4.4.1 Teaching strategies
4.4.1.1 The teaching strategies used to teach R425 learners
Table 4.5 The teaching strategies used to teach R425 learners
The teaching strategies
Always Sometimes Never
Count Row N % Count Row N % Count Row N %
Lecture method 109 54.8 79 39.7 11 5.5
Small group discussions 93 55.0 73 43.2 3 1.8
Problem-based learning 61 40.1 73 48.0 18 11.8 Case-based studies 64 39.0 65 39.6 35 21.3 Questioning 122 69.3 49 27.8 5 2.8 Reflective thinking/Journals 32 21.3 55 36.7 63 42.0 Outcome based 68 43.6 52 33.3 36 23.1 Demonstration 109 72.2 34 22.5 8 5.3 Workbooks 110 74.3 33 22.3 5 3.4 Nursing rounds 145 84.3 27 15.7 0 0.0 Ward rounds 165 92.7 13 7.3 0 0.0 Evidence-based 29 15.3 44 23.2 117 61.6
Although statistical evidence supports all teaching strategies employed, the majority of professional nurses 175 (61.6%) have never utilised evidence-based learning. Therefore, this evidence supports the researcher’s problem statement.
This section looks at the teaching strategies used by the respondents in the units/departments where they are working. For example, the last three options deal with nursing and ward rounds. It is understandable that these would be done very frequently as part of the job description. Furthermore, research use for ‘always’ measured 91 (13.9%) and use of ‘evidence based’ measured 42 (14.8%) and 150 (52.8%) for ’never’. These low figures in relation to 250 (88.1%) of nursing rounds are extremely low which according to the researcher proves that there is still a gap in the utilisation of research findings by the professional nurse in the institutions under study. This is supported by the study conducted in the United States and the Netherlands which indicated that 30– 40% of patients do not receive care in line with the latest research and that 20–25% of
the care provided is inadequate and in some cases even dangerous (Bohman et al (2012:525).
Data used from the United States of America and the Netherlands, Grol and Grimshaw (2003), cited in Llasus (2011:30), reported that 30-40% of all patients do not receive health care based on current relevant knowledge and as much as 20-25% of all patients receive harmful or unnecessary care. In supporting this view, Bakken and Jones (2006) suggest that it is essential that new knowledge be translated and incorporated into clinical practice to improve health care (Llasus 2011:30).
4.4.1.2 The teaching strategies used in teaching R683 programme
Table 4.6 The teaching strategies used in teaching R683 programme
The teaching strategies used in teaching R683 programme
Always Sometimes Never
Count Row N % Count Row N % Count Row N %
Lecture method 100 69.9 39 27.3 4 2.8
Small group discussions 65 58.6 43 38.7 3 2.7
Problem based learning 65 51.6 57 45.2 4 3.2
Case based studies 61 47.7 60 46.9 7 5.5
Questioning 68 60.2 42 37.2 3 2.7 Reflective thinking/Journals 23 20.2 34 29.8 57 50.0 Outcome based 44 42.3 53 51.0 7 6.7 Demonstration 107 75.4 32 22.5 3 2.1 Workbooks 84 67.7 39 31.5 1 0.8 Nursing Rounds 108 80.0 22 16.3 5 3.7 Ward Rounds 126 90.6 10 7.2 3 2.2 Evidence based 24 20.3 50 42.4 44 37.3 Projects 30 25.4 48 40.7 40 33.9 Teachable moments 92 67.2 42 30.7 3 2.2
Among all groups of learners, evidence-based learning is not employed as indicated by professional nurses as a teaching strategy. The table above portrays that 58 (20.3%) is shown under ‘always’. It is disappointing to note that research is not employed even to the Bridging course students who after qualifying will be registered as general nurses and expected to be conversant with the advancement in the nursing fraternity and be the change agents. The bridging course students (R683) are taught introduction to
research in the second year of study. The researcher views this as means of empowering nurses with increased knowledge in order to facilitate improvement in health care delivery that is evidence-based.
4.4.1.3 Teaching strategies used to teach post-basic programmes (R212)
Figure 4.7 Teaching strategies used to teach post basic programmes (R212)
The figures indicate that very little is done by professional nurses in terms of utilising reflective thinking which is, 24 (8.83%) followed by evidence-based 44 (15.38%) and web-based teaching which is 47 (16.67%). However, these teaching strategies are of paramount importance in the post basic course. In Singapore, research modules are being taught to nursing students during their course of study in polytechnics and universities at both undergraduate and postgraduate levels. After graduation, nurses are to utilise research findings and are encouraged to conduct research to evaluate and
improve patient care outcome (Ang, Kwan, Aloweni, Aw, Tee, Tan, Chua & Tay 2015:73).
Conducting research in addition to working in the clinical area is challenging. Many studies have identified lack of time, high workload, limited knowledge and competence to read and use research findings, as well as the lack of organisation support as barriers to utilising and conducting research. The nursing profession needs to improve its professional status. In supporting the role of the post-basic nurse (Duma, Dippenaar, Oosthuizen, Middleton, Phillips, Naude & Uys 2012:5) emphasised the following criteria:
Criteria designating advance nurse/midwifery specialities
According to Duma et al (2012:5), the advanced nurse/midwifery specialist needs to:
• use advanced clinical assessment and decision-making • function with a high degree of autonomy and independence • manage a specified caseload
• implement a range of advanced clinical competencies
• integrate research, education and clinical management in practice • provide consultancy to other health professionals
• be recognised as a first point of entry of service
• advocate for patient’s rights and improved evidence-based quality of care • develop best practice in a specialty field (evidence-based practice)
• participate in policy development for improved practice • publish based on practice and practise research
4.4.1.4 The teaching strategies used to teach the R254 programme
Table 4.7 The teaching strategies used to teach the R254 programme
The teaching strategies used to teaching R254 programme
Always Sometimes Never
Count Row N % Count Row N % Count Row N %
Lecture method 14 53.8 8 30.8 4 15.4
Small group discussions 18 64.3 8 28.6 2 7.1
Problem-based learning 14 70.0 4 20.0 2 10.0 Case-based studies 12 54.5 8 36.4 2 9.1 Demonstration 19 76.0 4 16.0 2 8.0 Simulation 12 46.2 12 46.2 2 7.7 Narrative styles 5 26.3 10 52.6 4 21.1 Inquiry/Socratic questioning 8 36.4 10 45.5 4 18.2 Portfolios 5 22.7 7 31.8 10 45.5 Reflective thinking/Journals 5 25.0 4 20.0 11 55.0 Web-based teaching 6 28.6 2 9.5 13 61.9 Evidence-based 9 40.9 5 22.7 8 36.4 Community-based 9 39.1 5 21.7 9 39.1
The figures of evidence-based are 103 (36.4%), which is a very high percentage of professional nurses doing training in midwifery and not utilising evidence-based when teaching the midwifery students. The midwifery students need to know more about research as they are already the practising professional nurses and their field deals with two lives, that of the mother and child. The focus on the upcoming new nursing qualifications in the new SANC curriculum is on mother and child.
The statistics on infant and maternal mortality rate reveal that there is 140 maternal mortality since 2010-2014. The overall 2013 infant mortality rate was 5, 96 infant deaths per 1,000 live births, nearly the same rate as the rate of 5, 98 in 2012 (Murphy, Jiaquan, Xu & Kochanek 2014:1). The graph remains static which confirms that there is no decline. It is disappointing to note that research is not the first priority to try and curb the high mortality rate.
4.5 SECTION D: EVALUATION OF TEACHING STRATEGIES AND QUESTIONS