Table Of ContentStudent nurses’ lived experiences
of their last practice placement.
Jillian Mary Phillips
A thesis submitted in fulfilment of the
requirements of Bournemouth
University for the award of Doctor of
Philosophy
February 2017
i
This copy of the thesis has been supplied on condition that anyone who consults it is
understood to recognise that its copyright rests with its author and due
acknowledgement must always be made of the use of any material contained in, or
derived from, this thesis.
Jillian Mary Phillips Abstract
Student nurses’ lived experiences of their last practice placement.
Since the mandatory twelve week minimum placement was introduced in 2010
by the regulatory body for nursing in the UK, there is little documented as to its
effectiveness from the students’ perspective.
The aim of this study was to explore the lived experiences of ten student nurses
as they completed a longer than usual practice placement as the last
component of their undergraduate pre-registration nursing education. Previously
students had been allocated to practice for periods of five or six weeks and this
was the first time they had experienced a longer placement.
Using a descriptive phenomenological approach, a purposive sample of ten
student nurses were interviewed within one week of completing their final three
months in practice in July 2013. Data were analysed using Giorgi’s (2009)
modified Husserlian approach to descriptive phenomenology.
Findings revealed the four invariant constituents of: belongingness and fitting in;
taking charge of own learning; making sense of the complexities of nursing; and
becoming a nurse.
Discussion exposed not only challenges to current thinking from the collective
views of ten students in the south of England, but revealed a process of
transformative learning that the students journeyed to prepare themselves for
registration as a professional nurse. Fuelled by their mentors facilitating and
encouraging autonomous practice, students began to experience a sense of
awakening to the responsibilities and accountability that they faced as a
registered nurse.
New insights from this research suggest that more could be done to enhance
the final practice placement experience for students on the point of transition. It
is seen as a dress rehearsal for the real world of work as a registered nurse and
mentors should supervise at arm’s length and encourage students to work
things out for themselves, take risks and make decisions. Nurse educators
should recognise that during the extended last placement students re-
contextualise their knowledge as they begin to make sense of the complexities
of nursing practice.
Conclusions from this study support the notion that a longer final practice
placement helps students to prepare for their impending transition to registered
practice. It recognises the key role of the mentor in supporting all four invariant
constituents and the process that these students undertook to gain the
confidence and competence to practise as a qualified nurse. This new
knowledge is of interest to a wider audience concerned with the preparation of
undergraduate pre-registration nursing students both in the UK and abroad.
Table of Contents
Chapter 1 Introduction and overview of the study ..................................................... 5
1.1 Background .................................................................................................... 5
1.2 The context of my research in relation to national and international
professional and political agendas............................................................................. 8
1.2.1 The final practice placement for student nurses in the UK ....................... 8
1.2.2 Length of placement allocations for student nurses in the UK ................ 10
1.2.3 Undergraduate pre-registration nursing programmes outside the United
Kingdom and the final year for student nurses ..................................................... 10
1.2.4 Role transition from finalist student to registered nurse .......................... 12
1.2.5 All graduate status for nurses in the United Kingdom............................. 14
1.2.6 Attrition in nursing .................................................................................. 14
1.2.7 The dynamic and political nature of contemporary healthcare in the
United Kingdom ................................................................................................... 15
1.3 Outline of thesis ............................................................................................ 16
1.4 Summary of chapter ..................................................................................... 19
Chapter 2 The Literature ........................................................................................ 20
2.1 Literature search strategy ............................................................................. 20
2.2 Mandates from the Nursing and Midwifery Council ....................................... 21
2.3 The longer final practice placement .............................................................. 22
2.4 Role transition............................................................................................... 24
2.5 Phenomenological research and student nurses .......................................... 25
2.6 Justification for this research ........................................................................ 26
2.7 Research question, aim and objectives ........................................................ 26
2.8 Summary of chapter ..................................................................................... 27
Chapter 3 Methodology .......................................................................................... 28
3.1 Philosophical assumptions............................................................................ 28
3.2 Justification for choice of methodology ......................................................... 32
3.3 Philosophical origins and theoretical underpinnings of phenomenology ........ 34
3.4 The development of a phenomenologically orientated approach to research in
psychology .............................................................................................................. 38
3.5 Phenomenology as a research method ........................................................ 39
3.5.1 Lived experience and meanings ............................................................ 40
3.5.2 Rich, expressive and full descriptions .................................................... 40
3.5.3 A concern with existential issues ........................................................... 41
