• acute care;
  • clinical education;
  • community of learning;
  • cooperative learning;
  • grounded theory;
  • nursing students;
  • Roy Adaptation model

ruth-sahd l.a. (2011) Student nurse dyads create a community of learning: proposing a holistic clinical education theory. Journal of Advanced Nursing67(11), 2445–2454.


Aims.  This paper is a report of a qualitative study of students’ experiences of cooperative learning in the clinical setting.

Background.  Although cooperative learning is often used successfully in the classroom, it has not been documented in the clinical setting with sophomore nursing students being paired with other sophomore nursing students.

Methods.  Using a grounded theory methodology a sample of 64 participants (32 student nurse dyads, eight clinical groups, in two different acute care institutions) were observed on their first day in the clinical setting while working as cooperative partners. Interviews were also conducted with students, patients and staff preceptors. Data were collected in the fall of 2008, spring and fall of 2009 and the spring of 2010 using semi-structured interviews and reflective surveys. Data were analysed using the constant comparative method.

Results/Findings.  A holistic clinical education theory for student nurses was identified from the data. This theory includes a reciprocal relationship among five categories relevant to a community of learning: supportive clinical experience; improved transition into practice; enhanced socialization into the profession; increased accountability and responsibility; and emergence of self-confidence as a beginning student nurse.

Conclusion.  The use of student dyads creates a supportive learning environment while students were able to meet the clinical learning objectives. Cooperative learning in the clinical setting creates a community of learning while instilling very early in the education process the importance of teamwork. This approach to clinical instruction eases the transition from the classroom to the clinical learning environment, and improves patient outcomes.