Interprofessional learning at work: what spatial theory can tell us about workplace learning in an acute care ward

Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review

Identifying ways to ensure resident safety is increasingly becoming a priority in residential settings and nursing homes. The aim of this qualitative systematic review was to identify, describe, and assess research evidence on managers' perceptions regarding the barriers and facilitators of daily resident and patient safety work in residential settings and nursing homes. A qualitative systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Published studies were sought through academic databases: Academic Search Premier, CINAHL, PubMed (MEDLINE), Scopus, SocINDEX, and Web of Science Core Collection in April 2023. Finally, 12 studies were included. The results of the included studies were synthesized using thematic synthesis after data extraction. According to the results, (1) competent staff and material resources; (2) management and culture; (3) communication, networks, optimal use of expertise; and (4) effective use of guidelines, rules, and regulations play a significant role in the success of resident and patient safety work. The findings revealed that promoting resident safety should not be seen solely as the responsibility of individual residential or nursing home personnel, as it requires multiprofessional cooperation and access to wider networks. Staff and managers must be receptive to learning, changing, and improving safety. Moreover, to ensure resident safety, it is essential to ensure that the organizations support safety work in residential and nursing home units.

Recasting Assessment in Continuing Professional Development as a Person-Focused Activity

ABSTRACT

In this article, we examine assessment as conceptualized and enacted in continuing professional development (CPD). Assessment is pervasive throughout the life of an individual health professional, serving many different purposes compounded by varied and unique contexts, each with their own drivers and consequences, usually casting the person as the object of assessment. Assessment is often assumed as an included part in CPD development conceptualization. Research on assessment in CPD is often focused on systems, utility, and quality instead of intentionally examining the link between assessment and the person. We present an alternative view of assessment in CPD as person-centered, practice-informed, situated and bound by capability, and enacted in social and material contexts. With this lens of assessment as an inherently personal experience, we introduce the concept of subjectification, as described by educationalist Gert Biesta. We propose that subjectification may be a fruitful way of examining assessment in a CPD context. Although the CPD community, researchers, and educators consider this further, we offer some early implications of adopting a subjectification lens on the design and enactment of assessment in CPD.

Workshops as Tools for Developing Collaborative Practice across Professional Social Worlds in Telemonitoring

BACKGROUND

Lately, patients suffering from chronic obstructive pulmonary disease use telemonitoring services from home. We discuss three professional groups' idea of good care in terms of living as a chronically ill patient.

METHODS

We scrutinize a workshop consisting of the following: (1) presentation of pre-workshop interviews focusing on good patient flows; (2) presentation of the participants' photos illustrating their idea of the good life with telemonitoring; (3) discussion of what the three social worlds of care can do together. We understand workshops as learning events founded on the symbolic interactionist idea of learning as reflexism. That is, the process where participants make joint action an object of attention.

RESULTS

We propose that not only people, but also objects such as applications, gold standards, and financial arrangement are actively involved in hampering collaboration across social worlds. The contribution is a discussion of the contemporary challenges of technological intensification into healthcare processes seen as a learning event.

CONCLUSION

Workshops constitute useful tools to understand more of how professional groups seek to adopt new technologies and learn about the larger structure of telemonitoring. Developing joint action among social worlds appears to be one of the main challenges of technologically driven innovation in healthcare.

The influence of culture, structure, and human agency on interprofessional learning in a neurosurgical practice learning setting: a case study

The World Health Organization supports the notion that interprofessional learning (IPL) improves healthcare outcomes and contributes to safe, effective, and high-quality care. Consequently, IPL is an integral component within most UK undergraduate healthcare programs. Although much is written about IPL, research to date has mainly focused on the classroom or simulation lab as a setting for IPL. Less is known about how the practice learning environment influences the experiences and outcomes for those involved. A case study research design, situated within a critical realist framework, was undertaken which aimed to better understand how IPL was facilitated for undergraduate healthcare students within a neurosurgical practice learning setting. Interviews, non-participatory observations, and secondary documentary data were used as the methods of data collection to inform the case. Thematic analysis was undertaken, and the findings clustered into overarching themes of culture, structure, and human agency, facilitating a more in-depth exploration of the complex interplay between the factors influencing IPL in the study setting. IPL was supported within the setting which operated as an 'interprofessional community of practice,' facilitating student engagement and investing in its staff for the benefit of the patients who had complex neurological needs. A practice-based IPL Multi-Dimensional Assessment Tool was also created to enable colleagues in practice learning environments worldwide to better understand their capability and capacity for the facilitation of practice-based IPL.

