Live your life. Create your destiny.

Dr C van Belkum (Tshwane University of Technology) & Prof Lize Maree (University of the Witwatersrand)

Adelaide Tambo School of Nursing Science

2011Annual Nursing Education Conference

Developmental Process to Facilitate Teaching and Learning

through a Nursing Community of Practice

(NCoP)

Background: R16 m grant awarded through UNEDSA

University-based Nursing Education (UNEDSA): Launched: December 2008 Through: A grant of R70-million (7 million UD$) by The Atlantic

Philanthropies Aim: Transform nursing scholarship in South Africa with the focus on

nurse academics and higher education Competitive grant: Awarded at an award ceremony to 4 universities– R16 m

over 4 years UWC, UFS, TUT & University of Fort Hare

Prof T Khanyile (University of Western Cape); Prof A van der Merwe (University of the Free State); Prof Lize Maree (TUT); Dr EM Yako (University of Fort Hare).

2008 City of Tshwane Annual Report:- Critical shortage of nurses

- Ratio: 1 nurse: 2689 members of the Tshwane population

South African Nursing Council (SANC):- Restrict number of nursing students according to number of accredited learning

opportunities in clinical settings

Generous grant:

- Enabled ATSON to develop a NCoP as strategy to:

facilitate teaching and learning for nursing students

increase the number of clinical learning opportunities

Background: Developmental process to facilitate teaching and learning

Background: Planning of NCoP – based on Wenger’s CoP Model

Community of Practice (CoP): = model of situational learning Cornerstones of the model: collaboration among peers and shared learning Defined by knowledge rather than task - individuals come together and work to

obtain a common purpose (Andrew, Tolson, & Ferguson, 2008; Wenger, 1998)

Literature emphasized: More patient care takes place in settings outside of hospitals in the community, than in hospitals.

CoPs have advantages for:- teaching, learning and scholarship, - nursing research and - development of the leadership and nursing as profession (Budgen and Gamroth 2008 in Maree

and Ferns 2008)

Therefore the CoP approach was selected to guide the greater Nursing Community of Practice (NCoP) as basis for the initiation of 5 individual nurse-led clinics.

Background: Planning according to the greater NCoP’s Objectives

1. To develop 5 nurse-led Nursing Communities of Practice (NCoPs) to form a greater NCoP• Mother and well baby,• Childhood development, • Lifestyle diseases, • Cancer screening, and• Palliative Care

2. To comply with the accreditation criteria for Community Health Centers(CHCs) of Gauteng DoH

3. To create appropriate community based learning opportunities for undergraduate students

4. To create appropriate community based learning opportunities for post graduate students

5. To facilitate nursing research and scholarship

6. To build capacity for the future needs of The School

7. To benchmark the greater NCoP as a nursing education model that can be utilized by other nursing education institutions, nationally and internationally

Background: Establishing of the NCoP - 4 phases

Additional Services

Additional LO’s & Skills Development

Additional Research Opportunities

Phase 1: Planning1. Grant application2. Planning 3. Formulation of objectives

Phase 2: ImplementationRoll-out of greater NCoP to the

community

Phase 3: Growth

DevelopmentResearch

&

Refine

Phase 4: Evaluation (continuous process)

Background: Development of greater NCoP – 5 Nurse-led NCoPs

Cancer (CA) NCoP (clinic)

GreaterNursing CoP

(NCoP)

Mother & Well Baby (M&B) NCoP (clinic)

Childhood Development (CD)

NCoP (clinic)

Lifestyle Diseases

(LSD) NCoP (clinic)

Palliative Care (Pall) NCoP

(clinic)

Background: Planning of NCoP – Nurse-led clinics

Nurse-led clinic:

= an umbrella term for an outpatient clinic that is managed by a Professional Nurse Practitioner (Registered Nurse) (Daly, Clark, & al, 2008)

Main objective: enable nurses to –- presume their own patient caseloads in specified time slot, - educate patients to promote health, - provide psychological support, - monitor the patients’ condition, and- to perform nursing interventions (Hatchett, 2008).

