Selection tests and their predictive value in university nursing students' success in the first year of study.

BACKGROUND: Academic performance factors, such as school-leaving grades and other academic indicators for selection, play a significant role in student success. The study aimed to determine the best predictors of academic success in the first year of study for nursing studies at a South African university using three National Benchmark Test (NBT) domains and four National Senior Certificate (NSC) subjects. METHODS: We conducted a retrospective review of the admission data of first-time students (n = 317), enrolled on the Bachelor of Nursing between 2012 and 2018. Hierarchical regression was used to explore important variables predicting success in the first year of study. Cross tabulations were used to determine the association between progression outcome, proficiency levels of the NBT and school quintiles. RESULTS: All predicting variables explained 35% of the variance in the first year of the study. The NBT MAT (Mathematics), Academic literacy (AL), and NSC's Life Sciences were statistically significant predictors for passing the first year. Analysis of progression outcomes by the NBT proficiency levels suggests that most students begin studies with lower entry-level skills than required, which hinders academic progress. No major differences in academic performance were observed for the students who attended different quintiles. CONCLUSION: Selection test results predict areas where students are likely to encounter difficulties and inform the interventions needed to achieve academic success. There may be serious implications for students admitted with low entry-level skills in variables predicting academic success and they would need tailored academic interventions to improve their grasp of mathematical and biological concepts and their ability to read, think and reason.

Experiences of primary health care practitioners dealing with emergencies - 'We are on our own'.

BACKGROUND: Primary health care (PHC) focuses on health promotion and disease prevention; however, acute episodes and emergencies still occur at this level of care. The World Health Organization (WHO) proposes strengthening emergency care at a PHC level as a way of lessening the burden of disease on the overall health system. It is not known how health care practitioners at the PHC level experience management of emergencies. AIM: To explore and describe the experiences of PHC practitioners dealing with emergencies at PHC facilities in Gauteng, South Africa. SETTING: The study was conducted in the District Health Services of Gauteng province in South Africa, including clinics, community health care centres and district hospitals. METHODS: Using a qualitative approach, semi-structured interviews were conducted with a purposively selected sample of professional nurses and doctors from various levels of the district health care system. Data were transcribed and analysed using qualitative thematic analysis. RESULTS: Various themes were identified related to the individual confidence and competence of the PHC practitioner, the team approach, the process of role and task allocation and the need for training. CONCLUSION: The study provided a voice for the needs of health care practitioners dealing with emergencies at the PHC level. The designing of a targeted and contextually appropriate approach to emergency care training of health care practitioners in the PHC setting that improves team dynamics and team performance, is recommended.Contribution: The insights of PHC practitioners dealing with emergencies contribute contextual relevance to any strategic improvement of care at this level.

The Public Health Value of Coding Surgery in South Africa Using the International Classification of Health Interventions.

BACKGROUND: The lack of a national intervention coding system and the current intervention coding in South Africa through the use of multiple billing and coding systems does not support quality intervention data collection and patient outcomes reporting for general surgery. This presents difficulties in the understanding of the different types of general surgical interventions performed in hospitals, the associated resources, risks, complications, outcomes reporting, public healthcare delivery, and determination of barriers to care. This study illustrates the use of accurate data on health interventions in South Africa's acute care general surgery coding to assist in improved resource allocation, using the new WHO International Classification of Health Interventions (ICHI). ICHI has over 8000 codes and consists of three axes: Target (the entity on which the Action is carried out), Action (a deed performed by an actor to a target), and Means (the processes and methods by which the Action is carried out). A key benefit of ICHI is that it can be used collectively with the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF). OBJECTIVES: to evaluate the suitability of ICHI for general surgery interventions by coding intervention descriptions to ICHI codes; to identify gaps in the ICHI system; and to provide a rationale for ICHI to be a nationally regulated system. METHODS: This study adopted a retrospective, descriptive design; in total, 3000 in-patient intervention data files, captured in an electronic database from April 2013 to August 2019 at three academic hospitals in Johannesburg, were extracted randomly, and coded using ICHI. Quantitative data analysis techniques were utilized to assess the overall degree of match between ICHI codes and the intervention descriptions. RESULTS: Of the 3000 patient case entries that were coded, there was an agreement of 67.6% of the coded data amongst the three coders, leaving a variability of 32.4%. The variability was largely due to the coders' experience and the quality of healthcare documentation. CONCLUSIONS: ICHI has the ability to cater for the broad range of general surgery interventions, thus indicating that ICHI is suitable for general surgery coding.

Consensus-based recommendations for strengthening emergency care at primary health care level: a Delphi study.

