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Work-integrated learning in a hospital ward setting: Exploring the interdependency between the professions and the organization
University West, Department of Health Sciences, Section for health promotion and care sciences. (KAMAIL LOVHH)
2023 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction:

Contemporary hospital settings are a challenging learning and working environment for healthcare professionals. The challenges are largely related to the increasing need for healthcare caused by an ageing population, a lack of personnel resources, and demands for time efficiency. Therefore, it is of interest to study how individuals and teams learn during these working conditions. Nurses are especially exposed when entering working life, why this profession has been of interest to explore further in this thesis. Furthermore, the interprofessional team is significant in providing qualitative care at the hospital wards, which could be affected by the lack of nurses and demands for efficiency. Aim: To explore work integrated learning from an individual nurse and interprofessional team learning perspective in a contemporary hospital ward setting.

Methodology:

Two qualitative approaches were used in this thesis. Study I was a qualitative content analysis based on individual interviews with 10 nurses within hospital ward care. Study II was an insider action research project (IAR) within a specific hospital ward. Data from the project in Study II were analyzed using the cycle of expansive learning.

Results:

Study I showed that, during their early working life, newly graduated nurses learned their profession by developing and using different learning strategies. Their initial strategy was to learn how to perform daily tasks as safely and effectively as possible. However, in learning how to provide qualitative care, the nurses realized the importance of participating in bedside care to gain clinical experience. Opportunities to learn from clinical experiences and reflection were essential for developing as a new nurse.

Study II explored work integrated learning in an interprofessional ward team. The learning process resulted in the establishment of a digital planning board to illustrate the patients’ recovery process during their stay at the ward. This board opened an opportunity to learn about core values and goals for discharge, but also contributed to boundary awareness between the professionals, which was important for collaboration to improve patient safety in daily work. Discussion: The results reveal that work-integrated learning was manifested in an interdependency between the professionals and the health-care organization. The interdependency was multifaceted as the professionals were dependent on each other to learn as individuals in relation to each other, and to develop their joint work processes. The professionals were also dependent on the organizational prerequisites to learn. This result shows the need for the professionals to develop their own learning strategies to manage daily work, which was associated with the professional’s motivation in leading their own professional development towards qualitative and safe care.

Conclusion:

The results of this thesis reveal that the professions within a hospital ward setting are largely dependent on each other to create conditions for work integrated learning. The individuals and the team both had strong determination, will, and desire to learn to provide patients with care that was as qualitative and safe as possible. The quality of work-integrated learning was found to be related to the professions’ awareness of boundaries, knowledge, and responsibilities related to each other within the interprofessional team.

Abstract [sv]

Denna studie har utforskat det arbetsintegrerade lärandet hos nyutbildade sjuksköterskor och hos ett interprofessionellt team, i en sjukhusavdelningsmiljö. Resultatet visade att organisatoriska förutsättningar såsom brist på personal, högt vårdflöde samt uppgiftsväxling, tvingar de nyutbildade sjuksköterskornas att anta strategier som gör att det måste förlita sig på andrahandsinformation för bedömning av patienters status. Även om det patientnära arbete uttrycks som väsentligt för att lär sig yrket, tvingas de nyutbildade ofta att prioritera administrativa uppgifter och därmed missas väsentligt information viktig för lärande och för att kunna hantera arbetet säkert och kvalitativt. Organisatoriska förutsättningar riskerar därmed också att ”förlänga” lärandet mot ett expert-kunnande.

Resultat visa dock att det finns en styrka i att hitta sina egna vägar att ta sig fram i en svår lärandemiljö, där den professionelles ”jävlar anamma”, engagemang och motivation för att lära, påverkar både riktning och innehåll i lärandet. Resultatet visar att hos både den enskilda sjuksköterskan och hos teamarbetets medlemmar fanns ett driv, vilja och önskan att lära för att kunna ge patienterna en så god och säker vård som möjligt. Det arbetsintegrerade lärandet visade sig också vara relaterat till professionernas medvetenhet om hur deras egna professionella gränser, kunskap och ansvar förhöll sig till övriga medarbetare i teamet. Att skapa ett medvetande om professionella gränser inom teamet innebar att utveckla kunskap om varandras professionella ansvar och bidrag till vårdteamet som helhet samt vilka värderingar och målsättningar som kunde leda teamets arbete framåt. Undersköterskans roll för sjuksköterskans och vårdteamets arbetsintegrerade lärande var central. Att tydliggöra gränser mellan professionerna kräver ett gediget arbete som tar tid, motivation och uthållighet hos både individer och ledning. Ett arbete som kan vara svårt att åstadkomma i vardagsarbetet och därför kräver särskilda insatser men kan ha avgörande beredelse för vårdkvalitén och patientsäkerheten.

