Learning in Health and Social Care最新文献

Nurses, including students, continue to report moral distress when facing ethical dilemmas in the clinical setting. Some nurses have even expressed wanting to leave the profession because of their frustration, fatigue and lack of power in this area. One of the possible reasons for this may lie in the type of educational preparation they have received to confidently analyse and successfully resolve ethical dilemmas. This manuscript describes the ethics content of an integrated ethics, legal and health policy course in the nursing curriculum of a large urban university. Teaching strategies such as discussion questions, case studies, ethical decision-making models and debate will be illustrated. Data from student course evaluations are provided. The influence of external agencies such as the American Nurses Association, the American Association of Colleges of Nursing and the National Council of State Boards of Nursing on the development of ethical content in nursing curriculums is discussed. Future research directions are suggested.

Healthcare professionals often encounter moral dilemmas in clinical practice that require increased responsibility and accountability for ethical decision-making. This paper reports the results of a 6-year longitudinal study that explored changes in moral judgement of five consecutive cohorts of occupational therapy (OT) and physical therapy (PT) students over the course of their professional training. The training programme included an ethics education component. The Defining Issues Test (DIT) developed at the University of Minnesota was used to measure moral judgement. A total of 548 students participated in the study. At entry into their professional training, the DIT scores of the OT and PT students were similar but higher overall than the norms established for college level students or for graduates from professional programmes in the DIT standardization sample. At the time of graduation, results showed no significant differences in moral judgement scores between males and females, their chosen programme of study (OT or PT), year of entry, or previous education. Comparing entry scores to exit scores from both programmes for 288 students who provided data at both times, we found that moral judgement scores increased significantly in both OT and PT students over the 2-year programme of study. No differences were found in scores across gender, programme, year of entry, or previous education. Implications are discussed for including a formal ethics education component in the curricula of all health professional training programmes. Recommendations for future research are outlined.

The concurrent realities of growing numbers of master's students in health and social care subjects, and developments in research governance processes in the public sector are discussed as a context for master's level dissertation projects.

Master's level continuing professional development of health and social care practitioners necessarily includes the development of skills in diverse approaches to research and systematic enquiry. The master's dissertation project gives an opportunity for extended applied learning and skills development in relation to this. Recent developments in National Health Service research governance processes, while essential to the protection of patients, have created difficulties for students in gaining the necessary governance and ethical approvals to carry out projects involving the collection of primary data within the timeframe of a master's dissertation project. The implications of this on opportunities for learning and development at this level are explored. The value of different types of master's dissertation projects and the appropriateness, respectively, of different types of governance processes are discussed. Approaches developed by one higher education/National Health Service partnership, to ensuring that the ethical approval of student project proposals is managed as expediently and appropriately as possible, are shared and discussed. These include the development of a toolkit to assist students and others in differentiating between, for example, research, audit and service evaluation activities. They also include consideration of appropriate governance frameworks and ethical review in relation to each of these potential project types.

The purpose of teaching ethics to nurses and other health and social care practitioners is not always clear. At the extremes of the continuum of aims sit (i) the teaching of ethics as a subject just like any other subject; and (ii) the teaching of ethics as a form of moral education. In this article, I outline the pedagogic tension this uncertainty creates before offering some insights into the educational implications of teaching ethics from the perspective of the ethics of Aristotle. In this conception, ethics is the pursuit of character development and specifically the development of practical wisdom, or what I have termed professional phronesis. I argue that while learning to approximate practical wisdom for nursing is possible, from the perspective of the ethics of Aristotle it is problematic for higher education. An Aristotelian approach has the potential to undermine the demarcation of teacher role as this is usually understood in higher education at the present time because, as I suggest, the best teachers of professional phronesis may turn out to be those practitioners (including practitioners of teaching) who exemplify the professional phronimos (or professionally wise practitioner).

The health and social care professions all rely on the use of practice placements for a substantial element of their pre-qualifying professional education, and these practice-based professions have roles for existing practitioners to oversee the education and training of students when they are on practice placements. Practice educators play a vital role in the development of new practitioners and also in the development and perpetuation of professional values and standards. In this paper, we argue that the practice educator role is thus fundamentally an ethical function, requiring moral commitment from the practice educator but also playing a critical role in maintaining the ethical values of the profession.

