CHAPTER 4: RECOMMENDATIONS, LIMITATIONS AND CONCLUSIONS
4.2 RECOMMENDATIONS REGARDING THE EDUCATIONAL CHALLENGES
The recommendations stemming from this research are formulated as a suggested action plan to address the educational challenges of pregnant student nurses, as identified in Chapter 3. The presented recommendations give answers to the second research question:
• What recommendations can be made by the college and pregnant student nurses to address these educational challenges?
The recommendations are given in Table 4.1 below.
Table 4.1
Recommendations for addressing the educational challenges of pregnant student nurses
THEMES AND SUB-THEMES RECOMMENDATIONS 4.1.1 Academic challenges
4.1.1.1 Lack of concentration
Alleviate academic challenges
Promote concentration span during class and in the clinical learning areas
• Promote regular attendance at ANC clinics to obtain supplements, encourage the intake thereof, and thereby prevent complications that are related to lack of micronutrients in the body.
• Effectively manage tension which predisposes pregnant student nurses to a lack of concentration by involving them in stimulating but non-strenuous activities as often as possible.
• Educate pregnant student nurses about the processes of labor and what to expect before, during and after labor to allay anxiety and eliminate misconceptions related to pregnancy and childbirth.
• Allay their anxiety by providing important information and making sure that the fetus is thriving and well-monitored during ANC visits. • Explain fetal movements, when they
commence, fetal positioning, and what to do in the absence of fetal movement.
movement.
• Promote the use of family planning to prevent unplanned pregnancies.
4.1.1.2 Failure to cope with workload
Help pregnant student nurses by easing their workload
• A timetable for extra classes has to be designed by lecturers to assist those who have a problem coping with the normal class schedule.
• Refrain from delegating extra-curricular work- related activities to pregnant student nurses that will take time away from their studies and rest.
• Labor-related duties and activities can be put on hold (if the pregnant student nurse is a member of the labor union).
• Advise pregnant student nurses not to do tiring non-nursing care activities that will cause fatigue.
• Pregnant student nurses should be supported in their activities wherever possible to reduce the work burden.
• Teach pregnant student nurses to balance their roles correctly and overcome frustrations that are related to workload. • Emphasize the importance of attending
classes regularly and whenever possible to avoid creating an accumulating workload that results from absenteeism.
• Encourage pregnant student nurses to complete tasks in time, and avoid procrastination that can lead to their work
piling up.
• If there are extra classes, the pregnant student nurses should ensure they make use of them to reduce anxiety over the workload. • Spend time with good, reliable and understanding friends who will assist and encourage them.
4.1.1.3 Physical discomfort
a) Nausea and vomiting
Eliminate physical discomfort and promote the well-being of pregnant student nurses
• Pregnant student nurses should work and be in a well-ventilated environment free of smells which cause nausea.
• They should avoid complications like dehydration and fatigue caused by severe vomiting.
• Advise pregnant student nurses to get medication from a doctor to relieve nausea and vomiting.
b) Backache and pain • Advocate for the provision of comfortable chairs in the classroom that will minimize backache.
• Advise on proper posture when seated, standing or walking to minimize backache. • Encourage the wearing of well-fitting,
supportive and comfortable shoes that will relieve tiredness on the lower limbs.
• Allow periods of rest in-between classes and in the clinical learning area.
• Avoid situations where pregnant student nurses stand for long hours and allow periods of rest in-between tasks.
• Advocate for allocation to a unit where the schedule is less busy and where pregnant student nurses will have sufficient periods of rest between their work.
c) Edema • Encourage pregnant student nurses to rest in- between their activities.
• Encourage the elevation of the lower limbs when seated or sleeping to promote circulation and to alleviate edema.
• Encourage the wearing of well-fitting and comfortable shoes at work, in the classroom, and at home to promote blood circulation. • They must walk around for short periods and
do moderate exercise to promote blood circulation and minimize swelling.
• Pregnant student nurses who have severe edema should reduce the salt in their diet to avoid retaining more fluids.
