An evaluation of the relevance and appropriateness of post-basic nursing programmes offered by the University of Zululand in meeting graduates ’ needs

This article aims at evaluating the relevance and appropriateness of post-basic nursing programmes of the University of Zululand Nursing Science Department in meeting the educational needs of the graduates in the Province. An explanatory descriptive survey was conducted in the hospitals,clinics, nursing colleges, nursing schools and the University of Zululand where the nursing graduates worked. Two sets o f interview schedules were designed, one for nursing graduates and one for their supervisors. These interview schedules consisted of open and closed-ended questions. The total number of graduates was 75 and 29 supervisors. The respondents were purposively and conveniently selected according to the availability of post-basic nursing graduates in each health and nursing education institution. The study revealed that post-basic nursing programmes of the University of Zululand catered for the changing learning needs of the graduates. This was due to the comprehensiveness of the programmes and their focus on community based and primary based health care from 1996. Based on the findings of the research it was recommended that a continuous evaluation of the post-basic nursing programmes is done , in order to check if they still meet the changing learning needs of the graduates. It was further recommended that the Nursing Science Department should develop more advanced clinical nursing programmes in order to cater for the recent learning needs of the graduates.


Introduction
Each nursing educational institution provide its own nurs ing educational programmes that differ from those of other institutions.However, they do have one thing in common, and that is to provide educational programmes that will cater for the needs of the students.The programmes should be evaluated from time to time to see if they are still appro priate and are relevant to these needs.Pietzak, Ramlar, Ford, Renner and Guilbert (1990: 220) indicate that pro gramme evaluation is done to assess the value or to make judgem ents on the worth of the programmes.This was the reason why the post-basic nursing programmes o f the Uni versity o f Zululand's Nursing Science Department were evaluated to determine whether they are appropriate and relevant to the needs o f the graduates in KwaZulu-Natal province.Mellish and Brink (2001:316-317) stated that evaluation of programmes should be done jointly by the principal, the staff and students considering the community needs and that the following questions should be asked:

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Are nurses registered as a result of the programme, able to act effectively?
• Do the programmes meet the needs o f the gradu ates?Billing and Halstead (1998: 198) agree with above authors by saying that every programme should demonstrate its relevance and appropriateness to the learning needs of stu dents.Furthermore, Rosie and Freeman (1991: 56) warn that if a programme do not cater for the above needs, it should be changed.

Background of the study
The N ursing Science D epartm ent of the U niversity of Zululand commenced with the introduction o f post-basic nursing programmes in 1981.There was no evidence that these post-basic nursing programmes had been evaluated since that date.As a result this study was conducted to evaluate post-basic nursing programmes offered from 1981 -1998.The subjects that were evaluated are nursing edu cation, nursing management and community health nurs ing science, all at diploma, degree, honours, masters and doctoral levels.
When the Nursing Science Department was established in 1981, the comprehensive health service approach was fol lowed in South Africa as a whole, including KwaZulu-Natal.This approach em phasised integrating the services and focusing them on the community.During this time education was based on the old system that did not serve the country well and was out of step with world trends.It catered for passive learners driven by examinations, learn ing in parrot fashion and completely centred on the teacher (Department of Education, 1997:5).
In 1996 the post-basic nursing program m e's philosophy was revised to cater for the requirements of the Govern ment of National Unity that was introduced in 1994, and the changed needs of the communities.The revised philoso phy became relevant to the recent changes in the curricu lum, the health needs o f the country and the learning needs of students.The philosophy was formulated based on the new system o f education that evolved around the concept o f transform ational outcom es-based education (OBE).
Under this system learners become active participants in school and throughout life, learners are at the centre of learning and teachers act as facilitators.Learners are thus responsible for their own learning and progress (Depart ment of Education, 1997:6).The revised programmes placed more emphasis on comprehensive primary health care de livery and nursing education, which was transformed and restructured.More emphasis was also placed on research, caring and the learning process, which is based on inquiry, discovery, creativity and critical thinking (Nzimande, 1990:8).Billing and Halstead (1998: 198) com m ent that traditional methods o f teaching need to be abandoned if we are to produce the critical thinkers that are needed in the clinical areas.All the above attributes of the philosophy will en able the nursing graduates to function within a transform ing health care system and society.
For the post-basic nursing programmes to be relevant and appropriate to the educational needs o f graduates the fol lowing goals and objectives were formulated for the nurs ing science department by the head o f department and staff members.

