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PERCEPTION AND ATTITUDES OF CLINICAL NURSES AT FEDERAL TEACHING HOSPITAL ABAKALIKI TOWARDS UNIVERSITY-BASED NURSING EDUCATION
Background of the Study
Prior to Florence Nightingale the matrix of modern nursing, historical records of nursing worldwide were sparse. The main function of the nurse then was to carry out simple orders as instructed by physicians. Kolleen, Ysanne & Karen, (2010), had it that care delivered by even the physicians in the olden days was more of nursing oriented while nurses themselves were relegated to merely serving of food to patients and administering prescribed medicine and healing liquids. During this period, there was no formal education for nurses and so they were receiving apprenticeship type of training.
Nursing model in Nigeria was borrowed from Europe during the colonial era and nursing then was carried out by interested men and women with no formal education (Uwah, 2010). This is in line with the statement of Ndukwe (2000), that nursing in Nigeria was regarded as work of maids and girls of lowest social status with no formal education and this was similar to the pre-Nightingale era in England.
In 1946, the Nursing and Midwifery Council of Nigeria laid down some requirements for nursing education with “standard 6” as entry requirement. A more laudable nursing education programme with secondary school certificate as entry requirement was commenced at University College Hospital (UCH) Ibadan in 1952. The Nursing Council of England and Wales was then responsible for the training, examination and registration of those nurses. This enhanced the status of nursing profession in Nigeria and the graduates of this programme were perceived differently from those trained at the missionary hospitals whose registration bore “Nigerian Registered Nurses” (NRN) as against “State Registered Nurses” (SRN) for the UCH trained nurses. Different perception about these two groups of nurses in the past was mainly due to difference in their entry requirement, type of programme and certificate obtained at the completion of the programme. In the same way, it is possible that different health professionals mainly the nurses hold different perception about university-based nursing education and or its products since the programme is not of the same duration, entry requirement and qualification as hospital-based nursing programme.
Nursing education in Nigeria at the university level started at University of Ibadan in 1965 (Olubiyi, 2009). The university nursing programme then was a three year course for registered nurses and midwives (RN, RM). This later gave way to the present programme of Bachelor of Nursing Science (BNSc) degree. Both BScN and BNSc programmes are referred to as university-based nursing programme. The main aim of university-based nursing programme was to produce polyvalent nurses, liberally educated who can function in all areas and all aspects of health and health care of the individual, family and community. According to Ndie (2010), another reason for opening the B.NSc programme was to ensure that health professionals were trained together under the same environment for the purpose of comprehensive care and team work.
The BNSc (generic programme) did not receive wide acceptance in Nigeria due to the entry requirement of five credits in physics, chemistry, biology, mathematics and English language and the long duration of five years. This accounted for the delay in adoption of the programme by other universities till around 2005 when Nursing and Midwifery Council of Nigeria insisted that the programme recommended by International Council of Nurses (ICN) should be adopted in Nigerian universities (Ndie, 2010). Many members of the society who are used to the image of the nurse as a “hand maiden” resent the idea of having university educated nurses. It is possible that clinical nurses may have varied perception and attitudes about university-based nursing education that has no background of the traditional school of nursing training. A call to change from a traditional method of doing things to a new one is always met with resistance. It is like transferring from a familiar terrain to another full of doubts and uncertainties (Okenyi 2009).
The transformation of hospital-based nursing programme to generic (BNSc) programme met a lot of resistance and complaints from health professionals especially those nurses that received hospital training as opposed to university education (Uwah, 2011). Some of the complaints were that generic students are not practically oriented; the graduates show lack of commitment to service, they regard the senior nurses of hospital training as inferior etc. This supposed attitude of the generic nurses has in no small measure generated a lot of complaints and different perception about both the programme and its products.
Today university nursing education is obtained through both full time and part time. All these aim at not only preparing the generic nurses adequately, but also to create opportunities for the already licensed nurses to further their education, improve their knowledge and skill for nursing practice, and enhance their career prospects. As stated by Olasehinde –Williams (2003), part time programmes in the university enable individuals who already have jobs to develop their knowledge. This is important because, given the rapid technological advancement of this age; and the rapid obsolescence of nursing and medical knowledge, initial education may no longer be enough for an individual (e.g. the nurse) to practice her profession till the end of her career service.
The perception of clinical nurses about university–based nursing programme/ products may affect the decision of these nurses to continue their education/improve their knowledge and skills for better practices, and will also determine their acceptability of university nurse graduates and their care practices. Richards (2007) stated that the performance of health care system ultimately depends on knowledge and skills of the people responsible for delivering services. Education and training, she said are key investment tools, since old skills become obsolete with the advent of new technologies. Adequate education/knowledge and skills update are very necessary for health care providers and this is in line with strategic planning of world health reports which places emphasis on continuing education for health care providers. Nurses are required to be competent practitioners, have scientific base for practice, be sufficiently knowledgeable to communicate with increasingly informed patients/family members and have a mastery of technology in the dynamic arena of patient care and condition.
However, in practice, the university trained nurses at the inception of the programme, graduated as either nurse educators or administrators, thus exposing them either to teach at schools of nursing or to work as heads in the hospitals or nursing services stations. This did not give room for practicing the new concepts and skill in clinical areas where they are mostly needed. Mgbekem and Makoleka, (2008) stated that basic Nursing Education was traditionally focused on teaching nursing students the knowledge and skill that will enable them practice only in the hospital setting. Today’s nursing practice is emphasizing client-centred and holistic care with the use of scientific nursing models and concepts such as the nursing process which gives professionalism and uniqueness to nursing. These models and concepts draw knowledge from other disciplines resulting in the nurse gaining and using liberal knowledge that brings the nurse at par with other professionals. With this approach nursing care is no longer adequate with apprenticeship type of training, rather it needs liberal knowledge of arts and science of which university-based nursing education is necessary.
