PREPARING NURSE MANAGERS FOR INFORMED ACTION

Nursing Adm inistration is one of the subjects taught to nurses study­ ing for post-registration courses, namely the D iplom a in Nursing A d­ m inistration and B Cur (I e t A) at M edunsa. Like o ther subjects in nursing, it is com posed of theoretical and prac­ tical aspects. For subjects in clinical nursing or patien t care and in nurs­ ing education, students have been able to apply theory to practice by being allocated to the real situation where they have been able to actu­ ally do. That is, in the wards and clinics w here patient care is actually done and in the nursing colleges where nursing students are actually taught. Students in Nursing Adm inis­ tration, however, have not been able to do. They have been sent to services but have so far only been able to observe what nurse adminis­ trators do, been given extra theory on how things are done, and have looked at the products of actions previously taken by nurse adminis­ trators, for example, a disaster plan.


INTRODUCTION
Nursing A dm inistration is one of the subjects tau g h t to nurses study ing for post-registration courses, nam ely th e D iplom a in Nursing A d m inistration and B C ur (I et A ) at M edunsa.
Like o th er subjects in nursing, it is com posed o f theoretical and prac tical aspects.F o r subjects in clinical nursing o r p atien t care and in nurs ing education, students have been able to apply th eo ry to practice by being allocated to th e real situation w here they have been able to actu ally do.T h at is, in the w ards and clinics w here p atien t care is actually done and in th e nursing colleges w here nursing students are actually taught.
S tudents in N ursing A dm inis tratio n , how ever, have not been able to do.T hey have been sent to services but have so far only been able to observe w hat nurse adm inis trato rs do, b een given extra theory on how things are done, and have looked at th e products of actions previously tak en by nurse adm inis trato rs, for exam ple, a disaster plan.

P R A C T IC A L P R E S E N T A TIO N S
In an effort to bridge the gap and thus m ake th e teaching of future nurse adm inistrators m ore m ean ingful, students studying tow ards a D iplom a in N ursing A dm inistration w ere each guided to select an adm inistration topic th at could be presented The practical presentations were divided into th ree.N am ely, roleplaying, application in the clinical area, and sim ulation exercises.

R O LE PLAYING
Role play's w ere done on the fol lowing topics: • Disciplining for specific prob lems: -drunkenness on duty -continuous late-com ing • Interview for a jo b (two were done) • Exit interview (tw o w ere done) The students who presented the role plays w rote th e play and asked for co-actors from th eir p eer group.

SIMULATION E X E R C IS E S
Sim ulation exercises included the following: The student who presented the practical experience w orked out the checklist, did the procedure and wrote rem arks.B rief explanations of the checklist and procedure were given.

EVALUATION
A t the end of each practica, the class, together with the teacher, evaluated the perform ance.
A fter all the presentations were done, a questionnaire was given to the students to evaluate the p er ceived increased understanding of the subject m atter.Tw enty-one out of 24 questionnaires w ere returned.The responses on the perceived increase in understanding w ere as given in table 1 .
The reasons given for the answers forw arded w ere as follows: • of the two students who felt only a slight im provem ent, one gave no reason and the o th er referred to class presentations of assign m ents as not having been m ean ingful.This sam e student was strongly against criticism by both the teacher and p eer group m em bers • the two doubtful respondents both stated their reasons as not being sure of how to apply the practica in the w ritten exam in ations • five of those who perceived a m oderate im provem ent felt that m ore drills were necessary, th at is, all procedures should be re peated The responses on suggestions for im provem ent w ere as given in table 2 .

DISCUSSION O F EVALUATION
The distribution on responses on the preceived increase in u n d er standing of the subject m atter is skewed tow ard the positive (see graph 1 ).
This strongly suggests th at the prac tica had a positive effect on m ost of the students, that is 80,99 % (from m oderate to a lot of im provem ent).This implies that there is a place for such practica in the teaching of the subject Nursing A dm inistration.
The reasons given for the answers on the perceived increase in u n d er standing suggest that som e students