• If edema is observed immediately after waking up in the morning, pregnancy-induced hypertension (PIH) should be ruled out, and the pregnant student nurses should be given medication to control blood pressure.
• Body weight must be checked daily to monitor edema and to exclude preeclampsia.
4.1.1.4 Academic stress
a) Adaptation
• Find ways to assist pregnant student nurses in dealing with excessive amounts of work and thereby overcome stress.
• Roles and duties which conflict with one
another must be prevented if possible by
dealing with and focusing on each task separately or breaking difficult tasks down into smaller, more manageable ones.
• Avoid unhealthy lifestyles and choices that cause stress.
• Complete work in advance if possible to prevent it piling up.
• The mind should be cleared of undesirable thoughts, and negative feelings need to be dealt with which can predispose pregnant student nurses to more stress.
• Encourage pregnant student nurses to sleep seven to eight hours a day to ensure sufficient physical rest and prevent psychological stress.
• Advise pregnant student nurses to remove themselves from stressful environments that can aggravate academic stress.
• They must learn to handle their work, tests and assignments as they come and finish each one before starting a new one.
• They must manage the effects of stress effectively to avoid relapse after each stressful event.
b) Frustration • Promotion of sufficient support for pregnant student nurses to prevent frustration.
• Ensuring that coping strategies are in place to ease the burdens that pregnant student nurses are experiencing or balance demands to reach equilibrium.
• Pregnant student nurses should reduce academic activities by attempting each and every work that is delegated to them.
• Pregnant student nurses should not place the blame on themselves if problems occur in the academic environment as this will increase their frustration.
• Identify positive activities that will make them feel better and engage and stimulate them in a healthy manner.
• Avoid procrastination to prevent a backlog of academic work that may be impossible to deal with the time remaining.
• Pregnant student nurses should keep a record of accomplished tasks and reward themselves for work well done.
• Learn to accept the reality of their situation and make the best of it to avoid hopelessness.
• They should change the way in which they do things if it is not to their satisfaction or benefit.
• Seek professional counselling, reflect on events and determine what is working and what can be done differently.
c) Work overload • Pregnant student nurses should ensure that they attend classes regularly as far as possible and avoid absenteeism that leads to their work piling up.
• Teach pregnant student nurses to avoid unhealthy competition and high expectations that may lead to stress and unnecessary burdens.
• Encourage them to prioritize tasks that should be done first and focus on secondary tasks when they can.
• Seek alternative means to improve the situations they are facing to avoid frustration. • Strive for progressive results and have a
positive attitude towards life.
• Set realistic objectives, and ensure that each objective is accomplished in time.
d) Deprivation • The academic environment should include helpful interpersonal relationships between pregnant student nurses, their peers and lecturers.
• The environment should be stimulating and have manageable challenges.
• Pregnant student nurses should participate in effective communication with peers and lecturers and have a sense of engagement in all academic matters.
4.1.2 Failure to examinations 4.1.2.1 Catching-up examinations write during
Assist pregnant student nurses to write their examinations through catch-up programs
• Encourage normal class attendance wherever possible to reduce chances of needing to catch and missed work related to absenteeism.
• Stress the importance of adhering to the class attendance policy at all times.
• Monitor the frequency of absenteeism and ensure that they do not miss more than 20% of their training time which will lead to their missing their examinations.
• Assist pregnant student nurses with catching- up before the beginning of the examinations.
4.1.2.2 Missed examinations Ensure that pregnant students do not miss their examinations if at all possible
• Encourage attendance of ANC to manage physical discomfort and to treat minor ailments to ensure that they do not miss classes due to illness.
• Encourage pregnant student nurses to report their pregnancies in time to be able to access maternity and other benefits that are due to them.
• Encourage the completion of theory and clinical hours to be able to write examinations.
4.1.3 Support system
4.1.3.1 Attitudes of colleagues
Promote positive attitudes among colleagues
• Lecturers should promote group interaction and participation between pregnant student nurses and their colleagues.
• Maintain a productive working environment where the atmosphere is conducive to ongoing communication and learning.
• Discourage other student nurses from discriminating against a pregnant student nurse.
