OPTIMISING THE TEACHING-LEARNING
ENVIRONMENT OF FIRST-YEAR NURSING STUDENTS
AT A PUBLIC NURSING COLLEGE
NTOMBIYAKHE VICTORIA MATSHOTYANA
OPTIMISING THE TEACHING-LEARNING ENVIRONMENT OF FIRST-YEAR
NURSING STUDENTS AT A PUBLIC NURSING COLLEGE
by
NTOMBIYAKHE VICTORIA MATSHOTYANA
Submitted in fulfilment of the requirements
for the degree of
MASTERS IN NURSING
(Research)
in the
FACULTY OF HEALTH SCIENCES
at the
NELSON MANDELA METROPOLITAN UNIVERSITY
Supervisor:
Prof. R.M. Van Rooyen
Co-supervisor
: Dr S. M. du Rand
DECLARATION
I, Ntombiyakhe Victoria Matshotyana, student number 210 148 357, hereby declare that the dissertation for Masters in Nursing (Research) is my own work and that it has not previously been submitted for assessment or completion of any post graduate qualification to another University or for another qualification.
DEDICATION
This study is dedicated to all the nurse educators who do their best in ensuring that students who graduate from the nursing colleges possess the knowledge, skills and attitudes they need to attend professionally to the individual, family and community health needs in the country.
“Whatever your hand finds to do, do it with your might; for there is no work or device or knowledge or wisdom in the grave where you are going”. Ecclesiastes 9:10.
ACKNOWLEDGEMENTS
I give God all the Glory for the strength, insight and courage He provided me to persist with this study; ‘The things which are impossible with men are possible with God’ Luke 18:27.
My sincere gratitude also goes to the following persons:
My family: my mom, Nokose; my sisters - Zameka (and her husband), Bulelwa, Boneka, Nomfundiso and Ntombizodwa; and my nieces and nephews - Sikelelwa, Abongile, Anivuyina, Emihle, Sanelisiwe and Asakhe - for continued support throughout the duration of the study.
My friend Roelof, for prayers, encouragement and support.
My supervisors, Prof Van Rooyen and Dr du Rand for the guidance, encouragement and expert leadership they provided throughout this journey, and moreover for believing that I could do it.
My College Principal, Mrs N. Links, for granting me time to study and permission to access the research participants.
My colleagues at Lilitha College of Nursing, Mr F.M. Mdolo, Mrs E.H. Jonas, Mrs N.P. Tyutyu, Mrs D. Swarts, Mrs N. Fodi, Mrs R. Abrahams, Mrs G. Yon, Ms N. Mtya, Dr H. de Mendonca, Mrs R. Meyer, and Mrs P. Kwanini - for keeping on asking ‘how far are you now Vicky?’. That question prompted me to move on during difficult times of this journey.
The Eastern Cape Department of Health, for the funding they provided and permission they granted to access the research participants.
Mrs M. Lourens, for independent coding.
Dr S. Blunt, for language editing.
Mrs E. Wagenaar for formatting.
Mrs H. Nel for technical support.
Last but not least, the research participants who allowed me to hear the stories of the first part of their journey in nursing education. I only hope that I have conveyed them convincingly to the people who matter.
ABSTRACT
Transition from secondary to tertiary education presents unique challenges for first-year nursing students, similar to those experienced by other first-year students at any other tertiary education institution. Nursing students’ experiences are further complicated by the fact that nursing education incorporates almost equal amounts of time for class attendance and clinical practice placement. As a facilitator of learning for first-year nursing students, the researcher had observed how some new students were apprehensive and uncertain in their first year of study at the college. These and other observations, including those of the researcher’s colleagues, prompted the researcher to conduct a study to obtain information on how the first-year students at her college experience their first year of the nursing programme. This study, therefore, examined the experiences of first-year nursing students at a public college in the Eastern Cape Province enrolled in the four-year diploma programme that leads to registration as a nurse and midwife with the South African Nursing Council (SANC). Insights into these experiences were used to develop guidelines for nurse educators to optimise the teaching-learning environment of these students.
Kotzé’s (1998) nursing accompaniment theory was used as a theoretical grounding for the study. The study followed a qualitative, explorative, descriptive and contextual design. Two of the college’s campuses were sampled for the study. One campus was in a more rural area and the other in a more urban area. Data was collected using purposive sampling of second-year students who were requested to think back to their first year of the nursing programme. Semi-structured, in-depth, face-to-face, individual interviews were conducted. Interview sessions were digitally recorded and then transcribed verbatim by the researcher. The researcher and an independent coder analysed the transcriptions using Tesch’s method of data analysis. The study’s trustworthiness was demonstrated through the criteria of credibility, transferability, dependability, confirmability and authenticity. The results indicated that students had positive and negative experiences in their first year of the nursing programme. Literature control placed the study’s findings within the existing body of knowledge with regard to students’ experiences of their first year. The students’ suggestions on how to enhance first-year
nursing students’ experiences were incorporated into the guidelines that were developed for nurse educators to optimise the teaching-learning environment of first-year nursing students at this college.
