ISSUES AND INNOVATIONS IN NURSING EDUCATION

The biological sciences in nursing: a developing country perspective

Una Kyriacos MSc

Part-Time Senior Lecturer, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Sue Jordan MB BCh PhD PGCE

Senior Lecturer, School of Health Science, University of Wales Swansea, Swansea, UK

Jean van den Heever BA

Freelance Nurse Consultant, Formerly of the University of Cape Town, Cape Town, South Africa

Accepted for publication 29 November 2004

Correspondence:

Sue Jordan,

School of Health Science,

University of Wales Swansea,

Swansea SA2 8PP,

UK.

E-mail: s.e.jordan@swansea.ac.uk

KYRIACOS U. , JORDAN S. & VAN DEN HEEVER J. (2005)KYRIACOS U. , JORDAN S. & VAN DEN HEEVER J. (2005) Journal of Advanced

Nursing 52(1), 91–103

The biological sciences in nursing: a developing country perspective

Aim. This paper reports a study to inform curriculum development by exploring the

contribution of bioscience education programmes to nurses’ clinical practice, their

understanding of the rationale for practice, and their perceptions of their continuing

professional development needs.

Background. The future of the health services worldwide depends on nurse edu-

cation programmes equipping practitioners to deliver safe and effective patient care.

In the developed world, the structure and indicative content of nursing curricula

have been debated extensively. However, despite the rapid expansion in nursing

roles brought about by social change, there is little information on the educational

needs of nurses in developing countries.

Methods. This study was undertaken in government teaching hospitals in Cape

Town, South Africa in 2003. A purposive sample of 54 nurses from a range of

clinical settings completed questionnaires and described critical incidents where

bioscience knowledge had directed practice. Questionnaires were analysed

descriptively, in the main. Analysis of critical incident reports was based on

Akinsanya’s bionursing model.

Findings. Most nurses felt that their understanding of the biological, but not the

physical sciences, was adequate or better: all felt confident with their knowledge of

anatomy, compared with 57Æ4% (31/54) for microbiology. Respondents attributed

the successes and failures of their education programmes to their teachers’ delivery

of content, ability to relate to practice and management of the process of learning.

The biological, but not the physical, sciences were universally (96–100%) regarded

as relevant to nursing. However, the critical incidents and nurses’ own reports

indicated a need for further education in pharmacology (40/54, 74Æ1%) and

microbiology (29/54, 53Æ7%).

Conclusion. To meet the needs of nurses in developing countries, and empower

them to meet the increasingly complex demands of their expanding roles, nurse

educators need to consider increasing the curriculum content in certain key areas,

including pharmacology and microbiology.

Keywords: bionursing, bioscience, developing countries, nurse education, role

expansion

� 2005 Blackwell Publishing Ltd 91

Introduction

The link between the nursing curriculum, the biological

sciences and the delivery of patient care has been explored in

the developed world. However, the educational needs of

healthcare professionals in developing countries is unre-

searched. In these countries, because of the immediacy of

clinical demands, nursing roles are often expanded and

delivery of patient care may be different: nurses in developing

nations may be facing different challenges. Whether the

effectiveness of teaching and learning of bioscience could

have an impact on practitioners in these settings has not been

investigated.

Background

Bioscience in nursing

The inclusion of the biological sciences in the nursing

curriculum went unchallenged for some 50 years, in the

belief that ‘The more that nurses know about these sciences,

and the more they can apply to practice, the more help they

can be to those they serve’ (Henderson 1978, p. 125).

However, some theorists felt that the reductionist biomedical

model associated with these sciences stifled the emergence of

a distinctive body of nursing knowledge (Akinsanya &

Hayward 1980). Trnobranski (1996, p. 1072) suggests that

nursing’s struggle to divest itself of medical control and assert

itself as an autonomous profession distinct from, but com-

plementary to, medicine engendered a change in nursing’s

ideology. This has been reflected in nurse education pro-

grammes. As the professions of nursing and medicine have

diverged, they have ceased to share a common language

(Lynaugh & Bates 1973) and body of knowledge. Reconsi-

deration of the place in the nursing curriculum of the

biomedical model of care has promoted the inclusion of the

social sciences; however, this welcome development may

have been at the expense of the biological sciences (Mulhall

1990, Jordan et al. 1999).

For three decades, nurse educators have reported problems

with the teaching and learning of bioscience. These subjects

are perceived as difficult and their application to practice

unstructured and even haphazard (Wilson 1975, Akinsanya

& Hayward 1980, Don 1995, Davies et al. 2000, McVicar &

Clancy 2001). Consequently, some learning material appears

extraneous to students’ perceptions of practice, leading to

dissatisfaction and impatience (Thornton 1997). These diffi-

culties may arise from students’ lack of day-to-day clinical

experience, their perception of biology as a ‘hard’ science,

their poor preparation in science, the volume of material and

intensity of teaching and learning within a 3-year pro-

gramme, lack of curriculum time, the range of background

and expertise of teachers and the teaching strategies

(Courtenay 1991, Race & Holloway 1992, Sutcliffe 1992,

Caon & Treagust 1993, Chapple et al. 1993, Trnobranski

1993, Nicoll & Butler 1996). Furthermore, in clinical areas,

practitioners may themselves lack the confidence in

bioscience necessary to mentor students (Clancy et al. 2000,

McVicar & Clancy 2001). Nurse educators in Australia (Ives

et al. 1996, Thornton 1997, Wilkes & Batts 1998) and New

Zealand (Casey 1996, Nicoll 1999) echo these concerns.

Strategies to improve integration and, subsequently, patient

care include: problem-based learning (Wong & Wong 1999,

Davhana-Maselesele et al. 2001), teaching principles of

rational drug use (Gray 1999), applying principles of phys-

iology to organize clinical experiences into meaningful

learning (Jordan & Reid 1997) and ‘linked teaching sessions’

involving co-teaching between physiologists and nurses

(Wynne et al. 1997).

Teaching and learning of the biological sciences need a

coherent, structured approach (Trnobranski 1993) and

integration with nursing content (Barclay & Neil 1987).

Unless nurses identify and define the biological basis of

nursing education and practice, they cannot claim a unique

body of knowledge derived from these sciences that is

distinctive from purely medical knowledge (Akinsanya &

Hayward 1980, p. 429). The ‘bionursing’ model, derived

from a conceptual consideration of four levels of nursing

actions, represents an attempt to construct direct links

between care delivery and bioscience (Akinsanya 1987,

p. 267) (see Table 1).

