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Collaboration in clinical skills lab: perspectives from students and educators in nurse education
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0002-0749-5718
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to explore the collaboration and the collaborative process between bachelor nursing students during clinical skills lab practices from the perspective of nursing students and nurse educators and the use of formative peer assessment in higher healthcare education programs.

In the first study, an exploration of formative peer assessment in higher healthcare education programs was carried out by mapping the existing research literature in the field. After critical appraisal of the literature, a thematic analysis was performed. The results revealed a process consisting of two consecutive phases. The first phase involved the rationale for formative peer assessment, which was to support student learning as preparation for the healthcare professions. The second phase concerned the organization and the structure of the formative peer assessment activity and how the complexity of collaboration between the students affected their relationships with each other. The revealed complexity of peer collaboration influenced the aim of the subsequent empirical qualitative studies because similar results have been described in previous studies in connection with collaborative learning activities.

The second and third studies explored how first-year bachelor nursing students collaborate as well as the collaborative process during practice in clinical skills labs. Fieldwork with participant observations and focus group interviews was performed. Thematic network analysis was carried out in the second study, and a narrative analysis of fieldnotes and transcribed focus groups interviews was conducted in the third study to analyse the collaborative process. In the fourth study, interviews were performed with nurse educators with teaching experiences from clinical skills labs. The aim was to understand their different conceptions of nursing students’ collaboration. The transcribed interviews were analysed with a phenomenographic approach.

The findings from the second study showed that collaboration between nursing students is a field of tension between adaptation and non-conformity. Adaptation represents the students’ ability to adapt to new knowledge, to each other, and to being a nursing student. The non-conformity in the collaboration corresponds to students’ difficulties in accepting the perspective of others, finding mutual goals, sharing decisions, and providing supportive and constructive feedback to each other.

In the third study a sequential process was identified in the exploration of the collaborative process between the nursing students. The initial period was characterized by navigating in unfamiliar territory, which included anxieties related to not being involved, not being familiar with the context, and not being sure of the expectations. Over time, the students started to navigate together to cope in response to the complexities of the tasks they had ahead of them. To overcome these complexities, they looked for people like themselves, which led to homogenous groups. At the end of their training period the students were approaching independence in anticipation of their future nursing profession. In this period the role of the educator became less prominent, and the students mostly relied on each other’s knowledge. The feedback they provided to each other became constructive with suggestions for improvement. The focus was now on the task at hand, and with whom it was practiced was of less importance.

In the final study, the nurse educators’ various conceptions of nursing students’ collaboration described an outcome space that indicated that the purpose of collaboration was the most complex descriptive category that formed the didactive activities related to collaboration, the nursing students’ interpersonal skills, and the group activity skills.

Conclusively, and reflected in Vygotsky’s theory of Zone of Proximal Development, the collaboration between the nursing students during skills lab practices shows that the students’ collaboration can develop from a zone of current development to a collective zone of proximal development with support from their peers. For education to support the students’ transition to independence, the educational purpose of collaboration needs to be defined by the faculty. The collaboration needs to be guided by scaffolding activities contextualized to the nursing profession and adjusted to where the students are in the collaborative process. Instructional directives for peer observations and feedback along with didactive activities might decrease anxiety and complexity in collaborative learning and thereby prepare students for the crucial collaboration that takes place in the nursing profession.

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2025. , p. 78
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383, E-ISSN 2004-9277 ; 2025:5
Keywords [en]
clinical skills lab, collaboration, collaborative learning, nurse educators, nursing students, the Zone of proximal development
National Category
Nursing
Identifiers
URN: urn:nbn:se:mau:diva-74750DOI: 10.24834/isbn.9789178776191ISBN: 978-91-7877-618-4 (print)ISBN: 978-91-7877-619-1 (electronic)OAI: oai:DiVA.org:mau-74750DiVA, id: diva2:1944828
Public defence
2025-04-11, Allmänna sjukhuset, HS aula, Jan Waldenströms gata 25, Malmö, 09:00 (English)
Opponent
Supervisors
Note

Paper 4 in disseration as manuscript.

