Can action research be applied in developing clinical teaching?

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  • Journal of Advanced Nursing, 1997, 25, 801-808

    Can action research be applied in developingclinical teaching?Kristiina Hyrkas MNSc RNActing Senior Lecturer, Doctoral Student, University of Tampere, Department of NursingScience, Tampere. Finland

    Accepted for publication 19 April 1996

    HYRKAS K. (1997) Journal of Advanced Nursing 25, 801-808Can action research be applied in developing clinical teaching?Nursing education has undergone significant changes during the last twodecades in Finland. However, clinical teaching has remained unchanged eventhough it forms the most extensive part of nursing education. National andinternational research results have also exposed several problems for clinicalteaching. In the Finnish nursing education system these problems haveremained unsolved probably because many ofthe suggestions for development,based on research results, presuppose changes in both the college and healthcare systems. The whole system of clinical teaching was changed during theyears 1992-1993 in one nursing college and in one hospital in Tampere,Finland. Action research as a research strategy was applied in this study. Thepurpose of this paper is to describe the solutions sought and to assess if actionresearch can be applied to the development of clinical teaching.


    In Finland in recent years the length and content of nursingeducation have changed. However, the clinical teachingcomponent has remained unchanged even though it formsthe most extensive part of nursing education and providesprofound experience for the professional growth of nursingstudents. Depending on the chosen specialization theamount of clinical experience varies from 50 to 60% ofthe total hours of the main subject. In reality this meansthat approximately three-quarters of tbe teaching duringthe clinical experience is accomplished outside the officialcolleges in different kinds of social and health careservice organizations (Ammattikasvatushallitus 1989,Opetushallitus 1991).

    Clinical experience is expected to be an integral part ofnursing education. It has been seen that sldlls and knowl-edge learned in the classroom setting only make sensewhen they are applied in clinical practice (Jacobson 1966,Ammattikasvatushallitus 1989, Dunn et al. 1995).

    One special feature of the Finnish nursing education

    Correspondence: Kristiina Hyrkas, University of Tampere, Department ofNursing Science, PO Box 607, FIN-33101 Tampere, Finland.

    system is that the clinical teaching is co-ordinated by nurs-ing teachers from the colleges of nin-sing but, even thoughthe nursing teacher is present in the clinical settings, theactual bedside teaching is carried out by staff nurses. Thereason for this is that the teachers' role in clinical settingsis very unclear and legally uncertain; the teachers are notlegal members of the social and health care serviceorganizations.

    From 1992 to 1993 a project was undertaken in Tampere,Finland. The aim of the project was to develop clinicalteaching as a goal-oriented, planned and collaborativesystem by systematic planning and reorganization betweena nursing college and a 282-bed hospital. Action researchwas chosen as the most appropriate methodology for theproject. The focus of this paper is to try to answer thequestion 'Can action research be applied in developingclinical teaching?' by a closer consideration of an exampleof how action research was applied and also by discussingthe problems raised.

    Review ofthe problems in clinical teaching

    In Finnish nursing education clinical experience has beenconsidered to be very difficult to accomplish both in

    1997 Blackwell Science Ltd 801

  • K, Hyrkas

    quantity and quality. One of the main problems of thesystem seems to be tbe flexibility in the curriculum. Thisis a result of the hierarchic structure of the curriculum ontwo different levels: the objectives are loosely determinedat both national and college levels leaving teachers a lotof freedom in their interpretation. Most of tbe personnelin social and health care service organizations, however,have not completed higher education. This means thatthe frames of reference to plan and accomplishclinical teaching and supervision may vary greatly(Ammattikasvatushallitus 1989).

    The problems of clinical practice have been noted ininternational research. The results reveal that clinical stud-ies have not been adequately founded and tberefore theffndings tend to be vague and ambiguous (Forthergill-Bourbonnais & Smith-Higuchi 1995). The reason for thisdifficulty has been found to be poor goal orientation andinadequate and baphazard planning. Students accomplisbjust the routine duties and work together (Costello 1989).Individual and all-inclusive nursing does not form theessential content of the studies, as students learn toaccomplish single tasks and task-centred nursing. Clinicalstudies do not support the educational goals to be attained.In Finland it has been found that minimal time has beenspent on clinical teaching and supervision even thoughclinical experiences are stated to be the most importantlearning opportunities for students' professional growth(Leino-Kilpi et al. 1987).

    These findings are notable because, in the Finnish nurs-ing education system, clinical teaching is organized by tbenursing teachers from the nursing colleges. The nursingteachers are responsible for the educational arrangementof clinical practice, and the personnel in social and healthcare service organizations are responsible for the super-vision ofthe students. The problems mentioned above arehardly likely to diminish the classical problem of thetheory and practice gap. Time as a resource is also expens-ive and needs to be taken into consideration because ofeconomic constraints; financial resources for Finnish nurs-ing education are decreasing (Hokkanen et al. 1994,Bamad & Dunn 1994).

    ACTION RESEARCH AS A RESEARCHIMETHODAttempts have been made to define action research inseveral different ways, with Cohen & Manion (1980)stating that there is no generally accepted definitionfor action research. Tbis problem can be seen to originatefrom the fact that action research is seen more as astrategy for change than as a research method. In spite oftbe differences between tbese definitions, four similarand common cbaracteristics have been found identifyingthat action research seeks (Holter & Schwarz-Barcott1993):

    1 to achieve collaboration between researcher andpractitioners;

    2 to solve problems in practice;3 to aim at change;4 to strive for theory development.

    The role of the researcher in action research differs fromthat of the traditional researcher's as the researcher is anactive member in the community. In action research theresearcher's intention is to solve problems in practice and,on the other hand, to collect data, which are essential forthe action and its development and are also of scientificinterest. However, the focus is also on collaborationbetween the researcher and tbe respondents. The partici-pating members in action research are in an equal positionthroughout the entire researcb process so that, during itsprogress, the researcher and respondents are able to con-trol all the different phases (Carr & Kemmis 1986, Argyrisef al. 1987, Holter & Schwarz-Barcott 1993).

    PhasesSeveral authors have described action researcb as beingcomposed of four or five different phases: diagnosing,planning, implementing, evaluating and learning(Rapoport 1970, Coates & Chambers 1990). Tbe mostcharacteristic feature of action research is considered tobe the spiral-like progress with alternating phases andcycles that evolve over a period of time. This means thatthe first phase is tbe basis of the second phase, and alsothat the first cycle forms the basis for the second cycle. Itis assumed that action research consists of at least twocycles. Arguments have been evinced for the idea of pro-gressive development (Cohen & Manion 1980). The basicidea of action research is illustrated in Figure 1.

    Action research as a research strategy in nursingNationally and internationally action research has beenused increasingly as a strategy to develop and change nurs-ing practice and education during the last decade. Themajor reason why its popularity has increased is that, asa researcb method, it combines the elements of theory,researcb and practice (Holter & Schwarz-Barcott 1993,Greenwood 1994). It has been seen to combine the researchmethods of human and natural sciences in a coherentwhole. Action research as an approach is also consideredto decrease the gap that is fraditionally identified as exist-ing between theory, research and practice. These interestshave also arisen because traditionally many researchershave been concerned about the emphasis of positivisticresearch in nursing science (Holter & Schwarz-Barcott1993, Titchen & Binnie 1994).

    The other reason why action research has beenincreasingly used in nursing researcb is because human

    802 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 801-808

  • Action research in clinical teaching

    First cycle Second cycle Third cycle ^ Figure 1 Action research, thephases, cycles and progress intime (Hyrkas 1996).

    beings are considered as holistic. Humans are compre-hended as self directing, having initiative and beingresponsible for their own learning. Humans are seen notjust as passive participants in their working community,but also as being capable and willing to confribute to theircommunity's functions. The basic assumption in actionresearch is that only the members of a community canexplore and develop their own community's functions inthe best possible way. Action research increases the aware-ness of people by activating or initiating both change anddevelopment (Holter & Schwarz-Barcott 1993, Gree