Development of a competency-based framework to standardise African traditional health knowledge and practices in nursing curriculum in South Africa.

Abstract

BACKGROUND The training of health professionals in South Africa remains fragmented, one-sided, and continues to disregard African Traditional Health Knowledge and Practices. Nurses are trained under the biomedical model, wherein the content of the curriculum hardly infuses the principles and practices inherent in African Traditional Medicine. Nurses possessing knowledge about African traditional health knowledge and practices can provide holistic care to patients and practice ethically in the communities where majority of the population still opts for the services of Traditional Health Practitioners. Nurses spend more time with patients and are well-positioned to advocate for them, including for patients who opt to use alternative therapies, including consulting traditional health practitioners. However, there is no existing standard or framework in South Africa regarding what should be included in the curriculum concerning African Traditional Health Knowledge and Practices. Nurses are expected to develop competencies for nursing patients from all cultural and social backgrounds. However, the content in the curriculum for preparing nurses for such a role is unstructured and implicit. This lack of clarity in the training of nurses on African Traditional Health Knowledge and Practices results in nurse practitioners ignoring, ostracising, and undermining the contribution made by the African traditional health system. Ultimately, the use of African Traditional Health Knowledge and Practices may go unnoticed or not interrogated during health assessments, with adverse health outcomes for patients. AIM The study aimed to develop a competency-based framework for standardising African traditional health knowledge and practices in the nursing curriculum in South Africa. RESEARCH DESIGN AND METHOD This study adopted an explorative sequential mixed method design underpinned by a pragmatic paradigm. The study was conducted in three phases. In Phase 1, a qualitative, explorative, and descriptive design was adopted to collect data from Traditional Health Practitioners about their views on African Traditional Health Knowledge and Practices, and their roles in the provision of health services. Snowball sampling was used. The themes and subthemes that emanated from the interviews were used to develop a self-administered questionnaire in Phase 2. Phase 2 adopted a quantitative, non-experimental descriptive survey design where questionnaires were distributed to public nursing education institutions, including universities, universities of technology, and public nursing colleges. The objective of this phase was to identify the level of teaching ATHKPs and determine the content of ATHKPs that is being taught in nursing curricula for the R425, R171, and R174 nursing programs at public NEIs. Based on the merged data from Phases 1 and 2, a competency-based framework was developed in Phase 3, guided by the South African Nursing Council’s generic competency framework for professional nurses. FINDINGS AND RESULTS In Phase 1, eighteen Traditional Health Practitioners were interviewed, with seven females (39%) and eleven males (61%) practising in various categories such as Sangomas, herbalists, and diviners. The themes that emerged were: 1) The features of African Traditional Health Knowledge and Practices, 2) Elements of practice in African Traditional Health Knowledge and Practices, 3) Challenges encountered by traditional health practitioners in practice, 4) Competencies of traditional health practitioners and 5) Views of THPs on the training of nurses on African Traditional Health Knowledge and Practices. The direct quotes, definitions, and descriptions from the qualitative findings or themes were used to design the survey measurement items. In Phase 2, a total of 408 nurse educators completed the questionnaires. The survey questionnaire yielded overall internal consistency and reliability of 0,9589. Although the response rate was high, there was a high level of disagreement with most items in the questionnaire by respondents. Results demonstrated that the teaching ATHKPs remains unstructured, or nurse educators do not necessarily know what needs to be taught and how as evidenced by 70,59% of respondents reporting that in their discipline, ATHKP is not taught. About 56,6% of the respondents indicated that ATHKP is not taught at any level of the nursing programme in their NEIs. Concerning the practical teaching ATHKPs, only 5,% agreed that Traditional Health Practitioners teach their nursing students in the institutions. The use of herbal medicine is the most prevalent content being taught, scoring a 5,00% level of agreement. Notably, 61,03% of respondents indicated that it is important to teach students about ATHKPs. In Phase 3, the developed competency-based framework was based on the merged data, where themes from Phases 1 and 2 were integrated. The SANC competency framework was adopted to cluster the competencies into five domains that encompass ATHKPs, namely 1) Professional, ethical, and legal practice, 2) Care provision and management, 3) Personal development and quality care, 4) Management and leadership, as well as 5) Research. Therefore, the competencies are clustered within each of the domain based on the relevance and similarity of themes from the merged data to each subdomain. Further, the competencies are divided into core competencies and specific competencies within the subdomains of the SANC framework. Components that were included in the competency-based framework include 1) the nature and purpose of the competency-based framework for nurses, 2) the scope and context of the framework, 3) the philosophical underpinning for the framework, 4) the benefits of the competency-based framework and, 5) the domains and subdomains. CONCLUSION The findings of the study and the developed competency-based framework are a positive move towards breaking the barriers to teaching ATHKPs in the nursing curriculum in South Africa. The developed competency-based framework will help facilitate an understanding and tolerance between nurses and THPs as they will have a broader view and appreciation of the similarities and differences between ATHKPs and the biomedical health system. The findings of the study confirmed that ATHKPs is a unique system of health care and nurses who are aware of the principles and ways of doing things within this system are better equipped to manage patients’ problems. Nonetheless, the study established that no structure existed on how nurses can be taught about ATHKPs as evidenced by the high level of disagreement and uncertainty among nurse educators on the content of ATHKPs being taught in curriculum. The developed competency-based framework can serve as a guide for NdoH and NEIs in recognising the importance of nurses having knowledge and skills on ATHKPs. Curricula reformations should consider how this framework can be integrated into the teaching of nurses at various levels of their training.