ERG SES D 13, Education and Teachers' Learning
The Danish healthcare system is undergoing changes optimising patient pathways leading to reduced length of hospitalisation. In the future, nursing as well as other health profession will become increasingly specialised and focus on transitions in patient pathways across professions and sectors. These demands will impact on the education programme for nurses.
Coherent patient pathways are a part of the strategy to improve quality in the Danish healthcare system (1). Cooperation between patients and professionals is challenged when patients are transferred between department, hospitals or sectors (2). Sharing and developing knowledge inter-professionally and in particular across sectors is inadequate (3-4). Establishing coherent patient pathways is a necessary goal and coordination and co-operation between professions, units and sectors is thus necessary.
Skills and framework to coordinate efforts in the healthcare system has become a theme in health professional education programmes to ensure that health professionals can meet the demands of tomorrow's health care system. According to D' Amour, a working relationship is based on the professional knowledge of each other's tasks, responsibilities and working conditions, and on the involvement of the patient's resources and needs (5-6).
Traditionally, the major part of clinical education in nursing and other health profession take
place at somatic hospitals attached to one profession and in one unit. This is challenged by short-term contacts and fast discharge from hospital and when treatment and nursing care take place in the patients’ own home. In this way clinical education does not focus on interprofessional and cross-sectorial transitions in patient pathways.
Historically, nursing has evolved because of the need for care among ill people. The methods in nursing have developed to meet the demands of society. It is a current challenge for the nursing profession to balance maintaining a professional identity and to play a role in the cooperation across professions and sectors.
This Industrial PhD Project investigates the concept of InterTværs, which is an ongoing collaboration project between Aarhus University Hospital, Municipality of Aarhus, Aarhus University and VIA University College, Faculty of Health Sciences. The purpose of InterTværs is to strengthen the skills of students in education. The PhD-project will follow the InterTværs project, mapping out the field and use empirical data to generate knowledge about how students develop interprofessional competencies related to patient pathways across professions and sectors.
Background and context
In the Summer 2012 Aarhus University and Aarhus University Hospital launched the Project InterTværs to strengthen interprofessional and cross-sectorial collaboration skills of health professional students (8). In the spring 2013 a pilot project was conducted where teams consisting of a student from the physiotherapy, occupational therapy, and nursing bachelor degree programmes and a medical student underwent clinical education together focused on a patient pathway during hospitalisation. After discharge they followed the patient in their own home together with the primary care services in the municipality. The teams were supervised inter-professionally by clinical supervisors. Together they described the patient pathway and identified opportunities and weaknesses.
Lessons learned from the pilot project are collected in a report (9).
This Industrial PhD Project will explore the embedded assumptions and challenges in InterTværs and examine how InterTværs influences the professional learning. The project focuses on how students develop interprofessional competencies and (inter)professional identity.
- How do students in the InterTværs project learn to cooperate interprofessionally and across sectors concerning patient pathways?
- How do the involved health education programmes and institutions interact in the InterTværs project?
- How does participation in the InterTværsproject and collaboration interprofessionally and across sectors impact on the development of the professional identity of the student?
(1) Institute for Quality and Accreditation in Healthcare. 2012. The Danish Healthcare Quality Programme. Accreditation Standards for Hospitals (2) Siemsen IMD. 2011. Patientovergange. Et eksplorativt studie af faktorer der påvirker sikkerheden af patientovergange. PhD.-afhandling. DTU Management (3) Gittell JH. 2009. High Performance Healthcare. Using the Power of Relationships to Achieve Quality, Efficiency and Resilience. New York: McGraw-Hill (4) Vinge S, Strandberg-Larsen M. 2010. Kontinuitet og koordination i sundhedsvæsenet. Ugeskrift for Læger; 172(Videnskab):775-777 (5) D’Amour D, Oandasan I. 2005. Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care (Supplement 1):8-20. (6) Reeves S, Hean S. 2013. Why we need theory to help us better understand the nature of interprofessional education, practice and care. Journal of Interprofessional Care; 27(1):1-3. (7) Barr H. 2013. Toward a theoretical framework for interprofessional education. Journal of interprofessional care; 27(1):4-9. (8) Kramer T, m.fl. 2013. Interprofessionelle, tværsektorielle studieforløb - En model. Aarhus Universitetshospital, Aarhus Universitet, Aarhus Kommune, VIA (9) Kramer T. 2013. Erfaringsopsamling: Interprofessionelle, tværsektorielle studieforløb. Aarhus Universitetshospital, Aarhus Universitet, Aarhus Kommune, VIA (10) Dahler-Larsen P. 2004. Selvevalueringens hvide sejl. Odense: Odense: Syddansk Universitetsforlag; 2.oplag (11) Borgnakke K. 2013. Etnografiske metoder i uddannelsesforskningen – mellem klassiske traditioner og senmoderne udfordringer. København: Institut for Medier, Erkendelse og Formidling. Det Humanistiske fakultet, Københavns Universitet (12) Borgnakke K. 2004. Etnografiske studier i pædagogik og læring – senmoderne udfordringer. Et analytisk bud på senmodernitetens gymnasium. Odense: Dansk Institut for Gymnasiepædagogik, Syddansk Universitet; p. 223-258. (13) Borgnakke K. 1996. Pædagogisk feltforskning og procesanalytisk kortlægning (bd.1), Procesanalytisk metodologi (bd. 2, Kap 3, s.52–64): Akademisk Forlag (14) Hammersley M, Atkinson P. 2007. Etnography: principles in practice. London: Routledge, 3.ed.ed. (15) Greenwood D, Levin M. 2007. The future of Universities: Action Research and the Transformation of Higher Education. In: Reasn P, Bradbury H, editors. Handbook of Action Research Los Angeles: SAGE Publications; p. 211-226. (16) Engeström Y. 1999. Innovative learning in work teams: analysing cycles of knowledge creation in practice. In: Engestrøm Y, et a. Perspectives on Activity Theory Cambridge: Cambridge University Press; p. 377-406. (17) Engeström Y. 2008. From teams to knots: activity-theoretical studies of collaboration and learning at work. New York: Cambridge University Press; (18) Klafki W. 2004. Skoleteori, skoleforskning og skoleudvikling i politisk-samfundsmæssig kontekst: udvalgte studier. København.: Hans Reitzels Forlag; (19) Dale EL. 2011. Utdanningsvitenskap og pedagogikk. Oslo: Gyldendal Akademisk; (20) Wenger E. 2004. Praksisfællesskaber: læring, mening og identitet. 1.udgave. Kbh: Hans Reitzel;
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