The nurse education and training landscape in South Africa has changed in different ways over the past century, with the result that education and training of nurses does not necessarily translate into an adequate supply of professional nurses for the health care service. Today there is a shortage in this category. Factors which contribute to this shortage include nurses moving from the public to the private sector due to perceived better conditions of service, migration, burden of disease, reduction in bed occupancy and an ageing nurse population. Many professional nurses are now reaching retirement, and it is imperative that the training and supply of young professional nurses for the country be reconsidered in the light of this. According to Pillay, the majority of nurses' training begins in the public sector and their knowledge is grounded on this experience. When sufficient experience is gained, they seek out better opportunities in the private sector and migrate to the more developed countries. This loss of experience from the public sector impacts negatively on the capacity to mentor new graduates, which in turn results in the young, professional, trained nurses seeking better opportunities with organizations where they can develop further. The net result of this is that the public sector is left with overworked, older staff who are on the verge of retirement.
The purpose of the study was to compare the extent to which the different teaching approaches applied in the Baccalaureus Curationis programme adequately prepare graduating learners for professional competence. The research methodology was a quantitative approach, based on descriptive research, with a clinical competence development model to guide the data collection procedure. The target population of the study included a sample of 250 learners in the four-year B.Cur programme, that extended from first-to-fourth-year. Stratified random sampling was applied to select the sample learners for this research and data were collected by means of a five-point Likert scale questionnaire. Data were organised and managed using the SAS statistical software package. Descriptive statistics were gathered with measures of central tendency and dispersion included, and their findings were illustrated on descriptive tables. A correlation technique was applied to determine the effects of the independent variable on the dependent variable.The results of the study indicated that progression in competence did not occur as learners progressed through higher levels of their training, except during the third-year of study. However, the study's results confirmed the strengths of the Case-based clinical reasoning approach to teaching and learning. This approach is able to combine the strengths of the traditional methods, which dealt with large class sizes and that had a focus on learner centred learning, with a focus on clinical practice. This approach provides realistic opportunities for learners to experiment with solutions to dilemmas encountered in real life situations, from the protected and safe environment of the classroom. The first-year learners who were observed in this study, who although novices, were exposed to Case-based teaching approaches and showed more self-perceived competence than learners in later years. This occurred in spite of the limited exposure of the first-year learners to real life clinical situations. The outcome of this study recommends that more studies are conducted, in the School of Nursing at the University of the Western Cape (UWC), to explore teaching and learning approaches that fully maximise the clinical and theoretical competencies of the learners. The outcome further recommends that learner-centred teaching approaches, such as Case-based method, are applied to all year levels of study in the B.Cur programme, due to its proven value when it was applied to first-year learners. The Case-based clinical reasoning approach to learning, that has been implemented at the school, promotes competence and self confidence in learners and has enhanced their sense of responsibility to be actively involved in their own learning.
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