Promoting moral imagination in nursing education: Imagining and performing.

Moral imagination is a central component of moral agency and person-centred care. Becoming moral agents who can sustain attention on patients and their families through their illness and suffering involves imagining the other, what moral possibilities are available, what choices to make, and how one wants to be. This relationship between moral agency, moral imagination, and personhood can be effaced by a focus on task-driven technical rationality within the multifaceted challenges of contemporary healthcare. Similarly, facilitating students' moral agency can also be obscured by the task-driven technical rationality of teaching. The development of moral agency requires deliberate attention across the trajectory of nursing education. To prepare nursing students for one practice challenge, workplace violence, we developed a multimodal education intervention which included a simulated learning experience (SLE). To enhance the realism and consistency of the educational experience, 11 nursing students were trained as simulated participants (SP). As part of a larger study to examine knowledge acquisition and practice confidence of learners who completed the SLE, we explored the experience of being the SP through interviews and a focus group with the SP students. The SP described how their multiple performances contributed to imagining the situation 'on both sides' prompting empathy, a reconsideration of their moral agency, and the potential to prevent violence in the workplace beyond technical rational techniques, such as verbal de-escalation scripts. The empirical findings from the SP prompted a philosophical exploration into moral imagination. We summarise the multimodal educational intervention and relevant findings, and then, using Johnson's conception of moral imagination and relevant nursing literature, we discuss the significance of the SP embodied experiences and their professional formation. We suggest that SLEs offer a unique avenue to create pedagogical spaces which promote moral imagination, thereby teaching for moral agency and person-centred care.

Reframing covenant for nursing: From individual commitments to covenant with society.

Today's constrained healthcare environment can make it very difficult for nurses to provide compassionate, competent, and ethical care, and yet their continued commitment to care is viewed as requisite. Nurses' commitment to care of patients, enmeshed with professional identity, may be understood as heroic. A few nursing scholars have advanced the concept of a nurse-patient covenant to explain or inspire nurses' commitment to care. Covenant describes an enduring relationship characterised by mutual promises and generous responsiveness. However, recent critique has revealed a general misunderstanding and misuse of the term covenant in much of the nursing literature whereby individual nurses are improperly and impossibly idealised as holding sole responsibility in the commitment to care. Such an interpretation obscures society's responsibilities in caring for both patients and nurses and contributes to the idealisation of nurses' commitment to extend themselves to fill in healthcare system gaps. Yet, the concept of a covenant relationship, when reframed as occurring between society and the profession of nursing, may lead us toward solutions to the very problems the originally misused concept sustained. Evidence within healthcare systems globally suggests that nurses' commitments are fragile or fragmented under duress due to increasing pressure, demands, and even risks. A reframing of covenant has the common good for society and nursing at its core and, we argue, may lead to a more sustainable nursing identity. We present the results of an exploratory project, undertaken to examine the utility and suitability of covenant as a relational framework for nursing. We explore a reframing of a covenant of care as a relationship between nursing and society, which may provide a fruitful path toward a sustainable, shared commitment for healthcare. This covenant of care re-centres shared work-a joint responsibility between society and nursing-as necessary for the common good.

Refining nursing practice through workplace learning: A grounded theory.

AIMS AND OBJECTIVES: To examine how experienced registered nurses in direct patient care learn within the constantly changing contemporary healthcare environment. The key objectives were to examine educational interactions amongst workplace, nurse and nursing practice, with a focus on the influence of context. BACKGROUND: Registered nurses must maintain competence throughout their careers. The related ongoing learning is triggered by external demands and nurses' internal motivation. Experienced nurses, poised to retire, have worked through the recent tumultuous changes in health care and therefore provide insight into how they sustained excellent patient care. DESIGN: The methodology for this study was a grounded theory informed by symbolic interactionism. EQUATOR guidelines for qualitative research (COREQ) applied. METHODS: Data collection entailed semi-structured interviews with experienced nurses across diverse settings and participant observation on two acute care units. Analysis of data was conducted using three-level coding, constant comparison, theoretical sampling and extensive memoing. RESULTS: Refining nursing practice begins during nursing education and early employment. Getting grounded involves establishing key capabilities, specifically becoming self-aware, setting high standards, cultivating healthy apprehension and seeing the whole patient picture. Three catalysts for workplace learning are mentor-guides, workplace camaraderie and a highly functional workplace team. Refining nursing practice includes both formal and informal learning; however, significant nursing expertise is developed through puzzling and enquiring, an iterative process of learning while nursing. CONCLUSIONS: Facilitating the development of capabilities for nurses' workplace learning during nursing education and early work experiences contributes to excellent patient care. Healthcare organisations need to value and support the unique contributions of mentor-guides in the clinical setting and promote individuals' development of expertise by nurturing camaraderie and developing highly functional workplace teams. RELEVANCE TO CLINICAL PRACTICE: Attending to the processes and catalysts for nurses' workplace learning will contribute to excellent patient care.

Getting grounded: Educational foundations for nurses' lifelong learning.

