Service development
Using action research to investigate and improve hospice staff participation in workplace education Sue Griffith
P Sue Griffith is Lecturer/Practice Educator, St Helena Hospice, Barncroft Close, Highwoods, Colchester, Essex, CO4 9JU, England Email: sgriffith@ sthelenahospice.org.uk
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alliative care has evolved greatly since gaining specialty status in the 1980s, (Doyle, 2004). Alongside this, hospices have grown significantly from the early isolated buildings of the 1960s to today’s international presence in over 100 countries (Doyle, 2004). Like many others, the hospice that was the setting for the study reported here is now a large and diverse organisation spread over multiple sites, including an inpatient unit, two day centres, and an expanding ‘hospice at home’ and community team. With this expansion it has become increasingly challenging to create learning events that are accessible to all, fulfil professionals’ CPD requirements and the organisation’s ‘strategic plan’, and remain in keeping with the ideals of practice development. Furthermore, ensuring that these events are timely and well attended by the people who will benefit from them the most has become progressively more difficult.
Methodology Action research is an ideal approach to address the ‘pragmatic concerns’ of an institution (Bell, 2005), bridge the ‘theory–practice divide’ (McNiff and Whitehead, 2005; Waters-Adams, 2006; Cohen et al, 2011), and generate a solution to a problem. It is particularly useful when a new initiative needs to be implemented but it is unclear how this can be achieved effectively (Waters-Adams, 2006). It is normal to begin with a period of review and focusing to identify points for development (Edwards and Talbot, 1999). Two strategies were used for the review. First, the attendance lists of events held over the preceding 6 months were analysed to establish whether there was any particular time, day of the week, or nature of event that was attracting higher or lower levels of attendance. Second, staff were questioned at their team meetings by members of the Education and Research Group (EARG), a group of ten members with representatives across the whole organisation (Box 1), to establish what they liked about the events and what they found to be principal barriers to participating. This gave the EARG access to the opinions of approximately 40% of the total staff.
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Abstract
Finding ways to make good quality education available to all staff in an expanding and increasingly busy hospice organisation is a real challenge. Constantly providing learning opportunities that are then poorly attended owing to the pressure of work is equally disappointing, and leads to questions of cost-effectiveness. An action research project was undertaken to investigate the reasons for low attendance rates at learning events in one hospice. Having identified time and conflict with patient need as major issues, a second cycle of research using literature review and a survey methodology was conducted to find a contemporary and innovative solution to this problem in an attempt to establish a vibrant learning culture. As a result a virtual learning environment—ORACLE (Online Research and Care Learning Environment)—was created to augment the face-to-face sessions and provide staff with access to appropriate learning materials 24 hours per day, 365 days per year. Although unique to this organisation, ORACLE has potential application to any other work environment. Key words: Virtual learning environment (VLE) l Action research l Survey l Learning styles l Education
This paper details how an action research approach over two cycles was used to study the problems of low attendance at learning events and generate solutions that could then be evaluated for effectiveness. Beginning with a review of the situation, followed by reflections and evaluation of attendance, it culminated in the decision to create an online learning resource named ORACLE (Online Research and Care Learning Environment). Literature review and a staff survey were then used to ensure that the site design is as useful and accessible as possible, using evidence-based approaches to learning. ORACLE will supplement face-to-face learning events and make learning materials available to all staff across the whole organisation, at any time of the day or night.
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The review revealed that the early morning events, introduced with the intention of being accessed by people at the beginning of their working day or the end of a night shift, although initially successful, had begun to suffer from particularly poor attendance. Team members revealed that they found the events too early to attend prior to work or unappealing at the end of a night shift. The lunchtime and mid-afternoon events achieved the highest attendance rates, and those staff questioned felt that these were the easiest to access. Staff also said that if given plenty of notice it was easier to plan events into diaries before other appointments arose. The mid-week sessions also gained more attendees, as many part-time staff work from Tuesday to Thursday. From these findings, a decision was made to abandon the unpopular early morning session and plan to hold events at lunchtime or 3pm on mid-week days, giving over a month’s notice whenever possible. The very topical and popular subject of complementary therapies (CT) was planned for the following month’s four events, coinciding with the successful appointment of a new team leader and an expanded team of volunteers. These four sessions would be the subject of the first cycle of the action research. For this cycle, a four-pronged approach was taken to enable triangulation of data—a vital aspect of action research (Webb, 1996; WatersAdams, 2006) that allows evidence to be verified (Burton and Bartlett, 2005) and provides greater validity. Although not essential in small-scale studies (Bell, 2005), validity is further increased by ensuring that methods are appropriate to the question (McNiff and Whitehead, 2005) and findings are recorded with accuracy and honesty (Burton and Bartlett, 2005). This first cycle involved studying attendance figures for comparison with previous events, devising an evaluation form to be completed by all attendees to illuminate the reasons for their attendance, and obtaining the reflections of the researcher and CT coordinator. Including personal reflections on the attitudes and thoughts of the researchers involves asking self-critical questions (McNiff and Whitehead, 2005) and is at the heart of action research (Edwards and Talbot, 1999). This also takes the project beyond simple quantitative data and offers a platform to include both subjective and objective data, another central tenet of action research (Edwards and Talbot, 1999). The EARG acted as ‘critical friends’ and ‘validation group’ (McNiff and Whitehead, 2005; Waters-Adams, 2006) to the primary researcher, listening to progress, offering advice, and evaluating the quality of the research
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Box 1. EARG members Medical Consultant, Education Director, Librarian, Lecturer, Inpatient Unit Nurse, Counsellor, Community Nurse Specialist, HR Assistant, Day Service Nurse.
(Edwards and Talbot, 1999). Ethical principles of non-maleficence, beneficence, confidentiality, non-traceability, and anonymity (Cohen et al, 2011) were considered and discussed with the validation group. All participants were aware that they could withdraw at any time, and the data was stored securely and anonymously (British Educational Research Association, 2011).
Findings and discussion The initial findings were analysed using ‘open-ended critical reflection’ (Winter and Munn-Giddings, 2001), questioning spontaneous interpretations and sharing them with the validation group for authentication. Analysis of attendance lists at the CT events revealed the second highest turnout for all sessions to that point, achieving almost double many other topics, with a total of 25 for all events. Attendance of the new volunteers in the CT team was not included in the figures, to ensure that comparison was equitable with the earlier records. However, this quantitative data reveals little about why the increase occurred. The evaluation sheets added depth to this finding, revealing that the main reason for attendance for most was a desire to learn more about use of CT with palliative care patients. The time of day suited many, and 5 of the 25 attendees revealed that a personal invitation from the researcher influenced their decision to attend. More controversial findings arose around the issue of whether people felt supported to attend learning events in work time. All but two people said that they did feel supported, but interestingly eight commented that using their own lunchtime was easier. Two attendees were voluntary staff, so felt that this was not relevant for them. The CT team leader’s reflections included that: ‘Lunchtime was chosen so that staff could legitimately attend in their own time.’
