Developing professional habitus: a Bernsteinian analysis of the modern nurse apprenticeship

"One of those things the student is left to do". Student midwives' experience of infant feeding education. A phenomenological study

AIM/OBJECTIVE

To explore final year student midwives' experiences of breastfeeding education and clinical experience during their three year pre-registration midwifery degree course.

BACKGROUND

Despite an increasing research base about what helps or hinders breastfeeding, there is a dramatic drop in breastfeeding prevalence within the first six weeks of birth. Breastfeeding support and education have been identified as influencing factors associated with breastfeeding prevalence, yet there is a paucity of evidence exploring infant feeding education for pre-registration student midwives.

DESIGN

Qualitative data was gathered using semi-structured interviews with seventeen final year midwifery students in a Higher Education Institution in the North of England.

METHODS

Interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis.

RESULTS

Three core themes were identified: The Mentor-Student Relationship, Midwives and student midwives' attitudes towards breastfeeding and Theory-Practice Disassociation. University-based input provided them with underpinning knowledge but provided little opportunity to develop skills. Attitudes towards breastfeeding were predominantly negative, and these negative descriptions were frequently linked by students to time constraints and workload pressures. The relationship between students and mentors had a direct impact on students' development of breastfeeding support skills and confidence: students who had mentors who were enthusiastic about their role in facilitating learning in clinical practice were confident in supporting women with infant feeding. However, many students described the hospital environment as too busy for infant feeding skills teaching and guidance.

CONCLUSIONS

Although few participants were dissatisfied with how their pre-registration midwifery education prepared them for clinical practice in general, the majority would have liked more opportunities to support women with infant feeding in complex and challenging cases, both in University and in clinical practice. There is a need for midwifery students to be provided with a variety of educational experiences such as theoretical classroom-based learning, simulation-based learning, peer learning, clinical care practice and direct service user engagement. These learning experiences need to include artificial feeding and breastfeeding.

Modeling Doctor of Pharmacy Students' Stress, Satisfaction, and Professionalism Over Time

Objective. To gauge multiple dimensions of pharmacy students' professionalism, stress, and satisfaction with the Doctor of Pharmacy (PharmD) program. Methods. An online survey of first- through fourth-year pharmacy students was conducted from 2015-2018 to gauge the degree of students' professionalism (personal reflection, patient-centric care focus, cultural and interprofessional competencies), program stress (levels, sources, and burnout syndrome), and satisfaction. Multilevel structural equation modeling (SEM) determined the relationship between stress and satisfaction, and the degree to which these impacted levels of professionalism after adjusting for potential correlates (age, sex, financial stress, relationship status, race, and employment status). Results. Seven hundred sixty-four responses to the survey were received across the four calendar years. Of the students in the sample, 51% were female with a mean (SD) age of 26.6 (3.4) years. The overall response rate to the surveys was 86.2%. Professionalism was most strongly indicated by the measures of community-centeredness, patient-centeredness, and perceived benefits of being part of a team-based environment. The SEM model demonstrated an inverse relationship between the two composite latent constructs of stress and satisfaction. When modeled simultaneously, program satisfaction was found to be the more significant predictor of professionalism than stress after adjusting for associations with age, sex, and relationship status. Conclusion. Professionalism of pharmacy students is positively associated with students' satisfaction with the program, but professionalism is not independently significantly predicted by stress. Students who have positive responses to community- and patient-centeredness and who feel they benefit from engaging in a team-based environment are most likely to have greater professionalism.

Contemporary factors shaping the professional identity of occupational therapy lecturers

Introduction

The contemporary factors of neoliberalism and evidence-based practice have implications for professional autonomy and values, education and training, ways of working and construction of knowledge. Occupational therapy lecturers are at the interface between student education and professional practice and therefore have unique insights into the way in which these factors are shaping their professional identity and that of the profession.

Method

Nine narrative inquiry focused interviews of occupational therapy lecturers from two universities were carried out. Data was interpreted through a Bourdieusian lens of professional habitus, and analysed thematically.

