Assessment of learning needs and the development of an educational programme for registered nurses in advanced midwifery and neonatology

A key step in the development of any educational pro­ gramme is learning needs assessment. This is however often neglected. The purpose of this research was to iden­ tify learning needs of potential students in order to de­ velop a relevant educational programme for registered nurses in advanced midwifery and neonatology. A survey design was used, and the population of the study was the registered nurses in the Free State. Two thousand ques­ tionnaires were mailed to respondents, selected by means of simple random sampling. Advanced educational pro­ grammes emphasize the teaching of advanced knowledge and skills and accept that the students entering these pro­ grammes already have specific knowledge and skills in­ cluded in the curricula for basic programmes. This is con­ trary to the findings of this study. The results underline the importance of learning needs assessment in the devel­ opment of relevant educational programmes. Opsomming ‘n B elan g rik e stap in die on tw ik k e lin g van en ige opvoedkundige program is die bepaling van leerbehoeftes. Dit word egter dikwels afgeskeep. Die doel van die studie was om die leerbehoeftes van potensiële studente te bepaal om sodoende ‘n toepaslike opvoedkundige program vir g e re g is tre e rd e v e rp leeg k u n d ig es in g ev o rd erd e verloskunde en neonatologie te ontwikkel. ‘n Opname ontwerp is gebruik, en die populasie van die studie was die geregistreerde verpleegkundiges in die Vrystaat. Twee duisend vraelyste is aan geregistreerde verpleegkundiges in die Vrystaat, wat op ‘n eenvoudige ewekansige wyse geselekteer is, gestuur. Gevorderde opvoedkundige pro­ gramme beklemtoon die onderrig van gevorderde kennis en vaardighede en aanvaar dat die studente wat vir hierdie programme inskryf, reeds oor spesifieke, basiese kennis en vaardighede beskik. D it is in teenstelling m et die bevindinge van die studie. Die resultate beklemtoon die b e lan g rik h e id van ‘n lee rb eh o efte b epa ling in die ontwikkeling van relevante opvoedkundige programme. Introduction and problem statem ent In the development of educational programmes, much atten­ tion is paid to the method of delivery. Just as important, but relatively neglected is the question of learning needs assess­ ment. Without any form of learning needs assessment, edu­ cation becomes teacher-oriented and directed. Learning needs assessment is important to obtain information to determine the nature, extent and priority of educational needs to de­ velop courses (Matiru, Mwangi & Schlette, 1995:43). It in­ volves identifying the gaps between current knowledge and skills and desired practice. Remedying these deficiencies is the aim of an educational programme. Only if these gaps are recognized is it possible to be confident that the aims and design of the educational programme are appropriate (Laidlaw, Harden and Morris 1995:80). Murray (1982:18) supports these statements and adds that the teacher’s primary function is to diagnose learning needs and problems and together with the student plan strategies C u ratio n is that will result in success for the learner. When one is learn­ ing what one wants to learn, and can use any resources avail­ able and any method that one chooses, learning and growing are life. Academic staff commonly overestimate skills, prior knowl­ edge and competencies of students. They assume that stu­ dents have the prerequisites that courses require. This gap between what is expected and what actually exists is signifi­ cant and is sometimes the cause of failure of students. In this regard Diamond (1989:47) refers to other studies and states that insensitivity to students’ backgrounds, interests and needs is a primary reason that many students feel dissatisfied with or leave their institutions. However, needs assessment is not the responsibility only of the teachers. As many universities move towards open and self-learning programmes it becomes increasingly important for students to undertake needs assessments themselves. Matiru et al. (1995:43) refer to an educational need as a dis­ crepancy between an existing set o f circumstances and some 1 0 7 Decem ber 20 0 0 T A B LE 1 : Categories of data covered in the questionnaire


