La formación en enfermería se vio afectada por la educación remota debido a la COVID-19 principalmente en la adquisición de habilidades de los estudiantes, al extenderse durante tres años el distanciamiento de la práctica clínica de los mismos. El objetivo formulado fue: comprender las percepciones de estudiantes y docentes de una escuela altoandina de enfermería, de una universidad nacional del interior del Perú, sobre las implicancias de la educación a distancia para la adquisición de habilidades, siguiendo los presupuestos de Patricia Benner. El método propuesto fue cualitativo – descriptivo. La muestra fue determinada de forma no probabilística, aplicando los criterios de saturación y redundancia. La técnica utilizada para la extracción de datos fue la entrevista semiestructurada, con preguntas abiertas a profundidad, validada por juicio de expertos. El procesamiento de los datos se realizó mediante análisis de contenido temático, cumpliendo con criterios de rigor ético y científico. La Educación de enfermería pasó de ser presencial a virtual, mediada por dispositivos electrónicos y la obligatoria distancia entre docente – estudiante – campo clínico, lo que condicionó la súbita implementación de estrategias didácticas y herramientas tecnológicas, generando resistencias, incertidumbre y deserción durante la pandemia. / Nursing training was affected by remote education due to COVID-19, mainly in the acquisition of students' skills, as the distance from their clinical practice was extended for three years. The objective was to understand the perceptions of students and teachers at a high Andean school of nursing, of a national university in the interior of Peru, on the implications of distance education for the acquisition of skills, following the assumptions of Patricia Benner. The proposed method was qualitative – descriptive. The sample was determined in a nonprobabilistic way, applying the criteria of saturation and redundancy. The technique used for data extraction was the semi-structured interview, with in-depth open questions, validated by expert judgment. Data processing was carried out through thematic content analysis, complying with criteria of ethical and scientific rigor. Nursing education went from being face-to-face to virtual, mediated by electronic devices and the mandatory distance between teacher –student–clinical field, which conditioned the sudden implementation of didactic strategies and technological tools, generating resistance, uncertainty, and desertion during the pandemic.

Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education in two sub-Saharan African countries - Botswana and Nigeria. The primary purpose of the study was to assess the design, the implementation, the factors that influence and the perceived usefulness of psychiatric-mental health nursing education programmes in developing African countries, using Nigeria and Botswana as examples. A self-reporting questionnaire, administered to psychiatric nurse educators from the two countries of concern, provided the primary source of data. A curriculum evaluation checklist based on Horan, Knight, McAtee and Westrick (1984) was used to assess the components of the existing psychiatric nursing education curricula from the two countries. Discussions were also held with practising psychiatric nurses and officials of the nursing regulatory bodies from the two countries. Data from both countries revealed that participants used various terms to describe the same model for psychiatric-mental health nursing education adopted in their countries. Botswana, however, adopted a more functional generalist basic diploma nursing education approach which encouraged a more advanced post-basic diploma specialisation and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital centred basic specialisation with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Community theme occurred in both countries' curricula with varying degrees of emphasis, as all the programmes claimed the intent to make psychiatric-mental health nursing service available to individuals, families and the communities at all levels of care. Psychiatric-mental health nursing education programmes of the two countries had been influenced at different times by war, colonial history, changing standards of health care delivery, government health policies, economic status of the country, professional status of nursing and the changing standard of education. A model that streamlined psychiatric-mental health nursing education within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of psychiatric-mental health nursing education was the need to create a mental health nursing role that would be appropriate for people's health needs rather than the needs of the health care system. / Advanced Nursing Science / D.Litt. et Phil.

Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education in two sub-Saharan African countries - Botswana and Nigeria. The primary purpose of the study was to assess the design, the implementation, the factors that influence and the perceived usefulness of psychiatric-mental health nursing education programmes in developing African countries, using Nigeria and Botswana as examples. A self-reporting questionnaire, administered to psychiatric nurse educators from the two countries of concern, provided the primary source of data. A curriculum evaluation checklist based on Horan, Knight, McAtee and Westrick (1984) was used to assess the components of the existing psychiatric nursing education curricula from the two countries. Discussions were also held with practising psychiatric nurses and officials of the nursing regulatory bodies from the two countries. Data from both countries revealed that participants used various terms to describe the same model for psychiatric-mental health nursing education adopted in their countries. Botswana, however, adopted a more functional generalist basic diploma nursing education approach which encouraged a more advanced post-basic diploma specialisation and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital centred basic specialisation with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Community theme occurred in both countries' curricula with varying degrees of emphasis, as all the programmes claimed the intent to make psychiatric-mental health nursing service available to individuals, families and the communities at all levels of care. Psychiatric-mental health nursing education programmes of the two countries had been influenced at different times by war, colonial history, changing standards of health care delivery, government health policies, economic status of the country, professional status of nursing and the changing standard of education. A model that streamlined psychiatric-mental health nursing education within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of psychiatric-mental health nursing education was the need to create a mental health nursing role that would be appropriate for people's health needs rather than the needs of the health care system. / Advanced Nursing Science / D.Litt. et Phil.

The purpose of this quantitative, descriptive study was to describe how registered nurses utilise teachable moments to enhance students' learning in the clinical setting. The research questions were: What are the problems faced by registered nurses when they teach students in the clinical setting? and How do registered nurses utilise teachable moments to teach students? A pilot study was conducted in the clinical setting involving the respondents who had similar characteristics than the population. The sample consisted of 45 registered nurses who provided direct patient care in the clinical setting. A self­ administered, structured questionnaire was used to collect data. Data analysis was done by using descriptive statistical tests. The findings brought to light strengths and weaknesses with regard to the utilisation of teachable moments by registered nurses, and problems faced by registered nurses with regard to clinical accompaniment in general. Recommendations to improve clinical accompaniment by registered nurses through effective utilisation of teachable moments were made. Further research was recommended to explore some problematic areas that emerged from this study. / Health Studies / M.A. (Nursing Science)

The study attempted to identify R425 diplomates' perceptions of their psychiatric competencies. An exploratory descriptive survey investigated specific strengths and weaknesses of the R425 diplomates in the psychiatric clinical units in the KwaZulu-Natal Province, as perceived by the diplomates themselves. The diplomates were reportedly competent in performing numerous, but not all cognitive, psychomotor and affective skills addressed by this survey. The R425 diplomates perceived themselves to be incompetent in designing and implementating rehabilitation programmes/workshops, managing community projects, conducting research and managing crises in psychiatric nursing units. / Health Sciences / M.A. (Health Studies)

The aim of this study is to determine the effectiveness of simulation training in improving the clinical competence of pupil nurses. A quantitative, quasi-experimental, non-equivalent control group before-after design is used. The method of data collection is observation using check lists. The population for this study includes the second-year pupil nurses (N=43) following the two-year programme leading to enrolment as a nurse at the Gauteng learning centre of a private hospital group during 2011-2012. The results reveal that although there is proof that clinical training in simulation improves the competence levels of the experimental group in the procedure administration of oral medication over a period of time, there is no proof that this is true for the procedure observation of patients’ neurological functions and, therefore, the researcher cannot come to a definite conclusion about the effectiveness of simulation training / Health Studies / M.A. (Health Studies)

