Abstract
The study reported in this thesis is concerned with the education of basic general nurses whilst they are working in the clinical setting. Set against a system where the position of the student is essentially that of an apprentice, previous studies have demonstrated that theory is often divorced from practice and any teaching which does take place is frequently sparse and erratic. In an attempt to alleviate this situation, this study examines the circumstances surrounding the introduction of a scheme of self-directed learning (in the form of learning packages) into two orthopaedic wards in a District General Hospital. Using a case study approach to educational research, the techniques of illuminative evaluation are used to monitor the project in all its phases (planning, production and implementation). Throughout the study the effects of this educational innovation are viewed from three main perspectives: i) the student and pupil nurses ii) the permanent, qualified staff on the wards; iii) the nurse teachers. Findings from the study demonstrate that although the planning and production of learning packages which are appropriate for use in clinical areas is both time-consuming and initially expensive, their use in promoting learning and in helping students (and pupils) from a wide range of educational abilities to apply theory to practice is effective. Since the learning package was introduced, i) the students' motivation to learn increased, their study habits improved and they became generally more questioning; ii) the quality of teaching by both the qualified ward staff and the nurse teachers improved in a variety of ways. The total effect was therefore one of a generally enhanced teaching/learning milieu within the clinical areas concerned. There was some definite evidence to suggest that this change of circumstances had a beneficial effect on patient care. The need for a "partnership approach" to nurse education between the nurse teachers and the clinical staff was highlighted by the findings from every stage of the study, as was the changing role of the teacher who employs methods of self-directed/ distance learning. In the last chapter of the thesis certain conclusions are drawn from these findings and they are examined alongside those from other studies which have investigated the teaching and learning of nurses in the clinical areas. The external validity (generalizability) of small, predominantly qualitative studies of this nature is also discussed. Finally several recommendations are made and suggestions are put forward for further research in similar areas.