Introduction and problem statement
In the development of educational programmes, much atten tion is paid to the method of delivery.Just as important, but relatively neglected is the question o f learning needs assess ment.W ithout any form o f learning needs assessment, edu cation becomes teacher-oriented and directed.Learning needs assessment is important to obtain information to determine the nature, extent and priority o f educational needs to de velop courses (Matiru, M wangi & Schlette, 1995:43).It in volves identifying the gaps between current knowledge and skills and desired practice.Rem edying these deficiencies is the aim o f an educational programme.Only if these gaps are recognized is it possible to be confident that the aims and design of the educational programme are appropriate (Laidlaw, Harden and M orris 1995:80).Murray (1982:18) supports these statem ents and adds that the teacher's primary function is to diagnose learning needs and problems and together with the student plan strategies Curationis that will result in success for the learner.W hen one is learn ing what one wants to learn, and can use any resources avail able and any m ethod that one chooses, learning and growing are life.
Academic staff commonly overestimate skills, prior knowl edge and com petencies o f students.They assume that stu dents have the prerequisites that courses require.This gap between what is expected and what actually exists is signifi cant and is sometimes the cause of failure of students.In this regard Diamond (1989:47) refers to other studies and states that insensitivity to students' backgrounds, interests and needs is a primary reason that many students feel dissatisfied with or leave their institutions.
However, needs assessm ent is not the responsibility only of the teachers.As m any universities move towards open and self-learning programmes it becomes increasingly important for students to undertake needs assessments themselves.
M atiru et al. (1995:43) refer to an educational need as a dis crepancy between an existing set o f circumstances and some

Aim of the study
The aim o f the research was to determ ine the learning needs of potential students in order to develop a relevant educa tional programme for registered nurses in advanced midwifery and neonatology.

Research methodology and sampling
The aim o f the research was descriptive and developmental.
The target population was identified as all the registered nurses in the geographical area o f the Free State.W ith the help o f a professional organisation the total population o f registered nurses and midwives in the Free State was established at 5 996.
Simple random sampling was done by m eans o f a com puter programme.A sample size o f 2000 (40% ) was used.This large sam ple was considered as a relevant approxim ation of the target population and the possibility o f achieving statisti cal significance was greater.(B um s & Grove, 1997:308).
Although strategies to increase the response rate, such as en closing a stamped, addressed envelope and m ailing a reminder were im plem ented, the response rate was 26,2%

Research technique
A questionnaire sim ilar to the one m entioned by Diamond (1989:59) was developed to obtain the data on the learning n eed s o f r e g is te re d n u rs e s re g a rd in g m id w ife ry and perinatology.Questionnaires are extrem ely effective tools for c o lle c tin g d isc ip lin e -sp e c ific in fo rm a tio n (D iam o n d , 1989:59).The questionnaire was thus considered appropri ate as a data collection technique.It was cost-effective in the sense o f m oney and time and the data which were collected, did not require in-depth interview ing.Q uestions were pre sented in a consistent manner, and there was less opportunity for bias than by interviews (B um s & Grove, 1997:358).
The questionnaire was divided in to two parts (Checklist A and Checklist B).In Checklist B respondents were requested to rate their clini cal competency as perceived on a five point Likert-type scale (Table 1).
The data was collected over a four month period, and a total of 523 questionnaires were returned; a response rate o f 26,2%.Nine questionnaires (0,45%) were returned as undelivered, thus 514 (25,7% ) questionnaires were analyzed.

