6 ARQUITECTURA
6.4 ACCESO A DATOS
6.4.6 CACHÉS EN HIBERNATE
The Communities of Practice theory (Wenger 1998) was chosen as a theoretical framework for conceptualising learning ‘by doing’ in a community of practice. Earlier situated learning theory (Vygotsky 1978; Brown et al. 1989) did not recognise that learning takes place in a
‘community of practice’. The following definition of a ‘community of practice’ will be applied throughout the thesis:
“a group of people who share a concern, set of problems or passion about a topic and who deepen their knowledge and expertise in this area by interacting on an on-going basis” (Wenger et al. 2002, p. 4)
This is the most up to date definition of a ‘community of practice’ used in the literature (Kislov et al. 2011; Morley 2016). This definition was also chosen as it captures the social-cultural context of learning which may be important in the learning of aseptic technique. Studies that have applied the Communities of Practice theory (Wenger 1998) to explore nursing students’ experiences of learning and applying bioscience in the clinical setting (Molesworth and Lewitt 2015) and models of clinical learning (Ranse and Grealish 2007; Grealish and Ranse 2009; Grealish et al. 2010) have overlooked defining a ‘community of practice’. In this study it was important to define a ‘community of practice’ to enable understanding of this concept in relation to when, what and how nursing students learn aseptic technique and are taught and assessed at each case-study site.
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The university and clinical practice setting may operate as two distinct Communities of Practice with different priorities, philosophies, culture and discourse (Wenger 1998) as shown in Figure 4 and discussed later in this section under ‘community’. Nursing students encounter many different clinical placements during their programme. The above definition of a ‘community of practice’ implies that nursing students may be exposed to different communities of aseptic technique practice. If the definition of a ‘community of practice’ is applied to what and how nursing students learn aseptic technique and are taught and assessed, knowledge and expertise in aseptic technique is developed locally through social interaction. The ‘communities of practice’ theory (Wenger 1998) could be applied to the learning of other core nursing skills. A ‘communities of practice’ approach could be developed where universities and NHS trusts function as one ‘community of practice’.
The literature review (see Chapter 4) suggested that there may be a theory practice gap in aseptic technique. Dissonance between what students learn and are taught about aseptic technique in university and observed to be practiced in clinical placements has been reported by students in some studies (Cox et al. 2014) and not in others (Carter et al. 2017) (see Chapter 4). The Communities of Practice theory (Wenger 1998) was chosen to be applied in this study to explore whether what and how aseptic technique is taught and assessed in university is congruent with what is taught and seen to be practised in clinical placements. It is a reasonable supposition to make that nursing students are only able to transfer their learning from university to clinical practice when what is learnt and taught in university is comparable to what is practised in clinical placements. Greater
understanding of what and how nursing students learn aseptic technique and are taught and assessed is required if the standard of aseptic
technique practice is to be ensured (see Chapter 1).
The importance of exploring the socio-cultural context in which nursing students learn and are taught aseptic technique was supported by the literature review findings (see Chapter 4). A recurring theme across studies was that nursing students were being exposed to poor and conflicting aseptic technique practices in clinical placements (Ribu et al. 2003; Geller et al. 2010; Ward 2010, 2011, 2012a, 2012b; Gould and Drey 2013; Carter
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et al. 2017). The influence of poor role models upon nursing students’ learning of aseptic technique therefore requires investigation.
The Communities of Practice theory (Wenger 1998) has been used to explore nursing students’ experiences of learning and applying bioscience in the clinical setting in the UK (Molesworth and Lewitt 2015) and clinical learning in Australia (Ranse and Grealish 2007; Grealish and Ranse 2009; Grealish et al. 2010). It has also been used as a conceptual framework to investigate the transfer of learning from the simulated environment to clinical practice in midwifery students (Dow 2012). No infection prevention studies have been found to use the Communities of Practice theory (Wenger 1998) as a theoretical framework. In Backman et al.’s (2012) study of infection prevention practices in a surgical unit, there was mention of a ‘community of practice’ but Wenger’s (1998) theory was not
referenced.
The ‘Communities of Practice’ theory (Wenger et al. 2002) has been under utilised in the UK to inform nursing students’ learning in clinical practice (Morley 2016). The Communities of Practice theory (Wenger 1998) identifies four interlinking but mutually exclusive components which
characterise social participation as a process of learning: meaning, identity, practice and community. These have been applied to the learning of
aseptic technique for the purpose of this study as illustrated in Figure 4 below.
83 Figure 4 Communities of Practice
Within the Community of Practice theory (Wenger 1998), Meaning is continuously negotiated and occurs through participation and reification. Reification “is the process of giving form to our experiences by producing objects” (Wenger 1998, p. 58). The meaning of learning and knowledge is constructed through participation in activities, relationships with other learners and environmental cues (Lave and Wenger 1991). The same qualities that support learning of aseptic technique might impede its achievement (Wenger et al. 2002). Nursing students construct their
understanding of aseptic technique through participation and learning in the different Communities of Practice in university and clinical practice. Nursing students’ meaning of aseptic technique may not remain static, but evolve as they move from placement to placement. The negotiation of meaning infers it is consensual and achievable, but disagreements or
misunderstandings might threaten this (Marshall and Rollinson 2004).
Identity is built as nursing students, as learners, negotiate meaning of
aseptic technique from their experiences as members of a community. Teachers and role models of aseptic technique can only play their roles through membership in their respective community of practice in the university or clinical practice setting. Nursing students as newcomers in clinical placements need peripheral participation to engage and get a sense of how the community functions. Students are neither fully on the inside nor
Learning of
aseptic
technique
Communities of practice in university & clinical placements Identity as members of different communities Meaning of aseptic technique Practice of aseptic technique84
the outside of the community (Wenger 1998). Nursing students develop their knowledge and skills in aseptic technique from practitioners who might be good or poor role models (Ward 2010; Gould and Drey 2013).
As nursing students become more competent they can fully participate in the socio-cultural practices of a community. If rejected or there is conflict, nursing students as newcomers are likely to have difficulty learning (Wenger 1998). Nursing students were found to lack confidence and be reluctant to challenge poor aseptic technique practices for fear of
repercussions upon relationships and their placement reports (Ward 2010; Gould and Drey 2013; Carter et al. 2017) (see Chapter4). Some nursing students felt the need to ‘fit in’ within clinical placements and adopt the aseptic technique practices of their mentor or others, to become part of the community (Ward 2010). Communities of Practice are not formed or static, but evolve over time as different members leave and join (Lave and
Wenger 1991). However, Communities of Practice might develop their own preferences and practices of aseptic technique and become static and resistant to change (Mutch 2003).
Practice describes ‘doing’, the practice of aseptic technique and the
historical and social context which gives structure and meaning to what we do. A limitation of the theory is that it does not consider how members’ practice might be changed (Fox 2000). Understanding how aseptic technique practice might be enhanced is important (See Chapter 2).
Community is defined by the pursuit of engaging in shared activities,
discussions and recognition of participation as competence. A community has three characteristics; mutual engagement, joint enterprise and a shared repertoire (Wenger 1998). Mutual engagement occurs through interaction to develop relationships and establish social norms. A joint enterprise unites a community of practice by having a sense of belonging and ‘of being in it together’ with shared accountability. In the pursuit of a joint enterprise, members of a community of practice develop a shared
repertoire of resources and shared practice e.g. routines and ways of
practising aseptic technique (Wenger 1998). The need for trust between members of the community in order to share knowledge is overlooked (Fox 2000). Nursing students have to adapt and learn aseptic technique in the different communities of practice in university and clinical practice which
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may have different social norms, sense of enterprise, resources and practices.