EMPIRICAL STUDIES

doi: 10.1111/scs.12169

Developing preceptorship through action research: Part 1 Yvonne Hilli PhD, RNT (Project Manager, Associate Professor)1,2 and Hanna-Leena Melender PhD, RMT (Principal Lecturer)3 1

Novia University of Applied Sciences, Vaasa, Finland, 2Oslo and Akershus University College of Applied Sciences, Oslo, Norway and VAMK, University of Applied Sciences, Vaasa, Finland

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Scand J Caring Sci; 2015; 29; 470–477 Developing preceptorship through action research: Part 1 Clinical preception in practice plays a significant role in both registered and practical nurse studies. As such, the cooperation between the faculty and working life is important to narrow the theory–practice gap, with emphasis being placed on a student-oriented approach promoting self-direction and lifelong learning. The aim of this project was to develop the preceptorship at five different units within the health-care sector in western Finland by implementing an action research (AR) approach. This article is the first of a two-part article on the project, focusing on a cultural analysis and the development of preception models conducted within the project. The five units participating in the study were the following: a long-term care ward in the community, a ward for people with dementia, a geriatric ward, a medical ward and a surgical ward representing specialised care. The starting point of the study was a cultural analysis, which was

Introduction In Finland, clinical preception in practice plays a significant role in the training of both Registered Nurses and practical nurses. As the nursing programmes integrate both theoretical and clinical studies, the nursing teachers are responsible for the theoretical and clinical teaching (1). In Finland, the extent of clinical education in different clinical settings forms 90 ECTS/210 ECTS (ECTS = 27 hours of the student’s work) of the Registered Nurse programme (Bachelor of nursing) and 30 study weeks/180 study weeks (study week = 40 hours of the student’s work) of the practical nurse programme. The purpose of clinical education is to introduce students to the activities of the social and health-care services and their value base, to enhance the ability of the students to reflect upon theory in different practical situations (2, 3).

Correspondence to: Yvonne Hilli, Novia University of Applied Sciences, Vaasa, Finland. E-mails: [email protected] or [email protected]

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made in all the five units to obtain a ‘bottom-up’ perspective. In each of the five units 3–5 nurses were appointed to become members of the core groups. This meant that all the units would start from the perspective of their own working environment when creating a preception model that would fit into their particular workplace. During this process, the participants received continuous support from the researchers. Several workshops and seminars were also arranged to further support the core groups and staff. The models were implemented and tested during the academic year 2010–2011 followed by an evaluation of the project. The evaluation results will be presented in the second part of the two-part article. The project showed that reflective practice and critical thinking can be improved through an AR approach. Keywords: preceptorship, clinical education, Registered Nurse, practical nurse, health care, action research. Submitted 5 February 2014, Accepted 29 June 2014

There are, however, many challenges, for both teachers of nurses and preceptors, when changing inappropriate and outdated approaches and in developing new practices that better meet the student learning needs in clinical education (4). In this article, the term ‘nurse’ is used interchangeably for both registered and practical nurses. Clinical preceptorship is defined as a ‘one-to-one relationship between a staff nurse and a student nurse during an intense, time-limited clinical experience, with the support of the nursing faculty to facilitate student learning and provide an evaluation of course objectives’ (5: 2). The one-to-one preceptorship model is rather common in undergraduate nursing education in the Scandinavian countries (5, 6). In a nursing context, concepts like supervisor or mentor are sometimes used instead of the term preceptor. In this study, we use the term preceptor. In Finland, at present, there exist no general recommendations concerning the work experience a nurse has to have before starting to precept nursing students. In a study by Carlson, only a few preceptors had ever © 2015 Nordic College of Caring Science

