Exploring e-learning adoption in nurse education: a socio-cultural case study using Q and Bourdieu

This research study employed Q-methodology (Q) to explore the factors influencing e-learning adoption in a nurse education context, and Bourdieu’s Theory of Practice (TOP) to analyse these findings using a case study of one school of nursing in the UK. E-learning adoption has been limited in nurse education despite a wide body of literature promoting its use for improved learning outcomes. Most research studies to date have used surveys to explore the overarching factors influencing academics to adopt e-learning across higher education more generally, but these findings have not identified the underlying issues influencing their responses to these factors, nor do they allow a deep analysis of discipline-specific factors. This study identified four groups (Factors) of academics each responding differently towards e-learning in their teaching. The first group represented the ‘e-advocates’ who saw technology as having the potential to improve nurse education by giving more control to learners and preparing future nurses for their evolving role in health care. The second group represented the ‘humanists’ who although sharing similar pedagogical beliefs as the first group had not been motivated to engage with technology because of the value they placed on human interaction. The third group was described as the ‘sceptics’ who had had previous negative experiences with e-learning and were unconvinced about technology’s ability to improve learning outcomes. Finally, the fourth factor, the ‘pragmatics,’ although ostensibly positive in their views towards e-learning, held different pedagogical beliefs from the three other groups and felt it was their responsibility to cover certain content in a face-to-face setting. The unique combination of Q and Bourdieu’s TOP enabled a deeper analysis of the four groups’ views and the socio-cultural context shaping them, thus providing new insights into academics’ responses to e-learning. Moving beyond the binary labels commonly attributed to those considered either ‘early adopters’ or ‘laggards,’ the findings make a contribution to the e-learning adoption literature by revealing a wider breadth of views and responses towards technology. Moreover, this study showed that internal beliefs determined the extent to which external factors were perceived as influential. This serves to explain why some individuals overcome certain barriers to e-learning adoption whilst others succumb to them. The findings from this study will inform policy-makers, e-learning strategists and professional development staff on how to more effectively present and promote e-learning

Exploring e-learning adoption in nurse education: a socio-cultural case study using Q and Bourdieu

This research study employed Q-methodology (Q) to explore the factors influencing e-learning adoption in a nurse education context, and Bourdieu’s Theory of Practice (TOP) to analyse these findings using a case study of one school of nursing in the UK. E-learning adoption has been limited in nurse education despite a wide body of literature promoting its use for improved learning outcomes. Most research studies to date have used surveys to explore the overarching factors influencing academics to adopt e-learning across higher education more generally, but these findings have not identified the underlying issues influencing their responses to these factors, nor do they allow a deep analysis of discipline-specific factors. This study identified four groups (Factors) of academics each responding differently towards e-learning in their teaching. The first group represented the ‘e-advocates’ who saw technology as having the potential to improve nurse education by giving more control to learners and preparing future nurses for their evolving role in health care. The second group represented the ‘humanists’ who although sharing similar pedagogical beliefs as the first group had not been motivated to engage with technology because of the value they placed on human interaction. The third group was described as the ‘sceptics’ who had had previous negative experiences with e-learning and were unconvinced about technology’s ability to improve learning outcomes. Finally, the fourth factor, the ‘pragmatics,’ although ostensibly positive in their views towards e-learning, held different pedagogical beliefs from the three other groups and felt it was their responsibility to cover certain content in a face-to-face setting. The unique combination of Q and Bourdieu’s TOP enabled a deeper analysis of the four groups’ views and the socio-cultural context shaping them, thus providing new insights into academics’ responses to e-learning. Moving beyond the binary labels commonly attributed to those considered either ‘early adopters’ or ‘laggards,’ the findings make a contribution to the e-learning adoption literature by revealing a wider breadth of views and responses towards technology. Moreover, this study showed that internal beliefs determined the extent to which external factors were perceived as influential. This serves to explain why some individuals overcome certain barriers to e-learning adoption whilst others succumb to them. The findings from this study will inform policy-makers, e-learning strategists and professional development staff on how to more effectively present and promote e-learning

