Trends In Coloured Nursing Education

OPSOMMING Die opvoedkundige ontwikkeling van verpleging toon 'n interessante verloop. Die daarstelling van doeltreffende en voldoende fasiliteite vir opleiding van basiese verpleegstudente op diplomaen graadvlak sowel as na-basiese kursusse wat aangebied word deur gesondheidsinrigtings en aan universiteite, het ’n daadwerklike invloed op die m othering en belangsteiling van verpleegsters gehad. Dit het daartoe bygedra dat die getal geregistreerde Kleurlingen Indiérverpleegsters wat in 1959 903 in getal was, gegroei het tot 3457 (slegs Kleurlinge) aan die einde van 1977. Dit is noodsaaklik dat alle verpleegsters hulself steeds op hoogte hou van huidige tendense in die beroep ten einde in staat te wees om die toenemende eise wat deur die beroep aan hulle gestel word, die hoof te kan bied. Hierdie ideaal kan slegs bereik word deur volgehoue studie, navorsing en indiensopleiding.


INTRODUCTION
E D U CATION as a selfgrowth process implies the po tential successful adaptation to the world in which one lives; the latter becom ing increasingly dem anding through the expansion and growth of society as a whole.
The C oloured nursing student of today, like all other students, lives in a fantastic era of technological advance m ent, industrialization, a continual struggle for academ ic achievem ent and above all the drive to achieve adjustm ent within the changing fram ew ork of society.The student m ust therefore be prepared to learn -w hich is a mental activity by means o f which know ledge, skills, attitudes, and ideals are acquired, resulting in the m odification of behaviour.
The present-day nurse educator, therefore, not only has to be professionally and academ ically prepared for the educa tional task in nursing science but has to constantly update know ledge so as to keep abreast o f the total interrelated picture of basic human science developm ent.The success or failure of the student when she enters the professional world is an irrevocable reflection o f the effectiveness o f her teachers.
In nursing education w e prim arily set a standard o f thoroughly motivated objectives w hereby the student may be successfully introduced to health science as a collective and applied discipline.A farsighted, highly m otivated and adapt able individual whose preparation goes beyond academ ic learning and professional skill, is needed to train the C ol oured professional nurse o f tom orrow .
There is no difference betw een the educational program m e followed for Coloured nursing students and that which is carried out for any other race group, but as in any other educational field the lecturer has to consider the social back ground e.g.religion, beliefs, morals and values o f the target group involved.Careful investigation o f the above could lead to know ledgeable insight into the biological and psycho social needs o f the particular com m unity dem anding the service o f the professional nurse on com pletion o f her train ing.
Although Coloured nursing education is reflecting a stead ily increasing picture o f grow th on basic and post-basic diplom a and degree levels o f nursing education, yet ad vancem ent is still being com plicated by certain relevant m atters in respect o f the existing situation.Factors worth mentioning are inter alia physical facilities such as the lack of living-in accom m odation for Coloured nurses at some training hospitals, public transport which is noticeably in adequate pertaining to the duty hours dem anded from the nurse and in su ffic ie n t a p p lican ts in p o ssessio n o f an academic senior certificate.The noticeable shortcom ing as regards the educational standard w hich is m aintained in Col oured schools, specifically relates to the shortage o f teachers in the tuition o f the natural sciences, the latter being a strong recom m endation in considering the pre-requisites for train ing in relation to the extent o f the syllabus.Very few Col oured teachers in these specialized fields hold the appropriate qualifications for teaching natural sciences or m athem atics.
Particular mention should be m ade how ever o f the fact that the provision for the training o f C oloured nurses has brought about a m uch larger num ber o f available nurse professionals.This results in a far m ore adequate staff position in hospital wards and/or other related services as well as the m ainte nance o f a high standard of patient care.
Since the beginning o f 1978 most South African univer sities have been open to post-basic, post-graduate nursing students o f all races.This factor is a very im portant one considering that som e universitites do not have M edical Faculties.Registered Coloured nurses are therefore in a position to do courses at universities with M edical Faculties where special courses e.g . in Advanced Clinical Nursing are offered.
It has been experienced at the University o f the W estern Cape that the particularly strict and careful selection o f pre graduate students is im perative as it has proved successful in raising the academ ic achievem ents and practical skills o f the students.They are also very responsible, mature and wellbalanced on com pletion o f the course.Total com m itm ent of these students as regards hospital nursing and nurses' home matters is im portant and all student nurses are therefore exposed to a full orientation program m e prior to com m ence ment o f lectures and practical skills.
The particular need to educate C oloured nurses on postbasic level m ust not be overlooked as within a Coloured population of 9 ,4 m illion (1970) which also reflects a particu larly high population grow th rate, the needs and dem ands of the com m unity should be considered in their entirety.
Coloured nursing education should not only concern itself with the academ ic achievem ent and skilful practical task fulfilm ent, but should objectively aim at the im provem ent of the socio-econom ic status and uplifting of the Coloured population as a w hole.

