Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Creativity and Power: A Qualitative, Exploratory Study of Student Learning Acquired in a Community Nursing Setting That Is Applied in Future Settings

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Creativity and Power: A Qualitative, Exploratory Study of Student Learning Acquired in a Community Nursing Setting That Is Applied in Future Settings

Article excerpt

Nursing students undertake clinical placements in a wide range of clinical areas as part of their preparation for professional prac- tice (Commonwealth of Australia, 2002). Within an organisation in the health system, each clinical area provides opportunities for students to learn about the clinical context and the work of nurses in that area. One such placement area for students is primary health and community based nursing care - a clinical area currently gaining more prom- inence in Australia (Commonwealth Department of Health and Aged Care, 2010; Douglas et al., 2009; Keleher, Parker, & Francis, 2010). In order to prepare undergraduate nursing students for work in this area, learning experiences must reflect approaches that are contemporary and rel- evant to primary health care, an experience that the acute sector is not always able to provide (Ali, Watson, & Albutt, 2011).

Community nursing units share an emphasis on primary health care, are nurse led and uti- lise philosophies and approaches such as self- management and harm minimisation as central to the care provided (van Loon, 2008b). In these units, community nurses are seen as visitors in the community of the patient rather than the native inhabitants of a health care system as is the case with nurses who work in hospitals. Accordingly, this has implications for the relationship between nurse and patient and involves a different dynamic of power (Russell, Daly, Hughes, & op't Hoog, 2003). Community nurses work with clients in a way that encompasses the person and their health needs as well as the client's lifestyle, workplace, culture and family (Brookes, Daly, Davidson, & Hancock, 2004). Caring for people in their own physical and social environment involves more uncertainty and is more uncontrolled than caring for people in hospitals. Community nurses pro- vide care to people across the life span in diverse settings that are situated in the social context in which people live (van Loon, 2008a).

The context of practice for students on com- munity nursing placements means that they may spend time in a variety of settings that differ in the nature of the clinical work as compared to an acute care setting, but have important alignments to the uniqueness of community practice. For example, students may spend time undertaking health screening in a school health clinic or with a home visiting community health nurse under- taking wound management. While on the surface these activities and settings are quite different from one another, the underlying approaches and recognition of the person situated within their own social context are similar. Issues of power, partnership and self-management have a differ- ent emphasis in the community setting where clinicians draw on specialised knowledge to prac- tice effectively in collaboration with their clients (SmithBattle, Diekemper, & Leander, 2004). Such knowledge is not always explicitly taught but for students an immersion in such a setting can lead to greater understanding of these con- cepts (Lave & Wenger, 1991).

This research explores the implicit knowledge that is gained by students in a community nursing placement and whether this new learning is then transferred to other settings.

Background

Schön (1987) suggests there is more to work- ing in a profession than that which is able to be described by practitioners and organisations. Schön recognised that practitioners were continu- ally doing things and making decisions that they weren't always able to explain and that formal education was not easily able to teach. Despite the inability to articulate what constitutes good practice, practitioners are able to recognise the work of other practitioners in their discipline and agree on what is sound or not sound practice. Despite this broad agreement amongst practitio- ners, Schön realised that it was difficult for them to articulate why they had done what they had done. Schön described this as professional artistry. …

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