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Att vara sjuksköterska: En studie av sjuksköterskeprofessionen avseende omvårdnad, handledning och utveckling
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Avhandlingens övergripande syfte var att klarlägga sjuksköterskors erfarenheter av sjuksköterskeprofessionen avseende omvårdnad, handledning och utveckling. Avhand‐lingen innefattar två kvalitativa (I, II) och två kvantitativa (III, IV) studier. Femton sjuksköterskor intervjuades sex år efter examen (I, II). Sjuksköterskorna var bland de första i Sverige med treårig sjuksköterskeutbildning. Handledare till sjuksköterske‐studenter i verksamhetsförlagd utbildning besvarade ett frågeformulär om handledning före/efter införd handledningsmodell (III, IV). I handledningsstudierna deltog 113 sjuksköterskor år 2000 (III) och 109 (III) respektive 142 (IV) sjuksköterskor år 2006. Svarsfrekvensen motsvarade ca 71% (III, IV). Innehållsanalys (I, II) och statistiska beräk‐ningar (III, IV) utfördes. Analysen visade att sjuksköterskor med treårig sjuksköterskeutbildning och sex års erfarenhet hade hittat sin nisch (II). Ingen ångrade sitt yrkesval. Många var under‐stimulerade samtidigt som de balanserade mellan påfrestning och stimulans (I) hinder och möjligheter (II). Flertalet var tveksamma till om de skulle orka arbeta fram till pensionsåldern (I, II). Inrättandet av en handledningsmodell som gav stöd till både sjuksköterskestudenter och handledare visade sig vara ett bra sätt i att organisera samverkan mellan handledare och lärare (III). Flertalet handledare var nöjda med det stöd de fått och upplevde säkerhet i handledarrollen (III). Emellertid, sjuksköterskor med och utan specialistutbildning värderade sjuksköterskestudenter olika (IV). Behovet av ett fokuserat lärande visades som ett mönster genom resultaten (I, II, III, IV). Avhandlingen visar genom resultaten att sjuksköterskor verkar i en komplex pro‐fession där det krävs skickliga sjuksköterskor för att klara det arbete sjuksköterskan är satt att sköta. För framgång i omvårdnad, handledning och utveckling är den lärande miljön central. En miljö där teori, praktik, forskning och reflektion vävs samman och där stöd, samverkan och professionell utveckling är ledstjärnor. Avhandlingen visar att en ökad samverkan mellan vårdverksamhet och universitet/högskola är nödvändig för att sjuksköterskeutbildningen och omvårdnadsarbetet skall kunna anpassas till hälso‐ och sjukvårdens ökade krav. Avhandlingens resultat kan användas som grund för fortsatta diskussioner med hänsyn till omvårdnadsvetenskap och beslut kring sjuksköterskans arbete såväl i utbildningssammanhang som i vårdverksamhet.

Abstract [en]

The overall aim of this thesis was to elucidate Registered Nurses’ (RNs) experiences of the nursing profession regarding nursing, preceptoring and professional development. The thesis includes two qualitative studies (I, II) and two quantitative studies (III, IV). Fifteen RNs were interviewed six years after graduation (I, II). These nurses were among the first in Sweden to graduate from the 3‐year Bachelor programme in nursing. Preceptors for nursing students in clinical education answered a questionnaire regarding experiences of the preceptor role before/after the introduction of a preceptor model (III, IV). In the studies related to preceptoring 113 RNs participated in 2000 (III), and 109 (III) respectively 142 (IV) RNs participated in 2006, with similar response rates of roughly 71% (III, IV). A content analysis (I, II), and statistic analysis (III, IV) were performed. The analysis showed that RNs graduates from the Bachelor programme in nursing, with six years nursing experience, had found their niche (II). None regretted the choice of profession. Several were under stimulated at the same time as they oscillated between strain and stimulation (I) and between obstacles and opportunities (II). The majority thought that growing old in nursing could prove to be difficult (I, II). The introduction of the preceptor model, with its support to both nursing students and preceptors, showed how to organize co‐operation between preceptors and teachers (III) successfully. The majority of the preceptors were satisfied with the support they had received and experienced a feeling of confidence in their role as preceptor (III). However, specialist nurses and non‐specialist‐nurses valued nursing students differently (IV). The necessity of adopting focused learning emerged as a pattern (I, II, III, IV). The results of the thesis show that RNs work in a complex profession that demands skilled nurses to accomplish the tasks they are required to perform. To successful nursing, preceptoring and development the teaching environment is pre‐dominant. It is an environment where theory, practice, research, feedback and reflection are interwoven and where support, co‐operation and professional development are the guiding‐stars. The thesis shows an increased co‐operation between the healthcare organization and university is necessary in order to adapt the nursing education and profession to the ever increasing demands in health care. The results of the thesis are a contribution to continued discussions regarding nursing science and RN’s work from both educational and health care context.