A study by Matsumura, Clark, Palmer, Cox and Larsen (2004) showed that the baccalaureate nursing programme contributed to personal and professional satisfaction of the staff nurses, whereas Krogstad, Hofoss & Hiortdahl (2012), found that perception of health professionals on clinical practice was influenced by professional culture, level of status, hierarchy and gender.
It is possible that perception of clinical nurses about university- based nursing education will determine how ready these nurses are to embrace the programme to update their knowledge and skills for better practices. Again a better understanding of clinical nurses’ perception and attitudes about university-based nursing education in Nigeria is necessary to inform nurse educators and administrators to better plan and organize educational experiences/clinical activities to produce polyvalent nurse practitioners that can function effectively as an individual practitioner and a team member within the health care delivery system.
Statement of problem
Professional nurses in the 21st century are faced with a lot of challenges within the dynamic state of health care. These challenges require professional nurses to have core competency in areas of research, critical thinking, evidence based care, and technical skills. University-based nursing educational programme helps to prepare nurses for these roles. However, it appears that some registered nurses with whom the researcher is in regular contact seem to have different perceptions about the programme. To buttress the above point Mikanowicz (2010), opined that nurses should stick to the basics and not to mimic doctors to become nurse consultants and practitioners. Chitty (2005) in his own view states that the baccalaureate nursing students take twice as long to complete their school and enter work force, thus causing constraints of supply of nurses. It is possible that different perception and attitudes of nurses about university-nursing education may affect negatively or positively their acceptability of the programme which will eventually affect patient care and recovery. This research work “Perception and attitude of clinical nurses towards university-based nursing education” specifically has not been recently carried out both in Abakaliki, (Eastern Nigeria), other parts of the country and even outside Nigeria. It is against this background that this study seeks to assess the perception and attitude of clinical nurses at Federal Teaching Hospital Abakaliki towards university-based nursing education and the performance of the graduates.
Purpose of the Study
The purpose of this study is to assess the perception and attitudes of clinical nurses at Federal Teaching Hospital Abakaliki towards university–based nursing education programmes and the performance of the graduates.
- To establish how clinical nurses at Federal Teaching Hospital Abakaliki view university based nursing educational programme.
- To determine the attitude of clinical nurses towards the programme.
- To determine the clinical nurses’ attitude towards university nurse graduates.
- To determine the perception of these nurses about the clinical performance of university graduate nurses working in their institution.
- How do clinical nurses at Federal Teaching Hospital Abakaliki (FETHA) perceive university- based nursing education?
- What is the attitude of clinical nurses at FETHA towards university based nursing education?
- What is the attitude of clinical nurses towards university nurse graduates?
- How do clinical nurses at FETHA perceive the clinical performance of graduate nurses in their institution?
- There is no significant statistical difference between the perception of male and female clinical nurses about university-based nursing education.
- There is no significant statistical difference between the way the lower and upper cadre nurses perceive university-based nursing education.
- There is no significant statistical difference between the attitude of upper & lower cadre nurses about university-based nurse graduates.
- There is no significant statistical difference between the perceptions of nurses in different units about clinical performance of the nurse graduates.
Significance of the study
- The result of this study will be useful to the nursing profession as it will expose nurses’ perception about university-based nursing programme. Ascertaining nurses’ perception about university-based nursing education and making recommendations will create room for improvement where necessary so that many nurses will embrace the programme for improved knowledge and skill needed in nursing practice. This will eventually enhance the development of nursing profession and the entire health system in Nigeria.
- It has always been the goal of stakeholders of nursing profession to bridge the gap between theory and practice. It is expected that the perception of clinical nurses about clinical performance of university based graduate nurses will help in realization of this goal. For instance where their performance is negatively perceived, recommendations and corrections will help to make amendments for future improvements, ensuring that the knowledge so acquired in university education will be utilized in nursing practice.
- This study will be useful to the health institution because the findings about perception and attitude of clinical nurses regarding university-based nursing education will be communicated to the hospital management and this will reveal the need for study leave and staff training which will eventually improve status of the working staff of the hospital and productivity.
- This study will serve as a reference point to other researchers who may wish to investigate into nurses’ perception and attitude towards university-based nursing education or other similar topics.
Scope of study
This study is delimited to perception and attitude of clinical nurses at Federal Teaching Hospital Abakaliki towards university based nursing education and the performance of the graduates.
Operational Definition of Terms
Perception of university-based nursing education: For this study it means how clinical nurses see, feel and what they think about the programme; their views and opinion about the programme in relation to being able to train safe practitioners, entry requirement, duration of programme, status of programme (whether full time or part time). Their perception can be described as positive or negative as the case may be.
Attitude towards university- based nursing education, attitude towards the graduates of the programme: For this work it means respondent’s positive or negative evaluation; expression of favour or disfavour towards university based nursing education and graduates of the programme, which is described as positive or negative attitude in this work.
Perception about the performance of graduate nurses: For the purpose of this work it means how clinical nurses see the clinical performance of graduate nurses including professional behaviour and overall performance as regards competence in performing nursing jobs, competence in communication skill, understanding of common disease conditions and maintenance of ethics and etiquettes.
Clinical Nurses: In this work, the term “clinical nurses” refer to all registered nurses working at FETHA, including those in the wards, clinics, theatres etc. who were not exposed to university-based nursing education.