The findings from phase one, both qualitative and the survey, showed that the NMT was expected to acquire knowledge and skills in the management of neonates with complications, as core competencies required for neonatal nursing practice. As such, the NMT’s teaching focused on assisting them to acquire basic nursing skills to enable the NMT to provide basic care to the health newborn baby. These basic nursing skills included resuscitation of the newborn baby, provision of immediate care, initial and subsequent assessment, helping the baby breath, Kangaroo mother care, administration of medication and management of a neonate with some complications, and communication. The participants’ responses on the skills taught to the NMT as clinical competencies were consistent with the document review findings and FGD.
The findings also showed that, in most of the nursing colleges, there was no specific allocation to neonatal nursing practice for students. This was because the participants believed that the
Strongly Disagree
Disagree Uncertain Agree Strongly Agree
Attitude 1 (2.3) 3 (6.3) 13 (27.1) 19 (39.6) 12 (25) Professional behaviour 0 (0) 6 (12.5) 10 (20.8) 16 (33.3) 16 (33.3) Technical skills 0 (0) 0 (0) 2 (4.3) 24 (50) 22 (45.8) Critical thinking and reasoning 2 (4.3) 3 (6.3) 10 (20.8) 20 (41.7) 13 (27.1) NMCM assessment tool provides clear
criteria for assessing the students’ level of competence 1 (2.3) 2 (4.3) 4 (8.3) 22 (45.8) 19 (39.6)
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neonate could not be separated from the mother. As such, the NMT neonatal nursing clinical practice was combined with labour and delivery and postnatal care. For those institutions which had a separate neonatal nursing clinical practice experience, the duration was limited to either two or three weeks in a neonatal care unit. To facilitate the NMTs’ acquisition of skills in neonatal nursing, the clinical teachers used demonstration, return demonstration, learning contract, assignments and discussions. In some colleges, students were assigned case studies which were also presented to colleagues to share knowledge and experience. The clinical teachers used a combination of approaches to facilitate the NMTs’ achievement of clinical competence.
Furthermore, the finding for the FGD showed that there were inadequate assessments performed for the NMTs’ neonatal nursing clinical competence. The clinical teachers depended on the skills check offs performed prior to the clinical placements as well as the NMCM assessment which was conducted on the care of a health newborn baby during low risk postnatal care clinical experience. In some cases, the NMT was exposed to neonatal nursing scenarios during midwifery OSCE. During these assessments, the clinical teachers used a checklist developed by NMCM, incongruent with competency-based approach, to evaluate the NMT’s performance. These findings were similar to that of the survey. Despite being commonly used for the assessment, the NMCM assessment checklist was reported to be outdated for assessing current practice, with an inconsistent grading for the items. For instance, there were no attributes to define the students’ clinical performance for a given score. In addition, despite some participants indicating that the NMCM tool assessed all domains of competence, some participants reported that the tool was challenging when it came to the evaluation of attitude, making it subjective. Students also perceived the assessment as stressful and subjective.
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In addition to NMCM and OSCE, the students were given green books which were comprised of the skills expected of the NMT in the clinical area. This was used as a record book for the basic skills which were performed and had no criteria for assessment of performance. The findings also showed that the students evaluated their own learning in the clinical area based on the clinical objectives and learning guides provided to them. However, lack of emphasis on clinical placements and assessment of clinical competence in neonatal nursing caused the participants to perceive neonatal nursing care as a neglected area in the training institutions. These results from both qualitative and quantitative strands are presented in table 4.12 below.
167 Table 4.12: Summary of phase one findings
Objective FGD Document Review Survey
Theme Sub-theme Average responses for clinical
teachers, students respectively Competencies taught to NMTs Assessment and management of a neonate Immediate care of a newborn baby Resuscitation Helping baby breath
Demonstration of knowledge of management of neonates with medical and surgical conditions and other complications.
Immediate care of a neonate Initial and subsequent assessment
Prevention of mother to child transmission of HIV
Resuscitation Drug administration Kangaroo mother care
Immediate care of newborn baby (98%, 99.5% A)
Resuscitation (91.6%, 100% A) Initial assessment (97.5%, 98.5% A) Subsequent assessment (100%, 98.4% A)
Management of neonates with different conditions (91.7%, 95.9% A)
Administration of medications (77.1%, 93.3% SA)
Infection prevention (93.8%, 97.4% A) Kangaroo mother care (97.9%, 99% A) Communication skills (89.6%, 91.3%A)
Collaboration (91.7% 91.8% A) Documentation (91.6%%, 90.7% A) Critical thinking (77.1%, 91.7% A) Ethical decision making (89.6% 88.3% A)
Initial and subsequent assessment of the newborn baby Initial examination of a neonate Subsequent examination Gestational age assessment Management of a neonate with complications
Kangaroo mother care Observing infection prevention measures
168 Drug administration Communication and collaboration skills Documentation of care Approaches to assist NMT acquire clinical competence Skills laboratory practice Demonstrations Return demonstrations
Demonstrations Demonstrations (95.9%, 85.5%A) Return demonstrations (89.5%, 81.6% A)
Practice-based learning
Learning contract Clinical mentors and peer teaching Assignments and discussions
Case studies and case presentations
Discussion
Question and answer Case study
Problem based learning Reflection Clinical conference Discussions (81.3%, 65.5%% A) Clinical assignments (81.3%, 64.1% A) Case studies (48%, 75.7% A) Case presentations (62.4% 55.9%D) Orientation (93.7%, 95.5% A) Support (97.9%, 73.2% A) Coaching (61.6%, 62.5% A) Guidance (95.8%, 73.3% A) Portfolio (70.8%, 82.1% D)
169 Approaches to
assess clinical competence
Neonatal nursing has been neglected
Lack of emphasis on clinical assessment in neonatal nursing Skills check offs
NMCM assessment for low risk babies
OSCE
Self-evaluation
Skills check offs (93,7%, 96.4%A) NMCM assessment (93.5%, 76.4%A) OSCE (93.8%, 92.9%A)
Direct observation (93.8%, 79%A) Question and answer (93.7%, 84%A) Clinical assignments (77.1%, 60% A) Self-evaluation (68.8%, 86.7%A) Peer assessment (66.7%, 59.5%D) Assessment tools Checklist
NMCM tool Green book Skills checklists NMCM tool Green book Competency checklist (83.4%, 76.4%A) Green book (58.4%, 74.3% A) NMCM tool (98%, 75.9%A) Criteria for evaluation
Students’ performance graded as a percentage
Criteria for assessment of student performance graded as percentage
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4.3 Phase two: Development of the neonatal nursing care clinical competency-based