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Background Continuing professional development (CPD) is central to nurses’ lifelong learning and constitutes a vital aspect for keeping nurses’ knowledge and skills up-to-date. While we know about the need for nurses’ continuing professional development, less is known about how nurses experience and perceive continuing professional development. A metasynthesis of how nurses experience and view continuing professional development may provide a basis for planning future continuing professional development interventions more effectively and take advantage of examples from different contexts. The aim of this paper is to conduct such a metasynthesis, investigating the qualitative research on nurses’ experiences of continuing professional development. Methods A metasynthesis of the qualitative literature was conducted. A total of 25 articles fulfilled the inclusion criteria and were reviewed. Results We determined five overarching themes, Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. This metasynthesis highlights that nurses value continuing professional development and believe that it is fundamental to professionalism and lifelong learning. Moreover CPD is identified as important in improving patient care standards. Conclusions Based on the metasynthesis, we argue that access to continuing professional development could be made more attainable, realistic and relevant. Expediently, organizations should adequately fund and make continuing professional development accessible. In turn, nurses should continue to actively engage in continuing professional development to maintain high standards of nursing care through competent practice. This paper highlights the perceived benefits and challenges of continuing professional development that nurses face and offers advice and understanding in relation to continuing professional development. We believe that this metasynthesis contributes with insights and suggestions that would be valuable for nurses and policy makers and others who are involved in nurse education and continuing professional development.

Background Although extensive research exists about students’ clinical learning, there is a lack of translation and integration of this knowledge into clinical educational practice. As a result, improvements may not be implemented and thus contribute to students’ learning. The present study aimed to explore the nature of clinical faculty members’ learning related to how they apply research about student autonomy. Methods A course, “Designing learning for students’ development of autonomy in clinical practice” was conducted for faculty responsible for students’ clinical education. Within the frame of the course the participants designed a project and planned how they would implement it in their clinical context. Fourteen clinical faculty members participated in the study. The participants’ interpretation of the educational intervention, which combines complex theory with the equally complex clinical practice, was explored by studying how the participants’ approaches and understanding of the facilitation of autonomy were manifested in their projects. The projects in the form of reports and oral presentations were analyzed using qualitative content analysis together with an abductive approach. Findings One identified domain was “Characteristics of the design and content of the projects”. This domain was signified by two themes with different foci: Preparing the soil for facilitating student autonomy ; and Cultivating opportunities for students to actively strive for autonomy. A second identified domain, “ Embracing the meaning of facilitating autonomy ” was connected to participants understanding of theories underlying how to support the development of autonomy. This domain contained two themes: Connection between activities and autonomy is self-evident and Certain factors can explain and facilitate development of autonomy. Conclusion Education directed to strategic clinical faculty members to develop evidence-based approaches to student learning can be productive. To succeed there is a need to emphasize faculty members individual understanding of actual research as well as learning theories in general. Faculty trying to reinforce changes are dependent on their own mandate, the structure in the clinic, and recognition of their work in the clinical context. To achieve a potential continuity and sustainability of implemented changes the implementation processes must be anchored throughout the actual organization.

Background The development of technology has provided new ways for active engagement and for visualizing structures in anatomy education including digital resources that may be used outside of the classroom. To support students’ learning, there is a need to better understand students’ experiences of using digital resources. This study aimed to identify which resources students use, their preferences, the purpose of using them, and barriers to adopting tools for self-study of anatomy. Methods A mixed -methods approach combining qualitative and quantitative data was used to collect and analyse data. Two consecutive cohorts of first-semester medical students (n = 278) were invited to complete an anonymized survey. The survey consisted of itemized questions, free-text space for comments, and one open-ended question. Descriptive statistics were used for demographics and itemized answers. Comments and free-text answers were analysed qualitatively using abductive inference. Results One hundred and twenty-seven students completed the survey (response rate 45%). Most students (46%) reported that they spend more than 30 h/per week on self-study. They used a variety of digital resources for different purposes. Most students used digital resources to prepare for examinations, when they encountered difficulties and after going through a section. Students reported that they would use digital resources to a greater extent if they were offered an introduction, if resources were more accessible, and if they could interact with a tutor. The free-text responses revealed that digital resources helped students understand anatomy, allowed them to make active choices, provided tools for repetition and memorization, accelerated and simplified the learning process, and complemented other learning resources. Conclusions Digital resources may support the understanding of anatomy by offering alternative modes of learning and providing a valuable complement to other learning resources. Educators should consider how digital resources are introduced and offer support and feedback.

