Learning in nursing home placement: A phenomenological study of student nurses' lived experience.

AIM: To explore first-year student nurses' lived experience of learning in clinical placement in nursing homes. BACKGROUND: Nursing homes traditionally represent students' first clinical placement sites during nurse education, and nursing home residents' care needs can provide opportunities for student nurses to acquire both fundamental and specialised nursing skills. In clinical placements, students have opportunities to apply and integrate theoretical knowledge, practical skills and ethical competence in a clinical setting. DESIGN: A qualitative design with a hermeneutic phenomenological approach was employed and reported in accordance with the COREQ guidelines. METHODS: The study was undertaken at three nursing homes affiliated with one Norwegian university. Close observation (173 h) and in-depth individual interviews (n = 7) with first-year student nurses were conducted to explore their lived experience of learning. Data analysis was guided by van Manen's hermeneutic phenomenological approach. RESULTS: The essential meaning of the phenomenon of learning in clinical placements in a nursing home setting is characterised by four themes: (1) navigating a new and complex learning context, (2) being emotionally affected when facing sickness and frailty, (3) having a vital need for support and guidance and (4) being engaged in learning. CONCLUSIONS: The findings are discussed against the backdrop of educational learning theory. Learning in clinical placements in nursing homes is a multi-faceted and complex phenomenon related to the students' lived experience on the contextual, relational and individual levels. Overall, our findings demonstrate that learning in clinical placements is part of the process of professional identity development. RELEVANCE TO CLINICAL PRACTICE: The clinical practice arena should emphasise emotional support for student nurses, enhance their self-directed reflection and explicitly focus on the essence of nursing in nursing homes.

Social Innovation Toward a Meaningful Everyday Life for Nursing Home Residents: An Ethnographic Study.

Background: The literature shows that innovation, which includes culture change, may be important to create a meaningful everyday life for nursing home residents. However, there is a gap in how social innovation practices may contribute to this. The theoretical discourse for the study is person-centered care. Aim: The main aim was to explore phenomena within social innovation that can contribute to improving nursing home residents' everyday lives. Design and Method: This study uses an ethnographic design with observations and interviews in two nursing homes in Southern Norway. Findings: The main theme was that social innovation within working practices in nursing homes includes phenomena that contribute to a meaningful everyday life for the residents. This main theme includes five subthemes: (1) opening the nursing home to the surroundings; (2) expanding and strengthening the community of practice; (3) facilitating customized activities; (4) ensuring sufficient nutrition and facilitating enjoyable mealtimes; and (5) preventing unrest and disturbing behavior. Conclusion: The study reveals that innovation practices grounded in person-centered care in nursing homes may contribute to opening the nursing home to the community and establishing a common community practice for all members of the nursing home. This enables residents to experience meaningful everyday life through customized activities, sufficient nutrition, and a pleasant milieu during mealtimes. Disturbing behavior is also prevented, making it possible to promote meaningful lives in nursing homes.

Nursing students' perceptions of combining hands-on simulation with simulated patients and a serious game in preparing for clinical placement in home healthcare: A qualitative study.

BACKGROUND: There is a growing demand to provide complex healthcare services in patients' own homes. However, high quality home healthcare clinical placements are often difficult to obtain, and arranging laboratory-based simulations to provide relevant clinical-practical learning experiences for all students is resource intensive. OBJECTIVES: The aim of this study was to explore nursing students' perceptions of using a blended simulation approach, including hands-on simulation with simulated patients and a video-based serious game, in preparation for their home healthcare clinical placements. DESIGN: An exploratory qualitative design using focus group interviews was utilized. SETTING AND PARTICIPANTS: Second- and third-year nursing students in home healthcare courses in Norway participated in this study. METHODS: Five focus group interviews were conducted with a total of 26 nursing students. Data were collected over two semesters in three home healthcare courses. The data were analyzed using thematic content analysis. RESULTS: The study identified four main themes that influenced students' perceptions of combining the two simulations. These included personal engagement, contextual and environmental factors, a safe and structured learning environment, as well as organizational and technical factors. In relation to the different themes, students expressed that disadvantages in one simulation were counteracted in the other. CONCLUSIONS: The blended simulation approach was perceived to address curricular objectives in different but complementary ways. The blended simulation approach was perceived to facilitate personal engagement and reflections and to provide relevant clinical-practical learning experiences. However, results also indicated that the organization of such a blended simulation approach (i.e., group compositions and size), facilitation from teachers, and technical issues (i.e., with medical equipment and the serious game) may influence students' perceptions and satisfaction directly. The results should provide useful information for designing future teaching strategies in Bachelor of Nursing programs.

Conflicting rationales: leader's experienced ethical challenges in community health care for older people.

BACKGROUND: Ethical challenges arise in all types of care, and leaders need to be aware of how to resolve these challenges. Healthcare systems tend to be organised around medical conditions, and the patient is often faced with a series of uncoordinated visits to multiple specialties. Ideally, care should be organised around the patient's needs. AIM: The purpose of this article was to highlight some ethical challenges perceived by leaders with responsibility for management and service distribution, finance and ensuring quality of community health services for older people. METHOD: This study had a qualitative design with a qualitative content analysis of one focus group with six leaders that met four times in total. Leaders from the community healthcare sector in one Norwegian municipality were included, representing both nursing homes and home-based health care. The study followed the intentions of the Declaration of Helsinki and standard ethical principles. The Norwegian Social Science Data Services approved the study. All participants voluntarily gave written informed consent. FINDINGS: The main theme that emerged from this study was the ethical challenge leaders felt in the form of an inherent conflict between a caring rationale versus economic or technological rationales. Four categories emerged: (i) Management: quality versus economy; (ii) Prioritisation: fair distribution of healthcare services; (iii) Responsibility: considering individuals' needs versus the needs of the whole community; and (iv) Welfare technology: possibilities and challenges. CONCLUSION: Leaders' responsibilities in community health care for older people need to strike a balance between ethical principles in the management of limited resources.

Ethical challenges in care for older patients who resist help.

BACKGROUND: Situations where patients resist necessary help can be professionally and ethically challenging for health professionals, and the risk of paternalism, abuse and coercion are present. RESEARCH QUESTION: The purpose of this study was to examine ethical challenges in situations where the patient resists healthcare. RESEARCH DESIGN: The method used was clinical application research. Academic staff and clinical co-researchers collaborated in a hermeneutical process to shed light on situations and create a basis for new action. PARTICIPANTS AND RESEARCH CONTEXT: Four research groups were established. Each group consisted of six to eight clinical co-researchers, all employees with different health profession backgrounds and from different parts of the municipal healthcare services, and two scientific researchers. ETHICAL CONSIDERATIONS: The study was conducted in compliance with ethical guidelines and principles. Participants were informed that participation was voluntary and that confidentiality would be maintained. They signed a consent form. FINDINGS: The findings showed that the situations where patients opposed help related to personal hygiene, detention in an institution and medication associated with dental treatment. The situations were perceived as demanding and emotionally stressful for the clinicians. DISCUSSION: The situations can be described as everyday ethics and are more characterised by moral uncertainty and moral distress than by being classic ethical dilemmas. CONCLUSION: Norwegian legislation governing the use of force seems to provide decision guidance with the potential to reduce uncertainty and moral stress if the clinicians' legal competence had been greater.