Before we engage in a debate about these issues, I think it is pertinent to clarify what is expected of a nurse in a health care centre in order for him/her to provide quality care. The nurse carries and has the following core responsibilities:
- Overall management of the clinic, including human resource development and management, financial administration, maintenance of an information system, drug management
- Overseeing the administration section to ensure that the patients have necessary records
- Supervision of environmental cleanliness
- Organisation of smooth conduct of clinical activities by various other health professionals such as doctors, physiotherapists etc. This includes all programmes such as TB, mother and child health, STD to mention only a few
- Assisting in clinical examination of patients (consultation process)
- Prescribing treatment within her/his scope of practice
- Administration of patients treatments
- Referral of patients to appropriate channels
- Conducting health education
- Keeping of records
It is evident from the participants interviewed that attempts to develop and offer appropriate curricula which are responsive to changing needs and demands of the SA community have been inadequate. These issues were fully debated at the recent Nursing Summit in August 1999, as a result a committee to take the resolutions forward, was formed. Subsequently, Minister Manto Shabalala-Msimango requested the committee to present the report to MinMec. It is understood that the Director General was requested to look into these issues. Also, the need for provinces to be involved was identified. Implementation of these resolutions is still in the pipeline.
While educational institutions have the freedom to develop curricula that are responsive to community needs, it is noted that these institutions have grappled with a number of issues:
- Undergraduate and postgraduate curricula which are responsive to changes ( new emphasis on PHC and DHS)
- Inadequate preparation of nurse educators for change
- Theory and practice divide
- Distribution of nurses in urban and rural areas
- Lack of standardised training (though training is widely available)
- Poor working conditions of nurses
Further, curriculum changes have taken place in an unstable environment that has been marred by lack of resources. Exodus of nurses from the country and severance packages for nurses bedevil the whole issue.
It is obvious that a lot of work still needs to be done to determine the core competencies of undergraduate and postgraduate students. These competencies need to be spelt out and developed bearing in mind the changing needs of the community. Educators and service providers need to actively develop innovative strategies of educating nurses for the South African community. One of these courses is described in this Update. The study that looks at developing core competencies for clinical PHC should contribute extensively in guiding the development of a curricula that meets the challenges nurses face in remote areas of this country. Onsite short training courses to enable the nurse to meet these challenges have been developed by various contributors who currently promote the implementation of the DHS.
It is important to state that Health System Trust (HST) continues to flag issues around nurse training because of its commitment to the promotion of and support for the district health system. It is also important to admit that HST does not claim to have all the answers to problems of nurse training and supply in this country. However, it is envisaged that by continually sparking a debate on these issues, a solution will eventually be found.
Further, the Initiative for Sub District Support (ISDS), a programme of HST that focuses on supporting district development onsite, is continually exposed to the plight of the clinic nurses. Hence the interest to keep this item on the agenda.
It is obvious that this issue of Update will not be able to cover all the issues related to nurse training. The item of nurse training will therefore remain on the agenda of this publication for some time. This will allow a broader community of role players to air their views. It is hoped that these discussions will culminate in a coherent education strategy that deals with issues of providing quality care to all communities particularly those who live in remote areas of South Africa. |
Publications