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completed a preceptorship training programme (7). As such, the competence level of the preceptors varies. Moreover, it is quite usual that there is no time allocated for preceptorship, and the preceptors precept the students while performing their own duties as nurses (7, 8). As it is difficult to obtain a reduction of workload, preceptors often have to balance patient care with the demands of preceptorship, leading to feelings of stress and inadequacy (2, 8). When a student-oriented approach is emphasised, the theory–practice gap can be narrowed, which is conducive to the promotion of self-direction and lifelong learning (2, 9). However, reflection is not always a planned activity. More often, reflection depends on the students’ own activity and the will to reflect (10). It is worth noting, though, that the students themselves state that reflection is essential, interesting and necessary for their learning. According to them, if reflection, for example, is limited to a conversation during a coffee break, it feels trivial and like a joke (11). According to the students, the preceptors really do play an important role in supporting the students’ professional development and the development of critical thinking (12). This is supported by Spitzer and Perrenoud (13) who found a widening gap between theory and practice. A recent study showed that research and development were excluded from the everyday life of the hospital units, leaving the student nurses somewhere between hospital practice, that is the real world of production, and the theoretical world of education and research (14). Although preceptors consider the support from colleagues to be important, they value and need feedback and support from the nursing teachers to strengthen and develop their preceptor competence (2, 8, 15). This is supported by earlier research, which has shown that a strong link and communication between the faculty and the clinical staff promotes a more effective integration of theory and practice (16). This study was an interprofessional project (2009– 2103) between two universities of applied sciences, two vocational institutes and four health-care organisations. The primary target group consisted of professionals within the health-care sector and nursing teachers at the universities of applied sciences and the vocational institutes. The aim of this study was to develop the preceptorship at five different units within the health-care sector in western Finland by implementing an action research (AR) approach. The research question was how can preceptorship be developed through an AR approach?

about research in action rather than about action itself. It is a collaborative process, meaning that there is active participation by those working towards solutions. AR seeks to develop aspects of practice by combining action and reflection, theory and praxis. In this sense, it differs from the traditional research approach, where research participants are viewed as subjects rather than collaborators. In AR, action and knowledge are joined in a simultaneous process of knowledge generation. The ideas must be appropriate in terms of being an active process of questioning old models as well as reconstructing and reenhancing ideas in relation to the values and interests of the host culture. Although AR is a broad concept, cooperation and critical reflection are necessary for the process to work. Moreover, AR is about people reflecting upon and improving their own practice by tightly interlinking their reflection and action. It is about making their experiences public to other people concerned by and interested in the respective practice (17, 18). Action research is fundamentally grounded in a qualitative research paradigm, which is designed to gain greater clarity and understanding of a question, problem or issue. The AR process starts by posing a rather broadly defined question, problem or issue. AR, in its most effective forms, is phenomenological; focusing on people’s lived experience and reality; as well as being interpretive and hermeneutic; and focusing on people’s interpretations of activities by incorporating the meaning people make of events in their lives (19). Moreover, AR can be time-consuming and frustrating, creating a role duality, especially if the researcher as an outsider initiates change that is not fully owned by the participants, or is resisted. The project will be presented as a two-part article. This first part will focus on the development of preception models and a cultural analysis, as a starting point. The findings from the cultural analysis unfolded the experiences, beliefs and attitudes of nurses in five units. Furthermore, documents used before, during and after clinical education implementing evidence-based practices were developed. AR seeks to develop aspects of practice by combining action and reflection, theory and praxis. The culture analysis served as a tool for reflection among practising nurses. The evaluation of the project will be presented in the second part. We were inspired by AR, founded on a partnership between the researchers and participants, which is educative, advancing knowledge and exploring the application of theory. AR is a cyclic process of different phases: problem identification, action planning, use of action to change practice and evaluation (20).

Methodology

Recruitment and settings

Action research is a process by which change is achieved and new knowledge about a situation is generated. It is

The leaders of nurses within four health-care organisations were sent an invitation to participate in this project.

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Five units within these organisations subsequently expressed an interest to participate. The partners in this study were two universities of applied sciences, two vocational institutes and five health-care development units in a region in western Finland. The project was interprofessional, including Registered Nurses, practical nurses and nursing teachers from the organisations. The units were selected after taking into account their geographical placement and characteristics. The five units represented were as follows: a long-term care ward in the community, a ward for people with dementia, a geriatric ward, a medical ward and a surgical ward representing specialised care. These wards functioned as clinical placements for both nurses and practical nursing students, with the qualified nurses acting as their preceptors. The staff were explained the purpose of the project and their possibility to lead for change by participating in the study. At each unit, 3–5 nurses, both practical and Registered Nurses, volunteered to be appointed by the head nurse to become members of the core groups. The schedules for the core groups were planned in close cooperation with the head nurses. Two researchers were appointed as contact persons to each unit.

