A comparative study of professional competence of nurses who have completed different bridging programmes

The aim of the study was to compare professional competence of nurses who completed different bridging pro­ grammes. Forty professional nurses from two different bridging programmes participated in the study. The newly qualified registered nurses were all from the province of KwazuluNatal working in various hospitals.The researcher utilized Slater Nursing Competencies Rating Scale. The instrument had the following categories (a) psychosocial (individual), psychosocial (group), (c) physical needs, (d) general, (e) communication and (0 professional implica­ tions. The results showed that newly qualified nurses from different bridging programmes were professionally competent. Age, experience and examination results had no relationship with the professional competency of the newly quali­ fied nurse.


Problem statement
Presently there are more than 35000 nurses in South Africa who wish to continue with their education and gain regis tration as a general nurse, since without the change o f sta tus they have no career path.There are few colleges which can train nurses, thus making the waiting lists very long.In order to bridge the gap between the professional nurses and the enrolled nurses, thebridging course was approved by the South African Nursing Council in 1989.(SANC, 1994).Most of the nurses registering for this programme are above the age o f 25 years, married with many responsi bilities.They have clinical experience as they have worked in the clinical situation for some time, but this experience was gained in a subservient role.Other sectors also find that continuing education is mandatory for ongoing com petency (Christensen, 2004:921).One wonders if the different types of curricula and teach ing approaches produce similar results in learners that com pleted different bridging programmes.The problems of mature learners with work habits, family roles and ingrained learning behaviour has to be addressed by such curricula.If programme objectives are not achieved; these nurses may not function at the level expected of them as registered nurses.

Aims and objectives
The aim of this study was to compare the professional com petency o f bridging course students who studied via dif ferent programmes.
In order to achieve this aim the study seeked to address the following objectives:

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To compare competency levels of newly qualified nurses who studied the case based curriculum and those who studied the traditional curriculum • To determine whether age, experience and examina tion results influence the professional competency of a newly qualified nurse.
According to Troskie (1993: 51) a competent nurse is a nurse who has completed her or his training and is able to perform nursing activities safely according to predetermined standards within the scope of practice, in coordination with other members o f the health care team.In this study the competent nurse will be measured using the Slaters Rating Scale.

Conceptual framework
The researcher used Slater Rating Scale variables and So cial learning theory by Bandura as a conceptual framework to describe the professional competency o f nurses who studied through different bridging programmes.The So cial learning theory of Bandura emphasizes the importance of observing and modeling the behaviours, attitudes and  , 1997).Social learn ing theory explains human behaviour in terms of continu ous reciprocal interaction between cognitive and environ mental influences.

Literature review Competency
Several authors describe competency in a similar way.Searle and Pera (1992) andQuinn (1983:248) define competency as a demonstrated cognitive, affective and psychomotor ability required for the performance o f specific activities.
Competency is based on comprehensiveness of an indi vidual's knowledge and the ability to perform skills in an efficient and effective manner.Likewise Saylor (1990 : 11) describe reflective thinking as the artistry of combining professional repertoire with current clinical problems to in vent unique responses.Saylor maintained that the ability to engage in reflective thinking is also essential for self evaluation and improving one's clinical competency.Society expects nurses to be professionally competent and emphatic givers (Duncan, 1996:45).
Rajanden (1995:90) linked competence to the qualifications, education or experience that is deemed necessary for ac ceptable performance o f the job.Qualification is the essen tial formal training or study that a new employee would require if s/he is able to perform a set job effectively.Expe rience is the minimum period of time necessary for an indi vidual with the prescribed educational qualification to as sume responsibility for the prescribed job and to perform it satisfactorily (Rajanden, 1995:98).
In order to evaluate the professional competency o f an individual it is necessary to check on the clinical perform ance of the nurse.Maynard (1996:13) evaluated com pe tency using criterion-reference performance standards for students which clearly displayed the behaviour of an indi vidual as dependent, assisted or independent.
Likewise Scheetz (1989:33) reported on the relationship between psychom otor skills and clinical competency.She concluded that the individuals who lack competency per form psychomotor skills awkwardly.Maynard (1996:13) and Nagelsmith (1985: 246) defined professional competency according to Benner (1984) as stages o f skill acquisition whereby an individual can be a novice, advanced beginner, competent, proficient and expert .At this stage the indi vidual lacks the speed and flexibility of the proficient nurse, but does have a feeling of mastery and ability to cope with many contingencies of clinical nursing (Maynard, 1996:13).
Competence goes beyond the performance of skills and acquisition of knowledge at or just above minimal levels of perform ance and cognitive standards, but also includes values, critical thinking, clinical judgm ent and integration o f theory into the nursing roles (Nagelsmith, 1985: 246).
The development o f professional competence was found to require a trio o f abilities including cognitive, psy chomotor and affective competencies initiated during the educational process.Acquisition o f competence is initi ated by education and developed through professional experience (Bloom, 1983).
According to M aynard (1996:15) the educational process must provide skills and knowledge upon which the learner can develop an educational base and service the opportu nity and time development.Likewise Meretoja, Isoaho and Leiono-Kipli (2004: 124) reported that self assessment as sist nurses to mantain and improve their competence which results in high levels of self confidence and professional competency.A similar view was expressed by Mulder (1992) when she defined clinical competence as the concept made up o f knowledge, skills and affect, which are necessary for successful fulfillment o f the professional nursing role.
Nurses need to acquire deep knowledge in order to master the skill in whatever action they perform.Status and legiti mization are essential to crediting the knowledge embed ded in the nursing practice.W hen the nurse's knowledge is taken seriously, patients benefit through having diag nostic and monitoring abilities of the nurses responded to appropriately (Benner and Wrubel, 1989).Skills need to be taught to those who are new graduates in the field of em ployment.
Nurse educators must share information about the skills to be learned for competency with student and the nursing service and they must teach and evaluate thoroughly those skills taught for competency .Joyce-Nagata, Reeb and Burch (1989: 316) reported on the importance of identifying spe cific nursing behaviours which reflect professional compe tency, because the actions of the nurse are strong indica tors o f competency.
Troskie (1993:53) recommended that the nurse's training background and age should be considered when placing those delegating responsibilities.They should receive the opportunity to develop their skills and become competent practitioners.
In summary therefore, apparently there is a relationship between, knowledge, attitude and skills whereby the learner acquires knowledge and the ability to perform skills.Unfor tunately there were no previous comparative studies be tween the traditional and case based curricula.

