Sulla base della teoria delle Comunità di Pratica e dell'Azione Situata, la ricerca si propone come scopo generale lo studio delle dinamiche interattive, relazionali e comunicative legate all’introduzione di una Cartella clinica medico-infermieristica informatizzata da parte di Comunità di Pratica professionali, composte da medici ed infermieri. Il primo obiettivo è quello di studiare in un’ottica psicosociale la creazione (primo studio) e il funzionamento (secondo studio) di Comunità di Pratica professionali nate intorno alle Nuove Tecnologie, tenendo conto anche se e in quale misura una comunità che segue un nuovo paradigma di interazione sociale possa essere considerata una vera e propria Comunità di Pratica. Il secondo obiettivo è quello di affinare una metodologia di indagine psicosociale in riferimento alle dinamiche che si concretizzano all’interno delle Comunità di Pratica, senza dimenticare la dimensione dell’Identità/Soggettività. I risultati, in un'ottica esplicativa di comprensione delle dinamiche sottostanti all’essere parte di una Comunità di Pratica o all’iniziare a farne parte, hanno restituito interessanti risvolti dal punto di vista interpersonale e organizzativo, con particolare riferimento alla costituzione e allo sviluppo delle due Comunità di Pratica e agli aspetti comunicativi e identitari della relazione medico-infermiere. Il terzo e ultimo obiettivo è provare a rispondere al quesito: per le Comunità di Pratica è possibile parlare di ‘Soggettività di pratica’? Per fare questo, una riflessione teorica conclusiva si propone di collegare il costrutto di Comunità di Pratica ai recenti sviluppi teorici sulla Soggettività. / According to the Community of Practice and the Situated Action Theories, the general aim of the research is the evaluation of the interactive, relational and communicative dimensions of the introduction and use of an interactive clinical-nursing record by medical professionals (doctors and nurses) Communities of Practice. In particular, the two studies investigate, from a psychosocial perspective, the emergence (first study) and the process (second study) of Communities related to the New Technologies, estimating if this kind of communities can be properly considered as Communities of Practice, referring also to the Identity/Subjectivity dimension. The results offers interesting practical implications -from the interpersonal and organizational point of view- on communication and identity aspects of the relationship among colleagues and between doctors and nurses. The last objective is then to try to answer to the question if it’s possible to assume a “subjectivity of practice”: a conclusive theoretical proposal aims to rely the Community of practice theory to the recent progress in Subjectivity concept.

Made available in DSpace on 2016-06-02T20:45:41Z (GMT). No. of bitstreams: 1 5323.pdf: 1239824 bytes, checksum: e10265e2651b624739cc1f4f8d63986e (MD5) Previous issue date: 2013-04-09 / This is a qualitative study aimed to evaluate the limits and possibilities for implementation of user embracement and risk assessment. In particular, from the perspective of local health managers of San Carlos, a town in the state of São Paulo. To collect the data, some semi-structured interviews were conducted with managers of the municipal health system: 61.53% graduated in nursing, 15.38% in medicine, 7.69% in dentistry; 7.69% in management and production engineering. The data were analyzed through thematic analysis. For this research, after collecting and analyzing data, six categories emerged from the analysis: (1) user embracement by organizing the service, (2) undesirable reality or constructed intentionally, (3) something intended but not accomplished, (4) A dream under construction, (5) learning to learn in daily service, (6) speaking the same language. From this definition, the study pointed out that there are different conceptions of user embracement , due to the approach assumed by each manager as suitable. There are also disparities in taking user embracement and under risk assessment as a procedure, possibly as a result of intricate political actions on health. To implement user embracement and risk assessment, it was possible to perceive the existence of limits and possibilities, with regards to organization of the service, local reality, care approaches, quality of assistance, permanent and continuing education as well as networking. / Trata-se de um estudo qualitativo cujo objetivo foi avaliar por onde perpassam os limites e possibilidades para implantação do acolhimento com avaliação de risco. Em específico, na perspectiva dos gestores municipais de saúde de São Carlos, uma cidade do interior do estado de São Paulo. Para coleta de dados, foram realizadas entrevistas semi-estruturadas com gestores do sistema municipal de saúde: 61,53% graduados em enfermagem; 15,38% medicina; 7,69% odontologia; 7,69% administração e 7,69% engenharia de produção. Os dados foram tratados através da análise temática. Para esta pesquisa, após coleta e análise dos dados, emergiram seis categorias de análise; (1) O acolhimento organizando o serviço; (2) Realidade não desejada ou construída intencionalmente; (3) Desejo algo e pratico outro; (4) Um sonho em construção; (5) Aprendendo a aprender no cotidiano do serviço; (6) Falar a mesma língua. A partir dessa delimitação, o estudo apontou que existem diferentes concepções sobre o acolhimento, em decorrência do modelo de atenção que cada gestor assume como sendo resolutivo. Também há disparidades em assumir o acolhimento com avaliação de risco como prática, possivelmente por questões políticas intrincadas nas ações em saúde. Para implementação do acolhimento com avaliação de risco, foi possível perceber a existência de limites e possibilidades, no que diz respeito à organização do serviço, realidade local, modelos de atenção, qualidade da assistência, educação permanente e continuada, trabalho em rede.

