Nurse educators' experiences regarding management practices at a nursing education institution.

Background: Currently nursing education is undergoing major transformation that pose considerable challenges with which nursing education institution (NEI) management must deal. Yet nurse educators displayed behaviour that reflected distrust, loss of respect and loyalty and a paucity of admiration towards NEI management. Aim: The article aimed at exploring the lived experiences of nurse educators regarding the management practices at a NEI. Setting: The setting was a public NEI in Gauteng, South Africa that had 11 departments and offered both undergraduate and post-basic studies. Methods: A qualitative, exploratory, descriptive, contextual and phenomenology study was conducted with a purposive sample of 20 qualified nurse educators who were fully employed, taught at the current NEI and were willing to participate. Data were collected from June 2015 to July 2016 through face-to-face, semi-structured individual interviews and analysed using Tesch's protocol. Ethical principles were observed and trustworthiness ensured. Results: The themes that emerged were management's dominant use of one leadership style with inconsistent treatment; lack of stimulation to aspire to higher academic levels; and lack of support with minimal resources. Conclusion: Nurse educators experienced ineffective management practices and this ineffectiveness had negative impact for nurse educators in coping with major transformational changes brought by the dynamic nursing education environment. Contribution: The recommendations made might assist NEI managers to improve their management practices, therefore assist nurse educators cope with transformation. The findings added to the body of existing knowledge on effective management of NEIs by aiming to achieve institutional and individual goals within a transformative environment.

Clinical learning opportunity in public academic hospitals: A concept analysis.

Background: Clinical learning opportunities (CLO) are vital educational encounters occurring in various clinical areas to provide the student nurses with clinical knowledge and experiences to develop their competencies for professional practice. However, CLO is a broad concept with varied characteristics that allow ambiguity, limiting its understanding and use. Its ambiguous nature leads to uncertainties and poor development of the required clinical attributes of successful theory to practice integration, higher-order thinking skills (HOTS) and clinical competencies. Aim: The aim of the study was to explore and describe the conceptual meaning of CLO, have a clear understanding and insight into the concept and identify the antecedents and consequences for pragmatic purposes. Setting: The study took place in a public academic hospital in Gauteng. Methods: The eight steps of concept analysis by Walker and Avant were followed. Multiple data sources not limited to nursing were explored and critically analysed for the definitions, characteristics, nature and uses of CLO from different fields of study. Results: The defining attributes of CLO were identified, namely the context, antecedents, processes, consequences and outcomes. The context within which CLO occurs was dynamic, multidimensional, real-life healthcare settings; antecedents included planning of clinical placement, provision of learning outcomes and consideration of the cognitive level of the students. Engagement and active participation in collaborative, problem-based learning activities, community-based research and the use of emerging technologies were the processes identified. The outcomes were autonomous, confident, competent professional nurses with critical thinking, clinical reasoning, judgement, critical decision making and problem-solving skills. Conclusion: A theoretical and operational definition of CLO was developed. The findings and results of concept analysis identified and specified the defining attributes of clinical learning opportunity. The findings can assist nurse educators, Clinical Education and Teaching Unit (CETU) personnel and operational managers to enhance CLO for student nurses to achieve their clinical learning goals and outcomes. The evaluation tools that may be adopted to assess the acquired clinical skills were also identified. Contribution: An increase in the existing body of knowledge in nursing education, considering that enhancing the CLO exposes students to various clinical experiences contributing to their development of clinical competencies to solve complex problems. The strategies to enhance the CLO will be developed, which may also provide vital information for policy development. Conceptualisation of the findings to nursing practice and quality patient care will be integrated into relevant literature.

The development and evaluation of a nurse anaesthesia model for practice in South Africa.

Objective: This article aimed to present a developed model for nurse anaesthesia practice in South Africa and then to evaluate the model by national and international anaesthetist experts. Methods: For the model development, a theory-generative research design was used as guided by Chinn & Kramer. The study included four steps to develop and evaluate the model: step one, concept analysis; step two, placing the concepts into relationships; step three, description and critical reflection of the model; step four, evaluation of the model. For evaluation of the model, data were collected using individual, in-depth interviews. Four South African medical specialist anaesthesiologists and four international nurse anaesthetists were interviewed. Transcribed interviews were analyzed using Tesch's eight steps of thematic data analysis. Results: The model was described in four phases: relationship phase, working phase, termination phase, and independent phase. The model shows a development process of a student nurse anaesthetist by a nurse anaesthetist facilitator to the mastery of the scope of practice of a nurse anaesthetist. Two themes (six categories) emerged through thematic analysis: the model and guidelines for implementation were found to be appropriate (model and guidelines for implementation are important because of the need for nurse anaesthetist, the model is applicable because it is described as comprehensive, the relationship phase was found to be important and the interdependence between disciplines is imperative, the affirmation that mastery has to be attained by nurse anaesthetists due to the complexity of services rendered), anticipated limitations to the South African nurse anaesthetist (the need to identify complex patients and limitations on the setting and refer to higher level of care, limitations due to red tape). Conclusions: This model provides fertile soil to inform and outline the education (curriculum) and practice (scope of practice) and research for nurse anaesthesia practice in South Africa.

