Balancing structure and flexibility in the ambulance service : the pursuit of professional judgement in caring and learning

Sammanfattning: The overall aim of this thesis was to describe the conditions for learning inthe ambulance service during clinical practice, and to develop an understanding of how to support the professional development of caring in this context.The findings of this thesis are based on four qualitative interview studies.The study group consisted of 28 specialist ambulance nursing students (I), 20 preceptors (II), 27 preceptors (III), and 16 specialist ambulance nursingstudents (IV), from all parts of Sweden. The data were collected by individual, dyadic, and focus group interviews. The study designs and analytical approach were guided by the critical incident technique, latent content analysis, reflexive thematic analysis, and a phenomenographic approach.The findings indicate that the contextual complexities of ambulance care contradict the students’ fundamental need to independently care for the patients in their development of all domains of knowledge. Caring and learning in the ambulance service requires a structured approach in medical, technical, and practical aspects to create a basic security for preceptors and students in dealing with the diversity in care situations, patient needs, and student needs. However, this structured approach may hinder an individualized and situationally adapted approach unless the preceptors and students develop a flexible and reflective questioning approach in the phronetic domains of knowledge. The support, educational strategies, and learning objectives needed for enhancing educational clarity and quality during clinical practice in ambulance care are presented at an organizational, environmental, situational, and interpersonal level.It is proposed in the conclusions that a reflective questioning approach and an embodied understanding of ambulance service work supported by critical reflections are fundamental to support professional development in this field. Higher education institutions and the ambulance departments should address the professional development as a mutual concern, where supporting the development of a caring competence should be viewed as a lifelong continuum of learning. The expanding scope of ambulance care requires professional judgement to manage the ethical complexities of clinical decision-making to safeguard the patient perspective in ambulance care.