The case study approach
The case study approach is a method with a long history, largely identified with law and business although it has been used in medical and nursing education.Since its in stallation in Harvard Law School in 1869, the case study method has gained popularity among educators in a vari ety of disciplines (Romm and Mahler, 1986).
Students are given a complete case for study and research in preparation for subsequent class discussion.The sub sequent interactive case discussion in class, facilitated by the teacher in a tutor role combines both student-directed and teacher-directed learning.This method provides a stronger challenge to generate hypotheses, analyze data and make decisions with more active structuring of infor mation in clinical content (Barrows, 1985).Therefore, the use o f case base method encourages the learner to be Self directed.The advantages of a case method include its suc cess in promoting theoretical understanding and insight, its strength in including motivation, psychological involve ment and identification and its superiority over traditional techniques in encouraging self direction in learning (Romm & Mahler, 1986).The conditions which enhance the suc cessful implementation o f case studies include the follow ing: • Careful choice of interesting, thought provoking cases by instructors; • In-depth preparation of the case by the instructors and students prior to the discussion in class, and • Flexibility and openness on the part of both the in structor and students during analysis of the cases in class (Romm & Mahler, 1986).

The lecture based method
This teaching strategy allows the learner to be passive be cause the teacher is the active participant.The lecture based method of teaching is also know as the traditional approach because the learner is not involved in his/her teaching.The educator is the most active participant .There is little or no self direction from the student.Critiques of the traditional teaching approach highlighted poor problem solving skills and critical thinking skills as the major disad vantages (Romm & Mahler, 1986).

Methodology Design
The study was a comparative study and the design used was ex post facto because the research was conducted after the variations o f the independent variable had oc curred.The researcher compared the professional com pe tency of graduates who studied via different curricula.Ex post facto is one of the broad classes of non-experimental research, in which the casual explanation are inferred after the fact (Polit& Hungler, 1993 :436).The independent vari able was the teaching approach and the dependent vari able was professional competence.

Population and sample
The target population consisted of newly qualified nurses within the twelve months of completion of the bridging course in Nursing Colleges and also at the University of KwaZulu-Natal.The King Edward College graduates were used in the study.The total numbers of graduates from both institutions were sixty eight (68).These graduates were in fifteen hospitals at the time of the study.All graduates were included in the sample and proportional random sampling was done to ensure representitiveness.Students were given numbers and randomly selected from the list of students registered in both institutions.The total number sampled amounted to forty (40).The forty gradu ates sampled were scattered over eight hospitals in KwaZulu Natal.There were 38 females and two males.The hospitals were in rural and urban areas.

