Nursing Unit Managers' learning facilitation practices: A philosophical hermeneutic study

The aim of this research was to more deeply understand how Nursing Unit Managers (NUMs) facilitate learning in clinical workplaces. In particular, an understanding of the nature of NUMs’ actions to facilitate qualified nurses’ learning in their clinical units was sought. This understanding is important in contemporary healthcare contexts as nursing knowledge and skill development underpins the delivery of safe, quality care to patients. While a review of the academic literature revealed a learning facilitation dimension of NUMs’ roles, few studies explored the nature of this facilitation, the influence of contextual factors, or of NUMs’ individual perspectives on their learning facilitation practices. This research sought a more nuanced understanding of NUMs’ learning facilitation practices, and how they were enacted within ordinary work routines.
A philosophical hermeneutic approach was chosen to frame this research. Philosophical hermeneutics, which enables deeper understanding of individual perspectives within a socially constructed environment, provided an appropriate framework for exploration of the diverse perspectives around learning facilitation held by research participants. Thirteen NUMs working in two public hospitals in a metropolitan location participated in the research. Text, as the source of understanding in philosophical hermeneutics was constructed from participant interviews and a period of observation of NUM learning facilitation in the clinical workplace. Consistent with a philosophical hermeneutic approach, interpretation was iterative and ongoing and occurred during all phases of the research including before, during and after each fieldwork interview as well as before, during and after each period of observation and shaped questions asked within subsequent fieldwork encounters.
Through iterative and deep exploration of texts, the unique and specialised ways that NUMs influenced learning in clinical workplaces were revealed. NUMs’ learning facilitation practices were found to be complex, fluid, embodied and embedded in their every-day work routines. NUMs’ learning facilitation practices were deployed through engagement with staff individually, within teams, and through artefacts, and were shaped by NUMs’ inherent qualities and knowledge including their identities, conceptions of staff learning, knowledge of staff performance, and motivations. Further, power was revealed as a central and uniquely enacted driver of NUMs’ learning facilitation practices.
The key contribution of this research is new knowledge of NUMs’ learning facilitation practices including the nature of those practices and the way that power, together with NUMs’ inherent qualities and a complex network of contextual factors arising from the external, organisational and unit environments, combine to shape those learning facilitation practices. This knowledge is meaningfully drawn together in a Living Systems Model of NUMs’ Learning Facilitation Practices. This model allows simultaneous consideration of the nature of NUMs’ learning facilitation practices and the way that contextual factors, NUMs’ inherent qualities and values and NUMs’ use of power come together to influence facilitation of nurse learning in clinical workplaces.
Given current concerns about safety and quality in healthcare, this research has contributed important new understanding around NUMs’ learning facilitation practices and has opened up possibilities to improve patient safety and care through enhancement of nurse learning. By making knowledge of NUMs’ practices explicit, there is potential for NUMs to learn more about their own practice, and for programs of nursing management education to enrich student understanding of their roles in influencing staff performance.