Elucidation and measurement of clinical learning opportunity


Mr D. Lewin, Nursing Education Research Unit, King's College, London, 552 King's Road, London SW100UA.


Competence in nursing derives from the actual practice of the craft. The authors describe ways of assessing the variety and extent of opportunities for clinical learning available to student nurses. Cohorts of students from each of three different types of hospital (72 students in all) were followed from the beginning to the end of training. From interviews with ward sisters, observation on the wards, and examination of nursing notes the pattern of clinical conditions characteristic of each training ward is established and hence, by aggregation, the pattern for each of the three training schemes. However, it is argued that only by investigating the learning careers of individuals can one gain knowledge and insight in sufficient detail to act as a guide to reform. Information on allocation to training wards is used to construct individual profiles of clinical opportunity, one for each student. Clinical conditions are grouped into 13 categories and it is shown how, for some categories, there are large differences between the experiences of individuals within a cohort, especially in one hospital. Finally the authors explain how, with a minimum of effort, these methods and findings could be adapted to improve and facilitate training; the procedures could be used to monitor each developing profile and, by judiciously modifying the continuing process of allocation, tutors would be able to achieve equality of clinical opportunity for their students.