Validity and reliability
The following steps were im plemented to measure up to the demands o f validity: • The scope o f practice o f the midwife was studied, and the essential content dimensions (student profile and competency) to be covered by the questionnaire were identified.Items were formulated according to the dimensions, and a decision was made on how many items were to be included under each dimension in order to collect the information required.(Skills, for example assisted deliveries, not included in undergradu ate courses but expected from nurses working in specific health care centres were included.) • For the sake o f clarity the questionnaire was translated into English and Afrikaans.A linguist evaluated the questionnaires in both languages.
• Open and closed ended questions were used to obtain a variety o f data.
• The questionnaires were submitted to six domain experts to be judged.They evaluated whether the items were repre sentative o f the dimensions identified, the sequence o f the items and the face validity o f the instrument.Several items were modified in accordance with suggestions from the ex perts.
• A pilot test o f the questionnaires was performed.or construction o f a few questions were m odified after the pilot study.
• Because o f the sensitive nature o f the questionnaire -re spondents were asked to evaluate their own know ledge and skills -anonym ity was ensured.
The reliability o f the questionnaire was ensured by asking five respondents of the pilot study to com plete a question naire tw o weeks after com pletion of the first one.The re searcher checked both questionnaires o f the five respondents for variation on specific questions and item s which were un answered.In this way am biguous and unclear questions could be identified and modified.The responses to both question naires w ere nearly identical and the m inim um num ber of questions were left unanswered.It was accepted that reliabil ity was proven.

Data-analysis
Descriptive and inferential statistics were used in the dataanalysis.The Statistical A nalysis System was used for the analysis.The chi-square non-param etric statistical and Fish er's exact tests were used to determ ine correlation.

Results
Profile data

Sociographic backgrou nd
The age distribution dem onstrates that the age group 40-49 was the largest group o f respondents.The second largest group was 30-39.This implies a potentially older student popula tion.There were significantly m ore fem ale (96% ) than male (4%) respondents.

Ed u ca tio n a l background
Eighty-nine percent o f the respondents were in possession of a Standard 10 certificate.A diplom a in nursing was the high est level o f education for 77,3% o f the respondents.Only 3,9% of the respondents had a higher qualification than a bacca laureate degree.This im plies the existence o f a large poten tial post-basic nursing student population in the Free State.
An analysis o f the professional registrations in nursing indi cates that 99,2% of the respondents had a professional quali fication in general nursing, 94,2% had a m idw ifery qualifi cation, 38,7% had a professional qualification in psychiatric nursing and 53,1% had a professional qualification in com munity nursing.Only 1,2% o f the respondents had a profes sional qualification in advanced m idwifery and neonatology.
A high percentage o f the respondents (93,6% ) had the two qualifications, general nursing and midwifery.M ost o f the respondents (80,6%) com pleted their basic training more than 1 0 years ago.

V o cation a l background
The m ajority o f the respondents (51,5% ) w ere w orking in hospitals and 27,9% worked in community settings.The analy sis indicated that 42,9% o f the respondents had worked in their current position for 0-5 years, w hile 30,1% had been employed in the specific capacity betw een 11 and 35 years.
Cumulatively 73,6% o f the respondents have a productive live of 11 years or more before retirement.
It was indicated that 71,2% o f the respondents had practised midwifery during their professional career, while 28,8% re spondents never had.The majority o f the respondents had not practised m idwifery for the past five years, 31,9% were practising midwifery at the time o f the study, while 19,1% had done 50 for the past 1 -4 years.

Opinion on services rendered
The m ajority o f the respondents were o f the opinion that the newborn and m other in all stages of labour receive optimum care.Cum ulatively 21,1% o f the respondents did not think or were unsure if optim um patient care was delivered to the new born.Twenty-three percent o f the respondents had the same opinion about antenatal care, while 20,9% and 22,7% indi cated these opinions on intrapartum and postpartum care re spectively.

Professional developm ent
The analysis o f the educational opportunities the respondents would be interested in attending indicated that 60,1% o f the respondents identified courses as the most likely followed by seminars (58,8%), in service training (57%) and workshops (47,3%).An interest in an advanced diploma in midwifery and neonatology exists as 36,3% o f the respondents stated their interest.It is important to develop an educational pro gramme appropriate for its users.M ost o f the respondents (43,3%) perceived the need for a distance learning programme, with self-directed learning packages and contact sessions.A full time residential course was preferred by 32,5% o f the respondents.