A meta-ethnographic review of interprofessional teamwork in hospitals: what it is and why it doesn’t happen more often

International audienceObjectives: Although interprofessional teamwork has been shown to improve patient safety, it is not yet routine practice in most hospital settings. There is also a lack of clarity regarding what teamwork actually means, with terms such as collaboration, coordination, networking and knotworking often being used interchangeably. In this study, we analyse 20 years of qualitative research on interprofessional teamwork in hospital settings and examine what it looks like and the factors influencing it. Methods: The literature search included articles published between 1996 and 2016, and articles were included if they examined interprofessional teamwork within a hospital using qualitative methodology. We used meta-ethnographic analysis of eligible primary studies applying reciprocal translation and line of argument synthesis. Results: Nineteen articles were included. Interprofessional teamwork was largely absent in acute care and found to be influenced by systems perpetuating power imbalances, organizational practices that interfered with interprofessional interactions, representations of teamwork and leadership. Conclusions: Future strategies to improve interprofessional practices should include policies and structural changes to develop healthcare systems that facilitate these practices

Travail en équipe et autonomie collective : une expérience dans les soins infirmiers à domicile

International audienceIntroduction: Teamwork is often identified as being a core value in care work. Studies on this topic often focus on pluri-professional configurations, whereas mono-professional teamwork has not aroused the same interest. In this study, we examine teamwork among a group of nurses providing homecare within a new organization, Soignons Humain (SoHu). SoHu was inspired by Buurtzorg, a Dutch homecare company composed of self-organized nursing teams. Given that the healthcare context for French and Dutch nurses is different, SoHu chose to focus primary on teamwork as a mechanism for improving the quality of care.Purpose of research: The article examines how this objective was implemented through the practices and representations of work: to what extent do these self-organized teams lead to deeper collaborations with other homecare actors? How does this type of organizational model differ from other forms of homecare nursing in France? How does SoHu’s experience allow us to rethink nurses’ autonomy in their work?Results: SoHu’s organizational model differs from both private nursing clinics and traditional nursing care centers. The SoHu nurses’ salaried status makes it possible for them to focus on delivering holistic care and highlights their autonomous nursing role, which they claim as being central to their profession. SoHu’s originality lies in its highly developed instrumentation of teamwork and its work organization that is attentive to the construction of a collective competence. The use of coaches appears to be one of the organization’s key investments in sustainably supporting teamwork and, paradoxically, their collective autonomy. Following an initial learning phase, and through other types of support work (workshops and facilitation meetings), the association has attempted to create and support a propitious environment for teamwork.Conclusions: Our work calls attention to the necessary conditions for real collaborative practices to take place, wether these are inter or intra-organizational. SoHu’s case shows what an organization can do to create an environment favorable to team collaboration. This consists in building reflexivity into care work with a focus on the patient and the family; investments in developing teamwork skills ; ensuring a frequency and specific type of exchange between the nursing teams; using both ad hoc arrangements and formalization of these collaborations; and finally by recognizing and objectivizing these invisible coordination practices.Introduction : Les études sur le travail en équipe portent le plus souvent sur des configurations pluriprofessionnelles, tandis que le travail en équipe monoprofessionnelle ne suscite pas le même intérêt. Nous avons étudié le travail en équipe des infirmières délivrant des soins à domicile au sein de l’association Soignons Humain (SoHu), inspirée de l’entreprise néerlandaise Buurtzorg. Dans le contexte français, SoHu s’est davantage axé sur le motif du travail en équipe comme mécanisme pour améliorer la qualité du soin.But de l’étude : L’article étudie comment le travail en équipe se décline concrètement dans les pratiques et les représentations du travail : dans quelle mesure permet-il d’approfondir la collaboration entre les acteurs intervenant dans le paysage des soins à domicile ? Sous quels aspects ce modèle organisationnel se distingue-t-il des autres formes de travail infirmier à domicile en France ? En quoi l’expérience engagée par SoHu permet-elle de reposer la question de l’autonomie du travail infirmier ?Résultats : Le modèle d’organisation de SoHu se distingue à la fois des cabinets de soins infirmiers libéraux et des centres de soins infirmiers classiques. Le statut salarial permet de mettre en valeur la volonté de délivrer des soins holistiques et le rôle propre infirmier, revendiqué par SoHu comme le cœur du métier d’infirmier à domicile. L’originalité de SoHu consiste dans son instrumentation plus développée du travail en équipe et son organisation du travail attentive à la construction d’une compétence collective. La création d’une fonction interne de coach apparaît comme un des investissements-clés de l’organisation pour soutenir durablement le travail en équipe et, paradoxalement, l’autonomie collective. Après une phase d’apprentissage, et grâce à un travail d’accompagnement (ateliers et réunions d’animation), l’association tente de créer et soutenir des dispositions favorables au travail en équipe.Conclusions : Nos travaux invitent à être attentif aux conditions nécessaires pour rendre effectives de réelles pratiques collaboratives, inter et intraorganisationnelles. Ce cas montre ce que l’organisation peut faire pour construire une dynamique d’action favorable à la collaboration au sein de l’équipe : elle se construit par la réflexivité sur le travail de soin autour du patient, de son entourage, par l’investissement du travail en équipe, la fréquence et la nature des échanges entre professionnelles, les arrangements ponctuels et la formalisation de ces collaborations et, enfin, par l’objectivation et la reconnaissance de ces pratiques invisibles de coordination

