Exploration of the Organisational Conditions that Influence the Utilization of Student Support Services in South African Nursing Colleges

: The recent migration of public nursing colleges from the Department of Health to the higher education sector in South Africa has compelled nursing institutions to ensure that their programs meet the Council of Higher Education requirements. One of these requirements is comprehensive student support services in line with the prerogative to widen access and success in higher education. Public Nursing Colleges have reported having systems to provide academic and non-academic support to their students. However, there is limited empirical research on lecturers' and students' perspectives on conditions that influence the utilization of available student support services in nursing colleges. Hence, this research explores organisational conditions that influence the utilization of student support services from the perspectives of lecturers and students at three selected campuses in the province of KwaZulu-Natal in South Africa. The research methodology is qualitative, in which a purposive sampling of 21 participants involved individual interviews. The interview of lecturers was due to their expected role in identifying and implementing some of the student support services. The students were involved in the study because they are the ones who benefit from the existence of such services and should therefore be in a better position to report on organisational conditions that enable utilization. Data analysis was thematic as guided by the academic and non-academic areas of student support services expected of nursing colleges. There was high agreement on the availability of systems to provide academic and non-academic student support services. However, there were limited coordinated, standardized, and structured efforts to implement them at different colleges. More so, lecturers reported a shortage of critical resources. The findings suggest improving conditions to utilize student support services effectively. It should help ensure that student support activities are well-coordinated, comprehensive, and aligned with policy .


Introduction
Over two decades ago, South Africa experienced massification in Higher Education Institutions (HEIs), which occurred around the democratic government taking over from the apartheid government. The new government changed education policies to widen access for students from underprivileged communities to ensure equity in accessing HEIs. However, enormous challenges accompanied this transformation endeavour and required that there should be student support services in place (Department of Higher Education and Training (DHET), 2013). One of the support measures was financial aid for underprivileged students called National Student Financial Aid Scheme (NSFAS). The NSFAS support significantly improved enrolment rates for black students from 25% to 70% from the early 90s to the early 2000s (Mohamedbhai, 2014). Once financial support was in place to support access, underprivileged African students had other challenges that affected their academic success. The challenges began to be evident in attrition rates which saw many students departing from their educational programs before completion due to academic exclusion or voluntary exclusion (Behilak et al., 2016; Roos et al., 2016). Zewotir and North (2015) attribute the enormous attrition and progression rates in South Africa to the teaching and learning environment that does not support African students. They argue that a supportive teaching and learning environment should address students' psychological needs (Zewotir & North, 2015).
Other factors associated with attrition, particularly among African students, are their unfavourable educational and economic backgrounds over and above the academic and social challenges they encounter in HEIs (Otu & Mkhize, 2018;Mudaly & Mtshali, 2018). These include the continued use of English, a second if not a foreign language to most of them, as the sole medium of instruction and assessment, resulting in poor academic success rates as evident in higher drop-out rates among African students (South African Nursing Council (SANC), 2017; Ngcobo et al., 2021; Seleka, 2019; Sibiya & Mahlanze, 2018). Ngcobo et al. (2021) lament the failure of some HEIs to embrace the multilingual educational policies that are aimed at decolonizing higher education and increasing academic success. Specifically, in nursing colleges, Ndawo (2019) finds that using English has numerous problems for students and lecturers. These include nurse educators' struggle to make their content meaningful and challenging to students due to their lack of proficiency in English. At the same time, students find using English a source of immense stress and anxiety, leading to low self-esteem when they fail (Ndawo, 2019).