Self perceived knowledge data South A fric a n Nursing Council regulations
It is alarming that although 94,3% o f the respondents indi cated that they were currently practising as nurses, less than a quarter of the respondents scored their knowledge o f the regulations of the South African Nursing Council as very good or excellent.Only 20,8% of the respondents evaluated their knowledge on the scope o f practice (R.260 of 1991) as very good or excellent, while 21,4% evaluated their knowledge on the regulation regarding acts and omissions (R.2490 o f 1990) on the same level.A hundred and fourteen (22,2%) and 22,6% o f the respondents respectively indicated that their know l edge of medications which midwives may prescribe (R.2418 o f 1984) and conditions under which midwives may carry on their profession (R.2488 of 1990) was very good or excellent.

C u ltu ra l, tradition al and custom ary beliefs and practices of patients
The respondents were also requested to score their knowl edge on cultural, traditional and customary beliefs and prac tices o f patients.Until recently these aspects were not em pha sized in the curricula.It is therefore not surprising that only a small percentage (13,6% , 14,2% and 14,6%) of the respond ents' knowledge in these categories was very good or excel lent.

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Cu ratio n is Decem ber 2000 T A B LE 3 : Self-perceived com petency: antenatal related nursing care Self-perceived com petency data S elf-perceived com petency: General nursing The self-perceived com petency of the respondents related to general nursing is set out in Table 2.It is a course for concern that only 27,4% of the respondents rated themselves very good or excellent at adult resuscitation -a life saving skill and 1 0 , 1 % rated themselves very good or excellent at endotracheal intubation.Only 20,6% and 28,4% of the respondents respectively rated their knowledge and skills at speculum and vaginal examina tion as very good or excellent.It is interesting to note that while 44,6% of the respondents indicated that they were very good or excellent at doing a general physical assessment, only 36,8% evaluated their skill at identifying physical needs on the same level.A very good or excellent competency in iden tifying psychological and educational needs was indicated by 31,3% and 35,2% respectively o f the respondents.A hundred and sixty-seven of the respondents (32,6%) indi-Curationis cated that they were very good or excellent at formulating a nursing diagnosis.Only 23,5% rated their competency as being very good or excellent at co-ordinating health care regimes provided for the patient by other categories of health person nel.It is alarming that only 23% and 26,8% of the respond ents respectively indicated that they were very good or excel lent at form ulating a com m unity diagnosis or prioritizing health risks.
The interpretation of vital statistics of the population seems to be a problem.One hundred and thirty-eight o f the respond ents (26,8%) indicated their competency at interpreting growth rates as being poor with 24,9% and 25,1% o f the respondents respectively evaluating their skills at interpreting birth and maternal and child mortality rates on the same level.A hun dred and fifty-one o f the respondents 29,4% indicated that their skills in interpreting fertility rates were poor.
S elf-pe rce ived com petency: A n te n a ta l related nursing care .Respondents were asked to evaluate their competency in nurs-T A B L E 4 : Self-perceived com petency: Intrapartum related nursing care ing actions related to the health care o f pregnant women in the antenatal period.These responses are set out in Table 3.
The com petency o f the respondents on the assessm ent o f foe tal well-being is distressing.Two hundred and eighty-tw o of the respondents (54,9%) indicated that they were poor at in terpreting and analyzing the foetal heart pattern.Even more, 64% o f the respondents evaluated their com petency at doing a non-stress test as poor, while 65,2% indicated that their knowledge and skills of an oxytocin stress test was poor.
Two hundred and sixty-six o f the respondents (51,8%) indi cated that their know ledge and skills at assisting with an amniocentesis was poor.Competency at interpreting the re sults o f exam inations/investigations performed in the ante natal period was perceived by 37,2% of the respondents as It is significant that respondents rated their competency (very good and excellent) much higher in nursing actions, such as recognising dysrhythmias (ECG) (15%); making neurologi cal observations (25,3%) and identifying anaphylaxis (18,8%) that are not exclusively related to perinatal health care.
It is encouraging to note that 33,9% respondents rated their competency at abdominal palpation at the very good or excel lent level, although only 15,6% o f the respondents rated their competency in doing a pelvic assessment as very good or ex cellent.
One hundred-and-five respondents (20,4% ) indicated that their knowledge and skills regarding the antenatal care of a woman with traum a due to an accident were poor.Compe tency in the antenatal care of battered pregnant women and pregnant women practising substance abuse was rated poor by 21,4% and 23,9% of the respondents respectively.Most of the respondents evaluated their competency as reasonable or good in the antenatal care of women with pathology.Only a few respondents indicated their com petency on the antenatal care of women in this category as very good or excellent.