Organizational learning in hospitals: A realist review

AIM

To establish a middle-range theory of organizational learning in hospitals.

DESIGN

A realist review of the literature, conducted according to established standards for realist and meta-narrative evidence syntheses. Middle-range theory development was performed according to Smith and Liehr's recommendations.

DATA SOURCES

Two comprehensive scientific databases and six discipline-focused databases spanning health care, life sciences, business, sociology, and psychology were searched from inception to 12 May 2016.

REVIEW METHODS

Citations meeting the inclusion criteria were appraised using the Mixed Methods Appraisal Tool. Data extraction was guided by a focus on the contextual factors, mechanisms, and outcomes associated with organizational learning.

RESULTS

The initial search yielded 2,332 citations, 147 of which were ultimately included in the review. The included citations were generally of high quality. Reviewed evidence indicates certain aspects of organizational context can be conducive to mechanisms of organizational learning, leading to a range of positive organizational outcomes.

CONCLUSION

This review updates and expands on a previous review of the literature on organizational learning in hospitals, refines the concept of organizational learning in hospitals, and provides a middle-range theory of organizational learning in hospitals.

IMPACT

This updated review provides a strong evidence base for future work on the topic of organizational learning in hospitals. The refined concept of organizational learning makes it possible to develop reliable, valid research instruments that better reflect of the full scope of organizational learning. Finally, the middle-range theory guides researchers and clinical leaders as they advance the science and practice of organizational learning.

The effects of clinical facilitators' pedagogic practices on learning opportunities for students who speak English as an additional language: An ethnographic study

BACKGROUND

Increasing numbers of undergraduate nursing students speak English as an additional language. Clinical placements can be difficult for many of these students and their clinical facilitators. The causes of challenges are often reported to be students' lack of English language ability or, for some students, learning styles that are not suited to Western style education.

OBJECTIVE

The purpose of this research was to investigate how clinical facilitators' pedagogic practices in hospital settings enabled or constrained the learning of students for whom English was an additional language.

METHOD

This research used an ethnographic design to observe the interactions of twenty-one first year students for whom English is an additional language, and their three facilitators. Observations occurred during three two-week clinical placement blocks, in three large metropolitan hospitals in Australia. Written ethnographic field notes were made during the observations. Field notes were analysed in two stages: firstly, to identify major themes, and secondly, to map the spaces and activities where facilitators and students interacted.

RESULTS

The study found that there were multiple learning spaces in the hospitals, each of which was associated with particular learning activities between facilitators and students. These activities provided access to opportunities for learning core nursing skills, as well as for socialisation into the language of nursing. However, not all students had access to these opportunities. The pedagogic practices facilitators used created or constrained learning opportunities for students.

CONCLUSION

This paper proposes a new way of thinking about the supervision of students for whom English is an additional language in clinical settings. Rather than focusing on a lack of English language proficiency or cultural heritage factors, it proposes that a guided approach to using spaces and activities can maximise students' opportunities for learning.

Using a sociomaterial approach to generate new insights into the nature of interprofessional collaboration: Findings from an inpatient medicine teaching unit

Today's hospitals are burdened with patients who have complex health needs. This is readily apparent in an inpatient internal medicine setting. While important elements of effective interprofessional collaboration have been identified and trialled across clinical settings, their promise continues to be elusive. One reason may be that caring for patients requires understanding the size and complexity of healthcare networks. For example, the non-human 'things' that healthcare providers work with and take for granted in their professional practice-patient beds, diagnostic imaging, accreditation standards, work schedules, hospital policies, team rounds-also play a role in how care is shaped. To date, how the human and non-human act together to exclude, invite, and regulate particular enactments of interprofessional collaboration has been subject to limited scrutiny. Our paper addresses this gap by attending specifically to the sociomaterial. Drawing on empirical data collected from an Academic Health Sciences Centre's inpatient medicine teaching unit setting in Ontario, Canada, we explore the influence of the sociomaterial on the achievement of progressive collaborative refinement, an ideal of how teams should work to support safe and effective patient care as patients move through the system. Foregrounding the sociomaterial, we were able to trace how assemblies of the human and the non-human are performed into existence to produce particular enactments of interprofessional collaboration that, in many instances, undermined the quality of care provided. Our research findings reveal the "messiness" of interprofessional collaboration, making visible how things presently assemble within the inpatient setting, albeit not always in the ways intended. These findings can be used to guide future innovation work in this and other similar settings.

