Teachers as recontextualization agents: a study of expert teachers' knowledge and their role in the recontextualization process across different subjects

This thesis investigates the knowledge that shapes the practice of expert teachers in physics, geography and history. The principal intention of this research is to illuminate the impact that the different knowledge structures and aims of these subjects have on teachers’ decision making in their classrooms. I argue that far from being implementers of the curriculum in their classroom, the teachers in my study are actively engaged in recontextualising their discipline into school subjects, drawing on two levels of knowledge to do so. The first level consists of their knowledge of their subject, the students they teach and wider social and educational goals. These combine to shape the aims that underpin the second level of practical curricular and pedagogic knowledge. Together, these two levels of knowledge form the basis of the teachers’ planning and teaching decisions and are shaped by their subject in profound ways. Furthermore, I argue that the recontextualising process evident in the teachers’ lessons was also shaped by variations in the closeness of the relationship between subjects in schools and disciplines in universities. The evidence for these claims was generated primarily through interviews and detailed lesson observations of three expert classroom teachers. Whilst across the subjects there were similarities in their pedagogic approaches, the aims underpinning these approaches reflected differences across subjects in two principal ways. First, there was variation in the extent to which the teachers drew on a conceptual structure deriving from the discipline and sought to make its epistemology visible. Second, the way in which the students and wider social goals influenced teachers’ practice differed. Finally, as expert teachers in their subject, it was interesting to discern variation in how far they were able to make curricula in their classrooms that reflected Young and Muller’s (2010) ‘Future 3’ scenario

The Right PREMTM: Rasch analysis of a new patient reported experience measure for use by older people in hospital

Healthcare rights exist to protect older people from harm and to empower older people to participate in their care with independence, choice and control. Multiple investigations revealing abuse provide evidence that older people’s rights are being breached. Older people must have the opportunity to report on their experience of care against their rights. The Right PREMTM is a new instrument designed to measure older people’s experience of care against their healthcare rights. The objective of this cross-sectional validation study was to assess the psychometric properties of a new instrument to measure the experience of care consistent with the healthcare rights of older people in the hospital setting. Data were collected from older people who were current hospital inpatients of medical wards in four South Australian metropolitan hospitals. The Rasch model was used to assess the psychometric properties of the patient version of The Right PREMTM. The analysis was performed using the Winsteps® software program. Two hundred older patients completed the 50-item questionnaire. During the process of analysis, four items were removed as they did not fit the model and a further 11 items were removed due to high residual correlations. The final 23 items had a Person Separation Index of 2.23, a Person Separation Reliability Coefficient 0.83, an Item Separation Index of 7.70 and an Item Separation Reliability Coefficient of 0.98. Rasch analysis of the patient version of The Right PREMTM, based on a robust sample, demonstrated this new instrument is psychometrically sound and warrants ongoing development. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Reflecting on Climate Change Education Priorities in Secondary Schools in England: Moving beyond Learning about Climate Change to the Emotions of Living with Climate Change

Schools in England remain a valued and important site of climate change education for secondary school pupils (aged 11–18 years). Drawing on focus group data (n = 85) from young people based in eight schools in England, we explored the language pupils used about climate change. We found that young people’s responses to climate change were predominantly focused on content knowledge about climate change, including the concept of global warming and a range of negative impacts, such as biodiversity and habitat loss and extreme and unpredictable weather. In addition, the young people expressed emotions in relation to climate change that were primarily negative and were focused on fear of the future and fear of frustrated youth action. We highlight that school-based climate change education requires support and resources from policy-makers so that young people do not solely learn about climate change, but rather, they are able to live with the emotions of a future shaped by the impacts of climate change. We highlight the need for teacher professional development which enables them to respond to the emotions young people experience in the context of climate change education

Care Depersonalized: The Risk of Infocratic “Personalised” Care and a Posthuman Dystopia

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due to the greater weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing

Necessary but Not Sufficient... Comment on “Knowledge Mobilization in Healthcare Organizations: A View From the Resource-Based View of the Firm”

The challenge of mobilizing knowledge to improve patient care, population health and ensure effective use of resources is an enduring one in healthcare systems across the world. This commentary reflects on an earlier paper by Ferlie and colleagues that proposes the resource-based view (RBV) of the firm as a useful theoretical lens through which to study knowledge mobilization in healthcare. Specifically, the commentary considers 3 areas that need to be addressed in relation to the proposed application of RBV: the definition of competitive advantage in healthcare; the contribution of macro level theory to understanding knowledge mobilization in healthcare; and the need to embrace and align multiple theories at the micro, meso, and macro levels of implementation

CONCERNS ABOUT THE SCHOLARLY DEVELOPMENT OF THE NURSING PROFESSION AND THE ACADEMIC NURSING PIPELINE

Editoria

Where and how does fundamental care fit within seminal nursing theories: A narrative review and synthesis of key nursing concepts.