KEY WORDS
Experience Facilitation of learning Nurse Nursing Education Teacher-student relationship UndergraduateTABLE OF CONTENTS Page DECLARATION ... i DEDICATION ... ii ACKNOWLEDGEMENTS ... iv ABSTRACT ... v KEYWORDS... vi
LIST OF TABLES ... xii
CHAPTER ONE: OVERVIEW OF THE STUDY 1.1 INTRODUCTION ... 1
1.2 BACKGROUND TO THE STUDY ... 1
1.3 PROBLEM STATEMENT ... 7
1.4 RESEARCH AIM ... 10
1.5 RESEARCH OBJECTIVES ... 10
1.6 CONCEPT CLARIFICATION ... 10
1.6.1 Public Nursing College ... 11
1.6.2 Nursing Student ... 11 1.6.3 Nurse Educator ... 11 1.6.4 Teaching-learning environment ... 12 1.6.5 Optimisation ... 12 1.6.6 Education guideline ... 12 1.7 PARADIGMATIC PERSPECTIVE ... 12 1.7.1 Meta-paradigm of nursing ... 13 1.7.1.1 Human being ... 14 1.7.1.2 Health ... 14 1.7.1.3 World ... 14 1.7.1.4 Nursing ... 15 1.7.2 Structures of accompaniment ... 15 1.7.2.1 Relationship structures ... 16 1.7.2.2 Course structures ... 16 1.7.2.3 Actualisation structures ... 16 1.7.2.4 Goal structures 16 1.8 RESEARCH DESIGN AND METHOD ... 17
1.9 DEVELOPMENT OF GUIDELINES ... 17
1.11 ETHICAL CONSIDERATIONS ... 17
1.12 CHAPTER DIVISION ... 18
1.13 CHAPTER SUMMARY ... 18
CHAPTER TWO: RESEARCH DESIGN AND METHOD 2.1 INTRODUCTION ... 19 2.2 RESEARCH DESIGN ... 19 2.2.1 Qualitative design ... 19 2.2.2 Explorative design ... 21 2.2.3 Descriptive design ... 22 2.2.4 Contextual design ... 22 2.3 RESEARCH METHOD ... 24 2.3.1 Phase one ... 24 2.3.1.1 Research population ... 24 2.3.1.2 Sampling ... 25 2.3.1.3 Data collection ... 26 2.3.1.4 Data analysis ... 30 2.3.1.5 Literature control ... 32 2.3.2 Phase two ... 32 2.3.2.1 Guideline development ... 32 2.4 PILOT STUDY ... 33
2.5 MEASURES TO ENSURE TRUSTWORTHINESS ... 34
2.5.1 Credibility ... 34 2.5.2 Transferability ... 35 2.5.3 Dependability ... 35 2.5.4 Confirmability ... 36 2.5.5 Authenticity ... 37 2.6 ETHICAL CONSIDERATIONS ... 37 2.6.1 Autonomy ... 38 2.6.2 Beneficence ... 39 2.6.3 Non-maleficence ... 39 2.6.4 Justice ... 40
2.6.5 Permission from stakeholders ... 40
2.7 CHAPTER SUMMARY ... 41
CHAPTER THREE: RESEARCH FINDINGS AND LITERATURE CONTROL 3.1 INTRODUCTION ... 42
3.3.1 Characteristics of the sample ... 44
3.3.2 Pilot study ... 44
3.4 DATA ANALYSIS ... 44
3.5 IDENTIFIED THEMES AND SUB-THEMES ... 45
3.6 THEMES AND SUB-THEMES AND LITERATURE CONTROL ... 48
3.6.1 Theme 1: participants’ experiences indirectly related to their education and training ... 48
3.6.1.1 Sub-theme 1.1: Participants had different experiences regarding the welcome to the college/campus and orientation ... 49
3.6.1.2 Sub-theme 2.1: Participants experienced challenges related to the management of the college and its campuses ... 50
3.7 THEME 2. PARTICIPANTS’ EXPERIENCES DIRECTLY RELATED TO THEIR EDUCATION AND TRAINING ... 56
3.7.1.1 Sub-theme 2.1: Participants had a variety of classroom experiences related to the programme, their lecturers and their fellow students ... 57
3.7.1.2 Sub-theme 2.2: Participants had a variety of experiences in the clinical practice environments related to their lecturers, clinical nursing staff members and patients ... 62
3.7.2 THEME 3: PARTICIPANTS’ REFLECTIONS ON THEIR EXPERIENCES OF THE TEACHING-LEARNING ENVIRONMENT. ... 70
3.7.2.1 Sub-theme 3.1: Students experienced personal growth and development through being enrolled in the programme. ... 70
3.7.2.2 Sub-theme 3.2: Participants experienced a lack of professionalism by a number of lecturers, nursing staff members in the clinical practice environment and members of the management team. ... 72
3.7.2.3 Sub-theme 3.3: Participants suggested how the teaching-learning environment at the college could be improved ... 75
3.8 CHAPTER SUMMARY ... 85
CHAPTER 4: GUIDELINES, LIMITATIONS, RECOMMENDATIONS AND CONCLUSIONS 4.1 INTRODUCTION ... 87
4.2 SUMMARY OF FINDINGS ... 87
4.3 DEVELOPMENT OF GUIDELINES ... 91
4.4 PRINCIPAL GUIDELINES TO OPTIMIZE THE TEACHING-LEARNING ENVIRONMENT OF FIRST-YEAR NURSING STUDENTS AT A PUBLIC NURSING COLLEGE ... 92
4.4.1 Principal guideline 1: develop a one week long orientation programme that will enable first-year nursing students to adapt to the college and its associated clinical practice environments as quickly as possible ... 97
4.4.1.1 Sub-guideline 1.1: Introduce the campus head, nurse educators and other staff members of the college to the first-year nursing students on the first day of orientation ... 97
4.4.1.2 Sub-guideline 1.2: Invite an official from the Eastern Cape Department of Health to address first-year nursing students on the bursary system
for student funding ... 99
4.4.1.3 Sub-guideline 1.3: Arrange an outing for the first-year nursing students and their nurse educators towards the end of the orientation week ... 100
4.4.2 Principal guideline 2: manage the transition of first-year nursing students from the secondary education institution to the tertiary education institution ... 101
4.4.2.1 Sub-guideline 2.1: Identify and manage the expectations of first-year nursing students about studying at a tertiary education institution ... 102
4.4.2.2 Sub-guideline 2.2: Indicate to the first-year nursing students the support that is available to them at the college ... 103
4.4.2.3 Sub-guideline 2.3: Advise first-year nursing students on effective study methods and time management ... 105
4.4.2.4 Sub-guideline 2.4: Advise first-year nursing students how to strike a balance between personal, student and social life ... 106
4.4.3 Principal guideline 3: improve the accompaniment of first-year nursing students in the clinical practice environments ... 108
4.4.3.1 Sub-guideline 3.1: Carefully plan the first week of first-year nursing students’ placement in the clinical practice environment ... 108
4.4.3.2 Sub-guideline 3.2: Advocate for employment of nurse educators whose sole responsibility would be to accompany first-year nursing students in the clinical practice environments ... 110
4.4.3.3 Sub-guideline 3.3: Build good working relationships with professional nurses in the clinical practice environments to encourage their support of the first-year nursing students ... 112
4.4.4 Principal guideline 4: maximise the possibility of student learning in all nurse educator-student encounters ... 114
4.4.4.1 Sub-guideline 4.1: Allocate competent nurse educators to facilitate learning of first-year nursing students ... 114
4.4.4.2 Sub-guideline 4.2: Define the boundaries of nurse educator-student relationships ... 116
4.5 COMPLETION OF THE STUDY ... 117
4.6 LIMITATIONS OF THE STUDY ... 118
4.7 RECOMMENDATIONS ... 118
4.7.1 Recommendations for nursing practice ... 118
4.7.2 Recommendations for nursing education ... 119
4.7.3 Recommendations for nursing research ... 119
4.8 CONCLUSION OF THE STUDY ... 119
4.9 CHAPTER SUMMARY ... 120
REFERENCE LIST ... 121
ANNEXURE A: APPROVAL LETTER FROM NMMU ... 134
ANNEXURE C: LETTERS TO AND FROM LILITHA COLLEGE ... 140
ANNEXURE D: LETTER TO THE RESEARCH PARTICIPANT ... 144
ANNEXURE E: INFORMATION AND CONSENT FORM ... 147
ANNEXURE F: INDEPENDENT CODER ... 149
ANNEXURE G: INTERVIEW TRANSCRIPT ... 151
LIST OF TABLES Table 3.1: Experiences of first-year nursing students at a public nursing college. ... 47 Table 4.1: Guidelines to optimise the teaching-learning environment of first-year nursing
CHAPTER ONE
OVERVIEW OF THE STUDY
1.1 INTRODUCTION
Commencement of studies at a nursing college presents unique challenges for first-year nursing students, which are similar to those experienced by other first-year students at any other tertiary education institution. Even intellectually gifted students experience some difficulty with transition from secondary to tertiary education (McPhail, Fisher & Conachie, 2009:3). Experiences of nursing students are further complicated by the fact that nursing education incorporates almost equal amounts of time for class attendance and clinical practice placement (Jonsén, Melender & Hilli, 2013:298). This study examined the experiences of first-year nursing students in a four-year diploma programme that leads to registration as a nurse and midwife with the South African Nursing Council at a public college in the Eastern Cape Province. Insights into these experiences were used to develop guidelines for nurse educators to optimise the teaching-learning environment of first-year nursing students at a college. Exploration and description of students’ experiences constituted phase one of the study, and guideline development was phase two.
