Service user perspectives on palliative care education for health and social care professionals supporting people with learning disabilities

Background and objectives
Evidence from European and American studies indicates limited referrals of people with learning (intellectual) disabilities to palliative care services. Although professionals’ perceptions of their training needs in this area have been studied, the perceptions of people with learning disabilities and family carers are not known. This study aimed to elicit the views of people with learning disabilities, and their family carers concerning palliative care, to inform healthcare professional education and training.

Methods
A qualitative, exploratory design was used. A total of 17 people with learning disabilities were recruited to two focus groups which took place within an advocacy network. Additionally, three family carers of someone with a learning disability, requiring palliative care, and two family carers who had been bereaved recently were also interviewed.

Results
Combined data identified the perceived learning needs for healthcare professionals. Three subthemes emerged: ‘information and preparation’, ‘provision of care’ and ‘family-centred care’.

Conclusions
This study shows that people with learning disabilities can have conversations about death and dying, and their preferred end-of-life care, but require information that they can understand. They also need to have people around familiar to them and with them. Healthcare professionals require skills and knowledge to effectively provide palliative care for people with learning disabilities and should also work in partnership with their family carers who have expertise from their long-term caring role. These findings have implications for educators and clinicians.

Improving a regional chemotherapy service by learning from deaths occurring within 30 days of treatment with systemic anti-cancer therapy.

Background: Outwith clinical trials, patient outcomes specifically related to SACT (systemic anti-cancer therapy) are not well reported despite a significant proportion of patients receiving active treatment at the end of life. The NCEPOD reviewing deaths within 30 days of SACT found SACT caused or hastened death in 27% of cases.

Method: Across the Northern Ireland cancer network, 95 patients who died within 30 days of SACT for solid tumours were discussed at the Morbidity and Mortality monthly meeting during 2013. Using a structured template, each case was independently reviewed, with particular focus on whether SACT caused or hastened death.

Results: Lung, GI and breast cancers were the most common sites. Performance status was recorded in 92% at time of final SACT cycle (ECOG PS 0-2 89%).

In 57% the cause of death was progressive disease. Other causes included thromboembolism (13%) and infection (5% neutropenic sepsis, 6% non-neutropenic sepsis). In 26% with death from progressive disease, the patient was first cycle of first line treatment for metastatic disease. In the majority discussion regarding treatment aims and risks was documented. Only one patient was receiving SACT with curative intent, who died from appropriately managed neutropenic sepsis.

A definitive decision regarding SACT's role in death was made in 60%: in 49% SACT was deemed non-contributory and in 11% SACT was deemed the cause of death. In 40% SACT did not play a major role, but a definitive negative association could not be made.

Conclusion: Development of a robust review process of 30-day mortality after SACT established a benchmark for SACT delivery for future comparisons and identified areas for SACT service organisation improvement. Moreover it encourages individual practice reflection and highlights the importance of balancing patients' needs and concerns with realistic outcomes and risks, particularly in heavily pre-treated patients or those of poor performance status.

An exploratory study of how a Korean chaebol’s learning culture facilitates customer service

This paper explains how the organizational learning concept is used by managers in a global Korean company to promote group work, information sharing and an open communication style in order to produce a high level of customer service. Previously collected data from a set of in-depth personal interviews undertaken with three senior managers in a Korean electronics company were analyzed and interpreted using the grounded theory approach, and a number of propositions are put forward. The research findings show that managers in a chaebol deploy organizational learning to identify skilled and knowledgeable staff, and improve the organization’s capability by placing emphasis on developing harmonious, mutually oriented relationships that permeate throughout the organization. Top management demand that staff identify with government economic objectives and align the organization’s strategy accordingly so that the products produced are marketable. To achieve this, the organization fosters continual interaction among managers throughout the organization’s hierarchy. The chaebol’s organizational learning model encapsulates a “corollary” (continual communication) and “tools” (cultural influence and relationship management), and manifests in a unique strategy that allows management systems to evolve naturally.

E-Learning as a shared service in shared services centers

Book Subtitle International Conference, CENTERIS 2010, Viana do Castelo, Portugal, October 20-22, 2010, Proceedings, Part II

CrimsonHex: a service oriented repository of specialised learning objects

The corner stone of the interoperability of eLearning systems is the standard definition of learning objects. Nevertheless, for some domains this standard is insufficient to fully describe all the assets, especially when they are used as input for other eLearning services. On the other hand, a standard definition of learning objects in not enough to ensure interoperability among eLearning systems; they must also use a standard API to exchange learning objects. This paper presents the design and implementation of a service oriented repository of learning objects called crimsonHex. This repository is fully compliant with the existing interoperability standards and supports new definitions of learning objects for specialized domains. We illustrate this feature with the definition of programming problems as learning objects and its validation by the repository. This repository is also prepared to store usage data on learning objects to tailor the presentation order and adapt it to learner profiles.

Odin: a service for gamification of learning activities

Existing gamification services have features that preclude their use by e-learning tools. Odin is a gamification service that mimics the API of state-of-the-art services without these limitations. This paper describes Odin, its role in an e-learning system architecture requiring gamification, and details its implementation. The validation of Odin involved the creation of a small e-learning game, integrated in a Learning Management System (LMS) using the Learning Tools Interoperability (LTI) specification.

