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

Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence.

Research aim

This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic.

Research design

This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and analysed thematically.

Participants and research context

Healthcare teachers (n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated.

Ethical considerations

This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research.

Findings

Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students’ ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone’s needs, and who gets my time?

Conclusions

This study highlights the importance of healthcare teachers’ continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible consequences for students and healthcare teachers.

Background A theoretical foundation in caring science is invaluable for nursing care because it enriches practice by providing explanations, clarity and direction. However, after graduation, students experience the frustration of not being able to sufficiently intertwine caring science theories in practice. Consequently, the integration of caring science theories in nursing education and practice is considered an essential focus area to reduce this theory-practice gap. Aim This study aims to elucidate master alumni's experiences of appropriation and application of caring science after completing a master's education. Methods The data were collected by semi-structured interviews with 21 alumni from Finland, Sweden and Norway who had recently completed a master's degree with caring science as the major subject. A thematic analysis was used. Findings The analysis resulted in two main themes, both with three subthemes. Educator's bearing and a learning community are important for students' appropriation of caring science theories. Learning through reflection and the response of others evoke new paths of thought, and practice-related teaching promotes the intertwining and application of caring science theory in practice. The appropriated theory has significance to alumni by providing a guiding basis that strengthens alumni's professional bearing and way of being. The caring science theory guides alumni in providing nursing care with an increased ethical awareness and questioning approach that enables good patient care. Their professional identity and confidence in caring are also strengthened. Conclusion Educators' bearing is of outermost importance for appropriation and application of caring science theory. It has a key function in facilitating students' understanding and intertwining of caring science theory and practice. Appropriated caring science theory provides authority and courage to practice nursing care. The appropriated theory promotes alumni's ethical awareness, confidence and a sense of pride in the profession.

Studenthandledning i vårdande verksamhet belyser studenthandledning ur både ett teoretiskt och ett praktiskt perspektiv. Utgångspunkten är en studenthandledning med en tydlig vårdvetenskaplig förankring som sammanflätar den vårdande kunskapen med studentens lärande i verksamhetsförlagd utbildning.

Understanding and formation - the essence in becoming a caring nurseA-H. Sandvik*2,3, K. Eriksson2, Y. Hilli1,31Novia university of applied sciences, Finland, 2Åbo Akademi University, Finland, 3BoråsUniversity, SwedenIntroduction: Nurse education most often focus on a linear problem-solving process,exemplifying a narrow, technical rationality (Benner & Sutphen 2007). In other words, attentionis largely given to tasks or technical skills (Mulcahy 2011), while the focus rather should be ondeveloping students' understanding (Gustavsson 2011). There is need for a new approach thattargets the processes of becoming and supports identity formation, with the key purpose ofdeveloping professional ways of being, rather than simply knowledge and skills (Dall’Alba2009).Aim: The aim was to clarify the meaning and essence of understanding, as well as to exploreand deepen the understanding of student nurses' processes of understanding and becoming,with the intention of developing a theory model for caring didactics.Methods: The study had a hermeneutical approach and was based on qualitative andquantitative data. The study was longitudinal and followed the students at three universitiesthroughout the education.Findings: Understanding was perceived as an unlimited, endless movement, which can beillustrated as a lemniscate, i.e. a lying eight. Seeing, knowing and becoming are the warpthreads that constitutes the lemniscate. These interwoven threads run throughout the sevenstages of the lemniscate. The infinite spiral movement leads to an ever-increasing degree offormation (Bildung). The lemniscate of understanding circles around two hubs, ethos and arête.A caring culture encloses the lemniscate of understanding, it provides the life space ofunderstanding, and the prevailing basic values are expressed in the culture of the learningspace.Conclusion: Learning and understanding is a process of formation (Bildung). It is not merelylearning and training, but having the opportunity and space to grow into the person one is meantto be. It is not sufficient to confine education to mediation of knowledge and technical skills,whereas true understanding and learning involves a transformation of oneself as a person.There is a need to emphasize this and give it a more prominent position in the nursingeducation.References:Benner, P., & Sutphen, M. (2007). Learning across the professions: The clergy, a case in point.Journal of Nursing Education, 46(3), 103-108.Dall’Alba, G. (2009). Learning to be professionals. Dordrecht: Springer.Gustavsson, B. (2011). Att humanisera och demokratisera utbildning. [To humanize anddemocratize education]. In M. Jensen (Ed.), Lärandets grunder. [The basis for learning] (pp.237-251). Lund: Studentlitteratur.Mulcahy, D. (2011). Teacher professional becoming: A practice-based, actor-network theoryperspective. In L. Scanlon (Ed.), 'Becoming' a professional: An interdisciplinary analysis ofprofessional learning (pp. 219-244). Dordrecht: Springer.Keywords: understanding, becoming, Bildung, formation

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

The specialist education for district nursing at the University of Borås is carried out as a distance education with students from all parts of Sweden. Due to long distances preception and assessment of clinical studies is challenging. Since web-based technology is being used in theoretical education, the idea of ​​using this technology also in clinical assessment emerged. 

