Background: Managers in clinical education units (CEUs) have the responsibility to facilitate evidence-based environments for both caring and learning. Promoting such environments might be challenging in times of financial constraints and organisation changes.

Objective: The purpose of this study was to describe how managers experience their responsibility to support the caring and learning environments in CEUs.

Methods: The study method followed the principles of Reflective Lifeworld Research (RLR) grounded in a phenomenological approach. The study was conducted at a hospital in Southern Sweden. Ten first- and second-line managers responsible for CEUs were interviewed. The interviews were conducted as reflective dialogues using an open, and bridled approach.

Results: The results show that clinical education unit managers regard the responsibility to support caring and learning environments as a challenging experience, elucidated in three themes: (1) to have or to take responsibility; (2) cooperation that supports and challenges; and (3) bringing it all together— a daily struggle.

Conclusions: In conclusion, the managers of CEUs need to be aware of the importance of common theoretical grounds for caring and learning. Caring and learning are more likely to be intertwined when responsibility is taken, when collaboration between actors is characterised by respect and when an awareness of the importance of reflection is present. Awareness of the importance of creating opportunities for reflection and mutual collaboration among the different actors involved could lead to improvements in nursing education and, therefore, improved patient care.

Aim

The overall aim of this thesis is to create knowledge about caring and learning as an intertwining phenomenon at a Dedicated Education Unit and how it can be developed.

Approach and method

A lifeworld approach, based on the phenomenological philosophies foremost derived from Husserl and Merleau-Ponty was used and carried out in lifeworld interviews and with meaning-oriented analysis in accordance with reflective lifeworld research. The participants were: 13 student nurses (study I), 11 patients (study II), 8 supervisors (study III) all from the same DEU in orthopedic care and 10 managers from various DEUs (study IV).

Main findings

Intertwined caring and learning is most evident in genuine encounters between students and patients, supported by supervisors and managers. The intertwining is created in appealing challenges where students feel safe and ready. In the encounter with the patient they gain a sense of the whole where they can find their personal style. Patients, who feel invited to participate, could describe the encounter with students as genuine and a new dimension in nursing care. These encounters are characterized by closeness, thoroughness, accessibility, acknowledgement and sensitivity. When the encounter is less genuine, supervisors constitute an essential support for stabilizing the care.  Supervisors constantly move in order to either stay close to or stand back, adjusting to the students’ and patients’ needs. Their demanding task as reflective supervisors requires pauses in order to maintain motivation. The managers’ daily struggle in a stressful and challenging reality is influenced by them either having or taking responsibility. Differences in approaches are shown in terms of more or less involvement and commitment in caring environment and educational issues. 

Conclusions

Genuine encounters are characterized by the core of both caring and learning and will thereby benefit both the students and the patients. Identifying and supporting genuine encounters is necessary for students, supervisors and managers. It is time to find ways to develop a unified view of how caring and learning can be intertwined. 

Supervising student nurses in clinical praxis entails dealing with both caring and learning aspects. There is a dearth of research focusing on both the caring and learning aspects in supervision. The present study describes how caring and learning is intertwined in supervision. The study was performed with a Reflective Lifeworld Research approach and analyzed phenomenologically for meanings. Eight interviews were conducted with supervisors on an orthopedic-dedicated education unit. The findings reveal how supervisors constantly move in order to be either close to or standing back, adjusting to the students’ and the patients’ needs. This is described in more detail via the constituents: handling responsibility in constant movement, participating in a new and different way, coexisting with students creates meaning and development. The findings show that a reflective attitude in supervision, clear structure for daily activities, and a lifeworld-led didactics can promote a learning and caring environment. Supervisors’ demanding task requires pauses in order to maintain motivation among supervisors. A mutual link between supervisors, students and patients is crucial in order to create an environment where caring and learning are intertwined.

Background

It is crucial for patients to be met by understanding in their vulnerability, to be treated by competence that ensure adequate care and met with an encouraging attitude to participate in their health process. They meet professional careers as well as students, but nevertheless the aim for caring is the same: to provide good and secure care for the patients, all in line with a caring science approach. A limit amount of studies illuminate patients’ experiences of receiving care from student nurses.

Aim

The aim was to describe how patients perceived being cared for by student nurses, in a clinical context

Method

The study has been performed with a Reflective Lifeworld Research approach founded on phenomenology. 11 lifeworld interviews were conducted with patients, recently discharged from an orthopedic Dedicated Education Unit. Data have been analyzed for meanings.

Results

Patients perceive that they are being carried along on the students' learning process like a journey together. This is characterized by a fluctuation between stable and unstable care from the students. Along this journey, patients are in need of a mutual invitation to participation, of genuine encounters, and essential support.

Conclusion

The patient-student-supervisor relationship is of importance for patients’ experience of being cared for by student nurses in a clinical setting. Genuine encounters between patient and student must be identified and can be stimulated by didactic support and reflection grounded in caring science with a lifeworld perspective. Supervisors have to support to both students and patients in order to create a safe environment in which caring and learning are intertwined. Students require patients in their learning process but patients’ vulnerability, need for participation, genuine encounters and essential support, must be taken into account.

The purpose of this study is to describe how patients perceive being cared for by student nurses, in a clinical context in the form of a Dedicated Education Unit (DEU). The study has been performed with a Reflective Lifeworld Research (RLR) approach grounded in phenomenology. Lifeworld interviews were conducted with patients who had received care from student nurses on an orthopaedic dedicated education unit (DEU) and data have been analysed for meanings. The findings reveal how patients experience to be carried along as a part of the students' learning process. This is described in more detail via the constituents: a mutual invitation to participe, the importance of genuine encounters, and essential support. Patients experience both a stable and a less stable care in a learning environment and it is thus essential for them to be invited to be a part of both the students’ learning process and their own health process. The findings also highlight the key role of the supervisors for patients’ sense of security. Finally there are indications that concepts such as DEU with a lifeworld-led didactic, based on reflection on both the patients’ stories and the students’ experiences, can create learning environments that support patients’ health processes and also students’ learning processes.

