Learning in Health and Social Care最新文献

Globalization might justifiably be considered as today's driving force for world trade and economies, but it has also become identified with the increasingly supra-national context in which healthcare and higher education (HE) institutions are now operating. This new context represents a range of challenges that cannot be seen separately from the ones related to the developments towards a knowledge economy, the role of new technologies and developments towards global citizenship and lifelong learning. However, whilst embracing the advance of globalization, its impact on individual nations has to be balanced by a process of internationalization, in which countries adapt to this phenomenon while preserving their own individuality and respecting that of others. Nowhere is this more pertinent than in the fields of education, health and social care where the effect of globalization is increasingly dictating academic and professional requirements for graduates, and disciplines must adapt to provide adequate preparation, not only in academic and professional knowledge and skills, but also in cross-cultural skills and attitudes, without sacrificing quality and safety. We are likely to see increased expectations from funding and professional bodies that educators can show that they prepare their students well for global citizenship.

It is clear that globalization affects a great many aspects of our lives and we know that it raises many questions. If we take this to mean that the world is being moulded into a shared social space, questions regarding what we do in the design of our curricula (and research endeavours) that equips our students to responsibly occupy that space need to be raised. In health and social care education, we need to give attention to what it is that we seek from education and what we regard as an educated person, acknowledging that education is never value-free. Although internationalization concerns might appear social, cultural, humanistic and educational, they are also directly connected to globalization and the worry that a marketization ethos will lead to a lack of emphasis on teaching and learning and that academic quality will suffer.

Debates on the internationalization of HE have been prefaced by a number of underlying issues ranging from pressure on institutions to internationalize and the kinds of forces that are driving this, to a need for greater clarity or a common definition of the concept. Perhaps I need to delineate what I mean by internationalization, and here I draw on Van der Wende (1996, p. 23), ‘any systematic, sustained effort aimed at making higher education responsive to the requirements and challenges related to the globalization of societies, economy and labour markets.’ In this context, I associate globalization with competition, while internationalization is presumed to be associated with cooperation and collaboration. Internationalization applies to both a process of making something intern

Internationalization is a growing priority for professions, universities and governments around the globe. This has led to increased numbers of health and social care students participating in international practice education experiences. This study identifies enablers and challenges to participation in international practicum education through a case study. The case involves one occupational therapy programme and its international partners, and investigates the perspectives of students, university personnel and preceptor stakeholders. Challenges included: lack of financial support, limited placement availability, and procedural complexity. Enablers included: external financial support, champions for the concept, international connections, and access to the appropriate communication technology. Practical insights that may be relevant for enabling student participation in international education experiences are highlighted.

Locating this paper in the wider context of evaluations of interprofessional education (IPE), this review explores the knowledge base of the pedagogic processes for interprofessional education. The article concentrates on evidence for professionals in health, social care and education, the challenges involved in IPE and the challenges involved in evaluating IPE. Although IPE is widely discussed, detailed descriptions of the underlying pedagogy are scarce. The paper aims to provide a more detailed account of the approaches to learning and teaching in IPE. A literature review was undertaken to collate information on approaches to IPE, concentrating primarily on identifying descriptions of pedagogical features for pre- and post-registration training and continuing professional development. The review identifies a number of pedagogical models and educational processes underpinning IPE. Although the findings indicate that social-constructivist approaches, small group working and problem-based learning are often referred to, evidence of pedagogical models used in IPE and ways of developing evidence of their effectiveness and usefulness are still limited. Based on the discussion of some challenges that face IPE in general and the evaluation of IPE in particular, the authors propose the need for a theoretical framework that conceptualizes learning by taking into account the wider context of learning and the pedagogy that is employed during IPE. Reference is made to a framework which would respond to evidence in the literature that evaluations of IPE need to take into consideration different, complimentary sources of data that go beyond traditional, often positivist evaluations.

