Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The support for portfolio-based learning as an authentic assessment method is increasing globally. However, there are no guidelines in South Africa for a clinical practice assessment portfolio (CPAP) for primary clinical practitioner training. The study set out to develop a CPAP for the Clinical Nursing Science, Health Assessment Treatment and Care programme. An exploratory, descriptive design was used that developed over three phases. In phase one, a CPAP was developed based on an extensive review of the literature. The CPAP was validated in phase two by experts and finally, student primary clinical practitioners assessed the possible contribution of the developed CPAP to their learning in phase three. The study sample for the three phases comprised of selected relevant studies published on portfolio development (n=15); experts in the field of primary health care and education in the Cape Metropole (n=11); and student primary clinical practitioners of one higher education institution in the Cape Metropole (n=45). Structured questionnaires were used for data collection from expert and student participants after they reviewed the CPAP. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences (N09/09/233), Stellenbosch University. Permission to conduct the research was obtained from the higher education institution. The content validity index for items (I-CVI) was used to determine the degree to which expert participants agreed with the content of the CPAP. Results identified an I-CVI of between 0.91 and 1.00, indicating that the contents and technical format of the CPAP constitute a suitable learning tool for student practitioners. Experts suggested minor revisions regarding the clarity of items, and those were included in the final CPAP. The data analysis of the student’s responses showed that adequate guidance was provided to complete the activities in the CPAP and that the CPAP would have a positive contribution to learning. Portfolio-based learning is an important teaching and learning strategy in the Clinical Nursing Science, Health Assessment Treatment and Care programme, whereby students can demonstrate their acquired clinical competencies. Recommendations include the use of a competency framework and consensus amongst stakeholders when developing the contents of a portfolio. / AFRIKAANSE OPSOMMING: Die ondersteuning vir portefeulje-gebaseerde leer as ’n outentieke assesseringsmetode is besig om globaal te verhoog. In Suid-Afrika is daar egter nie riglyne vir ’n kliniese praktyk-assesseringsportefeulje (KPAP) vir primêre kliniese praktisynsopleiding nie. Hierdie studie het ten doel om ’n kliniese praktyk-assesseringsportefeulje vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram te ontwikkel. ’n Verkennende, beskrywende ontwerp wat oor drie fases ontwikkel het, is gebruik. In fase een is ’n KPAP ontwikkel gebaseer op ’n ekstensiewe literatuurstudie. Die geldigheid van die KPAP is in fase twee deur kundiges verklaar en in fase drie is die moontlike bydrae van die KPAP tot die leerproses deur primêre kliniese praktisynstudente geassesseer. Die studiegroep vir die drie fases het bestaan uit geselekteerde relevante studies wat handel oor portefeulje ontwikkeling (n=15), kenners op die gebied van primêre gesondheidsorg en opvoeding in die Kaapse Metropool (n=11); en primêre gesondheidsorg studentpraktisyns van een van die tersiêre instansies in die Kaapse Metropool (n=45). Gestruktureerde vraelyste is gebruik vir data-insameling van kenners en studentedeelnemers nadat hulle die KPAP ondersoek het. Etiese toestemming is verkry van die Gesondheidsnavorsingsetiekkomitee van die Fakulteit Gesondheidswetenskappe (N09/09/233), Stellenbosch Universiteit. Toestemming om die navorsing uit te voer, is van die tersiêre instansie verkry. Die inhoud van die item-geldigheidsindeks is gebruik om die mate waarmee kenner-deelnemers met die inhoud van die KPAP saamstem, te bepaal. Resultate van die inhoud van die item-geldigheidsindeks van tussen 0.91 en 1.00 is geïdentifiseer, wat ’n aanduiding is dat die inhoud en tegniese formaat van die KPAP ’n toepaslike leerinstrument vir studentpraktisyns is. Kenners het klein veranderings vir die duidelikheid van items voorgestel en dit is ingesluit in die finale KPAP. Die data-analise van die studente se antwoorde het aangedui dat genoegsame leiding voorsien was om die aktiwiteite in die KPAP te voltooi en dat die bydrae van die KPAP positief is tot die bevordering van die leerproses. Portefeulje-gebaseerde leer is ’n belangrike onderrig- en leerinstrument vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram, waardeur studente kan demonstreer dat hulle die kliniese bevoegdhede bekom het. Aanbevelings sluit in die gebruik van ’n bevoegdheidsraamwerk en konsensus onder belanghebbendes wanneer die inhoud van ’n portefeulje ontwikkel word.

