1Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University, 53100 Kuala Lumpur, Selangor, Malaysia
2Department of Nursing, Sultan Ahmad Shah Medical Centre @IIUM, 25200 Kuantan, Pahang, Malaysia
3Department of Medical-Surgical Nursing, Kulliyyah of Nursing, International Islamic University 53100 Kuala Lumpur, Selangor, Malaysia
4Department of Professional Nursing Studies, Kulliyyah of Nursing, International Islamic University
53100 Kuala Lumpur, Selangor, Malaysia
*Corresponding Author’s Email: khin_ta@iium.edu.my
Nursing education is essential for producing qualified healthcare professionals who can meet the needs of the healthcare industry (Fawaz, Hamdan-Mansour, & Tassi, 2018). A recent meta- synthesis by Mlambo, Silén, and McGrath (2021) suggests that nurses must engage in continuing professional development (CPD) to maintain current knowledge and abilities while improving throughout their professional careers.
The Ministry of Health (MOH) in Malaysia offers a post-basic nursing program and an advanced diploma for nursing specialization. These courses range from six months to one year in duration (Ministry of Health, 2010). These initiatives improve nurse skills, prepare hospitals to achieve operational standards, and improve patient care and safety (Flaubert et al., 2021). Furthermore, a license in order to open new hospital beds currently requires post-basic nursing certificates, especially in critical care (The Practice Division, Ministry of Health Malaysia, 2023).
IUM's Post-Basic Nursing Program enhances registered nurses' skills for improved clinical practice and healthcare. Educational success relies on curriculum, teaching methods, and addressing stakeholders' needs (Shawer, 2017). Nursing education involves various stakeholders, including instructors, students, practicing nurses, healthcare institutions, regulatory agencies, and the public (Connolly et al., 2020). Stakeholder views, crucial for success, particularly in Western countries like Australia, contribute to national nursing and midwifery education, regulation, and practice (Gill et al., 2015). Evaluating the IIUM Post Basic Nursing Programme's success and identifying improvement areas necessitates understanding and incorporating these diverse perspectives.
Previous research highlighted stakeholder participation in nursing education (Doyle et al. 2017) emphasized stakeholder involvement in nursing education, particularly in curriculum development to align with industry expectations. Maniago et al., (2020) and Virgolesi et al., (2014), highlighted the significance of stakeholder engagement in enhancing nursing education and graduates' employability. Kaddoura (2016) utilized mixed approaches to assess postgraduate nursing program outcomes, revealing the importance of stakeholder viewpoints in program efficacy and student learning. Belita and Bryant-Lukosius (2020) noted that effective stakeholder involvement transforms students and teachers, benefiting the nursing profession. This study addresses the gap in research on the IIUM Post Basic Nursing Programme, using semi-structured interviews to explore stakeholder perceptions, including local preceptors, nurses, and healthcare institutions. Assessing stakeholder views and program efficacy is crucial for the evolution of the IIUM Post Basic Nursing Programme to meet community needs and healthcare sector demands.
Detailed exploration and data collection were made accessible by semi-structured interviews. This strategy revealed stakeholders' experiences, challenges, and suggestions for improving the programme (DeJonckheere & Vaughn, 2019).
Research Design
The qualitative descriptive study used an interview guide to examine stakeholders' opinions and fulfilment of their expectations on students' learning, obstacles and challenges in the Post Basic Nursing Programme, and future programme recommendations.
Data Collection Procedure and Sample Size
Hospital management staff, clinical instructors, and nursing managers with specific Post-Basic Nursing Programme administrative roles were purposively sampled (Palinkas et al., 2015). Eligible participants, identified through purposive sampling, received email invitations containing information sheets and consent forms. Upon confirmation, Google Calendar invitations were sent for interviews. Nine stakeholders from emergency, critical, and peri- operative care participated. Verbal and non-verbal responses were observed during the 30–45- minute Bahasa Malaysia interviews, recorded, and later translated and transcribed into English.
