaluation phases. There were measures in place to ensure validity and reliability in assessments. The need for a policy on clinical learning assessment emerged so as to serve as a guide to ensure consistency in conducting assessments. The need to build the capacity of nurse educators and external examiners also came up as very few had educational preparation for their roles. Most of them were specialists in the discipline not in nursing education. The findings also revealed that not all nurse educators were involved in decision making regarding clinical assessments for quality assurance purposes. Issues such as welcoming of students on the assessment day, giving of instructions to students, time spent on performing tasks, feedback to students, returning to tasks which were not completed and improvising during assessments due to limited resources emerged as areas of concern. Recommendations made are related to the assessment process, the building of capacity of nurse educators and external examiners, preparation of students for clinical learning assessment, and further research for the in-depth exploration of this area. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007.

This qualitative study examines the influence of culture on the teaching and learning process in an eastern Canadian college nursing program. The study reveals incongruency between the ideals of multiculturalism and teaching and learning processes. While teachers perceive they have the requisite skills to fulfill the content objectives using various pedagogical methods set out by the curriculum, they are not always able to promote successful achievement of these objectives in a multicultural student population. Moreover, students experience special learning difficulties in their interactions with teachers when the learning environment is unfamiliar to them and their own cultural identity and life values are not well understood. / The study concludes that the content of nursing education curricula needs to be broadened to include attention to cultural considerations. Most importantly, teachers practicing within multicultural student populations need training in cultural sensitivity and in developing culturally appropriate pedagogical approaches.

Clinical decision making is essential to clinical practice, yet research into the cognitive processes underlying clinical decision making is limited. The purpose of this study was to investigate the cognitive processes utilized by nurses in actual clinical decision making situations. Using a criterion sampling technique, eight experienced medical and surgical nurses from an acute care community hospital were selected as participants for in-depth interviews about clinical decision making in nursing practice. Actual clinical data documented by the eight nurses were obtained from a review of 100 randomly selected hospital records of patients discharged over a one year period. The study examined the influence of contextual factors (nursing subgroup, Problem Oriented Recording [POR] charting system and primary nursing system), task variables (complexity of clinical problems), and clinician characteristics (nursing expertise) on clinical decision making. The dependent variables included the accuracy of nursing diagnosis documentation and the utilization of specific thinking processes. Donald's model of thinking processes provided a framework for the analysis of the data. / The results suggest that clinical decision making is a complex cognitive process requiring numerous thinking skills and operations. Five different categories of thinking skills and 14 different operations were identified in the narrative notes. The clinical situations were categorized into three types based on the complexity of clinical problems. Nurses from both hospital units documented a wider range of thinking skills and operations in situations of greater complexity. The findings also suggest that structured charting formats such as SOAP narrative notes encouraged the use of higher order thinking processes. The introduction of the primary nursing patient assignment system did not result in significant changes in the documentation of nursing diagnoses or thinking processes utilized by nurses. The nurses were grouped into two levels of expertise according to Benner's categories: expert and proficient, with differences more evident in the medical nurses. An important outcome of this study was the development of nursing exemplars and illustrations of thinking processes that can provide a working vocabulary to describe the underlying cognitive processes used in clinical decision making.

Nursing schools today are bound by accreditation agencies to produce graduate nurses who can think critically. Clinical instructors play the dominant role in transitioning students from the didactic experience to the clinical experience. The clinical experience is where students practice higher levels of thinking under the supervision and guidance of a clinical instructor in order to arrive at safe patient care decisions. Regardless of the teaching method used to develop critical thinking skills, it is the underlying questioning skill of the instructor that facilitates the growth of critical thinking (Giddings, Dyson, Entwistle, Macdiarmid, Marshall, & Simpson, 2000; Hermiz, 2001, p. 183; Myrick & Yonge, 2002).The purpose of the descriptive study was fourfold: (a) to examine the cognitive characteristics of questions asked by clinical nurse faculty of baccalaureate nursing students, (b) to examine faculty perceptions of the questions being asked in the clinical setting, (c) to examine the questions asked under the categories posed by Myrick and Yonge (2002) of theoretical knowledge, clinical decision-making and action in an effort to determine if systematic questioning is occurring that moves students from theoretical knowledge through to nursing action, and (d) to compare faculty perceptions of the questions asked. Questions were examined for level and type as defined by Craig and Paige (1981); and context in which the question was posed utilizing the guidelines posed by Myrick and Yonge (2002) as theoretical knowledge, clinical decision-making and action. The academic and professional characteristics of clinical faculty were captured utilizing a demographic survey.Findings mirror that of previous research. Clinical faculty continue to ask low cognitive level questions of baccalaureate nursing students. Approximately 71.8% of the questions represented the categories of knowledge, comprehension and application. In addition, over 21% of the questions posed fell into the category of "other" representing questions that were primarily yes/no, and information seeking type questions When looking at sequencing of questions, again, primarily the questions fell into the theoretical knowledge category, and did not move the student through to the evaluation of nursing care. / Department of Educational Studies