Background: Patient database

Patient Database: Statistics January ‘10 to March ‘11 (15 mths)

NCoP M&B CD LSD CA Pall TOTAL

Mothers Babies Total ECI School Health

Total

Totals 1510 1820 3330 885 115 1000 1002 325 364 6021

Mobilization Intervention

√Door to

door approach

√2 Inter-ventions

Note: Intervention Research studies for CA NCoP: Cervical & Breast CA screening

2. Aim:

To determine the number and nature of additional learning

opportunities (LOs) created by means of establishing a NCoP

Aim: Developmental process to facilitate teaching and learning

The community we serve

Research methodology: Developmental process to facilitate teaching and learning

3. Method:

Research design:- Document audit

Unit of analysis:- Statistics of services delivered by each NCoP- Curricula of the various learning programmes

Data gathering: - January 2010 till March 2011- Structured observation - Data gathering instrument: Checklist

4. Findings:

Findings will be presented in terms of:

• the total number of new learning opportunities

• the different learning opportunities in relation to the statistics of the various

NCoPs

• micro curriculum requirements vs. LOs available at the NCoPs

Findings: Developmental process to facilitate teaching and learning

4.1 New learning opportunities developed through the establishment of the NCoP:

Findings: Developmental process to facilitate teaching and learning (cont)

Student Allocation (Inside and outside the mobile vehicle)NCoP (Clinic) 2nd yr 1st yr Total

Mother & Well Baby 6 4 10Childhood Development 4 3 7Lifestyle Diseases 8 6 14Cancer Screening 4 3 7Palliative Care 4 4 8Help Desk 2 2 4TOTAL 50

Undergraduate learning opportunities: 50 LOs

4.1 New learning opportunities developed through the establishment of the NCoP:

Findings: Developmental process to facilitate teaching and learning (cont)

Total new postgraduate LO’s: 14

Full-time scholarships 5

Part-time (Staff) 5

International students 4

Postgraduate learning opportunities: 14 LOs

NCoP Research Topics Identified

Scholarships UNEDSAFull – 5; Part–time - 5

Scholarships TUTFull – 4

Mother & Well Baby

Feeding of babiesImmunization

→ Mixed feeding (F)→ Immunization uptake (P)

CD ECD & ECI → ECD problems (P) → Child headed households (F)

LSD HIV/AIDSAlcoholismDomestic Violence

→ HIV stigmatization (F)→ Level of alcohol use (F)→ Effect of domestic violence (P)

→ Child led families (F)

Cancer Cervical cancerProstate cancerOral cancer

→ Cervical Ca screening (P)→ P &S Prostate Ca prevention (F)

→ P&S Prevention oral cancer (F)

→CHPs role Ca prevention (F)

Palliative Care Quality of lifeSymptom management

→ Patient perspective (F)→ Most prevalent & influence on

daily living (P)

New postgraduate learning opportunities: • Masters & Doctoral degree students - 14 LOs

Findings: Developmental process to facilitate teaching and learning (cont)

4.1 New learning opportunities developed through the establishment of the NCoP:

Findings: Developmental process to facilitate teaching and learning (cont)

Student Allocation (Inside and outside the mobile vehicle)NCoP (Clinic) Total

Cancer Screening 2

Palliative Care 2

TOTAL 4

New post basic learning opportunities : • = post registration qualification • Oncology and Palliative students = 4 LOs

Nur Isterate Injec-tion (76%)

Petagon Injection (66%)

Oral Pill Cycle (21%)

0%

10%

20%

30%

40%

50%

60%

70%

80%

Mother and Well Baby NCoP: Adults3 most prevalent LOs

Nur Isterate Injection (76%)

Petagon Injection (66%) Oral Pill Cycle (21%) 0%

10%

20%

30%

40%

50%

60%

70%

80%

3 most prevalent LOs

Mother and Well Baby NCoP: Adults • Number of different learning opportunities= 16• Mainly family planning: Nur Isterate injection, Petagon injection and oral pill cycle

4.2 The different LOs in relation to the statistics of the various NCoPs : 120

Findings: Developmental process to facilitate teaching and learning (cont)

Supplementation - Vit A and E (60%)

Immunization (48%) Deworming (14%)0%

10%

20%

30%

40%

50%

60%

Mother and Well Baby NCoP: Babies and YoChildren 3 most prevalent LOs

Mother and Well Baby NCoP: Babies and young children• Number of different learning opportunities= 15• Mainly preventative: Supplementation, immunization and deworming

