Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Nursing

Supervisor

Yolanda Babenko-Mould

Abstract

The future of the nursing profession in Rwanda in large part depends on the nursing students who join the workforce and the training they have received. Preparing them to enter the profession with the necessary clinical competencies, values, and attitudes requires practice-based learning environments to become more supportive of facilitating their professional development. The current learning environments experienced by nursing students in Rwanda, and the values, assumptions, practices, and behaviours of different stakeholders involved in preparing them to enter professional practice, have not yet been explored.

The aim of this study was to address that knowledge gap by exploring the values, assumptions, practices, and behaviours within acute care practice environments and an educational institution within a resource-limited context like Rwanda and how the cultural aspects of these environments influence the development of nursing students as future nurses in professional practice. Guided by a constructive lens, this study used focused ethnography to explore the values and assumptions co-constructed by multiple stakeholders involved in the professional growth of students, particularly from the perspective of students, staff nurses, clinical instructors, and nurse leaders. Individual interviews, observations, and document reviews were used as data sources.

Findings from this study revealed that the acute care practice learning environment is a multifaceted entity influenced by interconnected sets of values, assumptions, behaviours, and practices that intersect at institutional, unit, and individual levels. Nurturing, professional gatekeeping and engagement emerged as positive values and assumptions that guided clinical settings and academic program members in their behaviours and practices to nurture and support nursing students as they develop into future nursing professionals. On the other hand, collaboration, structural, and interpersonal barriers prevented the acute care practice environments and the academic institution from enacting these positive beliefs and values. This disconnect between values and the actual enacted practices and behaviours within acute care practice units and by individuals constrained practice environments and academic programs from creating and sustaining enriched and positive environments conducive to preparing students for professional practice.

The findings of this study illuminate that building and sustaining a nurturing and positive learning environment that fosters the professional development of nursing students requires a multifaceted approach that engages every concerned stakeholder in “co-creating” a learning culture to close the existing gap between the desired learning environment and the actual unit practices and individual behaviours. Recommendations related to policy, education, practice, and research have been formulated and addressed in this dissertation.

Summary for Lay Audience

Nurses constitute the majority of health professionals in Rwanda, yet, the country still face a significant nursing shortage. Educating future nurses required to mitigate this shortage and provide effective patient care requires the practice-based learning environments within which nursing students acquire necessary skills, attitudes and values to be more supportive and empowering. To date, how these environments facilitate or hinder nursing students professional development in Rwanda has not been researched.

The aim of this study was to explore how the current practice-based leaning environment in Rwanda support or hinder the professional development of nursing students. A qualitative, focused ethnographic approach was used and the study was conducted in three practice settings and an academic setting. Individual interviews were conducted with 38 significant people involved in the development of nursing students, namely students themselves, clinical instructors, staff nurses, and nurse leaders from both the practice and the academic settings. Observation of learning activities, and review of documents related to practice-based learning supplemented data from interviews.

Findings from this study revealed that professional development of nursing students is facilitated by positive values and assumptions of nurturing junior students, a shared professional responsibility to develop nursing profession, and individual, units, and institutional commitment. These values guided staff nurses and clinical instructors to nurture, care for, welcome, role-model, guide, integrate, respect, involve, and support nursing students’ development into future nursing professionals. However, the enactment of these positive values into practices and behaviours within units was hindered by different barriers- collaboration, structural, and interpersonal barriers. These barriers constrained practice environments and academic program from creating and sustaining enriched and positive environments conducive to preparing students for professional practice.

Recommendations from this study suggest that building and sustaining a positive learning environment for nursing students requires a collaborative approach that engages every concerned stakeholder in “co-creating” a learning culture that reduce the identified barriers and enhances the positive values. This will result in shaping the proficient, effective, and caring future nursing workforce required to deliver safe patient care in the predominantly nurse-based Rwandan healthcare system.

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