R ECO M M EN D ATIO N S
The following factors need to be taken into consideration when plan ning the practica: • more time is needed to be able to --dem onstrate the procedure at least once before students do it -have m ore than one p resen ta tion for a procedure when necessary -include as m any procedures as possible • M ore teaching staff m ay be needed^ This will depend on the num ber of students and the num ber of procedures • students need to be helped to be able to accept criticism especially from m em bers of their p eer group.It is surprising th at d e spite the fact th at it was done as Graph 1 A Frequency distribution polygon of the responses on the felt increased understanding of the subject matter constructively as possible six stu dents (27,3 % ) still did not ap prove of it.B oth the good points and w eaknesses w ere pointed out.• three students (13,6 % ) felt un c o m f o r t a b l e w ith d i f f e r e n t opinions in problem solving.T hey w anted m ore direction from th e teach er in regard to exactly w hat th e actors in roleplaying should have said and done.This rigidity m ay be due to the fact th at they have internal ised the use of policy with no flexibility.It m ay also be due to the fact th at these students were m ore w orried ab out hard facts for the exam ination ra th e r than understanding of the subject m atter.T he fact th at the teacher sum m arised the principles ap plied in each role play, as given in th e earlier lecture, m ade no im pression on them .

DIE G A STR O -IN TESTIN A LE P A TR O O N
D ie diaree en gewigsverlies w at hier voorkom , w ord gekoppel aan dermkanaalinfeksies as gevolg van C ryp tosporidium en ander organism es insluitend alfa herpesvirus 1 en 2. In 'n hele aantal gevalle bly die oorsaak van die sim ptom e egter onduidelik.

DIE P A T R O O N VAN K O O R S VAN O N B E K E N D E O O R S P R O N G
H ier is d aar ook gewigsverlies, m a laise en sw akheid teenw oordig.In sommige gevalle was d aar tekens van M ycobacterium avium intracellulare-besm etting teenw oordig in beenm urg-, limfklier-en lewerbiopsies.D ie m eeste van die pasiënte wat van een van die opportunistiese infeksies herstel het, het óf 'n terugval o ndervind óf 'n ander infeksie ontw ikkel direk na staking van behandeling.
In m eer as 30 % van VIG S-gevalle in die V SA en VK, was daar g e p a a r d g a a n d e k a p o s i-s a rk o o m teenw oordig.D it het egter ietw at verskil van die vorm w at aan ons bekend is.D it kom m eer verspreid in die liggaam voor m et betrokkenheid van lim fkliere, slymvliese en The above considerations will depend on the particular circum stances.
The sam ple was small.H ow ever, because the students filled in the questionnaire after they had w ritten the final exam inations for the year and the fact they rem ained an o nym ous, the responses are re garded to be a true reflection of the feelings of the students and can thus be generalised to other students studying the subject.
It is also w orthy to note that the students studying tow ards B Cur (I et A ) at the tim e and who learned of the practica experience by the diplom a students requested to have the sam e experience.

P R O B L E M S E N C O U N T E R E D
Problem s en countered by the te a cher w ere as follows: ingewande.K aposi-sarkoom is gew o o n lik t o t d ie e k s t r e m i t e i t e beperk.V erd er is die m aligniteit in VIGS-slagoffers m eer aggressief en is die reaksie daarvan op chem oter a p i e o n b e s t e n d i g ( W H O , 1985:31).

SAM EVATTIN G
Volgens W ells et al (1985:76) to th e class or part of the class m o re concretely.This was Mrs C.M. Makwakwa, RN, RM, CHN, BSC (Nursing), Hons BA (Nursing), MA, EdM.Senior Lec turersoorte praktiese aanbiedings naamlik rolspele, simulasie oefeninge en toepassing in die kliniese area.In evaluering na afloop van al die praktiese aanbiedings was meeste (80,9 %) van die studente van mening dat dit vir hulle 'n groter begrip van die vakinhoud gegee het.done after a theoretical p resen ta tion in class eith er by the teacher or by the stu d en t as a class assign m ent, u n d er th e supervision of the teacher.

•
compiling on-duty lists • compiling an in-service training program m e • A llocation of w ard duties • M asterplan for personnel alloca tion • Form ulating a hospital disaster plan • W riting a m em orandum -m otivation for personnel -m otivation for equipm ent • B udgeting for a clinic • B udgeting for an extension of a ward • A llocation of students for clinical experience • C om pleting different forms.Except for the first, third and tenth item s, all exercises w ere done by a small group o f students w ork ing as a com m ittee.The presenter o r presenters ex plained each step to the class, th at is, the what and why.Application in the clinical area Application in the clinical area was done on the following :-• Inspection o f a w ard.(Five in spections w ere done, each for a specific area in the ward) • Inspection of a clinic (three in spections w ere done in different clinics) • C ontrol of D .D .P .D .