Learning in Health and Social Care最新文献

The aim of this study was to evaluate a learning programme for Dutch community nurses and auxiliary nurses aimed at the development of competencies with respect to client-centred care for chronically ill clients. The study was guided by the Kessels's Eight-fields model. Several stakeholders, including clients, participated in the development, execution and evaluation of the programme. The concept of client-centred care, client goals and competencies for nurses were identified systematically. Competencies identified were a care-process in dialogue, enabling client participation and dealing with tensions. Principles of development of competencies were applied in the design of learning activities. The programme was evaluated at three levels: learning processes; performance of competencies in practice; and perceived client-centredness by clients. Three home-care organizations were involved in the evaluation study. In total, 175 employees participated in the basic module and 34 nurses and auxiliary nurses participated in the advanced module. In total, 107 chronically ill clients were involved in the study, of which 50 in the evaluation group and 57 in a group checking for selection bias. Findings indicate a positive impact on two of the evaluation levels: learning processes and the performance of nurse's competencies in practice. No statistical impact was found on clients 2 months after the end of the programme. The process evaluation provided knowledge concerning pre-conditions for learning processes and performance of competencies in practice. The study concludes that it seems that a change towards client-centred care has been initiated. Client-centred care encompasses more, however, than competence development in individual nurses. A corporate approach is recommended, encompassing the support of the primary process of client-centred care by the entire care organization. Further research aimed at the implementation of client-centred care is recommended.

Evaluation is an essential part of service development and quality management and this is especially pertinent when introducing new initiatives. In 2001 a new countywide assessment and rehabilitation Intermediate Care service, consisting of three care management Rehabilitation Link Teams (RLT), was implemented for older people. To monitor the implementation and impact of the service an evaluation study was conducted. The study centred on evaluating team development, interagency working, outcomes from multiple perspectives (client, carer, clinical and service) and the cost effectiveness of the service. Of particular importance to the study, however, was the action-research approach that provided the underpinning philosophy to the study. This paper provides insight into the ways that the action-research approach was used to facilitate learning and change within the organization. To enable this to happen, it was important for the health and social care staff to understand that the researchers’ role was not to judge their role proficiency, but to gather information to facilitate learning and understanding within the organization. It was also vital that the teams being evaluated were provided with regular insight into the emerging study findings and opportunity to address these. Three examples are provided to illustrate how regular information feedback sessions influenced the implementation of the service. Insight is also provided into the participant's views of being evaluated. Although at times, the RLT members found the evaluation burdensome, almost all stated that the action-research approach allowed opportunity for reflection, catharsis and personal action planning. Overall, the action-research approach to evaluation fitted well with the organization's need to learn and change simultaneously, allowing emergent data collection to inform decision making and service and team development.

In a world of innovation and change, healthcare graduates are expected to be capable of independent decision making, take responsibility, assume leadership and demonstrate confidence and commitment to lifelong learning in their respective professions. The academic belief systems (ABS) of 52 BSc (Hons) Physiotherapy students were measured during the course of their 3 years of undergraduate education. The patterns of ABS profile change in relation to the curriculum the students were experiencing revealed that these undergraduates’ ABS are susceptible to change over time with contact time (the academic terms) having a negative impact on all ABS variables associated with positive aspects of learning and personal development. Non-contact time (vacations) saw a ‘recovery’ in most variable mean scores. All ABS variable mean scores were lower on graduation than on admission. How the study results informed curriculum review is described and the specific changes implemented to help facilitate students’ perspectives as lifelong learners outlined.

This study describes the implementation of a supervision and assessment system based on a clinical log writing strategy, involving second year student nurses in two surgical units.

 The aim of the clinical log was to promote student nurses’ personal growth and to provide a database for competency assessment.

 The log system was designed as a collaborative and dialogical strategy, committing all parties involved to document the teaching and learning process. Faculty and nurse supervisors monitored and verified the students’ progress by documenting supervision and formative assessment in the students’ logs, and students submitted evidence about their learning process and self-evaluation. Summative assessment was conducted through tripartite conferences at the end of the clinical placements. Together, faculty, clinical staff and student considered the evidence presented in the log in order to establish the student's level of clinical competency.

 Using clinical logs to promote personal growth as well as to assess student performance in clinical placements is a controversial issue in the literature as critics argue that these aims are incompatible.

 The log system was pilot tested with 14 students expanding into an action research project including 28 other students during the second year of the trial period. The log project was evaluated at end of the second year based on a semi-structured questionnaire designed by faculty and additional evaluative material such as journals, field notes and minutes from meetings with clinical staff. The general consensus among faculty and nursing staff was that the log-based supervision and assessment strategy had improved the quality of supervision and created a more dynamic teaching and learning environment, enhancing the students’ possibility to develop personally as well as professionally.

This paper reports the results of a 2-year pilot study that involved 136 students from various health professions in 13 interprofessional education projects in north-western Ontario, Canada. The educational model was based on principles of problem-based, self-directed, small group learning and combined a clinical placement with a series of interprofessional tutorials and other shared learning experiences. Project evaluation entailed the use of both quantitative and qualitative outcome measures. Student ratings revealed a high level of learner satisfaction. There was no change in student perceptions of interprofessional collaboration between pre-test and post-test. A difference was observed between professions, with rehabilitation students having more positive perceptions than medical students. Qualitative analysis of student journals revealed four major themes: (i) new insights into interprofessional roles and the potential for collaboration; (ii) increased understanding of aboriginal culture, spirituality and health beliefs; (iii) new insights into healthcare system issues in rural and remote regions; and (iv) reflections on the benefits and challenges to interprofessional learning. Although barriers to implementing interprofessional education exist, the need to overcome them is critical in order to better prepare health professional students for collaborative practice within a changing healthcare system. Lessons learned and strategies for success are discussed.

In this paper, the author reflects on the process of analysing and interpreting what trainees said about their learning during an external evaluation of an innovative training programme for practitioners working in the emerging field of parenting education and support. Applying the ‘voice-centred relational’ method of qualitative analysis to a training evaluation context, qualitative accounts from trainees were read through four different lenses: the plot and evaluator responses to the narrative; the voice of the ‘I’; relationships; and placing people within cultural contexts and social structures. The use of this framework is then illustrated by an analysis of an interview with one trainee. The importance of the evaluator being emotionally and intellectually reflexive and aware of the impact of the content and process of the learning on the trainees is stressed.