Since transferring nursing and midwifery education to HEIs, students have been experiencing more psychological distress from loneliness, financial difficulties, and academic pressures (Akinla et al., 2018), resulting in poor academic progress. The continued failure rate is a precarious situation considering that the country has a high shortage of nurses (Langtree et al., 2018). Nurses are an urgent concern because they are part of the critical health sector since they proved valuable in saving lives during the novel coronavirus disease 2019 (COVID-19) pandemic (Jun & Rosemburg, 2022;Iwu et al., 2021). Sadly, nurses were not immune to death as high mortality rates were reported across the globe during COVID-19 in both developing and developed countries (Vera-Alanis et al., 2022). In a South African context with a shortage of qualified nurses, it becomes important to support student nurses (Bekelepi & Martin, 2022;Malatji et al., 2022). Student attrition and poor progression significantly affect the country's planned nursing and midwifery workforce projections (Mudlaly & Mtshali, 2018). Higher education institutions must have an intentional, structured, and coherent set of policies and actions to coordinate student support (Tinto, 2014), focusing on students from previously disadvantaged communities so that they succeed (Speckman & Mandew, 2014; National Department of Health (NDOH), 2022). Paniagua and Simpson (2018) define the students' support as the development of a student both academically, through learning and teaching, and non-academically, that is, the psycho-social aspect of the student, such as economic, social, and emotional aspects. Included in support services are practices aimed at improving the quality of learning and teaching in HEIs (Speckman & Mandew, 2014).
A study conducted by Arifin (2018a) on the role of student support in enhancing student persistence argued that conditions in HEIs may enable or discourage student persistence. It makes it necessary to investigate if the student support services in HEIs, especially in nursing colleges, are favourable to enabling student success. The approach should be holistic to look at academic and non-academic student support issues. Student support services that adopt a holistic approach should comprise financial, counseling, mental issues, health, and administrative assistance to create an environment conducive to student learning and success (Liu et al., 2020;Tait, 2000). Liu et al. (2020) posit that COVID-19 has made it essential for HEIs to revisit their campus conditions to adapt to the "new normal" and beyond in assisting vulnerable student populations. Vulnerable students would include those from impoverished communities and study in historically disadvantaged institutions whose conditions do not support quality education, such as in South Africa (du Plessis & Mestry, 2019).
Skakane-Masango et al. (2022) found that students had high awareness of available remedial programs, lecturers' support, medical services, and compulsory orientation. However, the authors found that the awareness did not match utilizing the available student support programs (Skakane-Masango et al., 2022). It makes it necessary to conduct follow-up studies on the conditions that hinder the effective utilization of student support services in nursing colleges. Furthermore, most available studies on student support initiatives have mainly focused on students' experiences and views on the availability of tutorials and peer and clinical mentorship (Carragher &  Hence, this study explores factors influencing student support services at KwaZulu-Natal (KZN) Nursing College, as reported by both students and lecturers. In taking this direction, the study is inspired by the Council on Higher Education's (CHE, 2019) institutional audit report, which postulates that aligning institutional goals, strategies, and planning with coordinating people and activities across institutional structures will increase student success. Providing effective student support to all students is a critical requirement for program accreditation (CHE, 2020) and should be strengthened through favourable conditions (Adi Badiozaman et al., 2020; Zulu & Mutereko, 2020). A study conducted in Turkey notes that organisational factors may have a critical role in student attrition and should therefore be investigated (Ertem & Gokalp, 2019). The main question that guides the study is: What are the conditions that influence the utilization of student support services?

Literature Review
The increased access to HEIs has not translated to high academic success among many African citizens in South Africa. It has been attributed to numerous academic and non-academic issues encountered by students, as evident in the low retention and high attrition rates that have given rise to the importance of student support services in HEIs (CHE, 2010; DHET, 2013). Arifin's (2018a) findings showed that students discontinued their course of study due to poor support. Therefore, students must be provided with holistic support at all levels of their needs if we are to match access with success (Mtshali & Zwane, 2019). Similarly, Ndlela (2017) concludes her study by citing the need for HEIs to provide student support services that appeal to students' expectations through a holistic approach that addresses academic and non-academic areas. However, it remains to be investigated if this is indeed the approach that nursing colleges adopt in KZN.