Ethical considerations All the health-care professionals and student nurses in clinical practice were informed about the project and its aims by the management at the units. Moreover, both oral and written information about the project was given to the staff in the five units by the researchers. The participants were informed that their confidentiality was assured, that participation was voluntary and that they could withdraw from the project at any time without giving any reason. According to Finnish regulations, no ethical application was needed. Approval for conducting the cultural analysis, however, was granted from the management in the organisations. In this regard, we have followed the guidelines of the National Advisory Board on Research Ethics (21).

with quick access to the material. In this respect, the members of staff in each unit were asked to put in writing how it is to function as a clinical preceptor in their ward. However, many meetings were held together with the staff before asking them to put anything in writing. The meetings had an important function, above all to prepare the staff at the units (22). The researchers spent several days at the units to better understand the working conditions of the wards. Together with the head nurse, it was decided when the cultural analysis should take place. The members of staff were allowed to complete the written assignment during working hours, which was then posted into a sealed box on the ward. After 4 weeks, the boxes were collected for analysis. In one ward, there were so few letters that we decided to complete the data collection with interviews among the nurses. The head nurse asked for nurses who would be willing to volunteer to participate in the interview, and five nurses agreed. The interviews took place during working hours and lasted approximately 45–60 minutes. The interviews were transcribed verbatim. All collected data were then analysed by the researchers using method content analysis. Qualitative content analysis is an interpretive process, focusing on subject and context, and dealing with differences and similarities between, and within, parts of the text (23). The letters and transcripts were read through several times by the researchers to obtain a sense of the whole. From this, meaning units, each comprising several words, sentences or paragraphs related to each other through their content and context, were condensed and labelled with codes. The codes and meaning units were interpreted in context, compared for differences and similarities, and abstracted (23). Through reflection and discussion, the researchers agreed on and formulated two unifying themes Fig. 1.

Findings The cultural analysis – a bottom-up perspective

Data collection and analysis The starting point in this project was to make a cultural analysis to be able to understand how and what the members of staff were thinking and how they were acting. This was carried out by analysing the workplace as an organisation, in an attempt to grasp the culture of the workplace and discover the kind of professional rules that exist. The first data collection, in the reflection and problem identification phase, took place in autumn 2009. Specifically, a cultural analysis was conducted at the five units, using the letter-writing method (22). This method was chosen because we wanted to reach as many members of the staff as possible and provide the researchers

The findings from the cultural analysis are presented as two emerging themes: perspectives on preceptorship and organisational aspects on preceptorship. Perspectives on preceptorship. Overall, there was a positive attitude towards preceptorship and students at the units. ‘It’s quite all right to precept students at the same time as caring for patients’ (U2). It was emphasised that preceptorship should be characterised by warmly welcoming the students to the unit and instilling an atmosphere where the students felt safe and dared to ask questions. I would like the students to receive a nice warm welcome when they come to our unit. In this way, © 2015 Nordic College of Caring Science

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The trustworthiness of the study was enhanced by the presence of experienced researchers, who analysed the data of the cultural analysis. The results were subsequently presented and discussed in all the units, where the researchers had the possibility to ensure the interpretation of the written letters. A limitation is that all staff did not participate in the cultural analysis although efforts were made to introduce it well. During a final seminar, the core groups presented their developed models and their experiences of the project.

Conclusions The project has shown the nurses’ great interest and capacity to develop preception models in close cooperation with researchers based on their specific needs through an AR approach. During this process, reflective practice and critical thinking was improved. However, pedagogical further education should be arranged on a regular basis to strengthen the knowledge base of the preceptors. Furthermore, enough time for preceptorship should be allocated, as it is a pedagogical duty. The implication of this project is that more cooperation between universities of applied sciences, vocational institutes and health-care units is needed, to increase interprofessional education and narrow the gap between theory and praxis.

