Tools for Knowledge and Learning: A Guide for Development and Humanitarian Organisations

Journal Club Article: Ramalingam, B. (2006). Tools for knowledge and learning: A guide for development and humanitarian organizations. London: Overseas Development Institute.

Background

“No one should be dying or suffering because knowledge that already exists in one part of the world has not reached other parts. It is up to each of us to take the responsibility to ensure the knowledge flows easily to where it is needed” (Geoff Parcell, Learning to Fly, 2006).

The application of learning and knowledge based strategies derived from learning from lessons of the past and from elsewhere, to then overcome the challenges and boundaries of time and space.

Strategies of the Learning Organisation

A Holistic View of Knowledge and Learning Tools

  • Organisational contexts: Strategic alignment, management behaviours, institutional pressures, funding cycles, historical evolution.
  • Relationships and collaborations: within and across organisation – via networks, ICTs, communications plans; core functions; support functions.
  • Organisational knowledge: Forms and locations; creation, sharing, storage, use; key activities and tools; relevance, how the message is packaged and communicated.

Five Competencies Framework (Collison & Parcell, 2001)

Aim: “To work out how well they are performing against organisationally established criteria for knowledge and learning, and to identify goals and priorities for improvement. The competency framework works on the principle that effective knowledge and learning is based on improving performance in:

  1. Strategy Development
  2. Management Techniques
  3. Collaboration Mechanisms
  4. Knowledge Sharing and Learning Processes
  5. Knowledge Capture and Storage.”

Knowledge Audits: Taking a systematic and strategic approach to knowledge and learning can help to integrate the diverse activities of an organisation, and facilitate more productive processes of knowledge sharing and dialogue between internal and external stakeholders.

Social Network Analysis: a research technique that focuses on identifying and comparing the relationships within and between individuals, groups and systems in order to model the real-world interactions at the heart of organisational knowledge and learning processes.

Most Significant Change (MSC): the process involves the collection of significant change (SC) stories emanating from the field level, and the systematic selection of the most important of these by panels of designated
stakeholders or staff.

Outcome Mapping: As development is essentially about people relating to each other and their environments, the focus is on people.

Visioning

A facilitator supports use of imagination to think of the ideal workspace, organisation and what the 5 year plan looks like,

Management Techniques

The SECI Approach

“There are four key processes through which tacit and explicit knowledge interact, namely, socialisation, externalisation, combination and internalisation. Together, these processes make up the SECI principles.

  • Socialisation allows to share tacit knowledge
  • Externalisation converts tacit into explicit knowledge
  • Combination combines different types of explicit knowledge
  • Internalisation converts explicit into tacit knowledge.”

SECI model of Knowledge creation.

Lewin’s Force Field Analysis

“Force Field Analysis was developed by Kurt Lewin (1951) and is widely used to inform decision making, particularly in planning and implementing change management programmes in organisations.”

 Activity Based Knowledge Mapping

“Is a tool which enables knowledge inputs and outputs to be
linked in a systematic fashion to ongoing organisational activities and processes – from office mail to strategic reviews.”

Other resources are also discussed.

Team Collaboration

“Team development has been described in terms of five stages, beginning with a simple ‘membership’ group, and working through ‘confrontation’ to a ‘shared-responsibility’ group (Bradford and Cohen, 1998). Bradford and Cohen suggest that the different stages of groups differ in terms of the following characteristics:

• Atmosphere and relationships
• Understanding and acceptance of goals
• Listening and information sharing
• Decision making
• Reaction to leadership
• Attention to the way the group is working.”

Communities of Practice

Action Learning Sets

Six Thinking Hats

Mind Maps or Concept Mapping

Social technologies for collaboration

Knowledge Sharing & Learning

  • Storytelling
  • Peer programs
  • Challenge sessions
  • How to guides
  • Blogs
  • Reviews and retrospects
  • Intranet resources

Additional Resources

Collison, C., & Parcell, G. (2001). Learning to fly: Practical lessons from one of the world’s leading knowledge companies. Capstone Ltd. [GoodReads]

Davies, R., & Dart, J. (2005). The ‘most significant change’(MSC) technique. A guide to its use.

Earl, S., Carden, F., & Smutylo, T. (2001). Outcome mapping: Building learning and reflection into development programs. IDRC, Ottawa, ON, CA.

Ramalingam, B. (2005). Implementing Knowledge Strategies: From Policy to Practice in Development Agencies. ODI Working Paper 244, London: ODI.