Available from: 2025-03-20 Created: 2025-03-17 Last updated: 2025-05-14Bibliographically approved
List of papers
1. Formative peer assessment in higher healthcare education programmes: a scoping review
Open this publication in new window or tab >>Formative peer assessment in higher healthcare education programmes: a scoping review
2021 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 2, article id e045345Article, review/survey (Refereed) Published
Abstract [en]

Objectives Formative peer assessment focuses onlearning and development of the student learning process.This implies that students are taking responsibility forassessing the work of their peers by giving and receivingfeedback to each other. The aim was to compile researchabout formative peer assessment presented in higherhealthcare education, focusing on the rationale, theinterventions, the experiences of students and teachersand the outcomes of formative assessment interventions.Design A scoping review.Data sources Searches were conducted until May 2019in PubMed, Cumulative Index to Nursing and Allied HealthLiterature, Education Research Complete and EducationResearch Centre. Grey literature was searched in LibrarySearch, Google Scholar and Science Direct.Eligibility criteria Studies addressing formative peerassessment in higher education, focusing on medicine,nursing, midwifery, dentistry, physical or occupationaltherapy and radiology published in peer-reviewedarticlesor in grey literature.Data extractions and synthesis Out of 1452 studies,37 met the inclusion criteria and were critically appraisedusing relevant Critical Appraisal Skills Programme, JoannaBriggs Institute and Mixed Methods Appraisal Tool tools.The pertinent data were analysed using thematic analysis.Result The critical appraisal resulted in 18 includedstudies with high and moderate quality. The rationale forusing formative peer assessment relates to giving andreceiving constructive feedback as a means to promotelearning. The experience and outcome of formativepeer assessment interventions from the perspectiveof students and teachers are presented within threethemes: (1) organisation and structure of the formativepeer assessment activities, (2) personal attributes andconsequences for oneself and relationships and (3)experience and outcome of feedback and learning.Conclusion Healthcare education must considerpreparing and introducing students to collaborativelearning, and thus develop well-designedlearningactivities aligned with the learning outcomes. Since peercollaboration seems to affect students’ and teachers’experiences of formative peer assessment, empiricalinvestigations exploring collaboration between studentsare of utmost importance.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2021
Keywords
formative assessment, peer, higher health care education
National Category
Medical and Health Sciences Health Sciences
Research subject
Care science
Identifiers
urn:nbn:se:mau:diva-41106 (URN)10.1136/bmjopen-2020-045345 (DOI)000618268000009 ()33563627 (PubMedID)2-s2.0-85100953831 (Scopus ID)
Available from: 2021-03-09 Created: 2021-03-09 Last updated: 2025-03-17Bibliographically approved
2. Collaboration between first year undergraduate nursing students: A focused ethnographic study
Open this publication in new window or tab >>Collaboration between first year undergraduate nursing students: A focused ethnographic study
2022 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 64, article id 103427Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to explore collaboration between first year undergraduate nursing students in a three-year bachelor program during clinical skills lab practices.

BACKGROUND: The ability to collaborate is important in the nursing profession to ensure patient safety. Thus, efforts supporting nursing students with learning activities emphasizing this ability is crucial in nurse education as a preparation for the requirements of the nursing profession. Collaborative learning models are described as ways that support the students' interaction during education. However, collaboration between students has shown to have challenges such as negative competition and confrontations. This stresses the need to explore the collaboration between students to find ways to support the interaction.

DESIGN: The study was conducted with a focused ethnographic approach.

METHOD: Data were generated by participant observations during one semester, involving 70 h observation of 87 first year nursing students for 6 months and 24 training sessions in clinical skills lab practices. Two focus group discussions were used to elaborate students' views of collaboration and to provide an opportunity for follow up questions and interpretations from the observations. Field notes and focus group discussions were interpreted as one unit of analysis conducted with thematic network analysis. A global theme were synthesized from organizational and additional basic themes presenting the overall metaphor of the students' collaboration.

RESULT: The global theme, Between adaptation and non-conformity, revealed a field of tension in the nursing students' collaboration. One the one hand, the global theme involved the students' ability to adopt to new knowledge and to being a nursing student in a clinical skills lab and to others' perspective. On the other hand, non-conformity creates a collaboration with less reflection between the students and non-synchronized and time-consuming laboratory work.