In this chapter the researcher presents the background to the study. Literature concerning the experiences of first-year, nursing and non-nursing students at tertiary education institutions is discussed. The background to the study is given and a problem statement presented. The research objectives are stated and concepts that relate to the study clarified. The paradigmatic perspective of the study is also explained. Mention is made of the research design, method and ethical considerations of the study (a detailed discussion is presented in chapter two).
1.2 BACKGROUND TO THE STUDY
Most of the first-year students who commence studies at tertiary education institutions are school leavers who might be leaving home for the first time (Feldman & Zimbler,
2011:1). Leaving home usually necessitates major adjustments socially, psychologically and even financially on the part of these teenagers. School leavers are separated from family and friends and might therefore lack the readily available support and help which they previously obtained. They are faced with the challenge of having to make new friends and develop different support systems. They must now take care of themselves and manage their finances and time. These adjustments are not always easy and can contribute to negative experiences on the part of students (Dzurec, Allchin & Engler, 2007:548; Mc Phail et al., 2009:3). In South Africa, most tertiary education institutions are located in cities (urban areas). School leavers from rural areas usually experience more culture shock than those who did their primary and secondary education in the townships (compare Jama, Mapasela & Beylefeld, 2008: 993). Students in rural areas are well known to their teachers, but when they arrive at tertiary education institutions they get lost in the crowd. Jama et al. (2008:993) support this statement; they indicate that tertiary education institutions have much bigger classrooms than secondary ones, in which relations are impersonal. This can have a negative effect on the first-year student.
According to Bruce, Klopper and Mellish (2011:11) and Gordon, Reid & Petocz (2010: 961), students entering tertiary education institutions are from diverse backgrounds and their ages vary. Some background differences include culture, attitudes, values, language, socio-economic status, education, ethnicity and religion. Matoti (2010:154) states that student background, particularly cultural and academic background, can affect students’ needs and preferences with regard to teaching methods, classroom climates, and study patterns. In an Australian study, first-year nursing students learned to write academic essays. Some students in that study indicated that they did not benefit much from the project (of learning how to write essays) because they lacked computer skills. This lack was related to the access students had to computers and the internet before commencing their studies in the tertiary education institution. According to Madsen (2009:43), the distance between these students’ homes and the university, and the students’ interest in computers contributed to their opinions.
South Africa, also known as the ‘rainbow nation,’ has considerable diversity in its tertiary education student body. Of particular importance is the difference in language. There are
11 official languages (Casale & Posel, 2010:2), yet only one language (English) is a medium of instruction. English is a second or third language for most of the country’s citizens and the result is that most students take longer to understand what is being said in the classroom (Parkinson & Crouch, 2011:84-85). This situation becomes even more difficult when the learning facilitator is also not very conversant with English (McLachlan, Alexander & Lehmann, 2010:85), which contributes to the challenges experienced by first-year students at tertiary education institutions in South Africa.
First-year students may be overwhelmed by the amount of independent study they have to do at tertiary education institutions because they might not have learnt to be independent learners in the secondary education institutions they have attended (Hodgson, Lam & Chow, 2010:6). In a study conducted in the US that examined first-year students’ reasons for depression, work overload was cited as the number one cause (Dzurec, et al., 2007: 548). In another study, nursing students who were interviewed before their first exposure to the clinical practice environment, said they were overwhelmed by the programme content and that they were not aware that nursing involved studying subjects such as psychology, sociology, chemistry and physics (O’Brien, Mooney & Glacken, 2008:1848).
A mismatch between students’ dreams and expectations about a tertiary education institution, and its reality, has the potential to cause difficulty in transition. Brinkworth, Mc Cann, Matthews and Nordström (2009:163) examined expectations and experiences of first-year students from Humanities and Science faculties and found a mismatch between students’ expectation about how soon they would receive feedback on assignments and the reality of when they received the feedback. Students expected to receive feedback within three weeks of submission of their work. The reality was that they sometimes received feedback as late as six weeks after submission. Billings and Halstead (2013:250) indicate that in professional situations faculty members frequently need to deliver critical feedback that is constructive in nature to facilitate professional development, and that students do not understand the benevolent motives behind feedback. Trust is therefore not established and may contribute to the confusion students experience when comparing themselves with the “ideal nurse” that is being put
forward. Adolescent students therefore struggle to establish their developing self-image (Billings & Halstead, 2013:250; Bastable, 2008:168).
In Brinkworth et al. (2009) participants indicated that they expected their lecturers to always be available when they needed them for one-on-one encounters, but in reality the lecturers were not always available when the students needed them: one-on-one encounters were scheduled for specific days and times of the week and not for everyday of the week (Brinkworth et al., 2009:163). This expectation is particularly true for those students from rural areas who are accustomed to individualised, readily available attention from their primary and secondary school teachers.
A South African study that examined why first-year university nursing students ‘dropped out’, concluded that a mismatch between students’ expectations and the reality of the nursing profession could be a contributing factor (Wright & Maree, 2007:606). The students who were interviewed in that study expected a nurse to function mainly at an affective domain and nursing itself to be mainly concerned with psychomotor skills. These students did not expect the extent of cognitive functioning they were required to engage in. Such a mismatch between expectations and the reality of a situation could contribute to students having negative experiences of their first year of the nursing programme (Wright & Maree, 2007:606). Andrew, Salamonson, Weaver, Smith, O’Reilly and Taylor (2007:868) found that first-year students who left the nursing programme during the first semester were reportedly not prepared for the challenges of certain theoretical courses because they expected nursing to be ‘more hands on’. In literature she reviewed, Orton (2011:2) found that the primary reason for first-year student attrition was the discrepancy between expectations about nursing education and the reality experienced by the nursing students.
