Rethinking clinical instruction through the zone of proximal development.

BACKGROUND: The complexity of the learning environment and intricacy of nursing tasks make it difficult for students to learn without the assistance of an expert. Teaching in the zone of proximal development (ZPD) aims at positioning learners in the zone of what they can do and develop with assistance to reach full potential and independence. ZPD is deemed essential to understand how teaching and learning take place; however, its implications for clinical educators are limited and need further exploration. OBJECTIVES: This research study aimed at exploring the instructional strategies that preceptors use to guide and support the development of undergraduate nursing students, from what they are capable of doing with assistance to what they can become and do independently. DESIGN: The qualitative multiple case study research design was used to gain insights into the teaching experiences of 18 nurse preceptors situated in three recognized hospitals in Lebanon. METHODS: Each preceptor was interviewed face-to-face using questions that were developed from a three-hour observation. Vygotsky's learning principles formed the reference point for this study. Analytic induction and constant comparison of preceptors' responses were applied throughout the study to unravel assisted strategies that target the potential learning zones of the student. RESULTS: Three assumptions emerged from the data to underpin the preceptors' assistive strategies that help move learners from a cannot-do-level to can do independently. The assumptions are: (1) learning from clinical experience, (2) teaching beyond student ability, and (3) teaching for autonomy. In-depth analysis of both assumptions and strategies that focus instruction within each student's ZPD converged on a framework of three constructs: differentiated instruction, instructional scaffolding, and influencing a positive learning environment. CONCLUSION: It is imperative that clinical educators be most receptive to instruction that targets the student's ZPD, as the zone represents a potential phase in student learning. This study provides a ZPD framework for intensifying learning gains from clinical practice.

Using frame analysis to re-analyse the results of inductive thematic analysis: A methodological discussion of investigating meanings and learning contexts in baccalaureate nurse education.

AIMS: Recovery of the antecedents and assumptions of Goffman's frame analysis to illustrate learning contexts in baccalaureate nursing programs. DESIGN: A discussion paper on the secondary analysis of focus group data. DATA SOURCES: Focus group data collected in a multi-site study conducted in 2017 to understand the challenges of transitioning to practice in Lebanon. The discussion is illustrated with empirical data, but the article is a conceptual paper not a research report. IMPLICATIONS FOR NURSING: Transition to practice research requires studies of interaction in university schools of nursing to examine the meanings embedded in classroom instruction. METHODS: Clarification and use of Goffman's concepts of primary frame, mainframe (storyline), keying, and re-keying to describe how differences in learning contexts make the transition to practice difficult. CONCLUSION: Baccalaureate nursing education consists in re-keying the knowledge students bring with them to university into an idealized conception of nursing practice. This storyline dominates classroom learning and is re-keyed into the pragmatic approach to nursing practice that dominates learning contexts in clinical units. Students respond to discrepancies between the meanings embedded in classroom and clinical unit learning contexts by striving to apply the classroom storyline or delaying their commitment to a nursing career. IMPACT: The discussion explains how secondary analysis can overcome some of the limitations of inducive thematic analysis. It promotes frame analysis as an intuitive, conceptually sound method for identifying dominant meanings in baccalaureate nursing education. Qualitative researchers who have used inductive thematic analysis can use frame analysis to complement their previous analyses with a structural sociological perspective. We suggest dimensions to help investigators interpret learning contexts. Frame analysis of classroom interaction will bring new insights to transition to practice research.

Nursing faculty teaching a module in clinical skills to medical students: a Lebanese experience.

Nursing faculty teaching medical students a module in clinical skills is a relatively new trend. Collaboration in education among medical and nursing professions can improve students' performance in clinical skills and consequently positively impact the quality of care delivery. In 2011, the Faculty of Medicine in collaboration with the Faculty of Health Sciences at the University of Balamand, Beirut, Lebanon, launched a module in clinical skills as part of clinical skills teaching to first-year medical students. The module is prepared and delivered by nursing faculty in a laboratory setting. It consists of informative lectures as well as hands-on clinical practice. The clinical competencies taught are hand-washing, medication administration, intravenous initiation and removal, and nasogastric tube insertion and removal. Around sixty-five medical students attend this module every year. A Likert scale-based questionnaire is used to evaluate their experience. Medical students agree that the module provides adequate opportunities to enhance clinical skills and knowledge and favor cross-professional education between nursing and medical disciplines. Most of the respondents report that this experience prepares them better for clinical rotations while increasing their confidence and decreasing anxiety level. Medical students highly appreciate the nursing faculties' expertise and perceive them as knowledgeable and resourceful. Nursing faculty participating in medical students' skills teaching is well perceived, has a positive impact, and shows nurses are proficient teachers to medical students. Cross professional education is an attractive model when it comes to teaching clinical skills in medical school.

The divergent opinions of nurses, nurse managers and nurse directors: the case in Lebanon.

AIM: The present study provides an overview of the status of the nursing profession in Lebanon and compares and contrasts the opinions of directors, nurse supervisors/managers and nurses regarding the nursing profession and the workplace. BACKGROUND: There are limited publications concerning the working conditions of nurses in Lebanon, and no studies on the views of directors, supervisors/managers and nurses regarding the priorities of the nursing profession. Such data are necessary to build a sound theoretical basis on which recommendations for improving the nursing profession in Lebanon are made as well as to compare and contrast cross cultural findings. METHOD: Data were collected from 45 hospitals using a mixed methods design. Qualitative data was obtained from 45 nursing directors whereas quantitative data were collected from 64 nursing supervisors and 624 nurses. RESULTS: Similarities and differences in the opinions of nurses, nurse supervisors/managers and nurse directors regarding critical issues for the nursing profession are discussed and contrasted. CONCLUSIONS/IMPLICATIONS: Nurses are more likely to be satisfied and committed to their profession when they feel that their opinions are being heard and that their work environment promotes professional advancement.