Students perceive healthcare as a valuable learning environment when accepted as a part of the workplace community

A nurturing and caring environment to facilitate nursing students' professional development in Rwanda: a focused ethnographic study

OBJECTIVES

To explore the values, practices, and behaviours that support nursing students' professional development in practice-based learning environments in Rwanda.

METHODS

A focused ethnographic approach was used. Nursing students (n=12), nurses (n=11), clinical instructors (n=7) and nurse leaders (n=8) from three teaching hospitals and an educational program participated in the study. Data was collected trough individual interviews and participant observation.

RESULTS

Participants embraced a culture of preparing nursing students for their professional roles as a professional responsibility, and a means of securing the nursing profession. Modeling the appropriate behaviours to students and respecting them as learners and humans constituted the caring attributes that sustain a positive learning environment for their professional growth.

CONCLUSIONS

Nurturing and caring environments offer students opportunities to integrate caring attitudes into their interactions with patients and to develop professionally.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

Findings underscore the need to enhance caring values within nursing curricula.

What Aspects of Supervised Patient Encounters Affect Students' Perception of Having an Excellent Learning Outcome? A Survey Among European Medical Students

Background

To investigate whether supervisor behavior, students' participation and approach, and psychological safety were associated with self-reported excellent learning outcome from supervised encounters with patients among European medical students.

Methods

A cross-sectional, online survey among European medical students asking about their latest clinical supervision experience. Associations were examined with logistic regression.

Results

Students (N=908) from >25 countries reported on experiences from supervised patient encounters in most types of hospital departments and general practice. One out of six (17%) students perceived the learning outcome as excellent. In the multivariable logistic regression, this was independently associated with supervisor role modelling (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.5-3.0) and addressing learning goals (OR 1.4, 95% CI 1.1-1.7), students' approach to learning (OR 1.7, 95% CI 1.0-3.0) and psychological safety (OR 1.5, 95% CI 1.1-2.0). Supervisors being present during the patient encounter, coaching students or asking questions to have students express their thinking, and student participation in examination and/or history taking was not associated with perceived excellent learning outcome.

Conclusion

We encourage supervisors to recognize that students are beginners in most supervised clinical settings and often appreciate having learning goals addressed, behavior and thinking role modelled, and psychological safety established before they participate more fully.

Nursing and medical students' experiences of interprofessional education during clinical training in psychiatry

The aim of the study was to describe nursing and medical students' experiences of participation in an interprofessional education (IPE) activity, "round school," during their clinical rotations in psychiatric care. Data were collected in six focus groups with 32 students from nursing and medical programs, focusing on their experiences of the IPE activity and their reflections on interprofessional collaboration. The students considered the round school to be meaningful and true-to-life. Important conditions for learning were well-informed staff, sufficient time for preparation and feedback, clear routines, instructions, and an open climate. Non-explicit instructions and limited preunderstanding of psychiatric care left the students feeling uncertain. Students' reflections regarding interprofessional competences encompassed both similarities and differences in roles, responsibilities, and collaboration. Evidence of hierarchical and stereotypical images of the nurse-physician relationship was identified. Round school is an example of how IPE can be integrated into the units' regular ward rounds. However, if the clinical everyday work is not based on collaboration between different professions, it can be arduous to implement IPE. Well-planned preparations are necessary, both in the clinic and at the faculty.

Nursing Students Learn to Handle Stress and to Prioritize in a Complex Context During Workplace Learning in Acute Internal Medicine Care - An Ethnographic Study

INTRODUCTION

A common focus in many studies, in the short-term perspective, is to evaluate students' workplace learning and its outcome. However, the outcome can be perceived differently depending on when it was evaluated. The aim of this study was to explore student nurses' learning activities in an acute internal medicine unit and the nurses perceived learning outcome in a long-term perspective.

MATERIAL AND METHODS

Repetitive ethnographic observations were performed in an internal medicine care unit at a teaching hospital in Sweden between 2011 and 2013. Four student nurses and supervisors were repetitively observed. Two years later retrospective interviews were performed with four nurses who had performed workplace learning, as students, in this unit during the observation period. An inductive comparative analysis involving all interviews and observational data was applied.

RESULTS

Three themes were identified: To handle shifting situations - illustrating how student nurses learnt to adapt to shifting situations, to manage stress, to create structure and space for learning and to deal with hierarchies; To build relationships - illustrating how student nurses learnt to collaborate and to interact with patients; To act independently - illustrating how student nurses trained to act independently in the unit, took responsibility, and prioritized in this complex context.

CONCLUSION

Learning activities in a complex acute medical unit setting were characterized by a high workload and frequent stressful situations, and a demand on students to interact, to take responsibility, and to prioritize. To learn in such a stressful context, have in a long-term perspective, a potential to develop students' embodied understanding of and in practice, making them more prepared to work and independently apply their nursing expertise in similar contexts as graduated nurses.

