Visualizing the Structure of First-Year Nursing Students’ Learning From Outpatient Experiences in Early Community-Based Practicum

Abstract

In Japan, nursing education has traditionally emphasized hospital-based ward training, underscoring the need for early practicum experiences in non-inpatient settings. Yet, little is known about how first-year students interpret and structure these community-based experiences into meaningful learning. This study aimed to clarify and visualize the learning structure of first-year nursing students during a community-based early practicum, focusing on learning derived from outpatient clinic/hospital experiences. During the practicum (45 hours), students recorded their learning on sticky notes and engaged in group-based label work as an educational and reflective activity. Data from 32 student groups (128 first-year nursing students), from whom informed consent was obtained, were analyzed. Researchers structured the notes using the Kawakita Jiro (KJ) method, a qualitative structuring approach known internationally as affinity diagramming, to derive symbolic concepts and structure their interrelationships. Eight symbolic concepts illustrated how students’ learning expanded through communication as a central mechanism, reflecting core competencies such as collaboration and safety. Community-based experiences and group-based label work deepened students’ understanding of patient-centered care and strengthened their readiness for subsequent, more intensive ward-based clinical practicums. The KJ method made the learning structure explicit and clarified key features of learning that emerge during early community-based practicums.