LEVELS OF USE OF SELECTED COMPONENTS OF THE COMPREHENSIVE BASIC NURSING PROGRAMME NS Gwele

Change in nursing education in South Africa has been characterised by the predominance of the use o f powercoercive 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 L evels o f Use d ia g n o stic dimension o f 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 rmrse 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. INTRODUCTION The passing of the 1985 regulations from the SA Nursing Council (R425 of 1985), resulted in two major changes in control of basic nursing education. Firstly the development of basic nursing curricula was transferred to individual nursing colleges at local level, although “basic” standards were laid down centrally. Secondly, basic nursing education became part of the country’s post-secondary education system through university-college affihation. Both of these developments had important ramifications for nursing education. Based on the regulations and guidelines of the South African Nursing Council (SANC), each nursing college was to develop its own curriculum. The comprehensive basic nursing programme (CBNP) had cast nurse educators as professionals who could rebuild nurse education almost single handedly. When nurse educators were expected to implement the new programme, preparing them to do so was not a central concern. According to Van der Merwe (1989, p. 37) the CBNP “expected every lecnirer to understand and implement the totality of the curriculum”. Centralised decision making assumed that the people re sp o n s ib le fo r the adop tion and institutionalisation of the new policies would do so with the necessary willingness and expertise. The need to evaluate this programme has been mentioned by a few authors (Rispel & Motsei, 1988; Uys, 1991). Rispel and Motsei (1988, p. 16) proposed that, “the most obvious suggestion for future research (in nursing education) is an intervention study to evaluate the comprehensive four-year course”. Without discounting this call for evaluating the CBNP, it is believed that in order to evaluate outcom es o f any educational innovation, it is vital to first determine whether the programme is being implemented, and if so, how. Several studies (Cameron, 1991; Hall & Loucks, 1977; Ross, Luepker, Nelson, Saavedra, & Hubbard, 1991) which used the Concerns Based Adoption Model (CBAM) to evaluate educational change reported on the importance of establishing levels of use before embarking on impact studies. Hall and Hoid (1987) warned that adoption of a particular innovation by an educational institution docs not necessarily mean that every teacher in that institution is using the innovation. This study aimed at investigating the process of adoption and implementation of the CBNP, w ith a view to b e tte r understand the consequences of legislated change in nursing education . S pecifica lly , the fo llow ing questions were asked: (a) At what level are the behaviours and skills of nurse educators at nursing colleges in their implementation of selected components of the CBNP?, and (b) Are there any differences in the levels of use of the four components of the CBNP by nurse educators at early and late adopter nursing colleges? LITERATUIUE R E V IEW AND RELA TED TH EO R Y THE CONCEPT O F CHANGE Debeauvais (1981, p. ix) noted that “an important feature of the 1970s was the unprecedented effort brought to bear on innovation and reform in the educational system”. On a similar note, Hord (1987, p. 22) asserted that “more recently, the concept of change, now inextricably linked with its Siamese tw in, progress, has becom e a philosophical cornerstone of many industrial democracies, that see it as an almost automatic good, equating continual change with a seemingly inevitable progression toward perfection”. H ow ever, educational researchers and a d m in is tra to rs , b as in g o p in io n on accumulated literature of implementation and outcomes of specific iimovations, have come to realise that educational innovation cannot be pursued arbitrarily. The last few decades have seen an evolution of change theories which has facilitated the study of change in educational institutions (Hord, 1987). The dominance of top-down (power-coercive, em p iric a l-ra tio n a l) approaches to the implementation of change in nursing and nursing education has been documented by a Curationis, Vol. 19, No. 2, 1996 47 number of authors (Filkins, 1986; Gibbs, 1991). This is not surprising. Nursing has always been and is currently managed according to an orthodox bureaucratic model. For instance, Uys (1991) attributed the lack of innovative educational program m es in nursing to (a) rig id in terpretation and implementation of the South African Nursing Council (SANC) regulations, and (b) the influence of the bureaucratic system in which nursing education and nursing services operate. The em phasis on bureaucratic m anagem en t has p e rp e tu a te d the p o w er-c o e rc iv e s tra te g y to the im plem entation o f change in nursing. Sheehan (1990) warned that such an approach is not likely to be acceptable to most individuals who find themselves caught up in the demand to change. THEORETICAL FRAM EW ORK The theoretical approach on which this study is based is the concems-based adoption model (CBAM). The relevance of this model to the questions posed by this study is its emphasis on the process of implementation rather than the origin of change itself. In CBAM terms, whether change originates from the top or bottom is not really important in terms of whether positive change will or will not occur in educational institutions. Hord(1987,p. 14) writes that “The key to successful innovation is implementation; and the unwritten rules of implementation remain the same, whether approached from above or below”. In nursing ed u ca tio n , perhaps in the in te re s t of maintaining standards, national education reforms will almost always originate from the top. The successful implementation of such reforms will be determined largely by whether or not the unwritten rules of implementation are adhered to or broken. Hall, Wallace and Dosset (cited in Hord, 1987, p. 93) described the CBAM approach as “an empirically based conceptual framework which outlines the developmental process that individuals experience as they implement an innovation”. The CBAM approach is based on the belief that there is a set of developmental stages and levels teachers and others move through as they become increasingly skilled in using new programmes and procedures. One of the assum ptions that underp in the CBAM approach is that change is a developmental process and it is believed that behaviours and skills related to an innovation tend to follow a certain developmental pattern (Hall & Hord, 1987; Hord, 1987). Based on these assumption the CBAM was developed. This conceptual model consists of four components. These include the (a) Stages of Concern (SoC), (b) Levels of Use (LoU), (c) Innovation Configuration (IC), and (d) Intervention Taxonomy. For the purposes of this study, only the LoU dimension wiU be described. LEVELS O F USE (LoU) O F AN INNOVATION The LoU dimension focuses on peoples’ behaviours and skills with respect to the innovation . In the CBAM approach, analyzing whether an innovation is being used en tails m ore than a sim ple yes or no dichotomous question. According to Hall and Hord (1987) the levels of use of an innovation in c lu d e ; LoU 0 (N o n -u se ), LoU 1 (Orientation), LoU II (Preparation), LoU III (Mechanical use), LoU IVA (Routine use), LoU IVB (Refinement), LoU V (Integration), and LoU VI (Renewal).