Possibilities for interprofessional learning at a Swedish acute healthcare ward not dedicated to interprofessional education: an ethnographic study

OBJECTIVES

Almost all healthcare today is team-based in collaboration over professional borders, and numerous students have work-based learning in such contexts. However, interprofessional learning (IPL) in clinical settings has mostly been systematically explored in specially designed contexts dedicated to interprofessional education (IPE). This study aimed to explore the possibilities for IPL activities, and if or how they occur, in an acute ward context not dedicated to IPE.

DESIGN AND SETTING

Between 2011 and 2013 ethnographic observations were performed of medical and nursing students' interactions and IPL during early clerkship at an acute internal medicine ward in Sweden. Field notes were taken and analysed based on the framework of IPE: learning with, from and about.

PARTICIPANTS

21 medical, 4 nursing students and 30 supervisors participated.

RESULTS

Learning with-there were no organised IPE activities. Instead, medical and nursing students learnt in parallel. However, students interacted with staff members from other professions. Learning from-interprofessional supervision was frequent. Interprofessional supervision of nursing students by doctors focused on theoretical questions and answers, while interprofessional supervision of medical students by nurses focused on the performance of technical skills. Learning about-students were observed to actively observe interactions between staff and learnt how staff conducted different tasks.

CONCLUSION

This study shows that there were plenty of possibilities for IPL activities, but the potential was not fully utilised or facilitated. Serendipitous IPL activities differed between observed medical and nursing students. Although interprofessional supervision was fairly frequent, students were not learning with, from or about each other over professional borders.

Implementing clinical education of medical students in hospital communities: experiences of healthcare professionals

OBJECTIVES

To explore healthcare professionals' experiences of implementing clinical education of medical students in communities of practice that previously focused on the delivery of healthcare services.

METHODS

Seven focus group interviews involving assistant nurses, nurses, and physicians were conducted at a regional hospital in Sweden. A total of 35 respondents participated. Open-ended questions were used to explore respondents' experiences of medical students in their community. Data were analysed using qualitative inductive content analysis.

RESULTS

Three main themes emerged: Staff members becoming learners, structural and sociocultural changes due to the implementation, and features designing the settings of the implementation. Reflection and interactive learning processes among staff, patients, and students were found to stimulate individual learning, to improve the learning climate in the organisation, and to enhance the structure of the clinical work. Attitudes to education among staff members as well awareness of how education is organised appeared to be vital for their experiences and approaches.

CONCLUSIONS

Implementing clinical education of medical students at a hospital previously focused on delivery of care was acknowledged to not only stimulate learning among staff but also trigger structural and cultural development in communities of practice. Opportunities for interprofessional interaction and reflection are vital to successfully implement a new student group in communities of practice. Addressing conceptions about and attitudes toward the clinical education of students among healthcare professionals are essential to promote their engagement in education.

Transforming Nursing Education to Strengthen Health System in Malawi: An Exploratory Study

Background:

Malawi made great strides to increase the number of nurses through the Emergency Human Resource for Health Program. However, quantity of health workforce alone is not adequate to strengthen the health system. Malawi still reports skill mix imbalance and geographical mal-distribution of the nursing workforce. Health systems must continuously adapt and evolve according to the health care needs and inform health professionals’ education to accelerate gains in health outcomes. The Lancet Commission reported that health professionals’ education has generally not lived up pace with health care demands.

Objectives:

The aim of this study was to describe the strategies being implemented in Malawi to improve nursing education. Specifically, the objectives of the study were to explore strategies being implemented, identify stakeholders and their targets in order to share practices with countries experiencing similar nursing education challenges.

Methods:

This was a cross sectional descriptive study with a concurrent mixed method design. One hundred and sixty participants including nurse practitioners and educators responded to a questionnaire. Fifteen nurse practitioners and eight nurse educators were also engaged in one to one interview.

Results:

Respondents showed varied opinion on how nursing education is being implemented. Six themes as regards strategies being implemented to improve nursing education emerged namely- capacity building, competency based curriculum, regulation, clinical learning environment, transformative teaching and infrastructure/ resources.

Conclusion:

Findings of this study show that the strategies being implemented to improve nursing education are relevant to closing the gap between health care needs and nursing education.

Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study

OBJECTIVES

To optimise medical students' early clerkship is a complex task since it is conducted in a context primarily organised to take care of patients. Previous studies have explored medical students' perceptions of facilitation and hindrance of learning. However, the opportunities for medical student to learn within the culture of acute medicine care have not been fully investigated. This study aimed to explore how medical students approach, interact and socialise in an acute internal medicine ward context, and how spaces for learning are created and used in such a culture.

DESIGN AND SETTING

Ethnographic observations were performed of medical students' interactions and learning during early clerkship at an acute internal medicine care ward. Field notes were taken, transcribed and analysed qualitatively. Data analysis was guided by Wenger's theory of communities of practice.

