CHAPTER FIVE
4.3. THE RESULTS
4.3.2 Antecedents or Casual Conditions
students themselves, with different stakeholders in the community and with different university departments.
The development of positive relationships among all stakeholders in a teaching and learning situation is a significant aspect in the facilitation for effective knowledge construction especially in CBSL context.
Knowledge construction requires inquiry-based learning: Participants revealed that students used inquiry methods to ask questions and investigate topics. They also used a variety of resources to find solutions through explorations that led to more questions and answers until, eventually, new knowledge would be
constructed. A few excerpts from some participant are as follows:
As students explore the topic, inquiry into the topic comes in, and students will use different means to reach solutions… then conclusions are drawn by students and as exploration continues, they revisit those conclusions.
Exploration of the questions through inquiry leads to more questions and, eventually, to new knowledge.
were: (a) the nature of the graduates produced from the traditional curriculum; and (b) the nature of the graduates produced after engaging in the new curriculum.
The Nature of the Graduates Produced from the Traditional Curriculum Data sources revealed that graduates produced from the old traditional curriculum were inadequately prepared. The academic NEIs had to revisit their curricula because of concerns that nursing graduates were inadequately prepared to respond to the needs of the communities as consumers of health care services. Their inadequate preparation was as a result of a curriculum which was not relevant to the realities of the immediate communities. It emerged that the curriculum was geared towards covering the content within the approved time frame of the school calendar. Both the teacher and the students worked towards ensuring that the examination syllabi were covered within the specified period, irrespective of the relevance of the content. Participants revealed that the traditional curriculum was teacher-centred, standardized and disconnected from students’ experiences and that this type of teaching did not promote either active or meaningful learning, as indicated in the following excerpts:
The graduates from the old programme were inadequately prepared in a number of ways. The old curriculum was content driven and fragmented…
was teacher-driven and did not promote student-centred learning.
Their clinical learning appeared to be fragmented and not reality driven…
students were only exposed to clinical learning sites based in hospitals to cover the required hours… therefore meaningful learning was not taking place thus causing students to struggle after graduation.
Furthermore, the old curriculum was blamed for producing graduates who were professionally competent, but who lacked transferable life skills such as problem solving skills, analytical skills or critical thinking skills. Students also experienced difficulty working in teams, particularly those which included other health care professionals such as doctors, social workers or pharmacists. A reflection from one participant revealed that:
The students were deprived of the opportunity to develop problem-solving and critical thinking skills, the skills which are crucial in practice and in a
community-oriented graduate… their product could not manage diversity…
functioning in teams, especially multi-disciplinary health care teams was a challenge.
It became apparent that as the old content driven programmes produced under-prepared graduates who were unable to meet the needs of the communities, there was a need to revisit the method of teaching so as to produce graduates who were professionally competent and in possession of transferable life skills. The traditional teaching programmes emphasised the theoretical content to be covered in the classroom, where the teacher was an active knowledge giver and the students were passive recipients of information. Participants explained that such educational programmes limited the active participation of students in class, thus limiting the development of the
transferable skills associated with student centred learning, as stated in these abstracts:
As a school, we had to revisit our teaching methodologies with an aim to improve and strive for relevance in our curriculum.
The old programme focused on pushing the content, with students passively taking notes… that crippled the students in developing to be active participants in their learning in preparation for their practice after graduation.
The methods of teaching which were used in the old programme were not
adequately synchronized with the principles of adult learning. There was no active learning or active involvement of students which, thus, promoted passive
academic behaviour and as a result the students were deprived of the opportunity to develop problem solving and critical thinking skills. The traditional curriculum which was used by the NEIs, was based on a bio-medical model which focused on sick and curative care, with little mention of health promotion or illness
prevention. Participants explained that this type of curriculum, which addressed health issues in developed countries, was irrelevant to the needs of many communities in SA, because such teaching approaches did not take into account the specific health problems of disadvantaged societies, as indicated in the following excerpts:
Students were taught about the health problems common in developed countries which some were very rare in the South African context… and allocated to urban areas. The current and critical health problems or issues were not addressed in the education of nurses.
The change to CBSL was brought about by the irrelevance of nursing education to the needs of under-resourced communities.
Changing to CBSL was aimed at broadening the curriculum by giving students the opportunity of experiencing real-life situations within a community. It emerged that CBSL programmes exposed students to diverse community needs, thereby enhancing the scope of knowledge constructed by exposing them to the different health related issues facing different communities in the South African context, as the some of the participants stated:
Changing to CBSL was in line with educating appropriate standard so that our graduates can be able to function appropriately.
South African context is wide and diverse… so the educational standards should be articulated to meet the needs of the diverse population in South Africa.
The Nature of the Graduate Produced after Engaging in the New Curriculum The data sources, especially the curriculum documents (graduate competencies, conceptual framework and programme philosophy sections), clearly reflected the nature of the graduate that should be produced after adopting a problem-oriented community-based curriculum. The nursing profession requires graduates who are responsive, not only to their own personal needs through self-awareness, but also to the needs of the consumers.
The participants described a responsive graduate as being professionally competent, according to the requirements of the regulatory body, and being in possession of transferable core skills which are in line with those stipulated by the South African Qualifications Authority (SAQA) as critical cross-field outcomes (CCFO’s). To
facilitate the development of such graduates, the participants believed that problem- based learning (PBL), community-based education (CBE), case-based learning (CBL) and service-learning (S-L) were the ideal innovative teaching approaches. Some of the participants explained that:
On completion of the programme, our graduates register with the South African Nursing Council as registered nurses and they can be employed wherever they want to work, here in Africa and abroad. Our programme therefore aims at producing graduates that are comprehensively trained to be able to use the knowledge and skills attained and to render synthesised, comprehensive nursing care and… across all context.
CBSL is the perfect tool to achieve that… graduates are critical-thinkers, problem-solvers and proactive competent professional nurses who will be able to function in all spheres within the nursing profession… and possess CCFO’s as needed by the SAQA and the regulatory body.
The new programme has created opportunities for us to permeate the advancement of the science and art of nursing to students and therefore, innovative teaching methodologies are required for the production of an innovative graduate.