Strategies to improve the performance of learners in a nursing college. Part I: Issues pertaining to nursing education.

The aim of this contextual, exploratory, descriptive and qualitative study was to describe strategies to improve the performance of learners in a nursing college. The article seeks to deal with factors relating to nursing education that contribute to the poor performance of learners and to outline related strategies to improve the situation. Three focus group interviews were conducted. One group was formed by seven tutors, and the other two groups were formed by fourth-year learners following a four-year comprehensive diploma course. All participants voluntarily took part in the study. Data was analyzed using the descriptive method of open coding by Tesch (in Creswell, 1994:154-156). Trustworthiness was ensured in accordance with Lincoln and Guba's (1985:290-326) principles of credibility, conformability, transferability and dependability. The findings were categorized into issues pertaining to nursing education as follows: curriculum overload; lack of theory and practice integration; teaching and assessment methods that do not promote critical thinking; tutors' lack of skills and experience; inadequate preparation of tutors for lectures; insufficient knowledge of tutors regarding outcomes-based education approach to teaching and learning; inadequate process of remedial teaching; discrepancies between tutors' marking; lack of clinical role-models and high expectations from the affiliated university as regards standards of nursing development programme by the staff development committee of the nursing college under study for implementation. Future research should focus on the effectiveness of the described strategies to improve the learners' performance. It is also recommended that similar studies be conducted or replicated in other nursing colleges to address the problem of poor performance of learners engaged in a four-year comprehensive diploma course.

Strategies to improve the performance of learners in a nursing college. Part II: Issues pertaining to management, attitudes and values.

UNLABELLED: This article forms part two of a bigger study that was conducted in a nursing college to explore and describe the reasons for the poor performance of learners. Part one of the study dealt with the issues pertaining to education, while this article (part two) seeks to describe issues pertaining to management, attitudes and values that lead to the poor performance of learners in the nursing college under study. A qualitative, exploratory and descriptive design that was contextual in nature was employed, and three focus groups interviews were conducted. Seven tutors formed one group while other two groups were formed by fourth-year learners following a comprehensive diploma course. All participants voluntarily participated in the study. Data was analyzed using the descriptive method of open coding in accordance with Tesch's protocol (in Creswell, 1994:154-156). Trustworthiness was ensured using the following principles: credibility, conformability, transferability and dependability (Lincoln & Guba 1985:290-326). Findings were categorized into issues pertaining to management, attitudes and values that had an influence on the poor performance of learners as follows: MANAGEMENT: Inadequate resources and study facilities; policies that change frequently; tutors' dissatisfaction with regard to staff development, the lack of involvement by management and lack of management support, staff shortage and maldistribution of staff members; ineffective selection process of learners; inconsistent regulations, and too many of them; policies and procedures resulting in confusion and poor discipline. Attitudes and values: Tutors' lack of motivation and interest, lack of respect by learners and no team work among tutors. Through a conceptualization process and the recommendations by participants, strategies to improve the learners' performance were described. It is recommended that these strategies be submitted to the staff development committee for implementation and future follow-up research be undertaken to determine the effectiveness of the strategies. It is also recommended that other nursing colleges replicate the study within their context.

Is pregnancy a time of changing drinking and smoking patterns for fathers as well as mothers? An initial investigation.

This paper describes changing smoking and drinking patterns before and during pregnancy in 313 expectant couples. Fathers were more likely to drink and smoke more heavily than mothers throughout. Before pregnancy in only 42% of couples were both partners safe drinkers and non-smokers. This increased to 50% during pregnancy. Most mothers reduced alcohol consumption during pregnancy and although about half of the fathers also changed their drinking patterns, only about a fifth decreased their consumption. Levels of paternal and maternal drinking in pregnancy were positively associated with pre-pregnancy levels. Rates and levels of both maternal and paternal smoking declined in pregnancy. There was a positive association between partners of both the prevalence and level of drinking and smoking between partners. There was some indication that mothers were more likely to reduce smoking and drinking if their partner joined them in doing so. Risk drinking in couples was more common in those who were older and of higher social status, but smoking was more common among the younger couples of lower social status.

