Internationalising university schools of nursing in South Africa through a Community of Practice

Communities of practice to facilitate change in health professions education: A realist synthesis

BACKGROUND

Communities of practice could contribute to transformations in health professions education to meet complex and emerging challenges. However, little is known about the underlying mechanisms of communities of practice in this setting, and how context influences outcomes.

OBJECTIVE

To understand when, why and how communities of practice with health professions education faculty work to facilitate higher education change.

DESIGN

A realist synthesis according to the RAMESES standards and steps described by Pawson and colleagues.

REVIEW METHODS

Early scoping of the literature informed the development of an initial program theory to describe underlying assumptions about how communities of practice in higher education, implemented with health professions education faculty, were likely to work. The theory was tested and further refined through a realist synthesis. A systematic search for evidence using search terms 'faculty', 'communities of practice' and 'higher education' and related terms was supplemented with citation tracking and hand searching of significant authors and journals. Following study appraisal, data were extracted and synthesised from 21 manuscripts describing 16 communities of practice. The realist synthesis focused on identifying patterns in context-mechanism-outcome interactions, and the alignment with substantive theory.

RESULTS

From the included manuscripts, ten context-mechanism-outcome configurations were identified that describe a range of individual, interpersonal and institutional outcomes of communities of practice with health professions education faculty and context-mechanism interactions that contribute to achieving these outcomes.

CONCLUSIONS

This study expands theoretical understandings of how and why communities of practice work. There is value in communities of practice in the higher education sector, primarily in the field of health professions education. Communities of practice implemented in the context of complex change with participants who have a desire to participate can facilitate change in health professions education, including institutional level changes, through reflection, experiential learning and creating a shared agenda for change. Findings from this study can be used by policy and decision-makers within health education to best apply communities of practice to achieve meaningful outcomes.

Intercountry master's degree in nursing: policy implications for the Mozambican health system

PURPOSE

Within an overarching evaluation framework, this study explored the experiences of course participants and administrators of an intercountry master's degree in nursing between South Africa and Mozambique. The lessons learnt were used to inform nursing and health policy for the Mozambican health system.

METHODS

Kirkpatrick's four levels of training evaluation and a results-oriented approach to capacity change were integrated to form a hybrid evaluation framework to capture information about course implementation and the context/environment within which it was delivered. The study used quantitative and qualitative methods including a self-administered survey of course participants, document review, in-depth, semi-structured interviews with course administrators and two focus group discussions with course participants.

FINDINGS

Participants enrolled in the course primarily to gain new knowledge and to improve health outcomes; course participants and administrators responded positively to the course design, course implementation and the quality of teaching. Knowledge and skills gained help to build graduates' confidence and boost their attitude towards nursing. Paradoxically, graduates felt powerless to transfer knowledge and effect change in practice.

CONCLUSION

This collaborative, capacity development project produced postgraduate nurses in two areas of specialization, namely, critical care and trauma nursing and maternal and neonatal health. While course participants gained significant benefits in new skills and knowledge and a higher degree qualification, the rewards available to them in the public health system remain unclear.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Lessons learnt may serve to influence policy decisions about the role of the Ministry of Health and other stakeholders in sustaining the output and quality of postgraduate nurses for the Mozambican health system. A strategic approach informed by multilevel policies at government, organizational and managerial levels should be adopted to systematically minimize and remove barriers to the transfer and utilization of knowledge and skills in the workplace.

The process of internationalization of the nursing and midwifery curriculum: A qualitative study

BACKGROUND

There is an abundance of literature on internationalization of curricula. However, research on how a curriculum is internationalized to accommodate non-mobile students studying in their home countries is limited.

OBJECTIVE

To describe the process undertaken by curriculum developers in internationalizing the Brunei nursing and midwifery curriculum through curriculum design.

DESIGN

A descriptive qualitative research design.

SETTING

A nursing and midwifery higher education institution in Brunei.

PARTICIPANTS

Seventeen nurse/midwife academics.

METHODS

Semi-structured interviews were conducted with 17 curriculum developers. Data were analyzed using thematic analysis.

RESULTS

Four themes emerged: expectations of an internationalized curriculum; formation of a committee; benchmarking and setting standards; and designing the curriculum for internationalization.