CONCLUSION: Collaborative activities in nurse education fosters and challenges nursing students' collaboration required for clinical practices and later in the nursing profession. By the presented scaffolding efforts, nurse educators can arrange a learning environment that can support the collaboration between students and facilitate the transition into the profession.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Collaboration, Collaborative learning, Focused ethnography, Nursing education, Nursing students, Skills lab, Socio-cultural theory
National Category
Nursing
Identifiers
urn:nbn:se:mau:diva-54560 (URN)10.1016/j.nepr.2022.103427 (DOI)000848777100003 ()35994802 (PubMedID)2-s2.0-85136018314 (Scopus ID)
Available from: 2022-08-26 Created: 2022-08-26 Last updated: 2025-03-17Bibliographically approved
3. Supporting each other towards independence: A narrative analysis of first‐year nursing students' collaborative process
Open this publication in new window or tab >>Supporting each other towards independence: A narrative analysis of first‐year nursing students' collaborative process
2024 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 31, no 3, article id e12627Article in journal (Refereed) Published
Abstract [en]

Collaboration for nursing is a core competence and therefore educational interventions are essentials for collaborative skills. To identify such interventions, we carried out a study to understand nursing students' collaborative process. A narrative inquiry method was used to explore the collaborative process of first-year undergraduate nursing students. The analysis was conducted on field notes from 70 h of observation of 87 nursing students' collaboration during skills lab activities. It also included transcriptions of four focus group discussions with 11 students. The results are presented as a sequential process of (1) navigating in unfamiliar territory, (2) navigating together to cope, and (3) navigating together towards independency and the future nursing profession. We identified a transition from teacher-led assistance and guidance to student interdependency and reciprocal learning, ending with student-led assistance supporting independency. In line with Vygotsky's theory of zone of proximal development, different scaffolding interventions are needed depending on where the students are in the collaborative process. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
National Category
Nursing
Research subject
Health and society
Identifiers
urn:nbn:se:mau:diva-65981 (URN)10.1111/nin.12627 (DOI)001160797100001 ()38351462 (PubMedID)2-s2.0-85185522122 (Scopus ID)
Available from: 2024-02-14 Created: 2024-02-14 Last updated: 2025-03-17Bibliographically approved
4. The phenomenographic outcome space of nurse educators' conception of nursing students collaboration in clinical skills lab
Open this publication in new window or tab >>The phenomenographic outcome space of nurse educators' conception of nursing students collaboration in clinical skills lab
2025 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 152, article id 106775Article in journal (Refereed) Published
Abstract [en]

AIM: This study aimed to understand the variety of nurse educators' conceptions of nursing students' collaboration in clinical skills lab activities.

BACKGROUND: Collaborative learning has gained attention in nurse education as an educational approach that supports learning and professional development. However, research is deficient concerning nurse educators in faculty-based education and their conceptions of student collaboration.

METHOD: The study adopted a phenomenographic approach. A purposeful sampling of nurse educators teaching in a skills lab setting was conducted at five universities in Sweden. Individual interviews with sixteen nurse educators were performed between November 2023 and February 2024. The interviews were analysed following phenomenographic procedures.

RESULTS: Four different description categories were identified: the purpose of collaboration, the didactic activities for collaboration, the student's intrapersonal skills, and the group activity skills. The outcome space presents the purpose of collaboration as the most complex descriptive category.

CONCLUSION: The educational purpose of collaboration should be settled by the faculty of nurse education and aligned to the collaborative requirements in the nursing profession. Introducing didactic activities specifically contextualized to the nursing profession and including peer observations and feedback in a formative manner may facilitate the development of collaboration.

Place, publisher, year, edition, pages
Elsevier, 2025
Keywords
Collaboration, Collaborative learning, Individual interviews, Nurse educators, Nursing students, Phenomenography, Skills lab
National Category
Nursing
Identifiers
urn:nbn:se:mau:diva-75818 (URN)10.1016/j.nedt.2025.106775 (DOI)40347730 (PubMedID)2-s2.0-105004362725 (Scopus ID)
Available from: 2025-05-12 Created: 2025-05-12 Last updated: 2025-05-14Bibliographically approved

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