Nurse education in South Africa

In transforming and democratizing South African higher

education, a policy of inclusivity has been embraced; with the

formal recognition of prior learning, the entry gates for access

to higher learning have been widened [Department of

Education (DoE) 2001]. This has major implications for

nurse education. Although most diploma and degree prereg-

istration nursing programmes worldwide include bioscience,

albeit at different levels, in South Africa there are particular

challenges: ‘[T]he terms ‘disadvantaged’, ‘under prepared’,

and ‘academic development’ are part of our complex history

and emerged within a context of discrimination, oppression,

and deeply rooted prejudice concerning the intellectual

competence, intelligence, or mental abilities of different

ethnic and racial groups’ (Miller 1997, p. 11). Approximately

90% of Registered Nurses are diploma-prepared, and 10%

are graduates. There are no requirements for mathematics

U. Kyriacos et al.

92 � 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103

and science for admission to diploma programmes, unlike

degree programmes.

Role expansion

To meet the health needs of the rural population after

achieving democracy in 1994, the South African government

established new primary health care clinics with Registered

Nurses as lead professionals. At this time, the only practical

strategy to meet the burgeoning demands for health care was

expansion of nursing roles. Because of resource constraints,

many of these nurses are working without recourse to

medical practitioners. To meet the educational needs of

nurses in their newly-expanded roles, the South African

Table 1 Level of performance described in critical incidents

Task level Level descriptor Incident example

Perception of knowledge needed

in the incident

1. Task operational

(0 responses)

Knowledge shared with the general

public; level of nursing auxiliaries

and orderlies, e.g. maintenance of

clean environment

No descriptions

2. Task specific

(three respondents

8, 31, 32)

Requires an understanding of basic

life sciences concepts, terms and

principles, in order to carry out

specific tasks but little evidence of

understanding reasons for actions

Patient received post caesarean

section from theatre. Started

bleeding perfusely [sic] when

arrived in ward. Intravenous

infusion in situ – infusion resited

20u Syntocinon� (synthetic

oxytocin) (Novartis SA (Pty) Ltd,

Kempton Park, South Africa.) put

in, infusion running fast. Uterus –

fundus rubbed up – tendency to

relax. Hb taken – very low. Blood

taken for cross-match. Outcome:

patient received two units red

blood cells. Patient fine

Anatomy – location of uterus

Physiology – rubbing of

fundus; Hb taken for

haemoglobin [sic]

Pharmacology – use of Pitocin

and Plasmalyte B

3. Task contextual

(six respondents

13, 15, 19, 36,

42, 48)

Depth and breadth of knowledge

and appropriate application;

informed decision-making, based

on precise knowledge, relating to

patient safety and well-being,

e.g. medication administration,

assessment, planning,

implementing and evaluating

nursing interventions

Assessment of a 90-year old

patient with a CVA and

hypertension, and prediction of

a poor outcome, which was

confirmed

Linking anatomy, physiology and

pathophysiology to predict a

poor outcome.

Dehydration was linked to

gastro-enteritis; dyspnoea,

central cyanosis, decreased heart

rate, drop in blood pressure

were linked to a failing heart

4. Personal and

professional

development

(one respondent

R54)

Evidence of wide-ranging

development of skills after initial

licensure, which reflects an

appropriate knowledge base for

professional practice

Nursing a preterm infant with

hyaline membrane disease in a

neonatal ICU required constant

assessment and monitoring of

physiological parameters and

titration of medication

Physics linked to principles of

mechanical ventilation; slow

bolus i.v. administration.

Pathophysiology linked to

hypoxia and resultant brain

damage, brain haemorrhage,

haematuria, jaundice,

necrotising enterocolitis,

pulmonary hypertension.

Chemistry linked to blood gas

results, acidosis. Microbiology

linked to washing and spraying

hands, sterile suctioning

technique. Pharmacology linked

to dopamine* and morphine

infusions and blood pressure

changes

*UK manufacturers indicate that the safety and efficacy of dopamine has not been established for individuals aged under 12 years.

Issues and innovations in nursing education The biological sciences in nursing

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103 93

Nursing Council incorporated specialist postregistration

training into the 4-year diploma and degree preregistration

programmes, leading to licensure as a Midwife and Nurse

(general, community and psychiatric) (South African Nursing

Council 1985). This approach was considered cost-effective,

as it reduced the need for postregistration study in these

specialty areas, other than at advanced level. However, there

remains a shortage of primary health care trained nurses

(Strasser 1999).

In primary care and occupational health, the South African

health service relies on nurses being able to prescribe (Gray

1999) and, under certain circumstances, dispense specified

medications from schedules 1–4 of the ‘Essential Drugs’ List’

(South African Nursing Council 1984, National Drug Policy

for South Africa 1996, Geyer 2001, Medicines and Related

Substances Act 2003). These include many antimicrobials

and cardiovascular drugs. Recent legislation confers prescri-

bing authority on all healthcare professionals, in addition to

medical practitioners, nurses and dentists, based on compe-

tency. Draft legislation proposes that doctors’, nurses’ and

dentists’ authority to dispense medication should be subject

to a special examination and triennial review before

re-licensure. However, incorrect administration of medica-

tion is a common problem (Gladstone 1995, Gray 1999, Fijin

et al. 2002). Analysis of the South African Nursing Council

hearings of misconduct between January and August 2002

(Ka Mzolo 2002) indicates that charges against Registered

Nurses included failure to: keep clear and accurate records of

patients’ conditions (5) and medication administered to

patients (4); assess, diagnose and monitor changes in patients’

conditions (4) and women in labour (4); summon a medical

practitioner (3); provide prescribed pain relief during labour

(1); monitor foetal heart rate (1). (The prevalence of

unreported misconduct is not known.) These reports suggest

suboptimal scientific and clinical knowledge.

The key to equipping nurses to manage both the increas-

ingly complex situations currently encountered and the

challenges of their expanded roles is the nursing curriculum

(Jordan & Reid 1997, Jordan 1998). We suggest that, if

education programmes are to keep pace with the evolving

demands of practice, examination and re-evaluation of the

content and delivery of nursing curricula are essential.

The study

In government-funded teaching hospitals in Cape Town, we

undertook a pilot project to explore practising nurses’

perceptions of the biosciences. Building on previous United

Kingdom (UK) work, we aimed to assess the extent to which

local curricula and pedagogic interpretations of the bio-

sciences are assisting nurses in their clinical practice and in

linking practice situations with underpinning knowledge. By

defining educational need, we hope to expedite the develop-

ment of an evidence-based nursing curriculum in our insti-

tutions.

Aim

The aim of the study was to evaluate nurses’:

• understanding of bioscience;

• perceptions of their learning experiences;

• perceptions of the relevance of these subjects;

• use of knowledge in critical incidents;

• continuing professional development needs.

