Putting knowledge to work in clinical practice: understanding experiences of preceptorship as outcomes of interconnected domains of learning

Aim: To understand newly qualified nurses’ learning during the preceptorship period. Background: Newly qualified nurses’ learning during their transition to confident professional practice is facilitated by effective and supportive preceptorship. Several studies have alluded to, but not directly investigated or addressed contextual factors which may prevent the delivery of effective and supportive preceptorship. Design: Two-phase ethnographic case study design in three hospital sites in England from 2011-2014. Methods: Phase One included participant observation, interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers, the design of a tool to develop newly qualified nurses’ delegation skills during their preceptorship period. This tool was piloted in Phase Two with thirteen newly qualified nurses in the same sites. Data were analysed using thematic analysis. Findings: Constraints on available time for preceptorship, unsupportive ward cultures, and personal learning styles may limit effective preceptorship if time for learning and knowledge recontextualisation is restricted. For newly qualified nurses in supportive ward cultures, limited access to formal preceptorship can be bolstered by team support. Newly qualified nurses in less supportive ward cultures may have both a greater need for preceptorship and have fewer compensatory mechanisms available to them when formal preceptorship is not available. We argue that organisational learning contexts and individual learning styles which facilitate recontextualisation of knowledge in this group of nurses are key to understanding effective preceptorship. Conclusions: This study reports constraints to effective preceptorship which affect newly qualified nurses in their early careers. We recommend a need for greater prioritisation and ‘ring-fencing’ of time for formal preceptorship to ensure newly qualified nurses are appropriately supported in their transition to confident professional practice. Relevance to clinical practice: We discuss ways to improve preceptorship at ward and organizational level through policy, practice and education and suggest future research in this are

Delegation and supervision of health care assistants’ work in the daily management of uncertainty and the unexpected in clinical practice: invisible learning among newly qualified nurses

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile’s (2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the health care assistant. In the British context, delegation and supervision are thought of as skills which are learnt ‘on the job’. We suggest that learning ‘on-the-job’ is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011-2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and health care assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the ‘invisible learning’ which occurs as newly qualified nurses learn to delegate and supervise

Validation of methods for monitoring of coastal and open sea areas with satellites and sensors on ships of opportunity

Årsliste 2003Final report to the Norwegian Research Council. The main objective of the project was to construct, install and test an automatic system for observations of temperature, salinity, chlorophyll fluorescence and turbidity from the cooling inlet aboard the ferry Color Festival (Oslo -Hirtshals). An automatic water sampler makes it possible to analyse other properties of the surface water, such as nutrients and organochlorides at selected positions. The potential of combined satellite and ship-sensor observations is illustrated as well as the use of the system for early warning of harmful algea. Examples are also given of the system's potential for low cost high frequency regular monitoring of the surface layer.Norwegian Research Counci

Clustering of vacancy defects in high-purity semi-insulating SiC

Positron lifetime spectroscopy was used to study native vacancy defects in semi-insulating silicon carbide. The material is shown to contain (i) vacancy clusters consisting of 4--5 missing atoms and (ii) Si vacancy related negatively charged defects. The total open volume bound to the clusters anticorrelates with the electrical resistivity both in as-grown and annealed material. Our results suggest that Si vacancy related complexes compensate electrically the as-grown material, but migrate to increase the size of the clusters during annealing, leading to loss of resistivity.Comment: 8 pages, 5 figure

'Doing the writing' and 'working in parallel': how 'distal nursing' affects delegation and supervision in the emerging role of the newly qualified nurse

Background: The role of the acute hospital nurse has moved away from the direct delivery of patient care and more towards the management of the delivery of bedside care by healthcare assistants. How newly qualified nurses delegate to and supervise healthcare assistants is important as failures can lead to care being missed, duplicated and/or incorrectly performed. Objectives: The data described here form part of a wider study which explored how newly qualified nurses recontextualise knowledge into practice, and develop and apply effective delegation and supervision skills. This article analyses team working between newly qualified nurses and healthcare assistants, and nurses' balancing of administrative tasks with bedside care. Methods and Analysis: Ethnographic case studies were undertaken in three hospital sites in England, using a mixed methods approach involving: participant observations; interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis, aided by the qualitative software NVivo. Findings:Multiple demands upon the newly qualified nurses' time, particularly the pressures tomaintain records, can influence how effectively they delegate to, and supervise, healthcare assistants. While some nurses and healthcare assistants work successfully together, others work ‘in parallel’ rather than as an efficient team. Conclusions: While some ward cultures and individual working styles promote effective team working, others lead to less efficient collaboration between newly qualified nurses and healthcare assistants. In particular the need for qualified nurses to maintain records can create a gap between them, and between nurses and patients. Newly qualified nurses require more assistance in managing their own time and developing successful working relationships with healthcare assistants

