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.