Allied Health Collaborative Practice Capability: A Coalescence of Capabilities.

Allied health professionals are key in collaborative practice in healthcare settings. To better inform allied health student preparation for collaborative practice, this research illuminated the nature of allied health collaborative practice capability. Literature and perceptions of allied health students and academics were examined using a philosophical hermeneutic approach. A literature text set was constructed from a range of health and health education related fields. An experiential text was constructed from two sources; focus groups with students and semi-structured interviews with academics. Through this research we identified a plurality of capabilities that coalesce to become allied health collaborative practice capability. These dimensions and capabilities are: contextual (adaptability, responsiveness and persistence), social (friendliness, openness and reciprocity), and individual (professional expertise, willingness and flexibility). Capabilities illuminated in this research included skills and qualities. The plurality and coalescence of capabilities identified in this research highlight the complex nature of collaborative practice capability. A challenge remains to bring the more tacit qualities and how they interact into focus so that they receive meaningful attention to inform practice development and education.

Power, autonomy and interprofessional practice in dietitian clinical decision making: An interpretive study in acute hospitals.

Dietitians learn clinical decision making (CDM) predominantly as an autonomous cognitive process that considers the needs and preferences of the patient. Although interprofessional education is increasing in tertiary dietetic programmes, a paucity of research exists that explores the nature of how practising dietitians make decisions, independent or otherwise. This qualitative interpretative study explored the nature of experienced dietitian CDM in the acute care setting. Philosophical hermeneutic principles guided text construction and interpretation via in-depth, semi-structured interviews with practising dietitians with at least 3 years of experience. A reference focus group commented on the emerging findings, increasing the rigour of the research. Ten dietitians participated in the interviews and there were five dietitians in the reference focus group. CDM was found to be a highly social phenomenon with varying degrees of autonomy involving complex power relations with various other health professionals, in particular, medical practitioners. Dietitians respond to existing power relations in key ways, including building and maintaining relationships, advocating on behalf of the patient and negotiating decisions with other healthcare staff when in pursuit of improved health and nutrition related outcomes for patients. Strategic interprofessional communication skills are foundational to effective patient care and advancing the role of the dietitian. Power and autonomy in dietitian CDM are important concepts that could inform interprofessional education when seeking to promote both effective dietetic and interprofessional practice.

Nurse managers' learning facilitation practices: A philosophical hermeneutic study.

AIM(S): To understand how nurse managers facilitate learning in clinical workplaces. BACKGROUND: Meeting staff learning needs in the complex workplaces of contemporary health care is paramount to the delivery of safe patient care. Hospitals employ a range of strategies to address these needs. However, nurse managers' contribution to staff learning at the unit level is underexplored in contemporary literature. METHOD(S): A Gadamerian philosophical hermeneutic framework guided data collection and analysis. Thirteen nurse managers from two Australian hospitals each participated in two interviews and a period of observation. FINDINGS: Nurse managers' learning facilitation practices were enacted with staff individually, within teams, and through artefacts, and were shaped by their identities, perspectives on staff learning, knowledge of staff performance, and motivations. Power was revealed as a uniquely enacted driver of their learning facilitation practices. CONCLUSION(S): This paper illuminates an aspect of nurse managers' practice that has been poorly acknowledged in contemporary nursing literature. Nurse managers' learning facilitation practices were found to be complex, fluid, and embedded in their everyday work routines. IMPLICATIONS FOR NURSING MANAGEMENT: Given current concerns about safety and quality in health care, this research opens up possibilities for definition and enrichment of nurse managers' practice as facilitators of learning.

Experiential learning in nursing and allied health education: Do we need a national framework to guide ethical practice?

Experiential learning is widely used in health courses to develop students' clinical skills. Students act as models for demonstrations of practical techniques and work in small groups to practise clinical skills. These classes present a number of ethical challenges including removing clothing, physical touch and disclosing personal information. The aim of this study was to ascertain the views of nursing and allied health regulators and professional associations regarding the need for a national framework to facilitate ethical experiential learning in health courses. Ten semi-structured interviews were conducted either face-to-face or by phone and their audio-recordings transcribed verbatim for thematic analysis. Students' willingness to participate as models was taken-for-granted by educators. Risks to students' wellbeing were considered minor and outweighed by the benefits of experiential learning. The increasing diversity of students enrolled in health courses has increased awareness of students' rights, including choosing not to participate in some learning activities. Ongoing cycles of curriculum review provided an opportunity to respond to changing social values, including increased collective awareness and respect for, students' rights, cultural diversity, professional standards, and risk/benefit analysis of all student activities. There is a need for a national framework to guide ethical experiential learning in practical classes.

