GUIDELINES TO IMPROVE CLINICAL COMPETENCIES OF LEARNERS OF THE PROGRAMME PHC: Clinical Nursing, Diag

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GUIDELINES TO IMPROVE CLINICAL COMPETENCIES OF
LEARNERS OF THE PROGRAMME PHC Clinical
Nursing, Diagnosis, Treatment and Care

• By Nomasonto Buso Doris Magobe
• RSA
• University of Johannesburg
• Faculty of Health Sciences
• School of Nursing

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Introduction

• In South Africa, a specialised group of
  registered nurses Primary Clinical Nurses
  (PCNs) function independently as frontline
  providers of clinical PHC services within public
  health care facilities (DoH, 1996 18).

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Introduction (continued)

• Global PHC approach by WHO at the Alma Ata
  conference (1978)
• South African Nursing Council (SANC) (1981)
  insertion of Section 38A (Gov. notice R1248)
  within the Nursing Act 50, 1978
• National Department of Health Policy document on
  restructuring of the health system in South
  Africa (DoH, 1996 17)

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Introduction (continued)

• University of Johannesburg
• (context of the study)
• ?
• Learning programme - PHC
• Clinical Nursing, Diagnosis, Treatment and Care
• ?
• High standard of clinical competencies to ensure
  quality health provision within PHC clinics.

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The learning programme

• Post Basic Diploma 2yrs.
• 2nd year - development of clinical competencies
• Limited contact programme 5 times per year
• Three days per contact session
• Day 1 theory by lecturer and others
• Day 2 3 clinical practise supervised by PHC
  clinical instructors
• In-between contact sessions clinical skills
  practice at appropriate PHC facilities under the
  clinical supervision of preceptors (PCNs / GPs)

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The research problem

• Despite the input of the lecturers and the
  clinical supervision of instructors and
  preceptors, the majority of learners
• (61 - 2002 results) still displayed poor
  clinical competencies at end of learning
  programme.
• Findings in previous research studies show that
  qualified PCNs in the PHC clinics are not
  displaying acceptable clinical competencies
  (Mofukeng 1998, Monamodi 1998 Oskowotz,
  et.al 1997)

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Research Question

• What are the reasons for poor clinical
  competencies of learners of the programme PHC
  Clinical Nursing, Diagnosis, Treatment and Care?

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Research Purpose

• To identify the reasons for poor clinical
  competencies of learners of the programme, and as
  informed by the findings to describe guidelines
  to improve clinical competencies of learners of
  the programme - PHC Clinical Nursing, Diagnosis,
  Treatment and Care within the context of the
  university.

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Research Objectives

• 1. Explore and describe the perceptions of both
  clinical instructors and learners, respectively,
  with regard to reasons for poor clinical
  competencies of learners of the programme
• (PHASE ONE Qualitative in nature)

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Objectives (continued)

• 2. To explore and describe the demographic
  profile of learners registered for the programme
  at the university in the academic year 2003 with
  regard to reasons for poor clinical competencies.
  
• (PHASE TWO quantitative in nature)

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Objectives (continued)

• 3.To explore and describe the relationship
  between scoring/rating of learners by clinical
  evaluators during summative clinical evaluations
  of learners registered for the programme in 2003,
  to ensure inter-rater reliability with regard to
  reasons for poor clinical competencies of
  learners of the programme
• (PHASE THREE- quantitative in nature)

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Objectives (continued)

• 4. To describe guidelines to improve clinical
  competencies of learners of the programme as
  informed by the research study findings.
• (PHASE FOUR)

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Research Design

• A mixed methodological design, qualitative and
  quantitative in nature (Creswell, 1994 184 De
  Vos, 2001 261 Creswell, 2003 213 )
• Sequential Exploratory Strategy
• ?
• QUAL ? QUAL ? quan ? quan ? Interpretation
• Data Data Data Data of Entire Analysis
• Collection/ Analysis Collection Analysis

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Rationale for use of the Sequential Exploratory
Strategy

• Primary focus is to explore the phenomena,
  which is reasons for poor clinical competencies
  of learners.
• Priority was given to the qualitative aspect of
  the study, and the quantitative findings assisted
  in the interpretation of qualitative findings
• Initial phase - qualitative data collection and
  analysis
• Followed by a phase of quantitative data
  collection and analysis
• Findings of both qualitative nd quantitative data
  were integrated during the interpretation phase
• (Creswell, 2003 215)

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Research methodSampling
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Data collection
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Data analysis
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Trustworthiness (Qualitative)Validity and
reliability (Quantitative)
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QUANTITATIVE FINDINGSSummative clinical
evaluation of learners results Statistical
results of t-Test (n38)
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Qualitative findingsQuestion to participants

• A central question posed to learners and clinical
  instructors in their respective focus groups was
• What are your perceptions with regard to reasons
  for poor clinical competencies of learners of
  this programme

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Qualitative findings Two Main Themes
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Qualitative findings Themes, major and sub
categories
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Qualitative findings Themes, major and sub
categories
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Development of Guidelines

• Guidelines to improve clinical competencies of
  learners of the programme PHC Clinical Nursing,
  Diagnosis, Treatment and Care were developed as
  informed by qualitative and quantitative
  findings.