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Hägg Martinell, AnnORCID iD iconorcid.org/0000-0001-6477-4441
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Publications (9 of 9) Show all publications
Hägg Martinell, A., Hult, H., Henriksson, P. & Kiessling, A. (2020). Nursing Students Learn to Handle Stress and to Prioritize in a Complex Context During Workplace Learning in Acute Internal Medicine Care – An Ethnographic Study. Advances in Medical Education and Practice, 11, 21-30
Open this publication in new window or tab >>Nursing Students Learn to Handle Stress and to Prioritize in a Complex Context During Workplace Learning in Acute Internal Medicine Care – An Ethnographic Study
2020 (English)In: Advances in Medical Education and Practice, ISSN 1179-7258, E-ISSN 1179-7258, Vol. 11, p. 21-30Article in journal (Refereed) Published
Abstract [en]

Introduction: A common focus in many studies, in the short-term perspective, is to evaluate students’ workplace learning and its outcome. However, the outcome can be perceived differently depending on when it was evaluated. The aim of this study was to explore student nurses’ learning activities in an acute internal medicine unit and the nurses perceived learning outcome in a long-term perspective.

Material and Methods: Repetitive ethnographic observations were performed in an internal medicine care unit at a teaching hospital in Sweden between 2011 and 2013. Four student nurses and supervisors were repetitively observed. Two years later retrospective interviews were performed with four nurses who had performed workplace learning, as students, in this unit during the observation period. An inductive comparative analysis involving all interviews and observational data was applied.

Results: Three themes were identified: To handle shifting situations – illustrating how student nurses learnt to adapt to shifting situations, to manage stress, to create structure and space for learning and to deal with hierarchies; To build relationships – illustrating how student nurses learnt to collaborate and to interact with patients; To act independently – illustrating how student nurses trained to act independently in the unit, took responsibility, and prioritized in this complex context.

Conclusion: Learning activities in a complex acute medical unit setting were characterized by a high workload and frequent stressful situations, and a demand on students to interact, to take responsibility, and to prioritize. To learn in such a stressful context, have in a long-term perspective, a potential to develop students’ embodied understanding of and in practice, making them more prepared to work and independently apply their nursing expertise in similar contexts as graduated nurses.

Place, publisher, year, edition, pages
Dove Press, 2020
Keywords
students nursing, nursing education research, clinical clerkship, ethnography
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-3127 (URN)10.2147/AMEP.S230476 (DOI)32021539 (PubMedID)
Funder
Stockholm County Council
Available from: 2020-01-13 Created: 2020-01-13 Last updated: 2020-02-14Bibliographically approved
Gudmundsson, K., Lynga, P., Langius-Eklof, A., Hagglund, E., Hägg Martinell, A., Persson, H., . . . Braunschweig, F. (2019). Daily body weight in patients with chronic heart failure: improved diagnostic value by analysing prolonged time intervals. In: : . Paper presented at ESC (European Society of Cardiology) Congress 2019 Saturday 31 August - Wednesday 4 September 2019 Paris - France.
Open this publication in new window or tab >>Daily body weight in patients with chronic heart failure: improved diagnostic value by analysing prolonged time intervals
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:rkh:diva-3033 (URN)
Conference
ESC (European Society of Cardiology) Congress 2019 Saturday 31 August - Wednesday 4 September 2019 Paris - France
Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-09-06Bibliographically approved
Hägg Martinell, A., Hult, H., Henriksson, P. & Kiessling, A. (2019). Possibilities for interprofessional learning at a Swedish acute healthcare ward not dedicated to interprofessional education: an ethnographic study. BMJ Open, 9(7), Article ID e027590.
Open this publication in new window or tab >>Possibilities for interprofessional learning at a Swedish acute healthcare ward not dedicated to interprofessional education: an ethnographic study
2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e027590Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Almost all healthcare today is team-based in collaboration over professional borders, and numerous students have work-based learning in such contexts. However, interprofessional learning (IPL) in clinical settings has mostly been systematically explored in specially designed contexts dedicated to interprofessional education (IPE). This study aimed to explore the possibilities for IPL activities, and if or how they occur, in an acute ward context not dedicated to IPE.

