Session 3A: Verksamhetsintegerat lärande

Moderator: Janet Mattsson

Is there space for learning in the clinical environment?

Aspects of clinical nurses’ situated supervision of specialist nursing students in the Pediatric Intensive Care Unit (PICU) are explored. To learn in the clinical context differs from learning theoretical knowledge and the supervisor has a key role in this process. The aim was to unfold nurses' concerns of the supervision of the student in the clinical caring situation of the vulnerable child. A qualitative approach, interpretive phenomenology, with participant observations and narrative interviews, was used. Two qualitative variations of patterns of meaning for the nurses’ clinical facilitation were disclosed in this study. Learning by doing theme supports the students learning by doing through performing skills and embracing routines. The reflecting theme supports thinking and awareness of the situation. As the supervisor often serves as a role model for the student this might have an immediate impact on how the student applies nursing care in the beginning of his or her career. If the clinical supervisor narrows the perspective and hinders room for learning the student will bring less knowledge from the clinical education than expected, which might result in reduced nursing quality.

Name of author: Mattsson, Janet; Forsner, Maria; Bolander Laksov, Klara
Working title: Programme director post graduate programme in specialist nursing, intensive care, PhD
University/College/Hospital: Red Cross University College
Department: Department of Technology and Welfare, Karolinska Institutet, Karolinska Institutet, Centre for Medical Education, Department of Learning, Informatics, Management and Ethics
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Trust – a must in clinical education

Trust between a supervisor and a student is central in clinical education. Less trust can hinder the achievement of student participation which is an important component in student learning in clinical practice. Over-trust in a student on the other hand might create uncertain situations jeopardizing patient safety. Prior research about trust in relation to clinical supervision and student learning mainly focus on physicians and from other countries than Sweden. The aim with this study was to investigate different perspectives on trust among clinical supervisors in Occupational Therapy. This is a phenomenographic study based on 12 individual interviews. The participants were occupational therapists with experiences of clinical supervision ranging from 6 months to 30 years. Three qualitatively different ways of thinking about trust were identified; 1) as being about the student and rather static, 2) as a dynamic process based on student performance, 3) as something mutual and interrelated. The findings indicate that trust can be understood as something inherent in the student, or alternatively, about the student, the supervisor and the surrounding context including the tasks performed. We suggest that moving beyond first impression based on demographic factors and student performance towards a more mutual process of getting to know each other in terms of expectations, ways of thinking about humans in general, individual learning styles but also own vulnerability seem to have a positive impact on the trust building process.

Name of author/athors: Lundh, Pernilla, & Stenfors-Hayes, T
Working title: Lundh, P: Occupational Therapist, Master of Medical Science
Stenfors-Hayes, T: Senior researcher, PhD
University/College/Hospital: Lundh, P: Karolinska University Hospital, Department of Occupational Therapy
Stenfors-Hayes, T: Karolinska Institutet, Evaluation Unit, Department of Learning, Informatics, Management and Ethics, LIME.
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Clinical assessment with a student centred approach

The advanced level critical care nursing program at the Red Cross University College in Stockholm is a one–year program consisting of four different courses, out of which two include clinical rotations at a critical care ward. During the clinical rotations students are precepted by clinical staff and faculty meet with the student and the preceptor at a mid-term meeting and as needed. To facilitate assessment and feed-back between students, preceptors and faculty an instrument is used. With recent changes in the curriculum the need for a new instrument was evident. When searching the literature for a validated and fitting instrument, we came upon the SPECT instrument developed by Gill et al in Australia. SPECT consists of different domains reflecting competencies of a critical care nurse. After communication and approval from the SPECT developers, we revised the instrument to fit Swedish standards and competencies as well as meeting the learning objectives for our program. We were particular in devising two instruments to clearly reflect a progression of knowledge throughout the program.  As our teaching strategy emphasizes student centered learning where the student takes responsibility for his/her own learning , identifies unique knowledge gaps and actively plans , together with faculty and preceptors ,on how to fill those knowledge gaps, we also needed the instrument to encourage student participation. The new instrument was discussed with an expert group of clinical teachers at three occasions and piloted at four clinical sites. Several revisions were made before implemented for all students.

Name of author/athors: Stevens, Lena
Working title: Registered Nurse, Lecturer
University/College/Hospital: Red Cross Community College Stockholm
Department: Nursing, Advanced Level
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