A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. Difficulties in the development of valid and reliable assessment measures in nursing competency continue to pose a challenge in nursing education. A holistic approach in the assessment of competency comprises knowledge, skills and professional attitudes, wherein the notion of competency incorporates professional judgement and management skills in the clinical situation. Therefore, the thesis aims to develop a holistic clinical assessment tool with a reasonable level of validity and reliability to meet the needs of clinical education. The conceptual framework underlying this research is formed by establishing a theoretical connection between the practice of learning, and of pedagogy and assessment. This research consists of five studies. In Study I, a systematic review was conducted to explore the current assessment practices and tools for nursing undergraduates. In Studies II, III and IV, a qualitative approach with focus group discussions was adopted to explore the views of final-year undergraduate nursing students, preceptors, clinical nurse leaders and academics on the clinical assessment. Based on the multiple perspectives, it therefore addresses concerns in clinical assessment. In Study V, a holistic clinical assessment tool was developed, for which a psychometric testing was conducted. The systematic review indicated that limited studies adequately evaluate the psychometric properties of the assessment instrument. The qualitative studies have raised an awareness of professional and educational issues in relation to clinical assessment. Workload, time, availability of resources, adequate preparation of preceptors, and availability of valid and reliable clinical assessment tools were deemed to influence the quality of students’ clinical learning and assessment. In addition, the presence of support systems and formal educational programs for preceptors influenced their preparation and self-confidence. Nursing leaderships in hospitals and educational institutions have a joint responsibility in shaping the holistic clinical learning environment and making holistic clinical assessment for students. The involvement of all stakeholders in the development of a valid and reliable assessment tool for clinical competency is also essential to the process. The Holistic Clinical Assessment Tool (HCAT) was developed by the author based on the systematic review, qualitative findings and the core competencies of registered nurse from the professional nursing boards. The HCAT consists of 4 domains and 36 assessment items. Furthermore, testing of the psychometric properties indicated that the HCAT has satisfactory content validity, construct validity, internal consistency and test-retest reliability. In conclusion, the HCAT is meritorious in that it carries the potential to be used as a valid measure to evaluate clinical competency in nursing students, and provide specific and ongoing feedback to enhance the students’ holistic clinical learning experience. The HCAT not only functions as a tool for self-reflection for the students, but also guides the preceptors in clinical teaching and assessment. In addition, the HCAT can be used for peer-assessment and feedback. It is imperative that the clinical and academic institutions establish various levels of ongoing support for both students and preceptors in the process of clinical assessment.

When people hear the word "nurse," they often think of qualities such as compassion and patience. While these are essential characteristics, nurses must go even further when striving for professionalism. Nurses also need strong morals and ethics and the commitment to always act in the best interests of their patients. The term professionalism embraces a set of attitudes, skills and behaviours, attributes and values which are expected from those to whom society has extended the privilege of being considered a professional. The core values of professionalism include: honesty, integrity, altruism, respect, responsibility, accountability, compassion, empathy, dedication, self-improvement, competency of clinical skills and knowledge. Professional nursing practice is a commitment to compassion, caring and strong ethical values, continuous development of self and others, accountability and responsibility for insightful practice, demonstrating a spirit of collaboration and flexibility. Rapid changes in the nursing sector have recently occurred across all areas and settings, making for a chaotic and seldom unstable work environment. All of these changes have impacted the ability of ENA learners to maintain high levels of professionalism and collaboration. In particular, the researcher, as an educator within a private NEI responsible for teaching ENA learners, experienced a lack of professionalism amongst ENA learners during the course of their training, as well as after their enrolment with the South African Nursing Council (SANC). Currently, there seems to be a difference between the professionalism portrayed