Findings

The main factors influencing occupational therapy lecturer identity were noted to be relationships between professional identity and artistry; the professional body of knowledge and language; evidencing practice, neoliberalism and changes to teaching and learning.

Conclusion

The structural factors of neoliberalism, evidence-based practice and associated policies are influencing the occupational therapy professional habitus and, in turn, occupational therapy lecturers’ professional identity. An effective critique of these structural factors is required to maintain the profession’s values and artistry and the knowledge upon which occupational therapy lecturers’ identity is formed and their approaches to teaching and learning are based.

Pierre Bourdieu: Expanding the scope of nursing research and practice

Bourdieu is an important thinker within the sociological tradition and has a philosophically sophisticated approach to theoretical knowledge and research practice. In this paper, we examine the implication of his work for nursing and the health sciences more broadly. We argue that his work is best described as a reflexive realist who provides a space for a nonpositivist approach to knowledge that does not fall into the trap of idealism or relativism. We emphasize that Bourdieu was not an abstract theorist, but only utilized theories to understand and explain the social world in all its empirical complexity. Theory is emphasized over method without denying the importance of method. We then provide a brief overview of some of his key concepts: habitus, field and capital. His work is a scientifically astute practice that has an emancipatory purpose, with particular resonance to the problems of nursing as a social practice. Some have criticized Bourdieu for undermining agency and we briefly address this issue, but argue that his conceptual framework helps us to understand what endures in social practice and why change is often problematic. In short, this paper argues that Bourdieu's work is a fruitful resource for critiquing existing nursing approaches that are preoccupied with agency over structure.

Students' and teachers' experiences of participating in the reflection process "THiNK"

OBJECTIVES

Reflective journal writing in clinical practice is used as a tool in bachelor programs in nursing. The reflection process THiNK was developed to enhance students' reflection processes. It was tailored to the needs of a nursing programme (in Norway) as former studies showed that many students had superficial level of reflection in their reflective journals, few students applied knowledge to their reflections and some met unprepared in the guided reflection groups. The teachers had inconsistent focus on the importance of reflection as a way of learning. This study aimed to describe students' and teachers' experiences of participation in reflection processes.

DESIGN AND METHOD

The development of THiNK is inspired by educational design research. This study used focus groups to gain insight into students' and teachers' experiences of the reflection processes. Data were analysed using qualitative content analysis.

PARTICIPANTS AND SETTING

The empirical sample included 5 focus groups with 28 students and 7 teachers in a bachelor nursing program at a University College in Norway.

RESULTS

The themes were as follows: stop and verbalise the experiences, stimulate and support the reflection processes and develop a conscious attitude. The students became aware of themselves and their own execution. The teachers and reflection groups were crucial in order to learn to see the complexity of a given situation and helped draw connection between the situation and the theoretical knowledge.

CONCLUSIONS

Enhancing students' professional development requires attention to facilitation skills as well as other contextual factors. Readiness in the culture can be ensured by tailoring frameworks of reflection that replies to students' and teachers' requests. Participating in reflection processes facilitates integration of modes of thinking when dealing with clinical situations.

The significance of communities of practice: Norwegian nursing students' experience of clinical placement in Bangladesh

AIM

The purpose of this study was to gain understanding of Norwegian students' experience of learning in clinical placement in Bangladesh without formal one-to-one supervision, by a personal mentor in the ward.

DESIGN

Using focus group interviews with bachelor nursing students we explored the significance of 'communities of practice' in nursing practicum abroad, socialization and knowledge transfer.

METHOD

Seven third year bachelor nursing students enrolled in a clinical placement programme in Bangladesh participated in focus group interviews prior to their departure to Bangladesh, during their stay in Bangladesh and after their return to Norway.

RESULTS

The Students' marginality and 'peripheral participation' triggered insight and reflection. The challenging but advantageous position of the peripheral students was heightened further due to the lack of one-to-one supervision in the clinic. Their previous experience with problem based learning and group learning was an asset that made them more resilient and helped them to cope.