Design

We undertook a cross-sectional descriptive survey, with

additional critical incident reports for a sub-sample of

respondents (interviews conducted in connection with this

study will be reported separately).

Participants

This study was undertaken in government teaching hospitals

that had a total bed status of 1113. The hospitals serve

mainly economically deprived urban and peri-urban sectors

of a regional population of 4Æ1 million, and employ 664

Registered Nurses (RNs) and 811 other nursing staff. In

South Africa, this second category encompasses two distinct

groups – Enrolled Nurses and Nursing Assistants – both

accountable to RNs. These hospitals educate the other

nursing staff, whereas RNs are educated in universities or

nursing colleges. Preregistration nursing students attend these

hospitals and other settings for clinical experience.

A purposive or judgemental sample of RNs was recruited

by the lead researcher (UK), who has intimate knowledge

of the hospitals, to ensure that respondents had a range of

ages, qualifications and linguistic backgrounds, and worked

on both day and night shifts in a range of clinical areas

(Table 2) (Polit & Beck 2004). Data collection was

arranged with hospital managers so that at least one nurse

from each clinical area could participate. Between 18

August and 5 September 2003, 54 nurses working on these

wards, outpatient and specialist departments were asked to

participate. No-one refused. A sub-sample of 10 respon-

dents, selected to include a range of clinical areas, with no

more than one respondent from any one ward, described

critical incidents (selection of clinical area is detailed in

Table 2).

U. Kyriacos et al.

94 � 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103

Recruitment was undertaken by investigators fluent in

English and Afrikaans (UK, JvdH). In South Africa, which

has 11 official languages, nurse education programmes are

offered in either English or Afrikaans and all Registered

Nurses, including Xhosa first-language speakers, are compet-

ent in these languages. The investigators administered and

explained the questionnaires to all respondents and were

available for further clarification during their completion.

Data collection and rigour

Selection of appropriate data collection methods to evaluate

education outcomes poses difficult decisions (Jordan 2000).

To strengthen internal validity, we collected both enumerat-

ive and qualitative data (Bryman 1988). The questionnaire

was developed from previous work (Jordan et al. 1999,

Davies et al. 2000), and contained both open and closed

questions. The biosciences considered were anatomy, phys-

iology, pharmacology and microbiology, based on our

current curricula and others’ work (Akinsanya 1987,

Courtenay 1991).

To maximize content validity, questionnaires were con-

structed around the main issues raised in the literature on

bioscience in nurse education:

• understanding of these subjects (Akinsanya 1987, Chapple

et al. 1993, Davies et al. 2000);

• learning experiences of the theory–practice links (Wilson

1975, Trnobranski 1993, Pearson & Clarke 1994, Jordan

1998);

• the value and relevance of bioscience to nursing practice

(Wilson 1975, Akinsanya 1987, Courtenay 1991, Pearson

& Clarke 1994, Jordan & Reid 1997, Jordan et al. 1999);

• reported critical incidents (Jacobs 1981, Benner 1984,

Jordan 1998);

• continuing professional development needs of nurses (Jor-

dan 1998, 2000, Bullock & Manias 2002, Otway 2002,

Sodha et al. 2002).

There is little evidence to recommend any one method of

ascertaining respondents’ views on any continuum; therefore,

a descriptive five-point scale was chosen for questionnaire

responses (Oppenheim 1992, Bowling 2002), from ‘very

poor’ to ‘very good’.

The questionnaire was examined for construct and face

validity by four healthcare professionals with PhDs. Follow-

ing prepilot work, questionnaires were piloted with three

practising nurses. Adjustments were made accordingly.

Respondents to critical incident questions were asked to

report factual situations where knowledge and understanding

of bioscience had helped them to deal with the situation and,

in so doing, had improved patient outcomes (Flanagan 1954,

Jordan 1998, Polit & Beck 2004). Such qualitative data

contextualize the evaluation and improve the generalizability

of the findings (Murphy et al. 1998). Also, the qualitative

data in this preliminary study allowed generation of new

ideas, which will feed into subsequent phases of the work.

Written responses to open-ended questions and critical

incidents were transcribed and translated into English, where

necessary.

Table 2 Respondents’ clinical areas

Total number of

respondents

Numbers on day shift

(07Æ00–16Æ00 or �19Æ00)

Numbers on night shift

(19Æ00–07Æ00)

Number of critical incident

respondents

Medical wards (all specialities) 12 9 3 1

Surgical wards (including

radiology/oncology)

11 9 2 3

Out patients’ departments 11 11 Not applicable 0 (Pilot site for this part of the

questionnaire)

Maternity 6 6 Not approached 2

Intensive care 4 3 1 2

Children’s wards 2 1 1 0 (Environment too noisy for

interviews)

Mental health 2 2 Not approached 0 (Not approached, because of

assumptions that many critical

incidents here would not

require bioscience knowledge)

Trauma and orthopaedics 2 1 1 1

Infection control 2 2 Not applicable 1

Administration 2 2 Not applicable 0 (Not approached. Critical

incidents are not usually clinical)

Total 54 46 8 10

Issues and innovations in nursing education The biological sciences in nursing

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103 95

Ethical considerations

The study was approved by the University of Cape Town

Faculty of Health Sciences Research Ethics Committee.

Access was granted by hospital management teams. Respond-

ents were shown letters of approval for the study from

hospital management and assured that responses would be

treated in confidence and anonymized. Participation was

voluntary and anonymous.

Data analysis

Questionnaire data were coded for analysis, entered into

STATASTATA 7 (StataCorp. 2002) and converted into statistical

package for the social sciences (SPSS) version 11.5. Frequen-

cies and distributions of responses were checked. The low

numbers in our sample indicated that inferential analyses

should be approached with caution. For variables related to

seeking further continuing professional development,

McNemar’s test for analysis of matched paired variables

was used to assess the likelihood of any changes over time

being due to chance. The Mann–Whitney U-test was used to

explore any differences on the ordinal self-assessed under-

standing and relevance scores between respondents seeking

and not seeking continuing professional development

(Altman 1991).

Open questions and critical incident responses were sub-

jected to content analysis (Berelson 1952). They were initially

read and indexed to form provisional headings and tentative

categories, which were confirmed or rejected in subsequent

readings. This allowed exploration of responses, which were

used to study all aspects of respondents’ perceptions of the

biological and physical sciences, taking a thematic approach

(Turner 1981, Strauss & Corbin 1990). The critical incident

responses were indexed and categorized, using the four levels

of performance from Akinsanya’s (1987) bionursing model,

to assess the demands made on the depth of knowledge and

understanding of the biosciences (Table 1). Enumeration of

responses provided a systematic overview of the data and

highlighted any gaps in the patterns of response (Becker &

Geer 1982, Silverman 2001).