Place, publisher, year, edition, pages
Östersund: Mittuniversitetet , 2009. , p. 76
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 68
Keyword [en]
Registered Nurse, profession, nursing, preceptoring, development, experience, satisfaction, support, preceptor, preceptor model, nursing student, interview, questionnaire
Keyword [sv]
Sjuksköterska, profession, omvårdnad, handledning, utveckling, erfarenhet, tillfredsställelse, stöd, handledare, handledningsmodell, sjuksköterskestudent, intervju, frågeformulär
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-8716ISBN: 978-91-86073-32-9 (print)OAI: oai:DiVA.org:miun-8716DiVA, id: diva2:207865
Public defence
2009-03-20, Sal F214, Campus Östersund, Östersund, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2009-03-13 Created: 2009-03-13 Last updated: 2009-03-16Bibliographically approved
List of papers
1. Registered nurses' experiences of daily work, a balance between strain and stimulation: A qualitative study
Open this publication in new window or tab >>Registered nurses' experiences of daily work, a balance between strain and stimulation: A qualitative study
2007 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, no 7, p. 1221-1230Article in journal (Refereed) Published
Abstract [en]

The challenges in the health care have given rise to a highly stressful work situation and a more complicated role for registered nurses (RNs). Qualitative studies about daily work as a whole is limited. It is therefore vital for future development of nursing knowledge and nursing education to recurrently investigate RNs' experiences of their ability to grasp and manage their daily work situation and to promote a high quality of care. Aim: The aim of this study was to explore RNs' experiences of their daily work. Methods and participants: This follow up study was carried out involving 15 Swedish RNs six years after their graduation. Interviews, conducted with conversational strategy, were chosen for the data collection and content analysis was used to handle the interview texts. Results: The analysis resulted in a main theme 'to balance strain and stimulation', two themes and seven sub-themes. The first theme 'a stressful work situation' consisted of the sub-themes: 'to meet all demands', 'to be insufficient', 'to be unsure of oneself', 'too little contact with patient'. The second theme 'a stimulating work situation' consisted of the sub-themes: 'to encounter patients and health care staff is enriching', 'to have the situation under control', 'to have the skills necessary to be independent'. A pattern emerged throughout the themes, which showed that due to the increasing number of patients RNs' capacity for management, prioritising and planning out of team work, and performing exacting documentation diminished. Conclusion: The RNs' daily work has been illustrated as a scale of balance that oscillated between strain and stimulation; an oscillation towards strain could lead to a vicious circle. The RNs need support from the start through nursing education and continuously in profession. This is a crucial issue for nursing education and health care sector.

Keyword
Bachelor degree, Content analysis, Follow up study, Registered nurses, Stimulation, Strain
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-1195 (URN)10.1016/j.ijnurstu.2006.05.011 (DOI)000249253500016 ()16844126 (PubMedID)2-s2.0-34547494294 (Scopus ID)4121 (Local ID)4121 (Archive number)4121 (OAI)
Available from: 2008-09-30 Created: 2009-03-13 Last updated: 2017-12-13Bibliographically approved
2. Registered Nurses' perceptions of their work and professional development
Open this publication in new window or tab >>Registered Nurses' perceptions of their work and professional development
2008 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 61, no 1, p. 62-70Article in journal (Refereed) Published
Abstract [en]

AIM: This paper is a report of a study to elucidate Registered Nurses' perceptions of their work and professional development 6 years after graduation. BACKGROUND: Nursing education and health care has rapidly changed in the last two decades. Education and experience are important components in Registered Nurses' ability to promote a high quality of care, but a great deal depends on their work circumstances. This study emphasizes Registered Nurses' view of their work in health care, at a time in their career when they have several years of experience. METHOD: Data were collected in 2003 from in-depth interviews with 15 Registered Nurses 6 years after their graduation. The interviews were semi-structured and analysed with interpretive content analysis. FINDINGS: The findings revealed two themes and five sub-themes. The first theme, An appropriate but demanding profession, consisted of two sub-themes: 'having found one's niche' and 'growing old in nursing may be difficult'. The second theme, A profession with opportunities and obstacles, consisted of three sub-themes: 'being aware of Registered Nurses' potential', 'having knowledge that is seldom made use of' and 'attaining professional growth is no matter of course'. CONCLUSION: Keeping Registered Nurses' satisfied and avoiding their dissatisfaction is crucial for both educators and employers. It is essential that employers give priority to Registered Nurses' time with patients and to motivate and support them in professional development. Further intervention studies regarding a change of the balance between obstacles and opportunities are needed.

