Auttajasta reflektiiviseksi sairaanhoitajaksi. Ammattikorkeakouluopiskelijan kasvu ja kehittyminen ammattiin

Abstract

Tutkimus on laadullisella tutkimusotteella toteutettu käyttäen grounded teoria -menetelmää.

Ammattikorkeakoulun sairaanhoitajaopiskelijat kirjoittivat syksyllä 2001 (n = 79) ja syksyllä 2003 (n = 92) eläytymistarinan toimimisestaan sairaanhoitajana (N = 171). Tarinat muodostavat poikkileikkausaineiston, opiskelijat olivat kaikkien neljän opintovuoden opiskelijoita.

Tutkimuksessa rakennettiin substantiivinen teoria opiskelijan ammatti-identiteetin kehittymisestä sairaanhoitajaksi vaiheittain. Tutkimuksessa rakennettiin myös formaaliteoria ammmatti-identiteetin muodostumisen ydinprosessista. Lisäksi tutkimuksessa rakennettiin ammattikorkeakoulun koulutusaloja koskeva, yleisesti opiskelijan kasvua ja kehittymistä koskeva vaiheittainen kuvaava ja selittävä formaaliteoria.

Tutkimuksessa rakennetuilla teorioilla on merkitystä ammattikorkeakoulun opiskelijan ammatillisen kasvun ja kehittymisen ohjausta kehitettäessä. Lisäksi tutkimuksen tuloksilla on merkitystä ammattikorkeakoulujärjestelmän suomalaista laatujärjestelmää kehitettäessä.

The purpose of this study was to construct a substantive theory to describe and explain the professional development of polytechnic nursing students to a regis-tered nurse and its phases during their nursing education. The aim of the study was to produce the kind of information that would facilitate the development of guidance of student s professional growth in a polytechnic. The participants con-sisted of 79 polytechnic nursing students who were in the first (n = 28), second (n = 17), third (n = 15) and fourth (n = 19) year of their education. The data was collected in the autumn 2001. The participants wrote narratives about themselves working as nurses during one day at work. The method of this research was qualitative. The perspective of the study was that of subject s, the student s. The data was analyzed with grounded theory method, which produced simultane-ously the concepts and the theory describing the phenomena.

The categories of the basic process of the professional growth included The Professional Identity of a Nurse, including the role of a nurse, the feeling of be-ing a member of a certain group (nurses) and how the nurses experienced their work. The second category was The Goal of the Nursing Practice, which in-cluded the aims of the nurse practising clinical nursing. The third category was The Relationship between the Patient and the Nurse. The fourth category was The Working Environment of the Nurse. The working environment of the nurse included the physical, social and symbolic environment. The fifth category was Acting as a Nurse comprising comforting, basic treatment, treatment of illnesses, helping other nurses within the basic treatment, and making things work in that certain unit and reflective nursing. The validity of the substantive theory was tested with a second data (N = 92), that was collected in five Polytechnic schools in Finland in the end of the autumn 2003. The nursing students wrote narratives about the nurse s work. The Iden-tity of a nurse was selected as the core category. It had five stages : I the Helper, We Assisting Nurses, I the Nurse, I the Proficient Nurse , I the Reflective Nurse. These five modes constituted the stages in the professional growth proc-ess of the nurse. In the transition stage, The Ambiguous Transition Identity from student to nurse there was also recognized in the narratives.

The basic process in becoming a nurse was realized when the student made observations about nursing in practice. Her nursing knowledge, beliefs and values guided the observations she made in the nursing practice as well as the beliefs, values, norms and roles within the nursing culture. The observations through five different senses and the feelings, which arose within the experience, were both formed to meanings in a way that was accepted in the culture. To understand those meanings the student reflected upon them and that understanding produced learning. The student makes adjustments in her practice of functioning as a nurse when she understands it in a new way. The re-evaluation of her own actions as a nurse leads her to reassess her identity as a nurse. This determination produces a new phase in her professional identity. A substantive theory can be formed into a formal theory through a comparison to other substantive theories. The comparison covers research concerning the professional growth and identity of students of two other significant polytechnic fields, engineering and business administration. The formal theory was built to describe and explain the professional growth of a polytechnic student into a professional. The student as a professional is able to function at work and in the culture of the profession. The work and the culture consists of the tasks, the processes, the values and the ways of functioning. The polytechnic student is constructing The Professional Identity in phases. She is learning, changing her way of working and identifies herself as a professional again and again. At the end of the studies the student recognizes the social status of the profession. The concistency of the personal identity with the professional identity supports the professional growth and development of the student. It also supports the commitment to the studies. The significance of the formal theory to the development of the polytechnic education in Finland was reviewed by examining the discussion concerning the European higher education area. The key question is the development of mutual quality assurance, its criteria and methodologies. The Finnish Higher Education Evaluation Council published a report on the Dutch Higher Education Quality assurance system. In the Netherlands the focus has shifted from Degree Programmes towards the accreditation of individual degrees. The central criteria of Quality assurance is a clear and up-to-date concept among the teachers in the Degree Programme unit about the future profession of the student. This concept includes the working life and the trends of the development on both national and international level.

The guidance of the professional growth and develpoment of the polytechnic student is a important part of the pedagogic work of the teacher. The ability to deal with one´s feelings, especially in the beginning and in the end of the studies, is significant for the professional growth and development of the polytechnic student. The ability to reflect one´s own actions as a professional is significant in guiding one´s professional growth and development from the beginning of the studies to the transition into a professional.