Selected findings from the qualitative aspect of an impact evaluation examining the effectiveness of a Root Cause Analysis 3-day Training Programme relating to interprofessional learning and work are reported in this paper. The study sample comprised managers, clinicians, administrators and human resource personnel (n = 38) employed at Band 6 or above, and 18 key organizational stakeholders from three National Health Service case study sites who seconded staff to the Root Cause Analysis programme. Although the study was primarily designed to assess the impact of using a blended e-learning approach to educate staff about Root Cause Analysis, participants revealed that working in interprofessional teams was a vital element of any patient-safety investigation. Interprofessional learning and inter-disciplinary collaboration was a particularly valued element of the training programme. One of the main benefits of interprofessional learning identified by participants was that it improved networking and promoted more open communication. Moreover, participants felt interprofessional learning allowed them to increase their understanding of each other's roles, leading to greater cooperation, collaboration and increased confidence. For this reason, the paper examines the extent to which the management of patient-safety-related incidents and patient-safety investigations can be improved by using an interprofessional learning format. Finally, the study will suggest that interprofessional approaches to patient-safety education should be adopted by course designers so as to encourage participants to think beyond their respective occupational silos.

This article will argue the advantages of interprofessional education as a context for learning about professional supervision. In a departure from most previous research which explores how the interprofessional learning situation affects the relationships between participants, we explored how the difference between the participants affected their learning. In recent years, there has been a resurgence of interest in professional supervision in health and human services and a corresponding development in opportunities for supervision training. Evidence from a small qualitative study of participants’ views on learning in interprofessional supervision programmes was examined. It was found that the interprofessional learning environment deepened the exploration and level of understanding about supervision and encouraged participants to question taken-for-granted professional assumptions. The identification of difference between participants, rather than impeding learning, was seen to enhance the breadth of learning and participants were challenged to clarify ideas and language.

This paper considers the issues involved in developing a programme for youth justice practitioners. Contemporary youth justice practice occurs in an increasingly managerialist and punitive context raising questions about how best to develop effective practitioners. It is argued that youth justice practice involves a recurring challenge of meeting situations of high complexity that must be dealt with on a case-by-case basis, guided by a clear understanding of how offending behaviour is constituted. The Professional Certificate in Effective Practice is reviewed and it is argued that education must emphasize reflective understanding. A critique of competency-based education in relation to the Diploma in Probation Studies is also presented arguing that such an approach renders invisible important aspects of practice. Recommendations are made for a curriculum for a youth justice programme which stresses humanism, reflective understanding of context and history, criminology, sociology and psychology, social exclusion, social control, risk, victimology and comparative youth justice.

This study evaluates the role of mentor for the new community matron role in England and identifies the implications for others in advanced practice roles. With the introduction of 3000 community matrons in England by March 2008, a national pilot education programme was introduced to prepare them for their role. Given the recent requirement by the UK Nursing and Midwifery Council to introduce support at the advanced level of nursing practice, a purposely developed mentorship module was introduced for those supporting the new community matrons.

A mixed-method approach to data collection was used. This involved documentary analysis of a range of sources and, during July 2006, a self-administered postal questionnaire was sent to all community matrons undertaking the pilot education programme (n = 70) with a response rate of 67% (n = 47). Individual telephone interviews were conducted with 17 students, and 6 mentors on the purposely developed mentor module. A focus group interview was undertaken with the education programme development team (n = 5). Quantitative data were analysed using spss and qualitative data analysed using content and thematic analyses.

Despite some initial problems, 96% (n = 45) students had access to a mentor during the programme. Overall, the findings reinforce the value placed on individual support for the role and identify the problems associated when support was absent or unsuccessful. For those who had support, there were different expectations of the mentoring role, variation in the quality of their relationship and the perceived value of education to support the mentors in their role.

The study concludes that supporting pioneers to develop new roles when neither party is clear about its strategic direction, nor fully aware of its impact on service, requires risk taking by both parties, and a genuineness, openness and commitment by both in forging the new pathway.

This study provides a critical assessment of the application of the ‘partnership’ model of clinical interaction in an educational context, in the light of ethnographic research on education in complementary and alternative medicine (CAM). The concept of ‘partnership’ in healthcare practice is central to current health policy developments in the UK and the sense of patient empowerment in a more equitable practitioner–patient relationship is often cited as a reason why people are turning to CAM in ever greater numbers. After locating the concept of partnership in its policy and theoretical context (comparing it with traditional and consumer models), the study draws on ethnographic research with student osteopaths and homeopaths to explore the extent to which partnership can be achieved in clinical training situations. The implications for a working concept of professional expertise are subsequently discussed. I argue that the partnership model of clinical interaction is a useful point of departure for critically exploring issues in the patient–practitioner relationship in an educational context.