Do Magnet®-accredited hospitals show improvements in nurse and patient outcomes compared to non-Magnet hospitals: a systematic review

International audienceBACKGROUND: The Magnet model proposes an accreditation for hospitals having demonstrated a healthy work environment and, as a result, positive staff and patient outcomes. Yet there are conflicting findings surrounding the actual impact of Magnet's organizational model on these outcomes, as well as a wide range of designs influencing the quality of these results.OBJECTIVES: To conduct a systematic review that explores the effect of Magnet accreditation on objective nurse and patient outcomes.INCLUSION CRITERIA: TYPES OF PARTICIPANTS: Magnet and non-Magnet accredited hospitals matched according to their similarity (e.g. size, type [urban or rural], level of acuity, location, etc.). Hospitals could be either university based or non-teaching hospitals and in any geographical location. As the focus of the study was outcomes specific to Magnet accreditation, studies reporting on "reputational Magnets" (the original hospitals), Magnet-aspiring and non-Magnet hospitals alone were excluded from the review. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: Exposure to Magnet accreditation. A Magnet hospital is defined as a hospital with American Nursing Credentialing Center -designated Magnet status at the time of study and having received this accreditation in the last four years, as this is the length of time for which the accreditation is valid, after which the hospital must reapply for another four-year accreditation. TYPES OF STUDIES: This review considered any quantitative study comparing nurse and patient outcomes in Magnet accredited hospitals with those in non-Magnet hospitals. Controlled clinical trials, controlled before and after and interrupted time series were considered first. When these were not available, case-controlled, descriptive comparative and descriptive correlational designs were considered. All studies presenting a "case study" with no comparison and other studies reporting on interviews and other qualitative data were excluded. TYPES OF OUTCOMES: The outcomes of interest were nurse outcomes related to turnover and absenteeism, as measured by the actual turnover rate if available, or the Anticipated Turnover Scale, the Revised Nursing Work Index or the Maslach Burnout Inventory, as well as nursing-sensitive patient outcomes (such as fall rates and hospital-acquired pressure ulcers) as measured by retrospective patient records, discharge abstracts, incident reports and reimbursement forms.SEARCH STRATEGY: Both published and unpublished literature between 1994 and 2014 were searched. The electronic databases searched were the following: CINAHL, MEDLINE, EMBASE, Academic Search Complete and Web of Science. Other resources included ProQuest Dissertations & Theses Database /Dissertation Abstracts Online and OpenGrey, the American Hospital Association and the American Nurses Credentialing Center websites, and the Sigma Theta Tau International library of abstracts. In April 2015, a search update was conducted including the years 2014-2015 in the databases listed above.METHODOLOGICAL QUALITY: No cut-off point for the Joanna Briggs Institute appraisal tool criteria was selected for inclusion of studies.DATA EXTRACTION: Data from included studies were extracted using the Joanna Briggs Institute Data Extraction Form for experimental/observational studies. Two reviewers extracted the data independently and results were compared for accuracy and categorized according to nurse and patient outcomes.DATA SYNTHESIS: All the studies analyzed retrospective data obtained from either combined databases or from questionnaires. The methodological heterogeneity and poor quality of the designs did not make it possible to pool quantitative results in a statistical meta-analysis. Results are presented in descriptive narrative form.RESULTS: From the 141 screened studies, ten met the inclusion criteria. Nine of these studies were retrospective analyses of data extracted from existing databases, one study collected original data. Of the seven studies examining patient outcomes, three found clear statistically significant improvements related to lower pressure ulcers, patient falls, failure to rescue and 30-day inpatient mortality in Magnet hospitals compared to non-Magnet hospitals. In the studies examining nurse outcomes, three found statistically significant improvements related to higher job satisfaction and lower intent to leave and turnover rates in Magnet compared to non-Magnet hospitals.CONCLUSIONS: Based on the mixed results and poor quality in the research designs in the ten included studies, it was not possible to conclude that Magnet accreditation has effects on nurse and patient outcomes. There is a need for more robust designs that can confidently measure the impact of hospital accreditation on objective outcomes.The Joanna Briggs Institute