by ENA learners and that which is expected of them. The overall aim of this research is to enhance the professionalism of ENA learners in a private NEI in Potchefstroom, North West. The following objectives have been identified in order to reach this aim: * To explore and describe professionalism amongst ENA learners in a private NEI in Potchefstroom, North West, and * To formulate recommendations to advance professionalism amongst ENA learners in a private NEI in Potchefstroom, North West. This study was conducted by means of a case study approach as the selected topic focuses only on a private nursing education institution situated in Potchefstroom, North West. From the qualitative instrumental case study approach, a qualitative, explorative, contextual research design was followed. The population in the study was all the ENA learners of a private NEI in Potchefstroom, North West. A sample was selected through non-probable, purposive sampling according to inclusion criteria (n=25). Data collection was conducted by means of a ―World Café‖ method and a focus group. The data collected through the World Café method was recorded and transcribed and reconstructed by means of thematic analysis. The main theme that crystallised from data analysis was that ENA learners viewed professionalism as a set of behaviours that are displayed in their external environment. The behaviours are grouped into the following five subgroups, namely punctuality versus absenteeism, adhering to scheduling and duty hours, responsibility of observations and awareness, the role of dress code and the image of nursing and finally obedience to organisational rules and regulations and tolerance towards others. The World Café and focus group results were integrated with case records according to repetitive themes. From the results and conclusions, recommendations were formulated for nursing practice, nursing education and nursing research to enhance professionalism amongst ENA learners in general. / MCur, North-West University, Potchefstroom Campus, 2014

Integrative Medicine (IM) is a care approach that focuses on the overall well-being and healing process of patients rather than solely on their disease. IM educates and empowers people to be active players in their own care, emphasizes the therapeutic relationship, and makes use of all appropriate evidence-based approaches. The health-oriented foundations of IM are in line with the recently posed concept that describes health as ”the ability to adapt and to self-manage”. Due to the shared underpinnings of both IM and the new concept of health, incorporation of this new concept of health may serve as a facilitator for the development and implementation of IM. From a practical viewpoint, working from an integrative care approach requires specific competences from healthcare providers, such as socio-communicative and self-reflective skills, and reflexivity towards a holistic perspective on health. Previous studies have shown that a Mind-Body Medicine (MBM) course can potentially foster these competences among future healthcare providers. This thesis intended to gain increased insight into the prerequisites and tools for implementation of IM. Therefore, in the first part it aimed to explore the attitudes and practice of IM among Dutch nurses and the support for the new dynamic concept of health as ”the ability to adapt and to self-manage” among main stakeholders within the Dutch healthcare community. Furthermore, in the second part it aimed to evaluate the possibilities of an MBM course among medical and nursing students as a tool to foster an integrative care approach. Methods Both quantitative and qualitative research designs were used. Attitudes and practice of IM were assessed in a semi-structured survey study among 355 Dutch nurses (study I). Support for the new concept of health was explored in a mixed method study, where in the first step data from interviews and focus-groups among 140 stakeholders were investigated by use of manifest content analysis, and in the second step a cross-sectional survey was performed among 1938 stakeholders to verify the findings of the first step (study II). The MBM course was evaluated by a controlled, quasi-experimental intervention study (74 participants / 61 controls among medical students and 47 participants / 64 controls among nursing students) in which validated questionnaires were used (study III). Furthermore, in-depth interviews with 11 medical and 15 nursing students were employed and analysed by a Phenomenological Hermeneutical method to obtain an in-depth understanding of the meaning of the MBM course for the participants (study IV). Findings Study I showed an overall positive attitude towards IM among nurses. Patient-centeredness and a focus on individuals’ own resources and responsibility to promote health met the most support among both nurses and other stakeholders. These elements were considered to be the main positive aspects of the new dynamic concept of health among stakeholders as well (study II). Use of evidence-based and safe complementary therapies and a healing environment received some