Background Many studies have investigated the value of three-dimensional (3D) images in learning anatomy. However, there is a lack of knowledge about students learning processes using technology and 3D images. To understand how to facilitate and support the learning of anatomy, there is a need to know more about the student perspectives on how they can use and benefit from 3D images. Methods This study used designed educational sessions informed by Educational Design Research to investigate the role of technology-enhanced 3D images in students’ anatomy learning. Twenty-four students representing different health professions and multiple study levels, and one tutor, participated in the study. A visualisation table was used to display the images of real patient cases related to disorders associated with the abdomen and the brain. Students were asked to explore the images on their own and audio/video capture was used to record their words and actions. Directly following the session, students were interviewed about their perceptions and different ways of learning and studying anatomy. The tutor was interviewed about his reflections on the session and his role as a facilitator on two occasions. Content analysis was used in its manifest and latent form in the data analysis. Result Two main categories describing the students’ and tutor’s accounts of learning using the visualisation table were identified: 1. Interpreting 3D images and 2. Educational sessions using visualisation tables. Each category had signifying themes representing interpretations of the latent meaning of the students' and tutor's accounts. These were: Realism and complexity; Processes of discernment; References to previous knowledge; Exploring on one's own is valuable; Context enhances learning experiences; Combinations of learning resources are needed and Working together affects the dynamics. Conclusions This study identifies several important factors to be considered when designing effective and rewarding educational sessions using a visualization table and 3D images in anatomy education. Visualisation of authentic images has the potential to create interest and meaningfulness in studying anatomy. Students need time to actively explore images but also get tutor guidance to understand. Also, a combination of different resources comprises a more helpful whole than a single learning resource.

Surgical simulation training substituting a live animal for a human patient is a continuing practice. Despite clear ethical controversy, many perceive this type of simulation to be 'high fidelity' and therefore valuable. This study employs a sociomaterial perspective to explore how use of a live animal mediates learning activity and behaviour during a trauma surgical simulation course. This international, focused ethnography generated data through observation of surgical simulation courses in six different countries. A narrative analysis was conducted using instrument-mediated learning theory as a lens for interpretation. The key finding is the dual and fluid existence of a live animal as an instrument for learning, variably perceived as a simulator tool for training and as a patient that must be saved. When framed as a tool, surgical knowledge and skills are practiced with learning acquired via epistemic and pragmatic mediation. Performing a thoracotomy denotes a critical moment; procedural unfamiliarity, evident haemorrhage and inherent risk of a deadly outcome contribute to uncertainty and clinical complexity. Learners are hence more likely to frame the animal as a patient. This experience has psychological fidelity, feeling more authentic as actions have consequences. Risk of failure to sustain the life of the animal mediates reflexive learning, teaching the learners about themselves and their abilities. Live animal simulation training mediates surgical learning differently, dependent on whether the animal is framed as an instrument or as a patient. The animal's ability to bleed and exsanguinate to death creates risk and uncertainty as learners perform complex skills under pressure of significant consequence. Authenticity could be amplified if the animal is framed as a patient throughout the simulated learning event.

Background The COVID-19 crisis had a significant impact on health care and nursing education as a large part of it is carried out in clinical practice. However, it is not known how the learning situations during the pandemic affected students’ learning. To deepen the understanding of students’ learning, learning theories within a constructive paradigm is used as a framework for this study. The purpose of the study was to explore nursing students´ perceptions of their learning in clinical practice during COVID-19. Methods In this interpretative qualitative study, seven focus group discussions were conducted with 21 nursing students at different stages of the nursing programme, all of whom performed clinical practice during the outbreak of COVID-19. The analysis of the discussions was performed with interpretative content analysis related to theoretical assumptions about learning. Results The learning situation was characterised by chaos and confusion affecting both the students’ opportunities to learn and what they learned. Despite the uncertainty the students appreciated having experienced this unique situation, which contributed to valuable learning. Things otherwise taken for granted or not encountered before became visible. The learning processes were characterised by complexity and challenges that hindered or stimulated learning. It depended on the student’s approach and the management of the clinical education. Concerns about one´s own and relatives’ health, and not being able to finish studies, also affected learning. The students learned about important measures during a pandemic regarding hygiene, care organisation, communication, and the multifaceted role of the nurse. Conclusion Unpredictable situations such as a pandemic can lead to unique learning since “the extraordinary makes the ordinary visible”. The students learned things additional to the formal learning outcomes, and the experiences strengthened their will to become nurses. Challenges due to a crisis can become important driving forces for learning, if not experienced as overwhelming. Some students felt they received space for own initiatives and responsibility while others felt lost and abandoned. Preparing for a crisis means preparing for an unknown future. Students therefore need to experience dilemmas and uncertain situations and reflect in a safe environment.