The thesis named "Current practice and possible ways of implementing clinical supervision in nursing" is the first doctoral dissertation establishing the concept of supervision in the Czech nursing environment. Itscentralresearch questionis as follows: How do nurses and university educators in nursing construct, interpret and practically apply theconcept ofclinical supervision and the supervisor's role in the context of nursing education at specific institutions of tertiary education and clinical nursing practice in the Czech Republic? The author draws on international theoretical literature and local empiricalevidence.Her qualitative research took the form of 26 semi-structured interviews with academic nursingeducators from the entire Czech Republic. In justified cases those are supplemented with qualitative data obtained through the study of legislative, policy and strategic documents in nursing and health care, including publicly available information and sources on clinical supervision, in order torefine the resulting picture of her interpretation of current clinical supervision practice in Czech nursing. A shift to the constructivist paradigm enabled one to conceive the term "clinical supervision" mainly in relation to learning, training and professional development of supervisees, also in the context of transformation of education and supervision not only of nurses but also of supervisors themselves in the Czech Republic. The author also focuses on the philosophical and theoretical foundations of clinical supervision and application of the postmodern approach in egalitarian clinical supervision. The empirical part of this dissertation is based on the qualitative research conducted. The author gradually presents her results as individual categoriesand relations between them that ensued from the analysed data in the process of open coding. The author draws a link between the category of implementation of clinical supervision in the context of nurses' professional education andexternal conditions, the environment and a broader professional and social-cultural context. Clinical supervision in nursing is constructed mainly as a unidisciplinaryconcept and a part of the nursing profession. The university nursing educatoris typically constructed as a role professional, but there is also an ongoing process ofdiversification, stratification, profiling and professionalization of non-academic nursing educators. Based on a content analysis of documents and post-modern philosophical-theoretical foundations and strategies of legitimizingclinical supervision, the author views the concept of clinical supervision in nursing as socially constructedand discursively legitimated. The author also defines the limitations of her research that arise from the choice of a qualitative research design. In the conclusion she outlines some future trends of clinical supervision in particular educational institutions that can be interesting and inspiring not only for supervisors but also for teachers of supervision themselves. Based on the results of her empirical analysis the author emphasises the need to integrate the theory and practice of education, clinical supervision and nursing. A comprehensive structure and methodology of system-wide implementation of clinical supervision, based on the situation of clinical nursing practice and supervision needs in the Czech Republic,should in future formthe basis of innovation of existing university programmes in nursing and approaches to the education and training of supervisors, as well as the subject of new research in clinical supervision.

Dans le système de santé québécois, il est attendu des infirmières qu’elles développent et démontrent un niveau élevé de leadership clinique infirmier [LCI] dans leur pratique. En effet, des auteurs soutiennent que le développement de cette compétence est primordial à l’optimisation de la qualité des soins et de la sécurité des patients (Goudreau, Pepin, et al., 2015; Stanley et Stanley, 2018). D’autres soutiennent que l’exercice du LCI présente un important défi pour les infirmières nouvellement diplômées [IND] qui continuent d’apprendre à prioriser, à organiser les soins et à déléguer (Benner, 2001; Ekström et Idvall, 2015). Une recension des écrits sur le LCI des IND n’a permis d’identifier que cinq recherches-clés. Elles portent sur le processus de développement du LCI (Pepin et al., 2011), ainsi que sur les moyens de soutenir ce développement et l’exercice de cette compétence en milieux cliniques (Chappell, & Richards, 2015 ; Ekström et Idvall, 2015 ; Larue et al., 2013 ; Won, 2015). À notre connaissance, seules une recension systématique (Chappell et Richards, 2015) et quatre études qualitatives (Ekström et Idvall, 2015 ; Larue et al., 2013 ; Pepin et al., 2011 ; Won, 2015) se seraient intéressées à l’exercice du LCI spécifiquement chez des IND. Ces articles illustrent les difficultés rencontrées très tôt dans la pratique des IND. Le développement et l’exercice du LCI permettent aux infirmières de faire face à l’exercice de leur rôle professionnel et ultimement à l’amélioration de la qualité de la prestation de leurs soins. Afin de mieux comprendre comment les IND exercent cette compétence auprès des patients, ce mémoire de recherche, publié par article, s’intéresse au parcours expérientiel du LCI chez des IND. Grâce et à une posture épistémologique constructiviste (Guba et Lincoln, 