Most studies on student attrition have explored this issue by applying Tinto's theory of successfully integrating students into institutional environments (Gaffoor & van der Bijl, 2019). Tinto (2006) has highlighted the need to explore the students' learning environment to determine if it supports their intention to complete their study program. In the context of this study, the available student support services must be evaluated if they are provided in an enabling environment or not. Skakane-Masango et al. (2022) found a mismatch between students' awareness of available support services and their actual utilization. This finding suggests that environmental factors might not be supportive of the utilization of student support services. Sineke et al. (2015) emphasize the need for student support services not to be merely available without being accessible. Hence, there is a need to evaluate if the institutional conditions are enabling the utilization of student support services.
Furthermore, Tinto has studied student retention for decades, beginning with student drop-out, which he criticized as not differentiating academic failure from voluntary withdrawal. In formulating a model of dropout behavior, he likened drop-out to Durheim's theory of suicide-alluding to poor institutional integration as a reason for student drop-out (Tinto, 1975). Having conceptualized the drop-out process, the next critical step to improve retention was developing a comprehensive model for institutional action. Tinto and Pusser (2006) identified [institutional] support as one of the conditions for promoting student success, elaborating that 'access without support is not opportunity' (Tinto, 2014). Tinto (2012) then conceptualized a coherent approach to student success, summarising what he had discovered to characterize institutions where students succeed. He asserted that institutional support, be it academic, social, or financial, significantly impacts student success. He emphasized that retention improves when an intentionally structured and coherent set of policies and actions coordinate all the work toward student learning on campus (Tinto, 2012).
Whether academic or psycho-social, student support positively influences academic performance ( . If left unchecked, challenges with support services may lead to students opting to withdraw from training, which Tinto likens to Durheim's suicide theory (Tinto, 1975).
The global challenge of attrition has spotlighted the need for HEIs to provide student support to improve teaching and learning. The literature revealed an attrition rate of up to 50% in nursing programs worldwide  (2022) cite their previous study, which found that attrition was at 42% in one of the best universities in Turkey, which suggests that there is more to this global challenge. In South Africa, Ramkilowan's (2014) study reported an attrition rate of about 45.5% in selected nursing campuses in KZN. Roos et al. (2016) concurred with these findings, stating an attrition rate ranging from 39.3 to 58.7%. At colleges, the attrition rates are reportedly higher than at universities due to inadequate academic support provided to students (Zulu & Mutereko, 2020) over and above the psychological issues they experience (Muchineripi, 2017).
The SANC (2005) nursing education and training standards outline student support as personal counseling, academic counseling, student health support, financial support, learning resources, and learning support. Among the factors influencing student success were academic and non-academic student support (Glendinning et al., 2019). However, these factors alone are only adequate if the institutional conditions support their implementation. Whitt et al. (2008) call for institutions to constantly ensure that their policies, practices, and learning environments support student success. Some of the variables used in models to assess student success are (1) institutional characteristics, (2) interactions among stakeholders, (3) stakeholders' perceptions of teaching and learning conditions, and (4) students' commitment to their education (Kuh et al., 2007). Whitt et al. (2008) found that high-performing educational institutions had favourable conditions for student success. Institutional leaders are encouraged to assess and shape campus conditions to support student success (Kuh, 2005;Liu et al., 2022;Whitt et al., 2008). Similarly, this study assesses the conditions of three selected colleges to determine the extent to which they enable the utilization of student support services. The principal investigator (PI) is a leader of one of the assessed colleges where she serves as the principal.
Edenfield and McBrayer (2021) and Whitt (2008) recommend assessing institutional conditions by seeking the perspectives of critical stakeholders in educational institutions. These main stakeholders are students, first and foremost, and lecturers. This approach would better inform institutional leaders on organisational conditions stakeholders must navigate and what they desire to succeed (Edenfield & McBrayer, 2021). A research method that is effective in understanding the organisational conditions is the qualitative approach since it allows the participants to share their perspectives and experiences (Calcagno et al., 2008; Du Plessis & Mestry, 2019). The themes worth exploring are interactions among stakeholders to determine how they contribute to success and institutional conditions' supportive role in effective interactions and resource access (Edenfield & McBrayer, 2021;Kuh et al., 2007). With the recent transition of nursing colleges to HE, strengthening student support services is paramount to meet CHE quality standards. It is, therefore, pivotal to explore current factors influencing the utilization of student support services.
