Assessment of a post-basic nursing education programme

A post-basic nursing education programme was introduced by the School o f Nursing, University of the Free State, in 1999. T he m ain aim o f the p rogram m e is to o ffe r vocationally directed specialisation and continuing edu­ cational opportunities to registered nurses. Qualifications, exit possibilities, the learning programme and the teaching-leam ing methods are described. A year after the pro­ gram m e was introduced student evaluation o f the pro­ gramm e took place by means of questionnaires. The sur­ vey method was used to obtain the opinion of students via questionnaires. A convenience sample was applied and 82% of the questionnaires were returned. Although stu­ dents appeared to be satisfied, they found some modules difficult. Twenty-three per cent found the lecturers help­ ful and considerate and 93% found contact with lecturers to be essential. The greatest advantage of the programme, however, is that it offers registered nurses an opportunity to qualify as clinical experts, because the programme fo­ cuses mainly on clinical specialisation. Tutorial staff are com pelled by student estimates to examine the relevancy of curricula on a regular basis. Abstrak ’n Nabasiese verpleegonderrigprogram is in 1999 by die Skool vir Verpleegkunde, Universiteit van die Vrystaat, in g e s te l. D ie h o o fd o e l m et d ie p ro g ra m is om b e ro e p s g e r ig te sp e s ia l is a s ie en v o o r tg e se tte onderrigeleenthede aan geregistreerde verpleegkundiges daar te stel. Kwalifikasies, uittredingsmoontlikhede, die leerp rog ram sow el as die onderrig leerm etodes w ord beskryf. Na ‘n jaar is studentevaluering van die program deur middel van vraelyste gedoen. Die opnam emetode is gebruik en deur middel van vraelyste is die mening van studente verkry. ‘n Gerieflikheidsteekproef is aangewend en 82% van die vraelyste is terugontvang. Alhoewel dit blyk dat studente tevrede was, is sekere modules moeilik gevind en 93% vind kontak met dosente noodsaaklik. Driee n tw in tig p e rse n t he t die d o sen te h u lp v a a rd ig en tegem oetkom end gevind. Die grootste voordeel van die p ro g ra m is e g te r da t d it aan g e re g is tre e rd e verpleegkundiges die geleentheid bied om as kliniese deskundiges te kwalifiseer, omdat die program hoofsaaklik op kliniese spesialisasie-areas fokus. Studenteberamings dw ing o n d errig perso n eel ook om v o o rtd u ren d hul kurrikulum s vir relevantheid te toets.


Introduction
It is alarming to think that know ledge acquired in formal educa tion is outdated within five years (Cox & Gibbs, 1994:5) Technological progress feeds on knowledge, and know ledge is increasing at such a rate at present that nursing education is probably experiencing one o f the m ost exciting periods in its history.Changes in the developm ent and needs o f the com m u nity, and advances in m edical technology daily open up new horizons in the provision of health care.Staff involved in teach ing and training nurses are therefore forced to adapt their teach ing goals and strategies and to develop new program m es.
The health o f the population o f South Africa rests on the know l edge o f health w orkers o f w hom nurses form the largest per centage.Basic teaching and training of nurses is no longer adequate and specialised skills and knowledge to provide nurs ing care are essential.A lthough non-clinical areas are m ost popular am ong nurses, the profession dem ands know ledge in the clinical field.Unfortunately, as far as prom otion opportuni ties are concerned "the clinical career ladder has been seen by m any as a dead end in term s o f prom otion " (W oodward, 1996:20).In spite o f this trend, the School o f N ursing concen trates m ainly on clinical specialisation, because this is where the need for actual practice lies.A program m e for post-basic training was introduced at the School o f Nursing, U niversity o f the Free State, in 1999.
C onsideration was given during the developm ent o f the p ro gram m e to the necessity o f equipping nurses with know ledge on specific specialties as required by the South A frican Q uali fication A uthority in the follow ing quotation: "A qualification shall represent a p la n n e d com bination o f learning outcom es which has a defined p urpose and which is intended to p rovide qualifying learners with applied com pe tence and a basis fo r fu rth er learning " (Ram phele, 1999:6-10).
In the first place the purpose o f this article is to provide an explanation o f the com position o f the program m e, and in the second place to provide the results obtained from the stu dents.