BACKGROUND: Emergency care at a primary health care (PHC) level must be strengthened to reduce overall mortality and morbidity in any country. Developing recommendations for improvement in this area should take into consideration the context and nuances of the current emergency care system and primary health care context. Contribution to policy from the experts in the cross-cutting fields of PHC and emergency care is lacking. OBJECTIVES: This study aims to evaluate the strengths and weaknesses of emergency care in primary health settings and develop consensus-based recommendations for the strengthening of emergency care at this level. METHODS: Using a modified Delphi technique, data were collected from various data sources to evaluate the strengths and weaknesses of emergency care at PHC level, from which recommendation statements were developed. These recommendations were proposed to a panel of experts using a Delphi survey to build consensus on 14 recommendations to strengthen emergency care at PHC level. RESULTS: Ten experts were recruited to participate (n = 10) with a response rate of 90% in round II and 80% in round III of Delphi. Recommendations broadly addressed the areas of education and training in emergency care, the role and placement of various actors, leadership in emergency care and the development of a national plan for emergency care. Consensus was reached in round II for 97.61% of the statements and after modification based on open-ended comments, 98.21% consensus was reached in round III. CONCLUSION: Strengthening emergency care at primary and subsequent levels of health care requires a coordinated effort and mandate from authority in order to effect real change.

How Health Care Practitioners experience emergencies at Primary Health Care facilities - Kinks in the chain of survival.

Background: The 72nd World Health Assembly has recognised that emergency care at primary health care level is vital for reducing overall mortality and disability. The system of emergency care at this level is affected by various external factors. Little is known about these factors and how they shape the experiences of health care practitioners dealing with medical emergencies in Primary Health Care (PHC) settings. The objective of the study was to explore the experiences of health care practitioners in dealing with emergencies in PHC facilities in the Gauteng province of South Africa. Methods: A qualitative formative evaluation approach was used. Data were collected using semi structured interviews and analysed using qualitative content analysis to describe the experiences of health care practitioners dealing with emergencies at a primary health care level. Participants included health care practitioners from various levels of the district health system. Results: Major themes that emerged explored challenges faced by health care practitioners, the referral system and influential policy such as the ideal clinic movement.

Investigating the risk factors for academic difficulties in the medical programme at a South African university.

BACKGROUND: The National Benchmark Test (NBT) that determines academic readiness is widely used by Faculties as an additional measure to select students for the study of medicine. Despite this, many students continue to experience academic challenges that culminate in delayed graduation and sometimes academic exclusion or discontinuation of studies. AIM: This study aimed to understand academic and non-academic variables linked with academic difficulties in the first three years of medical education. METHODS: The study sample consisted of six cohorts of medical students for the period 2011 to 2016 (n = 1392). Only the first three of the six-year medical programme were selected for analysis. Survival analysis and Cox Proportional Hazard (CPH) was used to identify academic and non-academic variables associated with academic difficulties. RESULTS: A total of 475 students (34%) experienced academic difficulty; 221 (16%) in the first year of study, 192 (14%) in the second year and 62 (5%) in the third year of study. The results show that Intermediate Upper, Lower and Basic levels for all NBT domains, living in university residence, rurality and male gender were risk factors for academic difficulty. CONCLUSION: In mitigating these factors, the NBT must inform the type of support programmes to augment the students' skills and promote academic success. Additionally, existing support programmes should be evaluated to ascertain if they reach students at risk and whether participating in these programmes yield positive academic outcomes.

Effect of a formative assessment intervention on nursing skills laboratory learning in a resource-constrained country.

BACKGROUND: Following a global trend, nursing education institutions in Malawi adopted the skills laboratory approach for the teaching and learning of essential nursing skills in the bachelor degree in nursing. Students and faculty expressed concern about the lack of regular and planned formative assessments that build the competencies required in the middle and senior years of study. PURPOSE: The aim was to investigate the effect of a Formative Assessment Framework (FAF) on students learning in skills laboratories. METHODS: A sequential, mixed methods design was chosen, starting with qualitative approach followed by a quantitative approach using a quasi-experimental design. Formative Assessment Framework (FAF) was developed after phase 1, validated and tested on the teaching of eight nursing procedures in phase 2. Quantitative data were collected from students (n = 160) for 6 weeks. Data were analysed using STATA software packages. RESULTS: Significant mean differences occurred between the pretest and posttest mean scores for seven procedures with a p-value of <0.05. CONCLUSION: The use of a Formative Assessment Framework had a significant effect on clinical teaching and learning. The findings indicate that the FAF has the capacity to improve the students' clinical preparation for competencies in the OSCE, which takes place in the skills laboratories.

Does improved postgraduate capacity shift the balance of power for nurse specialists in a low-income country: A mixed methods study.

AIM: To explore nurse specialists' experiences of change and influence on practice two years after graduating with a postgraduate degree. BACKGROUND: In the absence of further study opportunities for nurses in their own country, a master's degree was introduced to train the first group of nurse specialists in Mozambique. DESIGN: Within a hybrid evaluation framework an exploratory, sequential mixed methods design was followed. METHODS: Qualitative data from focus group interviews with nurse specialists (N = 12) led to five thematic data sets from which survey questions were formulated for the sequential quantitative component. FINDINGS: "Change expectations", "Ambiguous practice environments", "Feeling powerless", "Having some influence" and "Workplace support" were emergent themes from interview data. Areas of positive change occurred in research (100%) and the use of evidence (88.9%) and involvement in decision-making (77.8%). For some change did not happen as anticipated-reasons included lack of nurse mentors to support new graduates (55.6%); lesser respect compared with doctors (44.4%) and poor understanding of the value of a master's degree (44.4%). Improvements in service quality and elevating the status of nursing were areas of greatest influence (77.8%). CONCLUSION: Several enabling and limiting factors were identified in the experiences of change and influence on practice of newly qualified nurse specialists. Tacit change with respect to the value of the degree in improving the status of nursing seems not to have affected nurse specialists' own ability and power to influence practice. Improved postgraduate capacity on its own does not empower nurses in their role as specialists. IMPACT: The findings point to a two-tiered strategy to be developed to dismantle barriers to the empowerment and advancement of nurse specialists. The identification of designated nurse mentors is essential to induct and sustain newly graduated nurse specialists. A clear research policy should be developed that supports the conduct of relevant research and the use of evidence in specialist practice.

Self-directed Learning Readiness Is Independent of Teaching and Learning Approach in Undergraduate Nursing Education.

Selecting appropriate teaching and learning strategies within an overarching teaching philosophy is 1 way of influencing nursing students' self-directedness. We conducted research to compare the self-directed learning readiness and learning attributes in different years of study of undergraduate nursing students who are exposed to traditional, lecture-based learning and problem-based learning strategies. We found that readiness for self-directed learning is not dependent on the dominant teaching-learning strategy used in the nursing program.

Advancing nursing scholarship: the Mozambique model.

BACKGROUND: Despite the importance of Human Resources for Health for the development and functioning of health systems worldwide, many countries continue to be plagued by poor health systems and a lack of adequate health care. Health systems failures may be attributed to both quantitative and qualitative nursing shortages including the lack of advanced skills to lead health initiatives, to conduct research and to educate other nurses. The response by development partners is usually framed around the production of skilled nurses through the processes of up-skilling and scaling-up. The outcome is expanded practice but with scant attention to the professional advancement of nurses. OBJECTIVES: In this paper we present a two-phased capacity development model that adopted professionalization strategies to advance nursing scholarship and consequent postgraduate specialization of the first cohort of nurses in Mozambique. The main objectives were to: develop and implement a clinical course work master's degree in nursing; and ensure sustainability by capacitating the host institution to continue with the master's programme following graduation. METHODS: Rigorous processes for project discussions, negotiations and monitoring were necessary amid limited resources and a challenging political climate. Forging in-country partnerships, sustaining alliances and government investment are thus key to the success of the Mozambique model. OUTCOMES: Notwithstanding some difficulties, the process unfolded over a five-year period, graduating the first cohort of 11 senior nurses with a master's degree, specializing either in critical care and trauma nursing, or maternal and neonatal health. CONCLUSIONS: Bridging the skills gap between generalist and specialist nurses is essential for them to manage complex and high acuity cases and to reverse associated morbidity and mortality. We conclude that this model serves as a professionalization strategy to advance nurses' scholarship of clinical practice, research and teaching.

The difficulties of 'living while girl'.

In this Viewpoint, Judith Bruce answers questions from Journal of Virus Eradication Editor, Sabine Kinloch-de Loës, on the importance of fulfilling the basic human rights of adolescent girls and their relationship with viral epidemics such as HIV. Judith Bruce is a graduate of Harvard University and a Senior Associate and Policy Analyst at the Population Council, New York, USA, whose work is aimed at building the health, social and cognitive assets of girls in the poorest communities in the developing world.

Scaling up nurse education: An evaluation of a national PhD capacity development programme in South Africa, in the context of the global shortage of nursing graduates.