Brinkworth et al. (2009:158) argue that some schools may be under pressure to get students into universities, which results in teachers at these schools helping students excessively to get good grades for university entrance. According to these authors, this extra help could create unrealistic expectations on the part of first-year students regarding tertiary education institutions. Students in this study were aware that university study would necessitate working harder than at secondary education
institutions, but they were not prepared for the extent of that work. Research findings of Matoti (2010:145) indicated that first-year students were under-prepared to study at a tertiary education institution. Their under-preparedness was evidenced by the students’ need for notes from the lecturers and their desire for presentations to be conducted in the vernacular - pointing to their difficulty in engaging with academic text. Similar findings were reported by Fanetti, Bushrow and DeWeese (2010:80): first-year college students reportedly found difficulty with academic writing because at school their writing was simply a preparation for writing tests and examinations.
In addition to the common challenges faced by all first-year students in tertiary education institutions, nursing students have to cope with the unique experiences of clinical practice environments. Clinical practice environments are sometimes not what students expected when they applied for entrance into the nursing programme. In clinical practice environments, nursing students learn through exposure to real patient situations, and they do so in interaction with other members of the multidisciplinary team. In South Africa the multidisciplinary team includes professional nurses, enrolled nurses, enrolled nursing auxiliaries, doctors, pharmacists and dieticians. Professional nurses in clinical practice environments play a vital role in student learning, but nurse educators accompany students to ensure that they achieve the course outcomes for which they were allocated to that particular environment (Meyer & van Niekerk, 2008:108). Some staff members in the clinical practice environments fail to be good role models for first-year students, and students who are disappointed by the behaviour of these staff members sometimes leave the nursing profession.
In a study by Grealish and Ranse (2009:85), a number of first year nursing students experienced certain nursing staff members in clinical practice environments as not ‘caring’ for the patients, which they found disappointing. Staff shortages in the clinical practice environments sometimes result in first year-students being seen as ‘just another pair of hands’, rather than as the neophyte nurses which they are − in need of care from the experienced nurses in these environments (Carlson, Kotzé & Van Rooyen, 2003:35; Taylor, 2009: 134-135).
According to Gibbons, Dempster and Moutray (2007:283), nursing students’ stress is categorised as academic, clinical and personal in origin. First-year nursing students, particularly those who do not have a nursing background, usually find clinical practice environments anxiety-provoking, which may hinder their learning. Factors that may bring about the anxiety identified by Carlson, et al. (2003:31), Cilingir, Gursoy, Hintistan and Ozturk (2011:491) and Morgan (2006:159) include fear of making mistakes owing to incompetence, fear of dealing with dying or deceased patients and their relatives, non-supportive staff members, and the difference between what they are taught in the classroom and the way things are done in clinical practice environments. In Sharif and Masoumi (2005:4) a first-year student in her first clinical placement related how anxious she felt when she was asked by a patient what his diagnosis was - which she did not know. In another study, students whose first placement was in a cancer ward expressed how helpless they felt during the early periods of their placement because they did not know what to do for those patients (Yildiz & Akansel, 2011:2612). Terry and Carrol (2008:763) found that first-year students experienced working with dying and deceased patients as particularly difficult. These students reported being unable to sleep at night due to flashbacks of the scenes. Some of these students could still smell the deceased patients long after their death. In South Africa we have the highest incidence of HIV in the world, so nursing students in this country are often exposed to the protracted death of emaciated, depressed AIDS patients (Williams, Van Rooyen & Ricks, 2007:13).
Student-centred education encourages students to be actively involved in their own learning, which promotes the likelihood that what is learned will be remembered a long time after teaching has taken place (Moyer & Wittman-Price, 2008:58; Young & Paterson, 2007:5; Doyle, 2008:6). Nursing staff members, particularly nurse educators, have an influence and indeed, a responsibility to create an environment that is conducive to student learning (Pittaway, 2012:39). In a study by Taylor (2009:123-127) first-year nursing students indicated that they were inspired by nurse educators who were approachable, enthusiastic, interacted well with them, engaged them in discussion, and used humour in their facilitation of learning. The same students reported being de-motivated by nurse educators who yelled at them, and were too authoritative, disrespectful and dull when facilitating learning. The opinions of these students are
echoed by Clark (2008:56), and Meyer and Van Niekerk (2008:107), who suggest that a nurse educator can evoke positive responses from students by dealing with them in a humane, authentic, non-judgemental, caring and respectful manner. To avoid the problem of educator dullness in presenting lectures, Bennet and Kane (2009:52) indicate that managers they interviewed allocated interesting educators to first-year classes. In a South African study by Mc Lachlan et al (2010:85), findings similar to those discussed in the previous paragraph were obtained. Students in that study indicated that a contributing factor to their failing the first year was that some lecturers were uninteresting in their presentation of their subject and that others did not know the subject they were teaching (Mc Lachlan et al, 2010:85). In the clinical practice environment, nursing students are also motivated by mentors who interact with them in a non-intimidating manner and do not belittle them (Mhlaba & Mthembu, 2011:47). From the above discussion, it can be deduced that a nurse educator needs to employ a variety of strategies to facilitate student learning to cater for student diversity (Matoti, 2010:152). However, Madsen (2009:42) notes that it is not possible to meet the learning styles and needs of every student.
1.3 PROBLEM STATEMENT
The overall goal of nursing education is to educate and train nurse practitioners, to imbue them with knowledge and skills, which will enable them to care for patients in a variety of health care settings (Bruce et al., 2011:346; Kotzé, Armstrong, Geyer, Mngomezulu, Potgieter & Subedar, 2008:185). Throughout the world, the nursing profession forms the backbone of healthcare provision (Bezuidenhout, Human & Lekhuleni in Klopper, 2013:32). These views are echoed by Jeptha, Mc Laren and Watkins (2008:18) who suggest that the throughput rate of nursing students in South Africa is significant because the health-care industry depends on the quality and quantity of nursing staff in the country. Nursing colleges, according to Wildschut and Mqolozana (2008:24), dominate with regard to the output of professional nurses. To attest to these authors’ statement, of the 44 911 professional nurses who were educated and trained in all the South African nursing education institutions in the past ten years, only 5 564 (12.4%) were educated at
universities. This means that more than 80% of South African nurses are educated and trained at nursing colleges (South African Nursing Council 2012). However, the existing outputs of SA nursing education institutions are insufficient to meet the country’s health care demand for nurses and midwives (The National strategic plan for nurse education, training and practice 2012/13-2016/17:17). The researcher believes that endeavours to optimize the teaching-learning environment of first-year nursing students at the public nursing college under study could contribute to increasing their perseverance until graduation, thereby increasing the number of professional nurses in the country.