Background

Caring and learning in clinical educational contexts is characterized by an encounter between lived experiences of the patient and the student’s knowledge and understanding. In other words, it is an encounter between two lifeworlds, which has the potential to create a fruitful tension to develop deep knowledge about the patient’s world that can give direction for practice. We will argue that a particular kind of Caring science knowledge becomes an important tool to support this caring and learning process where the goal is to intertwine lived experiences of health and illness with professional knowing and scientific knowledge. From this perspective is even caring and learning an intertwined phenomenon, and it is this intertwining that enables lifeworld led care.

Aim

This paper presents a study that illustrate how caring and learning is intertwined from the students’ view in an educational clinical context.

Method/design

The study was carried out using Reflective Lifeworld Research (RLR) with a phenomenological approach. Lifeworld interviews were conducted with students after their clinical placement on a Dedicated Education Unit (DEU).

Result

The result shows that the essential meaning of the intertwined phenomenon is a movement where caring and learning fall into place which appears in an atmosphere filled with appealing challenges, but has to be sensitive to the students’ readiness. The atmosphere depends on their sense of security and how they experience confirming and affirming responses. Encountering the patient means that the students can gain a sense of the whole and the theory falls into place. The results also highlight how the student, in this atmosphere, has a desire to find a new role in a personal style.

Conclusions

On the basis of this study a challenge to the curriculum is presented, that is, to develop didactics and supervision models that use a holistic approach and adopt a reflective attitude upon caring and learning as intertwined and not separated.

Learning in caring contexts could be illustrated as an encounter between the scientific knowledge of caring and thelearner’s lifeworld. This encounter needs a support that has the potential to bring caring science to life and to start anintertwining process with the lifeworld that creates embodied knowledge. The aim of this article is to illustrate themeaning of this encounter with help of a theoretical foundation and two examples of research projects with a reflective lifeworld research approach (RLR) founded on phenomenology. Both examples describe the student nurses’ perspective.One illustrates promoting learning through lifeworld-led supervision in pairs of students. The other illustrates learning environments that bridges the gap between theory and practice. These two examples show how the intertwining of caring science theory with lived experience required a certain learning and caring atmosphere that is open and sensitive for the lifeworld. In conclusion, lifeworld-led learning is more than learning per se. Lifeworld theory as a basis for supporting students’ learning could provide both a broadened and deepened understanding of the meaning of learning and also a greater understanding of how to support students’ learning.

Background: Clinical studies in nursing education ought to create conditions for the students to link theory to praxis.Previous research in this field focuses on the gap between theory and practice, learning environments, supervision andreflection connected to caring and learning. In addition there are studies that propose the concept of learning and caring asintertwined. The aim of this study is to describe how caring and learning is intertwined from a student perspective.Methods: The study was carried out using Reflective Lifeworld Research (RLR) with a phenomenological approach.Lifeworld interviews were conducted with students after their clinical placement on a Dedicated Education Unit (DEU).Results: The essential meaning is a movement where caring and learning fall into place which appears in an atmospherefilled with appealing challenges, but has to be sensitive to the students’ readiness. The atmosphere depends on their senseof security and how they experience confirming and affirming responses. Encountering the patient means that the studentscan gain a sense of the whole and the theory falls into place. The results also highlight how the student, in this atmosphere,has a desire to find a new role in a personal style.Conclusions: The study emphasizes the importance of supporting the students in understanding learning and caring asintertwined and not separated. A dualistic approach could harm the students’ aim to get the knowledge embodied. Thisholistic perspective requires a reflective attitude on caring and learning and has to be further developed in the didactics andsupervision.

Scientific knowledge is characterized by abstract descriptions and structures, which are not identical to the lived reality. Scientific knowledge cannot directly be applied on the lived existence, without being transformed and adjusted to the individual’s very complex lifeworld. Learning in caring contexts is an encounter between the scientific knowledge of caring and the learner’s lifeworld. This encounter needs a support that has the potential to bring caring science to life and to start an intertwining process with the lifeworld that creates embodied knowledge. Lifeworld didactics are built on an approach about learning as an individual process and that learning takes its point of departure in the learner’s previous experiences, which accompanies the learning process. The challenges within lifeworld didactics are to be open and sensitive to the learner’s lifeworld and with tact support the development of a reflective attitude in the learning process. Lifeworld didactics strategies are of crucial importance in different caring contexts. This symposium presents three lifeworld led phenomenological research projects that have focused on acquiring caring science knowledge in caring contexts, more precisely it is the encounter between caring science and the lifeworld. The research is within the framework of lifeworld didactics, but the three projects each have a special focus.

This research aims to deepen knowledge whether caring and learning are an intertwined phenomenon in Dedicated Educational Units (DEU). The context is psychiatric and orthopaedic care, and the research is based on caring science.The research question is this: What characterizes the relationship between caring and learning in a DEU? This will be illuminated from three perspectives; the student, supervisor and patient perspectives.The question for the student is this: What is it like to learn the nursing profession by caring for patients on a DEU? The question for the supervisor is this: What is it like to supervise nursing students on a DEU? And the final question is directed at the patient: What is it like to be cared for by nursing students in a DEU?The underpinning philosophical and theoretical perspectives are lifeworld theory, caring science and its didactics.The aim of this project is to develop a supervision model that views caring and learning as an intertwined concept with the potential to support students‟ learning processes as well as patients‟ caring processes.