Supporting therapist engagement in evidence based practice: Developing a continuing education programme through participatory action research

Therapists find it challenging to integrate research evidence into their clinical decision-making because it may involve modifying their existing practices. Although continuing education (CE) programmes for evidence-based practice (EBP) have employed various approaches to increase individual practitioner’s knowledge and skills, these have been shown to have little impact in changing customary behaviours. To date, there has been little attempt to actively engage therapists as collaborators in developing educational processes concerning EBP. The researcher collaborated with seven clinical therapists (one occupational therapist, four physiotherapists and two speech and language therapists) enrolled in a new post-qualification Implementing Evidence in Therapy Practice (IETP) MSc module to monitor and adapt the learning programme over ten weeks. The participating therapists actively engaged in participatory action research (PAR) iterative cycles of reflecting→ planning→ acting→ observing→ reflecting with the researcher. Mixed methods were used to evaluate the IETP module and its influence on therapists’ subsequent engagement in EBP activities. Data were gathered immediately on completion of the module and five months later. Immediate post-module findings revealed four components as being important to the therapists: 1) characteristics of the learning environment; 2) acquisition of relevant EBP skills; 3) nature of the learning process; and 4) acquiring confidence. The two themes and sub-themes which emerged from individual interviews conducted five months post-module expanded on the four components already identified. Theme 1: Experiencing the learning (sub-themes: module organisation; learning is relational; improving the module); and theme 2: Enacting the learning through a new way of being (sub-themes: criticality and reflection; self agency; modelling EBP behaviours; positioning self in an EB work culture). The therapists’ perspectives had by then shifted from that of a learner to that of a clinician constructing a new sense of self as an evidence-based practitioner. Findings from this study underline the importance of the process of socially constructed knowledge and of empowering learners through collaboratively designed continuing education programmes. In the student-driven learning environment, therapists chose repetitive skill-building and authentic problem-solving activities which reflected the complexity of the environments to which they were expected to transfer their learning. These findings have implications for educators designing EBP continuing education programmes, during which students develop professional ways of being.

(Un)veiling desire: re-defining relationships between gendered adult education subjects and adult education programmes

My underlying argument, in this paper, is that conceptualisations of power as a commodity, through which the 'disempowered-as-illiterate' subject moves towards becoming an 'empowered-as-literate' subject, forces constructs of identities into a powerful/powerless dichotomy which does not always do justice to diverse experiences. The claimed 'empowering' intentions of adult education programme and policy practice may, in reality, contribute to the dominance of restrictive disciplining and regulatory discursive practices. Moving away from emancipatory trajectories of adult education programmes that allege only liberation from domination, through 'literacy', can promise freedom points to another position of hope. Drawing on Foucauldian analysis, I explore sites of resistance as possibilities of transforming 'structures of understanding' at different levels. Officially validated and recognised transformations, in adult education programme as well as policy understandings, of the 'illiterate' subject may also hope to include choices in postures of autonomy (see Spivak 1996) made by programme participants in other 'fields' of socio-cultural practice linked to their material realities. Subsequently, 'empowerment' of the 'illiterate Indian village woman' cannot solely be imagined as a product of laws, policies and institutional discursive practices (see, for example, Gouws 2005; Rai 2003 on gender mainstreaming and Mosse 2005 on aid policy and practice). The 'illiterate Indian village woman' represented as a site of resistance, throughout this paper, displaces homogeneous representations of the 'illiterate' which situate her in the role of 'dependent' or 'victim', as failed attempts to rob her of her historical and political agency (Mohanty 1996). Through narrating other 'images' of refusal in my ethnographic vignettes, I hope to recognise different individuals' sense of agency, at all levels, as embedded in and evolving through forms of collective action that activate differences in order to develop possibilities and sustain hope for transforming historically rooted discursive practices of inequality. I provide ethnographic accounts of resisting 'literacy' programme participants, based in different villages in Bihar (Northern India), as accounts of resistance impacted on by notions of norms, translating and interpreting Others, networks and empowerment.

‘Nothing will prevent me from doing a good job’. The professionalisation of part-time teaching staff in further and adult education

Approximately 85,000 part-time teaching staff working in further education (FE) and adult and community learning (ACL) are often seen as ‘a problem’. The intrinsic ‘part-timeness’ of these staff tends to marginalise them: they remain under-recognised and largely unsupported. Yet this picture is over-simplified. This article examines how part-time staff make creative use of professional autonomy and agency to mitigate problematic ‘casual employment’ conditions, reporting on results from Learning and Skills Development Agency-sponsored research (2002–2006) with 700 part-time staff in the learning and skills sector. The question of agency was reported as a key factor in part-time employment. Change is necessary for the professional agency of part-timers to be harnessed as the sector responds to ambitious sectoral ‘improvement’ agendas following the Foster Report and FE White Paper. Enhanced professionalisation for part-time staff needs greater recognition and inclusion in change agendas.