The assessment of self-directed learning among pre-service students in an Ontario faculty of education

The study determined students' perceptions of self-directed learning in their courses. Tests to assess perceptions are not being used in many programs. Assessments such as the Self-Directed Readiness Scale (SDLRS) and the Oddi continuing Learning Inventory (OCLI) have weaknesses that may have affected the use of tests. In this study, the creation of the Self-Directed Learning Test (SDLT) monitored students' perceptions by addressing what students were told before registration, how much input students had in developing the structure of the course, how much input students have in determining the evaluation for the course, what style of learning is taking place, and the characteristics of learning found among students. Fifty-one students in the pre-service program at Brock University completed the SDLT. Results showed that 47.1% of the sample liked self-directed learning. Several students who stated that they did not like selfdirected learning did not know what self-directed learning was. Results supported Brookfield's (1986) claim for more education on what self-directed learning is. The study did not support Knowles' (1980) assumption that adult students know and want to follow self-directed approaches to learning. The SDLT is a good method for monitoring self-directed learning and how students perceive their courses.

Reviewing the learning organisation model in a child and adolescent mental health service

From 1995 onwards, a child and adolescent mental health service (CAMHS) applied Senge's learning organisation model. This review compared service performance with that of peer services 5 years later and explored whether any differences were associated with the application of this model. The comparison methodology used quantitative analysis of external data from the Department of Human Services, together with qualitative analysis of material including interviews with CAMHS directors and service managers. Results showed high evaluation activity and high quality, efficiency and efficacy of care compared with other services. Several restraints to the optimal application of the model were identified, including inadequate training of new managers, service overload, major external organisational change and limited investment in information systems. Other outcomes are discussed.

What have we learnt? Pre-service music teaching and learning

Making pre-service teacher education relevant to teaching through onsite visits is not new to tertiary institutions in Australia. "The merits of field based teacher education are frequently cited, concluding increased relevance for students and greater accountability for colleges through participation of local schools" (Elmore, 1979, p. 378). This article reports on a Deakin University initiative with a local school in semester one 2008 with the Bachelor of Teaching (Primary and Secondary) music methodology students. The school chosen has a specialist music teacher. Conkling (2007) points out, "when the experienced music teacher presents a compelling vision of music teaching, pre-service teachers not only attend to this exemplar of teaching practice, but they also recognize the influences of teaching practices on younger students learning" (p. 45). This article explores the concept of school based partnerships and professional development as a way to enhance pre-service music methodology students understanding of teaching and learning. This article highlights some of our reflections during our five-week visit. We discuss the benefits of the experience from the point of view of a university student and a music education lecturer. Whilst such an experience had benefits for the school and the university, we also highlight some limitations that were encountered.

Shared learning : a collaborative approach for supporting pre-service teacher's reflective practice

Independent learning and critical thought are developed when students are encouraged to express and review their own understandings and the ideas of others as part of their learning journey. This paper focuses on an innovation to engage and support pre-service teachers (students) in a collaborative approach to learning following a teaching practicum. Through the creation of a learning community, information and practice is shared and further challenged in a supportive environment. The opportunity for students to review their own work in relation to responses of peers enables them to become involved in the process of critiquing their own beliefs and practices as well as their peers, within a set framework. Favourable outcomes for both students and university staff augur well for the future development of the process.  

Learning 'through' or learning 'about'? The ridiculous and extravagant medium of opera : Gardner's multiple intelligences in pre-service teacher education

In recent years, pre-service teacher education has attempted to incorporate into programs an understanding of Gardner’s theory of multiple intelligences as it applies to schools. In this paper the tension between ‘learning about’ multiple intelligences and ‘learning through’ multiple intelligences supports Gardner’s (1993) distinction between ‘understanding’ and ‘coverage’. This paper examines the use of the performing arts in the professional studies component of our teacher education program. During 2002 at The University of Melbourne, a group of education students were offered the opportunity to develop an opera in order to learn about assessment and curriculum. Thirty-seven of the students volunteered to be involved and over a period of six months met this challenge. Our action research study asked two critical questions. To what extent is the understanding of multiple intelligences by pre-service teachers improved by ‘learning through’? Can pre-service teachers address fundamental issues in curriculum and assessment through the development of a performance? This experience would be of value to other teacher educators.

Learning 'through' or learning 'about'? The ridiculous and extravagant medium of opera: Gardner's multiple intelligences in pre-service teacher education

In recent years, pre-service teacher education has attempted to incorporate into programs an understanding of Gardner's theory of multiple intelligences as it applies to schools. In this paper the tension between 'learning about' multiple intelligences and 'learning through' multiple intelligences supports Gardner's (1993) distinction between 'understanding' and 'coverage'. This paper examines the use of the performing arts in the professional studies component of our teacher education program. During 2002 at The University of Melbourne, a group of primary and secondary students were offered the opportunity to develop an opera in order to learn about assessment and curriculum. Thirty-seven of the students volunteered to be involved and over a period of six months met this challenge. Our action research study asked two critical questions. To what extent is the understanding of multiple intelligences by pre-service teachers improved by 'learning through'? Can pre-service teachers address fundamental issues in curriculum and assessment through the development of a performance? This experience would be of value to other teacher educators.