Self-perceived com petency: Intrapartum related nursing care
This item consists of two parts.Respondents were questioned firstly about their knowledge and skills regarding nursing actions related to intrapartum care and secondly on their com petency in giving patients information and advice on specific topics.These responses are set out in Table 4.
A small percentage (18,7%, 15,5% and 21%) o f the respond ents rated their competency on monitoring a patient on spe cific m edication (Ipradol R, M agnesium sulphate R and Syntocinon R) as very good or excellent.
Two hundred and eight-seven o f the respondents (55,8%) in dicated that their competency in setting up a cardiotocograph m onitor was poor, while an even larger percentage 59,5% evaluated their com petency in analysing and interpreting cardiotocograph findings as poor.The majority of the respond ents indicated that they were not competent at applying foetal scalp electrodes.Three hundred and eighty-two of the respond ents (74,3%) evaluated their competency in this skill as poor.A further 40,7% perceived themselves to be poorly compe tent in detecting threatening uterine rupture.These findings underline the poor competency respondents indicated in as sessing foetal well-being and uterine activity in the antepar tum period.
It is interesting to note that 19,2% of the respondents rated their competency (very good or excellent) higher in the treat ment o f foetal distress than in its diagnosis (analysing and interpreting cardiotocograph findings 12,9%).However, com petency in the treatment o f uterine hyperactivity was perceived by 48,4% of the respondents as poor.
A large number of respondents 45,7% rated their competency in assisting the anaesthetist during the administration of an epidural anaesthetic as poor.What is even more alarming is that 55,8% of the respondents were poorly competent in rec ognising spinal shock -a life-threating complication o f epi dural anaesthesia.The administration of Entonox seems also to be a problem.Three hundred and thirty-seven of the re spondents (65,6%) evaluated their competency in this skill as poor.
It is not surprising that a very small percentage of the re spondents rated their competency in assisted deliveries as very good or excellent, as these are viewed as advanced skills.Six percent and 6 ,8 % o f the respondents respectively indicated that they were very good or excellent at forceps and vacuum extraction deliveries, while 9,9% evaluated their competency in breech deliveries on the same level.Only 1,8% of the re spondents indicated that they were very good or excellent at performing a symphysiotomy.Very good or excellent compe tency in another advanced skill, manual removal of the pla centa, was also indicated by few respondents, 8 , 1 %.
T A B L E 6 : Self-perceived com petency: Newborn nursing care five o f the respondents (39,9%) indicated their competency in assessing hydration status as very good or excellent.It is interesting that 33,3% of the respondents rated their com pe tency on facilitating breast feeding as very good or excellent, while more that half o f them (56,6%) indicated the same level of competency in operating a breast pump.A hundred and twenty-five o f the respondents (24,3%) also perceived their com petency in providing em otional and physical com fort m easures as poor.
Two hundred and thirty-nine of the respondents (46,5%) rated their competency in nursing a patient who had had an epi dural anaesthetic on a very good or excellent level, while com petency in identifying and treating patients with com plica tions related to childbirth on these levels was much lower.A hundred and seventy-four (33,9%) and 31,5% of the respond ents respectively indicated that they were very good or excel lent at identifying patients at risk o f postpartum depression and identifying and treating postpartum haemorrhage.A hun dred and fifty-two (29,6%) and 23,2% of the respondents rated their com petency in identifying and treating infection o f the genital tract and identifying and treating thrombosis as very good or excellent.
S elf-p e rc e ived com petency: Fam ily planning care The respondents were requested to evaluate their competency regarding family planning.They indicated that they were fairly 1 1 4 C u ratio n is Decem ber 2000 A hundred and eighty-eight o f the respondents (36,6%) indi cated that they were poorly com petent at repairing perineal tears.Com petency in scrubbing for a caesarean section was perceived by 47,9% o f the respondents as poor.
Eighty-six (16,7% ) and 13,6% o f the respondents respectively rated them selves as being very good or excellent at alterna tive methods o f pain control and positioning during labour.Very good or excellent com petency in patient education re garding bonding was indicated by 30,4% o f the respondents.It is encouraging that nearly h alf o f the respondents, 46,3% , p e rc e iv e d th e ir c o m p e te n c y in p a tie n t e d u c a tio n on breastfeeding as very good or excellent.

