Evidence of application of the Basic Antenatal Care principles of good care and guidelines in pregnant women's antenatal care records.

BACKGROUND: Basic Antenatal Care (BANC) is an approach that is used in the public health institutions of South Africa to provide health care services to pregnant women. The approach was introduced as a quality improvement strategy based on the belief that good quality Antenatal Care (ANC) could reduce maternal and perinatal mortalities and improve maternal health. AIM: The aim of this study was to analyse pregnant women's ANC records for evidence suggesting that the BANC principles of good care and guidelines were being applied. SETTING: The study was conducted in the 12 primary health care clinics that were providing ANC services using the BANC approach in eThekwini district, KwaZulu-Natal. METHODS: A cross-sectional quantitative design was used to conduct the study. Data were collected through retrospective record review of 1200 maternity case records of the pregnant women who had attended for ANC services three or more times and was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. RESULTS: The majority of the processes detailed in the guidelines and principles of good care were evident in the records. However, several were missing or recorded in few reviews. These included the ANC plan, delivery plan, midwives' counter signatures on the cards, assessment for foetal congenital abnormalities, and consent for HIV testing. CONCLUSION: The study identified evidence of incomplete application of the BANC principles of good care and guidelines in pregnant women's antenatal care records which indicated that the BANC approach was not being successfully implemented. Recommendations were made with regards to policy development, institutional management and practise, nursing education, and further research to assist in successful implementation of the BANC approach in line with the guidelines and principles of good care.

A model for the integration of primary health-care services in the province of KwaZulu-Natal, South Africa.

AIMS: To analyse integrated primary health care and ultimately develop a model for integrated care. BACKGROUND: In South Africa, Integration of Services Policy was enacted in 1996 with the aim of increasing health service utilization. However, the problem with the policy arises in the implementation of integrated primary health care as there is no agreed understanding of what this phenomenon means in the South African context. METHOD: A cross-sectional study, using Strauss and Corbin's grounded theory approach was utilised. Policy makers as well as primary health care nurses at functional level participated in the study. The data was collected by means of observations and interviews. The sample size for interviews comprised 38 participants. RESULTS: Integrated primary health care was understood either as comprehensive health care, supermarket approach or one-stop shop. CONCLUSION: It was concluded that integrated primary health care meant different things in different contexts. IMPLICATIONS FOR NURSING MANAGEMENT: Integrated primary health care, if implemented, would advance health equity in all countries rich and poor and, as a result, promote human and national development. This model could be used to guide policy formulation and implementation of integrated primary health care at provincial and national levels.

The meaning of community involvement in health: the perspective of primary health care communities.

The goal of this study was to establish the understanding and appreciation of the essence of PHC principles in the two Primary Health Care (PHC) communities. The PHC communities in this study referred to the people who were involved in the operation of the phenomenon, that is health professionals working in the health care centers and the communities served by these health care centers. It was hoped that the study would enhance the understanding of the importance of community involvement in health (CIH) in health care delivery, for both community members and health professionals. A case study method was used to conduct the study. Two community health centers in the Ethekwini health district, in Kwa Zulu Natal, were studied. One health center was urban based, the other was rural based. A sample of 31 participants participated in the study. The sample comprised of 8 registered nurses, 2 enrolled nurses, 13 community members and 8 community health workers. Data was collected using individual interviews and focus groups, and was guided by the case study protocol. The findings of the study revealed that in both communities, participants had different, albeit complementary, understanding of the term 'Community Involvement in Health' (CIH). Essentially, for these participants, CIH meant collaboration, co-operation and involvement in decision-making.

Selected outcomes of community-oriented, problem-based nursing programmes in South Africa.

UNLABELLED: Whilst there is a significant body of research on the outcomes of problem-based learning (PBL) programmes (Albanese and Mitchell, 1993; Vernon and Blake, 1993), there is little information regarding the outcomes of community-oriented programmes (COL) for nursing students. Between 1994 and 1997, four university schools of nursing implemented problem-based, community-oriented learning (COL) programmes. This research sought to describe, evaluate and compare the outcomes of graduates from these four universities with graduates who had followed conventional programmes. RESEARCH OBJECTIVES: These were to describe and explore the incorporation of illness prevention and health promotion of graduates from PBL/COL programmes and non-PBL/COL programmes in South Africa, as described by the graduates and their supervisors. Secondly, to describe whether and how the graduates from PBL/COL and non-PBL/COL programmes engaged themselves in continued learning. RESEARCH METHODOLOGY: This was a qualitative evaluation study, which is descriptive and comparative in nature. In-depth interviews were held with the graduates and their supervisors about six months after completion of their training. Use was made of Miller and Crabtree's (1994) Template Analysis Style and of Benner's (1984) interpretative approach to analyze data. Analysis was done using the NVIVO computer programme. This programme was used to manage the categories which were developed with regard to each concept as the analysis proceeded. FINDINGS: Both the graduates and the supervisors appeared to have difficulty describing activities relating to health promotion and illness prevention. Only three types of health promotion were described--mass education, increasing personal skills and creating a supportive environment. The most commonly mentioned means of illness prevention were health education and medical-surgical asepsis. A few graduates described activities which indicated that they had taken context into consideration during patient care.

Graduates' perceptions of their midwifery training during the four year comprehensive nursing diploma.

Since its inception in 1986, the Comprehensive Nursing Diploma has received many criticisms from registered nurses, who graduated from the pre-existing programmes. This study attempts to examine the perceptions of graduates from this training programme, towards their midwifery education in terms of its adequacy in preparing them for midwifery practice. Twenty-nine graduates of the four year Comprehensive Nursing Programme completed self-administered questionnaires. Data was analysed by means of descriptive and inferential statistics, namely the paired t-test and the Wilcoxon test for matched pairs. Qualitative data was analysed to determine emerging themes and patterns. Differences in competence ratings on entry into midwifery units and those a year later, were significant at p = 0.0001. It was found that graduates appear to have a positive perception of the midwifery component of their training programme. They found the theory aspect to be more than adequate in preparing them for their professional roles. However, with regards to clinical exposure, it was felt that the time period was too short and needed to be extended in order for them to attain clinical proficiency.

