Learning by chance. Student nurses' conditions for learning in single-room hospital design. A realistic evaluation

The aim of this study was to explore how a single-room hospital design influenced student nurses' learning and competence development in clinical practice compared with shared-room accommodation, refining the programme theory: The student nurses' conditions for learning in single-room hospital design are associated with the values of the patient room as the patient's home during hospitalisation.

It is evident that a hospital design with single-room accommodation influences several parameters for both the patients and staff. Furthermore, studies have shown that the physical as well as the psychological learning environment affects the learning outcome for student nurses. A premise for learning and education is that the physical learning space must promote person-centred and collaborative learning in order for the students to achieve their competence development goals.

The study was conducted as a realistic evaluation that compares second and fifth-semester undergraduate nurses' learning and competence development in clinical practice in shared accommodation (a pre-study) to single-room accommodation (a post-study).

In the data generation, we drew on an ethnographically inspired participant observation method. We gathered data during the period 2019-2021, covering the time before and approximately one year after relocation to all single-room accommodation. We undertook 120 h of participant observation for the pre-study and 146 h of participant observation for the post-study.

We conclude that the learning environment in a single-room accommodation setting promotes task-oriented practices where the patient is often a mediator of activities related to nursing care. The learning environment in single-room accommodation places increased demands on the students' ability to reflect on verbal instructions on nursing activities whenever the chance for reflection presents itself. We also conclude that in a single-room accommodation setting, stakeholders must focus on conscious planning and follow-up on the student nurses' learning and educational activities which must support the students' competence development. Hence, summing up to a refined programme theory developed through the realistic evaluation process: The student nurse's conditions for learning in a single-room hospital design are associated with increased demands on the student's ability to reach out for professional reflection when the chance presents itself. This is because the value of the patient room as the patient's home during hospitalisation promotes a task-solving approach to nursing with the patient and the patient's relatives as instructors.