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Patients' approaches to students' learning at a clinical education ward: an ethnographic study
Department of Learning, Karolinska Institutet, Informatics, Management and Ethics.
Department of Neurobiology, Karolinska Institutet; Care Sciences and Society.
Department of Education, Stockholm University.
Department of Learning, Karolinska Institutet, Informatics, Management and Ethics.
2014 (engelsk)Inngår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 14, artikkel-id 131Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting.

METHODS: An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach.

RESULTS: The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students.

CONCLUSIONS: Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients actively participating in students' learning and they both experience it as a joint action. An attending relationship is based on a one-way relationship between patients and students resulting in patients passively participating by letting students to practice on their bodies but without engaging in a learning dialogue with the students.

sted, utgiver, år, opplag, sider
2014. Vol. 14, artikkel-id 131
Emneord [en]
Patient-student encounters, Clinical education ward, Patient-centeredness, Learning relationship, Attending relationship
HSV kategori
Identifikatorer
URN: urn:nbn:se:rkh:diva-1577DOI: 10.1186/1472-6920-14-131PubMedID: 24989155OAI: oai:DiVA.org:rkh-1577DiVA, id: diva2:795490
Tilgjengelig fra: 2015-03-16 Laget: 2015-03-16 Sist oppdatert: 2017-07-14bibliografisk kontrollert
Inngår i avhandling
1. Experiencing authenticity: the core of student learning in clinical practice
Åpne denne publikasjonen i ny fane eller vindu >>Experiencing authenticity: the core of student learning in clinical practice
2014 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The present thesis explored student learning at a clinical education ward with an explicit pedagogical framework. Although nursing students were the focus of the studies the intention is to gain more generally understanding of student learning in clinical settings. Learning in this thesis is understood as a transformative process that involves knowledge construction and meaning-making processes. Clinical education is carried out in real clinical work-places and consists of encounters with patients, healthcare professionals and peer students. Students train their future professional role in these encounters. Previous research has shown challenges that are tied to both organizational and pedagogical issues indicating that clinical learning environments are not always ideal. One way to meet these challenges is by introducing clinical education wards. These are units run collaboratively by educational institutions and the clinical settings; they train students on different levels and focus on inter-professional training or on one profession.

The overall aim of the present thesis was to contribute to our understanding of students’ learning at a clinical education ward where students are supported in taking care of patients independently. A qualitative approach was used to explore students’ learning from the perspectives of students, patients and supervisors. The theory of transformative learning and the concepts of authenticity and threshold were used in interpreting and understanding of the findings.

The results show that the core of student learning at a clinical education ward is the experience of both external and internal authenticity In Study I, first-year nursing students created mutual relationships with patients and expressed feelings of belongingness, which resulted in experiences of both external and internal authenticity. Experiencing authenticity resulted in learning and understanding of nursing and students’ future professional role.

In Study II, final-year students’ learning turned out to be more complex; they experienced only external authenticity, with feelings of ambivalence and selfcentredness creating uncertainty as a threshold for their learning. Taking care of patients in need of extensive nursing care helped students overcome the threshold and experience internal authenticity as well.

Study III explored student-patient encounters and showed that mutual relationships resulted in learning relationships, where patients were active participants in student learning.

In Study IV, supervisors’ approaches to student learning were explored, and the supervisors’ role was shown to involve balancing patient care and student learning by having a nursing care plan for patients and a learning plan for students. Supervisors allowed students to have independence while giving them adequate support at the same time.

To conclude, authenticity makes learning meaningful, and students need to experience both external and internal authenticity in their learning process. Patients’ active participation and supervisors giving both challenges and support are essential to students’ learning. An explicit pedagogical framework based on patient-centredness, peer-learning and supervisors working as a team creates prerequisites for experiences of external and internal authenticity. The present thesis points out that creating possibilities for experiencing authenticity should be the basis for designing clinical learning environments.

sted, utgiver, år, opplag, sider
Karolinska Institutet, 2014. s. 79
HSV kategori
Identifikatorer
urn:nbn:se:rkh:diva-1579 (URN)978-91-7549-532-3 (ISBN)
Disputas
2014-05-23, Vesalius Salen, Berzelius väg 3, Solna, 09:00 (engelsk)
Opponent
Veileder
Merknad

At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: Submitted. Paper 4: Submitted.

III. Manninen, K., Welin Henriksson, E., Scheja, M., Silén C. Patient-student encounters and students’ learning at a clinical education ward – an ethnographic study. [Submitted]

IV. Manninen K., Welin Henriksson, E., Scheja, M., Silén, C. Supervisors’ pedagogical role at a clinical education ward – an ethnographic study. [Submitted]

Tilgjengelig fra: 2015-03-17 Laget: 2015-03-16 Sist oppdatert: 2017-05-16bibliografisk kontrollert

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