Given the above discussion, it is evident that certain conditions affect the utilization of student support services. The assumption is that a well-supported student will achieve good academic outcomes. Hence, this study investigates how student support services are implemented in a public nursing College, given its transition to HE, in cognizance of the SANC and the Department of Higher Education and Training (DHET) minimum requirements for student support. The study is further inspired by the CHE's (2014) framework for institutional enhancement projects, which postulates that aligning institutional goals, strategies, and planning with coordinating people and activities across institutional structures will increase student success. Hence, in this context, the research aims to explore factors that enhance or hinder student support utilization and suggest strategies for improvement.

Methodology and Research Methods
A case study design was employed to investigate the student support phenomenon in the three Campuses of the NEI during its transition to HE. The study adopted a qualitative approach. Interviews were mainly employed as a research tool (Corbin & Strauss, 2008). The approach was deemed appropriate for a study seeking the participants' views and experiences. It enabled the principal investigator (PI) to understand the factors influencing student support utilization. A qualitative approach was, therefore, suitable for an uncommon phenomenon like student support during the transition of public nursing colleges (PNCs) to HE in South Africa (SA).
Study Setting. The PI selected three Campuses from a SA public nursing education institution (NEI), which were representative of and diversified in program offerings. Campus X offered both undergraduate and postgraduate programs; Campus Y offered an undergraduate program, and Campus Z offered postgraduate programs.
Sampling. The PI employed purposive sampling to recruit interview participants who would best inform the study (Roestenburg et al., 2021). These participants were academic staff (lecturers) and students in the form of student representative council (SRC) members. The inclusion criteria were second to fourth-year undergraduate and postgraduate students with six or more months of training. These participants were selected because they were expected to be knowledgeable and experienced about the available services and conditions that supported their usage (Cresswell & Creswell, 2017; Polit & Beck, 2020). The participants were 21 out of the 332 population and were selected equally from each Campus, as indicated in Table 1 below. Study Findings. The research aimed to explore the organisational conditions that influence the utilization of student support services. Moreover, the presentation of findings was thematic as guided by the academic and non-academic areas of student support services expected of nursing colleges. The two themes used are (1) institutional conditions and (2) interactions among stakeholders (Edenfield & McBrayer, 2021;Kuhn et al., 2007). In reporting the findings, the letter S represents students and L is used for lecturers. In providing the extracts from the interviews, we only focus on the main and diverse points rather than every point expressed by all the interviewees. Table 2 summarizes the findings prior to providing a detailed outline of findings with extracts obtained during the interviews. The responses suggested that some students were not aware of available support. However, students admitted that when they seek help, they become aware it is available, which points to the non-availability of structured support services. Participants specified predominantly academic and clinical support and cited the unavailability of a comprehensive support program. A further probe revealed the following responses: Some support facilities exist, although minimal, because we do not have a broad support system. The support we get is mostly academic. (S3).
In my opinion, we should have someone tutoring the students if we are lacking somewhere besides the lecturers. We need that support because sometimes it is difficult to go to a lecturer and say I have a problem with one and two. (S6) Sometimes when students ask the permanent clinical staff, they will say, "What does your book say? What did they say in college?", and stuff like that. (S3) Only when there has been a classroom disturbance than a lecturer comes and says we can see them between specific times. We were grateful for that, but if you go there and ask about a section you did not understand in class, that will be another story and you regret going there. As you go to the lecturer, you expect support, but they will ask you, "didn't you read this and that? (S4) It appears that minority students felt no support other than from lecturers performing their job. Students also experienced negative attitudes from academic staff. As a result, they felt more comfortable with peer support than approaching lecturers for help. Lecturers expect students to be knowledgeable about the conditions of their campus. There was an indication of impatience and intolerance of ignorance on the part of lecturers. Lecturers were also probed on the issue of institutional conditions and their attitudes towards students seeking assistance.