DESIGN AND SETTING: Between 2011 and 2013 ethnographic observations were performed of medical and nursing students' interactions and IPL during early clerkship at an acute internal medicine ward in Sweden. Field notes were taken and analysed based on the framework of IPE: learning with, from and about.

PARTICIPANTS: 21 medical, 4 nursing students and 30 supervisors participated.

RESULTS: Learning with-there were no organised IPE activities. Instead, medical and nursing students learnt in parallel. However, students interacted with staff members from other professions. Learning from-interprofessional supervision was frequent. Interprofessional supervision of nursing students by doctors focused on theoretical questions and answers, while interprofessional supervision of medical students by nurses focused on the performance of technical skills. Learning about-students were observed to actively observe interactions between staff and learnt how staff conducted different tasks.

CONCLUSION: This study shows that there were plenty of possibilities for IPL activities, but the potential was not fully utilised or facilitated. Serendipitous IPL activities differed between observed medical and nursing students. Although interprofessional supervision was fairly frequent, students were not learning with, from or about each other over professional borders.

Keywords
ethnography, intermediate care facilities, interprofessional education, medical students, nursing students, supervision, workplace learning
National Category
Nursing Learning
Identifiers
urn:nbn:se:rkh:diva-3017 (URN)10.1136/bmjopen-2018-027590 (DOI)31362963 (PubMedID)
Funder
Stockholm County Council
Available from: 2019-08-21 Created: 2019-08-21 Last updated: 2019-09-11Bibliographically approved
Hägg-Martinell, A., Hult, H., Henriksson, P. & Kiessling, A. (2017). Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study. BMJ Open, 7(2), Article ID e013046.
Open this publication in new window or tab >>Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, article id e013046Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To optimise medical students' early clerkship is a complex task since it is conducted in a context primarily organised to take care of patients. Previous studies have explored medical students' perceptions of facilitation and hindrance of learning. However, the opportunities for medical student to learn within the culture of acute medicine care have not been fully investigated. This study aimed to explore how medical students approach, interact and socialise in an acute internal medicine ward context, and how spaces for learning are created and used in such a culture.

DESIGN AND SETTING: Ethnographic observations were performed of medical students' interactions and learning during early clerkship at an acute internal medicine care ward. Field notes were taken, transcribed and analysed qualitatively. Data analysis was guided by Wenger's theory of communities of practice.

PARTICIPANTS: 21 medical students and 30 supervisors participated.

RESULTS: Two themes were identified: Nervousness and curiosity-students acted nervously and stressed, especially when they could not answer questions. Over time curiosity could evolve. Unexplored opportunities to support students in developing competence to judge and approach more complex patient-related problems were identified. Invited and involved-students were exposed to a huge variation of opportunities to learn, and to interact and to be involved. Short placements seemed to disrupt the learning process. If and how students became involved also depended on supervisors' activities and students' initiatives.

CONCLUSIONS: This study shed light on how an acute internal medicine ward culture can facilitate medical students' possibilities to participate and learn. Medical students' learning situations were characterised by questions and answers rather than challenging dialogues related to the complexity of presented patient cases. Further, students experienced continuous transfers between learning situations where the potential to be involved differed in a wide variety of ways.

Keywords
ethnography, internal medical ward, learning, medical students, undergraduate
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2443 (URN)10.1136/bmjopen-2016-013046 (DOI)28196948 (PubMedID)
Note

As manuscript in dissertation with title:

Activities at an internal medicine ward -medical students’ opportunities to participate and learn

Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-11-29Bibliographically approved
Hägg-Martinell, A., Hult, H., Henriksson, P. & Kiessling, A. (2016). Community of practice and student interaction at an acute medical ward: An ethnographic study. Medical teacher, 38(8), 793-800
Open this publication in new window or tab >>Community of practice and student interaction at an acute medical ward: An ethnographic study
2016 (English)In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 38, no 8, p. 793-800Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A deeper understanding is needed of the acute medical care setting as a learning environment for students.