S e lf-p e rc e ive d c o m p e te n c y: Po stn ata l nursing care
This item is divided into tw o parts.The first question re quested respondents to evaluate their com petency in nursing skills associated with the postnatal period and the second ques tion requests responses regarding their com petency in family planning m atters.These responses are set out in Table 5.
The results indicate that generally speaking respondents per ceived their com petency in nursing skills associated with the postnatal period m uch higher than nursing skills associated with the intrapartum period.It is interesting that com petency in identifying involution o f the uterus was the nursing skill that most respondents, 29%, rated poorly.Two hundred-and-competent in the items listed under this question except for the insertion or removal of an intra-uterine contraceptive de vice.Two hundred and ninety-six o f the respondents (57%) rated their competency in these skills as poor, while only 1 1 ,1% indicated they were very good or excellent at inserting or re moving an intrauterine contraceptive device.
S elf-perceived com petency: New born nursing care Two questions were asked under this item.Respondents were asked how well they assessed the new born physically and neurologically, and they were requested to evaluate their com petency in nursing actions related to neonatal care.The re sponses of the respondents are set out in Table 6 .
Only 27,2% of the respondents rated their competency in as sessing the newborn physically as very good or excellent.Even a smaller percentage 17,1%, indicated that they were very good or excellent at the neurological assessm ent of the new born.
It is alarming to note that only 19,3% o f the respondents in dicated that they were very good or excellent at diagnosing asphyxia, while even fewer, only 15,6% of respondents be lieved they were very good or excellent at resuscitation of the newborn.Two hundred and forty-nine o f the respondents (48,4%) evaluated their competency in setting up an intrave nous scalp line as poor.Taking blood from the newborn also seemed to be a problem, as 45,3% o f the respondents indi cated that their competency in this skill was poor.
Only 15,1% o f the respondents indicated that they were very good or excellent at nasogastric intubation of the newborn, while 33,7% rated their competency in nasogastric feeding of the newborn on the same level.
A hundred and three o f the respondents (20,1%) indicated that they were very good or excellent at nursing the neonate with jaundice, while fewer than 18% believed they were very good or excellent at nursing the neonate with problems.One hundred and eighty of the respondents (35%) evaluated their competency in nursing the respiratory distressed neonate as poor.Competency in nursing the neonate with hyper-or hypoglycaemia was rated by 37,4% of the respondents as poor.