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To prepare already qualified nurses to function within and to give direction to emerging nursing roles as patterns of a health care delivery change.
• To develop students so that they can assume lead ership responsibilities within their profession with transforming health systems and within the larger society.

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To participate as agents of change in the social and political actions for the empowerment of health care and its delivery.

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To prepare advanced nursing practice specialists to be competent to meet current and future challenges in the restructuring and transforming health care systems.

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To apply leadership knowledge and skills in imple menting the role of advanced nursing practice spe cialists and developing strategies that advance health care and nursing education.

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To develop collaborative relationships with profes sions in other disciplines to assess and meet the educational needs of the graduates (Nzimande, 1990: 7-10).
In this study the relevance and appropriateness of the nurs ing programmes in catering for the educational needs of the students in KwaZulu-Natal province, was evaluated by assessing the performances of the graduates in their work places.The supervisors o f the graduates were also in cluded and were given the opportunity to comment on the performance of the graduates in different health services and educational institutions.The good performances of the graduates would confirm their relevance and appropri ateness of the nursing programmes.Rossie and Freeman (1991:58) comment that nursing programmes that have failed to meet the community concerns and quality of services provided by the graduates, require some modification of objectives, outcomes criteria and preparation of the gradu ates.
For this reason it was deemed imperative that the impact of the post-basic nursing programmes of the University of Zululand Nursing Science Department be evaluated to see if they catered for the educational needs of the graduates.

Objectives of the study
The objectives of this study were: • To ascertain the relevance and appropriateness of the post-basic nursing programmes of the Univer sity of Zululand in catering for the educational needs of the nursing students.

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To identify the contributions made by nursing gradu ates in their work places.
• To identify the developmental needs of the nursing graduates.
• To make suggestions for future preparation o f the nursing graduates.

Statement of the problem
The financial constraints facing tertiary institutions today as well as the need for relevance, productivity and appro priate nursing programmes, demands continuous evalua tion of programmes that are offered.This should be done in order to assess the relevance of the curriculum to meet the educational needs of the graduates.Each tertiary educational institution should justify its ex istence by among other things providing cost-effective nursing education programmes.If any nursing programme is not relevant to the needs of the students, it will serve no purpose and therefore would require some changes and improvements.
Are post-basic nursing programmes of the Univer sity of Zululand Nursing Department relevant to the educational needs of students of the KwaZulu-Natal province?2.
What contributions have these graduates made in their working areas?

Definition of terms
Program m e Programme is defined in this study as a series of planned education activities a student is to undertake with the as sistance of the teacher.

Evaluation
Evaluation is defined as the collection and interpretation through systematic and formal means of relevant informa tion that serves as basis for rational judgem ents in deci sion-making (Billing & Halstead, 1998:423).

Post-basic nursing programmes
In the context of this study post-basic nursing is used to refer to all nursing programmes that are offered after a basic nursing programme, where a professional nurse obtains additional qualifications which are approved and registered by the South African Nursing Council.

Research Design
An exploratory and descriptive survey was used to collect data.This was used to evaluate the impact o f post-basic nursing programmes offered by the University o f Zululand and the relevance and appropriateness of these programmes in catering for the educational needs o f the graduates.Data collection took place in the province of KwaZulu-Natal, regions B, D, E, F and H health services and educa tional institutions.

Sample and Sampling
A purposive, convenience and systematic random sampling of 75 post-basic graduates and 29 supervisors was done.

Selection of the post-basic nursing graduates
Selection of the graduates was done according to their avail ability in the hospitals, clinics, nursing colleges, nursing schools and the University of Zululand where they were employed.This was done after doing a situational analysis in the above institutions.In the institutions where the nurs ing graduates were less than 10, they were all purposively and conveniently selected.In the institutions where nurs ing graduates were more than 10, a systematic random sam pling procedure was done.Every tenth nursing graduate was selected until the 75 graduates were selected.

Selection of supervisors
T he im m e d iate su p e rv iso rs o f the g ra d u a te s w ere purposively selected to comment about performances and contributions made by the nursing graduates in their work places.

Ethical consideration
Permission was obtained from the Department of Health, superintendents of individual hospitals,clinics, and princi pals of nursing colleges, principal of the nursing schools and heads of the department of the University of Zululand.
Informed consent was obtained from nursing graduates and their supervisors.They were requested to partake voluntarily and were assured o f confidentiality.

