The overall aim of this thesis was to explore the collaboration and the collaborative process between bachelor nursing students during clinical skills lab practices from the perspective of nursing students and nurse educators and the use of formative peer assessment in higher healthcare education programs.

In the first study, an exploration of formative peer assessment in higher healthcare education programs was carried out by mapping the existing research literature in the field. After critical appraisal of the literature, a thematic analysis was performed. The results revealed a process consisting of two consecutive phases. The first phase involved the rationale for formative peer assessment, which was to support student learning as preparation for the healthcare professions. The second phase concerned the organization and the structure of the formative peer assessment activity and how the complexity of collaboration between the students affected their relationships with each other. The revealed complexity of peer collaboration influenced the aim of the subsequent empirical qualitative studies because similar results have been described in previous studies in connection with collaborative learning activities.

The second and third studies explored how first-year bachelor nursing students collaborate as well as the collaborative process during practice in clinical skills labs. Fieldwork with participant observations and focus group interviews was performed. Thematic network analysis was carried out in the second study, and a narrative analysis of fieldnotes and transcribed focus groups interviews was conducted in the third study to analyse the collaborative process. In the fourth study, interviews were performed with nurse educators with teaching experiences from clinical skills labs. The aim was to understand their different conceptions of nursing students’ collaboration. The transcribed interviews were analysed with a phenomenographic approach.

The findings from the second study showed that collaboration between nursing students is a field of tension between adaptation and non-conformity. Adaptation represents the students’ ability to adapt to new knowledge, to each other, and to being a nursing student. The non-conformity in the collaboration corresponds to students’ difficulties in accepting the perspective of others, finding mutual goals, sharing decisions, and providing supportive and constructive feedback to each other.

In the third study a sequential process was identified in the exploration of the collaborative process between the nursing students. The initial period was characterized by navigating in unfamiliar territory, which included anxieties related to not being involved, not being familiar with the context, and not being sure of the expectations. Over time, the students started to navigate together to cope in response to the complexities of the tasks they had ahead of them. To overcome these complexities, they looked for people like themselves, which led to homogenous groups. At the end of their training period the students were approaching independence in anticipation of their future nursing profession. In this period the role of the educator became less prominent, and the students mostly relied on each other’s knowledge. The feedback they provided to each other became constructive with suggestions for improvement. The focus was now on the task at hand, and with whom it was practiced was of less importance.

In the final study, the nurse educators’ various conceptions of nursing students’ collaboration described an outcome space that indicated that the purpose of collaboration was the most complex descriptive category that formed the didactive activities related to collaboration, the nursing students’ interpersonal skills, and the group activity skills.

Conclusively, and reflected in Vygotsky’s theory of Zone of Proximal Development, the collaboration between the nursing students during skills lab practices shows that the students’ collaboration can develop from a zone of current development to a collective zone of proximal development with support from their peers. For education to support the students’ transition to independence, the educational purpose of collaboration needs to be defined by the faculty. The collaboration needs to be guided by scaffolding activities contextualized to the nursing profession and adjusted to where the students are in the collaborative process. Instructional directives for peer observations and feedback along with didactive activities might decrease anxiety and complexity in collaborative learning and thereby prepare students for the crucial collaboration that takes place in the nursing profession.

AIM: This study aimed to understand the variety of nurse educators' conceptions of nursing students' collaboration in clinical skills lab activities.

BACKGROUND: Collaborative learning has gained attention in nurse education as an educational approach that supports learning and professional development. However, research is deficient concerning nurse educators in faculty-based education and their conceptions of student collaboration.

METHOD: The study adopted a phenomenographic approach. A purposeful sampling of nurse educators teaching in a skills lab setting was conducted at five universities in Sweden. Individual interviews with sixteen nurse educators were performed between November 2023 and February 2024. The interviews were analysed following phenomenographic procedures.

RESULTS: Four different description categories were identified: the purpose of collaboration, the didactic activities for collaboration, the student's intrapersonal skills, and the group activity skills. The outcome space presents the purpose of collaboration as the most complex descriptive category.

CONCLUSION: The educational purpose of collaboration should be settled by the faculty of nurse education and aligned to the collaborative requirements in the nursing profession. Introducing didactic activities specifically contextualized to the nursing profession and including peer observations and feedback in a formative manner may facilitate the development of collaboration.