Parish Nursing is relatively new, having its original Scope and Standards from the American Nurses Association published in 1998. At the same time the Basic Preparation Curriculum for Parish Nursing, which had been developed through the International Parish Nurse Resource Center, was distributed to Educational Partners of the Center and used for Parish Nurse instruction. This curriculum has subsequently been revised in 2004 and 2009, but over this time a study of the learning needs of novice Parish Nurses has not been documented. This study is an assessment of the learning needs of one group of Parish Nurses. The study was constructed on 11 prioritized Parish Nursing skills from the “Getting Started” module of the Basic Preparation Curriculum for Parish Nursing and consisted of three questions about each skill. Survey respondents were asked to rank 1) the importance of the skill, 2) the percentage of new Parish Nurses whom they felt were deficient in the skill and 3) how important it was to add more training for that skill in the Parish Nurse course. Answers to the skill questions utilized a six point Likert scale. Among other biographical information, respondents were asked how many years they had been an active Parish Nurse and to rank themselves based on Benner’s (1984) levels of expertise. Although the outcomes of the study are focused on the learning needs of novice Parish Nurses, input was obtained from Parish Nurses of all levels of expertise. A qualitative component was obtained from the textbox at the end of each set of the three skill questions. The comments gave voice to the respondents and enriched the findings. The study affirmed that the skill of ‘Keeping Confidentiality’ was unanimously rated highly and well done, but this is an essential skill to all nursing. The most variance came with the skill of ‘Making a Budget’. Many Parish Nurses volunteer their services to their church, often with a ‘zero’ budget to work with, so making a budget is immaterial. The study showed that respondents in general were satisfied with their Parish Nursing training and that of their novice colleagues. / Department of Educational Studies

A major purpose of the study was to determine whether differences exist between perceptions about sources of power by deans of colleges of nursing in medical centers and deans in non-medical centers. Discernible differences attributable to position title and years of administrative experience were also investigated. A subsidiary purpose of the study was to explore relationships between expert and referent power and among coercive, legitimate, and reward power.Data were collected from 206 out of 300 administrators of National League for Nursing accredited baccalaureate and higher degree programs. A Power Assessment Instrument measuring the five sources of social power as formalized by French and Raven, and a Demographic Data Sheet were utilized for data collection.Decisions about three null hypotheses were made at the 0.05 level by use of multivariate and univariate analysis and, where appropriate, post hoc Newman -Keuls procedures. Findings for a fourth hypothesis were drawn from a Pearson Product-Moment correlation analysis.Major findings included:1. No differences were observed in perceptions about sources of power between deans in medical centers and deans in non-medical center settings.2. Coercive and referent power emerged as significant variables in comparing deans to all chairmen and deans to chairmen reporting directly to the chief academic officer. Deans perceive presence of more coercive power than chairmen while chairmen perceive referent power than deans. Deans and chairmen not reporting directly did not differ.3. Administrators with eleven or more years of administrative experience perceive presence of expert power more than administrators with ten years or less of experience.4. All five sources of power were highly correlated with no discernible tendencies for grouping between expert and referent power or among coercive, legitimate, and reward power.Additional observations, while not empirically supported by the data, were presented. Also presented were recommendations for further explorations pertaining to nursing education and power assessment.