Communication & Process

1. Practice-based Learning & Higher Education : Let the learners ‘lead the way’ – re-introducing independent learning & development. Nick Rowe - Institute of Health & Community Studies, Bournemouth University – U.K. EBP Multi-disciplinary Working & Education In Healthcare Evidence-Based Practice, delivered by an Inter-Professional Workforce = a system of Evidence-Based Healthcare that supports the delivery of Evidence-Based Medicine = E.B.H.C. ∂ E.B.M. I-P W Jargon:  • noun . words or expressions used by a particular group that are difficult for others to understand. [Case Study] Step 3 : Develop From Established Principles • Having established that both Higher Education, Clinical and Professional Practice were now ‘on the same side’, the initial issues of concern were quickly resolved: • Is this OK … ? [ ‘This is OK because it follows the current guidelines, published by …’] • How deep should the student go … ? • [‘The first year student requires a solid understanding of the basic concepts of … upon which, their future practice can be developed. You can determine this by …’] • Theory – Practice … c’est quoi ? • [‘My experience and opinion is valuable, but I need to measure and account for it. – Information that supports me might be found at …’] • H.E. – I don’t understand … • [‘In fact – many of the basic principles are comparable to professional practice. Once you see past the ‘jargon’, then you can work-out the ‘bells & whistles’ for yourself … It helps to have some help with the paperwork though.’ ] • Final consensus concluded that the ‘paperwork’ was not in fact, the main concern; rather, demonstrating the underlying principle. (Students) and staff were subsequently able to achieve this by mutually accessing auditable evidence and independently validating their rationales for practice and theory. • Feedback and Communication • (Single Placement Case-Study Only – 12.04.07) • Following the session, a Likert-Scale questionnaire was administered to participants by their Education Co-Ordinator, with collated results being fed-back to the education provider. • Strong agreement (83%) was expressed by the sample group in regard to the content and administration of the session, although there was initial doubt expressed as to the need for practice to be examined. • (80%) strongly agreed that University / Placement relations had been greatly improved, with clear channels of communication established for individual & group discourse. • [ Individual requests for consultation have been received, in addition to similar requests from other placement providers at Learning Facilitator Meetings.] • (100%) strongly agreed that the review of professional standards had provided a linked understanding of the academic requirements for students and those undertaking the Assessor role. In addition, they independently acknowledged strategies for role development and felt better empowered to gain access to further information & resource support (previously addressed as a barrier to implementing (evidence-based) research 9. • (88%) expressed greatly improved understanding of the programme documentation, and the requirement to link this to Evidence-Based Practice, in-line with published standards. • In addition to receiving clarification of assessment issues, it was expressed that (the session) had ‘given (Assessment) Staff confidence in the process and the potential to access support from University staff’ with reduced potential for un-substantiated student ‘sign-off’. In this respect, the process had been successful in achieving its original objectives. Stimulus Common Questions From Assessors ~ Is this OK … ? [ Related to … ?] How deep should the student go … ? [In regards to what exactly ?] Theory – Practice … c’est quoi ? [Where is YOUR evidence-base ?] H.E. – I don’t understand … [Are staff familiar with Higher Education ?] Practice Assessors (PA) of 3 NHS Trusts involved in the delivery of the Dip HE Operating Department Practice (ODP) programme, expressed on-going difficulty in establishing the suitability, depth and academic level of evidence, as required for the assessment in practice of student ODPs at level C and level I. This was formally raised at Strategic Health Authority (SHA) Practice Assessment Meetings, and again at programme Learning Facilitators (LF) Meetings of throughout the year. Set requirements for the assessment and mentorship of students are published at both local (programme)1 and national (governing body) level 2, with support given from the academic institution 3, yet approaches remain inconsistent and detrimental to both student welfare and the academic process. Re-evaluation of student work by the academic institution has previously resulted in students failing to achieve evidenced competency in practice and was the stimulus for change, reflected in this case-study. An urgent address of the issue was undertaken, with a view to highlighting the issues of evidence-based practice assessment and the formulation of long and short term measures to prevent a re-occurrence of student non-achievement (as a result of failures within the assessment process). This work looks