Doctoral thesis studied paradigms in nursing education
Nurses make up the largest group of health care professionals and are physically and emotionally closest to patients in the clinical environment. Therefore, their training is very important. Kristel Kotkas, who defended her doctoral thesis at Tallinn University, studied what meaning nurses themselves give to teaching and learning.
After the reform of higher education in the early 2000s, almost 50% of the nursing curriculum is practice in a clinical environment, which helps the student develop into an independent specialist who has the freedom to take action and make decisions, but also has rights and responsibilities. The modern nursing paradigm is characterised by the areas of responsibility reflected in the new curriculum, such as: quality of evidence-based nursing care, centrality and safety of patients, counselling and teaching.
Kristel Kotkas states that the success of nursing curriculum reform in nursing practice has barely been studied. There has been no interdisciplinary model with the support of which it would be possible to explain to nurses, who are clinical practitioners, students and teachers at the same time, the factors that support their professional development. In the conditions of the COVID-19 pandemic, it has been difficult to carry out nursing education and further education has been partially halted, therefore the topic of educational practice has become even more relevant than before.
In her doctoral thesis, Kristel Kotkas investigated the meaning given to teaching and learning in the changing nursing paradigm by nurses, analysing it from both a theoretical and an empirical point of view. The other goal was to create a theoretical model supporting the professional development of nurses. The hermeneutic research was conducted in the period 2010‒2019. Extensive empirical data was collected through surveys, written interviews and even drawing tasks.
Based on the results, it can be concluded that participation in the process of teaching, a patient supports the development of both the nurse and teacher identities of students. “Unfortunately, it is difficult for nursing students to test, use, and develop the knowledge they have acquired based on the new curriculum in a clinical environment, if the clinical nurse-teachers in hospitals do not have the teacher identity and the skills necessary for supervision,” says Kotkas. However, nurses who use a variety of reflective techniques, both in teaching and in providing patient-centred nursing care, are successful. Kotkas shows that modern vocational pedagogy, which is still in its early stages of development in the context of nursing in Estonia, has an important meaning in clinical practice. The results of the analysis reflect the connections, causes and consequences of teaching conceptions, which can facilitate the theoretical definition of nursing education, the preparation of goal-oriented teaching models and specific competency guidelines. According to Kotkas, the results are useful for understanding different aspects of interdisciplinary nursing education, integrating teaching with daily nursing practice and developing subjects related to various aspects of achieving patient centrality. The results of the study indicate that learning and teaching in the clinical environment has an important meaning in the modern nursing paradigm, which can be interpreted as a process that supports professional development.
“The conducted research is important for starting a broader discussion regarding the functioning of a sustainable national healthcare system, which is not realistic just by increasing the national training for nurses on the principle of “learn quickly and be useful” if employers do not value the learning and teaching that takes place in the clinical environment for nurses," states Kristel Kotkas.
Kristel Kotkas defended her doctoral thesis “The meaning of teaching and learning for Estonian clinical nurses after the curriculum reform” at the School of Educational Studies on 12 September. The doctoral thesis was supervised by Tallinn University associate professor Larissa Jõgi and Tampere University professor emeritus Anja Heikkinen. The opponents were professor Hanna Toiviainen of Tampere University and the rector of Tallinn Health Care College Ülle Ernits.
The doctoral thesis is available in Tallinn University Digital Library ETERA.