The Multifaceted Use of a Written Artifact in Student Supervision

This article explores the use of a written artifact, an assessment form encompassing a checklist with health care terms, in supervised nurse student-patient interactions during assessment interviews in a Swedish hospital ward. The students were doing their clinical practice and were in their first year of a three-year nursing degree. Even though the students are not in charge of the situation, they are expected to perform a professional task for which they lack adequate skills. As demonstrated, the use of the assessment form provided a useful way for the participants to manage specific tasks in an apprenticeship context, such as regulating affect display, demonstrating uptake of the patient's concerns and staging the interview as an exercise. For this article, three excerpts have been selected from history-taking sequences, when the patient's previous illness history is created. The analysis illustrates the affordances provided by the assessment form to handle perspective shifts, when the patient departs from a general pattern of unelaborated answers and offers a window into his/her concerns. Importantly, however, the students' feedback talk with the nurse preceptor offers evidence that the artifact also constrains their forms of action in the practice of gathering assessment data. The article argues for ward-level practices that socialize students into reflective ways of using the artifact