Coding was undertaken sequentially by all authors, with

the final categories reflecting joint decisions. We were aware

of the risks of trivializing the data in attempts to achieve

inter-rater reliability (Morse 1997). Emergent themes were

juxtaposed with quantitative data and the literature to

evaluate and reassess the overall picture, and ascertain the

degree of support for the ideas generated (Hammersley &

Atkinson 1983). The diverse perspectives of the data sets

afforded opportunity to corroborate and integrate findings

(Denzin 1970, Bryman 1988). The theme of educational need

emerged from both data sets, and is the focus of this paper.

Findings

Most respondents were female (51/54, 94Æ4%). Respondents

were aged 23–63 years (mean 41Æ3, SDSD 9Æ8 years), with

nursing experience of 4 months to 35 years (mean 15Æ2, SDSD

10Æ9 years). Most (45/54, 83Æ3%) were diploma-prepared,

while seven had qualified through bridging courses and two

were graduates.

Education and understanding

In their preregistration programmes, all respondents had

studied anatomy, physiology and pharmacology. Thirteen

had not studied physics, 15 had not studied chemistry and

two reported not studying microbiology.

On qualification, 32 of 54 (59Æ3%) respondents reported

that they had adequate understanding of anatomy and

physiology, while 21 (38Æ9%) indicated they had only a

superficial understanding of microbiology and 11 (20Æ4%)

felt they had only a superficial understanding of pharmacol-

ogy (Figure 1). Twenty-five respondents (46Æ3%), including a

graduate, felt that they had only a superficial understanding

of physics, and 48Æ2% (n ¼ 26) said this about chemistry.

Nurses’ descriptions of their successful or unsuccessful

learning experiences of bioscience in preregistration pro-

40.731.5

59.3

59.3

22.2 27.8

50.0

74.1

9.3

48.246.3

38.9

20.4

5.37.41.91.9

0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pharm

acolo

gy

Superficial Adequate Deep

Micr

obiol

ogy

Physic

s

Chem

istry

Physio

logy

Anato

my

Figure 1 Reported understanding of biosciences at completion of

preregistration programme.

U. Kyriacos et al.

96 � 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103

grammes fell into three main areas: teachers’ ability in

managing the process of learning, teachers’ personal attrib-

utes and the pedagogic interpretation of the academic

content. For example:

For anatomy, physiology and pharmacology, many examples were

given and clearly seen in practice and then compared with the theory.

[R5]

However: Some [teachers] were practical-orientated and found it

difficult to incorporate theory. [R13]

These data are presented in detail in Tables 3 and 4. The

extent to which teachers understood, explained and applied

bioscience to practice was most important to respondents.

While teachers’ positive attitude and interest in the subject

contributed to successful student learning (10 respondents),

more notable was management of the process of learning

(30 comments/27 respondents):

There was enough clinical contact with the college and the clinical

instructors (experienced registered nurses) made it their responsibility

to follow up theory with practice. [R39]

Clinical experience (24 respondents), the opportunity to

apply theory to practice (20), informal self-directed study

(16), postregistration studies (10), and teaching students

while on duty (8) were the most important factors contribu-

ting to increased understanding since qualification. Teachers’

poor knowledge (7), inadequate learning opportunities and

resources (4) and time constraints continued to be blamed for

any poor understanding of bioscience. Respondents’ reported

understanding of the theory–practice integration of the

biosciences had improved since qualification, with the

majority having adequate or better understanding, ranging

from 47 of 54 (87Æ0% microbiology) to 53 of 54 (98Æ1%

pharmacology and anatomy) for different subjects.

Knowledge in practice

Almost all nurses saw the biological sciences as essential or

relevant to practice. No-one considered physiology and

pharmacology irrelevant (Figure 2). However, there was less

interest in physics and chemistry. Since nurses were less sure

of the relevance of physics and chemistry, it was not

surprising that the theory–practice links for these subjects

were weaker. It was more disturbing that teachers had only

succeeded in linking pharmacology with practice at an

adequate (or worse) level for most nurses (42/54, 72%)

(Figure 3).

Thirty-four respondents suggested that biosciences are

included in preregistration nursing curricula to provide basic

knowledge, understanding, insight and skills:

To nurse patients adequately and use my own initiative in difficult

conditions with better understanding. [R34]

Table 3 How teachers clarified the relationship between bioscience theory and nursing practice: themes and data categories

Indicative content

(42 comments/41 respondents)

Managing the process of learning

(30 comments/27 respondents)

Personal attributes

(15 comments/13 respondents)

Knowledgeable (14) Teaching skills, experience, methods (13) Being professional, dedicated (2)

Application of theory to practice (14) Use of visual aids (8) Positive attitude, pleasant, made learning exciting

and interesting, passionate, motivated (10)

Clinical experience (4) Listening (2) Nurturing (1)

Explanations (7) Library and other resources (3) Patience (2)

Testing knowledge (3) Active student learning (1)

Adequate time allocation (3)

Numbers given are the numbers of respondents raising these issues.

Table 4 Barriers to linking bioscience theory with nursing practice: themes and data categories

Indicative content

(30 comments/30 respondents)

Managing the process of learning

(13 comments/13 respondents)

Personal attributes

(four comments/four respondents)

Inadequate knowledge and understanding (14) Inadequate teaching skills, experience,

methods, boring, no eye contact (7)

Lack of interest in teaching (3)

Course too comprehensive (3) Lack of time (4) Language problems (1)

Lack of application (6) Lack of student involvement (1)

Lack of explanation (6) Lack of resources (Afrikaans textbooks) (1)

No testing of knowledge (1)

Issues and innovations in nursing education The biological sciences in nursing

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103 97

Thirteen nurses pointed to holistic/total patient care:

Everything fits together like a puzzle and the understanding of one is

dependent on understanding them all to know how the human body

works. [R28, Afrikaans]

Eight respondents described the biosciences as fundamental

to nursing, that is, for an understanding of practice:

That’s what nursing is all about. [R8, R12]

Essential for developing nursing to its full potential. [R51, Afrikaans]

While two respondents said that the sciences provided the

foundation for further studies, three felt that bioscience was

included in preregistration nursing programmes to empower

nurses to use their initiative and question doctors’ orders:

‘Don’t follow like sheep’ [R17]. Six respondents indicated

that Registered Nurses needed to teach both patients and

students: for this, bioscience knowledge was essential. One

questioned the value of science in nursing, relating to pressure

of work:

Work is more nursing-orientated. We hardly have time to go into

biosciences. [R13]

The relationship between reported critical incidents and

Akinsanya’s four levels of task performance is detailed in

Table 1. No respondents gave the impression of performing

at ‘Task operational’ level, that is, not requiring any depth of

knowledge and understanding of bioscience. Three were

working at ‘Task Specific’ level. This requires an understand-

ing of basic life sciences concepts, terms and principles in

order to carry out specific tasks (Akinsanya 1987, p. 272) but

little evidence of understanding reasons for actions. R8

(25 years’ experience) linked patient/family education with

adverse effects of anti-inflammatory medication and stomach

ulcers, but the lack of detail in this response placed this

description at the Task Specific level. R31 (18 years’ experi-

ence) described a mechanistic approach to managing a

patient with a postpartum haemorrhage, devoid of detail,

thus giving the impression of Task Specific performance.

