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Pedagogical processes in health care: an exploratory study of pedagogic work with patients and next of kin
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
Högskolan Jönköping.
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
The County Council of Jönköping.
2009 (English)In: Education for Health, ISSN 1357-6283, E-ISSN 1469-5804, Vol. 22, no 3, p. 1-11Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Care and education have much in common, and work in the healthcare sector is closely associated with learning and teaching. It is felt that many in the healthcare and medical services are not aware of their pedagogic skills and how they can be developed. FRAME OF REFERENCE: Belonging to a community of practice means that you share perspectives, methods and language. OBJECTIVE: The aim is to describe the pedagogical discourse by identifying pedagogical processes and studying the staffs awareness of such processes or situations in which a pedagogical approach would be useful in their work with patients and next of kin. METHOD: A qualitative study based on individual and group interviews. The analysis is directed by grounded theory. RESULTS: The pedagogical processes varied in length and quality. Most were unplanned and were usually embedded in treatment. The pedagogical process is linear (planning, goal setting, teaching and evaluating) in an educational setting but we found that the beginning and end can be unclear and the goals can be vague or non-existent. The pedagogical process is best described using the concepts Read, Guide and Provide learning support. DISCUSSION: The pedagogical discourse in healthcare is almost silent. Data indicate that at the collective level there is very little support for professional development of pedagogical ability. Tacit knowledge may therefore remain silent even though it may be possible to formulate and describe it. CONCLUSIONS: There is a strong need to focus on the pedagogical parts of the work and to encourage and support the development of professional pedagogical knowledge.

Place, publisher, year, edition, pages
Carfax Publishing , 2009. Vol. 22, no 3, p. 1-11
National Category
Pedagogy
Identifiers
URN: urn:nbn:se:liu:diva-56867OAI: oai:DiVA.org:liu-56867DiVA, id: diva2:322676
Available from: 2010-06-08 Created: 2010-06-08 Last updated: 2018-04-20
In thesis
1. Läkare, lärande och interaktion i hälso-och sjukvårdspraktiker
Open this publication in new window or tab >>Läkare, lärande och interaktion i hälso-och sjukvårdspraktiker
2018 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Bakgrund: Komplexiteten i hälso- och sjukvården blir kontinuerligt större, liksom möjligheterna till diagnostik och behandling. Samtidigt pressas hälso- och sjukvården av förändringar i demografier och sjukdomspanoraman, olika uttryck för globalisering och tillämpning av nya teknologier. Ett omfattande antal olika professioner förväntas genomföra och utveckla det dagliga arbetet med ännu mer involvering av patienter. Vi behöver mer kunskap om hur lärande sker och hur det underlättas och utvecklas i dagligt hälso- och sjukvårdsarbete för att kunna möta förändringar och utmaningar.

Syfte: Avhandlingens övergripande syfte är att fördjupa kunskap och förståelse om pedagogiska processer och lärande i hälso- och sjukvårdspraktiker, med särskilt fokus på läkare.

Metoder: Intervjustudier och fältstudie med interaktiv forskningsansats gav data med både bredd och djup från autentiskt hälso- och sjukvårdsarbete. I pågående hälso- och sjukvårdsarbete studerades läkare, vårdgivare i andra professioner, patienter, redskap som användes och praktikens rumsliga utformning. Data analyserades genom både kulturella och sociomateriella praktikteoretiska linser, vilket möjliggjorde att flera dimensioner av lärande och interaktion i hälso- och sjukvårdspraktiker kunde spåras.