BASIC REGISTRA TION FOR GENERAL NURSES
The first Coloured general nurse was E.R .Gow.She passed in Decem ber 1919 and was registered on 6 January 1920.On 18 June 1920 she was admitted to the register as a m idwife, being the first Coloured person to be registered as a general nurse and midwife.
Since then the increase in the number o f Coloured nurses has been slow but steady.This slow rate was not only due to lack o f recruits with the necessary educational qualifications but also due to the lack o f facilities and em ploym ent oppor tunities for Coloured nurses.W ith the policy of separate developm ent additional training facilities as well as oppor tunities were provided.

5.
There is a com paratively high wastage o f Coloured nurs ing students.As studies have shown, it is virtually im possi ble to ascertain exactly why this is so.A few possible reasons for this phenom enon could be: 1. W rong choice o f vocation which points to the need for effective vocational guidance at school.Failure in passing as a result of inadequate academic preparation for nursing.
Com petition o f the private sector with nursing.Lack of sufficient and efficient orientation with regard to nursing at some training schools once the student has assumed duty.Personal reasons.There has been dissatisfaction with the standard o f general education o f recruits to the nursing profession since 1944 when the Colonial M edical Council com plained that the general standard o f education o f nursing recruits was not adequate for the dem ands which are made on them as profes sional persons with grave responsibilities.
Secondary education for girls had been very inadequately developed in the years before W orld W ar II, especially for N on-W hites.Com pulsory lower education had already been fully instituted in 1923 for W hite people but not yet for Coloureds.N ursing exam ination results w ere adversely af fected in the post war-period as selection procedures were virtually abandoned due to the great dem and for nurses.
N ow adays the picture is changing rapidly as there is an increasing num ber o f Coloured students in possession o f a Senior or M atriculation Certificate applying to follow nurs ing courses.This could be due to the follow ing reasons: 1.Rising unem ploym ent figures.
Population explosion.Security offered by nursing as a career.Im proved status o f nurses.Im proved standard o f living and educational facilities.A disturbing factor how ever, with respect to Coloured m atriculants applying for nursing, is the lack o f science subjects as background for nursing.On investigation, nurs ing officials were told that pupils make their own choice of subjects on enrolm ent at schools.On further investigation how ever, statistics at the University of the W estern Cape, the biggest source for science teachers at Coloured schools, reveal an alarm ing shortage of teachers follow ing the natural science courses.The total num ber o f graduates with B.Sc, since the U niversity opened in 1962 up to date (1978)  Tw o groups o f students have already com pleted the course.This table will be discussed in m ore detail w hen the process o f selection is dealt with.

O BJECTIV ES
The objectives underlying the curriculum design o f the course are not only oriented tow ards know ledge but are inclusive of goals such as preparation o f nurses to fulfil a com prehensive task against the background o f m odem changing society.C onstant attem pts are being made to guide students tow ards skilful, responsible and intellectual de velopment so as to ensure that they will react com petently and with confidence in em ergency situations.The role of the nurse in the com m unity is particularly em phasized.
The subjects these students have to com plete are believed to give them the necessary background and m aturity to be capable and responsible ward sisters once they have com pleted the course.
They are required to do Nursing I, II, III, IV and V of which the last sem ester in the fourth year and the first semes ter in the fifth y ear are devoted to m idwifery during which time they also do courses in cytology and family planning.They all have to follow Psychology I and Sociology I and are allowed to choose betw een one o f these two subjects as their second m ajor course.
Furtherm ore they are required to do Anatom y Special, Physiology Special, A pplied Physics, A pplied Chem istry, M icrobiology and Preventive and Prom otive Health.These subjects are offered to pre-graduate students and students following the D iplom a in Nursing Education on a combined level.This w ould enable the graduates exem ption for these subjects should they w ish to follow post-basic courses e.g.Diploma in N ursing Education or the D iplom a in Operating Theatre Technique.

