Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this 'understanding' in clinical education is and how it is promoted in clinical nursing education becomes important to clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third-year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding-based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding-based, interpretative education in nursing.

BACKGROUND: Preceptorship is one model of supporting student nurses' learning and development during their clinical education. However, little is known about what there is in preceptorship that promotes or hinders learning. Earlier studies found that there were ethical dimensions to students' encounters with preceptors.

AIM: The overall purpose of this Nordic follow-up study was to develop a model for learning compassionate care among student nurses during their clinical education - first, to deeper understand the learning of student nurses, and second, to investigate the phenomenon of preceptorship from the preceptors´ point of view.

METHOD: This study used a mixed methods design. Undergraduate student nurses (n = 139) from three universities in Finland and Sweden were shadowed for a period of three years. Quantitative data were collected through a questionnaire and were analysed using statistical methods. To better understand the learning acquired by the student nurses, focus group interviews (n = 70) were conducted. The phenomenological-hermeneutical approach was adopted. To capture the preceptors' point of view, narrative interviews were held with them (n = 88) in western Finland and northern Sweden. A hermeneutical approach was used when analysing the data.

FINDINGS: According to both student nurses and preceptors, a caring student-preceptor relationship, imbued with commitment, reverence and responsibility, is fundamental and serves as the basis for students' learning and development more than pedagogical methods used. Three main themes emerged: a caring student-preceptor relationship; a caring manner of being-the conduct; and a caring culture-the tone of the learning space.

CONCLUSIONS: This study shows the importance of preceptorship on student nurses in their quest of becoming compassionate and caring nurses. Therefore, based on earlier findings and the findings in this study, there is a need to facilitate and support the students' transformation, that is, the process of becoming, from student to a professional nurse.

Background: The majority (70%) of cardiac arrests in Sweden are experienced in the patient’s home. In these situations, the ambulance nurses may encounter several ethical dilemmas.

 Aim: The aim was to investigate Swedish specialist ambulance nurses’ experiences of ethical dilemmas associated with cardiac arrest situations in adult patients’ homes.

Methods: Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis.

Ethical considerations: Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process.

Findings: Two main themes with six sub-themes were identified: The scene – creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients’ integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being’s dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human.

Conclusion: The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient’s dignity and to serve life and health.

Bakgrunn: Helsetjenester skal være kunnskapsbaserte, men å omsette forskningsfunn til klinisk praksis beskrives gjennomgående som komplekst og utfordrende. Studien som presenteres i denne artikkelen var første del av et aksjonsforskningsprosjekt i samarbeid mellom et universitetssykehus og en høgskole.  Formålet var å understøtte implementering av kunnskapsbasert praksis som arbeidsform på sykehuset for å bidra til å styrke kvalitet på praksis og å utvikle praksisplassen som læringsarena. Hensikt med denne første delstudien var å avdekke faktorer av betydning for implementerings-prosessen blant ansatte.  Studiens forskningsspørsmål var: Hvordan erfarer helsepersonell kunnskapsbasert praksis i sin arbeidshverdag?

Metode: For å innhente deltagernes erfaringer ble det utført en kulturanalyse ved fire enheter på et sykehus i Sør Norge. Brevmetoden ble brukt datainnsamlingsmetode og data ble analysert med systematisk tekstkondensering. 

Resultat: Studiens resultat presenteres under tre hovedkategorier: Lederen angir tonen som motivator og pådriver; Positiv holdning til og bruk av kunnskapsbasert praksis i arbeidshverdagen; Organisatoriske forhold av betydning. Studien viser at for å lykkes med implementering av kunnskapsbasert praksis er det viktig å ha en leder med positiv holdning som motiverer ansatte og skaper forutsetninger for utviklingsarbeid. Når en slik holdning preger arbeidsmiljøet understøtter det åpenhet og samarbeid og gjør det mulig å dele erfaring og reflektere over praksis. I tillegg trengte en ildsjeler med kompetanse og interesse for kunnskapsbasert praksis. Tidspress, travelhet og varierende kompetanse ble beskrevet som hindringer for implementering av kunnskapsbasert praksis.

Konklusjon: Det kreves et samspill mellom alle disse faktorene for at implementeringen og utviklingsarbeidet skal lykkes.

