Studied how Swedish nursing students developed their perceptions of caring for older adults during their 3 years in nursing education. Interviews were audiotaped at the end of each academic year with 27 students from three colleges of nursing. In addition, 26 of these students wrote diaries during the clinical part of the course, in the second and third years. The interviews and diaries were analyzed using the phenomenological hermeneutic method, which is based on the idea that an interpretation of people's narrated, lived experiences is focused on the utterance meaning (Ricoeur, 1976). Four themes of caring emerged: respect for individual patients, responsibility for patients' well-being, sympathy with patients, and empathy with patients. Three themes emerged that were connected with impediments to caring: students' vulnerability, frustration and powerlessness in difficult situations, and ethically difficult situations. Findings revealed a development in the students' perceptions of caring as they proceeded through their education, moving from a naive, caring perspective, via a second-year stage of deeper relationships with patients, into a third-year organizational perspective, where they used their gained knowledge and experiences in taking responsibility for providing optimum care. Two students' narratives are used to illustrate the interpretations.
The overall aim of this longitudinal research project was to elucidate and reach an understanding of influencing aspects on nursing students' choice of future work area as newly graduated nurses. The influencing aspects should be affiliated with the three-year education, the students' transition into nursing and the care of the elderly. The first study (I) concerned the amount of projected education in gerontology and geriatrics in 30 colleges of nursing and health, and the result showed a variety between colleges. Newly admitted nursing students in three colleges responded to a questionnaire. A majority of the students preferred to work in the emergency care, rather than elder care, after graduation. Phenomenological analyses of one interview theme, after one year (II), gave two phenomena; patients' helplessness and identification/nonidentification of the individual patient. Phenomenological hermeneutic analyses were carried out on all interviews and diaries provided from the three years (III-V). The findings (III) show that the rneaning of caring for elderly patients was a process from naive caring via deeper relationships with patients to an organizational perspective. The transition into nursing (IV) meant for the students a process from a natural interest in caring to the perspective of an RN, where co-operation with team members had a strong influence. The students' experiences of theoretical and clinical elder care were not positive, which meant that their reluctance to work there was reinforced (V). Content analyses about students' reasoning regarding two fictitious elderly patient cases (Vl) showed a development in reasoning in a more acute oriented case but not in a case with a confused elderly patient. Conclusions drawn imply that both the theoretical and the clinical education in gerontology and geriatrics need to be strengthened.