This highlights a key question of whether using work time to learn is viewed by everyone as legitimate. If not, this could clearly be an important obstacle to attendance at any events. Four people specifically mentioned that workload on the day was more influential than advance notice or timing. Several nurses from the
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❛... it has become increasingly challenging to create learning events that are accessible to all ... and remain in keeping with the ideals of practice development.❜
in-patient unit said they would have relished the opportunity to attend but could not be spared from the patient area and needed to eat during their half-hour lunch break to sustain themselves through the 12-hour shift. Reflections also suggested that although some people attended because they felt that using their own time did not affect workload, others appeared to avoid this exactly because it was their own time, and they preferred to do other things. Clearly, using lunchtime can be a double-edged sword. Another interesting and unexpected finding was that the events generated discussion between those unable to attend and the organisers, leading to learning. For example, discussion between the CT team leader and the bereavement coordinator led to a decision to work together to improve the service to bereaved people in future. This conversation would not have occurred without the learning event. Likewise, discussion with another allied professional about when it is appropriate to refer for CT led to that professional making referrals, which they had not done previously. Clearly, learning was engendered by these events in more subtle ways than attendance figures alone can measure. Creation of a learning environment is more complex than just providing teaching sessions. These findings were shared with the EARG in order to plan the next intervention and cycle of research. The expectation had been that a clear time of day and/or day of the week would emerge as ideal. However, it became apparent that while the events continued to be non-mandatory and therefore not planned into people’s working day, there would always be a perception of conflict between direct patient care and education needs. It was concluded that the answer therefore must lie beyond the face-to-face learning events alone. The solution appeared to the EARG to be the introduction of a virtual learning environment (VLE) to provide staff with access to learning material and a discussion forum. Continuing the spirit of action research, it was decided that this would be the focus of the next cycle of investigation. A rigorous approach would ensure that the learning site created was supported by external evidence from literature review and generation of unique original evidence of what is beneficial for staff in the organisation.
Literature review Wilson (2009, p668) describes VLEs simplistically as ‘a modern teaching and learning style, using computer technologies’. A more comprehensive definition makes clear that the users are both
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‘active and actors’—members and contributors in a social and information space (Dillenbourg, 2000, p8). To give insight into how this is translated into action, a review of the existing literature helped to establish what is already known about VLEs in the workplace. It also helped to raise questions and identify areas for exploration and act as a guide for a suitable research framework (Burton et al, 2008). Although there has been a proliferation of articles on VLEs over the past decade, most of this has been based on formal courses in educational institutions rather than learning in the workplace (Wang et al, 2010). This was reflected in the limited amount of specific material acquired by the search. However, the situation may change in the near future if the trend for blending face-to-face teaching with computerbased learning in the workplace increases. One of the most potent points made in the literature is that if VLEs are viewed solely as ‘information delivery systems’, and the technology itself becomes the focus, then learning is not recognised as a social process and the site is not successful (Stiles, 2000, p2). Two essential ingredients for learning are content and dialogue—as long as these are created in a VLE then it serves the purpose (Weller, 2007). However, overemphasis on discussion can also be at the expense of students working together (Stiles, 2000), so it is clearly not the whole story. Dillenbourg et al (2002) suggest that the identifying features of a VLE are enrichment of classroom activities, overlap with the classroom environment, and use of several pedagogical approaches. E-learning tools should ‘link us seamlessly’ with our teaching–learning behaviour (Ravenscroft and Cook, 2007, p212). Learning theory should ideally underpin site design, with incorporation of ‘associative’, ‘constructive’, and ‘situative’ elements (Beetham, 2007, p26; Mayes and de Freitas, 2007, p23). However, these important pedagogical issues are often ignored (Wang et al, 2010). In the workplace, learning must be collaborative, involving sharing with colleagues and aligning individual and organisational needs with the materials and key performance indicators (Wang et al, 2010). Like Biggs’ (1999) ‘constructive alignment,’ outcomes should be defined and then activities planned to achieve them (Mayes and de Freitas, 2007). Ultimate effectiveness relies on people being able to access knowledge at the time that it applies to the work setting (Singh, 2006). From Stiles’ (2000) experience of setting up a workplace VLE, he found staff focused more on creating a ‘supportive learning environment’, and became increasingly aware of ways to promote
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Service development
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active learning in all aspects of their teaching. Pettit and Mason (2003) suggested that shy people may contribute more to online discussion and feel less threatened than in a classroom situation. Equally, both McPherson and Nunes (2004) and the Higher Education Academy (2010) stated that differentiation is incorporated, allowing learners to progress at their own rate using various styles of learning. Particularly pertinent to the area of study, Howatson-Jones (2012) made the point that online learning can help resolve the problem of health practitioners leaving the patient area to participate in learning activities. She pointed out that a VLE will fulfil the Department of Health’s (DH, 2001, p55) recommendation to provide ‘24-hour access to knowledge and learning resources, 365 days per year’ in a way that is both convenient and supported. Clearly, new skills are needed for both teachers and students to adopt new technology and ensure that any hype around introduction does not lead to disappointment (Pettit and Mason, 2003). Indeed, Masterman and Vogel (2007) caution that activities should not be set up simply because the tools exist, but should be used only where they complement practice.
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Methodology and methods for second cycle This review of the literature was very helpful in understanding aspects of a successful VLE and focusing on what needed to be investigated next. To augment these findings, a survey was used to establish factors that would influence the staff to use the site and make learning more accessible for them. It was also hoped that involvement in the research process would raise awareness of ORACLE and give ownership. Action research should be ‘emancipatory’ and empower those involved in the process (Streubert and Carpenter, 2011). The survey is one of the most widely used, common, and valued ways of tackling social research (Robson, 2002; Denscombe, 2007). It works well when aiming to analyse a representative sample of a population (Bell, 2005) and offers a chance to obtain wide and inclusive coverage in a quick, cheap, and simple way (Edwards and Talbot, 1999; Bell, 2005; Denscombe, 2007; Burton et al, 2008; Blaxter et al, 2010; Cohen et al, 2011). The questionnaire is the ideal tool to conduct a survey, as it has ‘close affinity’ to this method (Burton et al, 2008, p80) and can be administered without the researcher’s presence (Cohen et al, 2011). Questionnaires ensure that the same questions
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are asked in the same circumstances (Bell, 2005) and avoid interviews’ potential for ‘social desirability bias’ (Bryman, 2008, p218). Although they provide little opportunity to examine the ‘wider themes and issues’ (Blaxter et al, 2010, p79), this was not deemed to be a problem in these circumstances. The potential problem of low return rates highlighted by Denscombe (2007) can be greatly improved with the right approach (Cohen et al, 2011). For this reason, the ‘personal touch’ (Burton et al, 2008, p8) was used and the research team shared administration of the questionnaires with all of the smaller teams in the organisation, increasing validity by ensuring that they were representative of the whole population (Bell, 2005). A convenience sample of easy to access members (Burton et al, 2008) was used for speed. The first draft of the questionnaire was constructed to give qualitative data from open-ended questions as well as quantitative data from closed questions (Denscombe, 2007). This was scrutinised by the research team to further improve validity (Edwards and Talbot, 1999). The improved version was then piloted on a small group of nurses to further refine it and so achieve optimal responses for analysis (Bell, 2005).