BACKGROUND: The global shortage of nursing professionals educated at baccalaureate level and beyond has been highlighted. Within America, services are preparing to treat an additional 32 million individuals under the Health Reform Bill. Within South Africa nursing education outputs do not meet demands. Countries are addressing these shortages by developing advanced nurse roles which require research degrees. OBJECTIVE: To evaluate a national PhD programme within the context of a nurse education strategy and a national health insurance plan. DESIGN: A comparative effectiveness research design was employed. SETTING: The setting was in South Africa between 2011 and 2013, a county with 51.7 million inhabitants. PARTICIPANTS: Participants included PhD candidates, programme facilitators, supervisors and key stakeholders. METHODS: Data from a one day workshop was analysed using an inductive thematic analysis. Three years of evaluation reports were analysed. A mapping of the alignment of the PhD topics with healthcare priorities, and a comparison of the development of nurse education, of the national and international funder were conducted. RESULTS: The evaluation reports rated the programme highly. Three themes were identified from the workshop. These were, "support" with the sub-themes of burden, leveraging and a physical supportive place; "planning" with the sub-themes of the national context and practice, and "quality" with the sub-themes of processes and monitoring and evaluation. The mapping of PhD topics revealed that research was in line with development priorities. However, further investment and infrastructural changes were necessary to sustain the programme and its impact. CONCLUSIONS: To address sustainability and capacity in nations scaling up nurse education and healthcare insurance, it was recommended that top-up degrees for diploma educated nurses be developed along with, the implementation of a national nursing strategy for PhD and post-doctoral training encompassing clinical practice implementation and collaboration.

Teaching styles used in Malawian BSN programmes: a survey of nurse educator preferences.

AIM: This paper describes the teaching styles employed by Malawian nurse educators in the four year Bachelor of Science in Nursing (BSN) programme, according to Grasha's (1996) five teaching styles. BACKGROUND: An analysis of the educational processes of undergraduate nurses in Malawi followed anecdotal reports from stakeholders on the low levels of nurses' performance in the workplace. It was postulated that, in most instances, nursing students are exposed to traditional teaching approaches that do not equip them with skills for a demanding and ever-changing healthcare system. METHODS: A survey was conducted as part of a two-phased, sequential, explanatory mixed methods study. The target population comprised fifty nurse educators (N=50) who were invited to participate in the survey. Data were collected using Grasha's Teaching Styles Inventory (Version 3.0). A total of 44 inventories (n=44) were returned amounting to a response rate of 88%. Survey results were analysed using the Statistical Package for the Social Sciences (SPSS), version 16.0. Descriptive statistics were used to analyse the data. RESULTS: The Expert and Delegator teaching styles were moderately preferred (x̅ 4.02; SD 1.06) by the majority of nurse educators (70.45%; n=31 and 86.36%; n=38 respectively). The Facilitator teaching style was the least preferred (x̅ 3.7; SD 1.43) by 66.90% of educators (n=29), who also reported weak facilitative skills in the sub-scales. Similarly, educators reported a low preference for the Personal Model teaching style (x̅ 3.6; SD 1.17). CONCLUSION: Teacher-centred styles tend to dominate the teaching activities of Malawian nurse educators in the BSN programme. Facilitative pedagogical approaches must be encouraged coupled with appropriate staff development that enables educators to facilitate learning with confidence, competence and self-efficacy.

Protecting young women from HIV/AIDS: the case against child and adolescent marriage.

CONTEXT: In most developing countries, the majority of sexually active female adolescents are married. Although married adolescents are often assumed to be at low risk for HIV infection, little is known about the actual HIV risks these adolescents face or about ways to minimize these risks. METHODS: Demographic and Health Survey data from 29 countries in Africa and Latin America were used to examine the frequency of factors that may increase HIV risk in married women aged 15-19. RESULTS: Several behavioral and social factors may increase the vulnerability of married female adolescents to HIV infection. First, these young women engage in frequent unprotected sex: In most countries, more than 80% of adolescents who had had unprotected sex during the previous week were married. Second, women who marry young tend to have much older husbands (mean age difference, 5-14 years) and, in polygamous societies, are frequently junior wives, factors that may increase the probability that their husbands are infected and weaken their bargaining power within the marriage. Third, married adolescents have relatively little access to educational and media sources of information about HIV. Finally, the most common AIDS prevention strategies (abstinence, condom use) are not realistic options for many married adolescents. CONCLUSION: New policies and interventions, tailored to the sexual and behavioral profiles of women in each country, are needed to address the vulnerabilities of adolescent wives. In some countries, delaying age at marriage may be an important strategy; in others, making intercourse within marriage safer may be more valuable.