The instrument
The instrument consisted o f both close-ended and open ended and questions to allow respondents an opportunity to express their views freely.The design was guided by the literature review and objectives of the study.Two sets of interview schedules were designed, one for nursing gradu ates of the University o f Zululand and the other for their supervisors in the working areas.Both interview sched ules comprised of sections.
Section A comprised of demographic data with 2 questions on gender o f respondents and distribution and area o f em ployment.
Section B comprised of one question on the area o f em ployment.
Section C comprised of educational qualifications with one question where graduates had to mention the educational qualification they obtained from the University of Zululand.
Section D comprised of 3 questions on the relevance and appropriateness of post-basic nursing programmes to ca ter for work needs of the graduates.The questions are: • ability of graduates to correlate theory and practice

Data collection
The data was collected by the researcher and a well trained assistant researcher who was also an experiences researcher from each respondent during a face to face interviews.All the respondents that were on duty in each institution were interviewed until a sample of 75 graduates and 29 supervi sors was interviewed.

Data analysis
Data was analysed by a statistician.Responses from open ended questions were classified coded and sub-coded for purposes of quanti tative analysis by a statistician and was presented in the form of tables and graphs.

Age distribution
The results in table 2 shows that the majority (31) 41.30% fell in the age group 31 -40 years, (27) 36% within 4 1 -5 0 years, ( 14) 18.70% within the age group o f 51 -61 and (3) 4% into the age group of 21 -30 years.This was an indica tion that the nursing graduates were mature enough to work in the health services and educational institution.The majority of the supervisors fell in the category of 51 -61 years (14) 48.27%, followed by (9) 31.03% in the category 4 1 -5 0 years, 3 1 -4 0 years were (5) 17.30% and only (1) 3.40% were in the category 21 -30 years.This indicates that the supervisors were experienced enough to evaluate the nursing graduates.

Area of employment
The results indicates that the nursing graduates o f the University of Zululand and their supervisors were employed equally in rural, urban and suburban areas namely, 33.30% in each area.The reason might be that the University has

Educational qualifications
Most of the graduates (30) 40%, had B.Cur E at A (bac calaureate degree in nursing) with majors in nursing man agement, nursing education and community health nurs ing science.The others (29) 38.70% had diplomas in the above-mentioned specialities.Very few nursing graduates had post-graduate qualifications at honours, masters and doctoral levels.Eleven 14.70% had an honours degree, (4) 5.30% a masters degree and only (1) 1.30% had a doctoral degree.In the light of these findings it could be argued that nursing graduates were catered well for their educa tional needs.

Relevance and appropriateness of postbasic programmes to cater for the educational needs of nursing graduates
It became necessary to ask the nursing graduates whether the post-basic nursing programmes they undertook catered for their educational needs.

Coping with recent advances
Graduates were asked if they were able to cope with recent advances in the health services.This was done for the purpose of assessing the relevance of the post-basic pro grammes of the University of Zululand Nursing Science Department to the needs of the students and the needs of the country they served.The majority (72) 96.00% were coping with recent advances as compared to (3) 4.00% who responded negatively.
To confirm whether the graduates were coping with recent advances, they were asked about the relevance o f their education and training to outcome-based education and primary health care, which were some of the recently imple mented changes in the curriculum.Graduates (39) 52.00% felt that their education and training were relevant to pri mary health care and (36) 48.00% to outcome-based educa tion.These two educational strategies are relevant to all programmes, that is nursing education, nursing manage ment and community health nursing.Zum a(1996: 15), the previous minister of health in the Government of National Unity mentioned that training programmes o f health pro fessionals should be reviewed to include primary health care.
There are many other changes taking place in the country that require continuous updating of knowledge and skills of nursing personnel in order to cope appropriately.Mellish and Brink (2001: 316) state that nurse educators should evaluate the programmes they offer to assess whether they meet the health needs of the country and needs of the graduates.This points to the relevance o f the nursing programmes at the University of Zululand to the needs of the graduates in order to cater for the changing needs of the citizen of KwaZulu-Natal Province.
graduates training to face the future needs of the health services The supervisors of the graduates were asked if the training of graduates was appropriate for them to face the future needs of the services.The majority of supervisors ( 28) 96.60% as compared to (1) 3.40% confirmed that the gradu ates from post-basic nursing programmes of the University of Zululand were appropriately trained to face the transfor mational needs of South African health service needs.The reason for this is that these graduates had been prepared in the new curriculum strategies as well as new transforma tional leadership skills.This confirms the view o f Gumbi (1996: 35), the national human resource planner and chief Director of National Health, during that time in that "one of the contributions of human resources development will be education of health personnel who are innovative, with good leadership and supervisory skills and good decision makers who will effectively address the countries needs" .