References 1 Heinonen N. On-the-job learning and supervised training in health care education in Finland.Recommendations for social welfare and health care establishments. Ministry of Social Affairs and Health, Helsinki:MSA;2004. MSA report 22 (In Finnish). 2 Landmark BTH, Hansen Storm G, Bjones I, Bøhler A. Clinical supervision – factors defined by nurses as influential upon the development of competence and skills in supervision. J Clin Nurs 2003; 12: 834–41. 3 Lambert V, Glacken M. Clinical education facilitators: a literature review. J Clin Nurs 2005; 14: 664–73. 4 Saarikoski M, Warne T, Kaila P, LeinoKilpi H. The role of the nurse teacher in clinical practice: an empirical study of Finnish student nurse experiences. Nurse Educ Today 2009; 29: 595–600. 5 H€ aggman-Laitila A, Eriksson E, Meretoja R, Sillanp€a€a K, Rekola L. Nursing students in clinical practice developing a model for clinical

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Acknowledgement We wish to thank the staff on the five development units, the researchers and the students who participated in this project.

Author contributions Yvonne Hilli was responsible for the design and for drafting the manuscript. The article was written in close collaboration with Hanna-Leena Melender. Both authors are in agreement with the content of the manuscript.

Ethical approval According to Finnish regulations, no ethical application was needed. Approval for conducting the cultural analysis was granted from the management of the health-care organizations.

Funding This project has been funded by the European Social Fund, the European Union, Novia University of Applied Sciences, VAMK, University of Applied Sciences, YA! Vocational Education and Training and Vaasa Vocational Institute.

supervision. Nurse Educ Pract 2007; 7: 381–91. Luhanga FL, Billay D, Grundy Q, Myrick F, Yonge O. The one-to-one relationship: is it really key to an effective preceptorship experience? A review of the literature. Int J Nurs Educ Scholarsh 2010; 7: 1–15. Carlson E. Precepting and symbolic interactionism – a theoretical look at preceptorship during clinical practice. J Adv Nurs 2013; 69: 457–64. Carlson E, Pilhammar E, WannHansson C. Time to precept: supportive and limiting conditions for precepting nurses. J Adv Nurs 2010; 66: 432–41. Jokelainen M, Turunen H, Tossavainen K, Jamokeeah D, Coco K. A systematic review of mentoring nursing students in clinical placements. J Clin Nurs 2011; 20: 2854–67. Hilli Y, Melender H-L, Jonsen E. The experience of being a preceptor for nurse students in clinical practice – a cross-sectional qualitative study. Learn Commun Int J Learn Soc Cont Aust 2011; 1: 78–93.

11 Jonsen E, Melender H-L, Hilli Y. Finnish and Swedish nursing students’ experiences of their first clinical practice placement — A qualitative study. Nurse Educ Today 2012; 33: 297–302. 12 Thorkildsen K, R aholm M-B. The essence of professional competence experienced by Norwegian nurse students: a phenomenological study. Nurse Educ Pract 2010; 4: 183–8. 13 Spitzer A, Perrenoud B. Reforms in nursing education across western Europe: from agenda to practice. J Prof Nurs 2006; 3: 150–61. 14 Lindberg E, Persson E, Bondas T. The responsibility of someone else: a focus group study of collaboration between a university and hospital regarding the integration of caring science in practice. Scand J Caring Sci 2012; 26: 579–86. 15 Hyrk€as K, Shoemaker M. Changes in the preceptor role: re-visiting preceptors0 perceptions of benefits, support and commitment to the role. J Adv Nurs 2007; 60: 513–24.

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Those who are preceptors could be valued for their work done: they could be given the possibility to participate in pedagogical courses. . . some reward might spur them on a little. . . it’s not always obvious. . . not everybody is suitable as an instructor or preceptor. (U5) The nurses hoped that the cooperation between the units and the faculties would develop more. They also hoped that the nurse teachers in charge of the students’ clinical education would be more present at the units. Better cooperation with the school, more frequent contacts with the nurse teachers. The nurse teacher should come together with the student on the first day of practice and meet with the preceptor before the work begins. (U1) The nurses hoped that the nurse teacher would be more in contact with the clinical preceptor at the unit, helping the student to plan how to reach the learning outcomes. The preceptors also expressed that they needed support from the nurse teacher to cope with different situations. The preceptors also wanted to share the responsibility of preceptorship with other colleagues and not be left alone. ‘It’s good if there can be two preceptors for one student. Preceptorship has changed during the last years and has become much more demanding’ (U2). However, having two preceptors was also seen as somewhat challenging, especially if one of the nurses was working parttime. I think it’s quite difficult to act as a preceptor. . . I don’t know if it’s because I work part time. Although you are not available to the student all the time, you are responsible all the time. When two members of staff are sharing the responsibility it becomes more difficult for the student to know who to turn to and who is in charge. (U2) It was emphasised that it was important that the students followed the same working schedule as the preceptors. As many nurses work part-time, it was considered important that the student has two preceptors. If not, another preceptor should be appointed as a stand-in. But as a stand-in, the preceptor is not up to date with the situation of the student. ‘Many times one has to be a stand in for the regular preceptor, but then you’re not really updated with what the student needs or knows’ (U2). However, a shared preceptorship was also considered good because the student will see that two staff members might work and do things differently. All units considered it important to further develop the introduction of the students by creating material and documents to support this. The first day when the students come to the unit someone should have time to go through the routines at the unit in peace and quiet. Someone from the staff should be assigned for the students that entire day and not care for the patients. (U5)