• Pregnant student nurses can be helped to cope with negative comments from other student nurses which do not contribute towards cohesion.
• Promotion of sufficient support and healthy relationships with colleagues and instilling feelings of belonging.
4.1.3.2 Attitudes of lecturers and ward staff
Promote support and care from lecturers and ward staff
• Encourage pregnant student nurses to talk about their academic concerns with lecturers and ward staff so that areas and means to assist can be identified.
• Lecturers and ward staff should avoid labelling or judging pregnant student nurses.
4.1.3.3 Needs of pregnant student nurses
a) Basic, physiological needs
Assist pregnant student nurses in meeting their needs
• Allow and encourage periods of rest for pregnant student nurses.
• Allow pregnant student nurses a period of six weeks as maternity leave, encourage them to take advantage of this, and take steps to minimize the negative consequences of doing so.
• Ensure that their diet is adequate and nutritious for both the mother and the growing fetus.
• Ensure that the environment is quiet and allows for adequate rest and sleep.
b) Safety needs • Ensure that the environment is free from harm and is safe for both mother and baby.
• Provide secure employment during pregnancy and maternity leave by having pregnant student nurses sign for maternity leave to receive the benefits.
• Provision of comfortable chairs to pregnant student nurses in the classroom to prevent backache.
• Advocate for job modification to prevent employment hazards.
c) Love and belonging • Promote showing of care and involvement of friends, colleagues, family and other health workers.
• Avoid instilling feelings of negativity and prejudice against pregnant student nurses. • Ensure pregnant student nurses feel that they
belong and are welcome within the different groups at the college and in the clinical learning areas.
d) Self-esteem needs • Promote unconditional
acceptance of pregnant student nurses by all people.
• Promote confidence among pregnant student nurses by assigning responsibilities to them and give positive feedback.
• Make them feel they are valued and important to the groups and in the learning environment. • Promoting mutual respect among pregnant
student nurses and all other people in the academic environment.
e) Self-actualization needs • Promote morality, creativity and spontaneity among pregnant student nurses to help them reach self-actualization.
• Remove prejudice towards pregnant student nurses which may obstruct their progress towards self-actualization.
4.1.3.4 Support at clinical learning areas
Promote support at clinical learning areas • Provide a stimulating learning environment that is conducive to learning.
• Ensure pregnant student nurses’ physical, psychological and emotional readiness to learn.
• Reduce environmental strain and stressors that may cause hinder progress.
• Promote effective exposure to learning during each allocation.
• Reduce heavy manual workloads and prevent occupational hazards that may predispose pregnant student nurses to preterm labor or excessive fatigue.
• Promote safe working environments for pregnant student nurses that are free from dangers to the mother and the unborn baby. • Encourage effective communication with all
stakeholders in the academic arena.
4.1.4 Maternity leave
4.1.4.1 Address eligibility for maternity leave
Promote eligibility for maternity leave
• Assist pregnant student nurses to make use of the period of maternity leave after childbirth for physical and emotional stability.
• The college policy should make maternity leave a right and not a privilege to pregnant student nurses.
• The college administration should periodically explain the pregnancy policies to all student nurses, and ensure that they understand how to apply for the benefits when the need arises. • Encourage timeous reporting of pregnancies
by pregnant student nurses to ensure that they do not forfeit their maternity leave rights.
• Encourage student nurses who have given birth to continue with their maternity leave after writing their examinations and not to forfeit it.
• Postpone the writing of examinations if it poses a threat to the pregnant student nurse and encourage them to stay on maternity leave until they are fit to write.
• Encourage student nurses who have given birth to stay at home and rest for at least a full month to avoid complications post-delivery.
• Monitor student nurses and advice those who are supposed to be on maternity leave, but opt to be in class for fear of being left behind, to take the opportunity to rest instead. Reassure them that they will receive a chance to catch up.
• Advocate for granting of maternity leave to pregnant student nurses, even if they did not report being pregnant in time.
• Ask the student nurses to produce certificates of fitness before they can commence with classes and practice to ensure that they ready to continue with their studies post-delivery.