support from the nurses, but lack of knowledge and lack of evidence seems to hinder further incorporation in the current healthcare practice (study I). Additionally, study II revealed that health was perceived to comprise six dimensions: bodily functions, mental functions &amp; perception, spiritual / existential dimension, quality of life, social and societal participation and daily functioning. In line with patients, nurses had a more broad conception of health in comparison to other healthcare professionals. Study III showed long-term beneficial effects of the MBM course on two dimensions of empathy (personal distress and empathic concern) among medical students, and on perceived stress and empathy (personal distress) among nursing students. Study IV brought forth that the MBM course can be understood as a pathway to inner awareness and a support to connecting with others as well as the outside world. The following themes were identified: “ability to be more present”, “an increased perception and awareness of self”, and “connecting on a deeper level with others”. Conclusion It can be concluded from the results in the first explorative part of this thesis that the observed positive attitudes and perceptions among healthcare professionals toward IM and the newly proposed health concept can serve as important facilitators for further implementation of IM within the Dutch healthcare system. Furthermore, the increased ability to deal with stress, improved empathic abilities and more openness toward different perspectives on health and new treatment options among medical and nursing students following a MBM course, as reported in the second part of this thesis, suggest that this course might be a suitable tool to foster an integrative care approach among future healthcare professionals. / IM (Integrativ Vård mer adekvat term på svenska) är ett vårdkoncept/vårdansats som mer fokuserar på patienters välmående och läkeprocesser än enbart deras sjukdom. IM överlämnar makten och utbildar individen till att själv bli aktiva i sin vård, den framhäver vikten av en god vårdande relation och använder alla tillämpliga evidensbaserade metoder. Den hälsofrämjande grunden i IM är i linje med ett nyligen utvecklat hälsobegrepp, som beskriver hälsa som ”en persons förmåga till att anpassa sig och hantera utmaningar”. Utifrån den liknande grunden och förutsättningarna hos IM och det nya hälsobegreppet så kan en integration av dem vara en understödjande faktor för utveckling och implementering av IM. Utifrån en praktisk synvinkel så innebär en integrativ vårdansats att den som vårdar måste inneha specifika kompetenser och förmågor relaterade till bland annat socio-kommunikativ och självreflektiv förmåga, såväl som en reflektiv öppenhet till ett holistiskt perspektiv på hälsa. Tidigare forskning har visat att en Mind-Body Medicine (MBM) kurs potentiellt kan understödja utveckling av dessa kompetenser bland framtida vårdare. Denna avhandling avsåg i första hand att uppnå ökad insikt i förutsättningar och verktyg för implementering av Integrativ Vård. Mer specifikt syftade den till att beskriva attityder till, och utövande av IM bland Nederländska sjuksköterskor, samt undersöka stödet för det nya dynamiska hälsobegreppet (”en persons förmåga till att anpassa sig och hantera utmaningar”) bland intressenter inom Nederländsk Hälso- och Sjukvård. Vidare i andra hand, avsåg avhandlingen också att utvärdera förutsättningarna för att använda en MBM kurs som ett verktyg till att understödja och fostra ett mer integrativt förhållningssätt bland läkar- och sjuksköterskestudenter. Metod Både kvantitativ såväl som kvalitativ forskningsdesign tillämpades. Attityder till, och utövande av IM undersöktes i en semistrukturerad enkätstudie bland 355 Nederländska sjuksköterskor (studie I). Stödet för det nya hälsobegreppet undersöktes i en studie som genomfördes med mixad design, där i det första steget data från individuella- och fokusgruppintervjuer bland 140 intressenter genomgick en manifest innehållsanalys, och i det andra steget genomfördes en tvärsnittsstudie bland 1938 intressenter för att validera fynden från det första steget (Studie II). MBM kursen utvärderades i en kontrollerad, kvasi-experimentell interventionsstudie (71 deltagare/61 kontroller bland läkarstudenter, och 47 deltagare/64 kontroller bland sjuksköterskestudenter) med validerade frågeformulär (Studie III). Vidare även i en Fenomenologisk-Hermeneutisk ansats via individuella intervjuer med 11 läkar- och 15 sjuksköterskestudenter för att uppnå en djupare förståelse över MBM kursens betydelse för deltagarna (Studie IV). Fynd I studie I framkom att sjuksköterskorna övergripande hade en positiv attityd till IM. Patientcentrering och fokus på individens resurser, samt deras egna ansvar för att arbeta hälsofrämjande var områden som hade mest stöd bland både sjuksköterskor och andra intressenter. Dessa element ansågs också av intressenterna vara den mest positiva aspekten av det nya dynamiska hälsobegreppet (Studie II). Användandet av evidensbaserade komplementärmedicinska metoder och hälsofrämjande miljöer stöddes till viss del av sjuksköterskorna