Aim of the programme
The aim o f the program m e is to (i) prepare specialist nurses in significant and specific ar eas of nursing as subject specialists, facilitators o f re search, preceptors for other health workers and managers; (ii) provide professional specialisation and continuing edu cational opportunities at various academ ic levels for nur ses; (in) enable nurses to earn the credits that will be required should qualified re-registration with the South A frican N ursing Council be instituted; and (iv) equip nurses in new dim ensions to m eet the requirem ents o f the new ly phased-in prim ary health care policy o f the governm ent.

Qualification and exit possibilities of the programme
A b ach elo r's degree in advanced nursing can be obtained.However, the program m e has four exit possibilities determ ined by the choice o f modules.
T he follow ing exits are offered.They are represented in Table 1:

University qualifications achievable on exit
As stated in the introduction, the School considers it im por tant to focus m ainly on clinical specialties.At present 21 pro fessional registrations/certifications can be earned, as indicated in Table 2: O nly two o f the 21 qualifications are not clinical, viz.health care m anagem ent and nursing education.
The w ide choice available gives registered nurses w ith only a qualification in general nursing an opportunity to become quali fied in all the basic areas -m idwifery, com m unity nursing and psychiatric nursing.Organising and offering clinical specialties can have financial im plications for a School.
Student num bers in some courses are too low to be cost-effec tive.For some courses such as basic midwifery, operating thea tre nursing, paediatric nursing and intensive care, students  O n com pleting 360 credits the student earns a b ach elor's d e gree in advanced nursing and three registrations/certifications w ith the SA N ursing Council.The m inim um period is six se m esters as indicated in Table 1.
m ust take study leave w hich is difficult to com e by and re quires them to be away from their fam ilies.However, it has been observed that offering a course is a positive recruiting m ethod as students develop an aw areness o f the type o f spe cialisation.

The curriculum (learning programme)
The learning program m e for the degree consists o f a choice of three o f the 17 advanced areas, and is m ade up o f fundam ental, core and elective modules.A certificate consists o f only core modules.
The noun "su b je ct" has been replaced by "m odule", the lat ter being subdivided into "them es".Fundam ental or basic m odules are com pulsory for all students and provide the plat form or structure."C ore" m odules are also in this category and are selected as specialty by the student.A further cat-egory o f "elective" or "c h o ic e " m odules is not com pulsory,

Fundamental modules
The fundam ental m odules for all the areas are: • Health care m anagem ent D epending on the core module, for instance health care man agem ent, sociology is an additional requirem ent and educa tional psychology is an extra requirem ent for nursing educa tion.

Core modules
C ore m odules are those relevant to specific specialties and extend over two sem esters.The practical m odule extends over a year.

Elective modules
If a student does not have sufficient credits to com plete the degree, a choice can be m ade from a variety o f elective m od ules.Students may choose from m odules of eight or 16 credits.
Interesting, student-friendly m odules in various departm ents in other faculties on cam pus have been included as electives, for instance, introduction to E nglish language skills, the study o f w ell-being, and political science.

Teaching methods
A ccording to Smith (1994:49), am ong others, the success of any teaching-learning program m e depends on the teachinglearning method.As these are all working people and generally have a family, the teaching method has to suit the learner.

Contact sessions
C ontact sessions are scheduled learning facilitation sessions with the aim of m onitoring progress with study material and of clarifying questions.If appropriate, especially in practicals where know ledge is applied in practice and skills are developed and practised, the role o f the lecturer is critical.
C lasses rem ain necessary to handle general problem s, orien tate students to new learning m aterial and discuss learning evaluation.

Evaluation
C ontinuing evaluation, i.e. form ative evaluation, is built into the study material.Sum m ative evaluation is scheduled for spe cific periods.The main aim is to monitor the progress o f stu dents and to identify learning deficiencies.As regards resourcebased learning, Robertson (2000:3) stated that not all students are ecstatic about the m ethod, although part-tim e students and students not on cam pus appreciate w ell-com piled resources (m aterial) put at their disposal.However, some students realise that they m ust learn harder as they did not do much learning

Problem statement and aim
Student satisfaction is essential for the survival o f the School, as is the relevance o f the content.Students raised problem s in inform al feedback sessions regarding the num ber of contact sessions, fundam ental m odules and adm inistrative aspects.
The need also existed to assess the degree o f student satisfac tion during contact sessions and the learning resources pro vided.According to Price (1997:154) it is imperative to support adult students by m eans o f learning resources and discus sions.
The aim was to determine w hether students were satisfied with the presentation and content o f the program m e and to enhance student satisfaction.

