Feeling ready and always more to learn : students’ journeys towards becoming a professional nurse

Background: Well-educated competent professional nurses are needed to ensure sustainable healthcare systems and reduce health inequalities. Nursing is a global profession, and the requirements and competences vary between regions regarding both education and professional requirements. The Swedish nursing program contains both theoretical education and practical training, to prepare the students for working life. The learning process is affected by several factors, for example, learning environment, learning activities and feelings, so called academic emotions. Since students' experiences vary in relation to different learning activities and over time data was collected longitudinally to follow their development throughout the whole nursing program. Aim: The aim of this thesis was to contribute to a deeper knowledge and understanding about nursing students’ experiences of learning activities and the process of developing professional identity during higher education in the field of nursing. Methods: All students (n=459) starting the nursing program from August 2015 to January 2017 were invited to participate. The data collection started in August 2015 and was completed in January 2020. Data was collected via interviews at four occasions (n=286), and at 42 measurement (n=2,947) points using Contextual Activity Sampling System, CASS (Lachmann et al., 2012; Muukkonen et al., 2008). Study I was a mixed methods study including 126 semi-structured individual interviews and 158 CASS-questionnaires collected at the start of the program. The interviews were analysed using qualitative content analysis and the questionnaires with descriptive statistics. Study II was a longitudinal qualitative study using 136 semi-structured individual interviews performed at four stages, analysed using longitudinal content analysis. Study III was a longitudinal prospective study using 2,947 CASS-questionnaires collected throughout the program, analysed with descriptive statistics. In this study, the students’ academic positive emotions (determination; enthusiasm; interest), negative emotions (irritation; nervousness; anxiety) and their perceived challenge and competence related to their current learning activity were analysed. Study IV was a parallel mixed method study including 68 RIPLS questionnaires and 34 semi-structured individual interviews analysed with descriptive statistics, paired sample T-test, and qualitative content. Results: In Study I the findings from the interviews were summarized in the overarching theme: Making a difference if managing to become a professional nurse, from the seven main categories in the three domains Conceptions; Expectations; and Doubts. The selfrated questionnaires revealed emotions of high ambition and motivation. The ratings of negative emotions correlated with the fears and worries about uncertainty expressed in interviews. In Study II the overarching theme: Ready but not fully trained was summarized from the four main categories: Anticipation; Prepared for internship; Deepened understanding; and Insight. The students deemed that working as a professional nurse requires continuously learning and improvement and underlined in the final interview that there will always be more to learn. Study III revealed that the students experienced high positive academic emotions combined with low negative emotions when first entering clinical practice in the third semester, upon completion of clinical practice in the fourth semester and while writing their bachelor thesis in the fifth semester. Optimal experience during clinical practice was reported by 21 percent in semester three to five, and by 34 percent in semester six. The students’ reported low positive emotions and high negative emotions during theoretical courses in medical science and in research methodology preparing for writing their thesis. The negative emotions reported during the thesis preparation period shifted to more positive emotions during the time of writing it. While when writing the bachelor thesis, 29 percent experienced flow compared to 13 percent during the preparatory course. In Study IV the students’ reported learning styles and their attitudes to interprofessional collaboration were analysed. The findings indicated that 64.7 percent had a predominantly concrete learning style while 35.3 percent were predominantly reflective. No significant results were found regarding relationships between learning styles and attitudes to interprofessional learning. The theme Well-functioning teams improve patients’ outcome and working environment was summarized from the four main categories: Amazing when it’s functional; Deepened insight of care; Increased quality of care; and Understanding own profession. Conclusion: During the education, emotions experienced by students varied during the various learning activities. They started their education with a vision of making a difference. In the first academic year they developed a solid theoretical basis and were eager to enter internship to transform their knowledge into practice and to gain clinical experience. When entering clinical practice, students witnessed of a reality that did not always correspond with what they had been taught. At the time of graduation, students felt ready to join the workforce and stressed that there is always more to learn. These findings reveal a gap between theoretical and practical education that needs to be addressed

Marknadsföring i förändring. En studie om användandet av medveten uppmärksamhet inom reklambranschen.

Syftet med denna uppsats är att undersöka hur kommunikations- och reklambyråer ser på de förändringar som sker i samhället. Vidare är vårt syfte att undersöka hur de arbetar för att effektivt kommunicera ut budskap till önskad mottagare genom att medvetet skapa uppmärksamhet. Vi har använt oss av en kvalitativ metod med ett abduktivt tillvägagångssätt där litteratur och empiri tillsammans legat till grund för det fortsatta arbetet. Vår empiri har utgjorts av åtta stycken kommunikations- och reklambyråer där fem stycken ingick i en första intervjuomgång och de övriga tre i en andra. Det finns en medvetenhet om att dagens samhälle står inför ständiga förändringar i och med faktorer som tillänglig teknik, information och på grund av att nya generationer växer upp. Vid planering av marknadsföringsaktiviteter görs en anpassning till dessa nya förutsättningar och det används olika metoder när budskap sänds ut men emellertid spelar det mindre roll vilken etikett de har

