Choices of approaches in e-moderation: conclusions from a grounded theory study

Much has been published in recent years about the desirable nature of facilitated interactions in on-line discussions with educational purposes. However little has been reported about the roles which tutors actually adopt in real life learning contexts, how these range between ‘tutoring, ‘managing’ and ‘facilitating’, and what the distinctions between these three roles may be. In this paper choices of priorities in e-moderation, which were made in three naturalistic (real life) case studies by three higher education practitioners, are identified and discussed. These contrasting approaches were captured and analysed using grounded theory principles. The paper also discusses these occasions when the facilitation was less effective than might have been desired. It finally summarises the potential of various approaches within e-moderation – and some of the attendant risks. The finding is that principles and practices developed for face-to-face support of student-directed learning were found equally applicable in e-moderated online group work, despite several significant differences between the two types of setting. Keywords: higher education, e-learning, e-moderation, asynchronous discussions, learning outcomes, grounded theory

Intensive care survivors’ experiences of ward-based care: Meleis’ theory of nursing transitions and role development among critical care outreach services.

Aims and objectives. To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Background. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Design and methods. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.’s mid-range theory on experiencing transitions. Results. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. Conclusion. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Relevance to clinical practice. Meleis et al.’s work has resonance in terms of explicating intensive care patients’ experiences of psychosocial distress throughout the transition to general ward–based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed.