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by Daniel Blakely

Learning How Nurses Learn

Data Analysis

(Janesick, 2000) • Inductive approach to analysis; hallmark of qualitative research

Data collection

(Green & Thorogood, 2004) • Observational methods are considered the gold standard of qualitative methods • They provide direct access to what people do and what they say

Learning Theories

Informal Learning

(Eruat, 2004) • Informal learning exhibits greater flexibility of learning in a variety of spaces (workplace learning) • Acts as a complementary partner with experience • Informal workplace learning: invisible- part of the invisible labour shared by ECNs- based on their tacit knowledge and experience • Tacit knowledge is personal and institutive • Based on an invisible form of learning embedded in nursing practice

(Koopmans et al., 2006) • Informal learning is interactive and interpersonal • The transfer of knowledge is one-to-one and local • Interpersonal/interactive learning; enacting between the same two individuals throughout weeks

(Marsick & Watkins, 2001) • Informal learning may also be incidental learning- learning takes place, yet not always aware of it (subconsciously learning) • Buddying, preceptoring and mentoring are forms of informal workplace learning

(Carter, 1995) (Menard, 1993) • Informal and incidental learning are often the result of a significant unexpected event

(Lave & Wenger 1991) (Colley et al. 2003) (Eraut, 2004) • Workplace and informal learning theory (critical views of what education and learning)

Formal Learning

(Marsick & Watkins, 2001) • Formal learning as a didactic pedagogic style: highly structured and institutionally-based)

(Benner, 1984) • How nurses learn through a continuum of novice to expert (Bleakley, 2006) • Dynamicist model of learning emphasizes the fluidity of clinical teams • Workers may differ, but operate together through time and space

Neonatal intensive care units (NICU)

(Premji & Chapman, 1997) (Paul, 2000) (Carter, 2006)(Gunderson & Kenner, 1988) • Complex subculture of NICU • Clear primary task for staff of survival • Nurses continue to learn from each other even after their structured educational program (university/ placement) • Role modelling occurs over time (when nurses who are skilled at implementing specific interventions/care practices support those who are not yet accustomed to the practices • Nurses are encouraged

(Hall & Weaver, 2001) • Research with medical registers apprenticed to experienced nurses showed that the apprenticeships led to registrars gaining a better understanding of nurses work and better communication

(Greenwood et al., 2000) • “Highly experienced NICU nurses are found to opt for routine nursing practices to protect themselves from the risks associated with ‘individualized’ clinical decisions”

(Spence, 2000) • Nurses get to know the infants, therefore differ from the opinions of doctors

(Ewing et al., 2003) • Nursing activities are organized by the dependence of their level of expertise • Requires staff to handle large volumes and different types of information when clinical decisions are made • Blurring of professional boundaries may influence how decisions are made • New nurses do not handle the most complex infants/experience the most highly technological intensive care (IC) nursing

(Paul, 2000) • Diverse staff act as a community: arrive from different beginnings and orientations • The relationship between nurses and doctors is extremely important (life and death decisions) • Monitored observations: how it feels if someone is looking over the nurses’ shoulder and the doctors are constantly watched

(Ohlinger et al., 2003) • Subculture (beliefs, norms, attitudes and assumptions learned over time by staff) • Learning is manifested subconsciously • Team collaboration (doctors & nurses) with a purpose represent the essence of why people do their work and assists guide decision-making

(Premji & Chapman, 1997) • Researchers found that all nurses encountered conflict with other healthcare professionals (doctors in training) in trying to practice an individualised model of care • Nurses struggle with those who do not adhere to /do not understand the specific model of care within the NICU • Nurses ability to learn continuously from others and through role modelling

Communal practices

(Premji & Chapman 1997, Boud & Middleton 2003, Koopmans et al. 2006) • Modern workplace learning models (continuously learning)

(Lave & Wenger, 1991) (Boud & Middleton, 2003) • Orientation of new staff to a ward= orientation into a community of practices

(Solomon et al. 2006) • Long-term workers develop practices from stages of learning (experimental) • Two dimensions: time and space

(Boud & Solomon, 2003) • Traditional model of worker (nurses: go to work, perform duties, go home)

Socio-cultural (background)

Atkinson & Pugsley, 2005) (Pope, 2005) • Ethnographic research used in medical settings for 50+ years

(Van Der Geest and Finkler, 2004): • “comment on the lack of studies focused on socio-cultural processes within hospitals