The following responses came forward from lecturers: We are not here for the basics, so the person must know what they came for, so we test them around that area. Sometimes the hospitals just push to get a high number of specialists, so we need to know if a person knows and has worked in the area that they wish to specialize in. (L5) The response shows that lecturers expect postgraduate candidates to be ready and have some background knowledge based on their pre-exposure to the specialized units for at least one year. Lecturers suspected that some students did not have such exposure. Furthermore, lecturer participants elaborated on infrastructural challenges which limited the utilization of resources: We need disabled-friendly infrastructure because students in wheelchairs cannot reach other floors, and we are forced to use ground-level classes. (L1) Resources need to be developed. We sometimes lack counseling rooms, and they are not as comfortable as they are supposed to. Simulation labs and skills lab do not have adequate resources, even data to help students access online websites. (L2) Lectures were also probed on the availability and knowledge of an institutional policy that guided their activities. Their responses were mixed and contradictory. Those who were knowledgeable about the policy's existence stated as follows: I am not sure whether they do get support as stated in the policy, but it does exist; although I cannot remember the last time it was reviewed (L3)

We do have a student support policy, and an appointed student liaison officer handles the policy and ensures it is implemented. (L2)
There is an academic support policy that guides us to look after any student struggling academically or not performing students. (L4) The above responses suggest some uncertainty while stating that the policy is available. Other participants either denied the presence or stated that they were not aware of the policy existence, as follows:

Not that I know of. (L6)
The majority acknowledged the existence of a policy on their campuses. However, concerning that, some of them were either unaware or denied the policy's existence.

Interactions among Stakeholders.
Students were asked to report on their lecturers' role in providing academic support to them. The following views were expressed during focus group interviews: Despite time constraints and other challenges, lecturers go the extra mile to facilitate or encourage the utilization of support services (S1) Depending on the teaching style, they use different lecture methods, presentations, Q and As, WhatsApp groups, and zoom lectures. (S2) After hours they give us a lot of work and homework; in classes, they ask us questions and for us to discuss on our own; they are very helpful, and we even have remedial classes if you do not understand. (S3) Students indicated their satisfaction with the role played by lecturers in ensuring that the nursing college conditions were favorable to their success. Students praised the commitment shown by their lecturers in fulfilling their duties. Lecturers were seen as ready to explore different teaching methods to support students' effective learning. When lecturers were asked to report on students and the role, they play in supporting students, they stated as follows: Some are shy to come to our offices until we give them a written counseling warning that will also serve as evidence for our support attempts. (L1) We help those who come and give them guidelines that are baby steps for better support and understanding (L2).
Also, diverse learning approaches were utilized through class and after-class interactions, enabling in-person and online lesson engagement. (L3) Most students appreciated the academic support we offered. (4) Self-reporting by lecturers correlates with the positive sentiments expressed by students about them. Lecturers related several steps they undertook to provide an enabling environment for utilizing support services. It includes the lecturers' identifying students and making follow-ups to ensure that students seek help as provided by the organisation. In addition, lecturers undertook a blended approach to teaching by utilizing both physical and virtual classes to accommodate different students' preferences. They also received feedback from students who indicated appreciation for the role played by lecturers in assisting them access the available support services. Students were asked to comment on the extent of clinical support they received from peers and staff. The following responses emerged from the interviews: Clinical support is available because we get assistance when one is sick and tablets/online learning resources. ( The only support we get is from senior students. It's much better with students helping than with the permanent staff. (S5) The interviewees revealed that students received enormous clinical support from academic staff, peers, and clinical staff. Some students felt more comfortable with peer support than approaching lecturers for help.

Students' Findings.
