Strasser Susan, London Leslie, Kortenbout Elma
Department of Public Health and Primary Health Care, University of Cape Town, South Africa.
Educ Health (Abingdon). 2005 Jul;18(2):133-44. doi: 10.1080/13576280500145615.
Nurses provide the bulk of primary care services in South Africa. Post-apartheid health legislation envisions the provision of comprehensive primary services at all public clinics, which implies the need for a cadre of primary care nurses able to render such services.
To identify core competencies of clinic nurses and develop an evaluation tool for primary care nursing in South Africa.
The descriptive and exploratory techniques used included two meetings of a reference group of South African primary care professionals, followed by a consensus-building exercise. Using the Delphi technique expert opinion was solicited from South Africa, Canada and the USA.
The reference group meetings yielded a list of nine core competencies. Infrastructure issues, such as the supermarket (one-stop shopping) approach to service delivery, communication and transport systems, and the quality of supervision still cause concern. These issues underscore that competence cannot be measured in a vacuum. Input from Delphi participants affirmed the nine core competencies and the need to assess the impact of core competency training. One possible way to measure the nine core competencies would be to use proxy indicators.
DISCUSSION/CONCLUSIONS: Identifying core competencies is a complex process. There is a need to process a wide range of views and ideas. Also, balancing academic concerns with service delivery needs and constraints is an ongoing challenge. A potential limitation of the Delphi technique is participant selection bias and fatigue. Accessing a diverse international panel and making numerous follow up attempts via phone, mail and email were used to attempt to ameliorate these inherent limitations. Although the process is cumbersome, providing "experts" with a venue to wrestle with these ideas can be fruitful. Future studies would help to assess the reliability of the findings.
在南非，护士提供大部分初级保健服务。种族隔离后的卫生立法设想在所有公共诊所提供全面的初级服务，这意味着需要一批能够提供此类服务的初级保健护士。
确定诊所护士的核心能力，并开发一种南非初级保健护理评估工具。
所采用的描述性和探索性技术包括召开两次南非初级保健专业人员参考小组会议，随后进行共识达成活动。运用德尔菲技术征求了来自南非、加拿大和美国的专家意见。
参考小组会议得出了一份包含九项核心能力的清单。基础设施问题，如服务提供的超市（一站式购物）模式、通信和交通系统以及监督质量，仍然令人担忧。这些问题突出表明，能力无法在真空中衡量。德尔菲参与者的意见肯定了这九项核心能力以及评估核心能力培训影响的必要性。衡量这九项核心能力的一种可能方法是使用替代指标。
讨论/结论：确定核心能力是一个复杂的过程。需要处理广泛的观点和想法。此外，在学术关注与服务提供需求及限制之间取得平衡是一项持续的挑战。德尔菲技术的一个潜在局限性是参与者选择偏差和疲劳。通过联系一个多元化的国际专家小组，并通过电话、邮件和电子邮件进行多次跟进尝试，试图缓解这些固有局限性。尽管这个过程很繁琐，但为“专家”提供一个讨论这些想法的场所可能会有成效。未来的研究将有助于评估研究结果的可靠性。
