Till Örebro universitet

Background: Clinical practice is essential for student nurse anesthetists to integrate theory with practical skills; however, the demanding clinical environment can impact both stress and learning outcomes. Responsibilities and expectations differ across healthcare systems, and research in the Swedish context remains limited. Addressing this gap is essential for understanding how clinical practice contributes to the development of professional readiness and competence. This study, therefore, aimed to describe the learning experiences of students and newly graduated nurse anesthetists, with a focus on the clinical learning environment and the stress it entails.

Methods: A convergent parallel mixed-methods design was used. In the quantitative strand, student nurse anesthetists were recruited using convenience sampling to complete a web-based survey that included the two instruments, "Clinical Learning Environment Supervision and Nurse Teacher evaluation scale" and "Perceived Stress Scale" (with 10 items). Data were analyzed with descriptive statistics, while free-text answers were analyzed using summative content analysis and word frequencies. In the qualitative strand, newly graduated nurse anesthetists were recruited using purposive sampling to participate in individual semi-structured interviews. Data were analyzed with content analysis. After separate analysis, the pillar integration process was used to integrate quantitative and qualitative data.

Results: The analysis included data from 63 surveys (63/225, 28%) and 13 interviews. The integration of data from both strands yielded two divergent themes, "An unfamiliar but supportive learning environment" and "Experience of stress," and two convergent themes, "Supervisors, a facilitator to learning" and "Dynamic learning situations."

Conclusion: Despite the challenges of adapting to new knowledge contexts, participants reported high satisfaction with the clinical learning environment, as shown by elevated scores in the Clinical Learning Environment Supervision and Nurse Teacher evaluation scale. Clinical supervisors played a pivotal role in supporting learning, and the environment's pedagogical flexibility enabled both individual and collaborative approaches. Although stress levels varied, the average Perceived Stress Scale score remained low.

Purpose: This study explores student nurse anesthetists' (SNAs) learning in the operating room during the coronavirus 2019 pandemic.

Design: An explorative design with semistructured interviews was used.

Methods: Thirteen former SNAs and 12 clinical supervisors (8 of whom were included in the final analysis) were recruited from 6 counties in Sweden. Participants were purposively recruited. Inclusion criterion for former SNAs was having completed the nurse anesthesia program in the fall of 2020 to spring 2022; and for nurse anesthetists, those who have experience in supervising SNAs. The interviews were analyzed with thematic analysis.

Findings: The analysis identified one theme and five subthemes. The theme was that student learning was in focus despite an ongoing pandemic. Every learning situation contributed, and learning was triggered by the challenges. Both the SNAs and the supervisors exhibited resilience by accepting the situation and striving to do their absolute best in a nonoptimal learning environment. Over time, learning and supervision returned to normal.

Conclusions: During the pandemic, learning was ongoing despite stress, fear, and other challenging factors. Students' learning appears to have been prioritized. The study highlights that nurse anesthetists and SNAs were resilient, resourceful, and able to find new ways to keep learning going. 

BACKGROUND: The professional role of a nurse anaesthetist involves taking a pedagogical approach towards students, including supervision during clinical practice. Although supervisors are facilitators of student learning, they are offered little training in adult learning principles. The aim of this study was to describe supervisors' experience of student nurse anaesthetist learning during clinical practice in the operating room.

METHOD: In this qualitative interview study, 12 semi-structured individual interviews were carried out with clinical supervising nurse anaesthetists. The data were analysed inductively using thematic analysis.

RESULTS: The results are illustrated with one theme and five sub-themes. The clinical learning situation of student nurse anaesthetists is described as a reflection of different cultures coming together. The operating room environment is a new context to students, and students enter with different clinical background and experiences. There is tension in facilitating student learning due to demands for productivity; supervisors suggest the use of separate operating rooms with a special focus on learning in the future.

CONCLUSION: Clinical practice facilitates student learning and is a parallel process to routine care. Thus, it requires the cultures of higher education and healthcare organizations to co-exist. This is illustrated with the theme "Contributing to students' future professional roles by bridging the hospital and university cultures". In the operating room, student learning is challenged by a new context and time pressure as shown by subthemes. To overcome challenges and support student learning in the operating room from a supervisors' perspective, interprofessional student teams are suggested as a future approach and need to be further investigated.

PURPOSE: The purpose of this review was to identify supporting and hindering factors for student nurse anesthetists' (SNAs') learning in the operating room during clinical practice, from students' and supervisors' perspectives.

DESIGN: An integrative review.

METHODS: Systematic searches were conducted in Medline, Cinahl, PsycInfo, and ERIC. Search terms were related to nurse anesthetist, education, operating room context, and clinical setting. Searches were performed at three points in time and in total 1,530 unique articles were identified. After screening using Covidence and using Joanna Briggs Institute appraisal tools, 34 articles remained. These were analyzed inductively using a constant comparison method.

FINDINGS: Supporting factors include preparation before clinical practice, clearly stated expectations, a respectful relationship with the supervisor, daily planning and communication, and constructive feedback. Hindering factors include lack of time, disruptive behavior from supervisors or other team members, and environmental factors such as a high room temperature and noisy environment.

CONCLUSIONS: SNAs' learning situation in the operating room resembles undergraduate nurses' learning during clinical practice. Educators and supervisors can take several actions to promote SNAs' learning. Further research is warranted on the effect of teamwork on SNAs' learning.