PRACTICAL W O RK
The students are constantly m otivated to regard the patient as the most im portant person in a h o sp ital.They are therefore tvery enthusiastic about their practical work.During univer-^ sity holidays and during the fourth and fifth year they work Q for 40 hours p er w eek (excluding 44 days annual leave).^ They often express their regret that it is not possible to spend longer hours doing practical work during their first 3 years when they only do 9 , 16 and 20 hours respectively.

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The practical part of the course is offered at Tygerberg 2 H ospital, a unique field for training as the hospital is ex-p tremely well equipped and presents the student nurse with a Z true picture o f technological advancem ent, an academic cli mate for research etc.
The practical training is inclusive o f lecture dem onstra tions, procedures, case studies and presentations and pro jects.The clinical departm ent o f the hospital undertakes to a large extent the practical nursing science but university lec turers are also involved.Lecturers spend Sessions at the hospital to do bedside teaching w hile the student nurses are doing practical w ork in the wards.This is encouraging for the student and relates well to the correlation o f theoretical and practical work and also leads to reinforcem ent o f individua lized learning skills and spot teaching.----------------W astage During the fourth year the student is given the opportunity to become skilful in the more advanced technical skills such as suturing o f w ounds, blood-sam pling, history-taking, mak- The main reason for the great decline in numbers from first ing of a provisional diagnoses etc.Total patient-evaluation Year t0 second year is the fact that Anatomy Special is a and skilful intervention o f a therapeutic plan are given pre-requisite for prom otion to the second year and that the specific consideration.
students are not allowed to repeat the first year.

