Bringing caring and competence into focus in gerontological nursing: a longitudinal, multi-method study.

BACKGROUND: The recent literature suggests that caring has become increasingly devalued as health systems focus primarily on cure. This is a worrying trend, particularly for gerontological nursing, where cure is often not possible. Consequently, work with older people is often not seen as an attractive career option, a perception that is frequently reinforced during students' practise placements, which exert a considerable influence on the values that inform their future professional practise.

AIMS AND OBJECTIVES: To explore longitudinally the way that students experience their placement, and to identify the characteristics of an 'enriched' environment of care that potentially creates a positive view of work with older people.

METHODS: A multi-method longitudinal study using a constructivist methodology and comprising both conceptual and empirical phases was undertaken. This paper concentrates on the results emerging from 57 focus groups completed over a 3 year period in four School's of Nursing in England, short visits to 33 placement areas and in-depth visits to seven placement areas.

FINDINGS: The paper describes a temporal model of the student placement experience in which their focus of attention and effort varies over time. Five 'foci' are identified-self as focus, course as focus, professional care as focus, patient as focus, person as focus. The extent to which students are able to achieve person as focus is crucially dependant upon the input of their mentor, and their exposure to enriched environments of care that can be understood in terms of the 'senses framework'. RELEVANCE TO PRACTISE: The paper describes several important ways in which students' placement experiences can be enhanced, enabling them to form and consolidate a more rounded and positive view of gerontological nursing. Numerous practical suggestions for achieving an 'enriched' environment of learning that enables students to appreciate the value of care as well as cure are identified.