AIM: To explore workplace culture of an acute medical ward and students' interactions within this community.

METHOD: An ethnographic design was applied. Medical and nurse students' interactions were observed and informal questioning performed. Field notes were transcribed and analysed qualitatively, inspired by Wengers' "Community of practice" theory.

RESULTS: We identified four characteristics that regulated how students adapt and interact in the community of practice. Complex and stressful situations were stabilized by routines and carriers of culture. Variable composition and roles of community members were a part of the daily routine but did not seam obvious to students. Transitions through community boundaries were confusing especially for new students. Levels of importance and priority: Hierarchies and orders of priority were present as regulators of roles, routines and interactions, and of how staff approach different patient groups.

CONCLUSION: The culture shaped a pattern for, and created prerequisites that challenged students' adaptation and created a space for learning. Students' task on arrival was to enter the semipermeable membrane of the community of practice and to understand and adapt to its culture, and try to become accepted.

National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2441 (URN)10.3109/0142159X.2015.1104411 (DOI)26573137 (PubMedID)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
Hägg-Martinell, A. (2016). Medical and nurse students’ perspective on learning in acute care. (Doctoral dissertation). Stockholm: Karolinska Institutet
Open this publication in new window or tab >>Medical and nurse students’ perspective on learning in acute care
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Medical and nurse students’ professional training takes place in a complex and rapidly changing health care setting. Workplace learning in this context have a considerable potential to contribute to the development of professional competence. However, the complexity of the acute care context can also hinder such an advancement.

Aim: To explore medical and nurse students’ perspective on how and what they learn during acute care placements, and how aspects of such a milieu could influence learning.

Method: A qualitative design was chosen. In study I free text answers and interview data from medical and nurse students were collected and a content analysis was conducted. In study II & III ethnographic observations and informal conversations were collected in an acute medical ward. Medical and nurse students, staff and supervisors were observed and an inductive analysis was performed. In study IV interview data was collected from graduated nurses on their learning experiences as students in acute care. An inductive comparative analysis was performed on these interview data together with data from ethnographic observations of nurse students’ interactions and learning in the acute health care ward.

Results: In study I we identified three themes that influenced students’ progress towards professional competence: Management, planning and organisation for learning; Workplace culture and Learning a profession. In study II we identified four characteristics that formed how students adapted and interacted in the community of practice: Complex and stressful situations; Variable composition and roles of community members; Transitions through community boundaries and Levels of importance and priority. In study III we identified two themes that influenced medical students’ opportunities to participate and learn in an acute internal medicine ward: Nervousness and curiosity and Invited and involved. Finally, in study IV three themes described long-term outcomes of workplace learning for nurse students: To handle shifting situations; To build relationships and To act independently.

Conclusion: The workplace culture in an acute care ward formed the conditions in which students learn and interact. Students have at arrival to enter a community of practice, adapt to its culture and to be accepted. If students were given opportunities to participate actively in the real patient care, they successively developed a professional identity.

Medical and nurse students achieved differing competences and interacted in dissimilar ways during workplace learning. Medical students’ interactions and learning were dominated by queries and responses. However, the potential to develop competence to judge and approach complex patient cases was underutilised. Learning at the ward provided nurse students with understanding of their future profession as nurses, and they learnt how to handle stress and variable situations.

We found that the stressful, ever-changing, demanding, but also considerably structured and organised acute care ward offered abundant learning opportunities that could be used. Therefore, it is maybe not necessary to create and structure new learning situations. But rather to use real care situations and patient cases, and to form conditions and attitudes that make learning in this real world situation inspiring and valuable. However, the full potential of this is as yet not fully utilized.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2016. p. 70
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2439 (URN)978-91-7676-351-3 (ISBN)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
Hägg-Martinell, A., Hult, H., Henriksson, P. & Kiessling, A. (2014). Students perceive healthcare as a valuable learning environment when accepted as a part of the workplace community. Education for Health, 27(1), 15-23
Open this publication in new window or tab >>Students perceive healthcare as a valuable learning environment when accepted as a part of the workplace community
2014 (English)In: Education for Health, ISSN 1357-6283, E-ISSN 1469-5804, Vol. 27, no 1, p. 15-23Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The healthcare system is complex and the education of medical and nursing students is not always a priority within it. However, education offered at the point of care provides students with opportunities to apply knowledge, and to develop the necessary skills and attitudes needed to practice their future profession. The major objective of this study was to identify students' views of generic aspects of the healthcare environment that influences their progress towards professional competence.