Background: Health care services should be evidence-based, but exploiting the potential of new and existing clinical practice knowledge is challenging. The research presented in this article was the first sub-study in an action research project – a collaboration between a university hospital and a university of applied science. The joint project aimed to support the implementation of evidence-based practice at the hospital in order to strengthen the quality of its clinical practice and to develop practice placements as an arena for learning. The purpose of the first sub-study was to unfold the experiences and attitudes of the staff concerning the implementation of evidence-based practice. The research question was, ‘How do the health care personnel experience evidence-based practice in their daily work’?

Method: A cultural analysis was conducted using the letter-writing method to grasp the staff´s lived experiences. The data were analysed via a content analysis.

Results: The results are presented as three main categories: (1) The leader sets the tone as a motivator and an instigator; (2) a positive attitude towards the use and understanding of evidence-based practice in the working environment; and (3) organizational circumstances of importance. The study showed the importance of a leader who has a positive attitude regarding the development of the working environment and the importance of a leader who motivates staff and creates opportunities for implementation of evidence -based practice. The leader’s manner of attitude is revealed through a culture of openness and cooperation that enables sharing experiences and reflection. Furthermore, real enthusiasts with competence and interest in evidence-based practice are needed. Hindering factors affecting the implementation of evidence-based practice were lack of time, heavy work load and insufficient knowledge about the topic.

Conclusion: For health care services to successfully implement evidence-based practice, there must be an interplay between the leader as a motivator, staff with a positive attitude towards development and an organization that encourages development.

Vad innebär hemmet i djup mening för människan? Hemmet relateras kanske i första hand till den konkreta platsen där människan vuxit upp, barndomshemmet, familjen, hembygden och fosterlandet. Allt detta är fysiskt påtagbart. Men vad innebär det egentligen att känna sig hemma eller hemlös? Handlar hemma om en känsla och upplevelse som berör frågor om identitet, gemenskap och tillhörighet? Människor med samma kulturbakgrund delar ofta språket, sättet att uttrycka sig, humorn, gemensamma traditioner och värderingar. Är det detta som gör att man känner sig hemma med det bekanta och med människor som delar ens värderingar?

I mötet med andra människor och nya situationer finns hemmet som en klangbotten mot vilket allt det nya speglas, men kan hemmet innebär något mera? Hemma är inte nödvändigtvis bundet till en geografisk plats utan kan mera handla om en känsla.

Background: Over the last few decades, there has been an increase in mental health problems among adolescents, manifested as physical symptoms, such as stomach pain, headaches, feelings of anxiety, worry, stress and sleeping problems. Surveys among school nurses’ have revealed that mental health work now forms a key part of their role. Although an increasing number of adolescents are suffering from mental health problems in upper-secondary schools (16-19 years), there are few studies focusing on this matter. Therefore we wanted to explore the matter from the school nurses’ point of view. The aim of this study was to explore Swedish school nurses’ experiences of caring for and promoting the health of students suffering from mental health problems.

Methods: The present study had a descriptive design and a qualitative approach. A purposeful sample of eight (n = 8) school nurses was interviewed. Their working experience varied between 4 and 29 years. The data were analysed using content analysis. The ethical principles stipulated by the Swedish Research Council were carefully followed throughout the study.

Results: Three main themes with sub-themes were found: A caring relationship as the foundation for health promotion, organizing health-promoting work and interprofessional cooperation as a prerequisite for good caring.

Conclusions: The findings strengthen the evidence of the importance of the health dialogue as a tool for the school nurses to identify students with mental health problems. Creating a caring relationship with the students is a prerequisite for caring and health promotion. Further education concerning mental health and evidence-based-practice should be arranged on regular basis. More research and cooperation between different stakeholders is needed.

Background: Within nursing, the concepts of home and homelike have been used indiscriminately to describe characteristics of health care settings that resemble a home more than an institution.

Objectives: The aim of this study was to investigate the concept of home (hem in Swedish). The main questions were as follows: What does the concept of home entail etymologically and semantically? Of what significance is the meaning of the concept to caring science and nursing?