Aim

To test web-based meetings (WBM) for preception and assessment of district nurse students in clinical education and to elucidate the experiences of students’, preceptors’ and teachers’ perspective.

Method

All district nurse students and their preceptors were offered WBMs with the teacher instead of the usual telephone calls or on-site visits. Two teachers conducted WBMs with 9 students and their preceptors. Data collection methods were surveys to students and preceptors and a focus group interview with teachers. Data was analysed using content analysis.

Results

Support and information before WBM were mainly perceived as good and sufficient. WBM went well and above expectations, but minor technical problems sometimes occurred. The opportunity for all participants to visually share the same assessment form was highly appreciated.  All participants felt that WBM were better than telephone calls, the discussions improved and it felt like a genuine meeting. Teachers felt that WBM made it possible to read body language and thus get a picture of the relation between student and preceptor.

Conclusion

WBM is regarded as advantageous for preception and assessment in clinical education. Using WBM encourages and lowers the threshold for use of such technology in patient work as well. The use of WBM can also be justified from a sustainability perspective.

The shift from hospital-based nursing care to municipal home healthcare has led to the provision of more diverse, complex and advanced nursing care in this context. This poses challenges for undergraduate nursing students’ clinical education. The aim of this study was to describe nursing students’ experiences of learning nursing care through peer learning in a dedicated educational unit in municipal home healthcare. Data were collected through interviews with seven nursing students. The analysis was based on a reflective lifeworld research approach. The study followed the COREQ checklist. Strong cooperation and feelings of safety were found to boost learning and encourage the students to challenge themselves. Alternating between an observational and an active role during independent home visits was beneficial for intertwining caring and learning. Further, being trusted to work independently increased their ethical orientation, knowledge, self-esteem and self-confidence.

Background

Heart failure (HF) is a chronic condition with a variety of diverse symptoms. Patients with HF are usually elderly with multimorbidity, which are both multifaceted and challenging. Being a next of kin to patients with HF is described as a complex task consisting of managing care and treatment, monitoring illness and being an emotional support, while also being able to navigate the healthcare system especially in long-term contact. However, few studies have investigated next of kin’s perceptions of continuity of care in connection with HF. The present study aimed to describe continuity of care as perceived by the next of kin who care for patients with HF.

Methods

This study used a qualitative descriptive design. Semi-structured interviews were conducted with the next of kin (n = 15) of patients with HF to obtain their perceptions of continuity of care. A phenomenographic analysis method was used to capture the participants’ perceptions of the phenomenon.

Results

The analysis reveals that the next of kin perceive that support from healthcare professionals was strongly associated with experiences of continuity of care. Four categories reveal the next of kin’s perceptions of continuity of care: Want to be involved without being in charge; A desire to be in control without acting as the driving force in the care situation; A need for sustainability without being overlooked; and Focusing on making life meaningful while being preoccupied with caregiving activities.

Conclusions

Next of kin perceive continuity of care, when they have access to care and treatment and when caregivers collaborate, regardless of healthcare is given by primary care, municipalities or specialist clinics. A sense of “being in good hands” sums up the need for continuous support, shared decision-making and seamless transitions between caregivers. It seems important that healthcare organisations safeguard effective and collaborative models. Moreover, professionals need to plan and perform healthcare in collaboration with patients and next of kin.

Aims and Objectives: This study aimed to describe nurses’ perceptions of continuity of care for patients with heart failure. 

Background: Heart failure is a life-influencing condition that causes varying care needs over time with risks of fragmentation. Nurses play an important role in caring for patients with heart failure. However, nurses’ experiences of continuity of care seems to be less explored in this context. 

Design: A qualitative descriptive study with a phenomenographic approach. 

Methods: Four focus groups were chosen to collect the data. A purposeful sampling of nurses (n=14) with experience in caring for patients with heart failure was recruited from hospital-connected heart failure clinics, primary healthcare centres and municipal home healthcare settings in south-western Sweden. The COREQ checklist was used in this study. 

Results: The nurses’ various perceptions of continuity of care for patients with heart failure were categorised as: access and flexibility, responsibility and transparency, trustful and caring relationships and communication and collaboration. 

Conclusions: The results indicate that nurses have an excellent position to act as the “hub” in caring for patients with heart failure, but they need to have the possibility of networking and establishing trusting relationships with their colleagues. From the nurses’ point of view, mutual trust between the nurse, the patient and the patient’s next of kin is crucial for promoting and maintaining continuity of care in patients with heart failure. 

Relevance to clinical practice: To promote continuity of care for patients with heart failure, nurses expressed the necessity of establishing trusting relationships in a continuity-promoting organisation with seamless coordination. Nurses can be the “hub” supporting a person-centred care approach based on the patients’ needs. There seems to be a need for better collaboration with common guidelines across and within primary healthcare centres, hospital-connected heart failure clinics and municipal home healthcare settings.