Background Patients’ knowledge and participation are essential for safe care. Nurses must enhance their pedagogical knowledge and skills to support patients to understand their health and become active partners in care. Pedagogical activities were implemented in a specialist nursing program to support this learning. The aim of this study was to explore experienced nurses’ understanding of the meaning of pedagogical encounters with patients in cancer care, as well as how they think and act during these encounters to support patients’ learning. Methods Interpretative qualitative study using individual interviews with nurses ( n  = 8) undergoing specialist training. An interview guide along with the nurses’ written assignments during the specialist training were used to aid the interview. Data were analysed using reflexive thematic analysis. Results The nurses’ understanding of the meaning of pedagogical encounters with patients in cancer care could be described by one overarching theme “A holistic approach to support patients learning” and five sub-themes: “Supporting patient learning through pedagogical awareness”, “Creating an atmosphere of trust”, “Forming mutual understanding and participation”, “Using personal characteristics and experiences”, and “Engaging in continuous learning and team collaboration”. The nurses’ overarching goal with the pedagogical encounter was to support patients to understand and cope with their situation. They used strategies like active listening, observing non-verbal cues, and seeking feedback to create a supportive, person-centred learning environment. Theoretical knowledge enhanced their awareness of diverse learning methods and how to tailor nursing interactions to individual needs. Still, they emphasized the importance of personal characteristics and experiences over theoretical knowledge, where self-awareness, empathy, and human insight is vital. Conclusion The nurses’ thoughts and actions in their encounters with patients were supported by what they had experienced and studied about learning in the program, their competencies in nursing, and most strongly their own personal qualities and experiences. These are all important sources to support patient learning, but we want to forward the importance of including pedagogical knowledge and practice in health care education. Future research should explore how theoretical knowledge in pedagogy can be better integrated into practice. Clinical trial number Not applicable.

The complex nature of student learning in clinical practice calls for a comprehensive pedagogical framework on how to create optimal learning affordances. The purpose of this study was to describe characteristics of conducted research regarding investigated research questions, distribution of different health care student groups, and employed methodological approaches. A scoping review was chosen to capture the multifaceted characteristics in the field of learning in clinical practice. Funded local projects were analysed to provide significant core concepts for the literature search. A systematic search and review of articles published 2000-2019 in the Nordic countries was conducted according to PRISMA- ScR (23). The search was made in Medline (OVID), SveMed+ and CINAHL and resulted in 3126 articles. After screening of the titles and abstracts 988 articles were included for further review. The abstracts of all these articles were reviewed against established inclusion and exclusion criteria and 391 articles were included. Characteristics of purposes and research questions were analysed with a qualitative content approach resulting in identified subject areas including significant categories. Health care student groups and methodological approaches were also identified. Subjects predominating the research were , and followed by and . , and were investigated to a small extent. Sparsely occurring subjects were also and . Nursing students were involved in 74% of the studies, medical students in 20%, and other professions around 8%. Qualitative approaches were most common. Health care students' learning in clinical practice has been researched to a large extent within the Nordic countries and important subject areas are well represented. The research displays a great potential to extract and describe factors to create a pedagogical framework with significant meaning to support students' learning.

Aim To explore children's perspectives when facing anaesthesia and surgery. Design Interpretative qualitative design. Methods Children undergoing outpatient surgery were interviewed in three different phases, before and after anaesthesia and surgery (phase 1 and 2) and 1 month after the hospitalization (phase 3). Twenty‐two children (4–15 years) were interviewed in phase 1 and 2 and six children (5–13 years) in phase 3. Data were analysed using manifest and latent qualitative content analysis. Results Two contrasting themes were identified: Fearful in association with anaesthesia and surgery and Confident in association with anaesthesia and surgery. Comprehension of the perioperative procedures, continuous information and interaction with the healthcare providers were decisive factors for children's expressions of confidence or fearfulness. Events considered as major from a healthcare perspective may be of no importance to the child, while events considered as less important by healthcare providers may be significant to the child. Understanding children's perspectives and awareness of their need to process the information provided are significant factors for establishment of trust and confidence in a highly technological perioperative environment.

Background Mentoring has been employed in medical education in recent years, but there is extensive variation in the published literature concerning the goals of mentoring and the role of the mentor. Therefore, there is still a need for a deeper understanding of the meaning of mentoring for medical students’ learning and development. The aim of this qualitative study is to explore how formal and longitudinal mentoring can contribute to medical students’ professional development. Methods Sixteen medical students at a Swedish university were interviewed individually about their experiences of combined group and one-to-one mentoring that is given throughout their studies. The mentoring programme was focused on the non-medical skills of the profession and used CanMEDS roles of a physician for students’ self-assessment. Data were analysed using a latent, interpretive approach to content analysis. Results The results comprise three themes: Integrating oneself with one’s future role as a physician, Experiencing clinical reality with the mentor creates incentives to learn and Towards understanding the professional competence of a physician. The mentorship enabled the students to create a view of their future professional role and to integrate it with their own personalities. The students’ understanding of professional competence and behaviour evolved during the mentorship and they made advances towards understanding the wholeness of the profession. This approach to mentorship supported different components of the students’ professional development; the themes Integrating oneself with one’s future role and Towards understanding the professional competence of a physician can be regarded as two parallel processes, while the third theme, Experiencing clinical reality with the mentor creates incentives to learn, promotes these processes. Conclusions Formalized and longitudinal mentoring focusing on the non-medical skills can be recommended to help medical students to integrate their professional role with themselves as individuals and promote understanding of professional competence in the process of becoming a physician.