CHAPTER ONE
1.1 INTRODUCTION
A major challenge faces higher educational institutions around the world on how to achieve quality outcomes for students in an increasingly globalised and competitive environment (Harvey & Kamvounias, 2008:31). Education is a reciprocal process, during which the learners acquire knowledge, ability, and self awareness in gaining diversity to thought (University of Wisconsin, 2001:2). Nursing education is designed to educate and train nursing students to become competent and qualified professional nurses (Mellish, Brink & Paton, 2009:6). In order to provide skilled nursing care, professional nurses must be educated and trained to master certain skills and be knowledgeable about the science of nursing (Mellish et al., 2009:6-7). According to Leufer (2007:322), nursing students need the appropriate knowledge and skills to enable them to deliver safe and competent care to their patients.
According to Mellish et al. (2009:63), professional nurses enter the nursing programme with different expectations of what is to be learnt, different intellectual skills, types and levels of motivation, and different interests. Furthermore, professional nurses also come from different cultures and backgrounds. Consequently, professional nurse educators, who are responsible for educating and training these students, have a challenging task.
1.2 RATIONALE
Prior to 1994, nursing education in the Western Cape had been provided by four separate colleges in the public sector. These four colleges amalgamated during the post “apartheid” era to form one college. This nursing college has been especially challenged by poor academic progress of its students over the past decade. The students’ academic performances have shown a decline over the last few years, to such an extent that it has become a major concern to all the parties involved (Table 1). The problem has been further compounded by the expectation of Government to increase the number of students being trained, in order to counteract the critical shortage of professional nurses in the country. In South Africa the enrolment of nursing students for their first year has increased, whereas the number of students completing their fourth year has decreased, due to poor academic progress over the four years. Consequently, there is an imbalance between the input and output of students (Table 1). Since more students are failing, there is a backlog of students completing their programmes successfully., Stickney (2008:422), substantiates this problem by describing that the number of new enrollees into nursing programmes in the United States (US), is too low to provide an adequate nursing workforce to meet increasing health needs. Furthermore, the nursing shortage problem is exacerbated by the attrition of students over the course of their programmes.
Statistics obtained over a period of six years show a decline in the academic progression of students over this period. In 2002, 159 students commenced training at the college being studied, of which 104 (65%) students completed in 2005. In contrast, in 2003, 173 students registered for training, of which only 75 (14%) completed in 2007. No students were enrolled in 2004 since the college was in the process of preparing for the introduction of the bursary system. The 206 students who commenced training in 2005, had a high failure rate of 67 (33%) in their first semester, general nursing science examination in 2006. The college senate then approved the setting of a third opportunity examination for those students who had failed or had not written the second opportunity examination. 67 students wrote the third opportunity examination, of which only 7 (seven) passed. 60 students failed the examination, with 73% of these students obtaining an average of less than 40%. In 2007, only 76 (36%) of the 206 students remained in training, by entering their third year. Further in 2006, 192 students commenced their studies, of which 142 (73.9%) progressed into their second year of study, leaving 26.1% of unsuccessful students or drop outs at such early stages of their training (PGWC Nursing College Statistics, 2008).
Table 1 shows the decline in nursing student performance over the past six years at the college being studied. Ultimately the college is not producing sufficient, qualified, trained professional nurses in order to address the shortage of professional nurses in the country. According to the strategic plan of the Department of Health of the Western Cape, the projected number of students to be trained for the period 2009/2010 was
542. The current objective is to increase the availability of health science students in order to address scarce skills (Strategic Plan 2010-2014, 108). Consequently, the Department of Health of the Western Cape has offered the college being investigated,
§ bursaries for the 2011 academic year (Department of Health, 2010:1).
This study investigated whether selection criteria had been complied with and what measures had been taken when the intake target had not been met. This investigation further determined whether the selection criteria had been defied in order to comply with Government’s request to train more students. The findings of a study by Prymachuk, Easton and Littlewood (2008:149) indicated that those students who only had the minimum educational qualifications on entry were less likely to complete, than those with higher level qualifications.Upon completion of the four year nursing programme, the qualified graduate becomes registered as a professional nurse and thus as a member of the nursing profession. The professional nurse is then expected to deliver health care at an expected standard that is acceptable to the nursing profession. Once a member of the nursing profession, it would be expected of the professional nurse to have the necessary insight and knowledge to execute daily tasks, according to her/his scope of practice, as described in the Nursing Act 2005. Mr. Mabuda, the Director of Nursing, states that nursing as a profession is still faced with a number of challenges, which ranges from education and training, coaching and mentoring, the image of the profession, limited facilities for clinical placement of students and the nursing shortage (Professional nurses Update, September 2008). These challenges inevitably influence the academic performances of students and ultimately threaten the nursing profession.Figure 1 illustrates the imbalance between the number of students being registered in a particular year and the relatively small number of students completing their professional nurse training in that same year.
The typical learning environment comprises of the number of students in the classroom, the academic environment, teaching strategies and the perceptions of the impact of group size on the learning experience (Leufer, 2007:322). The learning environment plays an important role in captivating the student’s interest and in maintaining it. It is therefore important to consider how nursing students experience learning in a large class environment (Leufer, 2007:322). This would provide information such as:
§ Are students distracted by such large numbers?
§ Do students feel assertive enough to interact, or ask questions?
Large group learning suggests that there is a relationship between class size and participation levels, which then affects the learning experiences of students (Leufer, 2007:322). Furthermore, the recruitment of more students has been implemented without providing adequate infrastructure. Many logistical problems have been encountered, for example, inadequate sound systems, control of attendance, ventilation, increasing noise levels. These logistic problems create further problems such as difficulty in managing the group which results in lectures being commenced late. According to Leufer (2007:322) participation levels are lower in large class settings. The large student numbers thus impact on the academic environment and the quality of teaching provided. Herington and Weaver (2008:111) state that university courses with large enrolments hold challenges for course convenors, particularly in managing and maintaining course consistency and in accommodating different student learning approaches. The student-teacher relationship is also compromised and becomes impersonal and distant. Students thus find it more difficult to approach lecturers for support and assistance.