At the college under study, candidates for the four-year diploma programme include those coming directly from secondary education institutions, those who have been practising as nurses or other categories of workers at the clinical practice environments, and those who did their secondary education some time previously, but could not be admitted into the programme for a variety of reasons, for example, fewer positions in the programme for the number of applicants in a particular year. As a learning facilitator for the first-year nursing students for the past nine years, the researcher has observed that most first-year students at this college experience anxiety, fear and apprehension about the programme during their first year of study, particularly in relation to tests and examinations. These feelings are also true for mature students because of the long period between their secondary education years and the commencement of the nursing programme (Higginson, 2006:35).
A number of first-year students have often complained to the researcher and her colleagues that they do not understand what some nurse educators teach them. Others have wished that they could be taught in the same way that their teachers in the secondary education institutions taught them, for example, the nurse educators explained every aspect of the work and did not require them to do independent study, since it is difficult for them. This suggests that students observe a difference between how they were taught at the secondary education institutions and the way they are taught at the college. Guidelines that will be developed for nurse educators will hopefully help the first-year students to adapt at the college.
Nurse educators at the college who are the researcher’s colleagues often complain that the calibre of contemporary nursing students is different from the nursing students they taught previously. Two differences that are cited are that nursing students these days are not as hard-working as before, and they appear to have more family and social problems they need to attend to, than did former students. These differences suggest that the approach to facilitation of learning of contemporary students should be different from that of the former students, if these students are to succeed in their nursing education. Guidelines developed for nurse educators will hopefully contribute to accommodating contemporary students and improve their prospects of success in the nursing programme.
South African clinical practice environments are not what first-year students expect them to be. When students first enrol into the programme, they are at the college for about eight weeks for the programme’s theoretical component before they experience the clinical practice environments. Their idea of the hospital wards and clinics is the ideal situation they have read about in the textbooks and observed at the simulation laboratories. It is therefore inevitable that when they arrive in these environments − which suffer from a shortage of nursing staff and other nurses who have burnout syndrome − they experience a reality shock. A number of first-year students have reported to the researcher how the nurses in the wards do not have the empathy they learn about in Ethos of Nursing and Professional Practice and that this is frustrating to these neophytes. Simply put, these first-year students generally do not find role models in the clinical practice environments whose behaviour they can emulate.
As mentioned above, students at the college under study have a number of family and social problems that impact on them during their studies. Unfortunately the college does not have social workers and psychologists to whom students with problems can be referred, and thus nurse educators must sometimes assume this role. Guidelines that will be developed will hopefully make recommendations on how first-year students at this college can be better supported.
Africa, and in particular regarding the experiences of first-year students at the public nursing college of the Eastern Cape Province. This study will therefore partly bridge this gap by exploring and describing the experiences of first-year nursing students regarding their programme in order to develop guidelines for nurse educators to optimise the teaching-learning environment of first-year nursing students.
The two main questions posed in this study are:
What are the experiences of first-year nursing students at the public college in the Eastern Cape Province?
How can nurse educators optimise the teaching-learning environment of first-year nursing students at a public nursing college?
1.4 RESEARCH AIM
The aim of the study was to:
Explore and describe the experiences of first-year nursing students regarding their nursing programme at a public nursing college in the Eastern Cape Province, in order to develop guidelines for nurse educators to optimize the teaching-learning environment of these students.
1.5 RESEARCH OBJECTIVES
The objectives of the study are to:
Explore and describe the experiences of first-year nursing students in relation to their nursing programme at a public nursing college.
Develop guidelines for nurse educators to optimise the teaching-learning environment of first-year nursing students at a public nursing college.
1.6 CONCEPT CLARIFICATION
Botma, Greeff, Mulaudzi and Wright (2010:272) state that multiplicity of interpretation of concepts in the human sciences necessitates that the main concepts be clarified in
research. Therefore theoretical definitions and explanations are given for the following concepts:
1.6.1 Public Nursing College
According to Soanes and Stevens (2004:1161), ‘public’ means of the state, or provided by the state rather than an independent commercial company. In this study, a public college refers to a nursing college that is funded by the provincial government and governed by the Eastern Cape Department of Health.
1.6.2 Nursing Student
A nursing student is a person who is registered as a learner nurse with the SANC in terms of Section 32 of the Nursing Act (33 of 2005). According to the Education and Training of Nurses and Midwives Provincial Act, 2003 (no. 4 of 2003) a nursing student is any person registered as a student at the nursing college. Unless otherwise specified the concept ‘student’ refers to a first-year nursing student of the diploma programme that leads to registration as a nurse (General, Psychiatric and Community) and midwife with the South African Nursing Council (Regulation R. 425, 1985 as amended) in a public college in the Eastern Cape Province.
1.6.3 Nurse Educator
A nurse educator is a nurse who has been academically prepared to facilitate the learning of theory in the classroom, skills in the simulation laboratory and clinical practice in a variety of speciality settings (Utley, 2011:2). In South Africa, nurse educators are prepared only at universities and their preparation must comply with the minimum requirements of the South African Nursing Council (Bruce et al., 2011:107-108). For the purposes of this study, a nurse educator is an individual who has a nursing education qualification and is employed by the Eastern Cape Department of Health to facilitate first-year nursing students’ learning in the classroom, in simulation laboratories and clinical practice environments. At this public college the concepts ‘nurse educator’ and ‘lecturer’ are used interchangeably, but the researcher has mostly used the concept ‘nurse educator’ in chapters one, two and four. In chapter three the concept ‘lecturer’ was
1.6.4 Teaching-learning environment
Teaching-learning environment is the context in which the nurse educator facilitates learning and the students learn (Bruce, et al., 2011:106). For the purpose of this study, the teaching-learning environment includes the classroom, the clinical simulation laboratory, and the clinical practice environments. This environment includes the quality and quantity of facilitation of learning by nurse educators as experienced by the first-year nursing students and the quality and quantity of support obtained by first-year students in the clinical practice environments. The physical, social, emotional and spiritual domains are included in this environment.
1.6.5 Optimisation
To optimize, according to the Soanes and Stevens (2004:1004), means “to make the most effective use of a situation or a resource”. For the purpose of the study, optimization of the teaching-learning environment implies creating learning opportunities for first-year students in an environment that maximises their learning.
1.6.6 Education guideline
A guideline is defined by De Mendonca, Van Rooyen, Uys and Roux (2009:20) as a set of rules or standards which have been systematically developed to inform decisions on policy formulation and application. For the purpose of this study, education guidelines refers to the document that contains the recommendations of how to optimize the teaching-learning environment of the first-year nursing students with an emphasis on the quality of learning facilitation provided by nurse educators at the public nursing college in the Eastern Cape Province.