Organisational Self-Evaluation and Teacher Education for Community Relations in a Transforming Society?

During 2004, the School of Education at the University of Ulster embarked on an innovative three-year project designed to embed community relations objectives within initial teacher education. With the advent of more peaceful times in Northern Ireland, this was a precipitous time for initial teacher educators to review the preparation given to beginner teachers for teaching in an increasingly pluralist society emerging from conflict. The present paper reports on one very specific and time-limited element of the broader project. That is, development work designed to investigate the possibilities of using processes of self-review and evaluation as a lever for improvements in initial teacher education for community relations. Following a brief contextualisation, the background to, and the development of, a set of materials designed to support rigorous and systematic self-review of all aspects of provision in a university-based initial teacher education department is described. The Community Relations Index for Initial Teacher Education (Cr-ITE) was envisaged as being of use to initial teacher education establishments in order to help teacher educators take responsibility for rigorous learning from their practice, whilst placing inclusive values at the centre of organisational development. The final section includes further critical reflection on the role of organisational self-review in transforming teacher education for inclusion in a society emerging from longstanding communal conflict.

Registered nurses' perceptions of factors impacting on their continuing education /

This qualitative study examined the effects of hospital restructuring on a group of nurses at a community hospital. Eleven nurses were asked questions in order to gain insight into their experience in this situation. Ten of these participants were female, and one was male. The intent was to gather information about how restructuring has affected their lives, including, their motivational factors and barriers to participation in continuing education, and their descriptions of their workplace environment. Audiotaped interviews were conducted on two occasions to obtain this data. Emergent themes included the nurses' comments about continuing education, motivational factors, barriers that included geography and time, reactions of co-workers, restructuring, the College of Nurses' Quality Assurance Program including peer feedback, and performance appraisals. The literature review compares the barriers and motivational factors to the previous research findings. Thus, this study gave voice to the experience of this group of nurses, working in a healthcare setting that is involved in restructuring. This information is important to the healthcare system, since many areas are involved in restructuring. The whole process, if it is to be successful, depends on the frontline workers, namely the nurses. Thus, if there is anything to be learned from this group of people, that could be used to improve this progression, everyone would benefit from this information, were it to be implemented. Everyone is a stakeholder in the quality of healthcare in our province. The frontline workers are the ones that hold the vantage point to be able to provide suggestions for the changes needed to successful. These nurses are not just motivated by work issues however, and educating them and motivating them will also improve the care provided through increased knowledge and enhanced self-esteem.

Research in the clinical setting : a qualitative study of the value of play research in the continuing education of occupational therapists.

Occupational therapists have always recognized playas an important part of a child's life. However, until recently play has been viewed as a medium for reaching treatment goals, rather than as an activity that is valuable in and of itself. If occupational therapists think of playas the primary activity or occupation of childhood, then play should be a very important area of focus for paediatric clinicians. In order to assist children to become as independent as possible with play and to have fulfilling play experiences the occupational therapist needs to have a clear understanding of how to assess, set goals which lead towards competence in play, and promote play. Recent play literature has placed importance on play behaviours and looking at the relationship between the child and both the human and nonhuman environment. Believing that play and playfulness can and should be promoted, for children with physical disabilities, requires that therapists learn new assessment and intervention strategies. A new assessment tool, The Test of Playfulness, was developed by Bundy in 1994. It addressed play behaviours and environmental influences. The author, a co-investigator and eight occupational therapists were involved in a playfulness study using this test to compare the playfulness of children with physical disabilities with their able-bodied peers. After the study was completed the author questioned whether or not involvement in the playfulness study was enough of a change agent to bring about transformative learning in order to further the eight occupational therapists' education about play.This study investigated changes in either the therapists' thinking about play or their behaviour in their clinical practice. The study also examined the participants' retention of knowledge about the Test of Playfulness. The eight therapists who had been involved in the playfulness study (participants) were matched with eight therapists who had not been involved (nonparticipants). The therapists were interviewed 9 to 12 months after completion of the playfulness study. They were asked to describe various scenarios of play and open ended prompts were used to elicit the therapists' perceptions of play, good play, the role or value of play, environmental and gender influences on play, play assessment and intervention, and play research, for children with and without disabilities. The participants were also prompted to discuss their experience with the playfulness study. A self-report questionnaire was also completed at the end of the interview. The results of the study demonstrated that: (a) the play research project was a good format for continuing the participants' education about play; (b) their thinking had changed about play; (c) according to self report, they had used this new knowledge in their clinical practice; and (d) the participants remembered the items on the Test of Playfulness and could use them in describing various aspects of play. This study found that participating in a play research project had been an effective method of professional development. It also highlighted the need for increased awareness of the recent literature on play and the developing role of the occupational therapist in the assessment and intervention of play.

