Nurses' learning opportunities in the interactions of ruling relations

Laila Belinda Heldal, Pernille Brønnum Heideby, Gro Kjær & Dorthe Bjørndal

Student thesis: Master programme thesis



This Master’s Thesis is based on a hypothesis that workplace learning among nurses is under pressure due to political, structural, organizational and demographic changes. The production rationale and demands for efficiency represent a dominant logic, which to a great extent influences the nurses´ priorities in their work tasks. Through a literature review this issue is elaborated and a wider perspective of nurses´ learning conditions in the workplace is presented. Besides the preliminary hypothesis, our preconceptions are explicated. The problem definition rises the question: Which factors affect nurses learning opportunities in clinical practice - and how do these factors implicate the development of the nursing profession. A broad introduction to understanding workplace learning is presented along with a brief overview of the history of nursing, the nursing profession and the societal and political structures that shape the healthcare system. The empirical data was produced through participatory observations in medical wards and through a workshop, where the participating nurses produced a persona. The empirical analyses were conducted by an approach inspired by Dorothy Smith’s sociology; Institutional Ethnography. In the primary phase we used the concrete observations of the activities and interactions among the nurses, combined with the opinions and stories about the persona, to identify text mediated ruling relations, that have impact on and organize the tasks of the nurses. Disjunctures between conflicting ruling relations and the nurses experience formed a series of problematics affecting the nurses work and learning opportunities. These findings were assembled in overall tracks describing general influences of ruling relations, which was used as an analytical frame for the secondary phase. The tracks were defined as production, quality improvement, work structure, patient safety, profession and patient related. In this secondary analysis, the circumstances created by these ruling relations were discussed in conjunction to nurses worklife learning possibilities, using a triangle based model of the workplace learning-environment presented by Helms Jørgensen and Warring. Conclusively, it was stated that the tracks of ruling relations form fields of contradictions and tensions, that in the same time constrains and creates learning possibilities, and lead to both adaptive and developmental or reflective learning. It was argued that the traditional view on the patient care perspectives in nursing are changing. In order to maintain and improve learning possibilities among nurses and the development of the nursing profession, attention to and knowledge about the impact of ruling relations and the workplace learning environment must be present. Likewise, a change in nurses education, that prepares the nurses for their future work in a better way, should be implemented. We believe that the notion of and attention to ruling relations will serve as a liberating knowledge among nurses.

Educations, (Master) Master
Publication date2 Jun 2019
Number of pages97
SupervisorsChristian Helms Jørgensen