The preceptors felt that they knew too little about the students and their background. Therefore, many thought it would be important to create a document where the students could write a short presentation of themselves, their knowledge base and previous experience. I would very much like to have a presentation of the students and their actual level concerning their studies when coming to our unit – you don’t want to drag out everything. . . (U1) Overall, preceptorship was neither considered to be a planned and structured activity nor commonly discussed about. In this respect, preceptorship was a duty done at the same time as caring for the patients and not considered as a separate pedagogical duty. According to the nurses, there should be more discussions about preceptorship and it should also be structured and made visible. It would be beneficial to have some kind of common discussions together with the staff at the unit about preceptorship and about common principles and routines at the unit. (U4) Many preceptors expressed the need for further pedagogical education. They wanted regular meetings together with the nurse teachers responsible for the students’ clinical education to gain support from them concerning evaluation and preceptorship. Furthermore, they wanted more cooperation with the faculties to be updated with curriculum development and teaching methods.

Developing preceptorship at the units – the action In spring 2010, the findings of the cultural analysis were presented and discussed at each unit. The cultural analysis gave a ‘bottom-up’ perspective as a starting point, showing that our partners were five different cultures with different problems, needs and expectations. All the units started to create a preception model, based on their own experience, which would fit into their particular workplace. The participants received continuous support from the researchers during this process. During the action phase, our aim was to implement evidence-based practices (24). The description of how these practices were based on the best evidence available will be presented in another article. The practices implemented are presented in Table 1. Once the units had tested their developed preception models for 1 year (2010–2011), the process was evaluated at the five units (Table 1). Documents to support the preceptorship process were created in all units from somewhat different perspectives. Moreover, the preceptorship process was structured according to its stages with the aim of being a ‘roadmap’ (U1, U2, U4). One unit focused especially on developing the process of preceptorship, to obtain a clearer and more common structure at the unit. They developed an instrument serving as a practical tool for preceptors, clarifying © 2015 Nordic College of Caring Science

Developing preceptorship Table 1 Practices in the action phase Practice

Target group

Cultural analysis Delivery of the national researchbased guidelines for preception Further education

Pilot units Pilot units

Seminar 1 Seminar 2 Workshops 1, 2, 3 Publication of an algorithm on patient-centred clinical education Continuing pedagogical support Testing Web-based technology between the clinical placement and the faculty

All the staff of the organisations involved Pilot unit core groups All the staff of the organisations involved Pilot unit core groups All the staff of the organisations involved Pilot unit core groups One pilot unit and another unit of an organisation involved

core concepts and the responsibility of different stakeholders. In particular, the introduction phase was focused on and developed (U1, U3, U4, U5). A manual was also developed in some units for this purpose. As the units wanted to know more about the students and their background, a form was created whereby the students could give a short presentation of themselves. In an effort to make preceptorship more visible, new guidelines were created. The preceptor was to schedule sessions with the student, and document time was spent on preceptorship (U1). Furthermore, attention was paid to the need to schedule for planned reflection sessions (U1, U3). One unit developed preceptorship for students who had their practice placement far away from the faculty. They decided to test and develop the use of new technology, that is Adobe Connect Pro, in the preception and evaluation of the students. This enabled the student and the preceptor to be in regular contact with the nurse teacher despite the distance. As a parallel process, documents concerning the student’s presentation, the working schedule, an evaluation form and an algorithm on patient-centred clinical education were developed in close cooperation with nurse teachers and representatives from the health-care organisations. This was carried out in an effort to develop similar and uniform documents for all students.