Using Bourdieu's theory of practice to understand ICT use amongst nurse educators

BACKGROUND

Implementing changes in practice in either clinical or educational settings remains challenging. In the context of Information and Communication Technologies (ICT) adoption, the literature focuses either on organisational factors influencing its implementation, or on individual factors influencing its adoption into practice. Separately both fail to examine the issue holistically. Bourdieu's theory of practice provides a method for reconciling the two.

OBJECTIVE

To provide a practical example of how Bourdieu's theory of practice can be employed to better understand nurse educators' responses to ICT.

DESIGN

Exploratory descriptive design, using a Bourdieusian case-study to guide a documentary analysis.

METHODS

In 2009 a two-part study was conducted within a Department of Nursing (DON) in higher education (HE) in England. First Bourdieu's theory of practice was used to develop a case-study; then nurse educators were recruited for a Q-methodology (Q) study. This paper focuses exclusively on the case study and the use of the theory of practice to interpret the findings from the Q-study.

RESULTS

Nursing's transition into academia, promotions criteria in HE and the value placed on research over teaching have influenced educators' responses to technology.

CONCLUSION

The use of Bourdieu's framework provides a rich and contextual backdrop for understanding how organisational factors interact to influence individuals' responses to technology adoption.

The duality of professional practice in nursing: academics for the 21st century

Although pre-registration nursing in the United Kingdom (UK) is moving towards a graduate exit, the vocational/professional debate is still live and continues to be played out in both popular and professional literature. This study considers the nature of contemporary academic communities and the challenge of duality in professional nursing life. More than a decade after the move into higher education (HE) however the role of the academic is still controversial, with much of the debate focussed on the nature of clinical credibility. This article considers the dimensions of academic nursing, reports the views of academics and clinicians and introduces a model of working that could potentially harness and blend the skills of academics and clinicians, nurturing a culture of applied scholarship throughout the professional/academic journey.

A socio-cultural approach to learning in the practice setting

Practice learning is an essential part of the curriculum and accounts for approximately 60% of the current pre-registration nursing programmes in the Republic of Ireland. The nature and quality of the clinical learning environment and the student nurses' experience of their practice placements is recognised as being influential in promoting the integration of theory and practice. However, the problem experienced by many learners is how to relate their theoretical knowledge to the situation-at-hand within the practice setting. Socio-cultural or activity theories of learning seek to explain the social nature of learning and propose that knowledge and learning are considered to be contextually situated. Lave and Wenger (1991) argue that learning is integrated with practice and through engagement with a community of practice, by means of sponsorship; students become increasingly competent in their identity as practitioners. This paper examines the changes which have occurred within the pre-registration nursing curriculum in the Republic of Ireland with the transition from the apprenticeship system to the graduate programme, and the resulting reduction in clinical learning hours. It also examines the potential impact on the development of student learning with the implementation of the concepts proposed by Lave and Wenger to learning in the practice setting.

Subjectivity and the valid assessment of pre-registration student nurse clinical learning outcomes: implications for mentors

This discussion, supported by the author's personal reflections as a mentor and teacher, examines the issue of subjectivity when assessing the competence of pre-registration nursing students during their clinical placements. A difference is highlighted between valid and invalid subjectivity affecting the quality of mentors' assessments. Valid subjectivity refers to situations where students and mentors enter into a contract of trust and commitment from the outset of placement learning, enabling the 'substantiated' opinion of mentors to become a credible part of proficiency assessment. Invalid subjectivity presupposes that there has been limited investment in the student/mentor relationship and that assessment is therefore more reliant on the 'unconfirmed' views of mentors. Humanistic approaches to evaluating student learning are explored and a question is posed as to whether the trustworthiness of subjective assessment is improved when there is a sense of mutual reciprocity between students and mentors. Particular reference is made to reflective practice in adding meaning to this connection. Finally, an example of holistic assessment during 'live' clinical supervision involving a student and this author is offered (Table 1), in order to illustrate the implications for mentors attempting to enhance subjective evaluation of student learning.