Integration of research and nursing experiential learning : a case study

Teaching research to undergraduates has it own challenges and involving undergraduates in research practical experience is just one of those challenges. As nursing students are in the process of becoming professional nurses, knowledge and skills in research are specific outcomes of the curriculum. One of the outcomes of the B Tech Nursing Science programme offered by the Tshwane University of Technology states that for the baccalaureate nursing programme include analysis, interpretation and utilisation of a range of research findings in scientific nursing and midwifery care as well as the development of a research protocol in a given context. In an effort to ensure that students would experience research as an essential part of their daily activities, an integrated approach is suggested whereby the nursing experiential learning opportunities are also research experiential learning opportunities. Using the integration strategy, research theory come 'alive' for the students. The integration approach is uncomplicated and transferable to any other discipline. The case study presented is the second year nursing students using school nursing experiential learning as a research project. The second year nursing students have a community focus during their second year and one of the experiential learning opportunities is school health nursing in a primary school in Tshwane. The results of the school health survey are presented. The students developed a health education intervention based on the research results.


Introduction
"Nursing is a dynamic profession in a changing world." This statement is heard so often that it has almost lost it's meaning -it does however, represent a challenge to nurse educators in the p rep aratio n o f nu rsing learners.Educators are charged with preparing nursing learners to cope with future problem s -problem s not yet en co u n tered .L earners cannot be p repared for every ev en tu ality encountered in practice.Learners need to be competent in the knowledge, skills, attitudes, and values necessary to deal w ith d iv erse situ atio n s in th eir p ro fessio n al lives.
One o f the competencies that will empower learners in doing so is doing and using research.Wilson (1992:18) emphasises this point in w riting that the developm ent o f scientific knowledge as a foundation for safe, secure, scientifically based practice has been designated as a responsibility of all nurses.
Registered nurses in clinical positions rarely practise research, though research is regarded as one o f the four pillarsclinical, management, education and research -of nursing.Thorpe and Smutko (19 9 8 :1 3 ) w rite that every nurse, regardless of educational preparation, should be involved in and benefit from nursing research.The research process should therefore be an integral part of n u rsin g p ractice.
This ideal is unfortunately far removed from reality.Problems regarding the education o f research have been reported in literature for the past four decades.Integration of nursing theory, research and practice is a long-standing goal but it is well recognised that learners have difficulty in seeing the relevance of research in their future practice.Unless research findings are applied to practice, nursing research is little more than an 'ivory tower' exercise.
Teaching nursing research can be a challenging role for nurse educators.Even w hen the nurse ed u c ato r is equipped with a large arsenal o f teaching strategies designed to promote student interest; learners might still complete their studies without a basic understanding o f research (W isneski, 1998:135).Another problem that has been reported widely is the attitude towards research in undergraduate and postgraduate learners.Learners exhibit a negative attitude towards research and even the mention of research is met with resistance.Learners also complain that research has no value for th eir future roles as registered nurses.In most instances, research is done purely to obtain an academic qualification.
From experience in the Department of N ursing, Tshw ane U niversity o f Technology, teaching research to post basic baccalaureate learners for the last four years, research is perceived as separate from nursing-an optional extra for those who would choose to do so.These learners are experienced registered nurses with a high percentage o f unit managers in the group, but research is seen as irrelevant to their daily activities.On-going research has shown that the learners evaluate their own ability and w illin g n e ss to do research at the beginning of a year programme, at 3-3,5 on a scale that range from 0-10 (0=not willing/able and 10=completely willing / able) (Zeelie, 2002:182).The research program m e is a core m odule in the curriculum and less than 10% o f the learners w ould have chosen to do research if it was not compulsory.

Integration strategy
In the undergraduate baccalaureate programme, research is seen as an integral part of the programme and is introduced from the first year through to the fourth year.Tenets o f the programme rest on the following aspects:

A case study
School health nursing is part o f the second year nursing experiential learning.The aim of school heath services is to provide an appropriate service in order to achieve the best possible level of health (mental, physical, and social well being, current and future) for children of school age and to enable children to derive full benefit from their education (Adnams & W agstaff, 2001:287).S creening procedures include growth monitoring, vision testing and hearing.Screening is also done for various disorders such as

Weight categories
To em phasise the usefulness o f the survey in teach in g students about research, the results of the survey are discussed in class.