Lifelong learning is key to excellent nursing. Ensuring nurses have a strong foundation for lifelong learning requires a connection between pre-licensure nursing education and ongoing workplace learning. Currently, however, a line deeply divides nurses' learning during post-secondary education and their learning in the workplace. Expanding on the findings from a previously published grounded theory study exploring workplace learning in experienced nurses, I explore aspects of the theory relevant to nursing education in more depth. I describe the concept of Getting Grounded, a process of developing foundational knowledge and dispositions that unites nursing education to workplace learning. This differs from the current focus on knowledge-based examinations and pressure for job-ready graduates. Through this re-examination of dispositions necessary for workplace learning and consideration of current and emerging educational initiatives, I argue that nurse educators can, and should, contribute to graduates' lifelong learning and improved patient care.

Characteristics and processes of the dedicated education unit practice education model for undergraduate nursing students: a scoping review.

OBJECTIVE: The objective was to review literature related to the dedicated education unit practice education model for undergraduate nursing students, and identify common characteristics and processes for implementing and sustaining this model. INTRODUCTION: Although practice education is central to undergraduate nursing education, evidence-informed practices for learning in the clinical setting remain elusive. Changes to health care over the past decades related to the role and scope of practice for nurses, gradual shifts to community- and population-based care delivery, and expectations for interprofessional practice require forward-looking education models. The dedicated education unit model was developed in 1997 as a potential solution to globally recognized challenges in nursing education amidst discourses of nursing resource scarcity. Despite more than two decades of innovation and expansion, there is still limited understanding of the effectiveness of the dedicated education unit as a solution to those challenges, or for the anticipated benefits for students and patients, through enhanced evidence-informed health care. This analysis of the characteristics and processes of the model is timely for evaluating and sustaining implementation of the dedicated education unit across nursing practice and education settings. INCLUSION CRITERIA: English-only publications related to the dedicated education unit practice education model for undergraduate nursing students in baccalaureate and associate degree programs using qualitative, quantitative, or mixed methods research, and quality improvement, program evaluation, and opinion publications were included. METHODS: Using selected keywords including "dedicated education unit," we searched CINAHL, Google Scholar, MEDLINE, Academic Premier Search, ERIC, Cochrane Database of Systematic Reviews, JBI EBP Database, and ProQuest Dissertations and Theses. Two independent reviewers screened titles and abstracts against inclusion criteria. We reviewed reference lists for gray literature and additional references. Data were extracted from the included articles and categorized for characteristics and processes. Eighty-two publications from January 1997 to May 2020 were included. The findings were presented descriptively with tables and figures to support the data. RESULTS: Dedicated education unit models were based on five characteristics and four processes. Characteristics of the dedicated education unit model included effective academic-practice partnership, adaptability to diverse contexts, unit culture of educational excellence, responsive and supportive unit leadership, and clarity of roles and responsibilities. Processes included building nurse and faculty capacity, facilitating student learning, communicating regularly at systems and unit levels, and evaluating and sustaining the model. CONCLUSIONS: Evidence demonstrated that the dedicated education unit practice education model is well-established. However, there were existing gaps in this evidence, specifically evaluation and economic analyses. There was also limited attention to long-term sustainability of the model. The common characteristics and processes identified in this review may be used to support planning, implementation, and evaluation, including development and validation of evaluation tools. Although administrative infrastructure was noted as central to the dedicated education unit strategy, it was rarely acknowledged as part of management and thus also requires further study.

Characteristics of the collaborative learning unit practice education model for undergraduate nursing students: a scoping review protocol.

REVIEW QUESTION: What evidence on characteristics and processes of the collaborative learning unit practice education model for undergraduate nursing students is available?

The Role of Education in Developing Leadership in Nurses.

Nurses, with their intimate knowledge of person-centred healthcare, are called to lead at the point of care and to promote health across settings and the continuum of care. Capacity building and knowledge development for nursing leadership is a current priority in Canada, and therefore, academic preparation is foundational to developing nurses who lead. We provide examples of how to build leadership capacity in undergraduate, graduate and continuing professional development programs. Nurse educators across practice settings need to align educational content and pedagogies with the necessary knowledge, skills and attributes for leading both within and beyond healthcare contexts. Excellence in nursing education and strong partnerships with health sectors will contribute to effective and collaborative healthcare provided through nursing's distinctive lens.

Registered nurses' experiences of organizational change in acute care settings: a systematic review protocol.

REVIEW OBJECTIVE: The objective of this review is to explore how registered nurses working in acute care settings experience organizational change.

Reframing professional development for first-line nurses.

Within a context of healthcare restructuring and a shift toward individualized continuing competency in Canada, this inductive, narrative inquiry explored positive learning experiences of first-line acute care nurses. The written stories of eight self-selected participants were collected and unstructured follow-up interviews were conducted. The stories and interview transcripts were examined using categorical-content and holistic-form analysis, and analyzed in light of literature relating to adult education and professional development in nursing. Emergent themes included life-changing learning and learning through one's own, and other's, experiences. The findings highlight the need to re-frame professional development for nurses in Canada, specifically by valuing and utilizing shared workplace experiences.