Competence in work performance
Graduates were asked if they were feeling competent in their work performance.Competence of the graduates will always reveal the appropriateness of their knowledge and skills in catering for the changing health needs of the coun try.( 20) 93.30% graduates felt competent in their work per formance.Only (5) 6.70% were not competent.This means that the graduates were competent enough to cater for their work needs.Ferguson and Calder (1993:31) argue that com petence should not involve only psychom otor perform ance, but also knowledge, values, critical thought, clinical judgem ent and other complex skills.

Significant contributions made by the nursing graduates in their working areas
To confirm the relevance of the post-basic nursing pro grammes to their educational needs, graduates themselves were asked to identify some contributions that they had made in their work places.The supervisors also had to comm ent about the specific contributions made by nursing graduates in their work places.Supervisors stated that nursing graduates made various contributions in the insti tutions.The graduates m entioned various contributions that they made in each departm ent.The contributions ranged from nursing administration, working in the clinical areas, nursing education and primary health or clinics.

Contributions in nursing administration
Thirty one 41.30% graduates stated that they made contri butions in nursing administration on the following: • (15) 20.0% graduates formulated policies, rules and regulations.

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(3) 4.00% became Involved in conflict management of a multidisciplinary team.
• Another (3) 4.00% contributed by formulating and implementing orientation programmes for new staff members.
According to Nzimande (1984:45) nurse managers occupy ing high positions should be involved in planning of health services and policy making in order to utilize their knowl edge effectively.

Comments by supervisors on contributions made by graduates
Nine 31.00%supervisors of nursing graduates agreed that graduates contributed significantly in the following:

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(2) 6.80% supervisors stated that (5) 6.70% gradu ates contributed by formulating team leaders in the implementation of the nursing process.

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The last supervisor (1) 3.40% mentioned that (2) 2.70% graduates conducted meetings to solve prob lems for staff members on their own.According to supervisors (26) 34.60% graduates contributed tre mendously in nursing management, which is a sign that graduates were well prepared by the University of Zululand

Contributions in the clinical areas
Contributions in the clinical areas were made mostly in the improvement o f patient care as indicated by (6) 6.70% and (1)1.30%graduates by implementing of the nursing proc ess.Improvements in patient care are one o f the main ob jectives of health services, which is an indication that nurs ing graduates were properly prepared to cater for their edu cational needs.Huber (1996:491) states that quality meas ures are needed to measure professional actions in caring for the patients.
Ten 34.48% supervisors o f the nursing graduates identi fied the same contributions made by nursing graduates as those mentioned above.Over and above (7) 9.30% super visors stated that (2) 6.80% graduates contributed by su pervising clinical teaching for bridging students which is very difficult to do especially if there are staff shortages.

Contributions made in nursing education
Most contributions were made in nursing education, (36) 48.00% graduates indicated that they contributed by plan ning in-service education programmes for nursing person nel in order to update their knowledge and skills.Accord ing to Muller (2002:491) in-service education lead to higher productivity in all nursing personnel irrespective of the category.Six 20.68% supervisors agreed that nursing gradu ates contributed mostly in capacity building of personnel through these in-service education programmes.Over and above 6.70% graduates contributed in the curriculum de velopment of bridging course students that was introduced for the first time in their institutions.

Contributions made in primary health care /clinics
Contributions in primary health care/clinics were mainly made in the introduction of health education programmes for patients by (4) 5.30% graduates.Four 13.70% supervi sors on the other hand mentioned that nursing graduates contributed by com mencing HIV / AIDS counselling for patients and com m encem ent of primary health care in the outpatients department and the clinics.Henry, Hamran and Sorenson (1995: 11) commented on the changes in the health systems which will affect the roles of nurse managers which they see as a shift in resources to primary health care.