Why We Became Nurse Educators (Journal Club)

Journal Club Article: Evans, J. D. (2018). Why We Became Nurse Educators: Findings From a Nationwide Survey of Current Nurse Educators. Nursing Education Perspectives39(2), 61-65. [abstract]

Background: The need to build the nurse faculty workforce and resolve the persistent shortage of educators led to a study of nurse educator recruitment and retention. The shortage of nurse educators is a barrier to building the nursing workforce.

Aim: The study was designed to ask teaching nurse faculty what they believed would be effective strategies in the attraction, recruitment, and retention of nurse educators through a sample of national nurse faculty.

Method: This descriptive study used an online survey questionnaire. Participants were recruited through email requests to the deans and directors of 841 accredited associate (ADN), baccalaureate (BSN), master’s, and doctoral degree programs at schools and colleges of nursing across the United States. 940 nurse educators teaching at all levels were asked to rate the effectiveness of attraction, recruitment, and retention strategies.

The survey consisted of demographic questions and three Likert type scales that asked respondents to rate the effectiveness of attraction, recruitment, and retention strategies. Open-ended questions in each section allowed participants to expand on their answers.

This article reports on responses to one of the survey’s open-ended question; a content analysis was conducted to develop a narrative description about why respondents chose nursing education.

Results: Nurse educator’s chose education roles to:

  • teach in a stimulating yet flexible work environment,
  • hoped to influence the profession,
  • had been influenced by educators, and
  • sought change and challenge in their careers.

Conclusion: “Faculty find nursing academia satisfying and rewarding, but noncompetitive compensation and unsatisfactory work environments can eclipse satisfiers.”

Keywords: Healthy Workplace; Nurse Faculty Recruitment; Nurse Faculty Retention; Nurse Faculty Shortage; Nursing Education; Workforce.

‘Do not interrupt’ Bundled Intervention to Reduce Medication Interruptions.

Journal Club Article: Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017). Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility studyBMJ Qual Saf, bmjqs-2016.

Aim: Evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.

Method:parallel eight cluster randomised controlled study. Nurses were informed that the study was a direct observational study of medication administration and preparation tasks. Nursing staff were blinded to the study aim focused on interruptions and at baseline were blinded to the intervention. Only intervention ward staff were informed of the intervention subsequently.

Use of real time collected data using the Work Observational Method by Activity Timing Software (WOMBAT).

Setting: 4 wards in 1 hospital. Over 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications.

Intervention: Wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders.

Outcome Measures: 

  1. Primary outcome was non-medication-related interruptions during individual medication dose administrations.
  2. Secondary outcomes were total interruption and multitasking rates. A survey of nurses’ experiences was administered.

Intervention: The ‘Do not interrupt’ intervention comprised five ‘bundled’ elements:

  1. Wearing of a ‘Do not interrupt’ medication vest by nurses when preparing and administering medications,
  2. Interactive workshops with nurses regarding the purpose of the intervention to reduce non-medication-related interruptions and to identify local barriers and enablers to intervention use (eg, where to store vests),
  3. Brief standardised education sessions with clinical staff (eg, doctors, allied health),
  4. Patient information, which included why nurses were wearing a vest, and a request not to interrupt nurses during medication administration unless their concern was serious and urgent, or related to their medication. Patients were informed of other nurses and staff from whom to seek help if required,
  5. The use of reminders such as posters and stickers to inform health professionals, patients and visitors not to interrupt nurses during medication rounds for safety reasons.

Results: Baseline characteristics for control and interventions wards were similar.  Due to the observational approach of the study, the impact on influencing behaviours must be considered.

  • At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed.
  • A significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards.
  • Medication
  • The intervention more effective reducing interruptions from other nurses, no substantial impact from patient interruptions.
  • Intervention ward nurses reported that vests were time consuming, cumbersome and hot.
  • Only 48% of nurses indicated that they would support the intervention becoming hospital policy.
  •  There was reduction in multitasking rates in the intervention wards compared to control wards.

Discussion: The main aspect was the reduction of interruptions (30%) which potentially (as reduction in medication errors was not measured) translates to a reduction in medication administered errors (MAEs) of 1.8%.

This study was conducted in a paper system, so the impact of electronic medication administration records (eMARs) on reducing medication errors needs to be considered.

If visual aids such as vests are not a preference for nurses, also the infection control issue moving around the ward then educating nurses to deal with interruptions is advocated.

Resources

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administrationJournal of Clinical Nursing24(21-22), 3063-3076.

Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errorsArchives of Internal medicine170(8), 683-690.