❛... it became apparent that while the events continued to be nonmandatory and therefore not planned into people’s working day, there would always be a perception of conflict between direct patient care and education needs.❜
Findings and discussion The 234 paid members of clinical and non-clinical staff were divided into teams, and 105 questionnaires were administered to clinical staff. The purpose of the questionnaire was explained and consent gained, and then the forms were left with people to allow them to be completed and returned anonymously. As a result only 65 responses were received. However, this is still a 62% return, which far exceeds Denscombe’s (2007) prediction of a possible 20%. It is a potential limitation of the study that the results could be skewed by the nonrespondents (Sapsford, 2007), who may have been less interested in education and making the most of learning opportunities than those who responded. Nonetheless, it is an ethical strength that these staff felt able to withhold their forms and were not coerced into compliance by the researchers. Also, analysis revealed that before all of the questionnaires had been analysed no new information was being uncovered, akin to theoretical saturation (Bryman, 2008), so there was no need to continue gathering information. The data was analysed using simple descriptive analysis, to reveal the core elements lying behind the ‘surface content’ (Denscombe, 2007). During analysis the size and scope of the data was
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condensed by drawing out common themes of significance (Blaxter et al, 2010). The findings reinforced the first cycle of research, with 23 respondents (35%) saying they do attend the learning events, although a further 22 (34%) said that this was only ‘occasionally’ or ‘sometimes’, and 3 stated that they would like to attend more. Another 20 (31%) had never attended events, and of these 12 (18%) said that they were either not appropriate or not relevant to their role. Forty two people (65%) cited either workload or time as preventing them attending. Of these, one noted that she ‘does not put [her] own learning needs first’. Other relevant points raised were that shifts or part-time work patterns mean the events may fall on a day off. People were understandably reluctant to give up their own time, and one mentioned the added cost of travel if they were to attend on a day off. Working on a separate site was mentioned by three members of staff. Encouragingly, 57 of those questioned (88%) said that they would use ORACLE, with only 5 (8%) having no intention of doing so at this stage and 1 unsure. Likewise, 40 (62%) said that they would use a discussion forum, with 12 (18%) more saying ‘maybe’, and 2 (3%) stating clearly that they found the forums very useful in previous study. Twelve (18%) felt that they would not use the forum, one because they did not use the intranet (not believing that they needed to for their role). Two more were concerned about whether there would be adequate participation, and five still felt that time would be an issue within their very busy day. In response to the question of what would be useful on a site, 33 (51%) said that access to PowerPoint presentations, lecture notes, and video clips would be really helpful. Fourteen (22%) felt that links to useful websites and documents were a good idea and should include websites relevant to their role. Other suggestions included posting information from BSc modules run at the hospice, information on diseases and treatments, and new research into drugs. Three people suggested that pharmacy information would also help their role. Two people specifically said that access to the VLE at home would be a bonus, with a further one nurse pointing out that as their role does not include access to a desk and personal computer it would not be easy to make use of this kind of learning during work time and remain undisturbed. One respondent noted that it is useful to have access to teaching resources when they are mentoring students or new colleagues.
Setting up the VLE As the hospice is a charitable organisation with no separate budget for the project, ORACLE was set up as a ‘tab’ on the existing intranet (a free Microsoft Server product) by the author and the hospice IT Manager. Thus, technology limitations govern what can be achieved and prevent follow up recording of the number of users electronically. However, as evidence from the research cycles and the literature review was used in constructing the site, it was hoped that the site would be a close fit to people’s needs and readily accessible. This would not only improve their knowledge base but also assist in the quest to become life-long learners, and so fulfil professional responsibilities (Nursing and Midwifery Council, 2002). From the findings it appeared that 88% of staff would consider using ORACLE, and that there was potential for this to increase if good publicity was used to raise awareness and advertise what the site could offer. Time remained an issue for some, even though the site has the potential to fulfil the DH’s (2001) requirement to provide learning materials 365 days of the year at a time that does not affect patient need or diary scheduling. The intranet is available to staff at home via a link supplied by the IT department, thus increasing availability of information. The literature search made clear the need to have participation in the learning, and not just provide an information space. This was achieved by providing a discussion forum, and also by including links to existing sites such as e-learning for healthcare (www.e-lfh.org.uk), which has a comprehensive learning package on end-of-life care, using varied methods such as videos and interactive sessions to cater for all learning styles. The signposting to existing validated learning should help to override the limitations of the organisation’s technology. Links are also made to existing sites, such as that of the Resuscitation Council UK and PubMed, and to useful documents, such as the Royal College of Nursing (2010) IV standards for infusion. It is planned that some learning events in the hospice will be videorecorded in future and made available on the site and to stimulate discussion on the forum. This will be in addition to PowerPoint presentations and links to journal club articles. It was encouraging that 62% of staff questioned said they would use a discussion forum. One of the challenges will be to ensure that these people do use it, and to encourage the participation of the 18% of people who said ‘maybe’ and get the 18% of people who said ‘no’ to join in by stimulating interesting and worthwhile discussions.
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❛... if virtual learning environments are viewed solely as ‘information delivery systems’ ... learning is not recognised as a social process and the site is not successful.❜
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Evaluation Action research is only complete when evaluation is undertaken of the changes implemented. An evaluation was conducted 6 months after ORACLE was set up, using another survey with a similar layout to the previous one. For validity this was given to the same proportion of staff, to assess whether their intentions regarding use of the site had been realised. The return rate this time was only 36%, which was disappointing but still above Denscombe’s (2007) prediction of 20%. Of these, 62% said they had used the site, with frequency varying from ‘rarely’ to ‘weekly’. Everyone who had used it said they would continue to do so. Of those who had not used it so far, all but two planned to. Reasons for not accessing the site were heavy workload and difficulties in accessing computers at work. The launch of ORACLE coincided with the introduction of a new patient information computer system, which greatly affected the level of computer usage across all of the clinical teams. Access to computers for those not inputting patient information themselves became limited. However, one member of the inpatient nursing team has used the site every week and has been instrumental in encouraging colleagues to work through the interactive learning materials on the www.e-lfh.org.uk site and reflect on the learning together, in the way recommended by Wee (2012). It is hoped that this enthusiasm will continue within the team.
Limitations This small-scale project clearly has limitations. The data represents the opinions of those who responded to both surveys, rather than the entire population of the organisation or people working in other settings. Nevertheless, data saturation was reached, and the study therefore has validity. The literature review, although limited by the amount of published work specifically referring to workplace VLEs, added greatly to awareness of how a site should be constructed, with valuable suggestions like considering varied learning styles, the need for user participation, and setting learning objectives when designing the site.