INTRODUCTION
The passing of the 1985 regulations from the SA Nursing Council (R425 of 1985), resulted in two major changes in control of basic nursing education.Firstly the development of basic nursing curricula was transferred to individual nursing colleges at local level, although "basic" standards were laid down centrally.Secondly, basic nursing education became part of the country's post-secondary education system through university-college affihation.Both of these developments had important ramifications for nursing education.
Based on the regulations and guidelines of the South African Nursing Council (SANC), each nursing college was to develop its own curriculum.The comprehensive basic nursing programme (CBNP) had cast nurse educators as professionals who could rebuild nurse education almost single handedly.When nurse educators were expected to implement the new programme, preparing them to do so was not a central concern.According to Van der Merwe (1989, p. 37) the CBNP "expected every lecnirer to understand and implement the totality of the curriculum".Centralised decision making assumed that the people r e s p o n s ib le fo r the ad o p tio n and institutionalisation of the new policies would do so with the necessary willingness and expertise.
The need to evaluate this programme has been mentioned by a few authors (Rispel & Motsei, 1988;Uys, 1991).Rispel and Motsei (1988, p. 16) proposed that, "the most obvious suggestion for future research (in nursing education) is an intervention study to evaluate the comprehensive four-year course".
Without discounting this call for evaluating the CBNP, it is believed that in order to ev alu ate outcom es o f any edu catio n al innovation, it is vital to first determine whether the programme is being implemented, and if so, how.Several studies (Cameron, 1991;Hall & Loucks, 1977;Ross, Luepker, Nelson, Saavedra, & Hubbard, 1991) which used the Concerns Based Adoption Model (CBAM) to evaluate educational change reported on the importance of establishing levels of use before embarking on impact studies.Hall and Hoid (1987) warned that adoption of a particular innovation by an educational institution docs not necessarily mean that every teacher in that institution is using the innovation.
This study aimed at investigating the process of adoption and implementation of the CBNP, w ith a view to b e tte r u n d e rsta n d the consequences of legislated change in nursing ed u catio n .S p e c ific a lly , the fo llo w in g questions were asked:  Debeauvais (1981, p. ix) noted that "an im portant feature o f the 1970s was the unprecedented effort brought to bear on innovation and reform in the educational system".On a similar note, Hord (1987, p. 22) asserted that "more recently, the concept of change, now inextricably linked with its Siam ese tw in , p ro g ress, has becom e a philosophical cornerstone of many industrial democracies, that see it as an almost automatic good, equating continual change with a seemingly inevitable progression toward perfection".
H o w ev er, ed u c atio n al rese arch e rs and a d m in is tr a to r s , b a s in g o p in io n on accumulated literature of implementation and outcomes of specific iimovations, have come to realise that educational innovation cannot be pursued arbitrarily.The last few decades have seen an evolution of change theories which has facilitated the study of change in educational institutions (Hord, 1987).
The dominance of top-down (power-coercive, e m p iric a l-ra tio n a l) ap p ro a ch es to th e implementation of change in nursing and nursing education has been documented by a number o f authors (Filkins, 1986;Gibbs, 1991).This is not surprising.Nursing has alw ays been and is currently m anaged according to an orthodox bureaucratic model.For instance, Uys (1991) attributed the lack of in n o v a tiv e ed u c atio n al program m es in n ursin g to (a) rig id in te rp re tatio n and implementation of the South African Nursing Council (SANC) regulations, and (b) the influence of the bureaucratic system in which nursing education and nursing services operate.The em phasis on bureaucratic m a n a g e m e n t has p e rp e tu a te d the p o w e r-c o e rc iv e s tr a te g y to the im p lem e n ta tio n o f c h a n g e in nursing.Sheehan (1990) warned that such an approach is not likely to be acceptable to m ost individuals who find themselves caught up in the demand to change.

