The qualification of General Nursing Science registered at the South African Qualifications Authority (SAQA) for UWC provides qualifiers with graduate-level knowledge of health- related sciences and nursing skills and competence. This qualification provides credible, competent professional nurses who can provide care in the multifaceted South African environment and gives nurses the opportunity for personal and professional development as well as lifelong learning (SAQA, 2009). The first outcome for the programme states that the graduate should be able to apply relevant knowledge to meet the health needs. In the South African context, where HIV is one of the health priorities, this outcome is applied to providing care to those infected with and affected by HIV (SAQA, 2009), as well as the prevention of HIV. This is further supported by the WHO (2009), which emphasizes the need to train health care professionals such as nurses to provide care to their communities that are
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relevant to their health needs. It is therefore important to consider HIV epidemiology in South Africa when training nurses.
A number of documents have been produced on HIV and AIDS core competencies, and these include the international consensus on HIV core competencies from a meeting on HIV service delivery training and certification from the WHO (WHO, 2005), the United Kingdom National HIV Nurse’s Association (NHIVNA) document on National HIV nursing competencies (NHIVNA, 2007), as well as the essential nursing competencies related to HIV and AIDS (Relf et al., 2011b). In this study, documents were used when making decisions about the core competencies to be integrated in the curriculum, with the support of other South African policies and documents that provide information on what is expected of nurses with regard to providing comprehensive care and management to clients infected with HIV and AIDS in South Africa. Such documents include the Nursing Strategy for South Africa 2008, the 2007 and 2012 HIV/AIDS and STI strategic plan for South Africa, as well as the various guidelines on the care and management related to HIV and AIDS, such as counselling and ART guidelines (DoH, 2010a).
Garside and Nhemachena (2012) noted that the term ‘competence’ is used in reference to various professionals, and more so with regard to the nursing profession, and Cowan et al. (2007) as well as McMullan, Endacott, Gray, & Jasper (2003) noted that the terms ‘competence’ and ‘competency’ are often used interchangeably. McMullan et al.’s (2003) definition of competence focuses on a description of the action or outcome of performance, while Garside and Nhemachena (2012) define competence as a combination and integration of performance as well as knowledge and skills that enable performance. Many authors (Ashworth & Morrison, 1991; Carraccio, Wolfsthal, Englander, Ferentz, & Martin, 2002; Tilley, 2008; Dent & Harden, 2009; Garside & Nhemachena, 2012) define competence in nursing practice as a combination of attributes underlying aspects of successful professional performance in the provision of care, and further specify that competence is more than knowledge, skills and attitudes. It involves coordination of one’s cognitive and affective resources as well as a willingness to utilize those resources and any other resources or qualities, such as receptivity and personal interest, as required for the performance of a professional task (Ashworth & Morrison, 1991; Carraccio, Wolfsthal, Englander, Ferentz, & Martin, 2002; Tilley, 2008; Dent & Harden, 2009; Garside & Nhemachena, 2012), and competency is understood by Benner, (1982); Cowan, et al., (2007) and Pijl-Zieber, Barton,
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Konkin, Awosoga, and Caine, (2014) as the ability to perform. The International Council of Nurses (ICN), (2005) has defined competence as “Effective application of a combination of knowledge, skill and judgment demonstrated by an individual in daily practice or job performance” (p. 9).
Cowan et al. (2007) have pointed out that despite the lack of agreement on a definition of the term competence, in nursing practice competence involves an application of a combination of knowledge, skill, performance, values and attitudes. Cowan et al. (2007) further suggest an agreement on a holistic understanding that combines behavioural and psychological constructs, facilitating development of competencies that combines all aspects of holistic care to be provided by the nurse, and such competencies would then be properly measured and assessed. For the purpose of this project, a more holistic view will be adopted and competence will refer to a broad generic ability characteristic of the person that transfers across settings and situations and is not just a set of discrete skills. It is developmental and holistic, made up of several integrated components, and combines self-perception, skills, affect, personal interests, perceptiveness, confidence, critical thinking, motivation and knowledge, all outcomes of educational processes. This understanding of the concept is consistent with the outcome-based curriculum approach chosen for this project, as this approach is competency oriented (De Back & Mentkowski, 1986; Uys & Gwele, 2005).
2.6.1 Integration of HIV competencies into the undergraduate nursing curriculum
The four-year undergraduate nursing programme in South Africa (R425) is a comprehensive programme and nurses that complete the programme qualify as nurse generalists, community health nurses, mental health nurses and midwives. Nurses who complete this programme are expected to practice competently in any setting and provide appropriate care. With South Africa having a high number of people with HIV and AIDS, the new graduates are exposed to patients with HIV and AIDS and need to provide appropriate care; hence the need to integrate such aspects into the curriculum. The literature provides examples where specific aspects such as substance abuse, patient decision support, international and transcultural content as well as HIV have been integrated into the undergraduate nursing curricula to strengthen and coordinate the integration of such aspects in the nursing curricula (Lindquist, 1990; Hayes, 2002; Knebel et al., 2008; Stacey et al., 2009; Kohi et al., 2010). In Haiti a competency-based curriculum in HIV for nursing schools was developed (Knebel et al., 2008). This approach is similar to the outcomes-based curriculum chosen for this project, as it
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is an approach that relies on competency. In Tanzania a similar project was developed to strengthen nurse education in HIV care and management, by training nurse educators in nursing schools (Kohi et al., 2010).