Long-Term Follow-Up of Newborns with 22q11 Deletion Syndrome and Low TRECs.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Population-based neonatal screening using T-cell receptor excision circles (TRECs) identifies infants with profound T lymphopenia, as seen in cases of severe combined immunodeficiency, and in a subgroup of infants with 22q11 deletion syndrome (22q11DS). Purpose: To investigate the long-term prognostic value of low levels of TRECs in newborns with 22q11DS. Methods: Subjects with 22q11DS and low TRECs at birth (22q11Low, N=10), matched subjects with 22q11DS and normal TRECs (22q11Normal, N=10), and matched healthy controls (HC, N=10) were identified. At follow-up (median age 16 years), clinical and immunological characterizations, covering lymphocyte subsets, immunoglobulins, TRECs, T-cell receptor repertoires, and relative telomere length (RTL) measurements were performed. Results: At follow-up, the 22q11Low group had lower numbers of naïve T-helper cells, naïve T-regulatory cells, naïve cytotoxic T cells, and persistently lower TRECs compared to healthy controls. Receptor repertoires showed skewed V-gene usage for naïve T-helper cells, whereas for naïve cytotoxic T cells, shorter RTL and a trend towards higher clonality were found. Multivariate discriminant analysis revealed a clear distinction between the three groups and a skewing towards Th17 differentiation of T-helper cells, particularly in the 22q11Low individuals. Perturbations of B-cell subsets were found in both the 22q11Low and 22q11Normal group compared to the HC group, with larger proportions of naïve B cells and lower levels of memory B cells, including switched memory B cells. Conclusions: This long-term follow-up study shows that 22q11Low individuals have persistent immunologic aberrations and increased risk for immune dysregulation, indicating the necessity of lifelong monitoring. Clinical implications: This study elucidates the natural history of childhood immune function in newborns with 22q11DS and low TRECs, which may facilitate the development of programs for long-term monitoring and therapeutic choices. Keywords: 22q11.2 deletion syndrome; DiGeorge syndrome; T lymphopenia; TREC; long-term outcome; newborn screening; severe combined immunodeficiency.University of Gothenburg Regional research grant Region Halland Swedish Research Council European Commission Queen Silvia Jubilee Foundation Swedish Primary Immunodeficiency Organization Sparbanken Foundation Varberg Frimurare Barnhusdirektionen Foundation Gothenburg Medical Society Medical Faculty at Umea University Cancer Research Foundation in Northern Sweden Swedish government county councils, the ALF-agreement Umea University Vasterbottens County Counci

En kvalitativ studie om ledares syn på kreativitetsfrämjande ledarskap inom offentlig sektor

Syftet med uppsatsen var att undersöka chefers uppfattningar av det kreativitetsfrämjande ledarskapet inom offentlig sektor. Studien ingick i ett större forskningsprojekt där kreativitetsfrämjande ledarskap studerades utifrån en större population, vilken innefattar både offentlig och privat sektor. Undersökningen genomfördes enligt den kvalitativa metoden, grundad teori och datainsamlingen skedde genom semistrukturerade intervjuer på åtta chefer anställda inom Malmö kommun. Studiens resultat bygger uteslutande på intervjupersonernas utsagor och subjektiva uppfattning kring ämnet. Resultatet från studien kom att utmynna i tre huvudfaktorer vilka föreslås vara grundstenar i det kreativitetsfrämjande ledarskapet inom den offentliga sektorn. Dessa är; ”behov av tid”, ”stöd” och ”divergens”

Views on education and upcoming profession among newly admitted students at a Swedish baccalaureate nursing program : A descriptive mixed method study

AIM: The aim of this study was to investigate newly admitted nursing students' views on nursing education and their future profession. BACKGROUND: Students' choice of education can be influenced by societal and familial values and among nursing students' altruistic motives are common. Students', conceptions, expectations and doubts combined with their orientations to learning affect their ability to successfully cope with studies in higher education. DESIGN: A descriptive design using mixed method. METHODS: This mixed-method study is based on 126 qualitative semi-structured interviews and 158 questionnaires with newly admitted nursing students. The data collection was conducted during their first six weeks of education. Collected data were analyzed using content analysis and descriptive statistics. This study was conducted and reported in accordance with the COREQ checklist. RESULTS: The overarching theme: "Making a difference if managing to become a professional nurse", describing students' dichotomous emotions of expectations and doubts in relation to their conceptions, emerged from seven main categories. Students' ratings of emotions revealed high ambition and motivation. Fears and worries about uncertainty expressed in interviews correlated with ratings of negative emotions. CONCLUSION: Newly admitted nursing students think highly of the nursing profession and upcoming education. Students put faith in their own ability which is accompanied by doubts derived from uncertainty about forthcoming demands in academic, clinical and personal settings. Understanding of students' conceptions, expectations, doubts and their orientations to learning could be helpful in guiding them to acquire the nurse competencies necessary to become professional nurses that are able to handle complex situations