TH EO R ETIC A L FRA M EW O RK
The theoretical approach on which this study is based is the concems-based adoption model (CBAM).The relevance of this model to the questions posed by this study is its emphasis on the process of implementation rather than the origin of change itself.In CBAM terms, whether change originates from the top or bottom is not really important in terms of whether positive change will or will not occur in educational institutions.Hord(1987,p. 14) writes that "The key to successful innovation is implementation; and the unwritten rules of implementation remain the same, whether approached from above or below".In nursing e d u c a tio n , p e rh a p s in th e in te re s t of maintaining standards, national education reforms will almost always originate from the top.The successful implementation of such reforms will be determined largely by whether or not the unwritten rules of implementation are adhered to or broken.
Hall, Wallace and Dosset (cited in Hord, 1987, p. 93) described the CBAM approach as "an em pirically based conceptual framework which outlines the developmental process that individuals experience as they implement an innovation".
The CBAM approach is based on the belief that there is a set of developmental stages and levels teachers and others move through as they become increasingly skilled in using new programmes and procedures.One of the assu m p tio n s that u n d erp in the CBAM approach is that change is a developmental process and it is believed that behaviours and skills related to an innovation tend to follow a certain developmental pattern (Hall & Hord, 1987;Hord, 1987).
Based on these assumption the CBAM was developed.This conceptual model consists of four components.These include the (a) Stages of Concern (SoC), (b) Levels of Use (LoU), (c) Innovation Configuration (IC), and (d) Intervention Taxonomy.For the purposes of this study, only the LoU dimension wiU be described.
The LoU dimension focuses on peoples' behaviours and skills with respect to the in n o v a tio n .In th e CB A M ap p ro ach , analyzing whether an innovation is being used e n tails m ore than a sim p le yes or no dichotomous question.According to Hall and Hord (1987)  At this level, the individual exhibits no behaviour related to the innovation at all.He or she is doing absolutely nothing toward being involved with the innovation (Hall & Hord, 1987;Hall & Loucks, 1977;Hord, 1987).b) LoU I: O RIENTA TIO N At the Orientation LoU, the user is actively seeking information about the innovation.He or she is busy grappling with the innovation's value system as well as its demands upon the user and the user's system (Hall & Hord, 1987;Hall & Loucks, 1977;Hord, 1987).