1994), cette étude descriptive interprétative (Thorne, 2016) avait comme but de décrire le parcours expérientiel de l’exercice de cette compétence infirmière à travers la première année de pratique professionnelle. De plus cette étude avait comme autre objectif d’identifier les éléments du contexte de pratique qui facilitent ou contraignent l’exercice de cette compétence chez les infirmières bachelières nouvellement intégrées dans le milieu professionnel. Pour y arriver, le cadre de référence de cette étude reposait essentiellement sur le modèle de développement de l’expertise professionnelle (Benner, 2001), ainsi que sur la notion d’individuation au travers des parcours de vie, élaborée par Carpentier et White (2013) Grâce à un échantillonnage de convenance, huit infirmières ayant respectivement 1, 5 (n=2), 6 (n=3), 10 ou 11 mois de pratique clinique, ont été recrutées dans un centre hospitalier universitaire francophone. Des entretiens semi-dirigés d’une durée de 45 à 60 minutes ont été effectués. Une analyse de contenu thématique (Thorne, 2016) selon la méthode proposée par Paillé et Mucchielli (2016) a été réalisée. Les résultats indiquent que pour les IND le LCI est difficile à exercer durant les premiers mois de pratique clinique. Néanmoins, l’exercice de cette compétence s’avère évolutif et exponentiel à l’expérience clinique. Sur une trajectoire de 12 mois, les IND décrivent cinq manières cumulatives d’exercer leur LCI dans leur pratique clinique au chevet des patients, soit par 1) le maintien d’une qualité des soins optimale ; 2) la collaboration et la communication efficace avec les équipes inter et intra professionnelle 3) l’adoption du rôle de précepteur clinique ; 4) l’implication professionnelle au-delà des soins aux patients 5) la consultation des résultats scientifiques à des fins d’amélioration des pratiques. De plus, celles-ci identifient différents facteurs facilitants et contraignants l’exercice de cette compétence. Ces facteurs se regroupent dans trois grandes catégories, soit : 1) les équipes de soins, 2) les quarts de travail, ainsi que 3) les ressources. Cette étude contribue au développement des connaissances sur le LCI et fournit des pistes quant aux stratégies permettant d’appuyer l’exercice de cette compétence critique au sein de la pratique infirmière. Les IND sont une ressource précieuse « et tout devrait être mis en œuvre pour améliorer la rétention des effectifs et réduire le roulement de personnel de ce segment important de la main-d’œuvre infirmière » (Fallatah, Laschinger et Read, 2017, p. 173, traduction libre). Ainsi, de nombreuses pistes de réflexion ont été proposées pour la pratique, la recherche, ainsi que la formation. / In the Quebec health system, nurses are expected to develop and demonstrate high level of clinical nursing leadership (CNL) in their practice. In fact, researchers argue that the development of this competency is essential to optimizing the quality of patient care and patient safety (Goudreau, Pepin & al., 2015; Stanley & Stanley, 2017). Other researchers argue that the exercise of CNL presents a significant challenge for newly graduated nurses (NGN) who are still trying to learn how to prioritize, organize and delegate care (Benner, 2001; Ekström & Idvall, 2015). We found only five key research studies from our review of the CNL of new graduated nurses. They focus on the development process of this competency (Pepin & al., 2011), as well as ways to support this development and exercise it in clinical settings (Chappell & Richards, 2015, Ekström & Idvall, 2015, Larue & al., 2013, Won, 2015). To our knowledge, a systematic review (Chappell & Richards, 2015) and only four qualitative studies (Ekström & Idvall, 2015; Larue & al., 2013; Pepin & al., 2011; Won, 2015) have focused on CNL practice in NGNs specifically. The literature provides an understanding of the development of this nursing competency, with landmarks of its exercise, but remains silent regarding the pathways of its exercise. In order to better understand and complement the existing research, this qualitative interpretive descriptive study (Thorne, 2016) based on a constructivist epistemological theory (Guba & Lincoln, 1994), described the experiential path of exercising CNL among NGNs in their first year of professional practice, including the identification of elements that facilitated or impeded its exercise, from their perspective. The conceptual framework guiding this study encompasses the development of clinical nursing expertise (Benner, 2001) and the notion of individuation through life courses (Carpentier & White, 2013). Through convenience sampling, eight nurses with respectively 1, 5 (n=2), 6 (n=3), 10 or 11 months of clinical practice, respectively, were recruited from a francophone university hospital center. Semi-structured interviews varying in length from 45 to 60 minutes were conducted with each of the nurses recruited. A content analysis based on themes (Thorne, 2016) according to the method proposed by Paillé & Mucchielli (2016) was carried out. The results indicate that for NGNs, it is difficult to exercise CNL during the first months of practice. However, the exercise of this nursing competency is evolutionary and exponential to clinical experience. We found that over a 12-month period, NGNs identified five cumulative ways of exercising their CNL in their bedside clinical practice, either by 1) maintaining an optimal