Learning for practice: an analysis of the education process of graduate nurses in Malawi

Abstract

An analysis of the educational processes of graduate nurses followed anecdotal reports from stakeholders in Malawi on low levels of clinical performance and poor patient management skills among graduate nurses. Stakeholder observations pointed to issues around the educational preparation of graduate nurses. Learning for practice in nursing education is an absolute requirement for positive client outcomes in healthcare delivery. If graduate nurses’ level of performance is in question the educational processes must be examined because the educational level makes a difference on how nurses practice, the stakeholders’ observations of and concerns around graduate nurses must be taken into account and explored in terms of the educational processes deployed. This requirement gave an impetus to a two-phased, cross sectional, sequential explanatory mixed study, guided by pragmatic philosophical assumptions. Pragmatism emphasizes the fact that knowledge as social reality is based on beliefs and habits that are socially constructed. The study population consisted of nurse educators (N=50) from the Kamuzu College of Nursing (KCN) and graduate nurses (N=235) from various clinical settings in Malawi who were invited to participate. In phase one all educators and graduate nurses were invited to complete questionnaires that aimed at determining the teaching styles of educators, learning styles and approaches, and critical thinking levels among graduate nurses. In phase two purposive sampling was used to select nurse educators and graduate nurses for in- depth interviews to determine their perceptions of the educational process and learning experiences respectively. Qualitative evaluation of twenty-one subjects (n=21) in the BSN curriculum provided evidence of curriculum quality in accordance with the Malawi Nurses and Midwives Council standards. Data analysis, in phase one was conducted using the statistical package SPSS Version 16.0. Descriptive statistics were run for frequencies, means and standard deviation. Content analysis was used for the qualitative data analysis in phase two. The results of the study indicate that there in no diversity in the use of teaching styles among the educators; the Expert Teaching Style is the most preferred teaching style ( xˉ = 4.02 and SD = 1.06). The Facilitator Teaching Style was the least preferred method indicating lesser use of facilitative skills among the educators. The lecture method is the dominant and most preferred teaching method among educators; graduate nurses indicated that interactive teaching strategies had enhanced their learning and that they learnt most from those teachers who taught with passion and used examples. The Personal Model Teaching Style was not preferred despite graduates’ preference for this style. Learning diversity was also lacking among the learners where the Competitive Learning Style was the most preferred learning style (xˉ =3.93 and SD 0.54). The Independent Learning Style was the least preferred learning style (xˉ =2.84 and SD=0.80). This result concurs with the findings on learner dependence from the qualitative results. Curriculum evaluation showed that there were no small group teaching methods embedded in the BSN curriculum to reinforce interactive teaching methods. Despite educators stating that their teaching tasks were well planned there was no learner involvement in the teaching activities. The perceived challenges in the teaching tasks were in the form of information access, interconnectivity and physical resources that educators indicated influenced their choices of teaching methods. Despite the mismatch of the teaching and learning styles, a deep approach to learning was reportedly prevalent among graduate nurses ( xˉ = 3.98 and SD 0.77) while surface approach was low at (xˉ =3.24 and SD=1.00). The majority (65%) of graduate nurses reflected low levels of critical thinking abilities (xˉ = 2.94 and SD= 0.95) despite the high scores in deep approach to learning. Curriculum evaluation revealed there were partial standards on the benchmarks for the process and tools for students’ interest, learning styles and self-directedness (62.5%); assessing students’ prior knowledge (87.5%) and transparency in curriculum document (50%). The educational processes in BSN program are mandated by the Malawi Nurses and Midwives Council standards and as such, the partial standards on the curriculum brings into question the quality of education offered. Therefore, based on these findings, recommendations are made for the improvement of nursing education practice in Malawi. The BSN curriculum benchmarks must reflect the integration of the four learning pillars with cross-cutting competencies to promote transformative learning and interdependence in education. There must be enhancement of the curriculum standards to foster the development of reasoning, thinking, imagination, confidence among the graduate nurses and future research is recommended for educational reforms in nursing.