Increasingly, health and social work educators are joining their colleagues throughout higher education in exploring the possibilities of teaching and learning online. Online teaching and learning initiatives have been aided by both proprietary and open source course management systems such as BlackBoard and Moodle. However, the rush to put courses online is rarely informed by adequate consideration of the affordances of the World Wide Web to support different types of pedagogical dimensions or instructional design. In addition, academic staff members may jump into teaching online without sufficient consideration of the design components that can be implemented in online courses. This study provides an introduction to 10 design dimensions, derived from research and theory in instructional technology, cognitive science and adult education, for guiding the design and evaluation of online learning environments for health and social work education. It concludes by addressing the rewards and risks of online learning.

National Health Service policies of induction and supporting transition into posts face three key issues: meeting a diversity of needs in terms of change, the integration of induction into a service with profession-specific policies and practices, and their configuration with workforce policies designed to alter role boundaries and develop more interprofessional working. In examining these three areas, the study reported here reviews current practice in four professional groups (dentists working in the community dental service, children's nurses, pharmacists and radiographers) with the purpose of reviewing their experience of induction and transition in relation to National Health Service policies and contexts. The small-scale qualitative study was conducted between September 2005 and March 2006. Twenty-one interviews were undertaken with pharmacists and children's nurses working in hospitals and primary care, radiographers in hospitals and community dentists in primary care; relevant national and local policy documents were also analysed. The study concludes by recognizing that ‘statutory’ induction is secure, that more attention is needed to support interprofessional learning at points of transition; that disparities in access to training may become increasingly problematic; that significant aspects of current practice do not match contemporary policy requirements; and that more research into the models of learning that will facilitate more effective interprofessional working are needed.

This paper reports findings from a qualitative study exploring pre-qualifying health and social care students’ experiences of interprofessional learning and working in practice placement settings. The author argues that processes of non-formal learning and unconscious role modelling in these environments are key to students’ developing collaborative skills. Semi-structured interviews were conducted with a quota sample of 52 students from 10 health and social care professions. Data were analysed thematically. The nature of interprofessional collaboration varied across different settings, with students encountering a more disparate range of professions and agencies in community and social work settings than in acute healthcare settings. Most students appeared to have been exposed to examples of both effective and poor collaborative working. Although many students characterized interprofessional collaboration in placement settings as ‘good’, this assessment often conflicted with their description of behaviour that could be considered to constitute suboptimal collaborative practice. Students perceived the quality of interprofessional interaction to depend mainly on interpersonal communication, showing little awareness of how organizational systems influence collaboration. The findings show that some staff in placement settings experienced problems when working with colleagues from other disciplines, and indicate that consequently, through processes of non-formal learning and unconscious role modelling, some students may have learned inappropriate behaviours with regard to interprofessional working. Although students were not necessarily expected to appreciate the importance of appropriate organizational systems for the establishment and maintenance of effective interprofessional collaboration, it appeared that staff members might also not be aware of these issues. The author argues that staff in placement settings need to understand and model the relevant capacities in order to provide students with appropriate learning opportunities in this regard. It appears that qualified staff need support to develop their own collaborative practice, so that they are able effectively to support students’ interprofessional learning and working in practice.

In recent years, there has been a tendency to stress the active role and equal partnership of clients in social and healthcare. Moreover, research in the role of clients has attracted growing interest. Clinical education has been seen as an excellent arena for learning the distinctiveness of the interaction between the client and the professional physiotherapist by giving students the chance to participate in actual healthcare encounters. This study focuses on examining the construction of various client roles through interactions between participants in practical learning sessions that physiotherapy students took part in. These sessions were real professional physiotherapy encounters. Qualitative discourse analysis was applied to 12 videotaped practical learning sessions and four constructions of the client were identified. These interpretative repertoires were named according to the client's role in the interaction as ‘receiver’, ‘executer’, ‘participator’ and ‘fellow’. The identified repertoires represented the multi-dimensionality and contradictory construction of the client during sessions where two professionals differing in knowledge and skills worked together. Although the professional appeared to play a dominant role in constructing the client role, the client's eagerness to participate was also significant. Extrapolating from the study, we suggest that in aiming to enhance student understanding and practice of patient-centred physiotherapy, clinical educators should be aware of the interactional practices through which the participation of the client can be supported.