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Conclusion In conclusion, this small-scale project proved very useful in planning the construction of ORACLE. In highlighting elements that staff would find helpful, involving them in the planning, and including suggestions from published literature, it is hoped that the site will continue to be a useful resource. The return rate of 36% from the final survey was disappointing, and it
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revealed that 66% of respondents were using ORACLE in contrast to the 88% predicted in the previous survey, although there is no reason why this should not continue to increase in the future with ongoing publicity and word of mouth. In combination with face-to-face learning events, ORACLE can help to ensure that learning is addressed in a way more accessible to the whole organisation. It may offer a solution to other diverse palliative care establishments across the world that encounter the same difficulties in supporting all staff to undertake timely learning whenever they need it. I● JPN Beetham H (2007) An approach to learning activity design. In: Beetham H, Sharpe R, eds. Rethinking Pedagogy for a Digital Age: Designing and Delivering E-Learning. Routledge, Abingdon Bell JC (2005) Doing Your Research Project: A Guide for First-Time Researchers in Education and Social Science. 4th edn. Open University Press, Maidenhead Biggs J (1999) Teaching for Quality Learning at University. Society for Higher Research into Education and Open University Press, Buckingham Blaxter L, Hughes C, Tight M (2010) How to Research. 4th edn. Open University Press, Maidenhead British Educational Research Association (2011) Ethical guidelines for educational research. www.bera.ac.uk/ guidelines (accessed 23 April 2013) Bryman A (2008) Social Research Methods. 3rd edn. Oxford University Press, Oxford Burton D, Bartlett S (2005) Practitioner Research for Teachers. Paul Chapman Publishing, London Burton N, Brundrett M, Jones M (2008) Doing Your Education Research Project. SAGE Publications Ltd, London Cohen L, Manion L, Morrison K (2011) Research Methods in Education. 7th edn. Routledge, Taylor & Francis Group, London Denscombe M (2007) The Good Research Guide for SmallScale Social Research Projects. 3rd edn. Open University Press, Maidenhead Department of Health (2001) Working Together, Learning Together: a Framework for Lifelong Learning in the NHS. The Stationery Office, London Dillenbourg P (2000) Virtual Learning Environments. EUN Conference 2000. http://tecfa.unige.ch/tecfa/publicat/dilpapers-2/Dil.7.5.18.pdf (accessed 23 April 2013) Dillenbourg P, Schneider DK, Synteta P (2002) Virtual learning environments. http://hal.archives-ouvertes.fr/ docs/00/19/07/01/PDF/Dillernbourg-Pierre-2002a.pdf (accessed 29 April 2013) Doyle D (2004) The Essence of Palliative Care: A Personal Perspective. National Council for Hospice and Specialist Care Services, London Edwards A, Talbot R (1999) The Hard-Pressed Researcher: A Research Handbook for the Caring Professions. 2nd edn. Pearson Education Ltd, Harlow Higher Education Academy (2010) Using the virtual learning environment. www.ukcle.ac.uk/resources/enhancinglearning-through-technology/using-the-vle/ (accessed 23 April 2013) Howatson-Jones IL (2012) Translating an academic module into an online resource. Nurs Stand 26(31): 44–50 Masterman L, Vogel M (2007) Practices and processes of design for learning. In: Beetham H, Sharpe R, eds. Rethinking Pedagogy for a Digital Age: Designing and Delivering E-Learning. Routledge, Abingdon Mayes T, de Freitas S (2007) Learning and e-learning: the role of theory. In: Beetham H, Sharpe R, eds. Rethinking
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Pedagogy for a Digital Age: Designing and Delivering E-Learning. Routledge, Abingdon McNiff J, Whitehead J (2005) Action Research for Teachers: A Practical Guide. David Fulton Publishers Ltd, London McPherson M, Nunes MB (2004) Developing Innovation in Online Learning: An Action Research Framework. Routledge Falmer, Abingdon Nursing and Midwifery Council (2002) Supporting Nurses and Midwives through Lifelong Learning. NMC, London Pettit J, Mason R (2003) Virtual space, real learning: an introduction to VLEs. In: Fry H, Ketteridge S, Marshall S, eds. A Handbook for Teaching and Learning in Higher Education: Enhancing Academic Practice. 2nd edn. Routledge Falmer, Abingdon Ravenscroft A, Cook J (2007) New horizons in learning design. In: Beetham H, Sharpe R, eds. Rethinking Pedagogy for a Digital Age: Designing and Delivering E-Learning. Routledge, Abingdon Robson C (2002) Real World Research. 2nd edn. Blackwell Publishers Ltd, Oxford Royal College of Nursing (2010) Standards for Infusion Therapy. The RCN IV Therapy Forum. 3rd edn. www. rcn.org.uk/__data/assets/pdf_file/0005/78593/002179. pdf (accessed 23 April 2013) Sapsford R (2007) Survey Research. 2nd edn. SAGE Publications Ltd, London Singh H (2006) Blended learning and work: real-time work flow learning. In: Bonk CJ, Graham CR, eds. The Hand-
Fundamental Aspects of Palliative Care Nursing 2nd edition
book of Blended Learning: Global Perspectives, Local Designs. Pfeiffer, A Wiley Imprint, San Francisco Stiles MJ (2000) Effective learning and the virtual learning environment. www.staffs.ac.uk/COSE/cose10/posnan. html (accessed 23 April 2013) Streubert HJ, Carpenter DR (2011) Qualitative Research in Nursing: Advancing the Humanistic Imperative. 5th edn. Wolters Kluwer Health/ Lippincott, Williams and Wilkins, Philadelphia Wang M, Ran W, Liao J, Yang SJH (2010) A performanceoriented approach to e-learning in the workplace. Educ Technol Soc 13(4): 167–79 Waters-Adams S (2006) Action research in education. www. edu.plymouth.ac.uk/resined/actionresearch/arhome.htm (accessed 23 April 2013) Webb C (1996) Action research. In: Cormack DFS, ed. The Research Process in Nursing. 3rd edn. Blackwell Science Ltd, Oxford Wee B (2012) Can e-learning be used to teach end-of-life care? BMJ Support Palliat Care 2(4): 292–93 Weller M (2007) Virtual Learning Environments: Using, Choosing and Developing your VLE. Routledge, Abingdon Wilson L (2009) Practical Teaching: A Guide to PTLLS and DTLLS. Cengage Learning EMEA, Andover Winter R, Munn-Giddings C (2001) A Handbook for Action Research in Health and Social Care. Routledge, New York
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• Reflective activities and points
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of the NMC Code of It contains important material on Professional Conduct a wide range of initiatives that are The book will also prove useful to newly qualified nurses, those returning to practice and health nts incare many care settings. impacting on end ofassista life across care • Self assessment tests at the UK. Each chapter Abouexamines t the author a key the end of each chapter to Robert Becker MSc Dip N (Lond) component of care Care and includes: RMN RGN Cert Ed (FE)consolidate FETC 730 holds a Senior Lecture joint teaching appointment learning. r in Palliativ e between Severn Hospice in Shrops hire and Staffordshire University of Health based in Shrewsbury. Faculty Over the last 15 years he has developed a teaching and advisor number of European countries y role in a and regularly leads palliative care study tours for health professionals He is Chairperson of the Nation in China. al Association for Palliative Care Educators and is an active membe editorial board of the International r of the Journal of Palliative Nursing. He is also a recipient of the ‘Educa the Year Award’ at the Interna tionalist of tional Journal of Palliative Nursin g Awards for 2008.
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This title presents a sensitive and supportive approach to the key themes of palliative care nursing.