Data Analysis
Braun and Clarke's (2006) thematic analysis were employed to analyse data from semi- structured interviews in the IIUM Post Basic Nursing Programme. After transcribing interview tapes, open coding and labeling were conducted, and themes and sub-themes aligned with research objectives were identified. The arrangement of these themes followed sections from the semi-structured interview guide. NVivo 12 Plus was used for validation. Rigorous assessments were performed for credibility, dependability, transferability, and authenticity (Stahl & King, 2020). Internal validity was confirmed by participant verification, and reliability was enhanced through professional discussions and a literature review. Data saturation ensured transferability (external validity), and authenticity was maintained by building trust with participants for the open sharing of thoughts and feelings (Sutton & Austin, 2015).
Ethical Consideration
Ethical approval was obtained from the IIUM Research Ethics Committee, Malaysia with reference number ID No: IREC 2021-098 on 22nd March 2021.
The semi-structured interviews revealed stakeholders' perceptions, expectations, obstacles and challenges in achieving expectations, and future IIUM Post Basic Nursing Programme recommendations.
Nine stakeholders from emergency, critical, and peri-operative care participated in this study. Four men and five women have post-basic qualifications and ten years of experience in their respective fields. In this study, Table 1 refers to participant information.
Table 1: Participants’ Information
No | Pseudonyms or Fictional Names of Participants | Job Position and Place | Experiences (year) |
1. | Iz (I) | Head nurse, OT | 11 years |
2. | Si (S) | Senior Nurse, OT | 15 years |
3. | Zak (ZA) | Staff Nurse, OT | 12 years |
4. | Zul (ZU) | Medical Assistant Officer, ETD Department | 13 years |
5. | Fik (FI) | Staff Nurse, ETD | 10 years |
6. | Sya (SY) | Staff Nurse, ETD | 10 years |
7. | Fau (FU) | Head Nurse, ICU | 14 years |
8. | Lai (L) | Senior Nurse, ICU | 13 years |
9. | Roz (RN) | Head Nurse, ICU | 13 years |
The three main themes from thematic analysis of interview data were: (i) Perceptions and fulfilment of stakeholder’s expectations on Students' Learning (ii) Barriers and challenges to the fulfilment of stakeholder’s expectations on the Post Basic Nursing Programme and (iii) suggestions and expectations for future programmes.
The first main theme is perceptions and fulfilment of stakeholder’s expectations on students’ learning. On the basis of the first main theme, four subthemes are categorised as follows:
This subtheme focuses on the importance of attitude, manners, and skills in delivering high- quality patient care, particularly in handling a variety of patient emotions effectively.
The knowledge and skills that we need to have for us to deliver the best quality for patients are first our attitude. That attitude is like manners, the skill of treating patients. The reason is that when the patient comes, he has all kinds of emotions: angry, what else, jumpy, depressed, and anxious, so we have to be good at tackling them. (SY)
This subtheme stressed the importance of soft skills like communication, empathy, teamwork, and professionalism in medicine. It stressed the importance of these skills in holistic patient care. This subtheme also stressed the relevance of medical knowledge and clinical abilities in healthcare practice and the necessity to constantly update and develop medical knowledge and enhance clinical skills for optimal patient outcomes.
Soft Skills People Call (ZA)
People call it soft skills, and the second one is medical knowledge. Medical knowledge means our clinical skills; that's also important. That's it. (SY)
This subtheme emphasized medical experience's importance. Experience-based clinical knowledge, skills, and expertise were highlighted. It acknowledged that knowledge improves clinical decision-making and patient care. Teamwork was a priority, especially in the emergency department.
Every department's environment is different; every department will be different; it has its own environment. ED has a lot of teamwork; it must be teamwork; he doesn't have to do everything alone. (ZU)
This subtheme highlighted the significance of an effective learning approach and a well- designed syllabus in the post-basic (PB) programme, which ensure participants' understanding and competence in pertinent medical concepts and procedures.
