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.