Student nurses' experience of learning to care for older people in enriched environments : a constructivist inquiry.

The unpopularity of gerontological nursing is well established and, although numerous studies have sought explanations for this, few have explored how work with older people can be promoted as a more fulfilling and challenging career choice. Underpinned by a constructivist methodology, this thesis provides new insights into how the experiences of student nurses during their training influence their predisposition to work with older people. Using a two stage approach, data were collected from longitudinal focus group interviews with student nurses from four schools of nursing over a period of eighteen months, together with case studies in seven clinical placement areas where students had identified a positive experience of learning to care for older people. The study was part of a larger national investigation funded by the English National Board for Nursing, Midwifery and Health Visiting. Data analysis revealed that a positive experience of work with older people in a range of settings was key to determining whether gerontological nursing was seen as an interesting and exciting career option. Both 'impoverished' and 'enriched' environments of care were identified and analysed in terms of the 'Senses Framework' (Nolan et al 2001a). 'Enriched' environments ensured that students, staff and patients/carers each in their various ways experienced a sense of security, belonging, continuity, purpose, achievement and significance. The longitudinal nature of data collection also indicated that these senses varied in importance as students' experiences unfolded, and a number of foci for students' efforts emerged. These were: self as focus; course as focus; professional care as focus; patient as focus; and person as focus. Findings suggest that only in the most enriched environments will students have a vision of care that has the person as its focus. Based on the interdependency implicit in the data, the thesis concludes by arguing that future policy, practice and education in gerontological nursing should be informed by relationship-centred care, as opposed to person-centred care.