c) LoU H: PREPARATION
The individual who is busy preparing for first time use is at the preparation LoU.He or she actually in d icates in ten tio n to use the innovation.Typical behaviours include ac q u irin g the m a teria ls and reso u rces necessary for using (Hall, & Hord, 1987;Hall & Loucks, 1977;Hord, 1987).

d) LoU ni: M ECHANICAL USE
This is characteristic of an inexperienced and experimenting user.This kind of user is preoccupied with logistical aspects of the innovation.Demands of getting the materials needed, in tro d u cin g the program m e to students, making plans and time tables take much of the user's time.Hall and Hord (1987) maintained that people usually stay at this level for a long time and that it is possible that some people never get beyond the Mechanical Use level unless they receive sufficient training in how to use the innovation.

e) LoU IVA; ROUTINE USE
The LoU IVA user is comfortable with what he or she is doing and there is a feeling of having mastered the skills necessary to use the innovation.It is a period that follows the uncertainty and stress associated with the stage of mechanical use.More often than not, at this stage the user is relieved that he/she has finally reached a degree of stability and confidence with regard to the innovation.Hord (1987, p. 113) observed that "this stability, coming on the heels of a change and stress fulfils a crucial function for most people.
Regardless of what they do subsequently, almost everyone will need some period of IVA use before they will be ready to move forward".

f) LoU IVB: REFIN EM EN T
Based on know ledge of short-term and long-term consequences of the innovation, the user seeks to modify it, in order to maximise or improve its impact on the students.These modifications may affect the programme itself, or the way it is delivered, used, or managed.The behaviours and the activities of the user are no longer focused on helping himself or herself, but rather are directed at finding ways to help the students achieve something out of it (Hall & Hord, 1987;Hord, 1987).g) LoU V: INTEGRATION Teachers at LoU V make a commitment to collaborate with other teachers in the use of the innovation.They are now comfortable and confident enough with the innovation to be able to share and explore aspects related to how th e o th e r te ac h ers are u sin g the innovation (Hall & Hord, 1987;Hall & Loucks, 1977;Hord, 1987).

h) LoU VI: RENEW AL
At this point it almost can be said that "the o rig in a l in n o v a tio n has a lre ad y been o u tg ro w n " (H o rd , 1987, p. 114).T he renewing user is already seeking and making major modifications in the innovation, to the extent of even replacing it altogether.

HYPOTHESES
It was hypothesised that (a) the LoU of all four components of the CBNP for nurse educators would be at or above Routine use and that (b) nurse educators at nursing colleges where the programme was adopted earlier than it was legally necessary to adopt, will exhibit LoU at or above routine level of use, compared to nurse educators at late adopter colleges.

DEFINmON O F TERM S
NURSE EDUCATORS refers to individuals with a teaching assignment (classroom and clinical) at the four selected nursing colleges offering the four-year comprehensive basic nursing programme (CBNP).
LEVELS OF USE refer to behaviours and skills of nurse educators in relation to the implementation of the four components of the CBNP as measured by the focused levels of use in terv iew schedules (one for each component of the CBNP) developed by the researcher based on the guidelines by Loucks, Newlove, and Hall (1975).
The term CBNP refers to the four-year diploma in midwifery and nursing -general, psychiatric, and community health nursing mandated by the SANC in 1985.

