Sub-theme 1: Benefits of CPD attendance

skills

Code 2: Peer group teaching Code 3: CPD activities promote networking and team building Code 4: Correlation of theory and practice

4.3.2.2 Sub-theme 2: Challenges regarding CPD implementation

Code 1: Lack of educational resources

Code 2: Shortage of staff Code 3: Portrayal of SANC as a ‘scare crow’

4.4.2.1 Sub-theme 1: Benefits of CPD attendance Code 1: Up-to-date knowledge and skills

Participants reported that it was important for nurses and midwives to attend CPD activities and events in order that they may develop knowledge, skills, improve their attitudes, and add value to the profession. They indicated that nursing is not stagnant and those who attend CPD activities provide safe patient care because they learn about new diseases and how to manage them and how to deal with both adults and paediatric emergencies.

Tr2, PH

“Nursing is not stagnant … is continuous … now these days when you check CPR (cardio-pulmonary resuscitation), you are not going to check the airway first, you are going to check the pulse first. So, … If you are not going to attend the ... CPD points, then you will never know., just because most of the time we are busy in the ward, you can’t just sit down and say let’s give a lecture of this, sometimes in casualty when you sit down, and want to give a lecture, the patient comes , and we all stand up attend the patient ,then you’ll never go back and give the

lecture, then usually, in our wards, it’s busy everyday it’s not easy, sometimes you can do that, sometimes you can’t do, sometimes we do but we failed, just because to do that in our wards, In our wards, it is busy every day, you can’t give lectures. Most of the time in the wards because it is always busy”.

Tr1, PE

“We need to know or in-service ourselves, we need to revive ourselves for continuity of care …”

Tr2, PG

“CPD point is very much important according to my view … nursing is not something, stagnant, it’s something developing; when we go to CPD point… development, they are teaching us about something and … it is very much important for us, probably because, … some other nurses we have some attitudes towards patients, and then since CPD points was introduced we are improving, … nurses are having attitude since CPD was introduced to us, we have changed a lot …”

Participants viewed CPD as very important in that presentation of new diseases in casualty and orthopaedic cases were presented. They learned what was taking place in other wards/units, thus gaining new knowledge.

Tr2, PB, Pg3

“I think it’s very important to us just because when you go to the CPD points, they are presenting some of diseases that you might know how to treat it or to manage the patient, then, sometimes we work in casualty and they are presenting casualty cases and then someone from orthopaedic, he will present with something that they have been seeing in orthopaedic that I did not know how to treat it, ward, then I did not know from orthopaedic …”

Tr2, PF

“CPD is very fruitful; because we are developing us, it is reviving nursing (demonstrating with hands), because we learning … we are learning a lot of things, I am working in orthopaedic ward, it is a specialised ward, but sometimes when we go to CPD, we learn different conditions from somebody working in surgical ward or paeds, a lot of things, Orthopaedic learning a lot of things from surgical wards (showing with hands) or paeds.”

I am working with fractured patients, of which is specialised, I can’t just be like this, but when I attend CPD, I become broad. It is very fruitful.”

It was also reported that proficiencies in emergency care are developed. Participants in this study reported that nurses developed skills in resuscitation of both adults and paediatrics; stereotypes pertaining to one’s unit/ward were removed at CPD. Participants agreed that CPD has helped them to update their knowledge and skills on CPR as it changes rapidly. They indicated that currently CPR starts with pulse, not airway any longer, therefore making CPD very important.

Tr2, PH

“CPR of the past is not the like CPR of this nowadays. Last, ... The CPR of the old, when the patient is fainting you start checking the airway, but CPD of today, you start with the jugular, the pulse of the patient, not the airway. It is very much important…check pulse first”

Tr2, PB

“ Resuscitation of the paeds (patients), … you will be learning more, even if you come across such a problem of emergency, you will be saving the lives of patients, you cannot say you don’t know the resuscitation of paeds, I know to rescus adults, there is a difference thing between resuscitation of paeds and adults, you see … if you are working in maternity … you only learn the things that you come across in maternity, then you don’t even know about resuscitation of paeds but you only know resuscitation of adult life of patients. You don’t know resuscitation of paeds, then somebody can come in CPD in the boardroom, then she will be presenting about, that.”

Code 2: Peer group teaching

Participants felt that those who attend CPD activities add value to those who remain in the unit, colleagues who have attended CPD presentations, develop others, so said the participants. They [participants] felt that not all nurses can attend CPD workshops. Therefore, those who have attended would share the information with those who did not manage to attend. As such, participants felt that they get more information from those who attended workshops.