Students reported lecturers using a blended approach to teaching because they were utilizing both physical and virtual classes. It was seen as supportive of different students' preferences and circumstances in teaching and learning. The lecturers' teaching approach is commended as it also caters to times of crisis, such as the recent COVID-19, which dictated that virtual classes be conducted (Liu et al., 2020). More so, the blended approach accommodates vulnerable students from challenged socioeconomic backgrounds (du Plessis & Mestry, 2019).
Students pointed out the dedication of lecturers, clinical staff, and peers who provided the required conditions for student success. However, students revealed concerning institutional conditions that hindered the utilization of student support services. These were some lecturers' attitudes and inadequate information on available services. Tinto  It was concerning to note that some students felt more comfortable approaching peers than lecturers. Some lecturers appeared to be less sympathetic and intolerant of ignorant students. These results supported existing literature on challenges faced by mature students; who struggle to balance work, study, and family and, therefore, need more psycho-social and academic support (Morison & Cowley, 2017;Willans & Seary, 2018). According to (Shikulo et al., 2020), the challenge of balancing family and studying contributed to the underutilization of support services, including orientation. Moreover, some module tutors were unavailable, negatively impacting student outcomes. Students expressed satisfaction with available resources throughout their campuses.

Lecturers' Findings.
Contrary to students' findings on the availability of resources, lecturers' responses suggested that more needed to be made available. Amongst other things, lecturers were not satisfied with the lack of infrastructure that is disabled-friendly and counselling rooms. The availability of psychosocial support to the students did not come out clearly, which in other HEIs is the responsibility of student counsellors, psychologists, and social workers.
Lecturers expressed this perspective on the inadequacy of student support services from their advanced knowledge and experience of what is expected rather than an indication of contradiction between them and students. Lecturers are unaware of the importance of academic and non-academic student support services (Glendinning et al., 2019). These should include personal counselling, academic counselling, student health support, financial support, learning resources, and learning support (SANC, 2005). As Ertem and Gokalp (2022) put it, involving different participants in a study enables the PI to obtain diversity in perspectives.
Responses from lecturers suggested that some of them were unaware of the College's student support service policy. They had never heard of the student support policy. The fact that it was recently introduced in preparation for the transition to higher education could be why others are unaware of it. Others stated that the orientation did not mention the student support policy or structured service. This finding contradicts Tinto's (2012) assertion that institutional support, be it academic, social, or financial, significantly impacts student success. He then emphasized that an intentionally structured and coherent set of policies and actions that coordinate all the work toward student learning on campus are critical to student success (Tinto, 2012).
The study findings suggested a need for an institutionalized and comprehensive student support program for implementation across all campuses (Liu et al., 2020;Tait, 2000). The expectations differ between undergraduate and postgraduate students, with postgraduate students having unique support needs and an expectation that they should possess the basic academic skills required to cope in HE. Although the student support policy exists and there is an appointed student liaison officer to oversee the implementation of the policy, there is a necessity for a multidisciplinary team, such as, a student counsellor, social work, academic tutors and peer mentors and clinical mentors to deal with diverse student needs. This finding tallies the view Tinto (2014) expressed on the importance of an intentional, structured, and coherent set of policies and actions to coordinate student support. Staffing is, however, dependent on the availability of funding, hence the requisite to integrate this funding need in the institutional budget to support policy implementation. At times like these, institutional leaders need to play their role in shaping the conditions of their campuses to be favourable to student success (Kuh, 2005;Liu et al., 2022;Whitt et al., 2008).

Conclusions
This study explored the student support phenomenon in public NEIs in KZN during the transition to HEIs as a response to a call from DHET. The focus was on exploring the institutional conditions to determine if they support vulnerable students' academic success. Students' and lecturers' views on the issue produced positive and negative results. The positives were taken as an indication of areas where institutional leaders performed well in providing enabling conditions in their institutions. However, the opposing views are pivotal in pointing out room for improvement as the College transitions to HE. Institutional leadership needs to address the few areas of concern that were raised by participants about each other and the actual conditions of their institutions that were not entirely supportive.