In contrast, R32 (4 years’ experience) safely delivered a

patient with pre-eclampsia at a Task Contextual level, citing

vital sign recordings (except cardiotocograph recordings),

and appropriate administration of medications. However, she

attributed this to clinical experience rather than knowledge.

Six participants were using bioscience knowledge at a Task

Contextual level, demonstrating appropriate application of

knowledge and informed decision-making. However, the

critical incident reports implied an understanding of patho-

physiology and nursing practice, for example doing observa-

tions’ or dehydration due to gastro-enteritis, without

7.4

22.2 22.2

61.159.3

33.3

24.5

75.9 77.8

35.2 33.3

63.0

75.5

3.7 3.7 01.9 00%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EssentialRelevantNot relevant

Pharm

acolo

gy

Micr

obiol

ogy

Physic

s

Chem

istry

Physio

logy

Anato

my

Figure 2 Perceived relevance of biosciences to practice.

13.3 13.65.75.6

31.1 29.6

24.520.4

22.2

35.2

40.0 40.9

39.648.2

46.3

37.0

13.3 13.6

24.514.8

25.922.2

2.2 2.3 5.713.0

3.70 00%

20%

40%

60%

80%

100%

Anato

my

Physio

logy

Chem

istry

Physic

s

Micr

obiol

ogy

Pharm

acolo

gy

Very good

GoodAdequatePoorVery poor

5.6

Figure 3 Extent to which teachers linked science theory to nursing

practice.

U. Kyriacos et al.

98 � 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103

explicitly making the cognitive links and examining the

reasons for actions. Of interest at this level was prediction of

patient outcome.

Level four, personal and professional development (PPD),

characterized by wide-ranging skills and reflection, was

difficult to assess from descriptions of isolated critical

incidents but could be inferred in one case. R54 (19 years’

experience) described a Task Contextual performance, with

evidence of PPD, in caring for a preterm infant with hyaline

membrane disease, by titrating morphine and dopamine

infusions according to central BP monitoring and clinical

responses. There was evidence of deep knowledge and

understanding of science and informed decision-making,

resulting in confident, autonomous interventions. Descrip-

tions of pathophysiology and consequences of hypoxia were

detailed. R54 felt that physics and chemistry were needed

‘to understand blood gas results…and the need for

slow bolus administration if correcting acidosis because of

fluid volumes and the risk of intraventricular/cerebral

haemorrhage’.

Continuing professional development

Most respondents (38/54, 70Æ4%) said that, on qualifying,

they needed more information on pharmacology and micro-

biology, 29 (53Æ7%). Fewer needed more information on

physics (15/53, 28Æ3%) and anatomy (9/54, 16Æ7%). For most

nurses, there was no statistically significant change in the

proportions seeking further study since qualification

(Table 5).

Despite admitting relatively poor understanding of physics

and chemistry, few saw these subjects as sufficiently work-

related and/or important to seek professional development in

these areas. In contrast, most (74Æ1%, 40/54) felt that they

now needed continuing professional development in phar-

macology, more than any other subject (Table 5). This may

reflect the rapidly changing nature of practice:

All very important in modern day nursing. We need to know side

effects and interactions of the drugs we give to patients. [R18]

Nurses were aware that their knowledge could become

‘rusty’, reinforcing the need for clinical updates:

Many things has changed [sic]. Therefore we need to stay updated

with regard to the new advances. [R9]

Infection control and, by implication, the underpinning

microbiology, was raised spontaneously by three respond-

ents. Concerns were confirmed by infection control special-

ists, who considered that colleagues’ knowledge of

microbiology could be improved:

Working in infection control we liaise with staff in clinical areas.

There seems to be very little insight into microbiology. [R30]

Analysis of open-ended questions asking ‘Why would you

seek out these subjects for professional development?’

revealed three main themes: personal knowledge (63 com-

ments/51 respondents), clinical relevance (eight respondents)

and personal development (four respondents). Categories

within the personal knowledge theme relate to the need for

knowledge of medical conditions (10), knowledge and insight

in general (9), teaching (6), speciality areas (5), infectious

diseases (3), knowledge for change (3), intravenous medica-

tion (1), nutrition (1), the new National Health 2010 Plan

(1). Six respondents commented on the need to improve

personal knowledge and understanding of biosciences with

work-related relevance, most particularly the need for infor-

mation on medicines (18), for example:

There is an expectation that RNs would have knowledge of the

effects and side effects of medicines. [R27, Afrikaans]

Seven responses within the clinical relevance theme related to

quality and holistic patient care. Four respondents gave

reasons of PPD, such as ‘To be able to prescribe medication’

[R47]. In all responses, nurses were advocating continuing

Table 5 Perceived continuing professional development needs

Subject

Education need identified

on qualification, n (%)

Education need identified

currently, n (%) Change (%)

Significance, P value*,

two decimal places

Pharmacology 38/54 (70Æ4) 40/54 (74Æ1) þ3Æ7 0Æ77

Microbiology 29/54 (53Æ7) 29/54 (53Æ7) 0 1Æ00

Physiology 21/54 (38Æ9) 25/54 (46Æ3) þ7Æ4 0Æ45

Anatomy 9/54 (16Æ7) 19/54 (35Æ2) þ18Æ5 0Æ01

Chemistry 18/54 (33) 13/54 (24Æ1) �8Æ9 0Æ23

Physics 15/54 (27Æ8) 12/54 (22Æ2) �5Æ6 0Æ58

*Value based on McNemar’s test, d.f. ¼ 1, two-sided significance.

Odds ratios and associated 95% confidence intervals are not quoted, as the values given by SPSS take no account of the ties in the data, and are

therefore misleading.

Issues and innovations in nursing education The biological sciences in nursing

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103 99

professional development as a strategy to maintain patient

safety. For all participants, there were no statistically

significant differences between those seeking and not seeking

continuing professional development in relation to percep-

tions of understanding or relevance.

