Learning Caught in the System: An Interactionist Qualitative Study of Workplace-Based Clinical Education in an Acute Hospital Ward.

Educational activities are increasingly implemented in clinical nursing practice with the expectation that teaching will improve care. Drawing on Biesta and van Braak's theoretical perspective on learning as professional formation, this study critically examines a video-based educational activity as a case of workplace-based clinical education in an acute hospital ward in Denmark. Based on interviews and an interactionist, abductive analytical approach, the analysis shows how learning in clinical settings is shaped by organisational, epistemic and socio-material conditions, challenging assumptions of education as a linear process of knowledge transfer leading to practice improvement. The article shows that rather than operating as neutral interventions, clinical educational activities are embedded within existing clinical systems that shape what learning can become. The activity was experienced by nursing professionals as providing new knowledge; however, this knowledge was framed through risk communication and medical authority, reconfiguring oral care from a relational, well-being-oriented nursing practice into a treatment-focused and risk-oriented intervention, functioning as a socialising and identity-forming force. We conclude that without organisational engagement in the learning process, knowledge does not translate into learning in practice, and clinical workplace-based educational initiatives risk reinforcing existing constraints, transforming learning into professional adaptation rather than professional formation.