1.7 PARADIGMATIC PERSPECTIVE
The study was based on “An Anthropological Nursing Science: Nursing Accompaniment Theory” by W.J. Kotzé (1998: 3-14). Kotzé regards accompaniment as a conscious and systematic effort by a nurse to help another person obtain independence and self-reliance (Kotzé, 1998:3). In health care situations the person who is dependent on a nurse is the patient or client, and in nursing education situations the dependent person is the
student. The goal of accompaniment for patients/clients is to assist them regain health, and if this is not possible, to help them find meaning in life until their death. For nursing students accompaniment aims to empower them with knowledge, skills and attitudes that will enable them to become competent, independent, professional nurses on completion of the nursing programme (compare Kotzé, 1998:3). In the current study the second accompaniment situation described above is applicable.
The accompaniment theory implies that first-year nursing students come to the unfamiliar world of the college and the related clinical practice environments where nurse educators should relate understandingly and openly with them, thus enabling them to develop trust, which in turn will enable them to reciprocate the relationship. The nurse educator should be accessible to the student and prepared to enter into a meaningful relationship that will encourage the student to actively participate in activities that will lead to the attainment of the accompaniment goals (Kotzé, 1998:13).
When the student has gathered the courage to participate in goal-directed activities, the nurse educator should observe what the student is doing in order to identify his or her learning needs and give guidance where necessary. Guidance and assistance should be given in a manner that considers the dignity and feelings of the student. When students are treated with dignity and respect they gain confidence and self-esteem, which will enable them to be willing to risk more participation in goal-directed activities (Kotzé, 1998:11). As students show more independence, nurse educators should allow them to work on their own and only give occasional assistance. Gradually the educator should withdraw from the student because the goal of accompaniment, which is to assist the student to be an independent worker, is now achieved (Kotzé, 1998:13).
1.7.1 Meta-paradigm of nursing
According to George (1995:1), there is an agreement in literature that nursing is concerned with four major concepts, namely, person, health, environment and nursing (Moyer & Wittmann-Price, 2008:7; Mellish, Brink & Paton, 1998:13; Bruce, et al.,
following sections the nursing meta-paradigm described by Kotzé (1998:4) is briefly presented.
1.7.1.1 Human being
Kotzé (1998) views the human being as multidimensional with an inextricably linked body, psyche and spirit domains, which are in dynamic relationship with God, the world, fellow beings and time (Kotzé, 1998:4). According to Kotze (1998:6), the spiritual dimension is the centre of humanness because it is the origin of the human personality. The human personality manifests itself through the physical and psychical abilities, that is, through the other two domains (Compare Kotzé, 1998:6). The spiritual dimension enables humans to reach out beyond existing unfavourable circumstances and find meaning in seemingly hopeless situations. In this study the multidimensional human being refers primarily to the first-year nursing student in dynamic interaction with the nurse educator in the nursing education environment.
1.7.1.2 Health
Health is described as a person’s ability or inability to optimally maintain his or her relationships with fellow human beings, the environment and time (Kotzé, 1998:7). In this study health means a state of balance where the first-year student maintains an optimal relationship with fellow students, nurse educators, and the other members of the multi-disciplinary team in clinical practice environments.
1.7.1.3 World
As a multidimensional body-psyche-spirit being, the first-year student is in a dynamic relationship with the world (objective and subjective, or life world), time, fellow-beings and God (Kotzé, 1998:4). The student’s objective world consists of all that is outside the boundaries of his/her life world, including science, nature, ecology and the world of micro-organisms. The student is only vaguely aware of what constitutes his/her objective world (Kotzé, 1998:9). The subjective world includes the personal world, the world of co-existence with others, and the dimension of time in which the human being exists. For the first-year student, the subjective world is that world which the student has adapted
to, which he/she knows well and which meets his/her needs. When the first-year student initially comes to the nursing college to learn to be a professional nurse, he/she does not know much about nursing and health care facilities, in other words, nursing and health care facilities at that time constitute his or her objective world. The goal of educating and training the student (and accompaniment is an integral part), is to make nursing knowledge part of the students’ subjective world (Kotzé, 2008:9). At the college and its related clinical practice environments the student interacts with nurse educators and members of the multidisciplinary team − primarily professional nurses − who are responsible for ensuring that the goals of accompaniment are attained.
1.7.1.4 Nursing
According to Kotzé (1998:4), nursing is an interpersonal service to humankind, sick or well; it encompasses management, clinical care and teaching, which involves accompaniment. Nursing’s goal is prevention of illness, promotion of health and, where that is not possible, facilitation of the peaceful death of an individual. For this study the concept of nursing implies that the nurse educator should care for the students, making sure that their physical, emotional and spiritual environment is conducive to learning so that they can become competent, independent and professionally mature nurses who can provide competent care to patients.
1.7.2 Structures of accompaniment
Kotzé’s approach to the nursing accompaniment process is parallels the nursing process (Kotzé, 1998:10). Bruce et al. (2011:47) describe the nursing process as “a deliberate intellectual activity by which practitioners approach the practiceof nursing in an orderly, systematic manner and a specific method for applying a scientific or problem-solving approach to nursing practice”. Four structures should be observed in the accompaniment process − relationship, course, actualisation and goal (Kotzé, 1998:10). These overlapping structures are analogous to the steps of the nursing process listed by Bruce et al.
(2011:47), namely, assessing, diagnosing, planning, implementing and evaluating. The four accompaniment structures are briefly explained.
1.7.2.1 Relationship structures
Relationship structures are based on the assumption that for accompaniment to be successful, the accompanier and the accompanee must enter into a relationship that will bring about a sense of security for the accompanee. The accompanier should understand the accompanee’s experiences, anxieties, concerns, frame of reference and strengths. The accompanee, on the other hand, should understand the duties of a nurse in this relationship. The relationship between the two parties should be based on trust (Kotzé, 1998:10-11).
1.7.2.2 Course structures
Course structure assumes that the nature of involvement between the accompanier and the accompanee depends on the degree of support the accompanee needs. The implication is that the accompanier should initially observe the accompanee to identify his or her learning needs. When the accompanee is dependent on others to meet his/her needs, the accompanier relates closely with the accompanee, giving him/her the necessary information and support. As the accompanee gains independence, the accompanier gradually reduces the intensity of involvement until the accompanier is no longer needed by the accompanee (Kotzé, 1998:11).
1.7.2.3 Actualisation structures
Actualisation structures refer to the fact that the accompanier and the accompanee should each bring something to the relationship for it to be successful. For example, as the accompanier makes him/her available, the accompanee should explore new possibilities; as the accompanier praises/reinforces the attitudes, knowledge, skills and behaviour of the accompanee, the accompanee should develop confidence, self-respect and self-appreciation (Kotzé, 1998:11).