The college being investigated had a shortage of professional nurse lecturers for a relative period and the process of filling these positions has been slow. This has inevitably affected the academic climate in the learning environment, as it has led to a larger number of students in a classroom, increased levels of stress on the lecturer and on the learning environment.
In their study, Grainger and Bolan (2006:38) question how the perceptions of nursing influence potential applicants and whether nursing is viewed as a desirable career. In a study conducted by Ojeda, Creutzberg, Feoli, Melo and Corbellini (2009:400) among nursing students being registered for a nursing programme, 70% had chosen that program, because they were unable to qualify for another. According to Meadus and Twomey (2007:13), the most common reasons why men enter the nursing profession, are career opportunities, job security and salary.
Motivation plays a fundamental role in learning (Glynn, Aultman & Owens, 2005:150). Increased inspiration gives rise to an increase in enthusiasm and motivation, which may result in better academic performance. Similarly, the lack of inspiration would result in a lack in motivation, resulting in poor performance. Lack of motivation often becomes visible when students have difficulty in mastering the study material, which ultimately influences academic performance adversely. Motivation is considered a highly significant psychological concept in education and contributes extensively to learning and performances outcomes (Leufer, 2007:323).
Pedagogical literatures of higher education describe different ways of understanding learning, which are seen as underpinning two basic approaches to learning, i.e. the ‘surface’ approach and ‘deep’ approach (Haggis, 2003:90). Lizzio, Wilson and Simons (2002:27) further state that there is a fair degree of empirical evidence supporting the fact that students adopts two basic approaches, i.e. a deep approach to learning, which is striving for improved understanding, and conversely a surface learning, which involves reproductive strategies with little attempt to integrate information.
Students’ perceptions of the academic support and mentoring that they have been receiving were investigated, as well as the students’ own contributions to their academic progress. The role of the mentor in practice placements is important in supporting student learning and the assessment process. Mentors should assist students in bridging the gap between theory and practice. The type of relationship that exists is crucial to the student’s learning experience (Wilkes, 2006:42). The college being investigated have provided mentors in the clinical facilities, but whether they have met the expectations of the students require investigation. According to Baykal, Sokmen, Korkmaz and Akgun (2005:255-256), educational institutions should adopt the concept of total quality management, which would then necessitate them to regularly determine the satisfaction and expectations of their customers.
English as a second language (ESL) students are described as those students, whose primary language at home is not English and therefore may not be fluent in standard English (Guhde 2003:113). The amalgamation of the four colleges also resulted in a combination of diverse cultures and languages. As a dual medium of instruction was introduced at the college, lecturers were expected to accommodate both English and Afrikaans in one lecture. This was time consuming and necessitated extra manpower. A decision was then taken to implement English as the only language of instruction. This has resulted in language becoming a barrier to learning for many students, possibly contributing to their poor academic performances. Furthermore, students may be placed in hospitals where they are confronted with their second or third language, or even an unfamiliar language. Consequently, these students are being disadvantaged both in the classroom and in the clinical environment. Jacobs, Chen, Karliner, Agger-Gupta and Mutha (2006:111) state that many US residents, who speak little English, may face language barriers when seeking health care. South Africa also encounters the same challenges, because not only do citizens face barriers when seeking health care, but students who speak limited English are unable to communicate effectively with their patients. Language barriers can thus affect their clinical learning skills which can lead to incompetency in clinical learning skills and ultimately have an effect on the patient care delivered to health consumers.
Nursing student attrition is an international issue, causing concern in many parts of the developed world, including Australia, the United States and Europe (Prymachuk et al., 2008:149). Student attrition presents numerous challenges for directors and deans of nursing programmes and the nursing profession (Wells, 2003:230). The attrition rate in Canadian nursing programmes has been estimated to be between 20% – 40%. Students’ change in perception of nursing as an ideal career choice has been the main reason for attrition (Grainger & Bolan, 2006:39). According to Wells (2003:233), population data suggests that the student pool will continue to be more diverse and therefore a retention programme must include faculty / staff development relating to cultural issues.
Baykal et al. (2005:256) state that there are many factors that adversely affect nursing education in Istanbul, such as professional nurses having different levels of education, inadequate infrastructure and the inefficient uses of educational techniques and technologies. The college being studied faces similar challenges, which inevitably affect the academic performances of learners namely:
§ Selection criteria which are not adhered to;
§ Lack of infrastructure;
§ Lack of technology;
§ Language barrier;
§ Lack of motivation; and
§ Inadequate learning opportunities.
According to the Government Gazette (1997), the admission of students to training and educational institutions should reflect national demography. Student selection should therefore be co-ordinated at national level in order to implement and monitor affirmative action policies.
1.3 PROBLEM STATEMENT
A decline in academic performance of students, specifically at the nursing college under study was observed which adversely influenced the throughput and output of students. It was postulated that possible factors may exist which may be influencing academic performance. Therefore, it became essential to investigate possible factors influencing learning of students at this specific nursing college.
1.4 AIM
The purpose of this study was to investigate the factors influencing learning of nursing students at a nursing college in the Western Cape.
1.5 RESEARCH QUESTION
The research question which guided this study was “What are the academic factors that influenced learning at a nursing college in the Western Cape.
1.6 OBJECTIVES
The objectives for this study were to investigate whether the following factors influenced learning at a nursing college in the Western Cape:
§ Nursing as a career choice;