Fundamental Aspects of Palliative Care 2nd edition
Robert Becker
All nurses are intimately involve d in caring for the dying and bereav ed at some point in their career student nurses it is widely recogn and for ised as one of the most challen ging aspects of their role. This towards their particular needs book is centred and the difficulties that studen t nurses face when confronted how to use the palliative approa with the reality of ch in the multiple environments in which skills. This second edition mainta they are expected to develop their ins a sensitive and supportive approach to the key themes of nursing, but contains important palliative care new material of a wide range of initiatives that are impacting care across the UK. It will provide on end of life the reader with a concise, easy to read and learning oriented give advice and direction to the text that will many challenges faced in this most important area of patient care. Each chapter examines a key component of care and is structu red to include: • Learning outcomes to guide the reader • Clinical anecdotes to illustra te the reality of practice • Reflective activities and points for professional development • Links to appropriate clauses of the current 2008 NMC Code of Professional Conduct • Internet resources • Self assessment tests at the end of each chapter to consol idate learning • A palliative care quiz to test your knowledge
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Using action research to investigate and improve hospice staff participation in workplace education Sue Griffith
P Sue Griffith is Lecturer/Practice Educator, St Helena Hospice, Barncroft Close, Highwoods, Colchester, Essex, CO4 9JU, England Email: sgriffith@ sthelenahospice.org.uk
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alliative care has evolved greatly since gaining specialty status in the 1980s, (Doyle, 2004). Alongside this, hospices have grown significantly from the early isolated buildings of the 1960s to today’s international presence in over 100 countries (Doyle, 2004). Like many others, the hospice that was the setting for the study reported here is now a large and diverse organisation spread over multiple sites, including an inpatient unit, two day centres, and an expanding ‘hospice at home’ and community team. With this expansion it has become increasingly challenging to create learning events that are accessible to all, fulfil professionals’ CPD requirements and the organisation’s ‘strategic plan’, and remain in keeping with the ideals of practice development. Furthermore, ensuring that these events are timely and well attended by the people who will benefit from them the most has become progressively more difficult.
Methodology Action research is an ideal approach to address the ‘pragmatic concerns’ of an institution (Bell, 2005), bridge the ‘theory–practice divide’ (McNiff and Whitehead, 2005; Waters-Adams, 2006; Cohen et al, 2011), and generate a solution to a problem. It is particularly useful when a new initiative needs to be implemented but it is unclear how this can be achieved effectively (Waters-Adams, 2006). It is normal to begin with a period of review and focusing to identify points for development (Edwards and Talbot, 1999). Two strategies were used for the review. First, the attendance lists of events held over the preceding 6 months were analysed to establish whether there was any particular time, day of the week, or nature of event that was attracting higher or lower levels of attendance. Second, staff were questioned at their team meetings by members of the Education and Research Group (EARG), a group of ten members with representatives across the whole organisation (Box 1), to establish what they liked about the events and what they found to be principal barriers to participating. This gave the EARG access to the opinions of approximately 40% of the total staff.
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Abstract
Finding ways to make good quality education available to all staff in an expanding and increasingly busy hospice organisation is a real challenge. Constantly providing learning opportunities that are then poorly attended owing to the pressure of work is equally disappointing, and leads to questions of cost-effectiveness. An action research project was undertaken to investigate the reasons for low attendance rates at learning events in one hospice. Having identified time and conflict with patient need as major issues, a second cycle of research using literature review and a survey methodology was conducted to find a contemporary and innovative solution to this problem in an attempt to establish a vibrant learning culture. As a result a virtual learning environment—ORACLE (Online Research and Care Learning Environment)—was created to augment the face-to-face sessions and provide staff with access to appropriate learning materials 24 hours per day, 365 days per year. Although unique to this organisation, ORACLE has potential application to any other work environment. Key words: Virtual learning environment (VLE) l Action research l Survey l Learning styles l Education
This paper details how an action research approach over two cycles was used to study the problems of low attendance at learning events and generate solutions that could then be evaluated for effectiveness. Beginning with a review of the situation, followed by reflections and evaluation of attendance, it culminated in the decision to create an online learning resource named ORACLE (Online Research and Care Learning Environment). Literature review and a staff survey were then used to ensure that the site design is as useful and accessible as possible, using evidence-based approaches to learning. ORACLE will supplement face-to-face learning events and make learning materials available to all staff across the whole organisation, at any time of the day or night.
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The review revealed that the early morning events, introduced with the intention of being accessed by people at the beginning of their working day or the end of a night shift, although initially successful, had begun to suffer from particularly poor attendance. Team members revealed that they found the events too early to attend prior to work or unappealing at the end of a night shift. The lunchtime and mid-afternoon events achieved the highest attendance rates, and those staff questioned felt that these were the easiest to access. Staff also said that if given plenty of notice it was easier to plan events into diaries before other appointments arose. The mid-week sessions also gained more attendees, as many part-time staff work from Tuesday to Thursday. From these findings, a decision was made to abandon the unpopular early morning session and plan to hold events at lunchtime or 3pm on mid-week days, giving over a month’s notice whenever possible. The very topical and popular subject of complementary therapies (CT) was planned for the following month’s four events, coinciding with the successful appointment of a new team leader and an expanded team of volunteers. These four sessions would be the subject of the first cycle of the action research. For this cycle, a four-pronged approach was taken to enable triangulation of data—a vital aspect of action research (Webb, 1996; WatersAdams, 2006) that allows evidence to be verified (Burton and Bartlett, 2005) and provides greater validity. Although not essential in small-scale studies (Bell, 2005), validity is further increased by ensuring that methods are appropriate to the question (McNiff and Whitehead, 2005) and findings are recorded with accuracy and honesty (Burton and Bartlett, 2005). This first cycle involved studying attendance figures for comparison with previous events, devising an evaluation form to be completed by all attendees to illuminate the reasons for their attendance, and obtaining the reflections of the researcher and CT coordinator. Including personal reflections on the attitudes and thoughts of the researchers involves asking self-critical questions (McNiff and Whitehead, 2005) and is at the heart of action research (Edwards and Talbot, 1999). This also takes the project beyond simple quantitative data and offers a platform to include both subjective and objective data, another central tenet of action research (Edwards and Talbot, 1999). The EARG acted as ‘critical friends’ and ‘validation group’ (McNiff and Whitehead, 2005; Waters-Adams, 2006) to the primary researcher, listening to progress, offering advice, and evaluating the quality of the research
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Box 1. EARG members Medical Consultant, Education Director, Librarian, Lecturer, Inpatient Unit Nurse, Counsellor, Community Nurse Specialist, HR Assistant, Day Service Nurse.
(Edwards and Talbot, 1999). Ethical principles of non-maleficence, beneficence, confidentiality, non-traceability, and anonymity (Cohen et al, 2011) were considered and discussed with the validation group. All participants were aware that they could withdraw at any time, and the data was stored securely and anonymously (British Educational Research Association, 2011).