Clinical learning spaces: Crucibles for practice development in physiotherapy clinical education.

This paper, through a deep examination of clinical workplaces as learning spaces, uses a holistic interpretation of clinical education and offers a practice development crucible metaphor as a useful way to deepen how clinical education can be conceptualized. An in-depth conceptualization of clinical education is needed if educators are able to develop wise educational practice and optimize the time students spend in clinical learning settings. The research reported here was undertaken in the qualitative paradigm guided by philosophical hermeneutics. Data collection strategies included observation, semi-structured interviews, focus groups and photo-elicitation. Twenty-four undergraduate physiotherapy students and twelve physiotherapy clinical supervisors participated in this research. Consistent with hermeneutic principles of dialogue of question and answer and hermeneutic circle, data analysis was achieved through an iterative process of reading, interpreting and re-reading the transcripts resulting in the emergence of a deeper understanding of clinical education that is represented for the reader. Clinical education has been revealed as a multidimensional learning space where workplace influences, engagement in professional practices, clinical supervisors' intentions and actions in combination with students' dispositions interact to shape and challenge students' clinical learning. A practice development crucible metaphor has been introduced as a way to represent this complexity and conceptualize clinical education, not as a set of techniques or supervision ratios but as a relational, fluid, complex space where learning is catalyzed. Importantly, the crucible metaphor assists academics, clinical supervisors and students to harness the power of clinical education to facilitate learning during clinical placements.

Ethical experiential learning in medical, nursing and allied health education: A narrative review.

Students enrolled in medical, nursing and health science programs often participate in experiential learning in their practical classes. Experiential learning includes peer physical examination and peer-assisted learning where students practise clinical skills on each other. OBJECTIVES: To identify effective strategies that enable ethical experiential learning for health students during practical classes. DESIGN: A narrative review of the literature. DATA SOURCES: Pubmed, Cinahl and Scopus databases were searched because they include most of the health education journals where relevant articles would be published. REVIEW METHODS: A data extraction framework was developed to extract information from the included papers. Data were entered into a fillable form in Google Docs. Findings from identified studies were extracted to a series of tables (e.g. strategies for fostering ethical conduct; facilitators and barriers to peer-assisted learning). Themes were identified from these findings through a process of line by line coding and organisation of codes into descriptive themes using a constant comparative method. Finally understandings and hypotheses of relevance to our research question were generated from the descriptive themes. RESULTS: A total of 35 articles were retrieved that met the inclusion criteria. A total of 13 strategies for ethical experiential learning were identified and one evaluation was reported. The most frequently reported strategies were gaining written informed consent from students, providing information about the benefits of experiential learning and what to expect in practical classes, and facilitating discussions in class about potential issues. Contexts that facilitated participation in experiential learning included allowing students to choose their own groups, making participation voluntary, and providing adequate supervision, feedback and encouragement. CONCLUSION: A total of 13 strategies for ethical experiential learning were identified in the literature. A formal process for written consent was evaluated as effective; the effectiveness of other strategies remains to be determined. A comprehensive framework that integrates all recommendations from the literature is needed to guide future research and practise of ethical experiential learning in health courses.

Using theories of learning in workplaces to enhance physiotherapy clinical education.

Clinical education has long been accepted as integral to the education of physiotherapy students and their preparation for professional practice. The clinical environment, through practice immersion, situates students in a powerful learning context and plays a critical role in students' construction of professional knowledge. Despite this acknowledged centrality of practice and clinical environments to the students' experiential construction of professional knowledge, there has been limited exploration of learning theories underpinning clinical education in the literature. In this paper, we explore a selection of learning theories underpinning physiotherapy clinical education with a view to providing clinical educators with a firm foundation on which to base wise educational practices and potentially enhance physiotherapy students' clinical learning experiences. This exploration has drawn from leading thinkers in the field of education over the past century.