Fynd: I arbetet med patienter agerade läkare och andra professioner pedagogiskt med eller utan intentioner, i pedagogiska processer som bestod av att avläsa-färdrikta-lärstödja. Den pedagogiska dimensionen av arbetet var inte synliggjord eller diskuterad i relation till patientarbetet. Dynamiskt inbäddat i arbetet lärde och stöttade läkare också yngre läkares och andra vårdgivares lärande. Läkarnas mobilitet i olika vårdsammanhang, såväl som ansvarsfördelning och delande av olika perspektiv, hade betydelse för vilket lärande som uppstod. Genom att betrakta specifika vårdsammanhang som hälso- och sjukvårdspraktiker under utövning, framträdde vid studiet av en rondmodell både samskapande lärande ronder och operativa ronder med begränsat lärande. Det framträdde genom sättet som deltagande personer, rumsliga och materiella förhållande samspelade på, som ömsesidigt utbyte respektive separata individuella arbetsprocesser. Samspelet mellan hälso- och sjukvårdspraktikers arrangemang (praktikarkitekturer) och genomförande snarare begränsade än underlättade underläkares lärandepraktiker. Underläkarnas arbete hade inte kontinuitet, koherens eller progression för att bredden av kunnande i medicinsk praktiskt arbete skulle kunna utvecklas bra.

Implikationer: Att förstå och synliggöra lärande i hälso- och sjukvårdens dagliga arbete genom att gemensamt prata om pedagogiska dimensioner i det arbete som pågår, kan utveckla lärande och lärstödjande ageranden. Samskapande lärande hälso- och sjukvårdspraktiker där alla deltagande gruppers behov och uppdrag medräknas, har implikationer på underläkares kompetensutveckling, studenters lärande, patienters involvering i sin vård och interprofessionellt och interdisciplinärt samarbete. Det ger också ledare möjlighet att knyta arbete med förbättringar av vårdens kvalitetet och säkerhet till dagligt vårdarbete.

Abstract [en]

Background: The level of complexity within healthcare services is continually increasing. These services are put under pressure by changing demographics and associated illness profiles, the influence of globalization, and the introduction of new technologies. Physicians are expected to perform and develop their daily work in cooperation with other healthcare professionals and in association with increasing levels of patient involvement. In such a changing and challenging healthcare environment, more knowledge is needed about how learning takes place and how learning can be facilitated and developed in the daily provision of healthcare services.

Aim: The overarching aim of this dissertation is to deepen our knowledge and understanding of the pedagogic processes and the learning that takes place in healthcare practices, with particular focus on physicians’ learning.

Methods: The research methodology employed in this dissertation includes interviews and field studies that used an interactive research approach. Authentic healthcare practices, including physicians, other care providers, patients, clinical tools in use, and the spatial arrangements within which the healthcare practices were performed were studied. The data that was collected was analyzed from a practice-theory perspective, thus allowing the researcher to identify and describe several dimensions of learning and interaction in healthcare practices.

Results: The pedagogic processes that were identified in the physicians’ and the other healthcare practitioners’ daily work with their patients can be described as read-guide-learning support. The pedagogic dimension of this work was not immediately revealed nor was it overtly articulated. The physicians dynamically, by themselves, taught and supported the junior physicians and other healthcare providers’ learning. The physicians’ mobility in a variety of healthcare contexts was of relevance to the learning that took place. By viewing specific healthcare contexts as performing health care practices during the study, a rounds work emerged which included both (i) co-produced learning rounds and (ii) operative rounds which gave rise to limited learning. The interaction between arrangements in healthcare practices, ‘practice architectures’, and the performance of the healthcare practices actually limited the junior physicians’ learning.

Implications of the study: A proper understanding of the learning that takes place during the daily work in the provision of healthcare – by revealing and examining the pedagogic dimensions of the work that is done – can contribute to the development of learning and learning support mechanisms. Co-produced learning healthcare practices, where each participant’s needs and contributions are taken into account, have direct implications for professional development initiatives and learning, for patient involvement in their healthcare arrangements, and for interprofessional and inter-disciplinary cooperation. Such practices also provide responsible leaders and decision-makers with the opportunity to tie in healthcare quality assurance work with the daily work that is performed by healthcare practitioners in the field. 

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 107
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1615
National Category
Learning Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-147359 (URN)10.3384/diss.diva-147359 (DOI)9789176853368 (ISBN)
Public defence
2018-05-18, Rosensalen, Rosenlunds vårdcentrum, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Note

Mindre korrigeringar är gjorda i den elektroniska versionen (Sammanfattning sid. 3). / Minor corrections are maed in the electronic version (Swedish abstract p. 3).

Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2018-04-26Bibliographically approved

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Hult, HåkanLindh Falk, Annika

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