Cohort profile : Swedish Twin Study on Prediction and Prevention of Asthma (STOPPA)

Asthma is a common childhood disease and several risk factors have been identified, however the impact of genes and environment is not fully understood. The aim of the Swedish Twin study On Prediction and Prevention of Asthma (STOPPA) is to identify environmental (birth characteristics and early life) and genetic (including epigenetic) factors as determinants for asthmatic disease. Based on the Child and Adolescent Twin Study in Sweden (parental interview at 9 or 12 years, N~23,900) and an asthma and/or wheezing algorithm, we identified a sample of monozygotic (MZ) and dizygotic (DZ) same-sexed twin pairs. The twin pairs were identified as asthma concordant (ACC), asthma discordant (ADC) and healthy concordant (HCC). A sample of 9- to 14-year-old twins and their parents were invited to participate in a clinical examination. Background characteristics were collected in questionnaires and obtained from the National Health Registers. A clinical examination was performed to test lung function and capacity (spirometry with reversibility test and exhaled nitric oxide) and collect blood (serology and DNA), urine (metabolites), feces (microbiota) and saliva (cortisol). In total, 376 twin pairs (752 individual twins) completed the study, response rate 52%. All participating twins answered the questionnaire and >90% participated in lung function testing, blood and saliva sampling. This article describes the design, recruitment, data collection, measures, background characteristics as well as ongoing and planned analyses in STOPPA. Potential gains of the study include the identification of biomarkers, the emergence of candidates for drug development and new leads for prevention of asthma and allergic disease.NonePublishe

Interactional Structure Applied to the Identification and Generation of Visual Interactive Behavior: Robots that (Usually) Follow the Rules

Peer reviewe

Memory and superposition in a spin glass

Non-equilibrium dynamics in a Ag(Mn) spin glass are investigated by measurements of the temperature dependence of the remanent magnetisation. Using specific cooling protocols before recording the thermo- or isothermal remanent magnetisations on re-heating, it is found that the measured curves effectively disclose non-equilibrium spin glass characteristics such as ageing and memory phenomena as well as an extended validity of the superposition principle for the relaxation. The usefulness of this "simple" dc-method is discussed, as well as its applicability to other disordered magnetic systems.Comment: REVTeX style; 8 pages, 4 figure

Heritability and the Equal Environments Assumption: Evidence from Multiple Samples of Misclassified Twins

The final publication is available at Springer via https://doi.org/10.1007/s10519-013-9602-1Classically derived estimates of heritability from twin models have been plagued by the possibility of genetic-environmental covariance. Survey questions that attempt to measure directly the extent to which more genetically similar kin (such as monozygotic twins) also share more similar environmental conditions represent poor attempts to gauge a complex underlying phenomenon of GE-covariance. The present study exploits a natural experiment to address this issue: Self-misperception of twin zygosity in the National Longitudinal Survey of Adolescent Health (Add Health). Such twins were reared under one “environmental regime of similarity” while genetically belonging to another group, reversing the typical GE-covariance and allowing bounded estimates of heritability for a range of outcomes. In addition, we examine twins who were initially misclassified by survey assignment—a stricter standard—in three datasets: Add Health, the Minnesota Twin Family Study and the Child and Adolescent Twin Study in Sweden. Results are similar across approaches and datasets and largely support the validity of the equal environments assumption

Relaxation of the field-cooled magnetization of an Ising spin glass

The time and temperature dependence of the field-cooled magnetization of a three dimensional Ising spin glass, Fe_{0.5}Mn_{0.5}TiO_{3}, has been investigated. The temperature and cooling rate dependence is found to exhibit memory phenomena that can be related to the memory behavior of the low frequency ac-susceptibility. The results add some further understanding on how to model the three dimensional Ising spin glass in real space.Comment: 8 pages RevTEX, 5 figure