Appreciating complexity, context and continuum in undergraduate nurse clinical education : English and Australian perspectives

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Clinical learning experiences have long been considered a vital component of preparatory nurse education programs. Internationally, however, reports indicate providing sufficient quality experiences is increasingly challenging, as the demand for new nurses intensifies to address nurse shortages and replenish an aging nursing workforce. In addition, there is a need to meet the demands of societal and population changes which, in turn, are driving change and growth in healthcare policy and provision. This doctoral study aimed to generate an enhanced understanding of the factors that are conducive to promoting the quality and meaningfulness of the students’ clinical learning experience, and identify the individual and organisational factors that support this. Further, the study sought contemporary affirmation of the unique role of clinical learning in becoming a nurse and to envision how the design of innovative, sustainable clinical learning experiences can be promoted into the future. This study used a qualitative methodology, guided by an appreciative inquiry framework to identify enablers and barriers within clinical education to determine future direction. A two site, cross national study using an embedded case study design, explored the approaches to clinical education in two nursing programs – one in England, United Kingdom and one in New South Wales, Australia. Data were collected using semi-structured interviews (academic and professional staff n=43) and questionnaires (staff n=5, final year students n=78). Thematic analysis and cross-case synthesis were undertaken. Three major themes emerged from the data: the student experience, the organisational dimension of clinical placements and connecting with the past to create the future. The student experience centred on the people students’ encounter, their facilitated engagement as part of the healthcare team, and sufficient opportunities to develop and challenge their practice in order to transition to becoming a nurse. The second theme revealed the complex ‘hinterland’ at the interface of higher education and healthcare that facilitates placement and student supervision and the merits of the various program features, including placement duration. The findings in the third theme reflect the evolution of nurse education and the parallel shift in nurse and nursing identity over time. Visualising the context and the complex myriad of influences and interconnections spanning individual, organisational and professional domains was aided by a conceptual model, developed using ecological systems theory. The findings of this thesis provide greater insight into clinical education, the need to continue to promote a shared healthcare and education collaboration in nurturing next generation nurses and the importance of facilitating engagement in authentic practice at the core of meaningful clinical learning experiences. The findings of this thesis suggest that meaningful experiences are more than the sum of their parts and to identify innovate future designs, modelling the system as a whole is warranted. There is also scope to be flexible and inventive, as ‘one size does not fit all’ as the needs of students, clinical settings and the profession will continue to evolve over time.
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