1.7.2.4 Goal structures
Goal structures require that for the accompaniment to achieve its goals, the accompanee should realise several objectives, namely, accepting the challenge to create a meaningful
existence, becoming an independent decision-maker, and achieving realistic, responsible self-assessment and self-understanding, among others (Kotzé, 1998:11).
1.8 RESEARCH DESIGN AND METHOD
According to Polit and Beck (2010:74), research design is the overall plan that the researcher follows in answering the research question. This study followed a qualitative, explorative, descriptive and contextual design. Sampling was purposive and the data was collected through semi-structured, in-depth, face-to-face, individual interviews with second-year students at two of the college campuses. A comprehensive description of the design and method follows in chapter two.
1.9 DEVELOPMENT OF GUIDELINES
Guideline development constituted phase two of the study. Based on the research findings and the relevant literature, and discussion with experts in the field, guidelines were developed for nurse educators to optimize the teaching-learning environment of first-year nursing students at a public nursing college in the Eastern Cape Province. Details of guideline development are presented in chapter two of the study.
1.10 MEASURES TO ENSURE TRUSTWORTHINESS OF THE STUDY
Polit and Beck (2008:768) regard trustworthiness as the degree of confidence qualitative researchers have in the quality of gathered data and the research findings. In the current study, trustworthiness was assessed through using the following criteria − credibility, transferability, dependability, confirmability and authenticity − described in chapter two.
1.11 ETHICAL CONSIDERATIONS
Social research, as opposed to natural science research, deals with human beings, not objects. Human beings have rights, which should not be violated by researchers in the name of a quest for new knowledge. In this study, the ethical values that were adhered to are autonomy, beneficence, non-maleficence and justice. In addition to these principles, permission to conduct this study was sought from the relevant authorities.
1.12 CHAPTER DIVISION
This dissertation is presented in four chapters as follows. Chapter 1: Overview of the study.
Chapter 2: Research design and method.
Chapter 3: Discussion of research findings and literature control. Chapter 4: Guidelines, limitations, recommendations and conclusions.
1.13 CHAPTER SUMMARY
In this chapter the researcher explained the background to the study taking into consideration the reviewed literature concerning the experiences of first-year students in general, and nursing students in particular. The research problem and objectives were stated and concepts related to the study were explained. The paradigmatic perspective of the study was described. The research design and method, the study’s trustworthiness and the ethical considerations were briefly outlined. Chapter two provides a comprehensive discussion of the research design and method.
CHAPTER TWO
RESEARCH DESIGN AND METHOD
2.1 INTRODUCTION
In chapter one the researcher discussed the background of the study, the research problem and objectives, and the paradigmatic perspectives, and gave a brief outline of the research design and method, and the chapter outline of the study. In chapter two a detailed discussion of the research design and method applicable to this study is presented. The researcher was interested in ascertaining the experiences of first-year nursing students of the four-year diploma programme at a public college of the Eastern Cape Province that leads to registration as a nurse (General, Psychiatric, and Community) and midwife with the South African Nursing Council.
2.2 RESEARCH DESIGN
Research design, according to Burns and Grove (2009:696), is a blue print for conducting a study that maximises control over factors that could interfere with the validity of the research findings. As pointed out in chapter one, a qualitative, explorative, descriptive, and contextual design was utilised in this study.
2.2.1 Qualitative design
Qualitative research is described by Creswell (2009:4) as enquiry that seeks to explore and understand the meaning individuals or groups ascribe to a social or human problem. It focuses on how people perceive their experiences and the world they live in (Holloway & Wheeler, 2010:3). The researcher was interested in exploring and describing the experiences of students, therefore qualitative research was the design of choice because it would enable her to tap into those experiences.
Qualitative research takes place in a natural setting which contains the phenomenon of interest to the researcher (Creswell, 2007:37). In the current study, the researcher went to the campuses where students study nursing to interview the students concerning their
does not depend on instruments that have been developed by other researchers for data collection (Creswell 2007:175). To be an effective data collection ‘instrument’, the researcher needs to interact closely with the participants in order to understand their world. Closeness can be achieved when trust has been developed between the researcher and the participants (Parahoo, 2006:64). The researcher also needs to be flexible, in other words, alert, creative and imaginative during data collection, decide on further questions to ask during the interview to gain clarity concerning what the participants are talking about, and observe the participants’ behaviour to obtain a complete picture of their experiences. Polit and Beck (2008:550) emphasise that it is important that the qualitative researcher discloses his/her experience and qualifications to the participants so that there can be confidence in the data that was obtained and the researcher’ ability to conduct research. Although data for this study was collected by an inexperienced researcher, she was supervised by experienced qualitative researchers who kept on asking questions about the methods used and guided her where necessary. Before data collection the researcher read a number of books on qualitative interviews in order to acquire interviewing skills. The pilot study that was conducted before the main study helped the researcher in being an effective data collection instrument during the main study interviews.
Qualitative researchers accept the fact that research participants create and maintain meanings in their worlds and that these meanings may not necessarily be shared by the researcher (Miller & Glassner, in Silverman, 2011:135). The qualitative researcher’s objective is to uncover the meanings which the research participants attach to their daily lives (Holloway & Wheeler, 2010:6). To achieve this, qualitative researchers need to view the participants’ perceptions and behaviours holistically within the context in which they occur, and not allow their preconceived ideas, beliefs and opinions about the phenomenon under study to colour their interpretations of the participants’ worlds (compare Parahoo, 2006:65). In the current study, the researcher was committed to reflexivity where she constantly guarded that her knowledge about the first-year students from her experience as a nurse educator and reviewed literature would not interfere with her data collection and interpretation.
Qualitative researchers use inductive reasoning to address research problems, that is, they develop generalisations from specific observations they have made (Polit & Beck, 2010:13). They achieve this by observing research participants, conducting interviews, analysing the collected data and reducing it to its themes and sub-themes. Thereafter they identify patterns to enable other researchers to understand the phenomenon of interest (compare Creswell, 2009:63-64). Data collection and analysis in the current study revealed themes and sub-themes with regard to students’ experiences in their first year of the nursing programme.
In qualitative research, findings are presented in words and phrases, and not in numbers, as is the case in quantitative research (Babbie, 2010:394; LoBiondo-Wood & Haber, 2010:64). Quoting research participants adds to development of confidence to what is being reported, on the part of the readers of a qualitative report (LoBiondo-Wood & Haber, 2010:64). In the current study, the researcher categorised the data she collected into themes and sub-themes that captured the main ideas concerning participants’ experiences. Quotations from the transcripts supplemented the researcher’s descriptions of students’ experiences, as will be seen in chapter 3.