Preventing alcohol related birth damage: a review.

Since 1974 numerous clinical studies have made it clear that heavy alcohol consumption during pregnancy (in excess of 80 g or 8 units daily) can result in a child being born with a specific combination of physical and mental disabilities known as the Fetal Alcohol Syndrome. More moderate levels of intake (as little as 10 g of 1 unit daily) are associated with other fetal problems known as Fetal Alcohol Effects. The most common of these is growth retardation. Reduction of alcohol consumption is beneficial to pregnancy outcome. However, despite this great clinical and research interest within the field there has been comparatively little attention paid to researching possible preventative strategies and appropriate policy development. This paper first describes the size of the problem posed by drinking in pregnancy in the U.S.A. and the U.K., detailing the contrasting policy response on either side of the Atlantic. It examines the difficulties of formulating appropriate advice and then assesses the available research reports on preventative measures. The strategies described include general publicity and counselling for pregnant women. In addition, attention has been paid to the problems of dissemination by emphasising professional education. One major shortcoming is that most of these studies appear to have been carried out with little reference to existing knowledge on health education and promotion, or educational work in the antenatal or alcohol fields. In addition, little attention appears to have been paid to the characteristics of the groups at whom intervention might be targeted or the underlying social or psychological factors which maintain drinking in these groups. The second part of this paper, therefore, attempts to suggest appropriate avenues for developing preventative strategies by presenting a wide-ranging review with special reference to British experience. Particular attention is given to the issues of form and content of appropriate messages, targeting of risk populations, the venue for intervention, and media and the actual mechanisms involved in implementing the programme. We conclude that women should be advised to limit their alcohol consumption to no more than one unit a day when they are either pregnant or planning a pregnancy. We recommend that pregnant women should be asked about their alcohol and given appropriate advice during routine antenatal clinic visits. We suggest that the form of advice should be designed with the characteristics of the risk population in mind.(ABSTRACT TRUNCATED AT 400 WORDS)

Alcohol, smoking and pregnancy: some observations on ethnic minorities in the United Kingdom.

This paper describes drinking and smoking patterns before and during pregnancy in 363 women from ethnic minorities living in West London. Drinking and smoking were less common and levels of consumption were lower amongst women of Afro-Caribbean, Asian or Oriental origin than amongst Europeans. However, 75% of the Afro-Caribbeans, 56% of the Orientals and 47% of the Asians did drink alcohol before pregnancy. Twenty-one per cent of the Europeans, 5% of the Afro-Caribbeans, 3% of the Orientals drank more than 100 g alcohol per week (the level at which fetal harm may result). Drinking and smoking decreased in pregnancy in all ethnic groups, but 31% of Afro-Caribbeans, 29% of Orientals and 18% of Asians continued drinking. It is important to take alcohol and smoking histories from all pregnant women whatever their racial origin as part of good antenatal care.

Screening for alcohol related problems in the antenatal clinic; an assessment of different methods.

This paper assesses different methods of asking about alcohol consumption in the antenatal clinic. Reliable screening methods are essential if appropriate intervention is to be accurately targeted. Women attending antenatal clinic for the first time were questioned about their alcohol consumption in the period immediately before confirmation of pregnancy. Quantity-frequency questions, a question about bingeing and the Cage Questions were asked as part of the routine clinical history by the interviewing doctor. In addition, the women were given a further self-completed questionnaire which contained more detailed questions about the usual quantity and frequency of drinking beers, wines and spirits, the Cage Questions again and the Brief Michigan Alcoholism Screening Test (BMAST). Asking simple quantity-frequency questions coupled with a question about bingeing during the clinical history was shown to be a quick and efficient method of estimating alcohol intake. Self-administered questionnaires were shown to be unnecessary and although the Cage Questions performed better than the BMAST, these alcoholism screening tests were found to be unreliable in this population in which drinking was generally at a low level.

Drinking and smoking patterns amongst women attending an antenatal clinic--I. Before pregnancy.

