Community-based nursing education in South Africa: A grounded-middle range theory

Abstract

Background: The change to a democratically elected government in South Africa in 1994 brought with it an impetus for change in public health and education systems, which was signalled by a number of policy documents. Traditional content-driven education was to be replaced by a community-oriented approach to education. Community-based education was to be the vehicle through which health care students and health personnel educators would be equipped with the comprehensive knowledge, competencies and attitudes needed to respond to the health care needs of the South African population. There was, however, no shared understanding of the meaning of the term, community-based education, in the country. The purpose of this study was (a) to conceptualise the phenomenon CBE within the South African context, and (b) to develop a middle-range theory that would guide the practice of CBE in basic nursing education in the country. This article focuses only on describing the middle range theory of CBE.

Methods: A grounded theory approach was used to guide the research process. Purposive sampling followed by theoretical sampling resulted in 41 participants comprising of heads of nursing schools, program directors, facilitators from six nursing education institutions and policy makers. Data was collected by means of observations, interviews and analysis of program documents. Observations were carried out in community and classroom settings. Data analysis was performed using open, axial and selective coding.

Results: The results showed that in South Africa, community based nursing education was viewed as (a) relevant education; (b) responsive education; (c) education for social justice; and (d) a conscious and deliberate primary health care socialization process. Importantly, a process-outcomes approach to education was seen as the most appropriate curriculum approach for community based nursing education.

Conclusions: The tentative theory from this study requires subjection to scholarly critique and validity testing in order to facilitate its evolvement towards becoming a higher level substantive theory.