Keyword
empirical research report, interviews, job satisfaction, occupational
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-4377 (URN)10.1111/j.1365-2648.2007.04466.x (DOI)000251771800006 ()18034817 (PubMedID)2-s2.0-37249077961 (Scopus ID)5284 (Local ID)5284 (Archive number)5284 (OAI)
Available from: 2008-11-29 Created: 2008-11-29 Last updated: 2017-12-12Bibliographically approved
3. Being a personal preceptor for nursing students: Registered Nurses' experiences before and after introduction of a preceptor model
Open this publication in new window or tab >>Being a personal preceptor for nursing students: Registered Nurses' experiences before and after introduction of a preceptor model
2009 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 1, p. 161-174Article in journal (Refereed) Published
Abstract [en]

Aim. This paper is a report of a study to compare Registered Nurses’ experiences of acting as personal preceptors for nursing students in the year 2000 with the year 2006 and explores relationships between preceptors’ experiences and personal/clinical characteristics.

Background: Preceptoring is experienced as stressful and challenging. How successful preceptors are in this role depends largely on the support they receive. Knowledge about preceptors’ experiences over time and in relation to a preceptor model is limited.

Method: Data were collected by questionnaire in 2000 (n=113) and 2006 (n=109) with preceptor groups in a hospital in Sweden before and after introduction of a preceptor model. Data were analysed with descriptive and correlational statistics using parametric and nonparametric methods.

Findings: Statistically significant improvements were noted in preceptors’ experiences between 2000 and 2006. Statistically significantly more preceptors in 2006 reported that they felt prepared for their role and felt support from teachers, colleagues, chief nurses and enrolled nurses. Least improvement was seen in relation to the questionnaire items workload, constructive feedback and support in linking research results to practice. A strong positive relationship existed between preceptors’ experiences of the preceptor role and the level of interest in preceptoring.

Conclusion: The preceptor model offers a way to support and facilitate preceptors and to develop co-operation between university and hospital. Future research should focus on students’ experiences, experiences of first-time preceptors, head preceptors and teachers from a longitudinal perspective.

Keyword
experience, preceptor, preceptor model, questionnaire, Registered Nurses, support, nursing students
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-7098 (URN)10.1111/j.1365-2648.2008.04855.x (DOI)000261783500016 ()19032507 (PubMedID)2-s2.0-57649229264 (Scopus ID)
Available from: 2008-12-10 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
4. Preceptoring nursing students: Registred Nurses´ perceptions of nursing students´ preparation and study approaches in clinical education
Open this publication in new window or tab >>Preceptoring nursing students: Registred Nurses´ perceptions of nursing students´ preparation and study approaches in clinical education
2010 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 30, no 4, p. 296-302Article in journal (Refereed) Published
Abstract [en]

Preceptorship influences Registered Nurses’ (RNs) daily work to different degrees depending on nursing students’ knowledge, and willingness to learn. Consequently, it is of the utmost importance to investigate how RNs assess nursing students in clinical education. The aim of this study was to describe RNs’ perceptions of nursing students’ preparation and study approaches at hospital workplaces, and to explore relationships between RNs’ perceptions and their personal/clinical characteristics. A cross-sectional design was used. In 2006, 142 of 196 RNs at a Swedish hospital answered a questionnaire (response rate 72.5%). The majority of RNs (63–84%) rated students’ study approaches highly and thought students comprehended the outcomes of learning. Fewer (45–49%), rated students as having adequate theoretical knowledge highly and were of the opinion that they had acquired knowledge about the unit. Statistically, non specialist nurses rated significantly higher compared with specialist nurses. Significant positive correlations were found between the RNs’ perceptions of nursing students and their interest in preceptoring. The extent to which preparation programmes, established in collaboration between a university and a hospital, had improved preceptors and nursing students was not graded. Further descriptive and intervention studies are therefore needed.

 

Keyword
Preceptoring; Questionnaire; Registered Nurses; Nursing students
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-8717 (URN)10.1016/j.nedt.2009.08.004 (DOI)000276796800005 ()19735962 (PubMedID)2-s2.0-77949315803 (Scopus ID)
Available from: 2009-03-13 Created: 2009-03-13 Last updated: 2017-12-13Bibliographically approved

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