Discussion

Analyses of critical incidents, considered alongside the

number of respondents (51/54, 94Æ4%) indicating a need

for more knowledge and continuing professional develop-

ment, suggest that many Registered Nurses in Cape Town

would like more bioscience knowledge in order to understand

patients’ problems and to intervene appropriately.

Study limitations

Although small-scale research fosters the development of

practice-based innovations, the findings of pilot projects, such

as this, must be regarded as provisional. Such studies generate

hypotheses for testing in subsequent initiatives. The infer-

ences that can be drawn are logical rather than statistical

(Mitchell 1983).

As with all surveys, our respondents were volunteers, and

may not have been representative of the nursing population:

nurses perceiving a problem with their education provision

might have been less willing to respond to the questionnaire.

Those uncertain of their knowledge might have been

reluctant to describe critical incidents. A survey of lead

nurses working in rural clinics unsupported by medical

practitioners might have yielded different results. To some

extent, our direct approach to those working certain shifts

reduced the bias inherent in surveys that achieve an

incomplete response (Altman 1991, Polit & Beck 2004).

Questionnaires were completed in our presence. While this

had the advantage of improving flexibility, clarifying mean-

ings (particularly for English second-language speakers) and

reducing non-response rates, our presence, although we

were strangers to respondents, may have introduced a social

desirability response (Oppenheim 1992, Kelly & Long

2000). Like others, we did not explore nurses’ understand-

ing of subject terms, such as ‘physiology’, and no-one

sought clarification.

As with all reported data, our findings are vulnerable to

recall and acquiescence bias. We were unable to observe

practice or obtain clinical outcome data; therefore, congru-

ence between respondents’ reports and events cannot be

guaranteed (Stimson & Webb 1975, Jordan 2000). However,

observing this number of nurses might have been difficult, or

confounded by the Hawthorne effect (Roethlisberger &

Dickson 1939). It is also possible that observations would

not have yielded critical incidents, as described here.

There may be some tensions within the data. Most (89–

98%) respondents perceived their understanding of bio-

science and its theory–practice integration to be adequate or

better. However, depth and breadth of knowledge underpin-

ning practice in critical incident reports offered limited

evidence of informed decision-making, and a tendency to be

guided by previous experience.

The nursing curriculum: a worldwide concern

This study was undertaken in major teaching hospitals in

Cape Town. The similarities between our findings and others

(Courtenay 1999, Jordan et al. 1999, McVicar & Clancy

2001) indicates that our description of educational need in

bioscience may be of more than local importance, and reflects

the concerns of nurse educators internationally (Casey 1996,

Thornton 1997).

The place of physics and chemistry in the nursing

curriculum is not widely discussed. Critical incident reports

indicated the importance of understanding clinical chemistry,

particularly pH balance and oxygenation. Many respondents’

understanding of theory–practice integration at the time of

qualification was less than adequate for physics and chem-

istry, and also for microbiology and pharmacology (Figure 1).

This was particularly so where students perceived nurse

educators themselves to be educationally under-prepared to

teach science theory. This may reflect the fact that, in South

Africa, many nurse educators have not enjoyed a preregis-

tration university education. Similarly, a study (n ¼ 40)

undertaken with final year preregistration nursing students in

primary health care in the Northern Province of South Africa

(Davhana-Maselesele et al. 2001) observed important differ-

ences between taught theory and practical application in

relation to anatomy, physiology and pharmacology. Our

respondents (n ¼ 20) identified theory–practice links as the

key to successful teaching and learning in bioscience. These

were augmented where classroom teaching was reinforced in

clinical areas, suggesting that theory–practice integration

should be promoted by increased intersectoral collaboration

between educational and health service institutions (Davhana-

Maselesele et al. 2001).

Nurse educators in South Africa appear to be facing

challenges similar to those in the UK. However, in today’s

South Africa, practising nurses’ unmet professional develop-

ment needs are intensified by their often more difficult clinical

situations. The widely-acknowledged difficulties with bio-

sciences discussed earlier may be intensified in programmes

with no formal entry qualifications in science. It is of concern

U. Kyriacos et al.

100 � 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103

that over 70% of our respondents identified continuing

professional development needs in pharmacology both on

qualification and many years later. These unmet educational

needs may have their origins in both curriculum revisions

initiated in the developed world (Trnobranski 1993, Jordan

1994), and health care reforms and changes in South African

higher education (Kyriacos & Van den Heever 1999).

The knowledge needed to nurse safely

Although most respondents (96–100%) considered bio-

science relevant to nursing, it is disturbing that any students

find science irrelevant to practice, particularly in the current

climate of increasingly complex health care situations (Drew

1988, p. 25). Fundamental to professional competence is an

understanding of the reasons for nursing work, enhanced by

experience, rather than merely obeying medical instructions

(Akinsanya 1987). In some instances our respondents were

substituting experiential learning for theoretical understand-

ing of the rationale for nursing actions.

Respondents described how personal bioscience knowledge

is reinforced when teaching patients and students, thus

empowering individuals (Morgan 1994, p. 792). However,

Wilkes and Batts’ (1991) study questions the accuracy of

information conveyed: they found that shared experience and

ritualised language amongst nurses reinforced simplistic

ideas, and some nurses’ personal knowledge of physics and

chemistry differed from scientific texts. Transferred informa-

tion was evident in our critical incident reports, where

respondents ascribed personal knowledge to experience

rather than study.

The literature contains concerns that nurses’ weak personal

knowledge of science is reinforcing popular stereotypes of

nursing as a ‘doing’ sub-profession (Wilkes & Batts 1998),

and it is important that any such preconceptions are

challenged. One strategy for establishing professional auton-

omy and tempering medical hegemony is useful clinical

knowledge, reinforced by knowledge of bioscience. In this

study, as in others (Jordan & Reid 1997, Jordan 1998),

bioscience knowledge was perceived as important in ques-

tioning medical decisions, ensuring patient safety and

providing holistic patient care. Although most respondents

were contextualizing learning and applying knowledge, for

nurses to realize their potential, they need further support to

develop their knowledge base and work at fully autonomous

PPD levels. Such educational attainments will be important

for safe and effective nurse prescribing and, therefore, crucial

to the success of the newly established nurse-led primary

health care clinics.

Conclusion

To address the concerns of nurses in developing countries and

empower them to meet the challenges of their expanded roles,

nurse educators should consider focusing curriculum devel-

opment resources on forging the theory–practice links asso-

ciated with such key topics as medication management,

infection control, and patient monitoring. Further research is

needed to evaluate the capacity of education programmes to

meet the needs of practitioners in expanded roles and equip

them to diagnose and prescribe autonomously and safely.

Good practice in learning and teaching needs to be identified

and disseminated, via web-based materials and traditional

media.

