Community-based nursing education in South Africa: A grounded-middle range theory

Abstract

Background: The change to a democratically elected government in South Africa in 1994 brought with it an impetus for change in public health and education systems, which was signalled by a number of policy documents. Traditional content-driven education was to be replaced by a community-oriented approach to education. Community-based education was to be the vehicle through which health care students and health personnel educators would be equipped with the comprehensive knowledge, competencies and attitudes needed to respond to the health care needs of the South African population. There was, however, no shared understanding of the meaning of the term, community-based education, in the country. The purpose of this study was (a) to conceptualise the phenomenon CBE within the South African context, and (b) to develop a middle-range theory that would guide the practice of CBE in basic nursing education in the country. This article focuses only on describing the middle range theory of CBE. Methods: A grounded theory approach was used to guide the research process. Purposive sampling followed by theoretical sampling resulted in 41 participants comprising of heads of nursing schools, program directors, facilitators from six nursing education institutions and policy makers. Data was collected by means of observations, interviews and analysis of program documents. Observations were carried out in community and classroom settings. Data analysis was performed using open, axial and selective coding. Results: The results showed that in South Africa, community based nursing education was viewed as (a) relevant education; (b) responsive education; (c) education for social justice; and (d) a conscious and deliberate primary health care socialization process. Importantly, a process-outcomes approach to education was seen as the most appropriate curriculum approach for community based nursing education. Conclusions: The tentative theory from this study requires subjection to scholarly critique and validity testing in order to facilitate its evolvement towards becoming a higher level substantive theory.

Nursing education challenges and solutions in Sub Saharan Africa: an integrative review

“…Health care reforms alter the environment in which nurses and other health care workers practice. The review found that in Sub Saharan Africa, emphasis on primary care, emerging of new health challenges, increasing burden of disease significantly demand need for curriculum reforms [ 21 – 23 ]. Mthembu et al [ 22 ] reported that reforms in curricula are necessary to ensure that nursing education produces graduates who influence the quality of the health care system and are relevant to the needs of the population.…”

“…Mtshali and Gwele [ 21 ] developed a middle range model that would guide the practice of community based education in basic nursing education in South Africa. This curriculum reform in nursing education reported community based education as relevant, responsive education and education for social justice that consciously and deliberately socialize health delivery towards primary health care.…”

Attitudes toward Community - based training and internship of Nursing students and professors: a qualitative study

“…(7)(8)(9) This study showed that although community-based training and internship along with professors have some challenges such as shortage of facilities, equipment, and human resources, it was evaluated as useful for the community by students and professors participated in this study. The results were in line with those of similar studies.…”

Effect of community-based education on undergraduate nursing students’ skills: a systematic review

“…The findings of this systematic review indicate that community-based education promotes the development of professional skills in nursing students [11,19,20,22,24,27,31,32]. Research has shown that the use of community experiences in educational programs enhances professional skills [10]. Community-based education occupational competencies and skills such as problem-solving, leadership, and management [9].…”

“…Internationally, changes to education have taken place. For example, the South African government called for a shift in health care education from a traditional content-based approach to a community-based approach so that students and educators could experience it [10]. UK health policy has emphasized community-based care in recent years because it has been shown to increase nurses' competence and confidence [11].…”