Findings and discussion The initial findings were analysed using ‘open-ended critical reflection’ (Winter and Munn-Giddings, 2001), questioning spontaneous interpretations and sharing them with the validation group for authentication. Analysis of attendance lists at the CT events revealed the second highest turnout for all sessions to that point, achieving almost double many other topics, with a total of 25 for all events. Attendance of the new volunteers in the CT team was not included in the figures, to ensure that comparison was equitable with the earlier records. However, this quantitative data reveals little about why the increase occurred. The evaluation sheets added depth to this finding, revealing that the main reason for attendance for most was a desire to learn more about use of CT with palliative care patients. The time of day suited many, and 5 of the 25 attendees revealed that a personal invitation from the researcher influenced their decision to attend. More controversial findings arose around the issue of whether people felt supported to attend learning events in work time. All but two people said that they did feel supported, but interestingly eight commented that using their own lunchtime was easier. Two attendees were voluntary staff, so felt that this was not relevant for them. The CT team leader’s reflections included that: ‘Lunchtime was chosen so that staff could legitimately attend in their own time.’
This highlights a key question of whether using work time to learn is viewed by everyone as legitimate. If not, this could clearly be an important obstacle to attendance at any events. Four people specifically mentioned that workload on the day was more influential than advance notice or timing. Several nurses from the
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❛... it has become increasingly challenging to create learning events that are accessible to all ... and remain in keeping with the ideals of practice development.❜
in-patient unit said they would have relished the opportunity to attend but could not be spared from the patient area and needed to eat during their half-hour lunch break to sustain themselves through the 12-hour shift. Reflections also suggested that although some people attended because they felt that using their own time did not affect workload, others appeared to avoid this exactly because it was their own time, and they preferred to do other things. Clearly, using lunchtime can be a double-edged sword. Another interesting and unexpected finding was that the events generated discussion between those unable to attend and the organisers, leading to learning. For example, discussion between the CT team leader and the bereavement coordinator led to a decision to work together to improve the service to bereaved people in future. This conversation would not have occurred without the learning event. Likewise, discussion with another allied professional about when it is appropriate to refer for CT led to that professional making referrals, which they had not done previously. Clearly, learning was engendered by these events in more subtle ways than attendance figures alone can measure. Creation of a learning environment is more complex than just providing teaching sessions. These findings were shared with the EARG in order to plan the next intervention and cycle of research. The expectation had been that a clear time of day and/or day of the week would emerge as ideal. However, it became apparent that while the events continued to be non-mandatory and therefore not planned into people’s working day, there would always be a perception of conflict between direct patient care and education needs. It was concluded that the answer therefore must lie beyond the face-to-face learning events alone. The solution appeared to the EARG to be the introduction of a virtual learning environment (VLE) to provide staff with access to learning material and a discussion forum. Continuing the spirit of action research, it was decided that this would be the focus of the next cycle of investigation. A rigorous approach would ensure that the learning site created was supported by external evidence from literature review and generation of unique original evidence of what is beneficial for staff in the organisation.
Literature review Wilson (2009, p668) describes VLEs simplistically as ‘a modern teaching and learning style, using computer technologies’. A more comprehensive definition makes clear that the users are both
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‘active and actors’—members and contributors in a social and information space (Dillenbourg, 2000, p8). To give insight into how this is translated into action, a review of the existing literature helped to establish what is already known about VLEs in the workplace. It also helped to raise questions and identify areas for exploration and act as a guide for a suitable research framework (Burton et al, 2008). Although there has been a proliferation of articles on VLEs over the past decade, most of this has been based on formal courses in educational institutions rather than learning in the workplace (Wang et al, 2010). This was reflected in the limited amount of specific material acquired by the search. However, the situation may change in the near future if the trend for blending face-to-face teaching with computerbased learning in the workplace increases. One of the most potent points made in the literature is that if VLEs are viewed solely as ‘information delivery systems’, and the technology itself becomes the focus, then learning is not recognised as a social process and the site is not successful (Stiles, 2000, p2). Two essential ingredients for learning are content and dialogue—as long as these are created in a VLE then it serves the purpose (Weller, 2007). However, overemphasis on discussion can also be at the expense of students working together (Stiles, 2000), so it is clearly not the whole story. Dillenbourg et al (2002) suggest that the identifying features of a VLE are enrichment of classroom activities, overlap with the classroom environment, and use of several pedagogical approaches. E-learning tools should ‘link us seamlessly’ with our teaching–learning behaviour (Ravenscroft and Cook, 2007, p212). Learning theory should ideally underpin site design, with incorporation of ‘associative’, ‘constructive’, and ‘situative’ elements (Beetham, 2007, p26; Mayes and de Freitas, 2007, p23). However, these important pedagogical issues are often ignored (Wang et al, 2010). In the workplace, learning must be collaborative, involving sharing with colleagues and aligning individual and organisational needs with the materials and key performance indicators (Wang et al, 2010). Like Biggs’ (1999) ‘constructive alignment,’ outcomes should be defined and then activities planned to achieve them (Mayes and de Freitas, 2007). Ultimate effectiveness relies on people being able to access knowledge at the time that it applies to the work setting (Singh, 2006). From Stiles’ (2000) experience of setting up a workplace VLE, he found staff focused more on creating a ‘supportive learning environment’, and became increasingly aware of ways to promote
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active learning in all aspects of their teaching. Pettit and Mason (2003) suggested that shy people may contribute more to online discussion and feel less threatened than in a classroom situation. Equally, both McPherson and Nunes (2004) and the Higher Education Academy (2010) stated that differentiation is incorporated, allowing learners to progress at their own rate using various styles of learning. Particularly pertinent to the area of study, Howatson-Jones (2012) made the point that online learning can help resolve the problem of health practitioners leaving the patient area to participate in learning activities. She pointed out that a VLE will fulfil the Department of Health’s (DH, 2001, p55) recommendation to provide ‘24-hour access to knowledge and learning resources, 365 days per year’ in a way that is both convenient and supported. Clearly, new skills are needed for both teachers and students to adopt new technology and ensure that any hype around introduction does not lead to disappointment (Pettit and Mason, 2003). Indeed, Masterman and Vogel (2007) caution that activities should not be set up simply because the tools exist, but should be used only where they complement practice.
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Methodology and methods for second cycle This review of the literature was very helpful in understanding aspects of a successful VLE and focusing on what needed to be investigated next. To augment these findings, a survey was used to establish factors that would influence the staff to use the site and make learning more accessible for them. It was also hoped that involvement in the research process would raise awareness of ORACLE and give ownership. Action research should be ‘emancipatory’ and empower those involved in the process (Streubert and Carpenter, 2011). The survey is one of the most widely used, common, and valued ways of tackling social research (Robson, 2002; Denscombe, 2007). It works well when aiming to analyse a representative sample of a population (Bell, 2005) and offers a chance to obtain wide and inclusive coverage in a quick, cheap, and simple way (Edwards and Talbot, 1999; Bell, 2005; Denscombe, 2007; Burton et al, 2008; Blaxter et al, 2010; Cohen et al, 2011). The questionnaire is the ideal tool to conduct a survey, as it has ‘close affinity’ to this method (Burton et al, 2008, p80) and can be administered without the researcher’s presence (Cohen et al, 2011). Questionnaires ensure that the same questions
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are asked in the same circumstances (Bell, 2005) and avoid interviews’ potential for ‘social desirability bias’ (Bryman, 2008, p218). Although they provide little opportunity to examine the ‘wider themes and issues’ (Blaxter et al, 2010, p79), this was not deemed to be a problem in these circumstances. The potential problem of low return rates highlighted by Denscombe (2007) can be greatly improved with the right approach (Cohen et al, 2011). For this reason, the ‘personal touch’ (Burton et al, 2008, p8) was used and the research team shared administration of the questionnaires with all of the smaller teams in the organisation, increasing validity by ensuring that they were representative of the whole population (Bell, 2005). A convenience sample of easy to access members (Burton et al, 2008) was used for speed. The first draft of the questionnaire was constructed to give qualitative data from open-ended questions as well as quantitative data from closed questions (Denscombe, 2007). This was scrutinised by the research team to further improve validity (Edwards and Talbot, 1999). The improved version was then piloted on a small group of nurses to further refine it and so achieve optimal responses for analysis (Bell, 2005).