Self-efficacy in clinical performance is a very important aspect in quality of health care, because it is the ability of the person to produce the desired outcomes. The aim of the study was to evaluate self-efficacy in clinical performance of NIMART programme by professional nurses in Buffalo City Metropolitan in Eastern Cape Province South Africa. A quantitative, descriptive survey design was used to examine self-efficacy in clinical performance during implementation of NIMART programme. A purposive sample of 358 NIMART programme trained professional nurses was included in the study. Analysis of the finding was done using SPSS version 21.0. Descriptive statistics (frequencies, percentage, mean and standard deviations) were used to analyse categorical variables. To reduce data volume, factor analysis was used to identify six variable clusters: Evaluation; planning, assessment, implementation, and patient care mentoring. Factor 1 (evaluation) was highly loaded on patient driven results (0.63); nursing interventions (0.70); breakdown point location (0.80); prognosis based care decisions (0.79); prognosis based outcome monitoring (0.70); and prognosis based settings adjustment (0.70). These items collectively define evaluation of self-efficacy clinical performance of the participants. Factor 2 (planning) was termed planning of patient care in a clinical setting was significantly loaded on these items: data driven nursing diagnosis (0.51); patient driven nursing diagnosis (0.52); settings based nursing diagnosis (0.49); overall care plan formulation (0.52); short-term patients care formulation (0.58); long-term patient care formulation (0.66); goal based measurable outcomes (0.80); goal based daily patient care plan (0.79); settings based daily patient care plan (0.73). Factor 3 (assessment) which was termed assessment in clinical performance was not significantly loaded in some of the items: physical assessment (0.64); patient history (0.65); energy restoration (0.56); time management (0.71); objective patient health data (0.61); subjective patient health data (0.49); data collection documentation (0.44). Factor 4 (implementation) data source correlation; patient health data analysis (0.45); patient strength (0.46); nurse-patient/family communication (0.55); nurse patient collaboration (0.64); Experience driven decision making (0.58). Factor 5 (patient care) patient care plan adherence (0.65); setting based overall patient care (0.74); resource based overall patient care (0.59). Factor 6 (mentoring) patient’s concerns identification (0.48); patient problems prioritisation (0.46); mentor/colleague advice (0.43); mentor/colleague feedback use (0.61); patient discharge strategies (0.71); continuous reporting/documenting (0.63). The mean scores produced by the Kruskal-Wallis test showed the lowest scoring pattern as follows: 20122013201120142010. This order was the same for all the variables, confirming that the 2010 group scored significantly higher than any other group on all the variables. The overall results of the study revealed that professional nurses have high self-efficacy in clinical performance in implementation of NIMART programme, except in evaluation aspect of self-efficacy where they scored lessor. Professional nurses trained by FPD scored higher in the aspects of self-efficacy in clinical performance compared to RTC trained; but scored lower in evaluative ability of self-efficacy in both institutions (FPD and RTC). The findings of this study showed that the overall self-efficacy of the professional nurses trained on NIMART programme performed clinically satisfactorily. It is recommended that in-service education or continuous professional development for professional nurses working in PHC’s should not only concentrate on updating clinical skills, but also create opportunity for reflection and strengthening of professional nurses’ self-efficacy in clinical performance. Also, further study on other processes of goal realisation will aid our understanding of self-efficacy in achieving the desirable goals of the professional nurses for patient quality care. Further research is also needed to evaluate clients’ satisfaction during care based on the NIMART intervention programme.