Education programmes should be closely co-ordinated with

the changing demands of nursing roles, including diagnosis

and prescription. Nurses’ prescribing practices in primary

health care clinics have not been evaluated. Review of

such prescriptions would facilitate the identification of con-

tinuing professional development needs. Unless appropriate

What is already known about this topic

• Worldwide, there is growing recognition that the key to

improving health care for all citizens may be the

expansion of nursing roles and assumption of new

responsibilities, formerly the preserve of the medical

profession.

• To equip nurses to deliver health care safely and

effectively, nurse educators need to ensure that pre- and

postregistration curricula meet the needs of nurses and

patients.

• Studies in the developed world indicate that streng-

thening the bioscience curriculum, by forging the links

between theory and practice, enhances nursing practice.

What this paper adds

• Like their colleagues in the developed world, South

African nurses see the biological sciences as very rele-

vant to their practice.

• The key to teaching and learning in this area is bridging

the theory–practice gap by using relevant examples,

particularly in pivotal areas such as medication man-

agement, observation of vital signs and infection con-

trol.

• To address unmet continuing professional development

needs, nurse educators should review both pre- and

postregistration curricula with a view to expanding the

pharmacology and microbiology components.

Issues and innovations in nursing education The biological sciences in nursing

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103 101

preparation is defined, nurses working without medical

support may encounter failure and disciplinary procedures,

rather than success.

Acknowledgements

The authors thank Mr Rauf Sayed, Senior Biostatistician,

School of Public Health, University of Cape Town and the

research participants.

Author contributions

UK and SJ performed the study conception and design and

made critical revisions to the paper. UK and JvdH were

responsible for the data collection and provided administra-

tive, technical or material support. UK, SJ and JvdH

undertook the data analysis and drafted the manuscript.

SJ provided statistical expertise and supervision.

References

Akinsanya J.A. (1987) The life sciences in nursing: development of a

theoretical model. Journal of Advanced Nursing 12, 267–274.

Akinsanya J.A. & Hayward J.C. (1980) The biological sciences in

nursing education: the contribution of bionursing. Nursing Times

76, 427–432.

Altman D.G. (1991) Practical Statistics for Medical Research.

Chapman & Hall, London.

Barclay, L. & Neil J. (1987) An Integrated biophysical science cur-

riculum. Australian Journal of Advanced Nursing 4, 29–38.

Becker H. & Geer B. (1982) Styles of data analysis: approaches and

implications. In Field Research: A Sourcebook and Field Manual

(Burgess R., ed.), Routledge, London, pp. 235–238.

Benner P. (1984) From Novice to Expert. Addison Wesley, Menlo

Park.

Berelson B. (1952) Content Analysis in Communication Research.

The Free Press, Glencoe, IL.

Bowling, A. (2002) Research Methods in Health. Open University

Press, Buckingham.

Bryman, A. (1988) Quantity and Quality in Social Research. Rout-

ledge, London.

Bullock S. & Manias E. (2002) The educational preparation of un-

dergraduate nursing students in pharmacology: a survey of lec-

turers’ perceptions and experiences. Journal of Advanced Nursing

40, 7–16.

Caon M. & Treagust D. (1993) Why do some nursing students find

their science courses difficult? Journal of Nursing Education 32,

255–259.

Casey G. (1996) Analysis of Akinsanya’s model of bionursing.

Journal of Advanced Nursing 23, 1065–1070.

Chapple M., Allcock N. & Wharrad J. (1993) Bachelor of nursing

students’ experiences of learning biological sciences alongside

medical students. Nurse Education Today 13, 426–434.

Clancy J., McVicar A. & Bird D. (2000) Getting it right? An

exploration of issues relating to the biological sciences in nurse

education and nursing practice. Journal of Advanced Nursing 32,

1522–1532.

Courtenay M. (1991) A study of the teaching and learning of the

biological sciences in nurse education. Journal of Advanced Nur-

sing 16, 1110–1116.

Courtenay M. (1999) Why the biological sciences should be back in

the curriculum. Nursing Times – Learning Curve 3(6), 8–9.

Davhana-Maselesele M., Tjallinks J.E. & Norval M.S. (2001) The-

ory–practice integration in selected clinical situations. Curationis

24(4), 4–9.

Davies S., Murphy F. & Jordan S. (2000) Bioscience in the pre-

registration curriculum: finding the right teaching strategy. Nurse

Education Today 20, 123–135.

Denzin N.K. (1970) The Research Act in Sociology. Aldine, Chicago,

IL.

Department of Education (DoE) (2001) National Plan for

Higher Education. Government Printers, Pretoria, available at:

http://education.pwv.goc.za/DoE_Sites/Higher_Education/HE_Plan/

national_plan for_higher_educati.htm (accessed August 2005).

Don M. (1995) Integrating knowledges: the case of science. In

Problem-Based Learning in a Health Sciences Curriculum (Alavi

C., ed.), Routledge, London, pp. 71–85.

Drew B. (1988) Devaluation of Biological Knowledge. Journal of

Nursing Scholarship 20, 25–27.

Fijin R., Van den Bernt P., Chow M., DeBlaey C.J., DeJong-Van den

Berg L.T. & Brouwers J.R. (2002) Hospital prescribing errors:

epidemiological assessment of predictors. British Journal of

Clinical Pharmacology 53(3), 326–332.

Flanagan J. (1954) The Critical Incident Technique. Psychological

Bulletin 51, 327–358.

Geyer N. (2001) Enabling legislation in diagnosis and prescribing of

medicine by nurses/health practitioners. Curationis 24(4), 17–24.

Gladstone J. (1995) Drug administration errors: a study into the

factors underlying the occurrence and reporting of drug errors in a

district general hospital. Journal of Advanced Nursing 22, 628–

637.

Gray A. (1999) Nurses and the quest for rational drug use. In The

Changing Role of the Clinic Nurse. Health Systems’ Trust Update,

Issue 46, policy 4, available at: http://www.hst.org.za/publications/

13 (accessed August 2005).

Hammersley M. & Atkinson P. (1983) Ethnography: Principles and

Practice. Tavistock Press, London.

Henderson V. (1978) The concept of nursing. Journal of Advanced

Nursing 3, 113–130.

Ives G., Hodge K., Bullock S. & Marriott J. (1996) First year RNs’

actual and self-rated pharmacology knowledge. Australian Journal

of Advanced Nursing 14, 13–19.

Jacobs A. (1981) Comparison of Critical Incidents about Bacca-

laureate Associate Degree and Diploma Nurse. Research Project

Published by the National Council of State Boards of Nursing,

Chicago, IL.

Jordan S. (1994) Should Nurses be studying bioscience? Nurse

Education Today 14, 417–426.