What motivates registered nurses to participate in continuing education activities?

The study was undertaken to identify what motivates registered nurses to participate in continuing education activities. The primary questions were whether basic nursing education, employment status, clinical area, and position, as well as readiness for selfdirected learning influenced Canadian nurses' motivational orientations when deciding to participate in continuing education activities. Other individual differences (e.g., age) were also examined. The sample included 142 registered nurses employed at an urban community hospital. Three instruments were used for data collection: the Education Participation Scale, the Self-Directed Learning Readiness Scale, and a nursing survey consisting of demographic questions. Basic nursing education and employment status did not effect motivational orientation or self-directed learning readiness. Clinical area and level of position significantly influenced nurses' decisions to participate in continuing education activities. Motivational orientation had a significant relationship with selfdirected learning readiness. Implications for practice as a result of this study involves program planning and delivery. The identification of the motivational orientations of participants may assist in the development and delivery of continuing education programs that are beneficial, relevant, and address the identified learning needs of participants. Implications for future research also exist in relation to studying different groups of nurses, for example, registered nursing assistants, and investigating related issues, for example, what are the deterrents to participation in continuing education?

Research in the clinical setting : a qualitative study of the value of play research in the continuing education of occupational therapists.

Occupational therapists have always recognized playas an important part of a child's life. However, until recently play has been viewed as a medium for reaching treatment goals, rather than as an activity that is valuable in and of itself. If occupational therapists think of playas the primary activity or occupation of childhood, then play should be a very important area of focus for paediatric clinicians. In order to assist children to become as independent as possible with play and to have fulfilling play experiences the occupational therapist needs to have a clear understanding of how to assess, set goals which lead towards competence in play, and promote play. Recent play literature has placed importance on play behaviours and looking at the relationship between the child and both the human and nonhuman environment. Believing that play and playfulness can and should be promoted, for children with physical disabilities, requires that therapists learn new assessment and intervention strategies. A new assessment tool, The Test of Playfulness, was developed by Bundy in 1994. It addressed play behaviours and environmental influences. The author, a co-investigator and eight occupational therapists were involved in a playfulness study using this test to compare the playfulness of children with physical disabilities with their able-bodied peers. After the study was completed the author questioned whether or not involvement in the playfulness study was enough of a change agent to bring about transformative learning in order to further the eight occupational therapists' education about play.

Comparative and international education: policy transfer, context sensitivity and professional development

This paper examines the intellectual and professional contribution of comparative and international studies to the field of education. It explores the nature of the challenges that are currently being faced, and assesses its potential for the advancement of future teaching, research and professional development. Attention is paid to the place of comparative and international education (CIE)-past and present-in teacher education, in postgraduate studies, and in the realms of policy and practice, theory and research. Consideration is first given to the nature and history of CIE, to its initial contributions to the field of education in the UK, and to its chief mechanisms and sites of production. Influential methodological and theoretical developments are examined, followed by an exploration of emergent questions, controversies and dilemmas that could benefit from sustained comparative analysis in the future. Conclusions consider implications for the place of CIE in the future of educational studies as a whole; for relations between and beyond the 'disciplines of education'; and for the development of sustainable research capacity in this field.

What makes continuing education effective : perspectives of community pharmacists

Objective To explore how different aspects of the professional environment for Australian community pharmacists are perceived to be influencing the effectiveness of continuing education models in improving practice.

Setting Australian community pharmacy.

Methods A convenience sample of practising community pharmacists (n = 15) was recruited using the 'snowballing' technique to participate in one of four focus group teleconferences. Each focus group examined continuing education experiences from different professional perspectives and training needs (recent graduates, experienced practitioners, specialist practitioners and rural/remote practitioners).