Using the right method of evaluation for clinical competence in nursing education plays a major role in obtaining appropriate results and making correct judgements. Nurse educators favour the Objective Structured Clinical Assessment (OSCA) for this purpose. The objective of this study was two-fold; firstly to explore and describe the experiences of nurse educators and student nurses of the OSCA within a private nursing college in Gauteng. The second objective was to develop implementation guidelines for the use of the OSCA as an assessment method. A qualitative, exploratory, descriptive, and contextual design was used and employed individual in-depth interviews, as well as field and direct observations to collect data. A purposive sampling method was used to select participants for the study and the sample comprised of ten nurse educators and ten student nurses to represent the population. Data were analysed thematically and resulted in seven themes and eighteen categories relating to nurse educators’ and student nurses’ experiences of the OSCA. Nurse educators had a predominantly negative view of the OSCA as an assessment method related to the ability of the OSCA to assess all learning assessment method related to the ability of the OSCA to assess all learning domains, the quality, structure, and organisation of the assessment, the simulated nature of OSCA, the availability of resources, as well as the feedback, communication and remedial action during the process. Challenges were experienced with the assessment tools as well as the educator as instrument. Educators raised a concern regarding the students’ readiness for evaluation. Student nurses related their experiences prior to the OSCA, their experiences of the educator, the structure and organisation of the OSCA, and their experience related to the communication and feedback of the results. Students related mixed emotional experiences as recipients of the assessment, as well as the relevance and benefits of the OSCA / Health Studies / M.A. (Nursing Education)

Within the nursing profession, the transition from the student to a graduate nurse is a common rite of passage that marks the end of initial educational preparation in the discipline and the beginning of a professional journey as a nurse and a member of the multidisciplinary team (Nash, Lemcke & Sacre. 2009:48). This is a period of adjustment, stress, growth and development and the transitional nurse is likely to feel uncomfortable, fearful and may experience feelings of inadequacy. This study was undertaken to explore and describe the experiences of final year nursing students at a public college of nursing in the Eastern Cape regarding their preparedness to become registered nurses, with the aim to identify gaps and make recommendations on strategies to close the gaps. The objectives were to explore and describe the experiences of final year nursing students at the public college of nursing in the Eastern Cape Province with regard to their preparedness to become registered nurses and to recommend strategies to improve the preparation of nursing students for transition to become registered nurses. To answer the research question “What are the experiences of final year nursing students at a public college of nursing in the Eastern Cape Province with regard their preparedness to become registered nurses”, a qualitative, explorative and descriptive design was used as a framework for the study. Data were collected by means of unstructured focus group interviews with a purposively selected sample of 27 final year nursing students at the particular college of nursing. Data were analysed using Tesch’s method of analysis for qualitative research. Two themes emerged, revealing that participants at the college experienced preparedness and lack of preparedness to assume the role of a professional nurse. This related to certain aspects that had an impact on the preparation of the final year nursing students for practice and included: curriculum-related aspects; clinical teaching and learning support; learning opportunities; interpersonal relationships between lecturers, students and clinical staff; equipment; and library resources. It was concluded that the learning needs of the nursing students were not adequately catered for, leading to lack of preparedness. Through the involvement of nursing students in the evaluation of their learning, shortfalls in both education and practice areas could therefore be detected. Recommendations regarding strategies to be used to promote preparedness of final year nursing students included: continuous feedback on student performance in the form of exit evaluations on the part of students to identify learning needs; writing of progress reports on the part of clinical practice; and the employment of clinical preceptors with clear role specifications between the lecturers, ward sisters and preceptors to avoid role confusion.

