Perceptions of Students and Preceptors Regarding Primary Health Care Clinical Placements in Lesotho

Phafoli, Semakaleng Hyacinth

Background: As a practice discipline, nursing education has a mandate to collaborate with the clinical setting to prepare nursing students to function and practice independently, competently and confidently in different healthcare settings, including Primary Health Care (PHC). In Lesotho in particular, PHC is the main access point for people to access health care services, and nurses and midwives provide the majority of care at this level. However, nursing and midwifery students are not receiving adequate exposure to PHC settings during their pre-service education.

Since 2010, Jhpiego Lesotho has been working with the nurses’ training institutions, to support PHC clinical placements for nursing and midwifery students as well as to train and mentor clinical nursing and midwifery staff on preceptorship skills to support students while on clinical placements through support from the United States Agency for International Development (USAID) At baseline a pre-service assessment revealed that a large group of student nurses and midwives were placed predominantly in hospitals for clinical rotations; however, upon graduating they were often deployed to PHC sites where the skills needed differ significantly from those they acquired during their training.

Between May 1^st 2011 and April 30^th 2014, more than 500 nursing and midwifery students from four nursing training colleges were placed for 2-4 weeks in more than 35 rural PHC centres for clinical rotations, and more than 180 preceptors received preceptorship training. Student and preceptor perceptions of PHC clinical placements were assessed through qualitative interviews in a larger study. The objectives of the study were to:

Describe the effects PHC clinical placements have on students, and preceptors’ perceptions of PHC;
Describe whether PHC clinical placements increase students’ likelihood of accepting deployment at a PHC clinic post-graduation; and
Determine whether the PHC clinical rotations increase exposure to country-relevant clinical experiences compared to hospital settings.

Methods: The study employed qualitative method where seven focus group discussions (FGDs) were held with student and preceptors; four FGDs were held with the students, one with trained preceptors, one with the preceptors that were not yet trained and the final FGDs was done with nurse educators. All the FGDs were audio recorded in English and later transcribed. Data analysis followed the general principles of grounded theory where codes that surfaced from the data were grouped into categories and the emerging themes were then identified. This was done until theme saturation was reached.

Results: Analysis of data yielded eleven (11) categories, twenty seven (27) themes and thirty (33) sub-themes (refer to table 1.1). Both students and preceptors perceived PHC clinical placements as appropriate settings that provide students with rich learning environments which enable them to develop both personally and professionally. “I think we learned a lot from that experience because it was like, if the patient comes, you have to greet them, everyone you meet you greet because it is their norm. You learn a lot to interact with people from the rural areas; how do they do their things. Not how you are used to doing things. The service you are offering them they were so appreciated and it was so good [showing a gesture of appreciation] (2^nd year nursing student).

“…they (students) get to understand the different cultures… that in this country we have different cultures but we just never knew that there are people of this kind. … I never understood why our Prime Minister would say that Lesotho is poverty stricken, until, I got to the rural areas. That’s where I noticed, okay, there are still people who are living solely on World Food Program projects! At least they get to understand what’s going on down here; they get to understand what’s going on in the rural areas of the same country.” (Non-trained preceptor)

Most students – 71% (N= 34) indicated they would accept deployment at PHC settings post-graduation. “I would like to work in the health centers because they make us grow professionally, personally and professionally, because there are many challenges and you are on your own there, unlike in the hospitals where there doctors and maybe other health care workers, where, like in the hospitals you rely on doctors mainly, it most cases you rely doctors but in the health centers you are on your own.” (3^rd year nursing student)

Preceptors also expressed that PHC clinical placements were valuable to them as they enforced them to keep abreast with new developments in nursing and midwifery as well as to practice the facilitation skills they were trained on.

Conclusion: Given the priority of decentralized health care services, the geographic distribution of the people of Lesotho and the disease burden, there is a need to ensure that nurses and midwives graduating from nursing education institutions are trained to manage the health care priorities within the district health system structure in Lesotho. Both students and preceptors perceive PHC clinical placements as appropriate settings for acquisition of a variety of skills suitable for the nurses/midwives in Lesotho.