Collaboration for nursing is a core competence and therefore educational interventions are essentials for collaborative skills. To identify such interventions, we carried out a study to understand nursing students' collaborative process. A narrative inquiry method was used to explore the collaborative process of first-year undergraduate nursing students. The analysis was conducted on field notes from 70 h of observation of 87 nursing students' collaboration during skills lab activities. It also included transcriptions of four focus group discussions with 11 students. The results are presented as a sequential process of (1) navigating in unfamiliar territory, (2) navigating together to cope, and (3) navigating together towards independency and the future nursing profession. We identified a transition from teacher-led assistance and guidance to student interdependency and reciprocal learning, ending with student-led assistance supporting independency. In line with Vygotsky's theory of zone of proximal development, different scaffolding interventions are needed depending on where the students are in the collaborative process. 

AIM: The aim was to explore collaboration between first year undergraduate nursing students in a three-year bachelor program during clinical skills lab practices.

BACKGROUND: The ability to collaborate is important in the nursing profession to ensure patient safety. Thus, efforts supporting nursing students with learning activities emphasizing this ability is crucial in nurse education as a preparation for the requirements of the nursing profession. Collaborative learning models are described as ways that support the students' interaction during education. However, collaboration between students has shown to have challenges such as negative competition and confrontations. This stresses the need to explore the collaboration between students to find ways to support the interaction.

DESIGN: The study was conducted with a focused ethnographic approach.

METHOD: Data were generated by participant observations during one semester, involving 70 h observation of 87 first year nursing students for 6 months and 24 training sessions in clinical skills lab practices. Two focus group discussions were used to elaborate students' views of collaboration and to provide an opportunity for follow up questions and interpretations from the observations. Field notes and focus group discussions were interpreted as one unit of analysis conducted with thematic network analysis. A global theme were synthesized from organizational and additional basic themes presenting the overall metaphor of the students' collaboration.

RESULT: The global theme, Between adaptation and non-conformity, revealed a field of tension in the nursing students' collaboration. One the one hand, the global theme involved the students' ability to adopt to new knowledge and to being a nursing student in a clinical skills lab and to others' perspective. On the other hand, non-conformity creates a collaboration with less reflection between the students and non-synchronized and time-consuming laboratory work.

CONCLUSION: Collaborative activities in nurse education fosters and challenges nursing students' collaboration required for clinical practices and later in the nursing profession. By the presented scaffolding efforts, nurse educators can arrange a learning environment that can support the collaboration between students and facilitate the transition into the profession.

Objectives Formative peer assessment focuses onlearning and development of the student learning process.This implies that students are taking responsibility forassessing the work of their peers by giving and receivingfeedback to each other. The aim was to compile researchabout formative peer assessment presented in higherhealthcare education, focusing on the rationale, theinterventions, the experiences of students and teachersand the outcomes of formative assessment interventions.Design A scoping review.Data sources Searches were conducted until May 2019in PubMed, Cumulative Index to Nursing and Allied HealthLiterature, Education Research Complete and EducationResearch Centre. Grey literature was searched in LibrarySearch, Google Scholar and Science Direct.Eligibility criteria Studies addressing formative peerassessment in higher education, focusing on medicine,nursing, midwifery, dentistry, physical or occupationaltherapy and radiology published in peer-reviewedarticlesor in grey literature.Data extractions and synthesis Out of 1452 studies,37 met the inclusion criteria and were critically appraisedusing relevant Critical Appraisal Skills Programme, JoannaBriggs Institute and Mixed Methods Appraisal Tool tools.The pertinent data were analysed using thematic analysis.Result The critical appraisal resulted in 18 includedstudies with high and moderate quality. The rationale forusing formative peer assessment relates to giving andreceiving constructive feedback as a means to promotelearning. The experience and outcome of formativepeer assessment interventions from the perspectiveof students and teachers are presented within threethemes: (1) organisation and structure of the formativepeer assessment activities, (2) personal attributes andconsequences for oneself and relationships and (3)experience and outcome of feedback and learning.Conclusion Healthcare education must considerpreparing and introducing students to collaborativelearning, and thus develop well-designedlearningactivities aligned with the learning outcomes. Since peercollaboration seems to affect students’ and teachers’experiences of formative peer assessment, empiricalinvestigations exploring collaboration between studentsare of utmost importance.