men brist på kunskap och brist på evidens förefaller vara hinder för integration i nuvarande vårdpraxis (Study I). I studie II framkom att begreppet hälsa uppfattades som att bestå i sex olika dimensioner; ”kroppslig funktion”, ”mental funktion och perception”, ”spirituell/existentiell dimension”, ”livskvalitet”, ”social-samhällelig inklusion” samt ”daglig funktion”. I samklang med patienter, så hade sjuksköterskor en bredare syn på hälsa än andra hälsoprofessioner. I studie III framkom långsiktiga positiva effekter av att delta i MBM kursen avseende i två dimensioner av empatisk förmåga (Personal distress och Empatic concern) bland läkarstudenterna, samt avseende upplevd stressnivå (perceived stress) och empati (personal distress) bland sjuksköterskestudenterna. I studie IV framkom att MBM kursen kan ses som ”en väg till inre medvetenhet och stöd till att knyta an till andra och den omgivande världen” vidare identifierades temana: ”en förmåga till en mer medveten närvaro”, ”en ökad uppfattningsförmåga och inre medvetenhet” samt ”att knyta an till andra människor på en djupare nivå”. Slutsats Utifrån resultaten i avhandlingens explorativa (I, II) del är slutsatsen att de observerade positiva attityderna, och uppfattningarna bland vårdgivare avseende IM och det nyutvecklade hälsobegreppet kan ses som viktiga facilitatorer för ytterligare implementering av IM i det Nederländska hälso- och sjukvårdssystemet. Vidare, den ökade förmågan att hantera stress, utveckla empatisk förmåga och mer öppenhet för nya perspektiv på hälsa och behandlingsalternativ hos läkar- och sjuksköterskestudenter efter deltagande i en MBM kurs (implementeringsdelen i denna avhandling, III, IV), stöttar antagandet att kursen kan ses som ett användbart verktyg för att understödja en mer integrativ vårdansats bland framtida vårdpersonal. / <p>Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 3 i tryck, delarbete 4 inskickat.</p><p>At the time of the doctoral defence the following papers were unpublished: paper 3 in press, paper 4 submitted.</p>

L’approche par compétences est de plus en plus choisie pour guider les curriculums universitaires de formation professionnelle. Accordant un intérêt primordial au développement des compétences, les responsables des programmes élaborés selon cette approche doivent déterminer les stratégies pédagogiques qui seront les plus efficaces et qui permettront une participation active de l’étudiant. Depuis plus de 30 années (Cameron et Mitchell, 1993; Wellard et Bethune, 1996), le journal d’apprentissage favorise la construction des savoirs en pratique clinique et le développement de la pensée réflexive, une compétence nécessaire à la pratique des infirmières qui s’inspirent d’une vision spécifique de la discipline, comme celle du modèle de McGill (Kravitz et Frey, 1989; Thorpe, 2003). Malgré cela, les études sur les perceptions d’étudiants relativement au journal d’apprentissage sont rares, et ce, surtout au Canada (Epp, 2008). Il importe de s’intéresser aux perceptions d’étudiants afin d’atteindre l’efficacité optimale de l’outil. Le but de cette étude était d’explorer les perceptions d’étudiants au baccalauréat en sciences infirmières de l’utilisation du journal d’apprentissage. Elle a été réalisée auprès d’étudiants de 2e et 3e année, selon un devis de type qualitatif exploratoire. Les participants (n=52) ont rempli un formulaire constitué d’une mise en situation comprenant 5 questions ouvertes. L’analyse des données a fait émerger trois thèmes principaux de l’utilisation du journal soit : un outil personnel, un outil de communication et un outil d’apprentissage de la pratique. Des recommandations pour la formation et la recherche sont formulées. / The competency-based approach is increasingly chosen to guide university curriculum. In according an essential interest to the competency development, the responsible for programs developed using this approach must determine the most effective learning strategy. In the last 30 years (Cameron et Mitchell, 1993; Wellard et Bethune, 1996), the learning journal promote the building of clinical knowledge and the development of reflexive thinking, a competency that is necessary to the practice nurses inspired by a specific vision of the discipline, like the McGill model (Kravitz et Frey, 1989; Thorpe, 2003). Despite this, the studies on the student’s perceptions on the learning journal are rare, especially in Canada (Epp, 2008). It is important to look at student’s perceptions to attain the optimal efficacy of the tool. The purpose of this study was to explore the perceptions of undergraduate students in nursing of the utilization of learning journal. It was realized with 2nd and 3rd year undergraduate students in nursing, using a qualitative exploratory research design. The participants (N=52) completed a form presenting a simulated situation that contained 5 open ended questions. The three main themes that emerged during data analysis on the utilization of the learning journal were: a personal tool, a communication tool and a learning practice tool. Recommendations for education and future research are offered.