Learning with and from others in clinical practice

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This empirical study is set against the backdrop of the contemporary acute healthcare landscape in Sydney, Australia. Patients who are admitted to hospital today present with chronic disease and multiple co-morbidities that create a complex and unpredictable work environment. As registered nurses practice in this context, they are confronted with a multitude of information sources, then required to administer several complex medications at a time together with managing the increased use of technology. The research reported in this thesis examines how and what registered nurses learn as they carry out everyday work in this dynamic environment. Adopting a qualitative, focused ethnographic approach, this study collected data at one single study site in the natural setting of an acute care medical ward. Nine registered nurses were observed when providing clinical care to their assigned patients on the ward. Throughout the observations, the researcher conducted informal discussions with the nurses to enrich understandings of what was observed. Resulting descriptive data from the observations were used as the basis for one-to-one, semi-structured interviews conducted immediately after each observation period. Drawing on contemporary theories of workplace learning, spatial theory and sociomateriality, this research shows that nurses drew on several strategies to learn from knowledge challenges that arose during practice. Each strategy involved creating different relationships between spaces, objects and other nurses in the ward. Further, nurses made practical meaning of patient information in sociomaterial ways using a clinical handover sheet. Practices based around the sheet allowed nurses to bring specific patient information and expertise into meaningful contact so they could act on knowledge challenges and continue patient care. Thus, learning was enabled for nurses because they rendered the clinical handover sheet as an epistemic or boundary object. Awareness of what nurses do during times of uncertainty and not knowing—together with understanding how nurses make practical meaning of patient information—is crucial for the profession. These findings are particularly important in the context of acute care, so that more experienced nurses can provide better support and assistance to their colleagues in order to sustain a safe and high standard of patient care.
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