In today's world, nurses increasingly care for individuals from different cultures. Because culturally sensitivecare can improve patient satisfaction in care, nurses need to develop cultural competence in their practice. Todevelop cultural competence, one option is to build cultural awareness by exposing students to nursing practicesin other cultures through online internationalization-at-home activities. However, little is known about theprocess of cultural awareness development through internationalization activities. Therefore, this qualitativestudy aimed to identify the development process of cultural awareness in nursing students, who participated in aseries of internationalization-at-home activities. A total of 31 nursing students from Australia, Hong Kong, andSweden volunteered to participate in student-led learning groups. Groups consisted of two to four students fromeach university, who engaged in four weekly webinars and online reflections about nursing practice based on acase scenario. Data were collected from participants' ongoing reflective journal entries, and after the webinarsended, from three focus groups. A semi-structured interview guide was used to understand how the internationalization-at-home activities impacted their cultural awareness and knowledge of nursing. Data wereanalyzed using interpretive description. Following four levels of thematic analysis (i.e., comprehension,synthesis, theorizing, reconceptualization), we identified four themes in the development of cultural awareness:1) nurturing reciprocity through comparisons of nursing culture; 2) discovering common ethical values of thenursing profession; 3) developing cultural awareness in nursing ideology and practice; and 4) transformingunderstanding of nursing in the context of their healthcare systems. By the end of the internationalizationactivities, students appeared to have developed relational skills to facilitate their own inner dialogue aboutethical ideals of “self” and “other” in the context of being part of the global nursing community. Future researchshould develop and assess teaching strategies that can further facilitate the four themes in cultural awarenessdevelopment.

The clinical environment is a vital component of nurse education, constantly changing due to constraints of the current health care systems such as increasing number of students and a limited number of preceptors. Peer learning, is gaining momentum as an educational model highly suitable for clinical placements. The peer learning model incorporates structured learning activities that support student activity, but little is reported of the actual structure and content of those activities. Thereby, the aim of this study was to explore precepting nurses’ experience of using structured learning activities as part of the peer learning model during clinical placement. We used a qualitative research approach, using two open self-administered global questions. The result is based on the analysis of the written responses from 62 preceptors. Four categories followed the analysis: An opportunity for collaboration, An occasion for reflection, A new educational structure, and Recommendations for development. The preceptors perceived the structured learning activities as beneficial for increased collaboration and reflection among students. Moreover, utilizing the structured learning activities was perceived to be time saving for the preceptors, however this is an area where further research is needed.

Aims: To explore nursing students’ perception of peer learning during cross‐cultural learning activities through student‐led webinars. Design: An exploratory qualitative study. Methods: Thematic analysis of data collected from reflective journals and focusgroup interviews of participating nursing students across three international universities in Australia, Hong Kong, and Sweden during autumn 2017. Results: Three themes were identified: peer learning as creation of friendship; peer learning from interactions that went beyond what was originally intended; and peer learning as empowered learning. Conclusion: Combining peer learning as an educational approach with cross‐cultural and student‐led webinars provided new perspectives. On‐line learning across global boundaries, based on a sound educational model, creates new opportunities for internationalization without straining individual and institutional financial resources

Introduction: In formative peer assessment, the students give and receive feedback from each other and expand their knowledge in a social context of interaction and collaboration. The ability to collaborate and communicate are essential parts of the healthcare professionals’ competence and delivery of safe patient care. Thereby, it is of utmost importance to support students with activities fostering these competences during their healthcare education. The aim of the scoping review is to compile research on peer assessment presented in healthcare education programmes, focusing formative assessment. The result of the scoping review will form the basis for developing and conducting an intervention focusing collaborative learning and peer assessment in a healthcare education programme. Methods and analysis: The scoping review will be conducted by using the framework presented by Arksey & O’Malley and Levac et al. The primary research question is: How are formative peer assessment interventions delivered in healthcare education? The literature search will be conducted in the peer-reviewed databases PubMed, Cumulative Index to Nursing and Allied Health Literature, Education Research Complete and Education Research Centre between September and December 2018. Additional search will be performed in Google Scholar, hand-searching of reference lists of included studies and Libsearch for identification of grey literature. Two researchers will independently screen title and abstract. Full-text articles will be screened by three researchers using a charting form. Studies meeting the inclusion criteria will be critically evaluated using the Critical Appraisal Skills Programme. A flow diagram will present the included and excluded studies. A narrative synthesis will be conducted by using thematic analysis as presented by Braun and Clarke. The findings will be presented under thematic headings using a summary table. To enhance validity, stakeholders from healthcare education programmes and healthcare institutions will be provided with an overview of the preliminary results. Ethics and dissemination: Research ethics approval is not required for the scoping review.