Abstract
BackgroundA well-functioning education system for family nurses is a priority of the primary health care reform in Tajikistan. In 2015/2016, a baseline study was carried out to measure the educational environment at two nursing colleges, in Kulob and Dushanbe. Building on the study’s recommendations, the educational reform has addressed several key issues to improve the educational environment among nursing students with a focus on strengthening competency-based learning and clinical skills. A follow-up study was carried out in late 2018 to comparatively analyse progress in the educational environment against the baseline and assess potential impacts of tailored interventions.MethodA repeated cross-sectional survey involving 1239 students was applied to measure changes in the educational environment between 2015/2016 (baseline) and 2018 (endline) using the Dundee Ready Education Environment Measure (DREEM). We compared mean scores over time using Welch’s two sample t-test and the Wilcoxon-Mann-Whitney test. Single items have additionally been analysed using critical threshold (flags) for mean scores, and the percentage of answers falling above or below predefined values. A multivariate non-parametric regression was applied to control for confounding factors. Internal consistency was examined using Cronbach’s α.ResultsCronbach’s α for overall scores ranged between 0.87 and 0.89. Between 2015/2016 and 2018 the perceived educational environment improved with an increase of the mean total DREEM score from 131.8 to 146.9 in Dushanbe and from 134.9 to 151.2 in Kulob. Mean comparisons and multivariate regression revealed a significant increase of all sub-scores between 2015/2016 and 2018 with students’ social self-perception exhibiting the smallest progress. Despite the general improvements observed, analysis at the level of single items revealed persistent weaknesses including a lack of competency-based learning and stress.ConclusionsThe education environment has improved in several important ways between 2015/2016 and 2018 which points to a likely positive contribution of the nursing education reform. This progress notwithstanding, there is still notable room for further improvement. Targeted efforts aimed at a better organization of practical trainings, improved didactical competences of teachers, and support structures for lonely and stressed students still seem to be lacking for the achievement of a good nursing education system in Tajikistan.
Highlights
A well-functioning education system for family nurses is a priority of the primary health care reform in Tajikistan
The education environment has improved in several important ways between 2015/2016 and 2018 which points to a likely positive contribution of the nursing education reform
Targeted efforts aimed at a better organization of practical trainings, improved didactical competences of teachers, and support structures for lonely and stressed students still seem to be lacking for the achievement of a good nursing education system in Tajikistan
Summary
A well-functioning education system for family nurses is a priority of the primary health care reform in Tajikistan. All nurse students follow a common track for the first 3 years after which they can enrol in a fourth year to qualify as either a family nurse or a midwife [2]. Despite this political transition, progress in the medical education system was slow with the training of nurses not receiving sufficient attention [3, 4]. An assessment of the educational environment at two nursing colleges in 2015/2016 revealed substantial problems, including insufficient clinical exposure during training, lack of nurse tutors as role models, and weak pedagogical competencies at the faculty level -with an overemphasis on factual knowledge [5]
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