Décalages en blouse blanche : Diagnostic sur la mise en œuvre du nouveau référentiel infirmier

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Using Bourdieu's theory of practice to understand ICT use amongst nurse educators

International audienceBackgroundImplementing changes in practice in either clinical or educational settings remains challenging. In the context of Information and Communication Technologies (ICT) adoption, the literature focuses either on organisational factors influencing its implementation, or on individual factors influencing its adoption into practice. Separately both fail to examine the issue holistically. Bourdieu's theory of practice provides a method for reconciling the two.ObjectiveTo provide a practical example of how Bourdieu's theory of practice can be employed to better understand nurse educators' responses to ICT.DesignExploratory descriptive design, using a Bourdieusian case-study to guide a documentary analysis.MethodsIn 2009 a two-part study was conducted within a Department of Nursing (DON) in higher education (HE) in England. First Bourdieu's theory of practice was used to develop a case-study; then nurse educators were recruited for a Q-methodology (Q) study. This paper focuses exclusively on the case study and the use of the theory of practice to interpret the findings from the Q-study.ResultsNursing's transition into academia, promotions criteria in HE and the value placed on research over teaching have influenced educators' responses to technology.ConclusionThe use of Bourdieu's framework provides a rich and contextual backdrop for understanding how organisational factors interact to influence individuals' responses to technology adoption

