Spindeln i klistret : Den kliniska praktikens betydelse för utveckling av yrkeskompetens som sjuksköterska: en etnografisk-fenomenografisk studie

The aim of the study was to investigate the role of clinical experience in the acquisition of professional competence during education and training in nursing. Competence is given a relational interpretation. The acquisition of professional competence is considered in terms both of the subject area involved and of cultural and organizational aspects specific to the nursing profession and to nursing education. Contextual analysis represents the point of scientific departure and the basic methodology of the study. Within that framework, a particular qualitative pedagogical research approach - ethnographic phenomenography - was developed for studying the relationship between cultural factors in the form of traditions and conventions and how a student's individual conception of and approach to nursing evolves. The group investigated was a class in a two-year general nursing program. The experience of the members of the class was followed systematically by means of interviews and week-by-week diaries during the final year of their studies and the first few months at their later job, as well as being followed up by a questionnaire study four years later. The results indicate that the students' clinical experience was characterized by their being in a subordinate role initially, despite their work background being that of licensed practical nurses. They experienced their university student role as partly contradictory to this. It was their clinical supervisors who had the crucial say in determining to what extent the students could gain access to the medical-technical and practical ward-coordinating tasks the students regarded as specific to their profession, tasks to which they were strongly oriented. Through their clinical experience in several different areas, they developed a common understanding of the hierarchy of competence levels in their profession which different areas of specialty represented, acute medical treatment being at the top and long-term treatment at the bottom. Six differing conceptions of nursing competence that became manifest during their final year of the education could be distinguished. The most marked differences between these conceptions concerned the type and the degree of orientation towards the patient. Four years after their exams, one third of the group was found to be working on one of the wards where they had had clinical experience during their studies. Marked differences in their conceptions regarding what nursing involved were still evident in the group then, particularly among those who had obtained experience within different areas of nursing or had taken further specialized training. The basic practical competence of nurses appears, both from an individual and a professional-cultural perspective, to be multidimensional and partly contradictory, and to be closely oriented to a professional hospital culture associated with the acute treatment of somatic disorders