Variation in neonatal nurses' conceptions of competence in their practice : implications for the design of learning experiences
- Publication Type:
- Thesis
- Issue Date:
- 2002
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This study has examined the nature of competence in neonatal nursing practice from the
perspective of neonatal nurses. It has also explored the type of educational support
needed to help new graduates develop more complex and inclusive conceptions of
competence in their practice of neonatal nursing.
Ideas about being and becoming competent in nursing practice have been informed by
conflicting knowledge perspectives. The dominance of traditional research methods that
have an underlying dualist ontology and objective epistemology has resulted in
educational practices within nursing that separate the worker from the context in which
the work occurs. Nurses have made attempts to overcome the limitations of these
traditional methods by shifting toward research approaches concerned with the lifeworld
of individuals. Much of this newer research however, has not addressed
educational practices within nursing.
This study is situated within the life-world of neonatal nurses. The non-dualist
phenomenographic approach was used to capture and describe variation in the way 20
neonatal nurses conceived of competence in their practice. Analysis of descriptions
generated from unstructured interviews revealed four distinctive conceptions of
competence in neonatal nursing practice. These conceptions are expressed as
hierarchical internally related categories of description, with category IV being the most
complex and inclusive.
I Managing separate items within the NICU environment according to
technology-based policy and procedural rules.
II Managing integrated clusters of items within the NICU environment according
to technology-based policy and procedural rules.
III Managing a support system for the infant and family by using objective sensory
observation of the infant to guide the use of policy and procedural rules
according to priorities.
IV Managing a support system focused on the infant and family by using objective
sensory observation of the infant and tacit feelings about the infant arising from variation in the previous experiences of outcome for infant and family to guide
and challenge the use of policy and procedural rules.
Located within this hierarchy is the critical dimension of individual infant and family
response. This response is highly contextual and consists of numerical, sensory and tacit
aspects. It is postulated that learning activities should be structured to help new
graduates entering the specialty of neonatal nursing to discern and focus on individual
infant and family response. As such a learning framework (CONSERVE), based on this
critical dimension has been proposed. Structuring learning experiences in this way
should enable the development of more complex and inclusive conceptions of
competence about the practice of neonatal nursing.
Using conceptual variation about competence in neonatal nursing practice highlights the
importance of the relationship between the worker and the work. Moreover, it offers an
alternative educational approach for new graduates entering the specialty of neonatal
nursing that is both relevant and meaningful.
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