This study examines an educational intervention, which attempts to create experiential learning opportunities, to gain an understanding of the effects of teachers’ and students’ development as active democratic citizens. The educational intervention comes in the form of a youth program entitled ‘Day of Information for a Lifetime of Action’ (DILA). The research answers the following question: does an experiential approach to the delivery of the Grade 10 Civics Curriculum such as DILA affect the development of active democratic citizens - as characterized by civic identity, civic engagement, and civic competence? And if so, how does it influence the students' understanding of their role in a democratic society, their self-reported likelihood of future civic engagement and their self-reported ability to be civically effective?

Three experiments were conducted to identify the impact of factors associated with the environment (predictability of the environment) and factors associated with an available expert (the accuracy of the expert and the cost of the expert's advice) on the optimal utilization of the expert. Across all three experiments, participants overutilized the expert (requesting advice when advice was suboptimal) when the expert accuracy was higher and when the environment was less predictable. Conversely, participants underutilized the expert (not requesting advice when doing so was optimal) more when the environment was more predictable and the expert was less accurate. Participants showed little sensitivity to the cost of advice, further compounding the errors. Requiring participants to request advice on every training trial increased reliance on the later optional expert and led to properties of the expert primarily influencing the decision to request advice. Requiring participants to rely only on the environmental cue during training decreased overall reliance on the later optional expert and led to properties of the environment primarily influencing the decision to request advice. Requiring participants to interact with both the environment and the expert during training led to better overall decisions and to the integration of environmental cues and properties of the expert to inform the decision to request advice.

Philosophiae Doctor - PhD / This research explores a poorly understood area of health systems: the nature of managerial decision-making in primary healthcare facilities, and the information that informs decision-making at this level. Located in the emerging field of Health Policy and System Research, this research draws on constructivist and participatory perspectives to understand the role of information and, more broadly, learning and knowledge in decisions that primary healthcare managers make, and the systemic factors influencing this. Using a multiple case study design with iterative cycles of in-depth data collection and analysis over a three year period, it examined the decision-making and information use in three cases of managerial responsibility in 17 primary healthcare facilities in a sub-district in Cape Town. The cases were: improving efficiency of service delivery, implementing programme priorities and managing leave of absence. Using multiple strategies for engaging primary healthcare facility managers, often as co-researchers of their own practice, the research sought to elicit both their explicit and tacit, experience-based knowledge on these phenomena. Key insights gained in the research are that firstly, operational health management at facility level is less linear and simple than policy-makers and planners often assume, and is, instead, characterised by considerable on-the-spot problem solving and people management to meet multiple agendas, which can be surprisingly complex. Secondly, contrary to prevailing views, managers do actively use information in decision-making, but require a wide range of information which is outside of the current, and indeed the globally-advocated, health information system (HIS). Thirdly, they not only use, but generate, information in their management routines and practices, and must learn from experience in order to adapt new interventions for successful implementation in their facilities and communities. This research thus makes explicit the value and use of informal information and knowledge in decision-making. It demonstrates, amongst others, a relationship of functional interdependence between the use of formal information in the HIS, and informal information and knowledge, suggesting that the latter has the potential to improve the use and utility of formal health information by making sense of it within the local context. Furthermore, building on the public policy literature on governance, this research develops a model to understand the multiple contextual influences on decision-making and information use, showing the central role of values and relationships across the health system. It proposes a causal mechanism for strengthening the use of information in decision-making. Finally, in giving priority to the informational needs of facility managers, this research offers a bottom-up perspective which argues for an integrated approach to health system strengthening which moves beyond atomised treatment of HIS strengthening. It suggests the need to re-think how to support facility managers by re-positioning the HIS relative to organisational learning, and leadership and management development.

Yes / Background: Experience-based co-design (EBCD) brings patients and staff together to co-design services. It is normally conducted in one organization which initiates and implements the process. We used the traditional EBCD method with a number of adaptations as part of a larger research study in the British National Health Service.Methods: The primary aim was to assess the feasibility and acceptability of conduct-ing research-initiated EBCD, to enhance intervention development prior to testing. As well as embedding the method in a research study, there were 3 further key adap-tations: (a) working across primary and secondary care sectors, (b) working on multi-ple sites and (c) incorporating theory-informed analysis.Results: We recruited four sites (covering both primary and secondary care) and, on each site, conducted the initial traditional EBCD meetings, with separate staff and patient groups—followed by a single joint patient-staff event, where four priority areas for co-design were agreed. This event was driven by theory-informed analysis, as well as the traditional trigger film of patient experiences. Each site worked on one priority area, and the four co-design groups met over 2-3 months to design prototype tools. A second joint event was held (not usually undertaken in single-site EBCD) where they shared and compared outputs. The research team combined elements of these outputs to create an intervention, now being tested in a cluster randomized controlled trial.Conclusions: EBCD can be successfully adapted for use across an entire patient pathway with multiple organizations and as part of a research process to identify an intervention for subsequent testing in a randomized trial. Our pragmatic approach used the patient experience to identify areas for improvement and co-designed an intervention which directly reflected patient priorities. / National Institute for Health Research programme ‘Improving the safety and continuity of medicines management at care transitions (ISCOMAT)’ RP‐PG‐0514‐2009.