Developmental needs
The graduates were asked to identify some developmental needs that will improve their skills in order to cater for the changing educational and health needs of the country.The graduates identified the following needs: • Twelve 16,00% indicated the need for skills in trans formational admiadministration management, includ ing dealing with grievances from the public.Matsane (1998: 60)her study on industrial relations in health care in the eighties and early nineties, observed that approaches to management used by nurse managers prior to the new era (27 April 1994) were rigid and that all means should be made to help nurse managers to acquire new skills of manage ment that will be more flexible.
• Six 8.00% indicated the need for more development in business management in order to perfect their skills in budgeting, health service management and district health systems management skills.The above skills are required to improve their compe*tencies in the management of health services, edu cational institutions and primary health care serv ices.
The majority (43) 57.30% graduates needed development in clinical studies like clinical masters including intensive care and traum a care nursing courses.All the graduates expressed a need for computer literacy courses since the health services are changing to be in line with technologi cal advances.There was also a need to produce graduates at doctoral levels in order to enhance the standard of nurs ing.The inclusion of the above aspects in the post-basic nursing programmes can improve graduates, marketability, relevance and competencies in catering for their educa tional needs and the health needs of the country.

Suggestions made by supervisors for future preparation of the graduates
The 29 supervisors o f the graduates were asked to give suggestions as to which areas would be necessary for the post-basic programmes in order to cater for the needs of the country and those of the students.The suggestions were based on the three main areas of the post-basic pro grammes, that is nursing education, nursing management and primary health or community health nursing.These suggestions made by the supervisors will improve the fu ture post-basic programmes of the University o f Zululand.

Suggestions on nursing management
Most of the supervisors (15) 51.70% suggested courses focusing on assertiveness in order to improve com m unica tion skills, course on new legislation in order to improve patient care, transcultural nursing for provision of holistic nursing care, financial management so as to help in econo mising/ and proper utilization of material and human re sources, transformational skill and human resource man agement.These suggestions made by the supervisors will improve the future post-basic programmes of the Univer sity o f Zululand.

Suggestions on nursing education
The (9) 31.00%supervisors suggested that post-basic nurs ing education programmes should be focused on creative thinking in order to improve graduates problem solving skills, counselling skills and stress management skills that will both improve their interpersonal skills.
Community health and Primary health care suggestions (5) 17.30% supervisors made suggestions on community health and primary health care areas like training nursing graduates in rural health and project management courses, in order to assist primary health care nurses in community project management.

Conclusion
From the above findings it can be concluded that the postbasic nursing programmes of the University of Zululand catered for educational needs of the students in Kwazulu-Natal Province.Also that programmes did not only cater for work needs of the nursing graduate, but also helped them to cope with the recent advances in health care and nursing education.

Recommendations
The following recommendations were made in order that the post-basic nursing programmes may be more relevant and appropriate to educational needs o f the graduates: An evaluation model should be formulated to continually evaluate programmes that are offered by each educational institution for effectiveness and relevance.
The Nursing Science D epartm ent o f the U niversity of Z ululand should develop more advanced clinical pro grammes in midwifery, general nursing science, intensive care, trauma nursing care and a diploma in psychiatric nurs ing for graduates in order that they are more relevant and appropriate to the educational needs of the graduates.
The Nursing Science Department should also introduce primary health care programmes at certificate, diploma, bac calaureate and post graduate levels.These programmes may be offered as distance learning for greater accessibil ity.
Introduction of a certificate course on HIV/AIDS focusing on counselling, home based care and rights of people liv ing with AIDS, and their carers, including nurses.

Table 1 -
Gender of Respondentsbecause some specialities need male nurses in the nursing profession, such as orthopaedic nursing, psychiatric nurs ing, mining industries and others.If the males are less in the above specialities the health needs o f the country can not be properly met.The study revealed that there were more females (73) 97.40% than males (2) 2.60%.This pic ture was the same for supervisors o f the graduates, that is (28) 96.60% females and ( l ) 3.40% males.The nursing pro fession as a whole thus need to recruit and attract more males to change the picture of being dominated by females in order that the health needs of the country are properly catered for see (table1).
• ability of post-basic nursing programmes to cater for work needs of graduates Section E comprised o f 4 questions on contributions made by nursing graduates in their working areas.The questions are: • contributions in nursing management • contributions in the clinical areas

Table 2 -
Age distribution one at Empangeni that is rural, suburban and urban in nature and the Durban-Umlazi Campus, which has the same characteristics.This meant that nursing graduates were catered for equally for their edu cational needs in rural, suburban and urban com muni ties.

Table 3 -
Ability of post-basic programmes to cater for work needs of graduates