❛... it became apparent that while the events continued to be nonmandatory and therefore not planned into people’s working day, there would always be a perception of conflict between direct patient care and education needs.❜
Findings and discussion The 234 paid members of clinical and non-clinical staff were divided into teams, and 105 questionnaires were administered to clinical staff. The purpose of the questionnaire was explained and consent gained, and then the forms were left with people to allow them to be completed and returned anonymously. As a result only 65 responses were received. However, this is still a 62% return, which far exceeds Denscombe’s (2007) prediction of a possible 20%. It is a potential limitation of the study that the results could be skewed by the nonrespondents (Sapsford, 2007), who may have been less interested in education and making the most of learning opportunities than those who responded. Nonetheless, it is an ethical strength that these staff felt able to withhold their forms and were not coerced into compliance by the researchers. Also, analysis revealed that before all of the questionnaires had been analysed no new information was being uncovered, akin to theoretical saturation (Bryman, 2008), so there was no need to continue gathering information. The data was analysed using simple descriptive analysis, to reveal the core elements lying behind the ‘surface content’ (Denscombe, 2007). During analysis the size and scope of the data was
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condensed by drawing out common themes of significance (Blaxter et al, 2010). The findings reinforced the first cycle of research, with 23 respondents (35%) saying they do attend the learning events, although a further 22 (34%) said that this was only ‘occasionally’ or ‘sometimes’, and 3 stated that they would like to attend more. Another 20 (31%) had never attended events, and of these 12 (18%) said that they were either not appropriate or not relevant to their role. Forty two people (65%) cited either workload or time as preventing them attending. Of these, one noted that she ‘does not put [her] own learning needs first’. Other relevant points raised were that shifts or part-time work patterns mean the events may fall on a day off. People were understandably reluctant to give up their own time, and one mentioned the added cost of travel if they were to attend on a day off. Working on a separate site was mentioned by three members of staff. Encouragingly, 57 of those questioned (88%) said that they would use ORACLE, with only 5 (8%) having no intention of doing so at this stage and 1 unsure. Likewise, 40 (62%) said that they would use a discussion forum, with 12 (18%) more saying ‘maybe’, and 2 (3%) stating clearly that they found the forums very useful in previous study. Twelve (18%) felt that they would not use the forum, one because they did not use the intranet (not believing that they needed to for their role). Two more were concerned about whether there would be adequate participation, and five still felt that time would be an issue within their very busy day. In response to the question of what would be useful on a site, 33 (51%) said that access to PowerPoint presentations, lecture notes, and video clips would be really helpful. Fourteen (22%) felt that links to useful websites and documents were a good idea and should include websites relevant to their role. Other suggestions included posting information from BSc modules run at the hospice, information on diseases and treatments, and new research into drugs. Three people suggested that pharmacy information would also help their role. Two people specifically said that access to the VLE at home would be a bonus, with a further one nurse pointing out that as their role does not include access to a desk and personal computer it would not be easy to make use of this kind of learning during work time and remain undisturbed. One respondent noted that it is useful to have access to teaching resources when they are mentoring students or new colleagues.
Setting up the VLE As the hospice is a charitable organisation with no separate budget for the project, ORACLE was set up as a ‘tab’ on the existing intranet (a free Microsoft Server product) by the author and the hospice IT Manager. Thus, technology limitations govern what can be achieved and prevent follow up recording of the number of users electronically. However, as evidence from the research cycles and the literature review was used in constructing the site, it was hoped that the site would be a close fit to people’s needs and readily accessible. This would not only improve their knowledge base but also assist in the quest to become life-long learners, and so fulfil professional responsibilities (Nursing and Midwifery Council, 2002). From the findings it appeared that 88% of staff would consider using ORACLE, and that there was potential for this to increase if good publicity was used to raise awareness and advertise what the site could offer. Time remained an issue for some, even though the site has the potential to fulfil the DH’s (2001) requirement to provide learning materials 365 days of the year at a time that does not affect patient need or diary scheduling. The intranet is available to staff at home via a link supplied by the IT department, thus increasing availability of information. The literature search made clear the need to have participation in the learning, and not just provide an information space. This was achieved by providing a discussion forum, and also by including links to existing sites such as e-learning for healthcare (www.e-lfh.org.uk), which has a comprehensive learning package on end-of-life care, using varied methods such as videos and interactive sessions to cater for all learning styles. The signposting to existing validated learning should help to override the limitations of the organisation’s technology. Links are also made to existing sites, such as that of the Resuscitation Council UK and PubMed, and to useful documents, such as the Royal College of Nursing (2010) IV standards for infusion. It is planned that some learning events in the hospice will be videorecorded in future and made available on the site and to stimulate discussion on the forum. This will be in addition to PowerPoint presentations and links to journal club articles. It was encouraging that 62% of staff questioned said they would use a discussion forum. One of the challenges will be to ensure that these people do use it, and to encourage the participation of the 18% of people who said ‘maybe’ and get the 18% of people who said ‘no’ to join in by stimulating interesting and worthwhile discussions.
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❛... if virtual learning environments are viewed solely as ‘information delivery systems’ ... learning is not recognised as a social process and the site is not successful.❜
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Evaluation Action research is only complete when evaluation is undertaken of the changes implemented. An evaluation was conducted 6 months after ORACLE was set up, using another survey with a similar layout to the previous one. For validity this was given to the same proportion of staff, to assess whether their intentions regarding use of the site had been realised. The return rate this time was only 36%, which was disappointing but still above Denscombe’s (2007) prediction of 20%. Of these, 62% said they had used the site, with frequency varying from ‘rarely’ to ‘weekly’. Everyone who had used it said they would continue to do so. Of those who had not used it so far, all but two planned to. Reasons for not accessing the site were heavy workload and difficulties in accessing computers at work. The launch of ORACLE coincided with the introduction of a new patient information computer system, which greatly affected the level of computer usage across all of the clinical teams. Access to computers for those not inputting patient information themselves became limited. However, one member of the inpatient nursing team has used the site every week and has been instrumental in encouraging colleagues to work through the interactive learning materials on the www.e-lfh.org.uk site and reflect on the learning together, in the way recommended by Wee (2012). It is hoped that this enthusiasm will continue within the team.