to highlight the need for change in relation to the events that occurred, and illustrates the collaborative approach taken with Partnership Institutions, to inform staff and improve the assessment process. Linked issues of Professional Development, Evidence-Based Practice and Higher Education were also considered. Approach Methodology & Design Retrospective linked questioning helped to establish the locality, process and involvement of the problem, relative to its initiating incident. Analysis of current core documentation relating to the Nursing and ODP professions was undertaken to establish the professional and working requirements of each group. Topical academic consultation was sought, in conjunction with healthcare providers. The search strategy for information was conducted by accessing a variety of databases (BNI, Blackwell Synergy, CINAHL, MEDLINE) in relation to Nursing and Allied Health Professions. This was widened to include the British Education Index, and supplemented by manual meta-search engine employment (Ixquick). Key words relating to the identified issues were entered. Results were filtered and appropriate results accessed and reviewed. Manual review of institutional resources and personal texts was also employed. Non-statistical review of Likert Questionnaire provided feedback for the single placement study (500 bed District General Hospital) and indication for future development. bromine.servlet.net/.../ninarios/STEPPING.jpg It’s about getting from here … to there . • Shared values ? • In considering the key principles of Higher Education, it has been identified that: • It will have a theoretical underpinning, • It will be at a level which would qualify someone to work in a professional field • It will usually be taught in an environment which also includes advanced research activity. 4 • The system of assessment in question required an evidence-based approach, in that any learning or assessment outcome that met the required levels of proficiency, was required to be supported by demonstrable evidence that indicated how the outcome was achieved 5 . This also links to the on-going requirement for practitioners (Nursing6 and ODP7) to have an evidence-based approach to clinical practice, as outlined by the NHS Executive (1996)8, and as a component requirement for professional registration (NMC 2004 6), (AODP, 2003 9). Whilst specialist healthcare practice has a wide practical application and retains many of its vocational traits, the development of demonstrable evidence, is a key requirement of professional practice. • Considering the development of independent learners, it has been expressed that ‘we do not use assessment as well as we might, and tend to assess the product rather than the process’ 10.This is perhaps reflected in the range of questions raised by assessment staff, in relation to the case concerned. In order to work and learn independently (as outlined by the requirements of Higher Education and the published standards of the professions concerned), then the aims and objectives of the process needed to be fully understood, in order for the concepts to be applied to specific clinical or educational issues. • Comprehension often relies upon good communication 11. The challenge lay in ‘translating’ the required elements of both professional practice and Higher Education into a shared language, and finding a means of access and delivery to the workplace. Concerns tended to be focussed upon the language used in Higher Education, and a need for ‘concrete’ answers to assessment questions (which remain variable in relation to knowledge, experience and specific circumstances). Comparison of the events (and opinions) surrounding the initiating incident and the available guidance and literature, highlighted that there were fundamental flaws in the understanding and application of professional & educational practice. • This provided the focus for addressing the issue at workplace level. • Step 1 : Remove the Jargon Communication & Process The Education Provider (University) had no jurisdiction in the placement area, other than in a partnership advisory role. As such, access to the staff concerned had to be secured, and a mutually acceptable change process found. Both the clinical placement and the education provider were familiar and in agreement with the requirement for staff currency, so an existing Mentor Update format was chosen as a means of accessing the workplace environment. A group examination of related current standards of Education, Assessment and Professional Conduct, enabled a clear framework of acknowledged obligations to be identified. Many of these were directly applicable to the range of issues, as identified in the research lines of enquiry. As such, it was possible for assessment staff to relate the requirements of their own Codes of Conduct, to the wider aspects of professional support and development. • Step 2 : Find Common Ground • Professional ‘Codes’ extend beyond clinical applications into the basic framework of society, as do the concepts of ethics and accountability, yet (not uncommonly 12), many of the staff concerned did not feel empowered to