Westbrook, J. I., & Ampt, A. (2009). Design, application and testing of the Work Observation Method by Activity Timing (WOMBAT) to measure clinicians’ patterns of work and communication. International Journal of Medical Informatics78, S25-S33.

The Top Ten Websites in Critical Care Medicine Education Today (Journal Club)

Journal Club Article: Wolbrink, T. A., Rubin, L., Burns, J. P., & Markovitz, B. (2018). The Top Ten Websites in Critical Care Medicine Education TodayJournal of intensive care medicine, 0885066618759287.

Background

Looks at the rapid growth of online educational resources in the critical care environment. From another review by Kleinpell et al (2011) which identified 135 websites, only 67 now are still available online. This demonstrates a rapidly changing environment and provides a rationale for this papers focus.

Methods

  • Literature review and web search.
  • Website assessment using the Critical Care Medical Education Website Quality Evaluation Tool (CCMEWQET).
  • Evaluation and ranking of identified websites.

Results

  • 97 websites relevant critical care websites were identified and scored.
  • Common types of resources, included blog posts, podcasts, videos, online journal clubs, and interactive components such as quizzes.
  • Almost one quarter of websites (n 22) classified as Free Open Access to Medicine (FOAM) websites.
  • Top 10 websites analysed and described. “Most often included an editorial process, high-quality and appropriately attributed graphics and multimedia, scored much higher for comprehensiveness and ease of access, and included opportunities for interactive learning.”

The Top Ten 

In alphabetical order:

FOAM Highlight

“The majority of FOAM website domains were not educational, nonprofit, or governmental. The FOAM websites were updated more recently than the other critical care medicine educational websites” (pg. 5).

References

Kleinpell, R., Ely, E. W., Williams, G., Liolios, A., Ward, N., & Tisherman, S. A. (2011). Web-based resources for critical care educationCritical Care Medicine39(3), 541-553.

Olusanya, O., Day, J., Kirk-Bayley, J., & Szakmany, T. (2017). Free Open Access Med (ical edu) cation for critical care practitionersJournal of Intensive Care Medicine.

Wolbrink, T. A., Rubin, L., Burns, J. P., & Markovitz, B. (2018). The Top Ten Websites in Critical Care Medicine Education TodayJournal of Intensive Care Medicine. 0885066618759287.

An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators

Journal Club Article: Breytenbach, C., ten Ham-Baloyi, W., & Jordan, P. J. (2017). An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators. Nursing Education Perspectives38(4), 193-197. [abstract]

Keywords: Evidence-Based Teaching; integrative review; teaching; nurse educator.

Background

Evidence-based teaching strategies in nursing education are fundamental to promote an in-depth understanding of information. The teaching strategies of nurse educators should be based on sound evidence or best practice.

Method

Integrative literature review of sixteen studies.

Findings

Eight teaching strategies were identified:

  1. E-learning
  2. Concept mapping
  3. Internet-based learning (IBL)
  4. Web-based learning
  5. Gaming
  6. Problem-based learning (PBL)
  7. Case studies
  8. Evidence-based learning (EBL)

The following three strategies of concept mapping, IBL and EBL provided the highest level increase in knowledge.

Conclusion

All teaching strategies enhanced the learning experience, but more research is needed. A multi-modal approach to teaching and delivering content is required to suit the content, situation and learner.

Reference

Breytenbach, C., ten Ham-Baloyi, W., & Jordan, P. J. (2017). An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators. Nursing Education Perspectives38(4), 193-197. [abstract]

Educational Research: The Qualitative Path

Book Club: Creswell, J. W. (2012). Educational research: Planning, conducting, and evaluating quantitative. Upper Saddle River, NJ: Prentice Hall. [Link to 4th edition]

As I transitioned between the worlds of healthcare and higher education, I noted the differences in approaches and considerations to the hierarchies of research and evidence base. In healthcare the RCT is the respected way forward, but in education I was learning to ‘look through the lens’ and value qualitative research. Now I am aware that in nursing, a strong body of qualitative literature exists, but in the world of critical care it’s fair to say that quantitative methods rule. In educational research, John Hattie has utilised the ‘big data’ approach and created some of the first meta-analysis data and findings to guide theory and curriculum in education.

As I critiqued the articles for my academic projects, my biases and preconceptions around qualitative research, no doubt impacted on any critical analysis formed. However, the theoretical frameworks and paradigms led me to a new world of epistemelogical, ethnography, action research, phenomenology, grounded theory, mixed methods and the narrative. I found educational articles are sometimes long and extremely ‘wordy’, and took many twists and turns before getting to the main points. But I grew to appreciate the narrative studies, where the researcher embeds themselves in the lives of the subjects and their everyday lives are brought out in the stories being told. The Hawthorne effect and one person’s biases, are two quick critiques of such an approach but the art of storytelling can provide so much more for the reader than a table of statistics.