The focus of this study was to explore reasons for the failure of student nurses to present themselves for assessment of clinical skills at a public nursing college in the Eastern Cape. The objectives were to explore and describe reasons why these student nurses were not presenting themselves for such assessment of clinical skills; to develop strategies to motivate them to present themselves for clinical skills assessment; and to make recommendations for assessment of clinical skills. The population of the study was the second and the third-year student nurses undergoing a four-year comprehensive diploma course at a public college of nursing in the Eastern Cape. Non-probability convenience sampling was used. The research questions were, firstly, why the student nurses were not presenting themselves for assessment of clinical skills? Secondly, what recommendations could be made to motivate the student nurses to present themselves for clinical skills assessment? A qualitative, explorative, descriptive and contextual research design was used. Focus group interviews with six participants per group were used to collect data. The total number of participants five focus groups was 30 by the time data saturation was reached. Data were collected following the research question, “Why are you not presenting yourselves for clinical skill assessment?” Their responses were recorded using audiotape and notes with the help of an experienced colleague. Data was analysed following Teschʼs method. Findings presented one theme, being the reason for students not presenting themselves for feedback or delaying to do so. Categories indicated that students were afraid and overwhelmed with anxiety; had too much work to do; unpreparedness for learnt skills; equipment and resources; lack of confidence; and busy ward schedules. Subcategories included lecturersʼ attitude; unfamiliarity to lecturers accompanying them; having to study to master a lot of theory; having to prepare for many tests; unavailability of lecturers to mentor them; unavailability of unit professional nurses to guide them; reluctance of patients to be used for practising skills; a tendency not to practise skills; too many students; being used as work force; placement objectives; use of dolls for demonstration; tools used to support learning making reference to obsolete equipment; all skills demonstrated at the same time; lecturers improvising when they are demonstrating some skills, and not being released for practising of skills. The focus of this study was to explore reasons for the failure of student nurses to present themselves for assessment of clinical skills at a public nursing college in the Eastern Cape. The objectives were to explore and describe reasons why these student nurses were not presenting themselves for such assessment of clinical skills; to develop strategies to motivate them to present themselves for clinical skills assessment; and to make recommendations for assessment of clinical skills. The population of the study was the second and the third-year student nurses undergoing a four-year comprehensive diploma course at a public college of nursing in the Eastern Cape. Non-probability convenience sampling was used. The research questions were, firstly, why the student nurses were not presenting themselves for assessment of clinical skills? Secondly, what recommendations could be made to motivate the student nurses to present themselves for clinical skills assessment? A qualitative, explorative, descriptive and contextual research design was used. Focus group interviews with six participants per group were used to collect data. The total number of participants five focus groups was 30 by the time data saturation was reached. Data were collected following the research question, “Why are you not presenting yourselves for clinical skill assessment?” Their responses were recorded using audiotape and notes with the help of an experienced colleague. Data was analysed following Teschʼs method. Findings presented one theme, being the reason for students not presenting themselves for feedback or delaying to do so. Categories indicated that students were afraid and overwhelmed with anxiety; had too much work to do; unpreparedness for learnt skills; equipment and resources; lack of confidence; and busy ward schedules. Subcategories included lecturersʼ attitude; unfamiliarity to lecturers accompanying them; having to study to master a lot of theory; having to prepare for many tests; unavailability of lecturers to mentor them; unavailability of unit professional nurses to guide them; reluctance of patients to be used for practising skills; a tendency not to practise skills; too many students; being used as work force; placement objectives; use of dolls for demonstration; tools used to support learning making reference to obsolete equipment; all skills demonstrated at the same time; lecturers improvising when they are demonstrating some skills, and not being released for practising of skills. The researcher concluded that students had valid reasons for not presenting themselves for assessment of clinical skills but this could be rectified through the involvement of lectures, ward staff as well as students themselves. The researcher recommended that effective communication between the staff in clinical areas and the college is needed. Clinical laboratories needed laboratory managers and had to be well equipped. A revision of the student-lecturer ratio form feed-back on skills is also suggested.The researcher concluded that students had valid reasons for not presenting themselves for assessment of clinical skills but this could be rectified through the involvement of lectures, ward staff as well as students themselves. The researcher recommended that effective communication between the staff in clinical areas and the college is needed. Clinical laboratories needed laboratory managers and had to be well equipped. A revision of the student-lecturer ratio for feed-back on skills is also suggested.