Although I was trained as a nurse, I became curious about the views of psychiatric nursing staff as to what they feel would create a clinical learning environment for them. This was as a result of having my dearly beloved father admitted to a medical ward, and being on the receiving side of care. This created a fear in me that surprised me. I was scared at how my father would be treated if I was not present to witness his care. As a nurse, strangely, I felt that I could not trust the nurses to provide safe clinical care for/with my father. I began to feel concerned about the competencies of nurses as I observed the care that was being offered to him. My observation and experience was that the ward environment generated an atmosphere that needed a form of nursing care that was collaborative and transparent where the hand-over between professionals communicated the needs of the patients in their care – from making sure that patients’ bedding is comfortable, to checking whether they are trying to communicate something, to being sure that their medication has been properly given. This aroused my curiosity as to whether nursing staff themselves had views as to what is needed to have, or to create, an environment that sustained their original urge to take up nursing in the first place. I thus became curious to investigate the views and experiences of both qualified and non-qualified psychiatric nurses with the aim of improving the clinical learning environment within acute adult inpatient wards, as well as secure adult and male adolescent mental health inpatient wards, as these wards raise crucial issues to do with control, power, seclusion, rights and responsibilities, issues that are not easy for nurses to learn to deal with in their classroom training. For this study I interviewed sixteen staff members of wards within the National Health Service and the private sector. The staff varied in their experiences and qualification, from qualified mental health nurses to non-qualified nurses. My findings show that: (1) Nurses often felt the ward organisation had hindered their learning through the way in which it worked to organise them. (2) Nurses would have liked to experience a different kind of learning. However they were not sure in what way or how they would like the learning experience to be. (3) The expert nurses were able to work in a competent manner despite the sense of the organisation organising their practices, as they were able to sense which of the limited number of organisational possibilities were open to them so that their choices allowed for their practices to be learning experiences as well as providing sound clinical care. (4) Learning dialogues happen in contexts where nurses feel supported and where the episode of care in which they are engaged is also supported by a team approach and resourceful pulling together of skills and abilities. (5) There was a lack of space(s) for the nurses to use for reflection. (6) Nurses also expressed the need for supervision after an episode or critical event had taken place. (7) Throughout all the areas I inquired into, what was strongly echoed was that the psychiatric nurses all felt that they needed a voice within the organisation and its hierarchy of team structures within these wards. There was a felt sense that the nurses wanted and at times needed more expert nurses working in the teams. Overall, I was struck by the abilities which were brought to the forefront as the nurses shared their views and experiences of how they felt organised by the organisation. They were able to explore the factors that they felt would improve the quality of care that nurses provide and were able to share what they believe will help them in co-creating standards for how the clinical environment could become a learning environment for the nurses.

Diss. (sammanfattning) Umeå : Univ., 2005. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 93-100).

The process of environmental degradation is increasing, amazingly, and its effects are felt, everyday, in social and work spaces. However, few measures are taken to rein this process. We live in a "Risk Society", where environmental risks are part of human daily life, although these risks are not thought or reflected, but only confronted by individuals supposedly protected by protective cocoons, which are based on continuity of institutionalized routines, in the sense of ontological security and in the elements characteristic of High Modernity. However, when strategies for environmental education are offered to the individuals, becomes feasible for them to reflect about their behavior and be motivated to change. In this context, the objective of this research was to describe as it is developed the environmental education in a hospital, from the individuals directly involved in its planning and formal executing . Methodologically, we adopted a qualitative approach, using the research method of case study, and as collection procedures we use documentary research and semi-structured interview. The study was developed in one hospital of the Grupo Hospitalar Conceição and had as research subject the individuals who joined the Center for Environmental Education of this hospital and other people indicated by them. In this process, based on Content Analysis, we built five thematic axis. The first axis discusses the concepts of the research subjects about environment and environmental education, composing six categories of analysis. The second axis reflects about the experiences of the Hospital Conceição in environmental education, comprising four categories. The third axis describe the consequences of environmental education actions in the context of High Modernity, composing two categories of analysis. The fourth axis refers to discussion about difficulties and challenges of environmental education within the healthcare institution, covering six categories. And finally, the fifth axis of this research shows a possible way to develop environmental education in a hospital. At the end of this study it was concluded that the actions of environmental education in this institution are isolated, fragmented and limited to practices by individuals or groups interested in this theme; therefore it is necessary: an environmental institutional policy that works as a financial, legal, structural and human support to develop environmental actions; a group entirely focused on the discussion and elaboration of environmental activities in the hospital; and, furthermore, it is very important the involvement of managers with environmental cause. Despite these challenges, environmental education developed at the institution represents a small, but important step towards the construction of a complex environmental knowledge necessary in a context of Reflexive Modernity. / O processo de degradação ambiental cresce, assombrosamente, e seus reflexos são sentidos no cotidiano social e nos espaços de trabalho. Contudo, poucas medidas são tomadas no sentido de freá-lo. Vivemos em uma Sociedade de Risco , onde os riscos ambientais são parte do cotidiano humano, ainda que não sejam pensados ou refletidos, apenas autoconfrontados por indivíduos supostamente protegidos por casulos protetores; que se baseiam na continuidade de rotinas institucionalizadas, na noção de segurança ontológica e nos elementos característicos da Alta Modernidade. No entanto, quando são oportunizadas, aos sujeitos, estratégias de educação ambiental torna-se viável que eles reflitam sobre seus comportamentos e se motivem para a mudança. Diante desse contexto, o objetivo desta investigação foi descrever como acontece a educação ambiental (EA) em uma instituição hospitalar, a partir dos indivíduos diretamente envolvidos no seu planejar e executar formal. Metodologicamente, adotou-se a abordagem qualitativa, do tipo estudo de caso, como método de pesquisa; e como procedimentos de coleta, a pesquisa documental e a entrevista semi-estruturada. O estudo foi desenvolvido junto a um dos hospitais do Grupo Hospitalar Conceição, tendo como sujeitos os indivíduos que integraram o Núcleo de Educação Ambiental e informantes por eles indicados. Nesse processo, com base na análise de conteúdo, construíram-se cinco eixos temáticos. O primeiro eixo discute as concepções dos sujeitos da pesquisa acerca de meio ambiente e de educação ambiental, contemplando seis categorias de análise. O segundo eixo reflete sobre as experiências do Hospital Conceição em termos de Educação ambiental, compondo quatro categorias. O terceiro aborda as consequências das ações de EA em um contexto de Alta Modernidade, englobando duas categorias de análise. O quarto eixo remete a discussão das dificuldades e desafios da EA dentro da instituição de saúde, conglomerando seis categorias. E por fim, o quinto eixo desta pesquisa trilha um caminho possível para o desenvolvimento da EA no contexto hospitalar. Ao final desse estudo, concluiu-se que as ações de EA na instituição em questão são pontuais, fragmentadas e limitadas as práticas de dados indivíduos/grupos interessados no tema; carecendo portanto de: uma política ambiental institucional que funcione como um arcabouço financeiro, legal, estrutural e humano para o desenvolver das ações; de um grupo voltado integralmente a discussão e ao efetuar de atividades no aspecto ambiental; e de envolvimento das chefias. Apesar desses desafios, as ações de EA desenvolvidas na instituição representam um pequeno, mas importante passo, em direção a construção de um saber ambiental complexo e necessário em um contexto de Modernidade Reflexiva.