Biosciences in nurse education: the level of knowledge of antibiotic resistance and learning experiences among preregistration nursing students in Uganda

Biosciences form the basis on which our understanding of human biology and body functions is established. They guide nurses to detect risks to health, improve, and sustain health through informed decisions. Biosciences support nurses to understand and respond to public health threats such as Antimicrobial Resistance (AMR). Task-shifting has expanded the scope of practice for nurses in Uganda. In Uganda, there is limited evidence of the success of the current science teaching in supporting retention and application of biosciences in clinical practice. Antibiotic resistance, a bioscience concept applicable to clinical practice, was used as an indicator of the level of bioscience knowledge among preregistration nursing students in Uganda.

The aim of this study was to understand the nursing students’ current level of knowledge of antibiotic resistance, the associated factors, and the experiences of learning and applying biosciences in academic and clinical practice settings in Uganda.

Beginning in October 2017, this study utilized a two-phase sequential explanatory design. Phase one used two sources of data. Initially, secondary data originally collected from 203 students in one university was used to compare scores between bioscience and non-bioscience courses. Then, a quantitative cross-sectional descriptive survey was used to collect data from 207 students in the 3^rd and 4^th year, across four universities. Phase two utilized a hermeneutic phenomenological design to explore the students’ experiences of learning and applying biosciences. Data was collected using three focus groups (n = 19) from one Ugandan university, to explain and expand the quantitative results.

Failure rates in biosciences and non-biosciences were 15% and 0.5% (n = 203) respectively. The bioscience and non-bioscience scores were statistically significant for each student (Z= -11.203, p = 0.000) and by group (p = 0.000). Higher failures of 21.3% (n = 207) were recorded in the primary data. Sixty percent and 70% (n = 207) of the students failed core bioscience knowledge and clinical application questions on antibiotic resistance, respectively. Only 30% reported good antibiotic use and 48% passed questions on antibiotic resistance. Overall bioscience success was statistically associated with age group (p = 0.033), route of entry on the nursing program (t = 13.438, p = .001), employment status (p = 0.001), and university (p = 0.025). Core bioscience knowledge was significantly associated with the university of study (p = .000). Knowledge transfer was significantly associated with age group (p = 0.049), route of entry (z = -3.307, p = 0.001), and employment status (z = -3.277, p = 0.001).

Four themes emerged from the qualitative phase: bioscience curriculum; teaching methods; clinical supervision; and assessment and feedback. There was a consensus that the bioscience portion of the nursing curriculum was crowded despite the available opportunities to retain and apply biosciences in clinical practice. Students perceived lectures to be ineffective in conveying the complex bioscience concepts, because the learners had no relevant clinical experience to support their learning. Medical ward rounds were effective in supporting understanding and application of science knowledge in clinical practice because they were contextualized and situated at the patient’s bedside. Medical doctors were perceived to be the most important resource of bioscience knowledge because they were largely knowledgeable, approachable and were seen to actively apply science in their clinical decision making. Within the nursing profession, bioscience teaching was sidelined in favor of clinical nursing skills. There was a general lack of clinical supervision. The model of clinical supervision was perceived to be ineffective in supporting the integration and application of biosciences. Participants expressed dissatisfaction with their assessments and feedback due to a general misalignment with teaching, assessor absenteeism, and reduced time available for assessments.

Nursing students in Uganda struggle to retain and apply biosciences. Several challenges within their universities and clinical placement sites contribute to the bioscience problem. This study calls for reforms in bioscience curricula, teaching, clinical supervision, and assessments to support RNs to competently tackle antibiotic resistance and other healthcare challenges upon graduation. We make the following recommendations:

Nursification of the bioscience portion of the nursing curriculum by:

Aligning the RN curriculum with the competences required in clinical nursing practice of the 21^st century.
Integrating and embedding bioscience courses in other non-science courses where possible and explicitly connect them to clinical practice.
Spreading bioscience teaching along the nursing program, teaching these courses well into the later semesters. They should also be taught close to when students start clinical placements to ease recall and encourage the teachers to embed more science in their other courses.
Contextualizing teaching to clinical practice through using relevant clinical examples, integrating biosciences in procedural skills teaching by recapping bioscience theory, and teaching in authentic clinical contexts such as the bedside.

Hold off phasing out of the certificate programs and first strengthen the RN degree.

Give more support to students enrolled directly from A-levels by:

Designing and delivering mandatory courses to equip them with the skills required to learn in higher education.
Giving them more time for clinical practice, preferably during recess term.

HEIs should adopt a supervisor model of clinical supervision which increases the universities’ involvement in clinical teaching and supervision.

Project Team: Miriam Nantamu, Dr Mark Wilding, Prof Louise Ackers, Dr Joy Probyn

Research Group: CSHR, Knowledge Health and Place, PhD Projects

Project Funder: The Commonwealth scholarship commission, University of Salford