Learning How Nurses Learn

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

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

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

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

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

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

(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

(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

(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

(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

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

(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”

(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

(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

(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

Formal Learning

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

Informal Learning

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

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

(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

(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

(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

(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

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