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Experiencing authenticity: the core of student learning in clinical practice
Karolinska Institutet, Inst för lärande, informatik, management och etik .
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: urn:nbn:se:rkh:diva-1579ISBN: 978-91-7549-532-3 (print)OAI: oai:DiVA.org:rkh-1579DiVA: diva2:795663
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
List of papers
1. Authenticity in learning: nursing students’ experiences at a clinical education ward
Open this publication in new window or tab >>Authenticity in learning: nursing students’ experiences at a clinical education ward
2013 (English)In: Health Education, ISSN 0965-4283, E-ISSN 1758-714X, Vol. 113, no 2, 132-143 p.Article in journal (Refereed) Published
Abstract [en]

Purpose– This study aims to explore and understand first year nursing students’ experiences of learning at a clinical education ward.

Design/methodology/approach– The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students’ encounters with patients, supervisors, students and other health care professionals. A total of 19 students were interviewed. Data were analyzed using qualitative content analysis investigating both the manifest and the latent content.

Findings– The most important components in students’ learning are mutual relationships and a sense of belongingness. A mutual relationship between the students and the patients is created and becomes the basis of students’ learning. Belongingness means the students’ experience of being for real a part of the team taking care of the patients.

Research limitations/implications– The study, while linked to a particular teaching hospital, offers insights of more general nature by linking the findings to a theory of transformative learning.

Originality/value– This study adds a deeper understanding of students’ perspectives of significant characteristics to take into account when organizing clinical practice in health care education. Being entrusted and supported by a team of supervisors to take care of patients at a clinical education ward early in the education program provides an experience of internal and external authenticity. The students learn from, with and through the patients, which contributes to meaningful learning, understanding nursing, and professional development.

Keyword
Medical education, Authenticity, Belongingness, Clinical education ward, Meaningful learning, Nursing students, Relationships, Education, Students, Nursing
National Category
Nursing Learning
Identifiers
urn:nbn:se:rkh:diva-1560 (URN)10.1108/09654281311298812 (DOI)
Available from: 2015-03-12 Created: 2015-03-12 Last updated: 2017-05-16Bibliographically approved
2. Self-centeredness or patient-centeredness–final year nursing students’ experiences of learning at a clinical education ward
Open this publication in new window or tab >>Self-centeredness or patient-centeredness–final year nursing students’ experiences of learning at a clinical education ward
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.

Keyword
Clinical education ward, Self-centeredness, Patient-centeredness, Nursing students, Authenticity, Threshold, Engagement
National Category
Nursing Learning
Identifiers
urn:nbn:se:rkh:diva-1575 (URN)10.5430/jnep.v3n12p187 (DOI)
Available from: 2015-03-16 Created: 2015-03-13 Last updated: 2017-05-16Bibliographically approved
3. Patients' approaches to students' learning at a clinical education ward: an ethnographic study
Open this publication in new window or tab >>Patients' approaches to students' learning at a clinical education ward: an ethnographic study
2014 (English)In: BMC medical education, ISSN 1472-6920, Vol. 14, 131Article in journal (Refereed) 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.

Keyword
Patient-student encounters, Clinical education ward, Patient-centeredness, Learning relationship, Attending relationship
National Category
Nursing Learning
Identifiers
urn:nbn:se:rkh:diva-1577 (URN)10.1186/1472-6920-14-131 (DOI)24989155 (PubMedID)
Available from: 2015-03-16 Created: 2015-03-16 Last updated: 2017-05-16Bibliographically approved
4. Supervisors’ pedagogical role at a clinical education ward: an ethnographic study
Open this publication in new window or tab >>Supervisors’ pedagogical role at a clinical education ward: an ethnographic study
2015 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 14, 55Article in journal (Refereed) Published
National Category
Nursing Learning
Identifiers
urn:nbn:se:rkh:diva-1578 (URN)10.1186/s12912-015-0106-6 (DOI)26549985 (PubMedID)
Note

As submitted in dissertations

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

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