Sammanfattningsvis kan denna uppsats bidra med fördjupad kunskap om arbetsintegrerat lärande i dagens sjukhusvård. Inom sjukhusvården, där effektivitetskrav dagligen måste balanseras gentemot bristande resurser, kan sjukhusavdelningar lärandemiljö ifrågasättas. Strategiska lärandestrategier krävs för att kunna säkerställa ett kvalitativt arbetsintegrerat lärande för nyutbildade sjuksköterskor och för teamet.

Place, publisher, year, edition, pages
Trollhättan: University West , 2023. , p. 84
Series
Licentiate Thesis: University West ; 42
Keywords [en]
contemporary hospital care, occupational learning, expansive learning, interprofessional learning, newly graduated nurses
National Category
Nursing Learning
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science; Work Integrated Learning
Identifiers
URN: urn:nbn:se:hv:diva-20830ISBN: 978-91-89325-52-4 (print)ISBN: 978-91-89325-51-7 (electronic)OAI: oai:DiVA.org:hv-20830DiVA, id: diva2:1805012
Presentation
2023-10-27, J113, Gustava Melins gata, Trollhättan, 13:00 (Swedish)
Opponent
Supervisors
Note

Paper  B is not included in the electronic version. 

Available from: 2023-10-24 Created: 2023-10-16 Last updated: 2024-01-12Bibliographically approved
List of papers
1. The experience of new nurses’ early working life: learning in a hospital care context – An interview study
Open this publication in new window or tab >>The experience of new nurses’ early working life: learning in a hospital care context – An interview study
2022 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 65, article id 103506Article in journal (Refereed) Published
Abstract [en]

Aim: To explore how nurses during their early working life learn to provide high-quality care in relation to organisational prerequisites in a hospital setting.BackgroundWhen nurses enter employment in contemporary hospital settings, they face multiple learning challenges. Organisational prerequisites that have been identified to affect their ability to learn to provide high-quality care are related to staffing turnovers, large patient groups and a lack of experienced staff to support their learning.

Design: Qualitative.

Methods: The study was conducted between 2018 and 2019 at a medium-sized hospital in Sweden. Data from interviews with 10 nurses with fewer than two years’ work experience were subjected to qualitative content analysis.

Results: The results describe the nurses’ learning during their early working life in two categories: Performing tasks in relation to organisational prerequisites and Making use of clinical experiences to grasp the complexity of nursing care. The first theme reflected a learning process that was initially characterised by seeking confirmation and instructions from colleagues of how to act safely and by balancing the demands of time efficiency and sustaining patient safety. The second theme reflected that, after addressing organisational prerequisites, the nurses tried to understand and make use of clinical experiences to grasp the complexity of nursing care by encountering and processing clinical patient situations.

Conclusions: The results of this study revealed that nurses’ learning during early working life seemed to be primarily directed towards handling tasks, with sometimes limited opportunities to grasp the complexity of nursing care. Their learning depended largely on their own initiative and motivation and was strongly influenced by organisational prerequisites. The limited availability of experienced nurse colleagues and lack of time devoted for reflection needs to be dealt with to support nurses’ learning.

Keywords
Hospital care, Nursing, Novice nurses, Professional development, Workplace learning, Qualitative content analysis
National Category
Nursing Work Sciences
Research subject
Work Integrated Learning; NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-19439 (URN)10.1016/j.nepr.2022.103506 (DOI)000891151900011 ()2-s2.0-85141978207 (Scopus ID)
Note

This is an open access article under the CC BY license.

Available from: 2022-12-06 Created: 2022-12-06 Last updated: 2024-04-09

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