COM PONENTS O F T H E CBNP
The four components of the CBNP under study were teaching for producing nurses capable of (a) rendering comprehensive health care, (b) rendering holistic nursing (c) th in k in g c r itic a lly , and (d ) le a rn in g independently.(1979) it is of geccssity that for the purposes of this study a holistic cu rricu lu m refers to te ac h in g /learn in g activities and lesson content which take into account the biophysiological, psychological, sociological, and ethnic-cultural dimensions of health and disease.In essence the content of the lesson as described by the interviewee must explain how the above dimensions of health and disease interrelate.The ideal description was defined as that which dealt with all of these determinants of health and disease.
Within the context of this study, teaching for critical thinking was defined as teaching and learning activities that called for (a) inference, (b) comparing, (c) analysis, (d) interpretation, and (e) evaluation.These thinking abilities had to be integrated within the subject content of nursing.That is, ability to teach for critical thinking was measured in terms of whether or not the interviewees' descriptions of their teaching/learning activities revealed attempts at in v o lv in g th e s tu d e n t in the teaching/learning process in a questioning and facilitating manner.Specifically, use of highly interactive strategies such as debates, seminars and discussions in teaching and learning was seen as indicative of teaching for critical thinking.
Teaching and learning activities aimed at developing independent learning skills were d e fin e d as th o se d e s c rip tio n s o f teaching/learning activities which involved (a) use of a variety of learning experiences w h ich re q u ire th e stu d e n ts to u tilise information access skills, for example, library use, locate experts in a specific subject, and actual clinical experiences (case studes), (b) provision of an opportunity for the students to have some say in what is to be learned and when, and (c) use of self-evaluation by the students.

EARLY A D OPTER COLLEGES
These were colleges which had elected to adopt the C B N P before it was legally mandated for all nursing colleges in the country.Early adopter colleges for this study were colleges A and C.

LA TE ADOPTER COLLEGES
These were colleges which did not adopt the CBNP until it was legally required that they do so in o r d e r to c o n tin u e o ffe rin g program m es leading to registration for professional nursing and midwifery.These were colleges B and D.

M E T H O D S S A M P L E A ND SA M PL IN G P R O C E D U R E
The sample for this study consisted of 47 purposely selected nurse ^u cato rs .These interviewees were chosen from a cluster sample of four nursing colleges selected by timing of adoption of the CBNP and province of location.Two coUeges were randomly selected, whereas two were conveniently selected because of failure to gain access to other randomly selected colleges.
Twelve (12) nurse educators per college were selected purposively on the basis of their involvement with teaching the CBNP at the tim e of data collection.One refused to participate in the smdy.

IN S T R U M E N T A T IO N A N D D A T A COLLECTION
T he re se a rc h e r tap ed in te rv ie w s w ith individual nurse educators (n = 47) at the four selected nursing colleges.The levels of use of the four components o f the CBNP were assessed by means of a focused, open-ended interview.The LoU interview was based on a format designed by Loucks, Newlove, and Hall (1975).The interview schedule started with a specific question, for example."Are you teaching your students such that they would be able to render comprehensive health care?"D epending on the respondent's answer, the interview shifted to different parts of the interview guide.Each of the branching questions was followed by a series of category questions, which required the nurse educators to describe actions they had taken or would be taking in the future.
The interview ees were required to give d e ta ile d d e s c r ip tio n s o f (a ) th e ir understanding of each of the four components of the CBNP, (b) what they were actually doing in implementing these components, (c) their plans for the future, (d) as well as whether they were sharing any of their experiences with colleagues.The interviewees were asked to relate their responses to their behaviours outside and inside the classroom.Hall and Loucks (1977) reported that the inter-rater reliability for the LoU interview and rating procedures ranged from .87 to .96 on overall L evel o f U se. C o rrelatio n coefficients on validity ratings were reported at .98 and .65 (Hall & Loucks: 1977).For the present study, the interview schedules were pretested and an agreement of 75% between an initial and second rating-conducted a week later was found.An interrator reliability of rho .74 was achieved.Content validity of the instruments was acceptable to five nurse educators (two principals of nursing colleges and three university lecturers involved in teaching the CBNP).