Some appreciations of educational qualitative research:

  • The search for “The Truth” by Roller (2013)
  • Engaging in the environment
  • Collecting the data in qualitative research
  • Theoretical frameworks and paradigms
  • Process in identifying key themes
  • Ethical issues within qualitative research
  • The qualitative versus quantitative debate

The same steps of the quantitative research process occur in the qualitative approach, where the identification of a need or a problem occurs, this then provides the road map for the research journey. The justification and how then the project will be of benefit still needs to be explained in the research methodology.

Here are a small sample of the education focused articles that were part of my formal studies:

Just recently this discussion on Twitter around a journal now only accepting quantitative articles for submission. Some fields of healthcare research are really only suitable for the qualitative methodology and not to be classified as a p value.

 

References

Creswell, J. W. (2012). Educational research: Planning, conducting, and evaluating quantitative (pp. 146-166). Upper Saddle River, NJ: Prentice Hall. [Link to 4th edition]

Hattie, J. (2008). Visible learning: A synthesis of over 800 meta-analyses relating to achievement. Routledge [sample].

Ismail, S. (2009). Popular pedagogy and the changing political landscape: a case study of a women’s housing movement in South AfricaStudies in Continuing Education31(3), 281-295.

Kalman, J. (2000). Learning to write in the streetInternational Journal of Qualitative Studies in Education13(3), 187-203.

Larsson, S. (2009). A pluralist view of generalization in qualitative researchInternational journal of research & method in education32(1), 25-38.

Roller, M. (2013) Distinctive qualities of qualitative research. Research Design Review.

An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators

Journal Club Article: Breytenbach, C., ten Ham-Baloyi, W., & Jordan, P. J. (2017). An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators. Nursing Education Perspectives38(4), 193-197. [abstract]

Background

Evidence-based teaching strategies in nursing education are fundamental to promote an in-depth understanding of information. The teaching strategies of nurse educators should be based on sound evidence or best practice.

“To teach these skills, knowledge, behaviors, and attitudes, nurse educators must utilize a variety of teaching strategies that actively engage their students (Billings & Halstead, 2012).

Students, who are increasingly skilled in technology, benefit from a diversity of teaching strategies based on their needs, including experiential and active learning (Samarakoon, Fernando, & Rodrigo, 2013).”

The principles of adult learning where the strategies encourage and allow ownership for one’s own learning.

Method

Integrative literature review of sixteen studies.

Findings

Eight teaching strategies were identified:

  1. E-learning
  2. Concept mapping
  3. Internet-based learning (IBL)
  4. Web-based learning
  5. Gaming
  6. Problem-based learning (PBL)
  7. Case studies
  8. Evidence-based learning (EBL)

The following three strategies of concept mapping, IBL and EBL demonstrated the most increase in knowledge.

“Based on the findings from this review, the authors propose that multiple teaching strategies should be encouraged in a nursing curriculum to allow for the use of a set of strategies that are suitable for different learning styles and student needs.”

The authors recommend that nurse educators be trained to understand the different educational strategies and the benefits to learning that they offer to aid critical thinking, knowledge acquisition and decision making.

Conclusion

All teaching strategies enhanced the learning experience, but more research is needed. In summary a multi-modal approach to teaching and delivering content is required.

Keywords: Evidence-Based Teaching; integrative review; teaching; nurse educator.

Reference

Breytenbach, C., ten Ham-Baloyi, W., & Jordan, P. J. (2017). An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators. Nursing Education Perspectives38(4), 193-197. [abstract]

Create an Online Journal Club for Nurses

This post is to help guide the nurse educator on the creation of an online journal club for healthcare practitioners, and focuses on the theory of initiation and engagement aspects. Reasons for a journal club could be to increase uptake of evidence based practice, changing culture, improving patient outcomes or education development.

