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  • 1.
    Bos (Sparén), Elisabeth
    Karolinska institutet.
    A good learning environment for nursing students in primary health care2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Clinical learning is a key part for developing nursingursing education. Previous studies concentrated on hospitals as placement sites. Research results reported in this dissertation identify factors that encourage good learning environments in primary health care (PHC) placements.

    Aims and methods: The overall aim of the present research was to identify factors that promote good clinical learning environments in PHC settings. Clinical learning environment was investigated from students 'and supervisors' perspectives and their perceptions of the clinical part of nursing education in PHC settings. The present research implemented three quantitative studies (I, II, III) and one qualitative study (IV). In study I investigated district nurses’ (DNs’) student supervision experiences in PHC units before and after implementation of a new supervision model; 98 of 133 DNs (74%) responded to a questionnaire before and 84 (65%) respondes after implementation. In study II validated the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES+T) scale. In study III investigated students’ motivation, total satisfaction, and experience of professional role models associated with dimensions in clinical learning environments. In studies II and III collected data from undergraduate nursing students (n=356) using the CLES+T scale. In study IV interviewed six focus groups with 24 supervisors (DNs); these data provided understanding of student supervision in PHC units.

    Results: Study I revealed significant need for a new supervision model in PHC units. Supervisors had difficulties staying updated on changes in nursing curricula and experienced insufficient support from universities. They felt that they had to set aside time from their regular duties and get permission from unit managers to supervise students. The supervisors felt confident in the supervisory role, but few had formal educational and academic credentials. After the new supervision model implementation, several supervisors were more satisfied with the supervision organization. The model implementation resulted in improvements within PHC units. Study II confirmed good internal reliability in the CLES+T scale and demonstrated that the five-factor model within the scale is the best-fit model. Supervisory relationship was the most important factor and it strongly correlated with these factors: (i) pedagogical atmosphere and (ii) premises of nursing. Supervisory relationship was moderately correlated with the role of the nurse teacher, and leadership style correlated with PHC units. Study III revealed a statistically significant association between (i) students’ motivation, total satisfaction, and experiences of professional role models and (ii) five dimensions of clinical learning environments. The satisfaction factor had a statistically significant association (effect size was high) with the dimensions; this clearly indicated that students experienced satisfaction. Supervisory relationship and pedagogical atmosphere particularly influenced students’ satisfaction and motivation. Study IV revealed three themes related to supervisors’ experiences during student supervision in PHC units: abandonment, ambivalence, and sharing the holistic approach. Supervisors felt abandoned by their managers, colleagues, and nurse teachers rom universities. They were proud to be DNs and willing to share experiences with students – yet torn between being students’ supervisors and patients’ nurses.

    Conclusion: This dissertation reports six main factors for good learning environments in PHC units. Supervisors must be prepared and engaged, and students must be motivated. A close, reflective supervisory relationship is one of the most important factors for learning in PHC units. Successful supervision requires clear structure and organization. Adequate support and resources from PHC units are needed for supervisors. Collaboration and liaison between universities and PHC units are needed to link theoretical and practical parts of nurse education. PHC-unit circumstances contribute to holistic nursing care, which is an important factor for student learning. Furthermore, the CLES+T scale was shown to be a reliable tool to use for evaluating PHC settings as clinical learning environment.

  • 2. Bos (Sparén), Elisabeth
    Läkemedlens påverkan på miljön2010Ingår i: Äldre, läkemedel och specifik omvårdnad / [ed] Margareta Grafström & J. Lars G. Nilsson, Lund: Studentlitteratur AB, 2010, 1, s. 45-48Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 3. Bos (Sparén), Elisabeth
    Obstipation2010Ingår i: Äldre, läkemedel och specifik omvårdnad / [ed] Margareta Grafström & J. Lars G. Nilsson, Lund: Studentlitteratur AB, 2010, 1, s. 133-138Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 4. Bos (Sparén), Elisabeth
    Sömnsvårigheter2010Ingår i: Äldre, läkemedel och specifik omvårdnad / [ed] Margareta Grafström & J. Lars G. Nilsson, Lund: Studentlitteratur AB, 2010, 1, s. 155-164Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 5.
    Bos (Sparén), Elisabeth
    et al.
    Center for Family Medicine, Department of Neurobiology, Care Sciences, and Society, Huddinge, Sweden.
    Alinaghizadeh, Hassan
    Karolinska institutet.
    Saarikoski, Mikko
    University of Turku, Finland.
    Kaila, Päivi
    Karolinska institutet.
    Factors associated with student learning processes in primary health care units: a questionnaire study2015Ingår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 35, nr 1, s. 170-175Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Clinical placement plays a key role in education intended to develop nursing and caregiving skills. Studies of nursing students' clinical learning experiences show that these dimensions affect learning processes: (i) supervisory relationship, (ii) pedagogical atmosphere, (iii) management leadership style, (iv) premises of nursing care on the ward, and (v) nursing teachers' roles. Few empirical studies address the probability of an association between these dimensions and factors such as student (a) motivation, (b) satisfaction with clinical placement, and (c) experiences with professional role models.

    OBJECTIVE: The study aimed to investigate factors associated with the five dimensions in clinical learning environments within primary health care units.

    DESIGN AND METHODS: The Swedish version of Clinical Learning Environment, Supervision and Teacher, a validated evaluation scale, was administered to 356 graduating nursing students after four or five weeks clinical placement in primary health care units. Response rate was 84%. Multivariate analysis of variance is determined if the five dimensions are associated with factors a, b, and c above.