LIM ITATIONS O F T H E STUDY
Inability to gain access to the original randomly chosen nursing colleges in two provinces compromised the generalisability of the findings of this study.However, four colleges out of the 36 nursing colleges in the country represents an 11% sample.Secondly, in differentiating between early and late adopter colleges the study did not control for the fact that individuals are mobile in nature therefore there was minimal difference in the mean number of years teaching the CBNP for nurse educators at early and late adopter colleges.1.Except for nurse educators at nursing college B, LoU on teaching for holistic nursing were generally at or above routine use.Eight out of the 12 nurse educators interviewed at nursing college B were rated at mechanical level of use, whereas, two nurse educators at nursing college A were not teaching for producing nurses capable of rendering holistic nursing at the time of data collection.These data are depicted in Figure 2.

LEVELS O F USE ON TEACH IN G FO R CRITICA L THINKING
At all the nursing colleges, except for nursing college A, 50% or more of the nurse educators w ere e ith e r co m fo rta b le w ith or busy modifying and changing their teaching and le a rn in g a c tiv itie s in re la tio n to th is component.These data appear on Figure 3. Two nurse educators, one at nursing college A and one at nursing college B, were not teaching for critical thinking, whereas at nursing college C one nurse educator was preparing for initial use.In all, 22 nurse educators were rated at or below Mechanical Use.
Developing independence in learning was the only component with which 50% or more of the nurse educators at each of the colleges felt comfortable.At nursing college D, nurse educators had begun coordinating and sharing their teaching and learning experiences with others in order to develop independence in learning, whereas at all the other three nursing colleges a few nurse educators were busy refining their behaviours and skills in relation to this com ponent in order to maximise student outcomes.See Figure 4.
In order to answer the question on differences in LoU of nurse educators at nursing colleges by timing of adoption 2 x 2 Chi squares were computed.The LoU data were divided into two categories, that is, low and high levels of use.High levels of use were defined as levels of use at or above routine use.
It was predicted that nurse educators at nursing colleges where the programme was adopted earlier than it was legally necessary, would exhibit LoU at R outine use and above compared to those at late adopter colleges.No significant differences on LoU o f nurse educators based on timing of adoption were found for any of the four components of the CBNP.It was expected that early adoption would be associated with levels of use at or above routine use.This expectation was based on the assumption that the nurse educators at early adopter colleges would be more experienced in teaching the CBNP.The failure of this study's results to account for variance between groups by timing of adoption can be attributed to the fact that the average number of years of teaching the CBNP was 3.7 and 3.5 for nurse educators at early and late adopter colleges respectively.
One of the fundamental assumptions of the CBAM model is that progression o f the LoU is a function of time.This programme had been legally mandated for seven years at the time "of data collection (June 1993-January 1994).For the early adopter colleges (A & C ) the programme had been in operation for 10 and nine yean respectively.Furthermore, Hall and Hord (1987) maintained that over time, individuals develop their own patterns of using an innovation which works for them and that proficiency (levels of use at or above routine use) in using an innovation is a function of time.
This view was supported by the findings of this study for LoU on teaching for holistic nursing and developing independent learning skills.However, on teaching for CHC as well as teaching for critical thinking, proficiency had not been achieved by 26 and 22 nurse educators respectively.In addition, a number of nurse educators (n = 11) stated that they were not teaching for producing nurses capable of rendering CHC.
The findings pertaining to the presence of non-users at using educational institutions have been documented elsewhere.Hall and Loucks (1977) reported that, at schools where the teachers were supposed to have been using individualised instruction, 20% were not using such teaching in mathematics and 26% were not using it in reading.Hall and Loucks warned educational researchers about the tacit acceptance of use, simply because a "school" or "university" is su p p o s^ to be have adopted a particular innovation.
These results raised considerable concern for the investigator.After all, producing nurses capable of rendering comprehensive health care was one of the major reasons for the establishment of the CBNP (Searle, 1983;Uys, 1991;Van Huyssteen, 1989) (a) At what level are the behaviours and skills of nurse educators at nursing colleges in their implementation of selected components of the CBNP?, and (b) Are there any differences in the levels of use of the four components of the CBNP by nurse educators at early and late adopter nursing colleges?LITERATUIUE R E V IE W AND R E L A T E D T H E O R Y TH E CO N CEPT O F CHANGE the levels of use of an innovation in c lu d e ; LoU 0 ( N o n -u s e ), LoU 1 (Orientation), LoU II (Preparation), LoU III (Mechanical use), LoU IVA (Routine use), LoU IVB (Refinement), LoU V (Integration), and LoU VI (Renewal).a) LoU 0: NON-USE

