Clinical Teaching as a Challenge in Transforming the Nursing Profession in Estonia

Kristel Kotkas,Larissa Jõgi,Anja Heikkinen

doi:10.7577/pp.3995

Abstract

The changes in European healthcare education, building on the Bologna Process, aimed at the integration of clinical work and teaching and promoted a holistic patient and learner-centred professional paradigm. The article, based on the findings of two qualitative studies (2017–2019), focuses on the transformation of the nursing profession in the context of the Estonian healthcare curriculum reform. Thematic written interviews accompanied by a drawing task were collected from clinical nurse teachers and graduating students. The data was analysed using hermeneutic content and comparative analysis. The findings showed that the students had internalised the patient-centred paradigm and integrated teaching into their clinical work, but their learning was hampered by the institutional atmosphere dominated by clinical values. Among the nurses, only the “ideal clinical teachers” had combined clinical work and teaching in their professional paradigm. The tensions in the clinical internship limit the attainment of the reformed profession.

Highlights

Healthcare education faces the presence of the medical and the patient-centred professional paradigms
The patient-centred healthcare paradigm emphasizes communication and functional and metacognitive knowledge to build on input from patients where declarative knowledge must be applied to solve problems or to plan learning and teaching (Ericson, Masiello, & Bolinder, 2012)
In the following we present the findings from the two studies on respectively clinical nurse teachers and the other on nurse students and how they have experienced the curricular reform in nursing

Summary

Introduction

Healthcare education faces the presence of the medical and the patient-centred professional paradigms. The patient-centred healthcare paradigm emphasizes communication and functional and metacognitive knowledge to build on input from patients where declarative knowledge must be applied to solve problems or to plan learning and teaching (Ericson, Masiello, & Bolinder, 2012). Previous research indicates how difficult it is to engage healthcare professionals in teaching, since they focus more on their development as mono-professional clinicians than as multiprofessional clinical teachers (Dent, Harden & Hunt, 2017; Kotkas, 2018). This is why many practitioners, managers and policymakers do not consider teaching in a hospital setting an important topic (Zabat & Stabler-Haas, 2009). The lack of a patient-centred approach can lead to misunderstandings and communication problems and hinder the development of a learner-centred environment during internships (Stoilnicova-Hartmann, Franssen, Augustin, Wouters, & Barnard, 2018)

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