Design and methods: This study had a qualitative design with a hermeneutical approach guided by Gadamer. Eriksson’s model of concept determination was partly used to determine the etymology and semantics, the essence and epistemic category of the concept of home. In this study, etymological dictionaries and 17 Swedish language dictionaries published between 1850 and 2001 were investigated.

Findings: The home, framed as the ethos of caring, can be drawn as a three-dimensional picture where the three dimensions have a common core, enclosed and inviolable. Symbolically, the picture of home can be seen as the ethos of the human being’s innermost room, the human being’s manner of being and the tone cxpressed in the external or abstract room where the human being lives and interacts with others.

Conclusions: Based on the findings in this study we conclude that home as ethos is an inner ethical dimension within the human being. Human beings who are in contact with their ethos, the self, feel at home and dare to follow the voice of their heart. Nurses who experience at-homeness have an ability to invite the patient into a caring relationship. The home and the feeling of being at home have significant meaning in terms of human beings’ health and well-being.

Background: Changes have occurred in the nursing education system in Finland and Sweden as a result of the Bologna declaration.  At present, based on the European Directive, approximately 50% of a general nursing program is arranged as clinical practice (Zabalegui, Macia, Márgues, Ricomá, Nuin, Mariscal, Pedraz, Germán & Moncho, 2006). The one-to-one preceptorship model is rather common in undergraduate nursing education in the Scandinavian countries in order to prepare student nurses for the shift to the graduate nursing role (Luhanga, Billay, Grundy, Myrick & Yonge, 2010). The preceptor plays a vital role in the development of student nurses becoming professional nurses. Smith (1987; 1991) found that the emotional aspects of care associated with the nursing process emerged as an important component of the relationship between student nurses and preceptors. A recent study (Epstein & Carlin, 2012) found that the students’ encounters with the preceptors had ethical dimensions. Values which support the good care of patients are evident in the practice environment. As such, it follows that if the environment doesn’t provide a moral climate, the preceptors may not be able to recognize ethical issues.

Aim: The aim of this Nordic qualitative study was to explore the experiences of good preceptorship in relation to undergraduate student nurses in clinical education from the perspective of the preceptors themselves.

Method: Data was collected by narrative interviews with 27 preceptors in Finland and Sweden and analyzed using a hermeneutical approach.

Findings: The findings are presented as three themes in order to present the perceived experiences of good preceptorship among the research group. The three themes are as follows: The caring relationship as the foundation of learning and development; Mutual respect – a prerequisite for fellowship and a good atmosphere; A deep sense of responsibility towards the student and the profession. A caring relationship, based on caring ethics, is seen as the foundation for learning and development. Moreover, a mutual respect is a prerequisite for fellowship and a good atmosphere. As such, encounters are characterized by reciprocity and mutuality. The preceptors have a deep sense of responsibility toward the students and the profession. Furthermore, the preceptors have an inner responsibility to guide the students into working life and to share their knowledge by acting as role models.  Conclusions: Good preceptorship is based on caring ethics. The preceptors with a sense of ‘being at home’ have the motive and will to invite the students into a caring relationship and care for the students. Preceptorship has a great impact on student nurses in their process of becoming caring nurses and to remain in nursing. The findings suggest that preceptorship should be examined through new lenses. Moreover, preceptorship is an ethical issue that should be recognized by all stakeholders.

References

Epstein, I, Carlin, K. Ethical concerns in the student/preceptor relationship: A need for change. Nurse Educ Today. 2012;(32):897-902. doi:10.1016/j.nedt.2012.03.009.

Luhanga, FL, Billay, D, Grundy, Q, Myrick, F, Yonge, O. The one-to-one relationship: Is it really key to an effective preceptorship experience? A review of the literature. Int J Nurs Educ Scholarsh. 2010; 7(1):1-15.

Smith, P. The relationship between quality of nursing care and the ward as a learning environment: developing a methodology. J Adv Nurs. 1987;(12):413-20.

Smith, P. 1991. The nursing process: raising the profile of emotional care in nurse training. J Adv Nurs. 1991; 16:74-81.

Zabalegui, A, Macia, L, Márgues, J, Ricomá, R, Nuin, C, Mariscal, I, Pedraz, A, Germán, C, Moncho, J. Changes in Nursing Education in the European Union. J Nurs Scholarsh. 2006; 38 (2):114-118.