Different...one is in terms of knowledge. If knowledge is this, confidence is another. There are those who got two during the first batch; I don't know how they study, and I don't know if they want to learn while studying, but we'll see after they post. It’s all their skills and their knowledge, so there's more that's missing. (FI)
Regarding the stakeholders’ expectations of students’ learning, four subthemes are categorised as follows:
The interviewee mentioned that PB students are expected to become excellent team leaders who can lead a medical team and make key decisions.
Because if this is PB, he or she can be the team leader; if there is one case, he or she can lead the team. Credibility to take charge, meaning be a leader, be a leader, we have PB. So, PB staff will lead the team to resus patients. Lead the team and the rest. Or he or she can figure out what to do next. (ZA)
This subtheme explored the impact of the PB programme on students' knowledge and skills. The interviewee mentioned a change in knowledge and skills after completing the PB programme. They discussed how individuals who were previously hesitant or unsure of their communication skills became more confident and willing to speak up after completing the PB programme.
Hmm, The Knowledge has Changed Maybe. (SY)
Can't you see that when it comes to 1 brother to sister who met this staff before this, before PB, they don't dare to speak after PB dares to speak, speak up? Have you ever seen someone like that? (I)
This subtheme emphasized the unique capabilities and advanced knowledge demonstrated by individuals who have completed the PB programme. The interviewee highlighted that some PB programme students stand out due to their exceptional performance and knowledge. These individuals demonstrated a higher level of expertise and competence compared to those who have not undergone the PB programme.
There are a few candidates. As we can see, in terms of observation, there are some that really stand out. Something we saw after the PB was that he really stood out. He knows he is at the next level. He's on a different level than the normal one, who doesn't have PB. Because he knows he already has his roles. (ZA)
The second main theme is barriers and challenges to fulfilment of stakeholder’s expectations for the Post-Basic Nursing Programme. Regarding this second main theme, the following four subthemes are categorized:
This subtheme addressed the challenges of limited clinical cases in the first cohort PB programme. It stressed the need to have enough cases for practical skill development and clinical exposure and learning throughout the PB programme. It underscores the difficulties of limited trauma exposure and availability.
Ok, I am telling the story from SASMEC, the first batch, because we have just opened; it is still in the earlier phase. Anxiety because if we want to consider clinical practice at SASMEC, ED SASMEC, at that time, even in rhesus cases, sometimes you could only see a few cases a day, not in sync with the KKM. When we practice with a dummy, it's different with a real patient. So, we need a case. (ZU)
It's hard to say because we don't have many cases; it's like sitting down. hehe, do you understand? When there are not many patients, there are not many things to expose. But if it is possible now, I mean it can be exposed; there are not many cases; trauma may be very rare; find trauma cases; if other medical surgical cases are okay, I think you can find them now near Resus. But if the trauma case is still classified, which is very rare to see, (ZA)
Interviewee additionally mentioned limited time and teaching staff availability during practical period.
Teaching staff who focus on him, for example, like the batch before this, ok, the lecturer did come, but you can't focus 100% on him in practice, for example, for 3 weeks. The lecturer will come okay in a few hours like that. He has worked all day for 3 weeks, so he can't focus. If he wants to ask, he just asks us, and we are busy at that time, so we can't give him extra time. (RN)
The concerns of confidence, acceptance, and knowledge application in teaching and learning were underlined in this subtheme. Students are encouraged to overcome shyness, accept new ideas, and practise and share their expertise.
I think he has already returned to PB; even if he wants to teach, he doesn't have the confidence to do so. It means that he is not sure what knowledge he learned before regarding OT. (S)
Those who went to this PB course are maybe mostly seniors, but there are other seniors who work here; maybe when he returns to study, he will tell them, but seniors cannot be able to accept what people have learned because people learn with rationality and through experience. (I)
This subtheme emphasized course content and specialized skills. The PB programmes interviewee highlighted academic content and syllabus. Emergency courses include BLS, ACLS, paediatric life support, and trauma life support. The interviewee expressed a lack of awareness regarding the PB programme's syllabus and topics and a strong need for more information.