3.5.4 Embodiment .......................................................................................... 41
3.5.5 A phenomenological attitude.................................................................. 42
3.5.6 A potentially transformative relational approach..................................... 43
3.6 Phenomenology as a research methodology in nursing ................................ 43
3.7 Descriptive versus Interpretative Phenomenology ........................................ 44
3.8 Descriptive phenomenology as a research methodology of choice for this
study 45
3.9 Summary of chapter ..................................................................................... 46
Chapter 4 Method .................................................................................................. 48
4.1 My role as researcher: adopting a phenomenological attitude ...................... 48
4.2 The study design .......................................................................................... 50
4.3 Articulating an experiential phenomenon of interest for study ....................... 51
4.4 Gathering descriptions of others’ experiences that are concrete occasions of
this phenomenon ..................................................................................................... 51
4.4.1 Recruitment and sampling ..................................................................... 52
4.4.2 The interview process ............................................................................ 54
4.4.3 The interviews ....................................................................................... 55
4.4.4 Ethical considerations ............................................................................ 57
4.5 Data analysis: intuiting and ‘testing’ the meanings of the experiences .......... 61
4.5.1 Stage one: reading for a sense of the whole .......................................... 63
4.5.2 Stage two: deciding upon and dividing descriptions into meaning units . 63
4.5.3 Stage three: transforming participants’ natural attitude expressions into
discipline (i.e. nursing) sensitive expressions ....................................................... 64
4.5.4 Stage four: determination of the structure .............................................. 67
4.6 Writing a ‘digested’ understanding that cares for different readers and
purposes ................................................................................................................. 70
4.7 Summary of chapter ..................................................................................... 71
Chapter 5 Overview of Findings ............................................................................. 72
5.1 Naming the invariant constituents ................................................................. 72
5.2 Outline and rationale for the presentation of findings and ensuing discussions
in this thesis ............................................................................................................ 73
Chapter 6 Belonging to a team ............................................................................... 75
6.1 Seeking to belong ......................................................................................... 75
6.2 Developing survival strategies; navigating ways round different personalities
and seeing different ways of doing things ................................................................ 85
6.3 Working in a final placement with a potential job offer ................................... 92
6.4 Summary of chapter ..................................................................................... 95
Chapter 7 Taking charge of own learning and becoming a confident, competent
practitioner 97
7.1 Experiencing a longer thirteen week placement and making the most of the
learning environment on offer .................................................................................. 97
7.2 Learning from working with mentors and other staff .................................... 105
7.3 Being seen as a student on their final placement ........................................ 111
7.4 Becoming empowered and believing in self ................................................ 116
7.5 Summary of chapter ................................................................................... 120
Chapter 8 Making sense of the complexities of nursing; developing an
understanding of the nature of nursing and knowing nursing .................................... 122
8.1 Caring for people whilst showing humanistic concern and the acquisition of
technological skills ................................................................................................ 122
8.2 Making sense of theory and practice .......................................................... 126
8.3 Seeing the whole picture ............................................................................ 130
8.4 Summary of chapter ................................................................................... 136
Chapter 9 Becoming a nurse ................................................................................ 138
9.1 Beginning the transition .............................................................................. 138
9.2 Experiencing the security of student status for the last time ........................ 139
9.3 Becoming visible and being allowed to work independently ........................ 143
9.4 Rehearsing and preparing to be a registered nurse .................................... 146
9.4.1 Making decisions and being accountable............................................. 149
9.5 Feeling ready to qualify and looking ahead ................................................. 151
9.6 Summary of chapter ................................................................................... 154
Chapter 10 The essence of student nurses’ lived experiences of a longer final
practice placement .................................................................................................... 157
10.1 The essence of experiencing a longer, final placement experience for student
nurses. .................................................................................................................. 158
10.2 The phenomenon of how student nurses experience their final practice
placement expressed as poetry ............................................................................. 160
10.3 Summary of chapter ................................................................................... 162
Chapter 11 Discussion ........................................................................................... 163
11.1 Belonging to a team .................................................................................... 163
