Elsevier

Nurse Education Today

Volume 32, Issue 1, January 2012, Pages 105-110
Nurse Education Today

To take responsibility or to be an onlooker. Nursing students' experiences of two models of supervision

https://doi.org/10.1016/j.nedt.2011.02.005Get rights and content

Summary

Aim

The present study aimed at describing how nursing students engaged in their clinical practice experienced two models of supervision: supervision on student wards and traditional supervision.

Background

Supervision for nursing students in clinical practice can be organized in different ways. In the present study, parts of nursing students' clinical practice were carried out on student wards in existing hospital departments. The purpose was to give students the opportunity to assume greater responsibility for their clinical education and to apply the nursing process more independently through peer learning.

Method

A descriptive design with a qualitative approach was used. Interviews were carried out with eight nursing students in their final semester of a 3-year degree program in nursing. The data were analyzed using content analysis.

Findings

Two themes were revealed in the data analysis: When supervised on the student wards, nursing students experienced assuming responsibility and finding one's professional role, while during traditional supervision, they experienced being an onlooker and having difficulties assuming responsibility.

Conclusions

Supervision on a student ward was found to give nursing students a feeling of acknowledgment and more opportunities to develop independence, continuity, cooperation and confidence.

Introduction

Nursing is a practice-based discipline, and clinical education is an essential part of the Bachelor's Program in Nursing. The clinical parts of nursing programs have been developed to a lesser extent than have the theoretical parts. For instance, nursing students have reported difficulties in translating their theoretical knowledge into practice (Andrews et al., 2006). Thus, there is a need to develop nursing students' clinical education. The present study reports findings from a project investigating nursing students' experiences of two different models of clinical supervision: supervision on a student ward and traditional supervision.

Supervision for nursing students in clinical education can be organized in different ways (Budgen and Gamroth, 2008). In Sweden, the most common model is one in which the student is placed in a hospital department and follows a nurse/supervisor (familiar with routines and culture) during her shift; this model is defined here as traditional supervision. The nurse/supervisor role is to instruct and demonstrate. In a study by Andrews et al. (2006), students described this as a passive learning process; they felt they were flooded with information from the nurse/supervisor instead of actively searching for knowledge on their own. During the past decade, new models for supervision have received considerable attention and training education wards have been developed in a number of countries. Findings from several studies have shown that students on training education wards take great responsibility for their learning and are more satisfied with their clinical practice than are students undergoing traditional supervision (Lidskog et al., 2008, Lidskog et al., 2009, Ponzer et al., 2004, Reeves et al., 2002). Training education wards give students the opportunity to share experiences and reinforce knowledge, and it has been reported that such wards highly value peer learning (Ranse and Grealish, 2007). Moreover, Lidskog et al. (2009) found that students were more engaged and active in the care during their practice on training education wards. Similar findings were reported by Reeves et al. (2010), but they also stated that more rigorous mixed methods studies of training education wards are needed.

The learning taking place on training education wards has similarities with problem-based learning. The problem-based learning approach includes critical thinking, taking responsibility for one's own learning, solving problems and learning from peers (Cooke and Moyle, 2002). When students actively search for information, rather than having causal relationships explained by a teacher, they learn for life (Ramsden, 2009). Problem-based learning requires that the student build up adequate self-confidence, so that he/she can make critical analyses and take advantage of relevant information (Ramsden, 2009). The supervisor's role is to guide students and enable them to achieve their own objectives (Barrows, 1996), in a situation where students' questions and problems are the focus of their learning (Carlisle and Ibbotson, 2005). Reflection is central in this learning process. According to Gibbs (1988), reflection includes four stages: The first stage, description, concerns what happened in the situation. The stage, assessment, deals with what was good/bad, and whether the situation was easy/hard for you. The analysis stage involves reflection on any similar situations you have experienced before. The last stage conclusion focuses on what else you could have done/what would you have done. Gustafsson and Fagerberg (2003) reported on how nursing students reflected on caring situations. Their results showed that students did reflect on similar situations they had experienced before. They reflected before and after the nursing situation and applied earlier experiences. Using reflection as a tool was shown to increase students' development into their profession as well as to help them in providing good patient care. Several studies have shown that students find reflection valuable and that it provides opportunities for feedback and for combining theory with practice (Ekebergh, 2001, Löfmark and Wikblad, 2001, Mogensen et al., 2002, Reeves et al., 2002). Reflection has been shown to be a factor in promoting student learning and, according to Ekebergh (2007), it should never be objectified or reduced to a separate process or a technological function.