Discussion
Some of the respondents made com m ents at the end o f the questionnaire.They remarked that they had lost their compe tency in a num ber of midwifery related skills, because they had not updated these after completion of their basic mid wifery training.They felt that continuing education pro grammes in midwifery are necessary, as they feel particularly concerned about their competency in this field after comple tion of the questionnaire.Continuing education programmes in other fields o f nursing were also suggested.
It is striking that respondents (57,6%) who indicated that they were currently providing midwifery services or had provided midwifery services as a registered nurse the past one to two years, rated their overall competency much higher than the other respondents.The chi-square and Fisher's exact test used to determine whether a significant difference exists, were equal or lower than 0,05 in most o f the questions in Checklist B.
No statistically significant difference in competency was noted between respondents who indicated that they were currently providing midwifery services or had provided midwifery serv ices as a registered nurse the past one to two years and re spondents who indicated that they had not provided midwifery services as a registered nurse for the past three o f more years, in nursing care such as setting up an infusion pump, adult resuscitation, administering oxygen, wound care, identifying psychological needs, conducting research, writing a research report, interpreting research findings, training com m unity health workers, recognising spinal shock and taking blood from a neonate.All o f these skills except for taking blood from a neonate are considered general nursing skills.
The information obtained through the questionnaire under lines the importance o f needs assessment in the development o f an educational programme.Advanced midwifery educa tional programmes emphasize the teaching of advanced mid wifery knowledge and skills and accept that the students en tering these programmes already have specific knowledge and skills included in the curricula for basic courses.This is contrary to the findings of this study.Competency in knowledge and skills associated with basic courses, for ex ample adult resuscitation, South African N ursing Council regulations, assessing foetal well-being, and identifying in volution of the uterus and perineum to name a few, were alarm ingly low.On the other hand, competency in knowledge and skills such as operating a breast pump and nursing a patient who has had an epidural anaesthetic were rated much higher than expected.
These findings could be due to the fact that 81,6% o f the respondents completed their basic training more that 1 0 years ago, that 71 % o f them are not furthering their education and that primary health care has not been strongly emphasized until recently.The competencies which were rated higher than expected, as previously mentioned, may be due to the fact that 55,5% of the respondents are hospital based and these skills are usually associated with nursing care practised in hospitals.
The data indicates that respondents do not have specific knowldge and skills needed for entering an advanced educa tional programme.

Recommendations and conclusion
If at the outset the educational needs o f students or those of the society from which they come are not understood, they might be wrongly addressed (M atiru et al., 1995:40).The summary o f training needs should therefore establish the main areas and priorities for training (Bandaranayake & Irvine, 1985:11).
By doing this, the curriculum planner will ensure that the needs and interests o f the learners are being met, thus creat ing an appropriate educational programme.It is just as im portant when preparing lectures or seminars as when design-in g an e n tire p ro g ra m m e , an d w ill p ro v id e e s s e n tia l guidelindes for determ ining content, or the educational strat egies to be adopted in an educational program m e (Laidlaw et al., 1995:87).
It is therefore part o f the first step in the developm ent o f an education program m e and can also be used to identify rel evant problems, such as when students lack specific know l edge and skills included in the curricula for basic programmes, and to focus on areas of m axim um benefit to individual stu dents, lecturers, the com m unity and in the long run, the uni versity as a whole (M atiru et al., 1995:40).
It is considered a critical part o f a system atic approach to developing educational projects and ensures relevancy which is arguably the most im portant criterion o f effective educa tion.This is particularly im portant when tim e for educational activities is at a prem ium and when these activities have to be cost effective.
TA B LE 1 : Categories of data covered in the questionnaire Table 1 indicates the topics covered in the questionnaire.In checklist A the possible responses were pro vided, but an open category was left, where appropriate, for answers other than those provided.Three open questions were included in this part o f the questionnaire.

General NURSING KNOW LEDGE AND SKILLS Poor Reasonable Good Very Good Excellent
Ten reg istered nurses with midwifery registrations and expertise were used for the test.Respondents o f the pilot study were asked to judge the questionnaire for ambiguity, clarity and the time required to com plete the questionnaire.The phraseology and/ C u ratio n is Decem ber 2000 T A B L E 2 : Self-perceived com petency: