title: To belong or not to belong: nursing students' interactions with clinical learning environments - an observational study.
abstract: BACKGROUND
  Belongingness has been argued to be a prerequisite for students' learning in the clinical setting but making students feel like they belong to the workplace is a challenge. From a sociocultural perspective, workplace participatory practices is a framework that views clinical learning environments to be created in interaction between students and the workplace and hence, are dependent on them both. The aim of this study was to explore the interdependence between affordances and engagement in clinical learning environments. The research question was: How are nursing students influenced in their interactions with clinical learning environments?
  
  
  METHODS
  An observational study with field observations and follow-up interviews was performed. The study setting comprised three academic teaching hospitals. Field observations included shadowing undergraduate nursing students during entire shifts. Fifty-five hours of field observations and ten follow-up interviews with students, supervisors and clinical managers formed the study data. A thematic approach to the analysis was taken and performed iteratively with the data collection.
  
  
  RESULTS
  The results revealed that students strived to fill out the role they were offered in an aspirational way but that they became overwhelmed when given the responsibility of care. When students' basic values did not align with those enacted by the workplace, they were not willing to compromise their own values. Workplaces succeeded in inviting students into the community of nurses and the practice of care. Students demonstrated hesitance regarding their desire to belong to the workplace community.
  
  
  CONCLUSIONS
  The results imply that the challenge for clinical education is not to increase the experience of belongingness but to maintain students' critical and reflective approach to health care practice. Additionally, results suggest students to be included as an important stakeholder in creating clinical learning environments rather than being viewed as consumer of clinical education.
authors: Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Stockholm, Sweden. matilda.liljedahl@ki.se.|Clinical Genetics, Karolinska University Hospital, SE-171 76, Stockholm, Sweden. matilda.liljedahl@ki.se.
authors: Matilda
authors: http://orcid.org/0000-0003-2011-8180
authors: M
authors: Liljedahl
authors: Clinical Genetics, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.|Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
authors: Erik
authors: E
authors: Björck
authors: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
authors: Susanne
authors: S
authors: Kalén
authors: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
authors: Sari
authors: S
authors: Ponzer
authors: Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Stockholm, Sweden.|Department of Education, Stockholm University, SE-106 91, Stockholm, Sweden.
authors: Klara
authors: K
authors: Bolander Laksov
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D004508:Education, Nursing, Baccalaureate; D006801:Humans; D007400:Interprofessional Relations; D009042:Motivation; D015402:Nursing Education Research; D009745:Nursing, Supervisory; D018794:Problem-Based Learning; D036301:Qualitative Research; D013338:Students, Nursing / Q000523:psychology* / Q000706:statistics & numerical data; D013548:Sweden; D017132:Workplace
keywords: Belongingness; Clinical learning environments; Clinical nursing education; Observational study; Workplace learning; Workplace participatory practices