The development of self skills in an authentic learning environment: A qualitative study.

BACKGROUND:  The contemporary healthcare environment is an authentic, demanding, challenging and ever-changing environment that requires learners to possess good self skills when they need to engage in meaningful, critical discourse in order to solve authentic problems. However, nurse educators assume that learners already have well-developed self skills at the commencement of their nursing training and as a result do not explicitly teach and develop such skills in the learners. OBJECTIVES:  The objectives of this research were to explore and describe nurse educators' views on how learners' self skills can be developed within an authentic learning (AL) environment, and to formulate recommendations based on the findings. METHOD:  A qualitative and contextual research design was used to seek rich, in-depth data from 20 nurse educators who were purposively sampled. Semi-structured individual interviews were conducted, and the data were analysed using Miles, Huberman and Saldaña method. RESULTS:  The three themes that emerged were that nurse educators should (1) ensure an AL environment that promotes self skills, (2) engage learners in activities that will consciously evoke authentic self and (3) evaluate the developed self skills and metacognition. CONCLUSION:  By developing good self skills, learners should be able to deliver quality patient care, find solutions to complex problems and handle cognitive complexity and authentic conditions whilst creating their own identity.

Concept Analysis: The Scope of Practice of a Nurse Anesthetist in South Africa.

PURPOSE: The purpose of this article is to propose a definition for the concept "scope of practice" as it applies to a nurse anesthetist in South Africa. DESIGN: Concept analysis. METHODS: Walker and Avant's procedure of concept analysis was followed. The actions included "Select a concept"; "Determine the purpose of analysis"; "Identifying uses of the concept"; "Determining the defining attributes"; "Identifying antecedents and consequences"; "Define empirical referents"; "Identify model case"; and "Identifying additional cases." FINDINGS: The concept 'scope of practice' as it applies to the nurse anesthetist in South Africa can be defined as the individual's competence, accountability, and responsibility as a health professional. The nurse anesthetist is (1) competent: ready to use skills and judgement in practice; (2) accountable: able to be registered as a nurse anesthetist and willing to abide by the regulations; and (3) responsible: upholding professionalism and demanding recognition from the public and peers. CONCLUSIONS: A definition (revealing the concept's structure) and it's uses (revealing the concept's function) for "scope of practice" of a South African nurse anesthetist is proposed for the consideration of introducing nurse anesthesia to provide safe and affordable anesthesia services in South Africa. This article forms part of a larger study titled "A Model for Nurse Anaesthesia Practice in South Africa."

The influence of language of instruction in the facilitation of academic activities: Nurse educators' experiences.

BACKGROUND: Learners in most South African higher education institutions are taught mainly through English for most of their academic lives, yet many of them enter these institutions with poor proficiency in this language of instruction (LOI). AIMS: The purpose of this article was to describe the experiences of nurse educators teaching in a 4-year comprehensive nursing diploma programme regarding the use of English as the LOI during academic activities. SETTING: The nursing college under study offers a 4-year comprehensive nursing diploma programme as well as post-basic diploma qualifications such as Primary Health and Midwifery Nursing Science and is situated in Gauteng, South Africa. METHODS: Twenty nurse educators were purposively sampled for in-depth individual interviews until data saturation and were requested to participate in the study. Tesch's protocol of qualitative data analysis was used and the themes that emerged were confirmed by an independent coder. Trustworthiness was ensured, and ethical considerations were adhered to. RESULTS: It emerged that English language incompetence (1) undermines learners' self-esteem; (2) hinders critical, reflective and creative thinking; (3) renders understanding difficult and that (4) nurse educators' incompetence in LOI hinders meaningful teaching. CONCLUSIONS: Recommendations were made to improve the use of the LOI because through language interdisciplinary knowledge and understanding are integrated, thus ultimately providing patients with comprehensive, holistic and transcultural healthcare.

The influence of language of instruction in the facilitation of academic activities: Nurse educators' experiences

Background: Learners in most South African higher education institutions are taught mainly through English for most of their academic lives, yet many of them enter these institutions with poor proficiency in this language of instruction (LOI). Aims: The purpose of this article was to describe the experiences of nurse educators teaching in a 4-year comprehensive nursing diploma programme regarding the use of English as the LOI during academic activities. Setting: The nursing college under study offers a 4-year comprehensive nursing diploma programme as well as post-basic diploma qualifications such as Primary Health and Midwifery Nursing Science and is situated in Gauteng, South Africa. Methods: Twenty nurse educators were purposively sampled for in-depth individual interviews until data saturation and were requested to participate in the study. Tesch's protocol of qualitative data analysis was used and the themes that emerged were confirmed by an independent coder. Trustworthiness was ensured, and ethical considerations were adhered to. Results: It emerged that English language incompetence (1) undermines learners' self-esteem; (2) hinders critical, reflective and creative thinking; (3) renders understanding difficult and that (4) nurse educators' incompetence in LOI hinders meaningful teaching. Conclusions: Recommendations were made to improve the use of the LOI because through language interdisciplinary knowledge and understanding are integrated, thus ultimately providing patients with comprehensive, holistic and transcultural healthcare