This paper provides basic epidemiological data on smoking and drinking patterns before pregnancy amongst 1117 pregnant women attending a London antenatal clinic. Similar data are already available from North America and surveys have been done in Scotland but there is a dearth of information from England and Wales. In the early stages of pregnancy, prior to recognition, heavy alcohol consumption (in excess of 56 units of alcohol per week) is associated with the Foetal Alcohol Syndrome. More moderate levels of intake (as little as 10 units of alcohol per week) have been associated with Foetal Alcohol Effects such as growth retardation. In our sample 19% of the mothers were drinking more than 10 units of alcohol per week. Six per cent were consuming more than the 14 units of alcohol currently recommended by three of the medical Royal Colleges as 'safe' for non-pregnant women. Average weekly alcohol consumption was related to both the usual frequency and amount drunk, but also to binge drinking, beverage choice and combination, and reasons for drinking. In general, drinking was frequent and light. Those women who drank more per week tended to drink more frequently than those in the lower weekly consumption bands. Fourteen per cent of the sample admitted to binge drinking (more than 14 units of alcohol in a single sitting). Wine was the most popular beverage type. The range of beverages consumed was wider in the higher alcohol consumption bands. Those in the lower bands were more likely to drink only one beverage type. Social reasons for drinking were of far greater importance than reasons which emphasised the effects of drinking. However, heavy drinkers were unlikely to drink solely for social reasons. Seventy-seven per cent of the mothers were non-smokers, but the incidence of smoking increased in the higher alcohol consumption bands. The demographic characteristics of the smokers were in marked contrast to those of the heavier drinkers. Smokers tended to be younger, of lower social status and multiparous, whereas the heavier drinkers were more likely to be older, of higher social status and primiparous. This finding is of fundamental importance to those interested in planning screening or intervention programmes.

Drinking and smoking patterns amongst women attending an antenatal clinic--II. During pregnancy.

This paper describes smoking and drinking patterns during pregnancy amongst a cohort of 2266 women who enrolled at a London antenatal clinic 1982-1983. Only 12% of mothers were non-drinkers before pregnancy, but 44% abstained in the first trimester, 38% in the second and 50% in the third. Before pregnancy 20% of mothers were drinking more than the recommended 10 units of alcohol per week. This dropped to 6% during pregnancy. Mean consumption at each of the three stages of pregnancy was highest amongst those mothers who were the heaviest drinkers before pregnancy. The heaviest pre-pregnancy drinkers were also the least likely to abstain at any point in pregnancy. Of those mothers who were drinking less than 10 units of alcohol per week before pregnancy, 3% increased during pregnancy. Wine was the most popular beverage choice but heavier drinkers were more likely to drink beers and spirits in addition. Before pregnancy 29% of mothers smoked. This dropped to 23% in pregnancy. Consumption levels fell amongst those who continued smoking. The heaviest pre-pregnancy smokers were the most likely to reduce but the least likely to stop. Smoking was positively associated with the level of both pre-pregnancy and pregnancy drinking. The most commonly cited reasons for changes in drinking and smoking habits in pregnancy were concern for the child, concern for self or concern for both. Feeling sick or ill was a more commonly stated reason for reduction of drinking than smoking. Social pressures were important in reducing smoking, but the mass media were quoted as a more important influence in reducing drinking. Mothers who drank more than 10 units of alcohol per week during pregnancy were more likely to be older, of higher social status and primiparous. In contrast those who smoked in pregnancy were more likely to be younger, of lower social status and multiparous. This has important implications for planning antenatal health education.

Effects of moderate alcohol consumption and smoking on fetal outcome.

Previous studies of the effects of moderate drinking on the outcome of pregnancy are assessed. The results of a prospective study of the association between alcohol consumption in pregnancy and birthweight, length of baby, head circumference and premature delivery are described. Consumption of more than 10 g alcohol per day in very early pregnancy or even before conception approximately doubled the risk that the infant would have a low birthweight. Cigarette smoking was also a risk factor for low birthweight. It may therefore be beneficial for women to reduce their alcohol consumption to one drink a day or less from before conception and give up smoking as well.