 To Do List

  • Outline of the purpose of the journal club.
  • Set some short and long term goals.
  • Set up regular meeting dates- routines help.
  • Voluntary or mandatory attendance?
  • Closed or public journal club?
  • A journal club leader to facilitate discussion.
  • Set a code of conduct for respectful discussion.
  • Determine process to choose topics of the papers.
  • Flipped classroom- circulating papers prior to the meeting.
  • Decide on a critical appraisal process.
  • Managing the online resource and enable sharing for those not able to attend.
  • Inclusive: providing training or resources for those nurses not familiar with the online journal club resources.
Practicalities
It is advisable to share and discuss articles on one platform for simple access for participants and to focus all discussion in one area. The articles and links could be shared via a learning management system, blog, Wiki resource, Google+ community, Twitter or a Facebook group. Limiting the number of social media tools also reduces the facilitators workload. Deciding on the privacy settings should be decided by the facilitators, remembering that workplace and nursing have code of conducts and you will be the moderator. The copyright rules for sharing publications will have to be followed as well, so use hyperlinks to the relevant journal page for participants to access or consider using open access articles. Having a journal club code of conduct with  information regarding confidentiality, engagement and respect is advisable.

 

Critical Appraisal Tools
References
Chan, T. M., Thoma, B., Radecki, R., Topf, J., Woo, H. H., Kao, L. S., … & Lin, M. (2015). Ten steps for setting up an online journal clubJournal of Continuing Education in the Health Professions35(2), 148-154.
Deenadayalan, Y., Grimmer‐Somers, K., Prior, M., & Kumar, S. (2008). How to run an effective journal club: a systematic reviewJournal of evaluation in clinical practice14(5), 898-911.
Greenhalgh, T. (2001). How to read a paper: the basics of evidence-based medicine. (2nd ed.) BMJ Publishing.
Greenhalgh, T. (2014). How to read a paper: the basics of evidence-based medicine.(4th ed.) John Wiley & Sons.
Intensive Care Network (2017) How to make journal club work.

 

Workplace Training: Informal Learning?

Workplaces as Centres of Inquiry

Workplace learning and experiences are often seen as informal and subsequently ‘informal learning’ occurs. Billet (2002) states that an educational workplace pedagogy exists, and that learning does not just occur in schools and higher education. Workplace education delivers structured goal-directed activities and work practice relevancy so this ‘informal’ tag is actually incorrect. Learning is deemed as being “interdependent between the individual and the social practice” (Billet, 2002). This structuring of learning experiences is shaped and directed towards sustaining the continuity of current practice.

“Workplace practices and affordances, are dynamic, as their tasks, goals, interactions, participants and relations are likely to be constantly changing” (Billet, 2002, pg. 64).

Learning through work, and the participation and engagement in the social practice is an essential aspect. Just think of the importance of role modelling to set the culture of your workplace environment. Vocational learning is often considered of lower quality than education provided by educational institutions, but with current lifelong learning policies, the role of workplace learning is essential. Workplace participation and sustaining practice are required for positive learning experiences and outcomes. Workplace training can vary between ad-hoc to over structured teaching, which have contributed to some of the negative terms for workplace learning. If we think of the learners motivation to learning, there will likely be a difference in the learners level of engagement of learning in those opportunities chosen by the individual to that of enforced learning (such as mandatory training). Just think to the last time you went to an education event of your choice and compare to one you were ‘encouraged’ to attend, likely you experienced very different motivators. The workplace will have more mandatory training requirements so enthusiasm is likely to be low for such training, as the educator you will need to find a way to make the training meaningful for the participants.

Pathways of learning activities as part of a constructivist approach for skill development are approaches in contemporary work settings. Mentoring and apprenticeships are important learning pathways to navigate workplace practices and learn from experienced practitioners, again part of the social learning experience. Continuity of social practices and the opportunities of unintended learning is a product of these mentorship experiences in the work setting.

Relevancy in Nursing 

Nurse training is forever looking for the right balance between providing higher education and workplace experience for nurse training. Finding the perfect mix of theoretical with the hands on learning experience in the actual clinical setting is the overall aim. The mentor model is an essential part of nurse training in providing learning in the workplace setting. Workplace education is commonly more hands on and has a practical focus, combining theoretical and clinical. With simulation increasingly part of formal educational approaches to nurse training, a more hands on experiential learning approach is being embraced over the traditional ‘sage on the stage’ lecture approach. The multi-disciplinary teamwork and bonding that can occur in workplace training is vital as part of building a positive team culture.

Educator Program Aims

  • Professional growth and change (transformative practice).
  • Personal Change- Reorientation of values of attitudes.
  • Self-esteem linked to workplace confidence.
  • Teamwork and community of practice.

References

Billett, S. (2002). Critiquing workplace learning discourses: participation and continuity at work. Studies in the Education of Adults, 34(1), 56-67.

Harteis, C. & Billett, S. (2008). The workplace as learning environment: Introduction