Discussion The starting point of the project was a cultural analysis. The members of staff reflected on how it is to function as a preceptor in the units. The results of the analysis showed that all five units had different strengths and challenges. The nurses were concerned that there was no clear structure or enough time allocated for preceptorship. Because of this, all of the units focused on © 2015 Nordic College of Caring Science

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developing their introduction for the students. As they wanted to make preceptorship more visible, document time spent with the students was introduced. In this respect, the preceptors expected more cooperation with the nurse teachers, to know the students’ learning objectives. Reflection and critical thinking were an ongoing process throughout the project, with support from the nursing teachers. During the seminars and workshops, daily routines were questioned and discussed, to stimulate and promote the development process. New Webbased technology was proven to be a good method in precepting students who had their practical placements far away from the faculty. All five development units developed their own preception model during the project time, which they implemented during the academic year 2010–2011. An earlier study (8) showed that only a few preceptors have received further pedagogical education in preceptorship. In this project, the nurses expressed the need for continuous further education to be arranged to strengthen their pedagogical knowledge. The project showed that a close cooperation between researchers and nurses has a great impact when the goal is to lead for change and transformation in thinking. Reflection and extending the knowledge and understanding of the participants is a starting point in the process of change. The units developed a clearer strategy and structure to introduce and support the students in their learning process (15). The project had given preceptorship a ‘face’ and space at the units. The discussion about preceptorship was elevated to a new level. The nurses now not only talked about ‘doing’, but about preceptorship as a process to support the students in the process of becoming professional nurses. The strength of the project lay in the fact that the core groups and the nurse teachers participating in the project were very committed to the work done. Moreover, as the management was positive towards the goals of the project, they allocated time for the nurses in the core groups to work in the project. Another important factor that enabled the health-care units to participate was the fact that the project itself was financed externally. With regard to the factors mentioned above, there was a positive atmosphere towards developing preceptorship. However, a challenge for the project was due to turbulence in the health-care sector. In one unit, the core group had difficulties in getting started due to the arrival of many new members, as a result of some sick leaves and changes of work placements. Two other units lost members of their core groups either because of workplace changes or because one nurse did not want to continue in the core group. Finding replacements was time-consuming; it also took time for the new group members to catch up with those who had been participating from the start. A lack of staff was also a challenge in terms of enabling the core groups to continue with their work.

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The trustworthiness of the study was enhanced by the presence of experienced researchers, who analysed the data of the cultural analysis. The results were subsequently presented and discussed in all the units, where the researchers had the possibility to ensure the interpretation of the written letters. A limitation is that all staff did not participate in the cultural analysis although efforts were made to introduce it well. During a final seminar, the core groups presented their developed models and their experiences of the project.

Conclusions The project has shown the nurses’ great interest and capacity to develop preception models in close cooperation with researchers based on their specific needs through an AR approach. During this process, reflective practice and critical thinking was improved. However, pedagogical further education should be arranged on a regular basis to strengthen the knowledge base of the preceptors. Furthermore, enough time for preceptorship should be allocated, as it is a pedagogical duty. The implication of this project is that more cooperation between universities of applied sciences, vocational institutes and health-care units is needed, to increase interprofessional education and narrow the gap between theory and praxis.

References 1 Heinonen N. On-the-job learning and supervised training in health care education in Finland.Recommendations for social welfare and health care establishments. Ministry of Social Affairs and Health, Helsinki:MSA;2004. MSA report 22 (In Finnish). 2 Landmark BTH, Hansen Storm G, Bjones I, Bøhler A. Clinical supervision – factors defined by nurses as influential upon the development of competence and skills in supervision. J Clin Nurs 2003; 12: 834–41. 3 Lambert V, Glacken M. Clinical education facilitators: a literature review. J Clin Nurs 2005; 14: 664–73. 4 Saarikoski M, Warne T, Kaila P, LeinoKilpi H. The role of the nurse teacher in clinical practice: an empirical study of Finnish student nurse experiences. Nurse Educ Today 2009; 29: 595–600. 5 H€ aggman-Laitila A, Eriksson E, Meretoja R, Sillanp€a€a K, Rekola L. Nursing students in clinical practice developing a model for clinical

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Acknowledgement We wish to thank the staff on the five development units, the researchers and the students who participated in this project.