FIGURE II Analysis o f reasons for wastages 1972-1977 (First year students)
YEAR Not allowed to continue with training after first semester.Personal reasons Not allowed to enter for exam i nation or failed.
From the above figure it is obvious that the figure for exam ination failures for 1977 was very high.An analysis of this reveals: 12 failed or were not allowed to write Anatom y. 6 fa ile d o r w ere not allo w ed to w rite S o c io lo g y I/Psychology I or both. 2 failed nursing science.In 1977 all students were allowed to continue with their training in the second semester.As an experim ent borderline cases were allow ed to continue, but they all failed at the end of 1977.It is therefore clear that the norms for selection after the first sem ester have to be applied consistently.
N um erous changes and expansions o f this course have been contem plated.Its presentation has to be kept in line with the changing circum stances o f the m edical and social sci ences.Eventual changes are foreseen but much will depend upon the econom ic clim ate o f the point in time.It is felt how ever that students should be taught m ore intensively in research m ethods so as to enable and encourage professional nurses to undertake post-graduate research projects.These midwives render a valuable service to the Coloured com m unity either as private practitioners or in em ploym ent o f various Provincial district m aternity services.
In the Cape Peninsula they have an active and valuable discussion group linked with the W estcol Branch o f the South African Nursing A ssociation.OBJECTIVES 1.To regard m idwifery as a fundam ental in nursing educa tion.2. To establish a farsighted and com prehensive attitude to nursing practice.3. To ensure that a high standard o f fam ily-centred care is m aintained by professional nurses.4. To equip the professional nurse adequately for her ex tended role. 5. To lay some foundation prior to post-graduate educa tion.
PO ST BASIC COU RSES The 1,5-year Diplom a C ourse in N ursing E ducation was instituted at the U niversity o f the W estern C ape in 1966.This was the first nursing course to be introduced at this university and eight students com pleted this course in June 1967.By June 1976, a total o f 63 students had obtained this qualification at this university.
In 1976 the duration o f the course was extended to two years and the first seven students w ho registered for this longer course qualified at the end o f 1977.The main objec tives o f the D iplom a C ourse in N ursing Education are, firstly, to train educators w ho will not only teach nurses but who will becom e directly involved and com m itted in the health education o f the com m unity as a w hole.
Secondly the course is aim ed at giving student tutors a wide and m eaningful background at academ ic level so that they will be able to obtain exem ption for certain courses should they be interested in doing a post-basic degree.
The course for the D iplom a in Nursing Adm inistration was first instituted at the Conradie Hospital Lecture Depart ment and in l9 6 8 , when this Departm ent closed dow n, it was offered at Tygerberg H ospital.In 1975 the course was insti tuted at the U niversity o f the W estern Cape but due to the fact that there were too few suitable applicants, it was held over till 1976 when four candidates registered for and completed the course.
During 1977 the sam e problem of too few candidates in possession of the required academ ic standard (Std.10) was encountered and the course could not be offered.
At the beginning o f this year five candidates were admitted to do the diplom a course.The syllabus is com piled to give the students a background and know ledge to equip them ade quately to fulfil the extrem ely dem anding task of the chief nurse adm inistrator.M atrons working in specialized ad m inistrative units o f certain hospitals are requested to lecture on their specialities and subjects such as administration, public adm inistration, nursing education adm inistration, in dustrial psychology and the social sciences are emphasized.
W hen the 1,5-y ear D iplom a C ourse in O perating Theatre Technique was first introduced in 1976 at the University of the W estern Cape, it was the first time in history that a course in this branch o f nursing had been introduced at university level.
Five students registered n 1976.At present there are 1 1 students follow ing this course.It is required of the students to do Anatom y Special, Physiology Special.Applied Physics, Applied Chem istry and M icrobiology with the Diploma in N ursing Education students.Should they desire to do the N ursing Education course at a later stage, they could apply for exem ption for these courses.An intensive study is also made o f surgery, anaesthetics, operating technique and de partm ental m anagem ent.This course was introduced at university level for various reasons -the m ost important being: 1.The need to prepare the theatre nurse at university level in order to enable her to meet the dem ands o f the increas ing standard o f work and responsibility required of her.
2. To co-ordinate all the courses from the various' hospitals in the Cape Province where one or two students were trained at a time and which proved to be uneconomic as all the lectures had to be repeated at each hospital.
3. To give the course a university status with the idea of stim ulation o f interest as there is always a serious shor tage of trained operating theatre personnel.In order to meet the needs of the Coloured community presentation of Com m unity Health Nursing Science as a subject in their nursing tuition should be a primary considera tion.
The growth rate of the Coloured population has been estim ated as the highest of all races in this country, thus giving rise to the particularly high incidence of physical disease and social pathology.The necessity to educate Col oured nurses in this subject on basic and post-basic courses has been evident for more than a decade; so as to guide professional Coloured nurses towards high quality com m un ity care with specific and continual focus on family planning, health education, role fulfilment in environmental health.
At the present time Coloured nurses have the opportunity to obtain this qualification not only at diploma level at hospi tals or colleges but at diplom a or degree level through the University o f South Africa.

CONCLUSION
The remarkable motivation and drive of Coloured nurses to qualify academically has earned them the praise they deserve.It is therefore the obligation of all nurse-educators to uphold and constantly improve on the basic educational standards so as to equip as many Coloured professional nurses as adequately as possible to enable them to carry out the age-old health prerogative of man.

