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Refining Nursing Practice: A Grounded Theory of How Nurses Learn to Nurse Well in the Current Health Care Milieu Open Access


Other title
nursing education
professional development
grounded theory
continuing competence
workplace learning
refining nursing practice
Type of item
Degree grantor
University of Alberta
Author or creator
Jantzen, Darlaine D
Supervisor and department
Cameron, Brenda (Faculty of Nursing)
Examining committee member and department
Taylor, Alison (Faculty of Education Policy Studies)
Jensen, Louise (Faculty of Nursing)
MacLeod, Martha (School of Nursing UNBC)
Ceci, Christine (Faculty of Nursing)
Ross, Carolyn (Faculty of Nursing)
Olson, Karin (Faculty of Nursing)
Faculty of Nursing

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Continuing to provide high-quality care to patients in the present health care system is challenging. As with many contemporary organizations, health care is characterized by change. This grounded theory study examined nurses’ workplace learning, with a particular focus on the role of the workplace in improving nursing practice. The data comprised semi-structured interviews of nominated nurses from diverse areas of practice and participant observation on two units in acute care. Nurses with more than ten years’ experience working in direct patient care who were known for nursing well were recruited to the study initially, followed by theoretical sampling of nurses at diverse stages. Constant comparison, grounded theory coding, theoretical sensitivity, and memos were used to analyze the data. Nurses’ workplace learning is an essential process in the career-long process of refining nursing practice. Refining processes begin with a trigger for learning. These triggers include patient-specific concerns, changes in the workplace, and self-awareness of a learning gap. In the workplace nurses respond to the resulting need to know by engaging in puzzling and inquiring, an iterative process that involves deliberation and drawing on other nurses, physicians, and other accessible resources. Everyday workplace learning and the career-long process of refining nursing practice are dependent on the quality of nursing education and early work experience. Germane conceptual, procedural, and dispositional knowledge and four capabilities, which nurses utilize throughout their careers to discriminate learning demands and develop wisdom, constitute a necessary foundation for nursing practice. These capabilities are (a) setting and maintaining high standards, (b) having a healthy apprehension, (c) seeing the whole patient picture, and (d) being self-aware. Refining nursing practice is facilitated by mentor-guides, workplace camaraderie, and functional teams. The pressures of globalization, neoliberalism, technical rationality, and managerialism place demands on nurses working in health care. The professionalization agenda, with related decisions to promote academic nursing education and with responsibilities related to ensuring continuing competence, has created preparation practice gaps. Based on this theory, I propose that existing approaches for preparing and supporting nurses for practising nursing in current health care require complementary efforts to accomplish the goal of excellent patient care.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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