In 2006, a project with student wards was started in a surgical department at a hospital in central Sweden. The purpose of the project was to give students an opportunity to take greater responsibility for their clinical education and to apply the nursing process more independently. Another circumstance was that, at the time, the Bachelor's Program in Nursing had been changed, resulting in twice the number of nursing students. To ensure that all students could be offered a clinical practice the student wards were introduced. Learning on student wards is similar to learning on training education wards. Supervision on student wards entails that, during two weeks of their clinical practice, students work in pairs. These pairs of students have joint responsibility for a room/ward and a group of four patients. In contrast to traditional supervision, the nurse who is primarily responsible for these patients' care acts as a supervisor for a pair of students. When assuming responsibility for the patients' care, the students discuss and learn from one another, which is defined as peer learning (Lincoln and McAllister, 1993, Secomb, 2007). Peer learning gives students the opportunity to share experiences, assume responsibility and become involved in patient care (Ranse and Grealish, 2007). Findings from a systematic review by Secomb (2007), including 12 studies of peer learning, showed that the outcomes of peer learning were primarily positive. However, one negative aspect was that students spent less individualized time with their supervisor. Staun et al. (2010) evaluated student wards in existing units. They found that students on a student ward, with the support of their supervisor, seemed to become independent and assume responsibility for their own learning process.

According to the Swedish Higher Education Act (SFS, 1992), students should have the ability to make independent and critical judgments, and to independently identify, formulate and solve problems, and they should have the motivation to deal with changes in working life. Several studies have reported positive outcomes of training education wards (Lidskog et al., 2008, Lidskog et al., 2009, Ranse and Grealish, 2007, Ponzer et al., 2004, Reeves et al., 2002), as well as of peer learning (Secomb, 2007). To the best of our knowledge, only one study (Staun et al., 2010) has evaluated student wards in existing units. Our assumption is that, through peer learning on student wards, students should experience the same positive outcomes as they do on training education wards and achieve the goals of the Swedish Higher Education Act.

The aim of the present study was to describe how nursing students engaged in their clinical practice experienced two models of supervision: supervision on student wards and traditional supervision.

Section snippets

Design

A descriptive design with a qualitative approach was used.

Setting and subjects

The study was carried out in a surgical department with supervision for nursing students organized as student wards. A convenience sample of nursing students who had their clinical practice period during April to May 2008 on these wards were asked to participate. The students were in their final semester of a 3-year degree program in nursing. During two of the seven weeks, the students were supervised on a student ward. The remaining

Results

The findings are presented under the two themes: “assuming responsibility and finding one's professional role” and “being an onlooker and having difficulties assuming responsibility”. The themes are described by the categories they are comprised of, and the categories are supported by quotations from the interviews. The number in parentheses after each quotation stands for the interview the quotation was excerpted from. The categories within each theme are shown in Table 2.

Discussion

The main focus of the present study was on trying to understand how nursing students experienced two different supervision models: supervision on a student ward and traditional supervision. The results showed that students experienced supervision on a student ward as “assuming responsibility and finding one's professional role”. They described how the student ward gave them the opportunity to be independent and assume responsibility. Students believed in themselves and their knowledge and

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    Statements: On behalf of all the authors, the manuscript has not been published and is not being considered for publication elsewhere.

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