Online teaching and learning in a graduate course in nursing education.

Information technology has a potential to be the answer to one of Africa's most pressing problems-providing education to a number of geographically dispersed learners, who currently have to leave their countries for a number of years in order to pursue their studies elsewhere. The School of Nursing at the University of Natal launched an online graduate course in nursing education at the beginning of the year 2000 for the first time as part of a masters degree programme. A number of lessons have been learned from this experience. Firstly, it took too long to arrive at 'closure' on discussion of any one particular theme. There seemed to be a perpetual feeling of never "completing" teaching/learning tasks. Ordinarily, in a face-to-face (f2f) classroom, a particular theme or topic is scheduled for a particular lecture period. More often than not, whether clarity and/or resolution has been attained, the discussion moves on to the next theme, or topic. This has not been easy to do in computer mediated communication (CMC). The students' contributions, however, seemed more thought out and more focused than had been the case in the f2f classes. Secondly, the essentiality/importance of structure became apparent very early. After an initial tentative and slow start, once the students felt comfortable with the computer "classroom", the bulletin board was flooded with messages, necessitating re-thinking the original structure.

Perceptions of student nurses of their personal and academic development during placement in the community as a clinical learning environment.

A descriptive survey was conducted to investigate the perceptions of student nurses about the community as a clinical learning environment. Thirty nine students (21 second years and 18 third years) participated in the study. A seven-point Likert scale questionnaire was used to obtain data on how nursing students perceived the community as a clinical learning environment in facilitating their personal and academic development. The questionnaire items were categorised according to (a) independence on learning, (b) opportunities for learning, (c) peer support, (d) organisational support, (e) quality of supervision, (f) role clarity, and (g) satisfaction with chosen career.

Concerns of nurse educators regarding the implementation of a major curriculum reform.

This comparative descriptive study used the self-administered stages of concern questionnaire, a diagnostic dimension of the Concerns Based Adoption Model, to measure the stages of concern of nurse educators (n = 93) at four nursing colleges regarding implementation of a new comprehensive basic nursing programme (CBNP). Data were analysed using the guidelines from the manual designed by Hall et al. The MANOVA was used to measure variations between colleges in high and low stages of concern by (a) timing of adoption, (b) perceived level of experience with the CBNP and (c) training in use. Differences between colleges in timing of adoption were significant in intensity of lower stages of concern (awareness, informational, personal and management) only. Concerns of inexperienced users were significantly higher than those of experienced users on both lower and higher stages of concern. Training in teaching a comprehensive basic nursing programme failed to effect significant differences in intensity of concerns among nurse educators.

Levels of use of selected components of the comprehensive basic nursing programme.

Change in nursing education in South Africa has been characterised by the predominance of the use of power-coercive strategies to effect change. Changes in nursing curricula are legislated through the South African Nursing Council. The Comprehensive Basic Nursing Programme (CBNP) became mandatory for all institutions offering basic professional nurse preparation education programmes in this country in 1985. This was a comparative descriptive study aimed at examining the levels of use of 47 nurse educators at four nursing colleges regarding their behaviours and skills in implementing four selected components of the CBNP. The components of the CBNP which formed the focus for this study were teaching to produce nurses capable of (a) rendering comprehensive health care, (b) nursing holistically, (c) thinking critically, and (d) learning independently. The Levels of Use diagnostic dimension of the Concerns Based Adoption Model (CBAM) developed by the CBAM staff (Hall & Hord, 1987; Hall & Loucks, 1977, Hord, 1987; Loucks, Newlove, & Hall, 1975) was used as a guideline for designing the interview schedules for each of the four components of the CBNP. Data were collected by means of interviews using focused interview schedules designed by the researcher. A large number of nurse educators were rated at or below mechanical Level of Use on teaching for CHC (n = 26), and critical thinking (n = 22). More than half the nurse educators interviewed reported that they were comfortable with their behaviours and skills concerning teaching for holistic nursing and developing independence in learning.

The process-product dichotomy in education: relevance to nursing education.

Nursing education relies heavily on curriculum models originating in general education as a basis for curriculum design in nursing. As the content-product debate continues in general education, nurse educators will once again find themselves in a difficult situation of having to choose the best curriculum model in their efforts to reform nursing education. However, cognisance should be taken that whatever choices one makes, there are differences between professional education and general education. Although it might be appropriate for general education to choose a particular model because of its congruence with the curriculum designer's ideological views, many external forces impinge on professional education. Professional regulating bodies, the public and employers expect certain outcomes for professional education programmes. Nursing education programmes therefore should view the process and product models as alternatives rather than absolutes. There might be instances in which the process approach is suitable, whereas some programme aims might lend themselves perfectly to the product model.

Views of leading nurse educators regarding the comprehensive basic nursing programme.

This article describes a Delphi survey amongst nurse educators in South Africa. The aim was to describe their perceptions regarding the reasons for the comprehensive basic nursing programme (CBNP), its aims and expected outcomes. There was general agreement that the programme was necessary, and that it was designed mainly to produce a nurse who could function in a comprehensive health service. Integration of information and economic arguments were also mentioned. Making available a nurse who can deliver a comprehensive service to all people, was also seen as the main aim of the programme. Independent learning, competency in a whole range of skills, the ability to function in a multidisciplinary team and high level cognitive skills were mentioned as additional aims.