Findings: Developmental process to facilitate teaching and learning (cont)

4.2 The different LOs in relation to the statistics of the various NCoPs :

Physical growth monitor-ing (28%)

Neuro development (24%) Visual screening (24%)0%

5%

10%

15%

20%

25%

30%

Childhood Development NCoP: Early Childhood Intervention (ECI)

3 most prevalent LOs

Childhood Development NCoP: Early childhood intervention (ECI)• Number of different learning opportunities= 13• Mainly: physical growth monitoring, neuro development and visual screening

Findings: Developmental process to facilitate teaching and learning (cont)

4.2 The different LOs in relation to the statistics of the various NCoPs :

Physical assessment (100%)

Visual screening (100%) Hearing assessment (100%)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Childhood Development NCoP: School Health (SH)

3 most prevalent LOs

Findings: Developmental process to facilitate teaching and learning (cont)

4.2 The different LOs in relation to the statistics of the various NCoPs :

Childhood Development NCoP: School health (SH)• Number of different learning opportunities= 6• Mainly: physical assessment, visual screening and hearing assessment

BP screening for hyper-tension (100%)

HAST screening (47%) TB (8%)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Lifestyle Diseases (LSD) NCoP: 3 most prevalent LOs

Findings: Developmental process to facilitate teaching and learning (cont)

4.2 The different LOs in relation to the statistics of the various NCoPs :

Lifestyle Diseases NCoP: • Number of different learning opportunities= 20• Mainly: BP screening for hypertension, HAST screening and TB

Cervical screening (38%) Oral screening (38%) Breast examination (27%)0%

5%

10%

15%

20%

25%

30%

35%

40%

Cancer Screening NCoP: 3 most prevalent LOs

Cancer Screening NCoP: • Number of different learning opportunities= 13• Mainly: cervical screening, oral screening and breast examination

Findings: Developmental process to facilitate teaching and learning (cont)

4.2 The different LOs in relation to the statistics of the various NCoPs :

Pain (71%) Fatigue (18%) Cough (7%)0%

10%

20%

30%

40%

50%

60%

70%

80%

Palliative Care NCoP: Holistic patient assessment 3 most prevalent LOs

Findings: Developmental process to facilitate teaching and learning (cont)

4.2 The different LOs in relation to the statistics of the various NCoPs :

Palliative Care NCoP: • Number of different learning opportunities = 50 • Mainly symptom management: Pain, fatigue and cough

Under graduate learning opportunities: • Curriculum focus: Community based• B1 and B 2 students = 50 new LOs

Micro curriculum requirements vs. LOs available at the NCoPs

Nursing Subjects

Requirements (Assessment Criteria)B1 (1st year ) B2 (2nd year )

Total Applicable to greater

NCoP

Assessment Instruments applicable

Total Applicable to greater

NCoP

Assessment Instruments applicable

Medical Surgical 88 81 (92%) 33 68 52 (76%) 6Community 136 127 (93%) 37 Spread over 2 yearsMidwifery 125 93 (75%) 54 19 (35%) 2

Findings: Developmental process to facilitate teaching and learning (cont)

4.3 The micro curriculum requirements vs. LOs available at the NCoPs :

Micro curriculum requirements vs. LOs available at the NCoPsSubject Assessment Criteria

Total Applicable to applicable NCoP

Assessment Instruments

Oncology Nursing 94Ca

42 (47%)

Pall

28 (30%)

20

Palliative Care Nursing 72 9 (13%)

68 (95%)

2 (comprehensive case studies)

Findings: Developmental process to facilitate teaching and learning (cont)

4.3 The micro curriculum requirements vs. LOs available at the NCoPs :

Discussion: Developmental process to facilitate teaching and learning

Discussion:

NCoPs (clinical setting) serve as an effective tool for nursing schools to:

- create its own clinical learning opportunities

- not be affected by the shortage of clinical placements

- teach and learn while serving the community

Conclusion: Developmental process to facilitate teaching and learning

Conclusion:

Various additional LOs for all categories of students were created by means

of the establishment of a NCoP

A Greater NCoP - The Dawn of a New Era

What a journey...

Thank you

Developmental process to facilitate teaching and learning