Aims and objectivesTo elucidate the synergies between fundamental care and seminal nursing theories.BackgroundNursing theories are often criticised for their limited clinical relevance, with the existence of a theory-to-practice gap widely acknowledged. Pervasive examples of poor-quality care, particularly for people's most fundamental needs, raise questions as to whether nursing theories sufficiently prioritise fundamental care. The Fundamentals of Care Framework (hereinafter "the Framework") represents a valid, comprehensive and evidence-based description of fundamental care. The Framework captures the complexity and multidimensionality of fundamental care delivery, predicated on the nurse-patient relationship; integration of physical, psychosocial and relational needs; and a supportive context. Despite strong face validity, the Framework's alignment with seminal nursing theories remains unexplored.DesignNarrative review.MethodTwenty-nine seminal nursing theories were included. Categories for analysis were developed inductively and deductively, focusing on the themes of relationship, integration of care, context and the theories' ease of use. Results are reported in accordance with PRISMA-ScR guidelines.ResultsThough relationship, integration of care and context and were features shared across a number of nursing theories, no single theory depicts these collectively to the same extent as the Framework. In particular, integration of physical, psychosocial and relational aspects of care was found to be poorly described in the theories.ConclusionFailure to account for integration of care means that nursing theories continue to conceptualise fundamental care as a series of discrete tasks. To ensure relevance at the point of care, future nursing theories must accurately reflect the complexities of fundamental care delivery, specifically the need to integrate multiple care needs simultaneously, alongside being straightforward to apply in practice.Relevance to clinical practiceBridging the theory-to-practice gap requires a nursing discourse that is relevant at the point of care. We provide suggestions for how future nursing theories can bridge this gap

Can oral healthcare for older people be embedded into routine community aged care practice? A realist evaluation using normalisation process theory

This author accepted manuscript is made available following 12 month embargo from date of publication (December 2018) in accordance with the publisher’s archiving policyBackground An intervention ‘Better Oral Health in Home Care’ was introduced (2012–2014) to improve the oral health of older people receiving community aged care services. Implementation of the intervention was theoretically framed by the Promoting Action on Research Implementation in Health Services framework. Process outcomes demonstrated significant improvements in older people’s oral health. Objective To evaluate the extent to which the intervention has been embedded and sustained into routine community aged care practice 3 years after the initial implementation project. Design A Realist Evaluation applying Normalisation Process Theory within a single case study setting. Setting Community aged care (home care) provider in South Australia, Australia. Participants Purposeful sampling was undertaken. Twelve staff members were recruited from corporate, management and direct care positions. Two consumers representing high and low care recipients also participated. Methods Qualitative methods were applied in two subcases, reflecting different contextual settings. Data were collected via semi-structured interviews and analysed deductively by applying the Normalisation Process Theory core constructs (with the recommended phases of the Realist Evaluation cycle). Retrospective and prospective analytic methods investigated how the intervention has been operationalised by comparing two timeframes: Time 1 (Implementation June 2012–December 2014) and Time 2 (Post-implementation July 2017–July 2018). Results At Time 1, the initial program theory proposed that multi-level facilitation contributed to a favourable context that triggered positive mechanisms supportive of building organisational and workforce oral healthcare capacity. At Time 2, an alternative program theory of how the intervention has unfolded in practice described a changed context following the withdrawal of the project facilitation processes with the triggering of alternative mechanisms that have made it difficult for staff to embed sustainable practice. Conclusion Findings concur with the literature that successful implementation outcomes do not necessarily guarantee sustainability. The study has provided a deeper explanation of how contextual characteristics have contributed to the conceptualisation of oral healthcare as a low priority, basic work-ready personal care task and how this, in turn, hindered the embedding of sustainable oral healthcare into routine community aged care practice. This understanding can be used to better inform the development of strategies, such as multi-level facilitation, needed to navigate contextual barriers so that sustainable practice can be achieved

Designing and implementing two facilitation interventions within the 'Facilitating Implementation of Research Evidence (FIRE)' study: A qualitative analysis from an external facilitators' perspective

Acknowledgement: We extend our sincere thanks to FIRE project team colleagues, in particular lead investigators and research fellows involved in data collection and analysis that contributed to the current paper. We also acknowledge the facilitators and their buddy colleagues that we were worked with during the course of the study.Background The 'Facilitating Implementation of Research Evidence' study found no significant differences between sites that received two types of facilitation support and those that did not on the primary outcome of documented compliance with guideline recommendations. Process evaluation highlighted factors that influenced local, internal facilitators' ability to enact the roles as envisaged. In this paper, the external facilitators responsible for designing and delivering the two types of facilitation intervention analyse why the interventions proved difficult to implement as expected, including the challenge of balancing fidelity and adaptation. Methods Qualitative data sources included notes from monthly internal-external facilitator teleconference meetings, from closing events for the two facilitation interventions and summary data analyses from repeated interviews with 16 internal facilitators. Deductive and inductive data analysis was led by an independent researcher to evaluate how facilitation in practice compared to the logic pathways designed to guide fidelity in the delivery of the interventions. Results The planned facilitation interventions did not work as predicted. Difficulties were encountered in each of the five elements of the logic pathway: recruitment and selection of appropriate internal facilitators; preparation for the role; ability to apply facilitation knowledge and skills at a local level; support and mentorship from external facilitators via monthly teleconferences; working collaboratively and enabling colleagues to implement guideline recommendations. Moreover, problems were cumulative and created tensions for the external facilitators in terms of balancing the logic pathway with a more real-world, flexible and iterative approach to facilitation. Conclusion Evaluating an intervention that is fluid and dynamic within the methodology of a randomised controlled trial is complex and challenging. At a practical level, relational aspects of facilitation are critically important. It is essential to recruit and retain individuals with the appropriate set of skills and characteristics, explicit support from managerial leaders and accessible mentorship from more experienced facilitators. At a methodological level, there is a need for attention to the balance between fidelity and adaptation of interventions. For future studies, we suggest a theoretical approach to fidelity, with a focus on mechanisms, informed by prospective use of process evaluation data and more detailed investigation of the context-facilitation dynamic.Funding: The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 223646. The funder had no role in designing, conducting, or interpreting study findings.Funder: FP7 Health, Grants: 223646https://implementationscience.biomedcentral.com/articles13pubpub