For nurses to deliver effective transcultural care, it must be carried out in a way that recognizes cultural difference and responds sensitively to it. In this study, the authors address the meaning of ‘cultural awareness’ and its place in the development of cultural competence among healthcare professionals. They explore the difficulties of providing effective methods for enabling students to become culturally aware and consider the use of games/simulations, whereby the learning experience emphasizes action and students begin to explore and evaluate through reflection. The focus then turns to using games in promoting cultural awareness based on the authors’ experiences. Over several years, Bournemouth University and other European and American partners have developed and used with effect two particular games specifically tailored for work with healthcare professionals. The content and scope of the games are described which, together with supporting material, constitute a day's workshop and provide an excellent basis for furthering the development of cultural knowledge and skills. The final discussion describes how, with the present trend towards a scientific–technological approach to teaching/learning, the craft of nursing is being lost and therefore the complexity of caring is not being realized. This in turn jeopardizes the students’ emotional learning, thereby negating the strength of nursing and the understanding of nursing as a discipline and practice. We believe that re-investing in forgotten teaching methods like gaming/simulation may help students interpret nursing as a caring practice that is academically defensible.

Modernization of health services is a priority in the UK requiring changes in the working practices of all staff, and improved teamworking is a prerequisite of effective service delivery. This study evaluates a short teambuilding course delivered to health professionals. A longitudinal survey design was used to assess the feasibility of the course and the change in individual perceptions of team roles and team functioning, and communication skills by questionnaires immediately after the course (time 1), at 3 months (time 2) and at 6 months (time 3). Three questionnaires (Team Development Measure, Teambuilding Questionnaire and Teambuilding Questionnaire-II) were administered over this period, and telephone interviews were conducted with team members and managers at time 3. Combined results suggest that the teambuilding programme lead to an apparent slight improvement in perceived teamworking at 3 months but this had disappeared at 6 months. Although the development of individual teamworking skills is important, interventions must consider the impact of individual, team and organizational level factors on successful translation of learning into practice. Several limitations to the study are discussed.

Practice/clinical placements are central to learning in healthcare programmes, and optimizing learning during placements is important. However, little literature exists on physiotherapy students’ practice placement experiences. That which has been published presents a picture of both positive and negative experiences.

The topic was addressed within a larger longitudinal study into the learning experiences of students from non-traditional backgrounds undertaking a 4-year part-time physiotherapy programme. Seventeen students from the 2000 cohort participated in the qualitative phenomenographic study. The study met institutional ethical requirements and participants’ gave written informed consent. Within the individual semi-structured interviews undertaken in the final year, participants were asked to identify the aspects of their practice placements which had least and most facilitated their learning.

Data were analysed using a phenomenographic approach, which identifies variation in the ways in which people experience phenomena. The iterative process began with identification of interview responses from verbatim transcriptions of the interviews, and ended with a set of categories of description which, together, captured the full set of participants’ responses. Representative quotations illustrated the nature and scope of each category of description and provided evidence regarding the rigour of the data analysis process.

Some categories were identified as both positive and negative, for example direct involvement with patients, educator–student interaction, with the degree and nature of context deciding on the direction of participants’ perceptions. Factors relating to placement organization were also found to have both positive and negative influences on learning. Effective communication is proposed as a means to addressing the negative aspects identified.

This study provides useful information on participant's perceptions of the quality of their clinical placement experiences. However, the research base on this important topic continues to be small, and further research is needed on physiotherapy students from both traditional and non-traditional backgrounds.