2.2.2 Explorative design
According to Creswell (2009:26), explorative research is conducted when not much about the topic or the population has been studied previously. Neuman (2006:34) notes that explorative research is concerned with ‘what’ questions. The three main aims of exploratory research, identified by Babbie (2010:92), are to satisfy the desire and curiosity of the researcher to better understand the phenomenon of interest, to establish the possibility of a more extensive study on the particular phenomenon, and to develop tools/methods that could be used in subsequent studies on that phenomenon. Research methods that can be used in explorative research are quite varied because the researcher is aiming at investigating the full nature of the phenomenon of interest (compare Polit & Beck, 2010:22). Researchers could read books and articles about the phenomenon, conduct individual or focus group interviews with people who might shed light on the phenomenon, or observe those people or situations (Babbie, 2010:92). Researchers
content, relationships and context of the phenomena. One of the strengths of exploratory research design is that the researcher can conduct interviews and return to the informants to clarify and verify information where there is a lacuna in elucidated information (Polit & Beck, 2010:22). The literature revealed a paucity of research regarding the experiences of first-year nursing students in the nursing colleges of South Africa, which led the researcher in this study to decide on an explorative design.
2.2.3 Descriptive design
The major purpose of social research, according to Babbie (2010:93), is to describe situations or events. Neuman (2006:35) explains that descriptive research enables a researcher to obtain a rich description of a phenomenon of interest by giving specific details of a situation, social setting or relationship, focusing on ‘how’ and ‘who’ questions. Descriptive research studies can follow both quantitative and qualitative approaches (Polit & Beck, 2010:22). Qualitative descriptive designs, according to Polit and Beck (20O8:19), describe the ‘dimensions, variations and importance of phenomena’. These non-experimental descriptive studies are aimed at observing, describing, classifying and documenting aspects of a situation as it naturally occurs and can serve as a starting point for theory development (Polit & Beck, 2008:274). Quantitative descriptive designs, on the other hand, consider the prevalence, incidence, size, and measurable attributes of phenomena (Polit & Beck, 2010:22).
Neuman (2006:35) notes that explorative and descriptive research designs have similarities, and blur together in practice. In this study the researcher combined explorative and descriptive research designs, which enabled her to get a detailed picture of how the interviewed second-year students experienced their first-year of the nursing programme at the public nursing college, as will be seen in the chapter on research findings.
2.2.4 Contextual design
All research takes place within a context. For qualitative researchers to fully understand the experiences of research participants, they should place the research within the
setting in which it occurs (Babbie, 2010:297). According to Holloway and Wheeler (2010:4), context is both personal and social.
The study was conducted in South Africa, a country consisting of nine provinces. It was conducted at a public Nursing College in the Eastern Cape Province at two of its main campuses. This college has five main and 22 satellite campuses. It originated from the merging of public nursing colleges and nursing schools that existed in the Eastern Cape Province until 2004. The college was established through the Education and Training of Nurses and Midwives Provincial Act, 2003 (No. 4 of 2003).
The main campuses and satellite campuses of the college are scattered throughout the Eastern Cape Province in both rural and urban areas. The four-year comprehensive diploma programme that prepares a student for registration as a nurse (General, Psychiatric and Community) and midwife with the South African Nursing Council, and some post-basic diploma programmes are offered at the five main campuses. The satellite campuses, on the other hand, prepare nursing students for enrolment with the South African Nursing Council (enrolled nurse and enrolled nursing assistant) as well as bridging from being an enrolled nurse to being a registered nurse. All the campuses have live-in facilities for their students; however, not all students can be accommodated in these facilities because the accommodation is limited. Therefore some students commute to the college and its associated clinical practice environments. In 2013, approximately 2021 students were registered for the four-year diploma programme and there were 226 nurse educators. The campuses differ in the number of registered students and the number of nurse educators employed by the college. All students registered at this college are full-time students. There are approximately 650 first-year students from diverse backgrounds registered for the four-year programme. The lingua franca at the college is English.
Students who are admitted to the four-year diploma programme include candidates who have obtained study leave from public health care services and those who gain entry directly after secondary education. Each of the campuses has a campus head who reports to a college principal at a central office of the college. The deputy college principal is
Examinations for the four-year diploma programme at this college are set at the central office by the different subject programme managers. The programme managers set a common paper for all five campuses; the nurse educators on the different campuses, who facilitate learning in the different subjects, contribute the questions for the common papers.
2.3 RESEARCH METHOD
The research method is the technique the researcher uses to collect, analyse and interpret data for the study (Creswell, 2009:15). In the tradition of the qualitative, explorative, descriptive and contextual design, semi-structured, in-depth, face-to-face, individual interviews were selected as the method of choice for this study. The research process was divided into two phases, each phase aimed at meeting each of the study objectives.
2.3.1 Phase one
Phase one was concerned with meeting the study’s first objective, namely, to explore and describe the experiences of first-year nursing students in relation to their nursing programme at a public nursing college.
2.3.1.1 Research population
Punch (2014:351) describes a population as the target group about whom the researcher wants to develop knowledge. Because this group is usually large it is often not possible to study all its members, and for this reason researchers usually draw a sample from it to study. For this study, the research population included all the students who were registered for the four-year diploma programme at the five main campuses of the public nursing college in the Eastern Cape Province in 2013, since they had all had the experience of being first-year students at this college (compare Parahoo, 2006:257). In practice, not all units of the population can be studied for various reasons, for example, feasibility, time constraints and availability of funds to conduct the study (Parahoo, 2006:257). In this study the researcher delineated a sample from the research population making use of the eligibility criteria indicated in the section on sampling (below).
2.3.1.2 Sampling
Sampling is the process of selecting some elements of the population to represent the entire population (Polit & Beck, 2010:567). Researchers generally work with samples and not with entire populations because it is more practical and economical to do so (Polit & Beck, 2010:307). The researcher used purposive sampling to select two campuses from the five campuses of the college to participate in the study. One campus was in an urban area and the other in a more rural area. Purposive sampling involves a deliberate selection of people for the study on the basis that they can provide the necessary data (Parahoo, 2006:268). The researcher was interested in obtaining rich recent data about the first-year experience in the nursing programme so she decided to select her sample from second-year students because they were the ones who could provide the necessary data.
Eligibility criteria
Eligibility criteria (also called inclusion criteria) are the characteristics that an element, or subject must possess to be part of the target population (Burns & Grove, 2009:345). The researcher decided to collect data from only two of the main college campuses because of their accessibility. The campuses were also chosen for their geographical locations. One campus was an urban campus and the other was in a more rural setting. The researcher argues that including campuses from both urban and rural locations will contribute to the richness of the data.
Second-year students on these campuses were eligible for inclusion because they were likely to provide more complete and recent data than first- third-year or fourth- year students. Interviews were conducted during the first half of the academic year. First-year students were only four months into the programme during the data collection period; therefore their experience would not have been complete. The researcher decided not to use the experiences of third- and fourth-year students because many other influences could have marred their recollection of their