Limitations This small-scale project clearly has limitations. The data represents the opinions of those who responded to both surveys, rather than the entire population of the organisation or people working in other settings. Nevertheless, data saturation was reached, and the study therefore has validity. The literature review, although limited by the amount of published work specifically referring to workplace VLEs, added greatly to awareness of how a site should be constructed, with valuable suggestions like considering varied learning styles, the need for user participation, and setting learning objectives when designing the site.
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Conclusion In conclusion, this small-scale project proved very useful in planning the construction of ORACLE. In highlighting elements that staff would find helpful, involving them in the planning, and including suggestions from published literature, it is hoped that the site will continue to be a useful resource. The return rate of 36% from the final survey was disappointing, and it
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revealed that 66% of respondents were using ORACLE in contrast to the 88% predicted in the previous survey, although there is no reason why this should not continue to increase in the future with ongoing publicity and word of mouth. In combination with face-to-face learning events, ORACLE can help to ensure that learning is addressed in a way more accessible to the whole organisation. It may offer a solution to other diverse palliative care establishments across the world that encounter the same difficulties in supporting all staff to undertake timely learning whenever they need it. I● JPN Beetham H (2007) An approach to learning activity design. In: Beetham H, Sharpe R, eds. Rethinking Pedagogy for a Digital Age: Designing and Delivering E-Learning. Routledge, Abingdon Bell JC (2005) Doing Your Research Project: A Guide for First-Time Researchers in Education and Social Science. 4th edn. Open University Press, Maidenhead Biggs J (1999) Teaching for Quality Learning at University. Society for Higher Research into Education and Open University Press, Buckingham Blaxter L, Hughes C, Tight M (2010) How to Research. 4th edn. Open University Press, Maidenhead British Educational Research Association (2011) Ethical guidelines for educational research. www.bera.ac.uk/ guidelines (accessed 23 April 2013) Bryman A (2008) Social Research Methods. 3rd edn. Oxford University Press, Oxford Burton D, Bartlett S (2005) Practitioner Research for Teachers. Paul Chapman Publishing, London Burton N, Brundrett M, Jones M (2008) Doing Your Education Research Project. SAGE Publications Ltd, London Cohen L, Manion L, Morrison K (2011) Research Methods in Education. 7th edn. Routledge, Taylor & Francis Group, London Denscombe M (2007) The Good Research Guide for SmallScale Social Research Projects. 3rd edn. Open University Press, Maidenhead Department of Health (2001) Working Together, Learning Together: a Framework for Lifelong Learning in the NHS. The Stationery Office, London Dillenbourg P (2000) Virtual Learning Environments. EUN Conference 2000. http://tecfa.unige.ch/tecfa/publicat/dilpapers-2/Dil.7.5.18.pdf (accessed 23 April 2013) Dillenbourg P, Schneider DK, Synteta P (2002) Virtual learning environments. http://hal.archives-ouvertes.fr/ docs/00/19/07/01/PDF/Dillernbourg-Pierre-2002a.pdf (accessed 29 April 2013) Doyle D (2004) The Essence of Palliative Care: A Personal Perspective. National Council for Hospice and Specialist Care Services, London Edwards A, Talbot R (1999) The Hard-Pressed Researcher: A Research Handbook for the Caring Professions. 2nd edn. Pearson Education Ltd, Harlow Higher Education Academy (2010) Using the virtual learning environment. www.ukcle.ac.uk/resources/enhancinglearning-through-technology/using-the-vle/ (accessed 23 April 2013) Howatson-Jones IL (2012) Translating an academic module into an online resource. Nurs Stand 26(31): 44–50 Masterman L, Vogel M (2007) Practices and processes of design for learning. In: Beetham H, Sharpe R, eds. Rethinking Pedagogy for a Digital Age: Designing and Delivering E-Learning. Routledge, Abingdon Mayes T, de Freitas S (2007) Learning and e-learning: the role of theory. In: Beetham H, Sharpe R, eds. Rethinking
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About the book
• Reflective activities and points
for professional development
• Links to appropriate clauses
of the NMC Code of It contains important material on Professional Conduct a wide range of initiatives that are The book will also prove useful to newly qualified nurses, those returning to practice and health nts incare many care settings. impacting on end ofassista life across care • Self assessment tests at the UK. Each chapter Abouexamines t the author a key the end of each chapter to Robert Becker MSc Dip N (Lond) component of care Care and includes: RMN RGN Cert Ed (FE)consolidate FETC 730 holds a Senior Lecture joint teaching appointment learning. r in Palliativ e between Severn Hospice in Shrops hire and Staffordshire University of Health based in Shrewsbury. Faculty Over the last 15 years he has developed a teaching and advisor number of European countries y role in a and regularly leads palliative care study tours for health professionals He is Chairperson of the Nation in China. al Association for Palliative Care Educators and is an active membe editorial board of the International r of the Journal of Palliative Nursing. He is also a recipient of the ‘Educa the Year Award’ at the Interna tionalist of tional Journal of Palliative Nursin g Awards for 2008.
• Learning outcomes to guide
ISBN-13: 978-1-85642-394-6; 234 x 156mm; paperback; Other titles in the Fundamen 360 pages; publication 2010; tal Aspe • Clinical anecdotes to illustrate cts of Nursing series: Children & Young Peoples Nursing Procedures RRP: £26.99 Mental Health Nursing the reality of practice Community Nursing
the reader
Complementary Therapies Finding Information Long-Term Conditions
Nursing Adults with Respiratory Disorders Nursing the Acutely Ill Adult Pain Assessment & Management Research for Nurses
ISBN 1-85642-394-8
9
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Robert Becker
‘This book is a thoughtful and thought provoking text and will be a useful Series Editor: Fowler addition to the library ofJohn anyone teaching or taking palliative care courses or placements in end-of-life care settings’. Dion Smyth, The International Journal of Palliative Nursing
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Fundamental Aspects of
Palliative Care Nursing
An evidence-based handbook for student nurses
2nd edition Robert Becker
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This title presents a sensitive and supportive approach to the key themes of palliative care nursing.
Fundamental Aspects of Palliative Care 2nd edition
Robert Becker
All nurses are intimately involve d in caring for the dying and bereav ed at some point in their career student nurses it is widely recogn and for ised as one of the most challen ging aspects of their role. This towards their particular needs book is centred and the difficulties that studen t nurses face when confronted how to use the palliative approa with the reality of ch in the multiple environments in which skills. This second edition mainta they are expected to develop their ins a sensitive and supportive approach to the key themes of nursing, but contains important palliative care new material of a wide range of initiatives that are impacting care across the UK. It will provide on end of life the reader with a concise, easy to read and learning oriented give advice and direction to the text that will many challenges faced in this most important area of patient care. Each chapter examines a key component of care and is structu red to include: • Learning outcomes to guide the reader • Clinical anecdotes to illustra te the reality of practice • Reflective activities and points for professional development • Links to appropriate clauses of the current 2008 NMC Code of Professional Conduct • Internet resources • Self assessment tests at the end of each chapter to consol idate learning • A palliative care quiz to test your knowledge
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International Journal of Palliative Nursing 2013, Vol 19, No 6
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