Erobring av handlingsrom : Helsesøsterstudenters læring i praksis

<b>Conquering operational space – Public Health Nursing</b> <b>Students` learning in practice</b> The aim of this study was to learn about what the main concern of students in clinical practice was, and to develop a grounded theory that could explain how they acted to solve their concern. The purpose was to develop knowledge to contribute to quality improvement within higher education and the practical field. Clinical practice is frequently an integrated part of professional education, and research is increasing in order to understand how learning is connected to working life. Recent reforms and adaptations at every level in higher education in Norway have influenced professional education, and the need for increased expertise and acknowledgement in different education is paramount. Grounded theory was used to explore the question: what is the main concern for public health nursing students in practice? Data were gathered from 55 interviews and 108 weeks reports from 21 public health nursing students and analyzed according to grounded theory methodology. The students’ main concern was identified as how to obtain learning experiences to become a public health nurse. The substantive grounded theory of "Conquering operational space" explains how the main concepts are related to each other and how they work to "resolve" the main concern. "Conquering operational space" is a basic social process with three identified phases, which was generated from analyses of the data. This are "Positioning in operational space", "Involving in operational space" and "Integrating in operational space", each of them with its concepts, properties and dimensions, which are about the student role, relations with a supervisor, student activity and the consequences of each phase. Phase 1) Positioning, has concepts: "Role seeking", "Dialogue seeking" "Occasional participating" and "Glimpsing the operational space". Phase 2) Involving, has concepts: "Role challenging", "Supervision seeking", "Selective participating" and "Adjusting operational space". The concepts in Phase 3) Integrating are "Role integrating", "Acknowledgement seeking", "Fully participating" and "Realizing potential in operational space". The findings are compared and discussed in light of theories and research related to professional education and to a climate conducive to conditions for learning. The findings show that public health nursing student had to conquer their operational space in practical placements. They had to work towards obtaining independence, working against the system and to handle the suspense by daring to engage. The substantive theory of Conquering operational space represents what is defined to be the students’ main concern and explains most of their activity. This could be used as a model to supervise students in practice, to explain what supervisors, students and teachers need to do to achieve optimal learning outcomes.Hensikten med studien har vært å få innsikt i hva som var hovedproblemet til helsesøsterstudenter i praksisstudier og å utvikle en substantiv teori som kan forklare hvordan de handlet for å løse problemet. Målet er å utvikle kunnskap som kan være et bidrag i kvalitetsutvikling innenfor denne høgskoleutdanningen og praksisfelt. Praksisopplæring er ofte en integrert del av profesjonsutdanninger, og det er en økende interesse for forskning for å forstå den læringen som skjer i tilknytning til arbeidslivet. De siste års reformer og omstillinger på alle nivå i høyere utdanning i Norge har innvirket på profesjonsutdanninger, og det er et utstrakt behov for økt kunnskap og erkjennelse innenfor ulike utdanninger. Grounded theory er anvendt for å utforske spørsmålet: hva opplever helsesøsterstudenter som den viktigste utfordringen i praksisstudier? Data ble samlet fra 55 intervju samt 108 skrevne ukerapporter fra 21 helsesøsterstudenter og analysert i følge grounded theory metodologien. Studentenes hovedutfordring ble identifisert til "hvordan oppnå læringserfaringer til å bli helsesøster"? Den substantive teorien om "Erobring av handlingsrom" forklarer hvordan hovedbegrep er relatert til hverandre, og hvordan de fungerer for å "løse" hovedutfordringen. ”Erobring av handlingsrom” er en grunnleggende sosial prosess med tre identifiserte faser som ble generert ut fra analyser av data. Disse er "Posisjonering i handlingsrom", "Involvering i handlingsrom" og "Integrering i handlingsrom", hver med sine begrep, egenskaper og dimensjoner som omhandler studentrollen, relasjoner til veileder og praksisfelt, egen aktivitet, samt konsekvenser av hver fase. Fase 1) Posisjonering har begrepene: "Søker rolle", "Søker dialog", "Deltar tilfeldig" og "Skimter handlingsrom". Fase 2) Involvering har begrepene: "Utfordrer rollen", "Søker veiledning", "Deltar selektivt" og "Justerer handlingsrom". Fase 3) Integrering inneholder begrepene: "Integrerer roller", "Søker anerkjenning fra praksisfelt", "Deltar fullt ut" og "Realiser potensial i handlingsrom". Funnene er sammenlignet og diskutert i forhold til relevant forskning og litteratur om profesjonsutdanning og om relasjonelle forhold ved læring. Funnene viser at helsesøsterstudenter må erobre sitt handlingsrom i praksisfeltet. De må jobbe for å vinne selvstendighet, arbeide mot systemet og takle spenningen ved å våge å engasjere seg. Den substantive teorien om Erobring av handlingsrom representerer det som er definert som studentenes hovedanliggende i praksisstudiet og forklarer en stor del av deres handlinger. Den kan bli brukt som en modell for å veilede studenter i praksis, til å klarlegge hva veiledere, studenter og lærere behøver å gjøre for å oppnå optimale læringsresultat