Methodology
A n exploratory descriptive quantitative survey was used in an attem pt to identify possible problem s encountered by the stu dents.The survey method was used in order to m inim ize the tim e lost in interrupting the students' studies.This m ethod also allow ed easy com puter processing.Students enjoyed a sense o f security by not being exposed to the lecturers d i rectly, w hich prom pted honest answ ers (B urns & G rove, 1993:243).

Research instrument
A structured questionnaire containing m ostly closed ended questions, but also a num ber o f open-ended questions, was used because it was the only w ay in w hich all the students could be reached.
The questionnaire was com piled by the researchers and the questions were selected and included on the basis o f students' feedback to the researchers the previous year.The questions included were relevant to the modules, e.g. the fundam ental and core m odules.The significance o f the ques tions asked in relation to the clinical practice and difficulties experienced were investigated.C oncerning the core m odules, questions were formulated in such a w ay as to enable research ers to ascertain if students experienced problem s.
In order to evaluate the success rate o f resource-based learn ing, questions on the com position o f m odules (study m anuals) w ere included, am ong these questions on adm inistration, o ri entation and registration.

Sample
A convenience sample was used.Uys and B asson (1993:101) em phasized that this m ethod o f sampling is aim ed at the con venience it provides for the researcher.In this case the con venience o f the respondents (students) was also taken into consideration (80% o f the respondents were present and it took 15 m inutes o f their tim e).All those students attending a com pulsory m odule on that day were requested to respond.They w ere allow ed to take the questionnaire and com plete it in their own tim e and return it to the researchers.Two hundred questionnaires were issued in this way, and the response rate was 82%.because 164 w ere returned.The population com prised 300 students.

Reliability and validity of the research instrument
The reliability o f a research instrum ent is determ ined its stabil ity, consistency or dependability as an instrum ent that m eas ures certain attributes."The reliability' o f an instrum ent is the degree o f consistency with which it m easures the attribute it is supposed to be measuring " (Polit & Hungler, 1989:242).The item s included in the questionnaire were based on an in-depth literature review about resource-based learning, as w ell as on suggestions from lecturers and students who were part o f the program m e. Reliability was also enhanced by a pilot study.
Validity refers to the degree to w hich an instrum ent m easures what it is supposed to m easure (Polit & Hungler, 1989:246).
Content validity, concerning the adequacy o f the content b e ing covered by the questions, was assessed by requesting the lecturers who presented the various modules for com mentary.Problem s raised by students in inform al sessions regarding the program m e were also included.A fter the pilot study, cor rections w ere m ade and the lecturers were satisfied w ith the content o f the questionnaire.

Data analysis
One hundred and sixty-four students (82% ) out o f 200 com pleted the questionnaire.As discussed, contact sessions are not com pulsory and students who did not attend contact ses sions that day did not com plete the questionnaire.
Som e o f the students had not been exposed to studies for a very long tim e and found the w ork difficult and too much.The fact that students stated that they were not well prepared for tests and exam inations may indicate that the study guide does not include adequate information.The same applies to the com plaint vT confusion about test dates.
Students were also required to state w hether the fundam ental m odules broadened their know ledge and were o f value for their specialisation.In spite o f problem s experienced by students, 115 (70% ) o f them responded positively to this question.

Core modules
M ost students, 74 (45% ) had problem s with health care m an agem ent.The follow ing reasons were given: • Fifty (68% ) o f the 74 stated that the am ount of w ork w as unm anageable, 20 (27% ) felt that they w ere not given adequate guidance in practice and that the co m m unity project was tim e-consum ing.
• Ten (13.5% ) stated that the tests w ere difficult and the papers were too long.
• Ten students out o f 164 had problem s with other core m odules, including too m uch w ork and difficult work.
T he fact that students found the w ork difficult and unm anage able m ay indicate poor m anagem ent o f their personal lives and academic commitments (Chichering & Reissler, 1993:150).
H ow ever, these findings also force lecturers to re-evaluate whether the w ork is really meaningful and relevant and whether the curriculum is not ju st overloaded.

Number of contact sessions and composition of modules
Students in all the courses stated that they were satisfied w ith the num ber o f contact sessions, but those in pharm acology and health care m anagem ent indicated that they required more contact, i.e. 23 (14% ) in health care m anagem ent and 19(12% ) in pharmacology.D espite resource-based learning, contact with students rem ains essential (Cox & Gibbs, 1994:9) for pacing, motivation, sorting out problem s and understanding.O ne hundred and fifty-tw o (93% ) students indicated that they found contact sessions essential.O ccupational health was the only course in w hich students stated that the m odule was structured in such a w ay that they could w ork independently.A ccording to the resource-based m ethod it is indeed true that som e very good students do not need contact and w ill cope well w ithout it (Cooper, 1993:50).H ow ever, the resources m ust be such that independent study is possible.