In terms of the syllabus, it may have to be restructured because it's the first time. (S)
It's hard for me to say this; when I was in the past, I did it for a year; I did a diploma. I don't know what else is on the syllabus. Is it in block 1 that he teaches in terms of respi, CNS or neuro, right? I'm not sure about that; I don't know if 6 months is enough or not; maybe it depends on the person. Because I don't even know what is being taught or what is the syllabus is, I hope to be able to share the book with us by giving suggestions on what needs to be added and what is not needed. (FA)
Regarding on third main theme, the following seven subthemes are categorised:
This subtheme focuses on the requirements individuals must fulfil to qualify for the PB programme. It included the minimum follow-up period and APAR score requirement.
If you follow KKM for 3 years, a minimum of 3 years, based on another APAR achievement that must be 90 or above to 85 or above, when will I go to the PB program that day? (S)
Follow the hospital if that hospital, how much did he pass (SY)
This subtheme emphasized the importance of mutual support and encouragement between students and faculty in fostering a positive learning environment. It acknowledged the significance of encouragement in the learning process.
The current increase in the number of cases, including resuscitation cases, compared to the earlier phase. There is potential for students in the current batch to gain a higher number of clinical cases, leading to increased knowledge and skill acquisition. The importance of clinical exposure and hands-on experience in developing competence. (Z)
This subtheme focused on the significance of active participation and engagement in clinical settings in order to maximise knowledge and skill acquisition. It raised concerns regarding the nature of supervision and guidance for students' learning.
Now that it's full, the resus can be full one day. The current time is ok. If the batch is now, he will learn a lot...gain knowledge and skills... It's just that for me, whatever it is, encourage each other. Encourage the students, too. Sometimes we. I’m not even sure how he gets his supervision in terms of his learning, but in terms of the clinical site, if he wants to participate, he must be participating for him to gain knowledge. (Z)
This subtheme explored the need for an extended period of clinical postings for PB students. It suggested that a longer exposure to the hospital with specialty areas would improve their learning and skill development.
I think there are things that need to be added; for example, maybe 6 months is not enough for the student, I think. then if I study first, if the log book, aa... the log book is not what it is, the name is the one who signed it, the student has 2, one is a log book, and another is a procedure book, which means that if the student does the same to him, we tick what he says, what he does, we tick, and then we give him a score. (SY)
This subtheme emphasized the importance of collaboration and partnerships with other institutions to strengthen the PB programme. It included coordinating schedules, engaging with medical students, and involving subject matter experts. They mentioned the challenges of managing schedules due to various commitments.
I think it's like no issue, there's no issue, it's just for students; maybe we have to involve them with EP, with experts, then maybe we have to involve them with CME, oblige them to come to CME, things like that. (SY)
Yeh, EP involvement is very important. Apart from the local preceptor, who is PB, EP is very important because there is knowledge above and beyond, beyond for everyone, and beyond for you again. (ZU)
src="2357-Understanding Stakeholders’ Perceptions
Regarding the above subtheme, the interviewee suggested that the programme last one year instead of six months, that the syllabus be compared to others, that site visits and benchmarking be required, and that hospital and lecturer experts be involved in teaching. They also advised the PB plan to focus on quality over quantity.
For me in the future, the 6 months are only valid at SASMEC; maybe the future plan is to do it for 1 year for the advanced diploma, because sometimes even the short-term courses do not leave Pahang, and the long-term is at SASMEC. (L)
In terms of the syllabus, it may have to be restructured because it's the first time. (S)
Regarding the above subtheme, the interviewee expressed concern about the authorisation and recognition of this PB programme’s certification.
If it is not possible, if they go somewhere else, it is not possible either, they will lose. It must be a valid certificate, which IIUM gives, so it can be used in other hospitals. That's important. (S)
Yes, that's as far as I know. A candidate's mentality when he hears because he knows, he is the first candidate who knows that this PB is only in SASMEC. certified. so, it's like he said that if you go somewhere else, it's like there's no use for the PB (ZU)
Semi-structured IIUM Post Basic Nursing Programme interviews revealed stakeholder expectations for competence in nursing development. These expectations were made challenging by restricted resources, curriculum gaps, and assignments. For enhanced nursing education, the programme needs more practical training, faculty support, and healthcare institution engagement.