Instrument
The researcher used the instrument with two parts i.e. self designed demographic questionnaire and Slater Nursing Competencies Rating Scale (SRS) to conduct the study.SRS is a scale which consists of 84 items which identify actions performed by nursing personnel as they provide care to patients.The standard o f measurement is the quality of performance of care.The items are arranged into six subsections accord ing to the primary science and cultural bases for the nurs ing care actions to be rated.Few items will be included from each subsection.
These subsections are as follows: 1. Psychosocial-Individual-Actions directed towards meet ing psychosocial needs of individual patients.
• Gives full attention to patient • Avails self o f opportunities for learning.
The SRS was used by Troskie (1993:51) when she evalu ated the competency o f a newly qualified nurse who had completed the four year course.Also Fitzpatrick (1997:223) used it to measure clinical nurse performance.

Validity and Reliability
Content validity was obtained by using SRS which revealed an accurate picture of the newly qualified nurse in her or his work situation.The items on the Slater Rating Scale are similar to the Scope of Practice of a registered nurse in South Africa.Items on the scale have been examined ex tensively and repeatedly by nurse educators and nurse practitioners with expertise in all major areas (Wandelt & Slater, 1975).One can therefore accept that the SRS has content validity.

Data collection
The registered nurses in charge of the units where newly qualified registered nurses worked completed the rating scale according to the performance of the nurse.The unit managers were briefed about the questionnaire before evalu ating the newly qualified registered nurses.During the briefing sessions the unit managers were given documents which explained the yardstick against which observed nurs ing actions would be measured.T he u n it m an ag ers were also given cue sheets which further explained actions of a nurse in detail.The participants filled in th e d e m o g ra p h ic q u e s tio n n a ire th is was later verified by th e re s e a rc h e r b e cause she had all the records from both in stitutions.

Ethical consideration and confidentiality
Written permission was granted by the Department of Health of KwaZulu Natal for research to be done in hospitals where newly qualified nurses were working.The Principal of King Edward College granted the researcher permission to check the records of previous bridging students who met the in clusion criteria.Written permission was sought from the registered nurses who did the bridging programme.
The whole questionnaire package (demographic and Slater Rating Scale) had an introductory letter which explained the aim of the research to the subjects.The letter also as sured the respondents that anonymity and confidentiality would be maintained throughout the research.Willingness to participate was ensured by a consent letter and candi dates were free to withdraw at any time of the study.Codes were used to identify nurses from different institutions since names were not allowed on the questionnaire.

Sample description
There were forty (40) subjects from both training institu tions, twenty (20) from King Edward College and twenty from The University of KwaZulu Natal programme.All forty subjects were scattered in eight hospitals.The response rate was 100% since there were no missing cases.The age and experiences, as well as academic results of respond ents are summarized in table 1.
One of the most common non-parametrical statistical tech niques (t-test) for determining the significance o f differ ences between the means o f two sets o f data was used.Table 1 shows that there were no significant differences between the two groups in terms o f demographic variables which could influence professional competency.

Competency rating
The rating scale made use of a normative scale, with the best nurse=5, average nurse=3and the below average nurse = 1 .In between best and average =4 and in between average and below average r=2.An average out of a possible 5 (best nurse) was calculated for each category, giving a to tal possible score o f 30 for six categories.
The averages o f the categories were calculated for each group and is reflected in table 2.
From table 2 one can conclude that the mean difference was less than one on all subcategories.The mean score was close to 5 which were equal to the best nurse.In all the variables used, the scoring was above 4.00.The degree of variability in the set of scores was less than one.The differ ence in the clinical competency between the groups was found not to be significant (t-1.11, df=38 and p=0.448) .The nurses o f both groups therefore showed that they were equally professionally com petent.The question arises w hether age, experience and test results were related, posi tively to clinical competence.
Association was done using the Pearsons as shown in the table 3 and the results were not significant.Therefore age, experience or academic performance cannot be related to professional competency.
When associating age, experience and examination results of the newly qualified nurses with the scores obtained on the Slater Rating Scale, the results were not significant.The researcher deduced that since the result were not sig nificant on all variables used, there was no difference be tween the traditional and the case based curriculum.The r value was above 1 (r> 1) which means that the demographic variables used had to relationship on the professional com petence of a newly qualified nurse.

Conclusion
A total of 40 nurses from two groups were included in the sample to compare professional competence.The demo graphic variables used in the study were not related to professional competency.The newly qualified nurses from both programmes obtained high scores which determined the high quality performance of care.Since there is no significance difference between the two bridging pro grammes, both curricular and teaching programmes worked similarly in producing competent nurses.

Table 1 :
Description of sample in terms of age, experience and academic perform ance

Table 2 :
Professional com petency of groups according to subcategories

Table 3 :
Correlation between professional competence and other variables (n = 4 0 )