As for the previous stage, attending to procedure training, the participants reported that willing instructors/preceptors continuously gave them much help and encouragement, though this time the attention was on case care. Nearly half revealed they could obtain help and support from their instructors/preceptors as caring supervision in many ways. For example, some reported that instructors sought the more interesting cases for them, taught them to take the information from the charts, gave them suggestions about how to provide nursing care for their patients and enough time to learn about their immediately assigned cases, which could relieve their tension about caring for the cases when they did not have enough time to prepare. Meanwhile, others reported that their instructors were also concerned that they still did not understand about how to care for their cases, if they were trying to learn alone, so they suggested that they should review the contents with friends. A second year participant described the help of her instructor:
At first, I didn‟t know how to start and the chart was quite thick [documents]. I didn‟t know what I should take for notes. So, I just wrote down anything with no direction. If the page I opened I could read, I took notes on that. After that, my instructor taught me if taking information from a chart, you should start with patient‟s histories and then come along with each page, things like that. That meant checking from the back page up [to the front]. ...My instructor also told me to look at every detail and then think about that. Like, what problems my patient had that connected to the diagnosis of the doctor, things like that. ... (Wana, Interview 2, page 22)
In trying to explain the instructors‘ efforts when assisting students in case learning, these students also reported that they gave them enough opportunities to learn and welcomed their students asking for more explanation on the issues they were still not clear about, even during their late hours. They also attempted to provide opportunities for some students who were very reluctant to ask about what they did not understand, as well as suggesting some texts to their students for more reviewing. A third year participant claimed:
... Our instructor was interested in us, and paid attention to teaching us, even when she [instructor] got pregnant and had other workloads or something. She sacrificed much time for us. Yes! Like, if we didn‟t understand something, we could bring texts to her and tell her I already read that, but I didn‟t understand
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it or something. “What could you please suggest for me?” So, she said like, “Let me see the texts please.” Then she checked that and told me like, ah! It was like this/that. Yes! She also recommended the texts or journals I could use to make things clear. (Araya, Interview 1, page 10)
These students also indicated that their instructors attempted to assist them to learn the problems of their cases as much as possible. When their students were going to learn about nursing care in communities, they also sought opportunities to help their students to make suggestions for their clients. Before holding content conferences, their instructors tried to guide their students about the problems they had to analyse. A fourth year participant revealed:
Yes! Our instructor first asked us which case we were going to hold a content conference about. Then she [instructor] checked information from charts. She also took more information from students, the owner of that case, other friends in our group, and the patient. Like, she asked, “What are the problems this patient has?”…after that she would guide us that ah! “It is still another”. “Try to analyse more”. “Try to find out more”, things like that. Also, like about „labs‟ [lab results], if we didn‟t understand, we could ask for more explanations. She might tell us or suggest the texts where we should search more, things like that. … (Laina, Interview 2, page 27)
Moreover, to provide more opportunities to learn, both instructors and preceptors tried to make post-conferences possible to help these students learn about how to provide nursing care for their cases, especially when finding that their students still did not have much idea of what to do. These willing supervisors also taught them about important related issues, even when there were no relevant cases at the settings. A third year participant said:
…It wasn‟t common for another ward to call nursing students for clinical teaching in the afternoon, as I never experienced that before. But, in that [critical] ward, the head-nurse [said the name of the head- nurse] assigned the nurses there as to which nurse should teach us about which issue. So, each preceptor there would make appointments with us. Like, “This afternoon, 3pm, we will talk about that”. I mean they would teach us according to which one was good at which issue. I thought preceptors there paid enough attention to nursing students. … (Araya, Interview 1, page 10)
Although nearly all of the participants stated they experienced willing supervision in this stage, most of these students also encountered significant difficulties when they had to practise with inattentive supervisors.
Inattentive supervision
Besides making less opportunity for the participants to develop basic nursing skills as detailed in Chapter Five, inattentive supervision could also interrupt and/or inhibit their case learning. When practising with supervisors who were more focused on completing
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their own tasks, the students were concerned that they had no opportunity to learn from them, especially in the afternoons of day shifts, afternoon or night shifts, and when placed at outside settings. The facets of inattentive supervision that limited the students‘ learning opportunities are reported under five codes.