Author contributions Yvonne Hilli was responsible for the design and for drafting the manuscript. The article was written in close collaboration with Hanna-Leena Melender. Both authors are in agreement with the content of the manuscript.

Ethical approval According to Finnish regulations, no ethical application was needed. Approval for conducting the cultural analysis was granted from the management of the health-care organizations.

Funding This project has been funded by the European Social Fund, the European Union, Novia University of Applied Sciences, VAMK, University of Applied Sciences, YA! Vocational Education and Training and Vaasa Vocational Institute.

supervision. Nurse Educ Pract 2007; 7: 381–91. Luhanga FL, Billay D, Grundy Q, Myrick F, Yonge O. The one-to-one relationship: is it really key to an effective preceptorship experience? A review of the literature. Int J Nurs Educ Scholarsh 2010; 7: 1–15. Carlson E. Precepting and symbolic interactionism – a theoretical look at preceptorship during clinical practice. J Adv Nurs 2013; 69: 457–64. Carlson E, Pilhammar E, WannHansson C. Time to precept: supportive and limiting conditions for precepting nurses. J Adv Nurs 2010; 66: 432–41. Jokelainen M, Turunen H, Tossavainen K, Jamokeeah D, Coco K. A systematic review of mentoring nursing students in clinical placements. J Clin Nurs 2011; 20: 2854–67. Hilli Y, Melender H-L, Jonsen E. The experience of being a preceptor for nurse students in clinical practice – a cross-sectional qualitative study. Learn Commun Int J Learn Soc Cont Aust 2011; 1: 78–93.

11 Jonsen E, Melender H-L, Hilli Y. Finnish and Swedish nursing students’ experiences of their first clinical practice placement — A qualitative study. Nurse Educ Today 2012; 33: 297–302. 12 Thorkildsen K, R aholm M-B. The essence of professional competence experienced by Norwegian nurse students: a phenomenological study. Nurse Educ Pract 2010; 4: 183–8. 13 Spitzer A, Perrenoud B. Reforms in nursing education across western Europe: from agenda to practice. J Prof Nurs 2006; 3: 150–61. 14 Lindberg E, Persson E, Bondas T. The responsibility of someone else: a focus group study of collaboration between a university and hospital regarding the integration of caring science in practice. Scand J Caring Sci 2012; 26: 579–86. 15 Hyrk€as K, Shoemaker M. Changes in the preceptor role: re-visiting preceptors0 perceptions of benefits, support and commitment to the role. J Adv Nurs 2007; 60: 513–24.

© 2015 Nordic College of Caring Science

Developing preceptorship 16 Midgley K. Pre-registration student nurses perception of the hospital learning environment during clinical placements. Nurse Educ Today 2006; 26: 338–45. 17 Altrichter H, Kemmis S, McTaggart R, Zuber-Skerritt O. The concept of action research. Learn Organ 2002; 9: 125–31. 18 Williamson GR. Foundations of action research. In Action Research in Nursing and Healthcare(Williamson G R, Bellman L, Webster J eds), 2012, Sage Publications, London, 7–30.

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19 Stringer E. Action Research, 3rd edn. 2007. Sage Publications, London. 20 Williamson GR. Action research, nursing and healthcare. In Action Research in Nursing and Healthcare (Williamson GR, Bellman L, Webster J eds), 2012, Sage Publications, London, 51–65. 21 National Advisory Board on Research Ethics. Ethical principles of research in the humanities and social and behavioural sciences and proposals for ethical review. 2009, http://www.tenk.fi/eettinen_ ennakkoarviointi/ethicalprinciples.pdf (last accessed 25 January 2014).

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22 Berg G. Att f€orst a skolan (Understanding the School), 2003. Studentlitteratur, Lund (In Swedish). 23 Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004; 24: 105–12. 24 Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A, McCormack B. What counts as evidence in evidence-based practice? J Adv Nurs 2004; 47: 81–90.

Developing preceptorship through action research: Part 1.

Clinical preception in practice plays a significant role in both registered and practical nurse studies. As such, the cooperation between the faculty ...
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