Adjusting team involvement: a grounded theory study of challenges in utilizing a surgical safety checklist as experienced by nurses in the operating room

Background: Even though the use of perioperative checklists have resulted in significant reduction in postoperative mortality and morbidity, as well as improvements of important information communication, the utilization of checklists seems to vary, and perceived barriers are likely to influence compliance. In this grounded theory study we aimed to explore the challenges and strategies of performing the WHO’s Safe Surgical Checklist as experienced by the nurses appointed as checklist coordinators. Methods: Grounded theory was used in gathering and analyzing data from observations of the checklist used in the operating room, in conjunction with single and focus group interviews. A purposeful sample of 14 nurse-anesthetists and operating room nurses as surgical team members in a tertiary teaching hospital participated in the study. Results: The nurses’ main concern regarding checklist utilization was identified as “how to obtain professional and social acceptance within the team”. The emergent grounded theory of “adjusting team involvement” consisted of three strategies; distancing, moderating and engaging team involvement. The use of these strategies explains how they resolved their challenges. Each strategy had corresponding conditions and consequences, determining checklist compliance, and how the checklist was used. Conclusion: Even though nurses seem to have a loyal attitude towards the WHO’s checklist regarding their task work, they adjusted their surgical team involvement according to practical, social and professional conditions in their work environment. This might have resulted in the incomplete use of the checklist and therefore a low compliance rate. Findings also emphasized the importance of: a) management support when implementing WHO’s Safe Surgical Checklist, and b) interprofessional education approach to local adaptation of the checklists use

Adjusting team involvement: a grounded theory study of challenges in utilizing a surgical safety checklist as experienced by nurses in the operating room

Abstract Background Even though the use of perioperative checklists have resulted in significant reduction in postoperative mortality and morbidity, as well as improvements of important information communication, the utilization of checklists seems to vary, and perceived barriers are likely to influence compliance. In this grounded theory study we aimed to explore the challenges and strategies of performing the WHO’s Safe Surgical Checklist as experienced by the nurses appointed as checklist coordinators. Methods Grounded theory was used in gathering and analyzing data from observations of the checklist used in the operating room, in conjunction with single and focus group interviews. A purposeful sample of 14 nurse-anesthetists and operating room nurses as surgical team members in a tertiary teaching hospital participated in the study. Results The nurses’ main concern regarding checklist utilization was identified as “how to obtain professional and social acceptance within the team”. The emergent grounded theory of “adjusting team involvement” consisted of three strategies; distancing, moderating and engaging team involvement. The use of these strategies explains how they resolved their challenges. Each strategy had corresponding conditions and consequences, determining checklist compliance, and how the checklist was used. Conclusion Even though nurses seem to have a loyal attitude towards the WHO’s checklist regarding their task work, they adjusted their surgical team involvement according to practical, social and professional conditions in their work environment. This might have resulted in the incomplete use of the checklist and therefore a low compliance rate. Findings also emphasized the importance of: a) management support when implementing WHO’s Safe Surgical Checklist, and b) interprofessional education approach to local adaptation of the checklists use.</p