Factors Affecting The Learning Of Nurses In Practice Settings

Nursing Knowledge and Its Conceptual Framework

Although nursing practice offers the best method of learning, different other factors plays a decisive role in determining the overall competency level in nursing. By applying different nursing learning theories, the paper intends to critically analyze and discuss the factors that enable nurses to learn in the practice setting. Specifically, the paper will focus on individual factors such as curiosity, motivation and job satisfaction. It will also focus on contextual factors such as learning setting and time, and organizational factors.

Before focusing on the factors identified above, it is important to give a conceptual frame of nursing knowledge. Carper’s article (1978) entitled “Fundamental Patterns of Knowing in Nursing” Is an American classic that, even today, is abundantly cited in the nursing literature. This article proposes four sources of nursing knowledge: empirical knowledge, ethical knowledge, personal knowledge and aesthetic knowledge. According to Dey, Kumar & Kumar (2014), nurses are expected not only to have basic technical nursing skills but also moral and ethical knowledge. Moral and ethical knowledge starts from personal morality, duty and professional obligations. In addition, ethics should not guide behavior, but rather should be complementary to reasoning in order to make just and responsible choices. While intrapersonal knowledge refers to self-knowledge, interpersonal knowledge refers to the ability of the nurse to relate to others. From there, it is of paramount importance in the nurse’s relationship with others both from a multidisciplinary point of view and with the patient. However, the context in which knowledge is inscribed becomes crucial. Thus, given the importance given to the particular context found in critical care, Contextual knowledge is an important anchor by its very nature. This form of knowledge it consists of procedural, material, organizational and social dimensions (Sadatsafavi, Walewski & Shepley 2015). As far as procedural dimension is concerned, nurses are expected to understand the procedures and the specific protocols, omnipresent things in the development of critical care expertise. On the other hand, the material point of view focuses on the knowledge of equipment and technology, ubiquitous tools in critical care. The organizational dimension mainly includes the organization of work and the recognition of the functions of the staff members who are part of the organization chart. Thus, the nurse who works in critical care can develop practical knowledge. Nei, Snyder & Litwiller (2015) revealed that practical knowledge is highly specialized and prescriptive. It consists of indices and standard behaviors that integrate similar and specific situations which are frequently found in critical care (Nei, Snyder & Litwiller 2015).

Individual Factors Affecting Nurses’ Learning

A study by Horwitz & Horwitz (2017) to determine physicians’ perspective on organizational commitment revealed that most nurses and physicians acquire knowledge through academic training, past life experiences, and personal beliefs. Appointed to know a priori, this last one joins in a way the perceptual knowledge and the practical knowledge because of its development which also takes form by the experience, the perceptions and the personal meanings while being anchored in a context. As for perceptual knowledge, it is characterized by the immediate knowledge of the care situation experienced by the patient. Perceptual knowledge differs from intuition, which is of the conscious order, whereas perceptual knowledge is preconscious (Sadatsafavi, Walewski & Shepley 2015). In fact, it develops from the experience of the nurse and the events in which the professionals are confronted. Finally, there is knowledge emancipatory. This is the kind of knowledge that corresponds to the critical examination of a situation of care or work. It is shaped by the beliefs and values ??of individuals (Sadatsafavi, Walewski & Shepley 2015). Socio-political criticism and the issues arising from it are important. Having established the conceptual frame of nursing knowledge, it is now easier to explore how the different factors highlighted in the introduction influence how nurses learn in the practice setting.

From an individual point of view, the attributes of the nurse have been identified as being critical in the development of their competence. Gordon, Rees, Ker & Cleland (2015), for example revealed that curiosity, motivation and job satisfaction have been highlighted as facilitators. On the other hand, Saks & Burke-Smalley (2014), while attempting to establish between transfer of training related and firm performance discovered that dissatisfaction significantly hinder learning. Some of the major individual factors include age, experience and passion. The experience, for example is intended to facilitate the development of psychomotor skills. Informal learning, an inherent part of the experience, has been seen as extremely important in the learning process.  Education level is also essential to updating technical skills. In sum, individual factors determine whether a nurse will benefit optimally or not. This means that the nurse?who develops his critical care skill is therefore perceived as someone with particular qualities or attributes that will cause him to take part as much to the care of the patient than to the acquisition of scientific knowledge (Bhadoriya and Chauhan, 2013).

The intensive care environment has been identified as critical to the development of nurses’ competence. The culture prevailing, as suggested by Burt (2013) is very crucial in the success of training and skill acquisition. Some nurses have specified that training in all its forms and updating are very important on intensive care units. However, the timing is often inappropriate, that is during working hours or break times. With regard to the condition of patients’ health, the nurse who works in the intensive care unit of a university hospital center is trained to use much of her judgment and knowledge because of the precariousness of the patients who are hospitalized there. Factors such as the nurse’s relationship with physicians, particularly older physicians, often lead to a lack of recognition, dissatisfaction and even demotivation.

Contextual Factors Affecting Nurses’ Learning

While the critical care environment can encourage independence, excellence and professionalism, leaders of health care organizations support employees in integrating their skills. Sharing decision making is a model of care because critical care nurses need to make decisions about their practice, procedures and protocols. While it has been shown that a good work climate and positive leadership (eg motivation and encouragement) can make a significant contribution to the development of competence. That is why Becker, Kernan, Clark & Klein (2015) stress the significance of dual commitment between organization and individuals. The head of unit within the team as the master key to learning because he is responsible in putting in place different organizational factors that are crucial to nurses. Whether it is through his personality, his expertise, the establishment of an adequate work climate or the offer of training, the participation of the leader is irrefutable in the learning process. While attempting to find out about persistence scale, Hart (2014) established that it is advisable for hospitals to offer critical care training so that new nurses feel a minimum level of confidence. For example, providing mentoring support for novice ICU nurses is an educational strategy that capitalizes on knowledge transfer and at the same time develops socialization in the community. However, critical care training for new nurses must be a major concern for unit leaders.

Conclusion

The analysis has demonstrated that unlike scientific knowledge, practical knowledge seems to be acquired by observing expert nurses and talking to them. The same is true of the notion of perceptual knowledge. In fact, perceptual knowledge seems to come from situations in which the nurse is confronted. Thus, the learning opportunities that intensive care provides both individually and collectively, places the nurse in different situations that lead her to search, question and discuss with others. Based on these concepts, the paper manages to explain how individual, contextual and organizational factors influences the ability of nurses to learn in the practice setting.

References

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