Socialarbetare använder sig av flera typer av kunskap för att hantera komplexiteten av deras arbete, en del får man via utbildning men en del behöver förkroppsligas utifrån ett eget utforskande. Syftet med denna studie var att undersöka hur fronesis kommer till uttryck bland socialarbetare som jobbar med ungdomar med missbruksproblematik. Med inspiration från hermeneutik har i denna studie utforskat hur socialarbetare översätter deras tidigare erfarenheter till praxis. Empirin består av sex intervjuer med praktiserande socialarbetare som har flera års erfarenhet i behandlande arbete med ungdomar. Datat analyserades utifrån fronesis teori vilket är uppbyggd ur tre subkategorier: praktisk handling, moralen och personlig utveckling. Fronesis i denna studie är förmågan att anpassa sig till sammanhanget hos en situation och förmågan att handla i enlighet med en målsättning. Resultatet visar att subkategorierna gick att identifiera hos informanternas utsagor samt hade påverkan på varandra. Analysen visar att behandlarens målsättning kunde påverka både arbete samt möjligheter till vidare utveckling. / Social workers use several types of knowledge to get about in their complex work, some of which is given through education but some you have to embody on your own. The aim of this study is to use phronesis as a theory and see if this theory can explain some of the nature behind social workers experience-based knowledge. Using an approach inspired by hermeneutics this study aimed to explore how social workers translate their experience into praxis. The data consists of six interviews with practicing social workers with several years of experience in caring work with adolescents. The material was analyzed with phronesis theory which is built up by three subcategories¨: practical action, morals and personal development. Phronesis in this study is the ability to adapt to the context of the situation and the ability work towards a goal. The results show that the subcategories were identifiable in the data and had an influence on one another. Analysis shows that one’s goals could have effect on work and possibilities for further growth.

Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts. Purpose: This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden. Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design. Results: The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far. Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future. Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals. Keywords: Quality Improvement, Maternity Care, Neonatal Intensive Care, Experience-based Co-design

Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts. Purpose:This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden. Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design. Results:The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far. Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future. Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals.

The Association of American Colleges and Universities considers internships as one of several “High Impact Educational Practices.” While these experiential learning exercises are not new, there are resurgent calls for universities to help students find and engage in more internship experiences before completion of their undergraduate degrees. At the same time, however, the US Department of Labor has strict guidelines as to what constitutes “internships” and what constitutes “unfair labor practices.” While there is a history of the private and public sectors creating internships for students in professional-degree programs and business schools, a need exists for more internships for humanities students—particularly English and writing students. This dissertation examines considerations for faculty members working with English majors to develop internship initiatives with structures that have pedagogical foci and follow the US Department of Labor internship guidelines. Using a case study approach, this project examines the growth of Georgia State University’s English Department internship program over the past twenty years. Through exploration into the opportunities, locations, and structures relevant to an urban university, the study reveals how faculty members designed a student-focused program that serves students, the university, and the community. Relying largely upon the review of departmental archives; a study of the history of GSU in the Atlanta community; interviews with faculty members and internship providers; and an exploration into the terms “intern” and “internship,” the dissertation ultimately sets forth considerations for those working with student internship programs and a model for college and university internship program evaluation.

Wireklint Sundström, Birgitta, 2005. Prepared to be unprepared. A phenomeno-logical study of assessment with a caring approach and how it can be learned in the ambulance services.A focal point in this dissertation is that there is knowledge in the ambulance ser-vice that is experience-based, which has not always been made explicit, and that provides the foundation for the caregivers’ assessment of the patients and their needs for care. The first aim of the study was to describe and analyse the ambu-lance services with a focus on the phenomenon of assessment from the lifeworld perspective in the caring sciences. The second aim of the study was of an educa-tional nature where the object was to be able to draw conclusions about the learning process in the ambulance service in the light of the knowledge generat-ed by the empirical findings. Thus the aim was to create a synthesis consisting of didactic ideas that are based on the caring sciences and describing how assess-ment can be learnt and can support future caregivers in the ambulance services.Assessment in the ambulance service entails, on an overall level, having a natu-ral caring attitude that includes striving in two directions at the same time. These are that on the one hand the caregivers strive to bring order to that which is dis-ordered as soon as possible, to structure the unstructured, and in short define the indefinite in order to provide medical assistance. There is a need to quickly as-sess the patient’s condition and which measures are necessary. On the other hand the caregivers strive to let the indefinite wait a while in order to be able to meet the patient’s suffering. There is thus a desire to listen attentively to the individual patient.The essential meaning of assessment of patients in the ambulance services is that there are conflicting demands on assessment and care, which entails that the caregiver adapts him/herself to the prevailing care situation in a way that means being flexible and adaptable to the patient’s medical condition. The caregivers also have a flexibility and adaptability in relation to their colleague, which leads to a mutual interplay in the assessment. Assessment in the ambulance services also means that the caregivers are paradoxically prepared at the same time as be-ing unprepared, i.e. they are prepared for the unprepared. The assessment thus starts before the caregivers have reached the patient and the actual situation. Even if they “know” what awaits them, they do not really “know”. It becomes a dynamic struggle between on the one side the expectancy that feels certain and on the other the unknown in every new situation. The struggle contains a desire for control and effectiveness in a care practice full of surprises. / Kunskapscentrum PreHospen vid Högskolan i Borås, Institutionen för vårdvetenskap.

This study examined links between antisocial behaviour, moral emotions (i.e., sympathy and guilt), and negative emotionality in an ethnically diverse sample of 4- and 8-year-old children (N = 79). Primary caregivers reported their children’s antisocial behaviour, sympathy, and negative emotionality through a questionnaire and across a 10-day span via daily diary entries (n = 474 records). In a semi-structured interview, children reported their sympathy levels and guilt feelings. Children with high guilt in harm contexts and low negative emotionality were rated as less antisocial in both questionnaire and diary reports. For children with low guilt in exclusion contexts, low sympathy ratings predicted higher questionnaire-reported antisocial behaviour. For children with high guilt in prosocial omission contexts, high sympathy ratings predicted lower diary-reported antisocial behaviour. Lastly, high sympathy ratings predicted lower questionnaire-reported antisocial behaviour for children with low negative emotionality.