Experiencing authenticity : the core of student learning in clinical practice

The present thesis explored student learning at a clinical education ward with an explicit pedagogical framework. Although nursing students were the focus of the studies the intention is to gain more generally understanding of student learning in clinical settings. Learning in this thesis is understood as a transformative process that involves knowledge construction and meaning-making processes. Clinical education is carried out in real clinical work-places and consists of encounters with patients, health- care professionals and peer students. Students train their future professional role in these encounters.

Previous research has shown challenges that are tied to both organizational and pedagogical issues indicating that clinical learning environments are not always ideal. One way to meet these challenges is by introducing clinical education wards. These are units run collaboratively by educational institutions and the clinical settings; they train students on different levels and focus on inter-professional training or on one profession.

The overall aim of the present thesis was to contribute to our understanding of students’ learning at a clinical education ward where students are supported in taking care of patients independently. A qualitative approach was used to explore students’ learning from the perspectives of students, patients and supervisors. The theory of transformative learning and the concepts of authenticity and threshold were used in interpreting and understanding of the findings. The results show that the core of student learning at a clinical education ward is the experience of both external and internal authenticity.

In Study I, first-year nursing students created mutual relationships with patients and expressed feelings of belongingness, which resulted in experiences of both external and internal authenticity. Experiencing authenticity resulted in learning and understanding of nursing and students’ future professional role.

In Study II, final-year students’ learning turned out to be more complex; they experienced only external authenticity, with feelings of ambivalence and self- centredness creating uncertainty as a threshold for their learning. Taking care of patients in need of extensive nursing care helped students overcome the threshold and experience internal authenticity as well.

Study III explored student-patient encounters and showed that mutual relationships resulted in learning relationships, where patients were active participants in student learning.

In Study IV, supervisors’ approaches to student learning were explored, and the supervisors’ role was shown to involve balancing patient care and student learning by having a nursing care plan for patients and a learning plan for students. Supervisors allowed students to have independence while giving them adequate support at the same time.

To conclude, authenticity makes learning meaningful, and students need to experience both external and internal authenticity in their learning process. Patients’ active participation and supervisors giving both challenges and support are essential to students’ learning. An explicit pedagogical framework based on patient-centredness, peer-learning and supervisors working as a team creates prerequisites for experiences of external and internal authenticity. The present thesis points out that creating possibilities for experiencing authenticity should be the basis for designing clinical learning environments.

List of scientific papers

I. Manninen, K., Welin Henriksson, E., Scheja M., Silén, C. (2013). Authenticity in learning - nursing students' experiences at a clinical education ward. Health Education. 113(2), 132-43.
https://doi.org/10.1108/09654281311298812

II. Manninen, K., Scheja, M., Welin Henriksson, E., Silén, C. (2013). Self-centeredness or patient-centeredness – final year nursing students’ experiences of learning at a clinical education ward. Journal of Nursing Education and Practice. 3(12), 187-98.
https://doi.org/10.5430/jnep.v3n12p187

III. Manninen, K., Welin Henriksson, E., Scheja, M., Silén C. Patient-student encounters and students’ learning at a clinical education ward – an ethnographic study. [Submitted]

IV. Manninen K., Welin Henriksson, E., Scheja, M., Silén, C. Supervisors’ pedagogical role at a clinical education ward – an ethnographic study. [Submitted]