B IB L IO G R A PH
GROW TH IN THE NUM BER OF COLOURED NURSES AND M IDW IVES Due to the similarity in the surnames o f Coloured and W hite nurses, it is not possible to arrive at an accurate figure o f Coloured registered nurses who had been admitted to the register o f the various Councils prior to 1957.Prior to 1973 Indians were included under Coloured per sons.The Nursing Amendment Act No. 50 o f 1972 intro duced separate registers and rolls for Indians.This involved the transfer o f a num ber of persons from the register of Coloured persons to that o f Indian persons.Increases in respect o f Coloured persons were com para tively high.This was due to the fact that the training of Coloured nurses developed rapidly during the past 1,5 de cades.Regulations prescribing standard 10 as an admission re quirem ent were published on 28 N ovem ber 1968 in respect o f student general nurses and became compulsory on 28 Novem ber 1970.This resulted in a decline in the num ber of Coloured student nurses who commenced training in 1970 and 1971.Notwithstanding this fact there is a vast change in the picture as regards the num ber of Coloured registrations over the past 70 years.The registration figure for Coloureds and Indians rose from 0-903 during the period 1909-1959.The num ber o f Coloured registered persons during the period 1969-1977 was as follows: 31 D ecem ber 1969 (including Indian 2455 31 D ecem ber 1974 (only Coloureds) 3107 31 D ecem ber 1976 (only Coloureds) 3279 31 D ecem ber 1977 (only Coloureds) 3457 Throughout the years there was also a steady rise in the num ber o f training schools for student nurses.
. -The History o f the developm ent o f N ursing in South Africa -p.307.T A BLE II N um ber o f Recognized Training Schools for N on-W hite persons for1969, 1974 and 1976.
amount to 208.D iscussions with educationalists at the university made it clear that although pupils enroll for science subjects at schools, suitably qualified science teachers are sparsely distributed over Coloured schools in the Republic and at most schools are non-existent.The pupils are therefore forced to choose non-science subjects or should they choose science subjects, lectures are offered by teachers w ho are not ade quately qualified to give pupils the necessary background.This brings about poor academ ic material and a vicious circle develops.B.CURATIONISThis integrated course o f 4, 5-year duration com m enced in 1972 when 11 students registered.Since then the total of students following the B. Cur.course has show n an increase; the present total being 34 for 1978.
N ovem ber o f the preceding year and is based on scholastic achievement.On completion o f the first semester, a second selection is done and the following points are considered: -M arks obtained in all courses -Practical performance -W ard reports -General attitude of student towards nursing.This selection program m e has ensured that only the best students have continued with the course throughout.The quality o f the practical work of these students as well as their academ ic achievem ent is reflected in the final exam ination results obtained.The failure rate of students in the years follow ing the selection has been relatively low.
FIGURE ICom parison between appointm ents and wastage during the first year: 1972-1978 B A SIC N U R SIN G E D U C A T IO N L E A D IN G T O E N ROLM EN T In 1948 the Cape Provincial A dm inistration introduced training for Coloured auxiliary nurses.This was done to meet the shortage o f registered nurses in hospitals.TH E ROLE OF M ID W IFERY IN C O LO U R E D NU RSIN G EDUCATION St. M onica's M aternity H ospital was the first hospital in the Republic o f South A frica to train C oloured m idw ives.The first course started in 1917.O ne o f the three students who started their training, M rs.G eorgina A .P .D .Judson, wrote her final exam ination on 14 D ecem ber 1917 and was registered on 8 January 1918, being the first C oloured m id wife in South Africa.The total num ber o f m idw ives trained by St. M onica's M aternity Hospital totals 796 up to date.Since 1917 the num ber o f training schools for m idw ives steadily increased e.g . in 1969 there were 39 and in 1974 -64 training schools, and a total o f 197 coloured m idw ives were registered in 1977.
In 1965 the Cape Technical College offered a course in Public Health at post-basic level on an extra-m ural basis to trained coloured nurses, as no provisions had yet been made in this respect.The Peninsula Technical College for Higher Education com m enced a course full-time in 1968.During the period 1968-1976, 120 qualified coloured nurses have ob tained the Diploma in Com m unity Health Nursing Science on this basis.
The H istory o f the D evelopm en t o f N ursing inSouth A frica.Pretoria: S .A .Nursing A ssociation 1966.SE A R L E , C. A spekte van G em enskapgesondheidsorg in Suid-Afrika -Pretoria: S. A. Verpleegstersvereniging, 1973.S. A. N UR SIN G COUNCIL R eport o f the Sixth Council Pretoria: Term o f o ffice 1 .4.1 9 7 0 -3 1 .4.1 9 7 5 S. A. VERPLEEGSTERSVERENIGING Beknopte reeks no. 4 U NIV ERSITY OF THE W ESTERN CAPE S tatistics.Department o f D evelopm ent.1977.

TABLE I N
um ber o f N ursing Schools which admitted Coloured and Indian Nurses and Student Midwives during the year ending 31 D ecem ber.