Jordan S. (1998) From classroom theory to clinical practice: evalu-

ating the impact of a post-registration course. Nurse Education

Today 18, 293–302.

Jordan S. (2000) Educational input and patient outcomes: exploring

the gap. Journal of Advanced Nursing 31, 461–471.

U. Kyriacos et al.

102 � 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103

Jordan S. & Reid K. (1997) The biological sciences in nursing: an

empirical paper reporting on the applications of physiology to

nursing care. Journal of Advanced Nursing 26, 169–179.

Jordan S., Davies S. & Green B. (1999) The biosciences in the pre-

registration nursing curriculum: staff and students’ perceptions of

difficulties and relevance. Nurse Education Today 19, 215–226.

Ka Mzolo B. (2002) The Nursing Council hearings. DENOSA

Nursing Update 26, 34–37.

Kelly B. & Long A. (2000) The design and execution of social sur-

veys. Nurse Researcher 8, 69–83.

Kyriacos U. & Van den Heever J. (1999) A nontraditional curriculum

for the preparation of nurse educators in a developing country.

Journal of Nursing Education 38, 319–325.

Lynaugh J.E. & Bates B. (1973) The two languages of nursing and

medicine. American Journal of Medicine 73(1), 66–69.

McVicar A. & Clancy J. (2001) The biosciences and fitness for

practice: a time for review? British Journal of Nursing 10, 1415–

1420.

Medicines and Related Substances Act (2003) Schedules. South

African Government Gazette 24727, regulation 7636, 10 April

2003, available at: http://www.info.gov.za/regulations/2003/24727a

(accessed June 2004).

Miller R. (1997) Mark my words, part 2: students. South African

Journal of Higher Education 11(1), 11–17.

Mitchell J.C. (1983) Case and situation analysis. Sociological Review

31, 187–211.

Morgan A.K. (1994) Client education experiences in professional

nursing practice – a phenomenological perspective. Journal of

Advanced Nursing 19, 792–801.

Morse J. (1997) Perfectly healthy, but dead: the myth of inter-rater

reliability. Qualitative Health Research 7, 445–447.

Mulhall A. (1990) The contribution of the basic sciences to nursing

practice research. Journal of Advanced Nursing 15, 1354–1357.

Murphy E., Dingwall R., Gratbatch D., Parker S. & Watson P.

(1998) Qualitative research methods in health technology assess-

ment: a review of the literature. Health Technology Assessment 2,

16.

National Drug Policy for South Africa (1996) National Drug Policy

for South Africa. Government Printers, Pretoria, available at:

http://www.info.gov.za/reports/1996/drugpol.pdf (accessed June

2004).

Nicoll N. (1999) Whither nursing in the 21st century? Kai Tiaki

Nursing New Zealand 5(2), 24–26.

Nicoll L. & Butler M. (1996) The study of biology as a cause of

anxiety in student nurses undertaking the common foundation

programme. Journal of Advanced Nursing 24, 615–624.

Oppenheim A.N. (1992) Questionnaire Design, Interviewing and

Attitude Measurement, 2nd edn. Pinter Publishers, London.

Otway C. (2002) The development needs of nurse prescribers. Nur-

sing Standard 16(18), 33–38.

Pearson L. & Clarke M. (1994) A Project to Identify Good Practice

in Biological Science Teaching Within Courses of Initial Prepar-

ation of Health Professionals. University of Hull, Internal Publi-

cation, Hull.

Polit D.F. & Beck C. (2004) Nursing Research: Principles and

Methods, 7th edn. Lippincott, Philadelphia, PA.

Race A. & Holloway D. (1992) An Innovatory honours degree

programme for nurse teacher preparation: development and eva-

luation. Nurse Education Today 12, 266–273.

Roethlisberger F.S. & Dickson W.J. (1939) Management and the

Worker. Harvard University Press, Cambridge, MA.

Silverman D. (2001) Interpreting Qualitative Data: Methods for

Analysing Talk, Text and Interaction, 2nd edn. Sage, London.

Sodha M., McLaughlin M., Williams G. & Dhillon S. (2002) Nurses’

confidence and pharmacological knowledge: a study. British

Journal of Community Nursing 7(6), 309–315.

South African Nursing Council (1984) South African Nursing

Council, Regulation 2418, 2 November 1984. Government Print-

ers, Pretoria.

South African Nursing Council (1985) South African Nursing

Council Regulation 425, 22 February 1985. Government Printers,

Pretoria.

StataCorp. (2002) Stata Statistical Software: release 7.0. Stata

Corporation, College Station, TX.

Stimson G. & Webb B. (1975) Going to See the Doctor. Routledge,

London.

Strasser S. (1999) Transforming Nursing Education towards Pri-

mary Health Care. In The Changing Role of the Clinic Nurse.

Health Systems’ Trust Update, Issue 46, policy 4, available at:

http://www.hst.org.za/uploads/files/upd46.pdf (accessed June

2004).

Strauss A. & Corbin J. (1990) Basics of Qualitative Research:

Grounded Theory, Procedures and Techniques. Sage, London.

Sutcliffe L. (1992) An examination of the implications of adopting a

process approach to curriculum planning, implementation and

evaluation. Journal of Advanced Nursing 17, 1496–1502.

Thornton T. (1997) Attitudes towards the relevance of biological,

behavioural and social sciences in nursing education. Journal of

Advanced Nursing 26, 180–186.

Trnobranski P.H. (1993) Biological sciences and the nursing

curriculum: a challenge for educationalists. Journal of Advanced

Nursing 18, 493–499.

Trnobranski P.H. (1996) Biological sciences in Project 2000: an

exploration of status. Journal of Advanced Nursing 23, 1071–

1079.

Turner B. (1981) Some practical aspects of qualitative data analysis:

one way of organising the cognitive processes associated with the

generation of grounded theory. Quality and Quantity 15, 225–

247.

Wilkes L.M. & Batts J.E. (1991) Registered nurses’ constructed

meaning of concepts of solution and their use in clinical practice.

Science Education 21, 328–336.

Wilkes L.M. & Batts J.E. (1998) Nurses’ understanding of physical

science in nursing practice. Nurse Education Today 18, 125–132.

Wilson K. (1975) A Study of the Biological Sciences in Relation to

Nursing. Churchill Livingstone, Edinburgh.

Wong J. & Wong S. (1999) Contribution of basic sciences to

academic success in nursing education. International Journal of

Nursing Studies 36, 345–354.

Wynne N., Brand S. & Smith R. (1997) Incomplete holism in pre-

registration nurse education: the position of the biological sciences.

Journal of Advanced Nursing 26, 470–474.

Issues and innovations in nursing education The biological sciences in nursing

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 52(1), 91–103 103