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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).
Keywords: ACADEMIC FACTORS AFFECTING LEARNING AT A NURSING COLLEGE
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