Tr2, PD

“I think it’s more important because not all of us go to the workshops and if somebody from another ward has gone to the workshop, from our wards, there is no one from the workshop, in other wards there is someone from the CPD point in other words, if we go to the CPD points, they give us more information about their workshops, on CPD points there is someone who has attended the workshops, then they develop us, workshops, then they develop us. In other wards, there’s someone has been workshops, they will give us more information. In other wards there is somebody who has been workshopped …”

CPD reminds nurses and midwives of their obligations, of their purpose and how to take care of their patients. The participants were of the view that CPD is progressive because it enables nurses and midwives to gain more knowledge and enables them to educate one another in terms of professional ethics, professional management, professional leadership, and better relations.

Tr2, PC

“… hen we are there, it reminds us why we are here for patients, because we are here for the patients … it reminds us that, on how to take care of our patients in the wards, and to teach one another.”

Code 3: CPD activities promote networking and team building

Participants stated that CPD assisted them with coping mechanisms for issues that they would not discuss with other colleagues, such topics were handled at CPD presentations.

Tr2, PB

“CPD activities help nurses to deal with issues that they cannot share with others. Topics addressed at CPD on burning issues, make participants to learn coping mechanisms to deal with difficult issues they face in life So If you will be dealing with a burning issue that you cannot even reveal it to someone a burning issue to the others. When we are together in the CPD points (activities), may be they can give us a topic on how to deal with burning issues or how to deal with this, then we gain a lot…”

They [participants] further stated that attendance at CPD improves interpersonal relationships. For the lower categories, they indicated that CPD helped them to build confidence and reminded all nurses about their obligations of rendering quality patient care. Participants viewed CPD as offering team-building opportunities; they got to know each other and make relationships. They felt that they spent most of their time in hospital.

Tr2, PB

“CPD promotes interpersonal relationships and team building opportunities. When we get together we will know each other in the hospital that who is he or who is that, and we are going to … something like, to entertain ourselves; we are here 99% of our year, whatever, whenever, we are in the hospital …”

Code 4: Correlation of theory and practice

Participants reported that CPD assisted them to correlate theory with practice, which had always been a challenge. In addition, they appreciated that CPD had motivated them to remain up-to-date with new developments; they cited an example of CPR, which has evolved over time. Participants stated that CPD has assisted them to learn new conditions, especially in Casualty and Maternity wards. The lower categories indicated that CPD removed the stereotypes that they always carried. They felt that CPD helped them in that they can now assist in emergency deliveries.

Tr2, PE

“… CPD helps nurses and midwives a lot … we are having those who are from in the maternity you’ll’ find that they will call you to come and assist patients in labour how to give birth. CPD builds nurses’ confidence to intervene in emergency situations, especially for enrolled nursing auxiliaries …”

Participants reported that CPD was very crucial and beneficial. They reported that there were other conditions that nurses and midwives would learn at CPD sessions. They reiterated that there was a problem of correlation of theory and practical in the wards. Therefore, CPD enabled nurses and midwives to learn skills and conditions. There are

other conditions that nurses and midwives will learn at CPD that they did not know before. Nurses stated that attending CPD was very crucial and had benefits.

Tr1, PG

“… what I feel about the implementation of CPD … it’s really a good thing in short … because here is where you learn more skills and conditions. Because if you check, there are other conditions that we just know, but when coming to the implementation in the ward, correlating theory that you know and together practical, it’s a problem. If you go to the CPD point and we learn more knowledge, that is in certain conditions, then we are able to correlate whatever we have just learnt in the practical situation, So, I think it is very a nice thing and we should just continue doing and attending because it is very crucial and very beneficial.”

Participants reported that nurses gain knowledge on specialised care in other units, beyond what transpires in their units such as orthopaedics and maternity. Nurses and midwives should not give excuses for not attending CPD, they lose out

Tr2, PB

“If you are working in maternity, you only know procedures in maternity. If you come across with an orthopaedic patient with fracture, you will be knowing how I am going to immobilise the fracture, if you are working in maternity, you will never know how to immobilise the fracture. So if you go to CPD points, they will teach you how to immobilise the fracture, and you will gain knowledge, so if you go to the CPD points, they will teach you how to immobilise the fracture …”

4.4.2.2 Sub-theme 2: Challenges regarding CPD implementation