METHODS: We collected free text answers of 75 medical students and 23 nursing students who had completed an extensive questionnaire concerning their learning in clinical wards. In order to obtain richer data and a deeper understanding, we also interviewed a purposive sample of students. Qualitative content analysis was conducted.

RESULTS: We identified three themes: (1) How management, planning and organising for learning enabled content and learning activities to relate to the syllabus and workplace, and how this management influenced space and resources for supervision and learning; (2) Workplace culture elucidated how hierarchies and communication affected student learning and influenced their professional development and (3) Learning a profession illustrated the importance of supervisors' approaches to students, their enthusiasm and ability to build relationships, and their feedback to students on performance.

DISCUSSION: From a student perspective, a valuable learning environment is characterised as one where management, planning and organising are aligned and support learning. Students experience a professional growth when the community of practice accepts them, and competent and enthusiastic supervisors give them opportunities to interact with patients and to develop their own responsibilities.

National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2440 (URN)10.4103/1357-6283.134296 (DOI)24934938 (PubMedID)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
Lyngå, P., Persson, H., Hägg-Martinell, A., Hägglund, E., Hagerman, I., Langius-Eklöf, A. & Rosenqvist, M. (2012). Weight monitoring in patients with severe heart failure (WISH). A randomized controlled trial.. European Journal of Heart Failure, 14(4), 438-444
Open this publication in new window or tab >>Weight monitoring in patients with severe heart failure (WISH). A randomized controlled trial.
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2012 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 14, no 4, p. 438-444Article in journal (Refereed) Published
Abstract [en]

AIMS: This multicentre, randomized controlled trial hypothesized that daily electronic transmission of body weight to a heart failure (HF) clinic will reduce cardiac hospitalization in patients recently hospitalized with HF.

METHODS AND RESULTS: A total of 344 patients were randomized to either an intervention group (IG) or a control group (CG). Of the 319 patients included in the final analysis, the mean age was 73 years (SD 10.2), 75% were males, and 57% had a left ventricular ejection fraction (LVEF) <30%. Patients in both groups were recommended to weigh themselves daily and, in the case of sudden weight gain >2 kg in 3 days, to contact the HF clinic. Patients in the IG were given an electronic scale and the weight was automatically transmitted to and monitored at the HF clinic. No significant differences were found for the primary endpoint, cardiac re-hospitalization [70/153 CG, 70/166 IG; hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.65-1.26, P = 0.54], or for the secondary endpoints, which included all-cause hospitalization (84/153 CG, 79/166 IG; HR 0.83, 95% CI 0.61-1.13, P = 0.24), death from any cause (8/153 CG, 5/166 IG; HR 0.57, 95% CI 0.19-1.73, P = 0.32), or the composite endpoint of cardiac hospitalization and death from any cause (78/153 CG, 75/166 IG; HR 0.90, 95% CI 0.65-1.26, P = 0.54). Subgroup analyses did not show any benefits for patients in the IG despite their more frequent monitoring; 398 occasions compared with 30 occasions in the CG.

CONCLUSION: Daily electronic transmission of body weight and monitoring three times a week did not decrease hospitalization or death in HF patients followed up at a HF clinic.

National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2442 (URN)10.1093/eurjhf/hfs023 (DOI)22371525 (PubMedID)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
Hägg-Martinell, A., Hult, H., Henriksson, P. & Kiessling, A.Nurses' perspective on their undergraduate professional learning in acute care.
Open this publication in new window or tab >>Nurses' perspective on their undergraduate professional learning in acute care
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2444 (URN)
Note

As manuscript in dissertation

Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-6477-4441

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