level of quality of their patient care; 2) collaboration and effective communication with the care team; 3) adopting the role of clinical preceptor; 4) professional involvement beyond the patient care; 5) improving practices through consulting scientific evidence. In addition, we identified various factors facilitating and impeding the exercise of their CNL. In all, these advanced-beginner nurses identified four facilitating factors and five impeding factors. We conclude that the influence of organizational contexts and institutional cultures plays a role in the exercise of this particular leadership competency at the beginning of clinical practice is present. These factors are grouped into three main themes: 1) teams; 2) shifts and 3) resources. We believe that this study contributes greatly to the literature and provides insights into strategies to support the practice of this critical competency in nursing practice. In addition, we hope that this study will serve as a guide for health institutions in adopting strategies that support the exercise of CNL in the nursing field. NGNs are a valuable resource “and every effort should be made to improve retention and reduce turnover of this important segment of the nursing workforce” (Fallatah, Laschinger & Read, 2017, p. 173). Thus, many recommendations have been proposed for practice, research, as well as education.

Text in English / The purpose of this study, was to identify and describe factors, which facilitate or impede learning in clinical learning settings. The study adopted an exploratory descriptive approach, incorporating both quantitative and qualitative designs. Data collection tool, comprised of two sections: Section 1 focused on demographic characteristics. While section 2 addressed study variables of clinical setting, staffing, patient care/ practice standards, nurse manager's commitment and interpersonal relationships. The last section had two parts; part 1 being close ended Likert type scale ranging from strongly agree to strongly disagree. Part 2, was open ended, and solicited respondents' feelings opinions and experiences on factors they perceived to facilitate or impede clinical learning. The findings indicate that the majority of settings studied did not provide adequate factors to facilitate clinical learning. Factors such as availability of learning experiences, acceptable unit organization, space and resource availability, and accessibility to students, adequate staffing with qualified staff who actively participate in teaching, appropriate and quality patient care role modelled, lecturer availability and involvement in clinical teaching, team building and inclusion of students in the team, committed nurse managers involved in students' learning, conducive relationships among staff, students and patients, comfort relationships, advocacy and creating conducive relationship by the nurse manager, were identified as necessary for learning. These factors however, were found to be either lacking, inadequate or inaccessible to students. Findings were based on data from a quota sample of 202 participants proportionately drawn from students, nurse managers and nurse lecturers. The study made recommendations to improve and enhance the conduciveness of clinical practice settings used for learning in Botswana. / Health Studies / D.Litt. et Phil. (Advanced Nursing Science)

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

Text in English / The purpose of this study, was to identify and describe factors, which facilitate or impede learning in clinical learning settings. The study adopted an exploratory descriptive approach, incorporating both quantitative and qualitative designs. Data collection tool, comprised of two sections: Section 1 focused on demographic characteristics. While section 2 addressed study variables of clinical setting, staffing, patient care/ practice standards, nurse manager's commitment and interpersonal relationships. The last section had two parts; part 1 being close ended Likert type scale ranging from strongly agree to strongly disagree. Part 2, was open ended, and solicited respondents' feelings opinions and experiences on factors they perceived to facilitate or impede clinical learning. The findings indicate that the majority of settings studied did not provide adequate factors to facilitate clinical learning. Factors such as availability of learning experiences, acceptable unit organization, space and resource availability, and accessibility to students, adequate staffing with qualified staff who actively participate in teaching, appropriate and quality patient care role modelled, lecturer availability and involvement in clinical teaching, team building and inclusion of students in the team, committed nurse managers involved in students' learning, conducive relationships among staff, students and patients, comfort relationships, advocacy and creating conducive relationship by the nurse manager, were identified as necessary for learning. These factors however, were found to be either lacking, inadequate or inaccessible to students. Findings were based on data from a quota sample of 202 participants proportionately drawn from students, nurse managers and nurse lecturers. The study made recommendations to improve and enhance the conduciveness of clinical practice settings used for learning in Botswana. / Health Studies / D.Litt. et Phil. (Advanced Nursing Science)