La fabrique du travail en équipe dans les établissements de santé

International audienceAcross healthcare facilities in France, and around the world, better teamwork has been presented as a solution to the patient safety issue. The Hight Authority of Health (HAS) endorsed the value of teams learning to work together and created a program providing various levels of support to voluntary teams wishing to improve their teamwork. This article presents preliminary findings from a study that used this nationally sponsored program as an opportunity to study how health professionals practice teamwork. We developed interview, observational and analysis guidelines based on the Teaming framework (Edmondson, 2012) to identify five decisive dimensions of teamwork: the existence of shared representations of work; psychological safety among team members; the ability to learn from failures; spanning across team boundaries; and the presence of leaders who can facilitate the articulation of these different dimensions. This framework made it possible to observe how the teams compared on these different dimensions. Results show that teamwork was shown to be laborious. The dimensions considered necessary for effective teamwork were often absent. In addition, a variety of structural constraints highlight the limitations of policies to improve teamwork that focus only on the teams themselves.Dans les établissements de santé en France et à travers le monde, l’amélioration du travail en équipe est présentée comme une réponse au problème de la sécurité des soins. Cette politique est portée par la Haute autorité de santé (HAS) et prend forme dans un programme fournissant divers supports à des équipes volontaires désirant améliorer leur fonctionnement. L’article saisit la mise en œuvre de ce programme comme un terrain opportun pour étudier comment les professionnels de santé, au sein des services, pratiquent le travail en équipe. Notre analyse repose sur une méthodologie qualitative (entretiens, observations) auprès de trois services. Nous avons construit une grille d’analyse à partir du concept de Teaming d’Edmondson (2012), que nous traduisons par faire-équipe. Ce concept identifie cinq dimensions décisives : l’existence de représentations partagées du travail, la création d’un climat de confiance entre membres de l’équipe, la capacité à affronter les échecs pour mieux les surmonter, la capacité à enjamber les frontières de l’équipe et la production d’un leadership pour articuler ces différentes dimensions. Cette grille permet d’observer comment les professionnels tentent de développer et d’améliorer de manière durable leur travail en équipe. Les résultats montrent qu’au-delà de l’enthousiasme initial, faire équipe s’avère laborieux. Les dimensions considérées comme nécessaires au travail en équipe ne sont souvent pas présentes. En outre, diverses contraintes d’ordre structurel pointent les limites des politiques d’équipe pensées à l’échelle d’un service

Exploring the underlying factors influencing e-learning adoption in nurse education

International audienceAIMS:To report a study undertaken to explore the underlying factors influencing e-learning adoption in nurse education.BACKGROUND:Despite e-learning's high profile it has not been readily integrated into teaching practice in nurse education. Previous research has identified generic, cross-disciplinary factors but has left out 'soft' factors.DESIGN:The study adopted an exploratory descriptive design.METHODS:Q-methodology was used to explore e-learning adoption in a Division of Nursing located in an institution of Higher Education in the UK. Between September-December 2009, 38 participants were recruited to participate in Q-sorts and post-sort interviews. The Q-sort data were factor analysed and the interviews were coded to their respective factors to develop in-depth narratives.FINDINGS:Four factors were identified: 'E-learning advocates' saw e-learning's potential to improve nurse education and prepare future nurses for their evolving role; the 'Humanists' had avoided e-learning because they valued human interaction; the 'Sceptics' doubted that technology could improve learning outcomes; and the 'Pragmatics,' only used e-learning as a tool to post lecture notes online to supplement what they covered in class.CONCLUSION:The findings point to the variety of responses existing among nurse academics faced with integrating e-learning into their teaching. Moving beyond the binary labels commonly attributed to those considered either 'early adopters' or 'laggards,' the findings contribute to the literature by revealing a wider breadth of views and responses towards technology. Acknowledging these views can inform future e-learning strategies and lead to improvement in e-learning use in nurse education

France’s transition to academic nursing: the theory–practice gap

International audienceNursing education’s shift from vocational settings to academic institutions is a trend that has accelerated recently in Europe with the advent of the Bologna accords. France has adopted this model using a centralized, policy-driven approach. This article describes the background to this change and explores the process and impact of this shift in the lives of practicing nurses in clinical units. Between April 2011 and June 2013 nurses and students were observed using the shadowing method and were interviewed in a nursing school and four hospital units where students had clinical placements. The key interviewer elicited descriptions of the process as seen by the nurse mentors and generated themes and summary statements that encapsulated the phenomena of policy change at the individual level. The nurses expressed a broad understanding of the process, but were required to adapt the changes to their everyday professional needs under difficult time pressures. Nursing students found little sympathy and support from their mentors during the process and perceived a general lack of understanding of the goals of the reform. Three significant types of reactions were noted from new graduates: the exploitation of the hospital setting to find more rewarding work; a renewed interest in developing nursing activities traditionally undervalued; and finally, withdrawl from the profession. These factors point to the difficult future for nursing in France and globally, as systems try to reform toward greater perceived efficiency and restructuring of professional roles without providing adequate time or ressources to implement adopted policies