PARTICIPANTS

21 medical students and 30 supervisors participated.

RESULTS

Two themes were identified: Nervousness and curiosity-students acted nervously and stressed, especially when they could not answer questions. Over time curiosity could evolve. Unexplored opportunities to support students in developing competence to judge and approach more complex patient-related problems were identified. Invited and involved-students were exposed to a huge variation of opportunities to learn, and to interact and to be involved. Short placements seemed to disrupt the learning process. If and how students became involved also depended on supervisors' activities and students' initiatives.

CONCLUSIONS

This study shed light on how an acute internal medicine ward culture can facilitate medical students' possibilities to participate and learn. Medical students' learning situations were characterised by questions and answers rather than challenging dialogues related to the complexity of presented patient cases. Further, students experienced continuous transfers between learning situations where the potential to be involved differed in a wide variety of ways.

Community of practice and student interaction at an acute medical ward: An ethnographic study

BACKGROUND

A deeper understanding is needed of the acute medical care setting as a learning environment for students.

AIM

To explore workplace culture of an acute medical ward and students' interactions within this community.

METHOD

An ethnographic design was applied. Medical and nurse students' interactions were observed and informal questioning performed. Field notes were transcribed and analysed qualitatively, inspired by Wengers' "Community of practice" theory.

RESULTS

We identified four characteristics that regulated how students adapt and interact in the community of practice. Complex and stressful situations were stabilized by routines and carriers of culture. Variable composition and roles of community members were a part of the daily routine but did not seam obvious to students. Transitions through community boundaries were confusing especially for new students. Levels of importance and priority: Hierarchies and orders of priority were present as regulators of roles, routines and interactions, and of how staff approach different patient groups.

CONCLUSION

The culture shaped a pattern for, and created prerequisites that challenged students' adaptation and created a space for learning. Students' task on arrival was to enter the semipermeable membrane of the community of practice and to understand and adapt to its culture, and try to become accepted.

A safe place with space for learning: Experiences from an interprofessional training ward

Interprofessional learning in a real ward context effectively increases collaborative and professional competence among students. However, less is known on the processes behind this. The aim of this study was to explore medical, nurse, physiotherapy, and occupational therapy students' perspectives on the process of their own learning at an interprofessional training ward (IPTW). We performed a qualitative content analysis on free-text answers of 333 student questionnaires from the years 2004 to 2011. Two main themes emerged: first, students found that the IPTW provided an enriching learning environment--a safe place with space. It included authentic and relevant patients, well-composed and functioning student teams, competent and supportive supervisors, and adjusted ward structures to support learning. Second, they developed an awareness of their own development with faith in the future--from chaos to clarity. It included personal, professional, and interprofessional development towards a comprehensive view of practice and a faith in their ability to work as professionals in the future. Our findings are discussed with a social constructivist perspective. This study suggests that when an IPTW provides a supportive and permissive learning environment with possibilities to interact with one another--a safe place with space--it enables students to move from insecurity to faith in their abilities--from chaos to clarity. However, if the learning environment is impaired, the students' development could be halted.

Development and Validation of the Scan of Postgraduate Educational Environment Domains (SPEED): A Brief Instrument to Assess the Educational Environment in Postgraduate Medical Education

Introduction

Current instruments to evaluate the postgraduate medical educational environment lack theoretical frameworks and are relatively long, which may reduce response rates. We aimed to develop and validate a brief instrument that, based on a solid theoretical framework for educational environments, solicits resident feedback to screen the postgraduate medical educational environment quality.

Methods

Stepwise, we developed a screening instrument, using existing instruments to assess educational environment quality and adopting a theoretical framework that defines three educational environment domains: content, atmosphere and organization. First, items from relevant existing instruments were collected and, after deleting duplicates and items not specifically addressing educational environment, grouped into the three domains. In a Delphi procedure, the item list was reduced to a set of items considered most important and comprehensively covering the three domains. These items were triangulated against the results of semi-structured interviews with 26 residents from three teaching hospitals to achieve face validity. This draft version of the Scan of Postgraduate Educational Environment Domains (SPEED) was administered to residents in a general and university hospital and further reduced and validated based on the data collected.

Results

Two hundred twenty-three residents completed the 43-item draft SPEED. We used half of the dataset for item reduction, and the other half for validating the resulting SPEED (15 items, 5 per domain). Internal consistencies were high. Correlations between domain scores in the draft and brief versions of SPEED were high (>0.85) and highly significant (p<0.001). Domain score variance of the draft instrument was explained for ≥80% by the items representing the domains in the final SPEED.

Conclusions

The SPEED comprehensively covers the three educational environment domains defined in the theoretical framework. Because of its validity and brevity, the SPEED is promising as useful and easily applicable tool to regularly screen educational environment quality in postgraduate medical education.