Results of the school survey Biography
The ch ild re n 's (n=96) ages ranged between five to thirteen years; 57.3% were m ales and 42.7% fem ales.All the children's general health appearance was good, except for one child who was described as obviously uncared for as evident by bedraggled clothes with buttons missing, lack o f body hygiene with dirty skin, nails, teeth and ears and an unpleasant body odour.He had an obvious umbilical hernia, which was reported the previous year and not attended to.

Obesity
For

Number of affected teeth
From Table 3 it is clear that the obese children are more frequent from age 9-13 with a peak at 11 years.Childhood obesity is rapidly emerging as a global epidemic that will have profound public health consequences as overweight children becom es overw eight adults.These children are also at an increased risk for co-m orbid co n d itio n s such as orthopaedic, pulmonary, gastrointestinal, and endocrine conditions.
It is important that the health intervention regarding weight control/nutrition is of such a quality that the children would understand the im portance thereof, w ithout being put under too much pressure to reduce weight.To achieve

Dental caries
The second most important problem identified from the data was dental caries.Dental caries was found in 37.5% (n=36) o f the group.The number o f affected teeth per child varied as shown in Table 4.
Having three or more teeth affected would mean that 41 % of the children with dental caries have a serious problem.It should be noted that two children had five and another two children had six affected teeth each.If the dental problem is cross tabulated with age (Table 5), it can be seen that the highest prevalence of dental caries is in the 9-11 age group with a peak at 11 years.This correlates with the overweight/obesity prevalence in the group.There is however, a higher incidence of dental caries in the younger ages as compared to overweight/obesity.

Other health risks identified
The o ther health risks th at w ere identified are presented in Table 6.
From More acute problems that could influence the child schoolwork were ear and throat problems, respiratory problems, anaemia and enlarged lymph nodes.The children should be referred to a m edical practitioner for treatment as soon as possible.

Positive outcomes of the integration strategy
The most important positive outcome is that the learners participate in the research process as part o f their nursing clinical experiential learning.Research is not experienced as an optional extra but as an integral part of nursing.Using the nursing experiential learning as research experiential learning makes the research theory 'alive'.The learners accept research as a tool to be able to nurse effectively.In the school health data, the learn ers w ere guided by the data regarding the health intervention and from the data, it is clear that the obesity and dental caries are serious problems in that population.
A question from the students following the research was what the prevalence of these health risks were in South Africa, and what could it be in other schools.
Thus the learners experienced the need for fu rth er in v estig atio n and the exposure to research, though at a limited level, stimulated their curiosity.Learners perceived their experiential learning as possible research problems -echoing Wilson's statement that the dailiness of nursing practice offers an important source o f clinically relevant research problems (Wilson, 1991:280).
Another important aspect is that nurse educators o f diverse disciplines are joining forces in a most productive way.
The educators are seen to be interested in research and actively engaged in research.This aspect is most important to be able to be good role models for the learners.Wax, 1966:70).
The research data were of immediate use to the learners.In a small way, the learners made the first step in using research data as the basis of their nursing decisions.L earning about research and implementing research was experienced as meaningful.This positive experience prepares the learners for the research theory and experiential learning of the third year of study.

Conclusion
Obscuring the traditional lines between nu rsin g and research in the undergraduate programme will produce nursing professionals who are less conscious of this division.If learners could accept that experiential learning is sim ultaneously nursing and research experiential learning, or actually that nursing and research experiential learning is one concept, much would be gained in the process of producing professional n u rses w ho are know ledgeable consumers o f research and productive scholars in nursing.

Table 1 : BMI-for-age of school children (n=96)
ex am in atio n , w eight and height measurement and an eye test using the Snellen chart.The data is recorded on standard pre-printed school medical forms.Any problem identified is referred to a medical doctor who is part of the educational team and if a problem is diagnosed, a letter written to the parents.

Table 6 : Other health risks identified in the school survey (n=96)
Learners will not develop an interest in research if there are no positive role models available.Wax wrote the following in 1966: 'If nursing is to have enough specialists in research, faculties in baccalaureate and graduate programmes not only must develop a healthy attitude towards it, but must stimulate interest in their students and encourage those with potentialities for research to pursue it.'(