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Self-centeredness or patient-centeredness–final year nursing students’ experiences of learning at a clinical education ward
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet.
Department of Education, Faculty of Social Science, Stockholm University.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet.
2013 (English)In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 12, 187-198 p.Article in journal (Refereed) Published
Abstract [en]

Background: Different types of clinical education wards with the aim of facilitating transition from student to professional have been established giving students more autonomy and responsibility. Studies report positive effects but deeper understanding concerning how clinical education wards can contribute to learning for students nearing graduation is needed.

Aim: To explore final year nursing students’ experiences of learning when they are supported to take care of patients independently.

Methods: The context for this study was a clinical education ward for nursing students at a university hospital in Sweden. Individual and group interviews with 18 students of 29 eligible students were conducted after their clinical practice. The data was analyzed using qualitative content analysis with a focus on students’ experiences of their encounters with patients, supervisors, students and other professionals.

Results: The two main themes appeared as important aspects influencing final year students’ learning, uncertainty as a threshold and experiencing engagement. Sub-themes characterizing uncertainty as a threshold were self-centeredness and ambivalence describing the patient from the perspective of performing nursing tasks. Sub-themes characterizing experiencing engagement were creating mutual relationship and professional development. Caring for patients with extensive need for nursing care helped the students to become patient-centered and overcome the threshold, experience engagement and authenticity in learning the profession.

Conclusions: A clinical education ward may enhance the students’ experience of both external and internal authenticity enabling meaningful learning and professional development. It is important to acknowledge final year nursing students’ need for both challenges and support in the stressful transition from student to professional. Therefore, an explicit pedagogical framework based on patient-centered care and encouraging students to take responsibility should be used to help the students to overcome self-centeredness and to focus on the patients’ needs and nursing care.

Place, publisher, year, edition, pages
2013. Vol. 3, no 12, 187-198 p.
Keyword [en]
Clinical education ward, Self-centeredness, Patient-centeredness, Nursing students, Authenticity, Threshold, Engagement
National Category
Nursing Learning
Identifiers
URN: urn:nbn:se:rkh:diva-1575DOI: 10.5430/jnep.v3n12p187OAI: oai:DiVA.org:rkh-1575DiVA: diva2:795474
Available from: 2015-03-16 Created: 2015-03-13 Last updated: 2017-05-16Bibliographically approved
In thesis
1. Experiencing authenticity: the core of student learning in clinical practice
Open this publication in new window or tab >>Experiencing authenticity: the core of student learning in clinical practice
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Karolinska Institutet, 2014. 79 p.
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-1579 (URN)978-91-7549-532-3 (ISBN)
Public defence
2014-05-23, Vesalius Salen, Berzelius väg 3, Solna, 09:00 (English)
Opponent
Supervisors
Note

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]

Available from: 2015-03-17 Created: 2015-03-16 Last updated: 2017-05-16Bibliographically approved

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