Abstract
BackgroundIn South Africa, the critical skill base shortage of healthcare workers, the underperforming global health indicators and the planned roll out of the National Health Insurance have burdened South African higher education authorities to rapidly expand nursing student enrolments. The expansion in student numbers has placed increased demands on overstretched educational institutions, and students are confronted with challenges of congestion in classrooms and clinical facilities, while lecturers encounter difficulties in the process of clinical allocation. A solution is to utilise decentralised clinical training platforms (DCTPs) and allocate students in rural hospitals.AimTo explore and describe undergraduate midwifery students’ reflections of their DCTP experiences, in order to inform future practice of decentralisation in student training.SettingThe study was conducted in the nursing discipline of an urban-based university in KwaZulu-Natal, South Africa, involving undergraduate midwifery students. The university had commenced a programme of allocating students to decentralised clinical sites.MethodElo and Kyngäs’ content analysis was used to analyse the experiences of DCTP by undergraduate midwifery students (n = 14) as expressed in a focus group (n = 11) and three individual interviews (n = 3).ResultsThe following four categories emerged: Recognition as a team member, engaging support, win–win platform and juxtaposed challenges.ConclusionIn the presence of support and teamwork, rural settings can develop undergraduate student midwives, not only in the areas of midwifery competency but also in their personal capacity, and strengthen the responsiveness, preparedness and relevance of midwifery graduates.
Highlights
In South Africa, the critical skill base shortage of healthcare workers, the underperforming global health indicators and the planned roll out of the National Health Insurance have burdened South African higher education authorities to rapidly expand nursing student enrolments
From the exploration and description of the experiences of the undergraduate midwifery students who had participated in the decentralised clinical training platforms (DCTPs), four categories and related sub-categories emerged
As seen in this study, the rural settings with smaller number of students appeared to lessen the power discourses, provided for teamwork, and access to clinical learning opportunities (Ahmadi et al 2018). It is through the DCTP, as in other studies (Talib et al 2017), that the participants were afforded an opportunity to work with other professionals, for example medical doctors, medical students, obstetricians, midwives and advanced midwives
Summary
In South Africa, the critical skill base shortage of healthcare workers, the underperforming global health indicators and the planned roll out of the National Health Insurance have burdened South African higher education authorities to rapidly expand nursing student enrolments. In South Africa, the skill-based shortage is of concern in a healthcare context characterised by global health indicators such as mounting maternal mortality and morbidity rates (Saving Mothers 2017; WHO 2016b), increased under-five mortality rates (World Bank 2019) and a life expectancy lower than the global average (Worlometer 2020), further complicated by social determinants of health such as poverty (Ataguba, Day & McIntyre 2015) These critical shortages, the changing healthcare landscape and the planned roll out of the National Health Insurance have burdened South African higher educational authorities to rapidly expand nursing student enrolments (de Villiers et al 2017; Fakude et al 2014). Students enrolling in these already overstretched institutions are confronted with numerous challenges that include, but are not limited to, congestion in classrooms (Fakude et al 2014) and clinical facilities, while lecturers encounter difficulties in the process of clinical allocation (de Villiers et al 2017)
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