Experiential learning in practice: An ethnographic study among nursing students and preceptors

Highlights

• Experiential learning is a key component within reflective learning processes.

• Preceptors rely on examples and links to practice to encourage student learning.

• Preceptors must learn to delegate on their students, enhancing their autonomy.

• Nursing students require a more active role in their learning processes.

• Exchanges and discussions with other clinical team members should be encouraged.

Abstract

This study aimed to explore the reflective dialogues and processes that take place between preceptors and their nursing students and to examine how preceptors make use of their expert knowledge in order to enhance students' experiential learning during clinical placements. Two 30-h courses on reflective teaching were conducted. The study sample included 15 preceptors and 27 undergraduate nursing students. Data were collected during the course and during clinical placements at two X hospitals. Data collection included non-participatory observation and informal conversations with preceptors, in-depth interviews and focus groups. Preceptors used a series of strategies to promote experiential learning; these included creating links with practice, the use of examples, allowing students to adopt professional roles and enhancing autonomy. The value of preceptors is their wealth of professional experience, which is key during the learning process of nursing students. Preceptors must learn to master the art of questioning and stimulating reflective dialogues, in order to stimulate students' critical thinking and encourage them to resolve common problems that arise during practice. Students demand a more active role in their own learning processes.

Introduction

Clinical settings are considered to be the focal point for student learning, within which preceptors fulfil a complex and multifaceted role (McClure and Black, 2013). In Spain, as well as elsewhere, the supervision of clinical rotations is an added responsibility to the registered nurse's workload (Carlson et al., 2010, Rodríguez et al., 2014), who are faced with time and space limitations, as well as a lack of organizational support (Harrington, 2011, Broadbent et al., 2014). Several terms are used in different countries to describe the registered nurse who facilitates and evaluates student learning during clinical placements. Here we have adopted the term “preceptor”, as used in North America, which is akin to the role of the Spanish “tutor”, nurse teachers, mentors and/or supervisors used throughout Europe (Warne et al., 2010). Specifically, the preceptorship model is an approach to the teaching and learning process within the context of clinical practice, in which the preceptor has a duty to serve as a role model for students regarding the role of the registered nurse, while maintaining ongoing communication with the faculty member (Billay and Myrick, 2008). Recent studies have highlighted the need for preceptors to receive formal training in order to prepare them for teaching, together with the need for access to targeted resources and improved communication between universities and clinical placements Broadbent et al., 2014, Carlson and Bengtsson, 2014. These measures all contribute towards decreasing the distance between theory and practice in nursing (Duffy, 2009, Lisko and O'Dell, 2010, Hilli and Melender, 2015).

Students, on the other hand, value the information and feedback they receive from preceptors as learning tools (Juanola et al., 1998). Furthermore, they recognize a number of positive practices that can be adopted by preceptors, namely: they must be a model of good practice, offer explanations and rationales regarding professional practice, grant students a degree of responsibility, and always be questioning and seeking answers from the students themselves (Jackson and Mannix, 2001). There is no doubt that the student-preceptor relation has a great influence on student learning (Levett-Jones et al., 2009) and that professional practice and reflection are both key to learning in practical contexts (Schon, 1987, Medina and Parra, 2006, Acevedo, 2009, Molina and Jara, 2010, Ruiz-López et al., 2015). Thus, the ability to reflect on one's own professional acts is currently perceived as a key element for professional development (Burns et al., 2006).

In view of these issues, it is important to consider the role of experiential learning in relation to reflective practice in order to provide students with the necessary tools to develop into reflective practitioners (Fernández, 2005, Rodríguez et al., 2014). Experiential learning is described as “the product of reflection upon experience” which is influenced, in turn, by the nature of the reflection and the quality of the experience itself (Fowler, 2008). Experience itself encourages critical and reflective thought processes (Padierna and González, 2013). After a specific experience, students observe and reflect on the same, integrating reflective thoughts as guides in later actions. Kolb (1984) proposes a cyclical process of experiential learning with four distinct phases: concrete experience, reflective observation, abstract conceptualization, and experimentation of these abstractions in new situations. In this model, experience is the basis and origin of learning which leads to significant learning (Kolb, 1984). Furthermore, the ability to reflect on and analyse daily practice is a fundamental process for ensuring professional development, especially if reflection is based on the observation of others (Baggio and Erdmann, 2010). Students must therefore also be able to integrate the knowledge that arises from the observation of the actions performed by the preceptors. Considering the relevance of this subject for nurse educators today, this study was devised in order to learn more about how this learning process actually occurs in practice and to explore the strategies available to preceptors in order to promote experiential learning in their students.

Thus, the aim of this study was to explore the reflective dialogues and the reflective processes that occur between preceptors and nursing students and to examine how preceptors make use of their expert knowledge to enhance students' experiential learning during clinical placements.