Applying spatial literacy to transform library space: a selected literature review

Purpose

The purpose of this paper is to review a selection of articles and books that highlight aspects of spatial theory and literacy from various disciplinary perspectives, along with a review of library space studies.

Design/methodology/approach

This study reviews library literature that uses spatial literacy and its related tools. The authors searched in two databases: Library, Information Science & Technology Abstracts, and SCOPUS. The paper records were analyzed to find primary research studies, published between 2010 and 2017, which study patron use of library space using various single and hybrid methodologies.

Findings

The findings of the literature reveal that of the 26 studies reviewed, 23 have a descriptive research question and three have a relational research question. Based on the analysis of the research methodologies used, there is more that can be done in support of a librarian’s research efforts as well as the arenas in which research is conducted.

Practical implications

These findings highlight ways in which library and information science researchers and those who educate them can broaden knowledge within the profession regarding spatial theory, literacy and applicable research methodologies for studying library space.

Originality/value

Current and best practices for designing library space studies that use spatial literacy to collect and analyze data are identified along with a discussion of future directions for researchers to better assess space and communicate the value of physical space in libraries.

Work-based learning in health care organisations experienced by nursing staff: A systematic review of qualitative studies

The aim of this review is to systematically summarise qualitative evidence about work-based learning in health care organisations as experienced by nursing staff. Work-based learning is understood as informal learning that occurs inside the work community in the interaction between employees. Studies for this review were searched for in the CINAHL, PubMed, Scopus and ABI Inform ProQuest databases for the period 2000-2015. Nine original studies met the inclusion criteria. After the critical appraisal by two researchers, all nine studies were selected for the review. The findings of the original studies were aggregated, and four statements were prepared, to be utilised in clinical work and decision-making. The statements concerned the following issues: (1) the culture of the work community; (2) the physical structures, spaces and duties of the work unit; (3) management; and (4) interpersonal relations. Understanding the nurses' experiences of work-based learning and factors behind these experiences provides an opportunity to influence the challenges of learning in the demanding context of health care organisations.

Organizing for teamwork in healthcare: an alternative to team training?

Purpose

The purpose of this paper is to explore how organizational design could support teamwork and to identify organizational design principles that promote successful teamwork.

Design/methodology/approach

Since traditional team training sessions take resources away from production, the alternative approach pursued here explores the promotion of teamwork by means of organizational design. A wide and pragmatic definition of teamwork is applied: a team is considered to be a group of people that are set to work together on a task, and teamwork is then what they do in relation to their task. The input – process – output model of teamwork provides structure to the investigation.

Findings

Six teamwork enablers from the healthcare team literature – cohesion, collaboration, communication, conflict resolution, coordination, and leadership – are discussed, and the organizational design measures required to implement them are identified. Three organizational principles are argued to facilitate the teamwork enablers: team stability, occasions for communication, and a participative and adaptive approach to leadership.

Research limitations/implications

The findings could be used as a foundation for intervention studies to improve team performance or as a framework for evaluation of existing organizations.

Practical implications

By implementing these organizational principles, it is possible to achieve many of the organizational traits associated with good teamwork. Thus, thoughtful organization for teamwork can be used as an alternative or complement to the traditional team training approach.

Originality/value

With regards to the vast literature on team training, this paper offers an alternative perspective on how to improve team performance in healthcare.

Requirements for reflection in the critical care environment

BACKGROUND

Reflection is recognised as an important method for practice development. The importance of reflection is well documented in the literature, but the requirements for reflection remain unclear.

OBJECTIVES

To explore and describe the requirements for reflection in the critical care environment as viewed by educators of qualified critical care nurses.

METHOD

A focus group interview was conducted to explore and describe the views of educators of qualified critical care nurses regarding requirements for reflection in the critical care environment.

RESULTS

The themes that emerged from the focus group were buy-in from stakeholders -management, facilitators and critical care nurses, and the need to create an environment where reflection can occur.

CONCLUSION

Critical care nurses should be allowed time to reflect on their practice and be supported by peers as well as a facilitator in a non-intimidating way to promote emancipatory practice development.