    RESULTS: The analysis revealed a statistically significant association with the five dimensions and two factors: students' motivation and experiences with professional role models. The satisfaction factor had a statistically significant association (effect size was high) with all dimensions; this clearly indicates that students experienced satisfaction.

    CONCLUSIONS: These questionnaire results show that a good clinical learning experience constitutes a complex whole (totality) that involves several interacting factors. Supervisory relationship and pedagogical atmosphere particularly influenced students' satisfaction and motivation. These results provide valuable decision-support material for clinical education planning, implementation, and management.

  • 6.
    Bos (Sparén), Elisabeth
    et al.
    Center for Family and Community Medicine, Huddinge, Sweden.
    Alinaghizadeh, Hassan
    Karolinska institutet.
    Saarikoski, Mikko
    University of Turku, Finland.
    Kaila, Päivi
    Karolinska institutet.
    Validating the 'clinical learning environment, supervision and nurse teacher' CLES+T instrument in primary healthcare settings using confirmatory factor analysis.2012Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 11-12, s. 1785-1788Artikel i tidskrift (Refereegranskat)
  • 7. Bos (Sparén), Elisabeth
    et al.
    Craftman, Åsa
    Sophiahemmet Högskola.
    Följsamhet till läkemedelsordinationerna2010Ingår i: Äldre, läkemedel och specifik omvårdnad / [ed] Margareta Grafström & J. Lars G. Nilsson, Lund: Studentlitteratur AB, 2010, 1, s. 93-101Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 8.
    Bos (Sparén), Elisabeth
    et al.
    Karolinska institutet.
    Löfmark, Anna
    Högskolan i Gävle.
    Törnkvist, Lena
    Karolinska institutet.
    District nurses' experience of supervising nursing students in primary health care: A pre- and post-implementation questionnaire study.2009Ingår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 9, nr 6, s. 361-366Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Nursing students go through clinical supervision in primary health care settings but district nurses' (DNs) circumstances when supervising them are only briefly described in the literature. The aim of this study was to investigate DNs experience of supervising nursing students before and after the implementation of a new supervision model. Ninety-eight (74%) DNs answered a questionnaire before and 84 (65%) after implementation of the new supervision model. The study showed that DNs in most cases felt that conditions for supervision in the workplace were adequate. But about 70% lacked training for the supervisory role and 20% had no specialist district nurse training. They also experienced difficulty in keeping up-to-date with changes in nurse education programmes, in receiving support from the university and from their clinic managers, and in setting aside time for supervision. Improvements after the implementation of a new model chiefly concerned organisation; more DNs stated that one person had primary responsibility for students' clinical practice, that information packages for supervisors and students were available at the health care centres, and that conditions were in place for increasing the number of students they supervised. DNs also stated that supervisors and students benefited from supervision by more than one supervisor. To conclude, implementation of a new supervision model resulted in some improvements.

  • 9.
    Bos (Sparén), Elisabeth
    et al.
    Karolinska institutet.
    Silén, Charlotte
    Karolinska institutet.
    Kail, Päivi
    Karolinska institutet.
    Clinical supervision in primary health care: experiences of district nurses as clinical supervisors - a qualitative study2015Ingår i: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 14, nr 39Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Learning in the clinical environment is an important part of nursing education. Several recent studies focusing on clinical learning have been based on hospital settings. Little is known about primary health care (PHC) as clinical environment where district nurses (DNs) or nurses supervise students. It is important to understand more about opportunities and difficulties in supervising in this area in order to develop PHC as an optimal learning environment for nursing students. The main objective of this study was to gain an understanding of supervisors’ experiences of supervising undergraduate students at PHC units.

    Methods A qualitative research approach was used to collect data and analyse supervisors’ experiences. Six focus groups were carried out with 24 supervisors. Focus group data were audio-taped. The data were analysed using an inductive content analysis.

    Results Three themes illustrated supervisors’ experiences: abandonment, ambivalence and sharing the holistic approach. Supervisors felt abandoned by their managers, colleagues and nurse teachers from universities. They experienced ambivalence due to simultaneously being supervisors for students and carrying out their daily work with patients. At the same time, they were proud to be DNs and willing to share their unique role to apply a holistic approach and continuity in patient care with students.

    Conclusion When supervising students in PHC, social support and communication between supervisors and their colleagues and management as well as nurse teachers need to be taken into consideration both at universities and at primary health care units.

  • 10.
    Bullington, Jennifer
    et al.
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Söderlund, Mona
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Bos Sparén, Elisabeth
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Kneck, Åsa
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Omérov, Pernilla
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Cronqvist, Agneta
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Communication skills in nursing: A phenomenologically-based communication training approach2019Ingår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 9, s. 136-141Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this article is to present a communication skills training curriculum for nursing students, based upon phenomenology. Research shows that nurses have difficulty prioritizing dialogue with patients, due to lack of time, organizational and cultural factors. Like other health care professionals, nurses may also have difficulties communicating with patients due to personal fears and shortcomings. The communication training curriculum based upon phenomenology aims at systematically training students to stay focused upon patients' and relatives' narratives, allowing them to reflect upon and better understand their current situation. This approach to communication is applicable in any clinical situation where it important to provide space for the patients' experiences. The philosophical principles guiding the training are presented here as well as the practical steps in the program. Finally, the approach is compared to other common communication methods used in nursing (motivational interviewing, caring conversations, empathy training). The authors hope that the article will highlight the nurses’ role as dialogue partner as well as emphasize the importance of communication skills training in nursing education. This approach can be refined, tested and modified in future research and may serve as an inspirational model for creating a generic communicative competence for nurses.

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