11.11. Nursing Students' Significant Nursing Experiences and Learning from Them in a Clinical Learning Environment

Public examination of a doctoral dissertation in the field of nursing science

Doctoral candidate: MHC Maija Romppanen

Time and venue: 11.11.2011 at 12 noon, Medistudia ML3, Kuopio Campus

Language of the public examination: Finnish

Background and purpose: The purpose of the study was to describe significant nursing experiences and learning from them in different clinical learning environments, as experienced by nursing students. The information obtained from the study can be utilised in further development of supervision of nursing students’ practical training.

Material and methods: The material of the study consisted of accounts written by nursing students (n=547) between 1996 and 2003 describing significant nursing experiences and learning to nurse in a clinical learning environment. The study focused on accounts written by nursing students at one University of Applied Science in their second year or the beginning of the third year of study, describing their experiences during supervised training or earlier work experiences. The Critical Incident Method was used to gather material for the study, and grounded theory content analysis was used to analyse the material.

Results: The significant learning incidents experienced by the nursing students were manifold, focusing primarily on encountering patients and their families as well as ethical aspects. Students considered the significance of their own actions to be important for the patients. This was particularly emphasised in patient-student relationships that were perceived as confidential, as well as in challenging relationships. Confidential relationships with patients gave nurse students confidence and courage to make independent decisions and encouraged them to develop the quality of patient care. Promoting the good of the patient was a key feature of thinking and operation among nursing students. This was manifested particularly in acting as patient’s advocate or representative. Through their experiences, students also learned to understand the importance of family members in patient care. Encountering families involved confidential cooperation with them, but students were also faced with anxiety, internal conflicts and discontent on the part of family members. Assuming and being given responsibility as well as trust shown by patients and their families promoted the professional self-esteem of nursing students. Ethically challenging situations, such as nursing a critically ill or dying patient and unethical practices encountered in the workplace, were emotionally challenging experiences for students. Realisation of the limitations of one’s own actions and those of others launched a process of reflection between the reality and ideals of nursing, which made the students become aware of the limitations of the nursing process. Awareness of the limitations of their own actions made the students adopt more professional values and attitudes, which promoted their professional growth. In developing their own actions, the students were able to reflect on their feelings and the information available, to make use of the supervision they had received and to learn from individual and group-based role models and multiprofessional collaboration. The students described their own professional growth as follows: learning about being a responsible primary nurse, improvement of communication skills, learning about ethicality and becoming aware of limitations, showing collegiality, becoming aware of boundaries between professional and personal actions, awareness of continuous self-improvement and a more clearly defined career.

Conclusions and recommendations: Experiences during clinical training and learning from them are an important part of nursing studies. It is important to learn to realise that nursing is multifaceted and has limitations. During practical training, analysis and reflection over the critical incidents experienced leads to learning how to nurse. The aim is that this leads to ethically high-quality nursing and development of a professional identity right from the onset of studies, helping students to grow professionally in the later stages of their studies and once they start working. According to the study, it seems important to support individual learning processes and coping, especially in challenging nursing situations, with good clinical supervision. Supervision and the study atmosphere should be developed so that even the limitations of nursing work can be safely examined within educational and health care organisations, particularly in student-supervisor relationships. An open culture in the learning environment that promotes professional discussion as well as constructive, regular contacts with the supervisor are key prerequisites of learning. This study focused on learning to nurse from students’ perspective. In further studies the perspective should be widened to encompass the connection between the supervisory relationship and the learning environment in students’ learning process. It would also be useful to investigate more widely the possibility of using written significant learning experiences as support in the clinical learning process.

The doctoral dissertation of Master of Health Care Maija Romppanen, entitled Nursing Students’ Significant Nursing Experiences and Learning from Them in a Clinical Learning Environment will be examined at the Faculty of Health Sciences. The opponent in the public examination will be Professor Arja Isola of the University of Oulu, and the custos will be Professor Hannele Turunen of the University of Eastern Finland.

Photo available for download at http://uef.fi/vaitoskuvat

For further information, please contact Maija Romppanen, tel. 0405730693, maija.romppanen@elisanet.fi     

Publishing year: 2011

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