For
the purposes of this study, teaching for producing nurses capable of rendering CHC w as d e fin e d as a d e s c rip tio n o f teaching/learning activities and lesson content in c o rp o ra tin g th e (a) p re v e n tiv e , (b) promotive, (c) curative, and (d) rehabilitative aspects of health and disease within the context of the clinical nursing disciplines.Specifically, does the interviewee describe how a particular health problem can be p rev e n ted , any d e sc rip tio n s o f health maintenance behaviours, what to do once health has been impaired, as well as how to ensure that the individual and /client restores the maximum capability for functioning independently?TEACHING FO R H O LISTIC NURSING Because the concept of an individual as a holistic human being creates difficulties in terms of traditional research; to; reiterate Stevens's words Comparisons on LoU of the nurse educators in th e im p le m e n ta tio n o f each o f the components of the CBNP were conducted by means of descriptive statistics.Except for nurse educators at nursing college B, levels of use for this component were mainly at or below mechanical use.At all four nursing colleges, a few nurse educators were in fact not teaching for producing nurses capable of rendering CHC (A: = 3; B = 1; C = 3;D = 4 See Figure 1).None of the nurse educators interviewed at nursing college D was at Routine use, whereas th e re w as o nly o n e n u rse e d u c a to r comfortable with own teaching and learning activities in relation to teaching for CHC at colleges A and C. LEVELS O F USE ON TEA CH IN G FO R H O LISTIC NURSING FIGURE 2: Variations between Colleges on Levels of Use on Teachingfor Holistic Nursing

Variations between Colleges on Levels of Use on Developing Independent Learning Skills
Although consensus is high in terms of its desirability, authorities in this field do not always agree as to what the term means.In the light of the large number of nurse educators rated at or below mechanical LoU on teaching for CHC (n = 26) and critical thinking (n = 22), it is concluded that impact studies aimed at assessing outcomes on these components of the CBNP, would be premature at this stage.Im plem entation of two of the four m ajor co m p o n en ts o f th e 'C B N P needs to be facilitated.Exphcit interpretations of the o p e ra tio n a l m e an in g o f te a c h in g fo r "producing nurses capable of rendering CHC and critical thinking" are required from the program m e planners.T his needs to be work-shopped with nurse educators to ensure u n d e rsta n d in g and o w n ersh ip .N urse educators must know what it is that they are supposed to be doing differently and how this can be achieved.R E F E R E N C E S Cam eron, H. (1991).Effect of inservice training on implementation of a health curriculum in N ova Scotia, C anada.Journal Of School Health, 61(3).131-135.D alton, T. H. (1988).The challenge of curriculum innovation: A Study o f ideology and p ra c tic e .Philadelphia: Farmer Press.Debeauvais, M. (1981).Foreword.In R. S. A dam s & D. C h en , The process of educational innQvation; An international perspective (pp.ix-xi).London; Kogan . Why then would nurse educators at three out four nursing colleges still be fiinctioning at or below mechanical level of use almost a decade past legislated adoption?It was assumed that there was a common percepbon and interpretation of the concept teaching for CHC at South African nursing co lleg e s.T h is p ro v e d to be a g rav e Loucks, S. F., Newlove, B. H., & Hall, G. E. (1975).Mea.suring levels of use of the in n o v a tio n : A m anual fo r irainocs.interviewers and raters (Report No. 3013).Austin: The University of Texas at Austin, Research and Development Center for Teacher Education.