11.2 Taking charge of own learning and becoming a confident, competent
practitioner ............................................................................................................ 170
11.3 Making sense of the complexities of nursing; developing an understanding of
the nature of nursing and knowing nursing ............................................................ 174
11.4 Becoming a nurse ....................................................................................... 184
11.5 Summary of chapter ................................................................................... 189
Chapter 12 Further discussion of the essence: the evolutionary and transformative
journey experienced by student nurses during their longer final practice placement . 191
12.1.1 Stage One: Settling in .......................................................................... 194
12.1.2 Stage Two: Making sense ................................................................... 195
12.1.3 Stage Three: Looking ahead................................................................ 196
12.2 Transformative learning theory, nursing and my study ................................ 197
12.3 Summary of chapter ................................................................................... 200
Chapter 13 Conclusion ........................................................................................... 201
13.1 The way forward ......................................................................................... 202
13.2 Recommendations from this research ........................................................ 204
13.2.1 Recommendations for sign-off mentors and finalist student nurses
working together in practice ............................................................................... 204
13.2.2 Recommendations for the preparation of sign-off mentors ................... 207
13.2.3 Recommendations for nurse educators concerned with the planning and
delivery of undergraduate pre-registration nursing programme .......................... 208
13.2.4 Recommendations for the statutory professional body of nursing (NMC) in
the United Kingdom ........................................................................................... 209
13.3 Concluding thoughts ................................................................................... 210
13.3.1 Relevance of this research to the wider international audience ............ 211
13.4 Strengths and limitations ............................................................................ 212
13.5 Implications for future research ................................................................... 214
13.6 Summary of chapter ................................................................................... 215
Chapter 14 Reflexivity, my experiences as the researcher of this study ................. 216
14.1 Writing in the first person ............................................................................ 217
14.2 Articulating an area of interest .................................................................... 218
14.3 Getting to grips with using phenomenological research .............................. 219
14.4 The researcher as the research instrument: my role as researcher, educator
and nurse .............................................................................................................. 221
14.5 My learning from this PhD study ................................................................. 222
References ............................................................................................................... 225
Appendices ............................................................................................................... 247
Appendix 1: Summaries of Nursing and Midwifery Council publications highlighting
aspects that are relevant to my study .................................................................... 248
Appendix 2: Example of key search terms used for initial literature search ............ 250
Appendix 3: Example of literature matrix on student nurses and their final/significant
placement and/or role transition ............................................................................ 251
Appendix 4: An anonymised copy of emails sent to finalist students who had passed
all elements of their nursing programme................................................................ 262
Appendix 5: Anonymised participant interview details ........................................... 263
Appendix 6: Ethical Approval Report ..................................................................... 264
Appendix 7: Participant Information Sheet ............................................................. 265
Appendix 8: Consent Form .................................................................................... 268
Appendix 9: General Risk assessment Form ......................................................... 269
Appendix 10: Extract from a participant interview which shows the process of
transforming meaning units into discipline (i.e. nursing) sensitive expressions. ..... 272
Appendix 11: Example of a participant’s collection of transformed meaning units into
discipline (i.e. nursing) sensitive expressions taken from Column 3 ...................... 273
Appendix 12: Extract from Mark’s collection of discipline (i.e. nursing) sensitive
expressions that demonstrate how they formed part of an invariant constituent .... 280
Appendix 13: Photograph of data analysis phase. ................................................. 290
Appendix 14: Dissemination of research through the 8th Post Graduate Researcher
Conference at Bournemouth University March 2015 ............................................. 291
Appendix 15: Dissemination of research through publication of a paper ................ 294
Figures and Tables
Figure 4-1: Summary of data analysis process based on Giorgi’s (2009)
modified Husserlian approach to phenomenological research .................................... 70
Figure 12-1: The evolutionary and transformative journey experienced by
student nurses during their longer final practice placement ....................................... 194
Figure 12-2: Three phases of Mezirow’s (2000) Transformative Learning
Theory 199
Table 2-1: Key words used for literature search ...................................................... 21
Table 4-1: The four stages of empirical-phenomenological research (Todres
and Holloway 2004, p. 83) .......................................................................................... 50
Table 11-1: Humanization of healthcare framework (Todres et al. 2009, p. 70)... 178
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