O Lúanaigh, Pádraig
Becoming a professional: what is the influence of registered nurses on nursing students’ learning in the clinical environment?
The Open University.
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Aim: This thesis sets out to explore and understand how nursing students learn in the clinical environment, specifically through the influence of registered nurses.
Background: At a time when public confidence in the quality of health and nursing care is called into question, the United Kingdom Nursing and Midwifery Council’s (NMC) new standards for pre-registration nursing education are intended to prepare the UK nursing workforce of the future to provide high quality nursing care across a range of health care environments (NMC, 2010b). While existing UK nursing research has examined learning in the clinical environment, little work has been undertaken to understand how nursing students on placement learn in the clinical environment and specifically the influence of others.
Methods: Using Yin’s (2009) case study approach, this thesis explored the learning experiences of a group of five final year nursing students through descriptions of their learning within the clinical environment. In keeping with Yin’s (2009) case study approach of gathering a richness and depth of understanding, additional data were collected from a focus group with eight registered nurses. The collection of two types of data from both learners and registered nurses allowed for an exploration from both perspectives and experiences of these two groups. The interviews and focus group were conducted between October 2010 and January 2011.
Findings: The study identified three specific overall themes relating to the influence of registered nurses on student learning in the clinical environment; responsiveness to student learning needs; creating a sense of belonging; and influencing professional identity development. A fourth theme identified was the importance of the clinical environment in that it allows students to learn what cannot be facilitated elsewhere.
Discussion: The findings while supporting previous research also provide new understanding. The nursing student participants had and wanted to actively manage their learning in the clinical environment. As a result of this active management the students did not passively acquire knowledge or simply replicate what they observed from others. There was evidence that the students had strong and established perceptions of what constituted ‘good’ nursing and described an ability to discriminate between differing levels of nursing practice. Student nursing knowledge was gained from respected registered nurses who were best able to describe and demonstrate the ‘tricks of the trade’ and ‘little things that matter’ when providing ‘good’ nursing.
Conclusions: The findings have informed a number of suggestions on how to support nursing students and clinical staff to enhance and improve the learning experience in the clinical environment. Curriculum design and preparation of registered nurses and mentors needs to stress the strong social aspects of clinical learning while raising awareness of the importance of creating a sense of belonging and respect for students as individuals. Pre registration curricula need to explicitly explore concepts such as caring, professionalism and support learners to articulate and examine their developing concepts of nursing and what constitutes ‘good’ and ‘bad’ nursing.
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