make rationalised arguments in order to meet their role requirements. • ‘Medicine is a profession for social service, and it developed organisation in response to social need’. (C. Mayo U.S. Physician – 1931) – Need creates process, yet the process often becomes centre of attention. • In examining some of the ‘markers’ of professionalism 14, it was found that – once again, the educational and clinical groups had a commonality in purpose, which was shared with the student group they aimed to develop. • Specialized Body of Knowledge • Set of Skills • Group Mission or Identity • Standards of Behaviour and Practice • On entering a profession, practitioners (at all levels) subsequently take-on the responsibilities and accountabilities that are required for the objectives of that role to be accomplished 6,7. In examining the ‘evidence’ of their professional existence, assessment staff were able to approach both their own judgements, and those of others (student and employer), from an evidence-based perspective. Far from being viewed as being ‘taught to suck eggs’, the group found that they could consider issues independently, in a manner that both validated clinical and educational practice, and enhanced both their own learning and that of the students. Many expressed that where once they had felt threatened by ‘academia’, it could be used as an effective ‘tool’ in professional communication and development, once basic principles had been established. Conclusions & Ideas For Further Consideration (Active Learning Step 4 ?) Both the Practice Environment & Higher Education had established common ground, with mutual benefit to all involved. It was anticipated by those concerned, that this would result in greater efficiency in the assessment process, which in-turn would improve evidence-based practice and subsequent patient care. Morale was improved, and the process proved to be inclusive, as opposed to critical. This approach aims to be repeated at the remaining placement institutions with the intent of improving assessment standardisation, communication links and aid staff development. Further analysis of the wider findings will help to inform and direct future practice and related change, and perhaps demonstrating transferability to other fields of work-based learning. Higher Education / Evidence-Based Practice / Professional practice: shared values – common goals. If we fail to engage others, … we remain separated from the wider (healthcare) community. Invite people on-board – (but preferably in a language they understand). • Contributory factors of the issue constructed the following lines of enquiry: • Scope of application within professional body publications: What are the requirements concerning practice assessment, and are they being met ? • Definitions of competency and evidence: Is there a clear understanding of the basic pillars of healthcare placement assessment, and of the associated academic & clinical descriptors currently employed ? • Is the requirement for evidence-based practice evenly applicable to pre and post registration development, and how does it relate to assessment practice ? V. Volny, Vermilion Sea Institute. References:1BOURNEMOUTH UNIVERSITY, 2006. The Essential Guide to Pre-Registration Operating Department Practice - Clinical Staff Guide. Bournemouth: BU / ODP, version 3. 2ASSOCIATION OF OPERATING DEPARTMENT PRACTITIONERS, 2006. Qualifications Framework for Mentors Supporting Learners in Practice: Standards and Guidance for Mentors and Practice Placements in Support of Pre-registration Diploma of Higher Education in Operating Department Practice Provision. London: AODP, Issue 2. 3BOURNEMOUTH UNIVERSITY, 2006. The Essential Guide to Pre-Registration Operating Department Practice - Clinical Staff Guide. Bournemouth: BU / ODP, version 3. 4 UNIVERSITIES SCOTLAND, 2004. What is Higher Education ? Available from: http: / www.universities-scotland.ac.uk/Facts%20and%20Figures/HigherEducation.pdf [Accessed : 01.05.2007]. 5HEALTH PROFESSIONS COUNCIL, 2005. Standards of Education and Training. London: HPC. 6 NURSING & MIDWIFERY COUNCIL, 2004. The NMC code of professional conduct: standards for conduct, performance and ethics. London: NMC, Standards.07.04. 7 HEALTH PROFESSIONS COUNCIL, 2004. ODP Standards of Proficiency. London: HPC.8 NHS EXECUTIVE, 1996. Promoting Clinical Effectiveness: A framework for action in and through the NHS. London: NHSE. 9 ASSOCIATION OF OPERATING DEPARTMENT PRACTITIONERS, 2003. Scope of practice. London: AODP, Issue 1 Revised 2004. 10 Hoskins, S. 2004. Developing Independent Learners. Available from: http: / www.business.heacademy.ac.uk/resources/landt/learning/independant [Accessed : 01.05.2007]. 11GOLEMAN, D. 1996. Emotional Intelligence. London: Bloomsbury. 12 PARAHOO, K., 2000. Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. Journal of Advanced Nursing 31(1), 89-98. 13MAYO, CH, 1931. Collected papers of the Mayo Clinic and Mayo Foundation, 23:1020. Rochester, MN 14 PLAUT, M. 2006. What does it mean to be a member of a profession ? Available from: http: / www.medschool.umaryland.edu/Professionalism/professionalism_dmrt.pdf [Accessed : 01.05.2007].