Orientation, registration and administration
Forty-nine (30% ) o f the students stated that the orientation to the program m e did not include all aspects such as cam pus orientation.This shows that post-basic students require thor ough orientation.As regards registration and daily adm inistra tion, students also m ade rem arks that em phasize the im por tance o f adm inistrative support in a program m e.
their observations indicated that they experienced personal gain from the programme.However, some o f them still reflected negatively on the language issue as w ell as the level o f diffi culty o f the programme.
It was m entioned that lecturers are often not available.Com plaints were expressed that fellow -students w ere irritated by late-com ers and interruptions by cellphones.
Suggestions w ere submitted that m ore subcam pusses should be established and that com m unication betw een students and the school should improve.T his m ay suggest that students regard direct contact with lecturers as essential in spite o f other sources o f learning being available.

Conclusion
The fundam ental (basic) m odule produced the m ain issue, nam ely the mass o f work that students had to master.D espite this enorm ous challenge students responded positively in ad m itting that the m odules increased their level o f know ledge of clinical practice.Lecturers should heed to this tim ely w arning not to overburden curriculae and om it irrelevant aspects.

Information gleaned about the programme
A s a m atter o f interest a question was included to enquire w here students received inform ation about the program m e. Table 4 gives the particulars: The table shows that students obtained inform ation from a w ide variety o f sources.M ost, 41 (25% ) students, indicated that they obtained information from lecturers.This demonstrates the pow er o f lecturers as role models.Som e students (20.4% ) m entioned the inform ation sessions as well, thus indicating personal contact to be o f great value when a program m e is being m arketed.
In the concluding question students were invited to state what they found to be positive as well as negative.It w as gladdening to notice that students experienced their lecturers as helpful and accom m odating.Certain areas o f spe cialisation w ere raised such as critical care and paediatrics, and A lthough source-based learning has becom e the accepted way o f studying, respondents still clearly indicated a preference to m aintain strong ties with the lecturer.Som e students experi enced hassles w ith orientation, registration and other adm inis tration related issues.For an institution in transform ation the language issue still rem ains a regular bone o f contention, but a challenging opportunity for lecturer and student alike to find a workable solution.
In general students indicated that their lecturers were helpful and accom m odating, thereby m otivating teaching staff to co n tribute m ore than is expected.

Recommendations
• Course guides should be com piled in a way that pro vides a fram ew ork that w ill help students to select and exploit a range o f other resources effectively and to operate independently w ithin a course.
• Lecturers should respond to students' opinions regard -ing problem areas such as pharm acology, and health care m anagem ent should receive attention.

•
The language question rem ains very sensitive for stu dents and should be m anaged w ith circum spection.
• C ontact sessions rem ain essential as dem anded by stu dents.
• A ttention should be paid to aspects such as study m ethods, tim e m anagem ent and preparing students to w ritetests and exam inations.
• T he im portant process o f re-developing curricula to determ ine relevance cannot be overem phasized.The greatest advantage o f this program m e is, how ever, that it offers registered nurses an opportunity to qualify as clinical experts.Student estim ates furnish teaching personnel with the necessary feedback that can assist them with future planning.
before -possibly took a few notes and put them in the back o f a file for use a few days before the exam ination.Student evaluation of the program m e was conducted infor m ally in 1999.In 2000 it took the form o f questionnaires.A sum m ary o f the findings is given.

Summary
A n overview was given o f the post-basic nurse training pro gramm e im plem ented by the School o f Nursing o f the U niver sity o f the Free State.Students gave their opinion o f the proed to k n o w n e w p e o p le w ith o th e r w a y s o f th in k in g 3 > C a m e o u t o f a g r o o v e and had n e w e x p e r ie n by m eans o f questionnaires.The m ost com m on com plaint was that students found the learning content difficult and com prehensive.It appears that the resources put at the disposal o f students require continual attention.

Table 3 : Problems mentioned (N = 128) Fundamental modules
Students were asked to indicate whether they experienced prob lems with the fundamental modules.Problems were experienced by 64 (39% ) students in pharm acology and 82 (50% ) students found health care m anagem ent to be a problem .T he above problem s w ere m entioned as indicated in table 3 above.