The organisational and social environment of the simulation laboratory, a mediator of Vertical Horizontal Abuse (VHA) among second-year nursing students: A critical Ethnography

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Vertical and horizontal abuse (VHA) has been reported in the nursing literature for more than 30 years. Previous research has focused specifically on VHA among nurses employed in the health sector, with some studies examining nursing students’ exposure to VHA during clinical training. Little attention has been paid to simulated environments used in the education of student nurses as a potential arena for VHA. This critical ethnographic study sought to address this knowledge deficit by investigating whether the organisational and social environments of a simulated hospital laboratory may enable episodes of VHA. Carspecken’s critical ethnography informed the conduct of this research endeavour. Ethical clearance was obtained from the university’s Human Research Ethics Committee. In all, 43 participants consented to participate in the study. Monological and dialogical data were collected over 24 weeks, in two sessions. Data collection tools included observations, field notes and artefacts such as codes and policies. Semi-structured interviews were conducted with the key informants. The data were analysed using Carspecken’s pragmatic horizon analysis and the findings were explained using Pierre Bourdieu’s social practice theory. The key finding was that episodes of VHA were evident among second-year nursing students and academics engaged in learning and teaching in a simulated hospital environment. This study showed that the organisational and social spaces of learning and teaching have been influenced by curriculum design. More significantly, however, by the modern managerial approaches to university and healthcare sectors. In this context, the pressures from outside the university, as well as the challenge for capital within the university, have begun to fracture various fields of practice and in particular, the field of the simulation laboratory. This study contributes to a body of evidenced-based work that argues that education curricula embed values and act as a mechanism to reinforce dominant practices.

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