Klas Karlgren on Nursing Students’ Clinical Placement Experiences

Nursing is more than just a medical profession; it preserves human health, provides quality healthcare, and is the heart of the healthcare system, standing beside patients at their most vulnerable moment.

Given this responsibility, institutions and educators are held to a high standard for producing qualified healthcare workers. Nurses embody this role as frontline caregivers because they play a vital role in upholding quality healthcare.

There’s no question that their responsibilities significantly impact human lives. That’s why Klas Karlgren, a principal researcher in medical education, utilizes ecological momentary assessment to uncover how clinical placements affect nursing students’ training experience in real-time.

In this article, we will explore how Klas Karlgren and his colleagues leverage EMA to improve the future of education for our healthcare students.

About the Study

Klas Karlgren's study explores nursing students' experiences during clinical placements, focusing on feelings of competence and challenge. It compares real-time ecological momentary assessment (EMA) data collected via smartphones during placements with retrospective interview data gathered afterward.

Karlgren explained, "How the methods should be used depends on the research question. However, in our experience from this and previous studies, contrasting EMA data with other data, such as retrospective interviews or questionnaire data, can be eye-opening."

For this reason, balancing the data from EMA and retrospective interviews can provide educators with valuable insight into improving nursing students' educational and training experiences.

He added, "Any differences in the data are likely to be particularly interesting. Retrospective methods have certain strengths, as they can capture generalizations made in hindsight in a calm setting. However, EMA can capture rich, detailed data about activities and experiences in context. Combining and comparing the two may be especially valuable."

Now, let's delve deeper into the differences between retrospective interviews and EMA.

Retrospective Interviews vs EMA

Nursing education should balance real-life training and textbook learning. This can give nursing students a more well-rounded understanding of the healthcare industry and their responsibilities.

Karlgren explained: "We know that clinical placements are significant for students; it is in the clinical environment that they learn to understand what it means to be a nurse."

He also shared, "Previous research has shown that students may be overwhelmed in clinical settings, while other studies have indicated that students may find nursing home placements undemanding. For anyone with an educational interest, it is crucial to find a reasonable balance between challenges and students' skills."

The dilemma of balancing the right approach for nursing education leads to the consideration of retrospective interviews and ecological momentary assessment (EMA). The key distinction between retrospective interviews and EMA is when data is collected relative to the experience.

Here's a summary:

Retrospective Interviews

Conducted after an event, experience, or behavior has already occurred.
Participants recall and reflect on past experiences, which can introduce recall bias or memory distortions.
Helpful in understanding long-term patterns, perceptions, and interpretations.
Common in qualitative research, diary studies, and post-experiment debriefing.

Ecological Momentary Assessment (EMA)

Conducted during or right after an experience in real-time or near real-time.
Participants report on their current thoughts, emotions, behaviors, and environment at multiple time points.
Reduces recall bias and provides more accurate, granular data on moment-to-moment experiences.
Often used in psychology, behavioral health, UX research, and intervention studies (e.g., Just-in-Time Adaptive Interventions).

Learning the difference between retrospective and EMA can help educators and researchers discover valuable insights into improving nursing education. Understanding students' contextual assessments is also crucial.

Importance of Students’ Contextual Assessments

Institutions and educators are responsible for understanding students' conditions and providing appropriate curricula for a better educational experience. They must proactively adapt the academic landscape to nurture future nursing professionals effectively.

Karlgren supported this idea, stating, "Educators need to, as far as possible, prepare students for the clinical environments because these are environments that the students will eventually be working in. To create optimal learning experiences ("flow"), perceived challenges should stretch but not overmatch existing skills."

Fortunately, educators can now learn more about the students' experiences with EMA and retrospective interviews. They can use the insightful data from these research methods to better understand learning in a clinical setting.

Karlgren added, "If challenges are too low, students may become bored. And conversely, when challenges exceed students' skills, this may lead to anxiety. Neither is good for learning. This is why educators need to understand students' experiences in the clinical context, or there is a risk that learners' challenges are not addressed adequately and that optimal conditions are not created for rewarding learning experiences."

Moving forward, let’s examine the interesting results from their study to understand the students' contextual assessments further.

Findings About Nursing Student Experiences

The findings from this study are valuable for other educators, so let us help you summarize the 576 responses of first—and final-year students in 21 nursing homes over five weeks.

Remember that the study has five main themes: Specific Activities Are Challenging (EMA), Lack of Challenge (EMA & Interviews), Learning and Developing (EMA & Interviews), Reflects Critically on Competence (Interviews), and Arrangement of the Clinical Placement (Interviews).

Here's a summary:

Final-year students rated their competence higher and challenges lower than first-year students.
First-year students experienced more flow (engagement) and anxiety, while final-year students experienced more boredom.
Nearly 75% of final-year students' responses were categorized as boredom or apathy, implying a lack of challenge.
Many challenging clinical activities reported during EMA were not mentioned in retrospective interviews.
First-year students initially found experiences overwhelming but later viewed them as valuable learning opportunities.
Final-year students acknowledged challenges in real-time (EMA) but did not mention them in interviews; instead, they focused on a lack of challenges.

Karlgren and his colleagues also observed significant differences between first- and final-year students. The first-year students were more challenged than the final-year students, and their clinical activities were more strongly associated with flow and anxiety. Conversely, the final-year students were more bored.

He added, "During the placements, both first and final-year students described numerous clinical activities as challenging. In the interviews, many other aspects of the placements were brought up, but none of these challenges was mentioned by any of the participants."

When gathering data, Karlgren and his team proved the difference between retrospective interviews and EMA. He shared, "It is quite fascinating how the participants would focus on such matters in the clinical context and other things a few weeks later, in interviews. We would never have learned about these challenging experiences if we had only conducted interviews"

How Can EMA Help Educators in the Medical Field

EMA is not just about collecting data; it can also be a trailblazer in improving the educational experience for our future healthcare professionals. EMA is a method that can clarify barriers to learning and data analysis.

Karlgren also believes that EMA can be leveraged to improve education quality: "EMA studies can provide educators with valuable insights into the challenges of clinical learning and help them further develop clinical education to better prepare students for future clinical work."

When educators know how to formulate an effective curriculum, Karlgren states, "Learners' challenges can be addressed, and if more experienced students are less challenged, their learning environments can be adjusted to become stimulating."

Finally, EMA data can add insights about clinical experiences that respondents may overlook or not remember when using retrospective methods. Since EMA data are collected in the context of interest, there is also less risk for various forms of bias, leading to more accurate data collection.

Invitation to the Research Community

The ExpiWell team is excited to have supported Klas Karlgren and his team's research. We continue to work toward innovating and enhancing scientific discovery.

According to Karlgren, ExpiWell is a tool that enriches data. He mentioned, "In many cases when planning a research study in medical education/health sciences education involving interviews or questionnaires, it is probably a good idea to ask oneself whether the study could be turned into an ESM/EMA study using a tool like ExpiWell. The chances are high that adding such data collection will capture richer and more interesting data."

To explore more studies with Expiwell, we invite you to visit our Journal Publications section. There, you can learn about insightful research studies and discover how ExpiWell has facilitated critical experience sampling and ecological momentary assessment data collection.

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