Practice learning and nursing education: rethinking theory and design

Abstract

The significant influence that practice learning plays within undergraduate nurse education cannot be overstated. By practice learning, I mean work-based learning immersed in the activities of nursing practice, typically involving learning undertaken in placements at hospitals and other clinical worksites. Practice learning is intended to achieve standards defined by professional regulatory bodies, and aims to enhance learners' capability and employability. Learning here refers to processes through which student nurses develop capabilities to practice effectively, critically, confidently and professionally in health care settings. Practice is a key concept in this thesis, much contested in debates about professional learning in practice which I will examine in detail in chapter 2. In terms of current policy regarding practice learning, I would, however, suggest that what we have at the moment is an inherited legacy which to date has not been robustly scrutinised. Based on my experiences as a nursing educator I came to believe that it was timely for a re-examination of policies, practices and philosophies underpinning the duration and structure of the current practice learning model. Taken together, the above experiences led me to focus this thesis on the following research question: How might practice learning experiences be better designed to promote nursing capability? This thesis brings together six published papers reporting studies that I conducted to explore this question, as well as chapters explaining the background literature, theory and methodology guiding these studies. My overarching aim is to contribute to the improved practice learning experiences of undergraduate student nurses, retaining them on programmes and easing their transition into the role of newly qualified practitioners (NQP). Chapter 1 charts the history of nursing educational developments. The aim is to demonstrate the influence of government and professional policy over nursing’s development from an apprentice-style model to the current-day academic model. In charting these developments alongside reviewing the contemporary research literature, what is obvious is that the issues of support, retention, models of practice learning and curricula to prepare nurses are perennial challenges. However, as a practice-based discipline, the focus of preparation has always remained grounded in practice. Chapter 2 sets forth the theoretical constructs of this thesis. During the course of conducting the studies reported in the publications of this thesis, I became frustrated with the relative lack of emphasis on contemporary learning theory in nursing education, and the paucity of supporting evidence for the ‘reflective’ theory that seems to be dominant in nursing. The discussion presented in this chapter aims to provide an overview of the major traditions of constructivism and reflective practice, as well as their historical theoretical foundations, which have been widely adopted in nurse education. I discuss the strengths and limitations of these theories as they apply to undergraduate nurses’ practice learning and capability development. These are then contrasted via the means of a critical discussion with more novel alternative models. These include situated learning theory and legitimate peripheral participation, and practice-based learning theory as advocated by contemporary writers such as Schatzki (2002). These theories changed my thinking about practice learning and informed my efforts to develop a more cogent understanding of learning through, for and at work for undergraduate nurse education. In setting out Chapter 3, I am presenting a brief overview of these publications for a nursing education audience. Firstly, I have included information that is generally considered important to this audience, such as details about the journal’s standing and article citations, the databases searched, and the percentage of my own contributions. Secondly, I report the studies from an evidence-based perspective of prediction and control aligned with the contexts of the commissioning process and the conduct of each project. By this I mean that I treat the findings in these papers as valid and credible within the stated limitations

Chapter 4 presents the six publications in their entirety for the reader Chapter 5 explains the research methodology adopted in the papers presented for this thesis, and offers my critical reflections on these methodologies. I outline the philosophy that underpins the approach taken with the research studies, discussing the interpretive stance that was taken to research and the consequent choice of qualitative approaches. The chapter also discusses the strengths and limitations of the methods employed in each of my papers along with the means used to analyse the data, and the ethical considerations that an interpretive researcher must consider. In retrospect, given where my theoretical orientation has moved (as explained in chapter 2), I now look rather more critically on the premises of these studies, their categories of definition, multiple causes and uncertainties at play. In my reflections on the research approach, I explain some of these issues.

In concluding this thesis, Chapter 6 details my recommendations and some future implications for policy and practice. It also explains my plans for carrying forward different methodological and theoretical approaches in my future research work examining nurses' practice learning.