Från allmänsjuksköterska till specialistsjuksköterska inom intensivvård : en studie av erfarenheter från specialistutbildningen och från den första yrkesverksamma tiden inom intensivvården

Abstract

Aim: The overall aim of the thesis was to describe and analyse experiences of learning in the intensive care nurse’s knowledge and competence areas. What knowledge content is learnt in the study program, what competence is developed in the profession and what prerequisites of learning are experienced in the study program and the profession are addressed. Method: Data were collected via questionnaires and interviews on two different occasions. The sample consists of one annual cohort of students (n=221) from all the higher education institutions in Sweden (n=18) where specialist study programs for nurses in intensive care (ICU) were offered in 2000. The response rate is 81 per cent in sub study I and 85 per cent in sub study II. Chi-square was used to test for any differences between variables and groups, respectively, and McNemar was used to analyse changes. Content analysis has been used to analyse questions with open answers. Interviews (n=7) were carried out for further elaboration of the answers in the questionnaire. Results: The students’ age, educational background and professional experience vary. Forty per cent of the students had prior experience from intensive care. One year after having completed the study program, 21 per cent of the students were no longer working in intensive care. The research group as a whole rate learning highest in the knowledge and competence areas, which are related to monitoring and medical treatment, both at the end of the study program and after one year of professional practice. At the end of the study program, the relation-oriented areas of ethics and communication are considered to be equally important to the professional function, although they take longer to learn. However, after one year in the workplace, ethics was no longer considered to be as important. In the case of academic schooling, the group with a nursing education after the 1993 reform rated their competence higher than the group with an older nursing education. The group with previous ICU experience considers this competence to be more important to the professional function than the group without ICU experience. After having worked for a year, all the nurses feel that they have achieved self-mastery in their work, i.e. that they can take responsibility and initiatives and that they know the limits of their own competence. There is correspondence between formal competence and job-related competence. There are, however, differences between the rated competence and the competence utilised. The competence developed to carry on development and quality work is either utilised in full or, alternatively, is utilised but not officially required or recognised. Conclusions: The relative incongruence between the students’ rated competence and the competence required in the health care sector indicates that we have an important task to further influence the educational and health care systems to increase the academisation process.