Undergraduate nursing students' experiences of becoming a professional nurse : A longitudinal study

BACKGROUND: During education it is essential for nursing students to develop professionalism in nursing. Nurses are placed in situations based on trust, and it is crucial that their patients have confidence in them to provide professional and safe care. A key period in nursing students' development of a professionalism occurs during training when students gain knowledge and skills that separate nurses as professional healthcare workers from laypeople. The purpose of this study was to investigate nursing students' experiences of professional competence development during education. METHODS: A longitudinal study was carried out using qualitative content analysis with a manifest inductive approach. Thirty-four students enrolled in a Swedish three-year nursing program, from August 2015 to January 2017 were interviewed on four occasions. RESULTS: The results revealed that students' professional role developed gradually. The students' started their education with dreams and a naive understanding of the profession, but their understanding of the complexity of the nursing profession gradually evolved. Students became theoretically equipped at the university and developed clinical skills through practice. Students' focus went from mastering medical technology to a more holistic approach. Before graduating, students felt ready but not fully trained. CONCLUSIONS: Our findings indicate a discrepancy between the content of the theoretical education and the clinical settings since students identified a lack of evidence-based practice. A solid theoretical education before entering clinical training offered students possibilities for reflecting on evidence-based practice and the clinical settings. The realization that there is always potential for professional improvement can be interpreted as an emerging awareness, and development of professionalism. It is clear that students could benefit from increased collaborative work between clinical supervisors and faculty staff at the university

The impact of learning styles on attitudes to interprofessional learning among nursing students : A longitudinal mixed methods study

BACKGROUND: A functional interprofessional teamwork improves collaborative patient-centred care. Participation in interprofessional education promotes cooperation after graduation. Individuals tend to use different approaches to learning depending on their individual preferences. The purpose of this study was to explore nursing students' experiences of professional development with a focus on the relationship between attitudes to interprofessional learning and learning styles. METHODS: A longitudinal parallel mixed-methods design. The study was carried out at a Swedish three-year nursing program from August 2015 to January 2020. On enrolment, thirty-four students self-assessed their attitudes to interprofessional learning according to the Readiness for Interprofessional Learning Scale, and their learning style according to Kolbs' Learning Style Inventory. In the final semester the students participated in an interview focusing on their experiences and perceptions of teamwork and they self-assessed their attitudes to interprofessional learning again. RESULTS: Our findings indicated that 64.7% had a predominantly concrete learning style and 35.3% had a predominantly reflective learning style. No significant relationship with internal consistency reliability was identified among the participants between attitudes to interprofessional learning and learning styles. The content analysis resulted in four main categories: Amazing when it's functional; Deepened insight of care; Increased quality of care; Understanding own profession which were summarized in the theme: Well-functioning teams improve patients' outcome and working environment. CONCLUSION: The students' attitudes to interprofessional learning were positive and it was considered as an opportunity to participate in interprofessional cooperation during internship. Transformative learning is a useful strategy in fostering interprofessional relationships due to the interdependence of various professions in interprofessional teams. When students are guided to use reflection to develop new perspectives and meaning structures, they acquire emotional and rational skills beneficial for interprofessional cooperation

Nursing students experienced academic emotions during education : A longitudinal desciptive study from a nursing baccalaureate program in Sweden

Aim: To explore nursing students' academic emotions during ongoing learning activities focusing on perceived challenge and competence. Background: Emotions plays an important part in learning. Positive emotions can be beneficial while negative emotions can be detrimental to educational outcomes. Optimal experiences are situations when learners simultaneously experience sufficient challenge and competence. Since various learning activities are performed in different learning environments during the nursing program, it is of interest to investigate students' ongoing emotions in the occurring contexts. Design: A longitudinal descriptive study. Methods: By using the Contextual Activity Sampling System, data was collected every third week on a three-year nursing program. From August 2015 to January 2020, a total of 2, 947 questionnaires were answered by 158 students. Experiences of positive and negative academic emotions were calculated for the entire program. Optimal experience was calculated for courses where high discrepancy between positive and negative experiences were identified. Results: Students self-reported academic emotions varied over time and in relation to learning activities. High ratings of negative emotions were reported during clinical practice in all semesters except the final. Students' positive academic emotions and optimal experience in clinical practice increased after having deepened their academic knowledge. Conclusion: Nursing students had an increased positive experience when they themselves practice a learning activity and it appeared that they benefit from academic preparation prior to entering internship. Nursing students need an academic competence to develop their skills during training in the clinical reality. Increased collaboration between academia and clinic would be beneficial for students' clinical development.Keywords: Academic emotions; Contextual activity sampling system; Longitudinal study; Ongoing learning activities; Students, nursing

How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress

Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patients Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.Funding Agencies|Marianne and Marcus Wallenberg Foundation; Medical Faculty of Uppsala Universities; Family Planning Foundation at Uppsala University; Regional Research Committees of Uppsala and Orebro Counties Councils; Sophiahemmet Foundation</p