CONCLUSIONS

This study has implications for the development of an internationally-oriented curriculum that takes into account the cultural context of a specific country. The findings highlight the need to involve students in curriculum design, a practice that is not common in Brunei.

Building midwifery educator capacity in teaching in low and lower-middle income countries. A review of the literature

AIM AND OBJECTIVE

midwifery educators play a critical role in strengthening the midwifery workforce in low and lower-middle income countries (LMIC) to ensure that women receive quality midwifery care. However, the most effective approach to building midwifery educator capacity is not always clear. This paper will explore approaches used to build midwifery educator capacity in LMIC and identify evidence to inform improved outcomes for midwifery education.

DESIGN

a structured search of bibliographic electronic databases (CINAHL, OVID, MEDLINE, PubMed) and the search engine Google Scholar was performed. It was decided to also review peer reviewed research, grey literature and descriptive papers. Papers were included in the review if they were written in English, published between 2000 and 2014 and addressed building knowledge and/or skills in teaching and/or clinical practice in midwifery educators who work in training institutions in LMIC. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) was used to guide the reporting process. The quality of papers was appraised in discussion with all authors. The findings sections of the research papers were analysed to identify successful elements of capacity building approaches.

FINDINGS

eighteen (six research and 12 discursive) papers were identified as related to the topic, meeting the inclusion criteria and of sufficient quality. The findings were themed according to the key approaches used to build capacity for midwifery education. These approaches are: skill and knowledge updates associated with curriculum review, involvement in leadership, management and research training and, participation in a community of practice within regions to share resources.

KEY CONCLUSIONS

the study provides evidence to support the benefits of building capacity for midwifery educators. Multilevel approaches that engaged individuals and institutions in building capacity alongside an enabling environment for midwifery educators are needed but more research specific to midwifery is required.

IMPLICATIONS FOR PRACTICE

these findings provide insight into strategies that can be used by individuals, faculties and institutions providing development assistance to build midwifery educator capacity in LMIC.

Communities of Practice in Nursing Academia: A Growing Need to Practice What We Teach

Although the community of practice (CoP) concept has been heavily utilized in business literature since its inception in the 1990s, it has not been significantly featured in nursing research. With student-centered approaches increasingly infusing nursing classrooms, including opportunities for collaborative learning and the development of student learning communities, it may be time to ask: Do we practice what we teach? Nursing academia faces challenges related to recruitment and retention, scholarly productivity and engagement of new faculty, and increasing demands for collaborative research. Challenges, some would argue, that could be addressed through CoPs; a sentiment reflected in the recent expansion of nursing CoP literature. What is the current state of the application of this concept in nursing academia and what barriers present in the promotion and development of CoPs in the academy? This article addresses these questions and provides guidance for those in search of community.

Collaborative approaches towards building midwifery capacity in low income countries: a review of experiences

OBJECTIVE

to explore collaborative approaches undertaken to build midwifery education, regulation and professional association in low income countries and identify evidence of strategies that may be useful to scale-up midwifery to achieve MDG 5.

DESIGN

an integrative review involving a mapping exercise and a narrative synthesis of the literature was undertaken. The search included peer reviewed research and discursive literature published between 2002 and 2012.

FINDINGS

fifteen papers were found that related to this topic: 10 discursive papers and five research studies. Collaborative approaches to build midwifery capacity come mainly from Africa and involve partnerships between low income countries and between low and high income countries. Most collaborations focus on building capacity across more than one area and arose through opportunistic and strategic means. A number of factors were found to be integral to maintaining collaborations including the establishment of clear processes for communication, leadership and appropriate membership, effective management, mutual respect, learning and an understanding of the context. Collaborative action can result in effective clinical and research skill building, the development of tailored education programmes and the establishment of structures and systems to enhance the midwifery workforce and ultimately, improve maternal and child health.

KEY CONCLUSIONS

between country collaborations are one component to building midwifery workforce capacity in order to improve maternal health outcomes.

IMPLICATIONS FOR PRACTICE

the findings provide insights into how collaboration can be established and maintained and how the contribution collaboration makes to capacity building can be evaluated.