Key findings Facilitation of professional development by accreditation bodies, and new challenges resulting from the introduction of cognitive services were seen to promote a favourable environment for continuing education engagement. Complex continuing education delivery models combined with high costs and excessive workloads made it more difficult to engage with continuing education systems or try to apply knowledge to the workplace.

Conclusion Results support findings from previous research that practice development requires a multifaceted approach with continuing education as just one component. Affordable and integrated models of continuing education are required in order to optimise efficacy for participants.

Barriers to pharmacist participation in continuing education in Australia

Background: The pharmacy profession recognises of the need for continuing education (CE), however, the rate of participation in organised CE remains low. Little is known about the reasons for low participation rates in CE, particularly in the Australian context. Aim: This research aimed to identify the barriers to participation of Australian pharmacists in CE. Method: Focus groups were held with Australian community pharmacists, grouped into experienced pharmacists, recently qualified pharmacists, pharmacists with specialist-training needs, and pharmacists practising in rural or remote areas. Focus group transcripts were thematically analysed. Results: Barriers identified by pharmacists included time constraints, accessibility - in terms of travel and cost, relevance, motivation, quality and method of CE delivery. Participants provided ideas to improve uptake of CE. Conclusion: The major barriers identified were time, accessibility and relevance of content. To improve uptake of CE a wider variety of flexibly delivered programs supplemented with in-depth workshops could be utilised.

The evolution of a state-wide continuing education programme for allied health professionals

Allied health professionals require continuing education (CE) to maintain and improve competencies and standards of care. Research suggests that professional access to CE in rural areas can be difficult.

This article uses an action research framework to describe the development and implementation of a CE programme for allied health professionals in a rural area in Australia, and its subsequent evolution into a state-wide programme. To evaluate programme relevance, attendance and perceived clinical relevance, physiotherapists (n = 75) in southwest Victoria were surveyed 1year after commencement of a CE programme. A secondary outcome was the perceived effect on clinical practice.

More than two-thirds (68.6%) of physiotherapists attended at least one workshop, 57.2% attended four or more sessions and 22.9% attended at least one of the two conducted courses over the period. In addition, 20% of the physiotherapists perceived that attending the programme had a large positive effect on their therapeutic skills, whereas 68.6% reported some effect. From a regional CE programme for physiotherapists the programme evolved into a state-wide programme for 22 allied health professions.

'Girls talking about girls' issues' : the importance of girls-only health and physical education in promoting well-being

Recognition of the important role schools play in the promotion of student well-being can be seen in the growing number of policies and programs being implemented in schools across Australia. This paper reports on some initial data from focus group interviews with Year 9 and 10 girls involved in the pilot of a health and physical activity intervention designed to connect them to their local community and reconnect them with their school and their peers. The aim of the program was to build connectedness and resilience by engaging young women in non-traditional physical activities whilst providing them with a sound understanding of health issues relevant to adolescent girls. Situated in a relatively isolated rural community 200 kilometres south-east of Melbourne the program was overwhelmingly delivered by regional and local agencies in conjunction with the local secondary school. The intervention was built on a partnerships model designed with the purpose of increasing participation and access for young women whilst building a sustainable program run in partnership between the school and local agencies and services. The initial data from this pilot indicates the program is having a positive impact on the young women's sense of self and their bodies, their relationships with their peers and in reducing bullying behaviour amongst the girls. However, the data raises some important questions around the adequacy of school-based health education, and the sustainability of approaches designed to be delivered by outside agencies rather than classroom teachers.

Community pharmacists' preferences for continuing education delivery in Australia

Introduction: New technologies such as the Internet offer an increasing number of options for the delivery of continuing education (CE) to community pharmacists. Many of these options are being utilized to overcome access- and cost-related problems. This paper identifies learning preferences of Australian community pharmacists for CE and identifies issues with the integration of these into contemporary models of CE delivery.
Methods: Four focus group teleconferences were conducted with practicing community pharmacists (n = 15) using a semistructured format and asking generally about their CE and continuing professional development (CPD) experiences.
Results: Pharmacists reported preferences for CE that were very closely aligned to the principles of adult learning. There was a strong preference for interactive and multidisciplinary CE. Engaging in CPD was seen as valuable in promoting reflective learning.
Discussion: These results suggest that pharmacists have a strong preference for CE that is based on adult learning principles. Professional organizations should take note of this and ensure that new CE formats do not compromise the ability of pharmacists to engage in interactive, multidisciplinary, and problem-based CE. Equally, the role of attendance-based CE in maintaining peer networks should not be overlooked.