The Post-Basic Nursing Programme is essential to prepare registered nurses for the changing healthcare profession. A recent study found three major findings: (i) Perceptions and fulfillment of stakeholder’s expectations for Students' Learning (ii) barriers and challenges to the fulfilment of stakeholder’s expectations; and (iii) suggestions and expectations for future programmes. These findings and the consequences on programme effectiveness, stakeholder satisfaction, and industry requirements will be discussed.
The satisfaction of students, educators, clinical instructors, healthcare professionals, employers, and policymakers determine nursing education outcomes. Other studies indicated that there is a need to develop an effective strategy for nurses to participate in continuous nursing education (Bit-Lian et al., Programme performance, student satisfaction, and the creation of competent nurses improving healthcare depend on meeting these expectations. Positive stakeholder perceptions of curriculum, instruction, clinical experiences, and support services motivate and commit learners (Hamshire, Willgoss, & Wibberley, 2013; Cleary et al., 2018). Faculty retention and pleasant teaching environments are improved by meeting professional development and research expectations (Ghazali, Nordin, & Manaf, 2017). Student results, licensing pass rates, and employability improve when stakeholders view a programme as effective and relevant (Hamshire et al., 2013). Aligning with stakeholder expectations provides qualified nurses who deliver high-quality care, contribute to evidence- based practices, and uphold professional standards, helping community healthcare. The perception of competent nurses improving healthcare depends on meeting these expectations. Positive stakeholder perceptions of curriculum, instruction, clinical experiences, and support services motivate and commit learners (Cleary et al., 2018). Faculty retention and pleasant teaching environments are improved by meeting professional development and research expectations (Ghazali, Nordin, & Manaf, 2017). Student results, licensing pass rates, and employability improve when stakeholders view a programme as effective and relevant (Hamshire et al., 2018). Aligning with stakeholder expectations provides qualified nurses who deliver high-quality care, contribute to evidence-based practices, and uphold professional standards, helping community healthcare.
The Post Basic Nursing Programme had certain challenges in satisfying stakeholder expectations, research showed. Outdated curriculum, insufficient resources, academic support, and industrial alignment may be issues. To ensure course efficacy and meet industry needs, the curriculum must be evaluated and revised regularly to include the latest evidence-based practises and healthcare trends. Faculty development courses can improve teaching, communication, and learning environments to solve faculty support challenges. The study found similar problems to past nursing education research. Comprehensive research by Jamshidi et al., (2016) found faculty shortages, outdated curricula, and inadequate clinical placements in nursing schools. These restrictions may hinder students' practical learning and skill development. The post-registration phase may raise employment difficulties that hinder the achievement of learners.
Participants provided feedback on upcoming Post-Basic Nursing Programmes. Hands-on experiences extended clinical rotations, mentorship, and specialization were advised. Practical experiences and clinical rotations can bridge theory and practice for nursing students. Specialization can meet corporate objectives and provide graduates with an edge in the employment market. Former and current study participants' views and expectations are similar. Ironside et al. (2014) highlighted mentorship, specialization, and hands-on experience in nursing courses. These attributes enhance nursing students' skills, professional growth, and satisfaction. The present study may offer new post-basic Basic Nursing Programme expectations and recommendations.
The study showed that stakeholder perceptions impact post-basic students' learning and the program's success. This study also suggested improving clinical placements, technology integration, multidisciplinary collaboration, and community participation. Addressing these areas would improve the plan and ensure it meets industry and community healthcare needs.
The authors declare that they have no conflict of interests.
The authors would like to thank the Department of Education and Research Sultan Ahmad Shah Medical Centre @ IIUM (SASMEC) for funding this study SASMEC.
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