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The demands upon the social care workforce in the UK are only likely to increase over the next decades. The social care sector is heavily reliant on NVQs and this is regulated through the Care Standards Act (2000). It is thus important that these qualifications appropriately support staff development. The purpose of the research was to explore this in one social care organisation (Homecare) through researching staff perspectives on factors that inhibited or supported learning through NVQs and to examine the Homecare/Centre delivery of NVQs and workplace learning with this in mind. The research is broadly qualitative in design and draws on the principles of narrative research combined with analysis focused on key themes (interpersonal, personal and organisational factors). The research found that an understanding of the key concepts of workplace learning is relevant to the delivery of NVQs and can help these qualifications be implemented successfully as a part of a more holistic approach to teaching, learning and the assessment of competence in the workplace. The research identified that the organisation had a particular approach that strategically integrated assessment both at organisational and practice level. Additionally the research identified areas within the NVQ process, where integrated assessment proved of benefit to practice through professional level development of skills and knowledge, values and reflective learning and confidence. From this eight key elements of an enhanced model of NVQ delivery were identified that constitute the contribution to practice. The contribution to theory lies in linking the literatures of NVQs, competence and workplace learning and the suggestion that previous understanding of NVQs as behaviourist and atomistic is not as important as the approach to assessment adopted by organisations. The research has relevance to any social care organisation but also to wider audiences where NVQs are used as it adds to understanding of workplace learning through a depth of practitioner-researcher understanding of specific qualifications in a specific context.

Theses (Ed. D.)--Marshall University, 2007. / Title from document title page. Includes abstract. Document formatted into pages: contains vii, 261 pages. Bibliography: p. 193-241.

Therapy decision-making for patients with chronic diseases can be difficult. Such patients usually live with their illness(es) all their life, and therapies can only help them improve their condition by managing symptoms, not curing them. Patient-oriented approaches are common to caring for people with chronic conditions because patients’ priorities become relevant means of prioritizing therapies in the absence of a cure. While such type of approach is shown to be effective, it does not leverage evidence on the success of given therapies to achieve specific similar patient goals in the past. Evidence-Based Medicine (EBM) is a concept that was introduced to the medical field in the early 90s to invalidate previously accepted tests and therapies and replace them with new, more powerful, more accurate, more efficacious, and safer ones. Unfortunately, despite the prevalence of patient-oriented approaches for patients with chronic diseases, data collected on patients is not systematically leveraged to support therapy decisions. Combining evidence-based decision-making and patient-oriented approaches could potentially further improve patient outcomes by leveraging the most up-to-date data to recommend and discuss therapy options for patients with chronic conditions. The development and implementation of Learning Health Systems (LHS) is another solution to improving patient outcomes, one that the US Institute of Medicine strongly recommends. The development and implementation of a LHS to support therapy choice for patients with chronic conditions could improve related decisions by fostering continuous learning regarding which therapy may help better achieve which patient goals. However, a learning process that systematically leverages a relevant basis of evidence to support patient-oriented approaches has yet to be defined. As such, this study aims at articulating a learning process for therapy decision-making in the context of chronic conditions. The result is framework and a demonstration of its application using the Goal Attainment Scale (GAS) and synthetic data.

Det är viktigt hur kontorsmiljöer utformas så att de kan skapa förutsättningar för lärande, välbefinnande och hälsa på arbetsplatsen. Syftet med aktivitetsbaserade kontor (ABkontor) är att ge de anställda möjligheten att välja den kontorsplats som bäst lämpar sig för den uppgift som ska utföras. Det innebär att ingen har en egen plats att gå till. Även om den här kontorstypen blir alltmer populär finns det begränsat med forskning som undersökt vilken effekt ABkontor har på kommunikation, stöd, hälsa och välbefinnande, särskilt ur ett lärandeperspektiv. Syftet med den här studien var att undersöka om det finns skillnader mellan män och kvinnor i hur de skattar hälsa, välbefinnande och hur nöjda de är med olika förutsättningar för informellt lärande i ABkontor, samt om det finns ett samband mellan förutsättningar för informellt lärande på arbetsplatsen och upplevd hälsa och välbefinnande. Ett frågeformulär skickades ut till 174 arbetare på ett av Trafikverkets kontor och svarsfrekvensen var 53 %. Analyserna visar att det inte fanns någon signifikant skillnad mellan män och kvinnor i hur tillfredsställda de är med de olika förutsättningarna, generellt så skattades tillfredställelse högt. Ett signifikant samband hittades mellan informellt lärande och välbefinnande men inte mellan informellt lärande och hälsa. Vidare forskning behövs för att undersöka om informellt lärande faktiskt äger rum i ABkontor genom att undersöka en större population och en större variation av ABkontor för att reda ut den kausala relationen mellan informellt lärande och välbefinnande. / It is important how office environments get designed so they can promote conditions for learning, well-being and health in the workplace. The purpose of an activity-based office (ABW) is to give the employees a possibility to choose the workplace best suited for the task at hand, implying that no one has their own private office to go to. Although this office environment gets increasingly popular, there is a lack of research demonstrating the effects of ABW:s on communication, collegial support, health and wellbeing, especially from a learning perspective. The aim of this study was to investigate differences in how satisfied women and men are in an ABW with the conditions for informal learning, such as work-related information exchange, cooperation and social support and test whether it is a relation between informal learning at work and self-rated wellbeing and health. A questionnaire was sent out to 174 employees working at the Swedish Transport Administration and the response rate was 53 %. The analyses showed that there is no significant difference between men and women in how satisfied they are with the conditions for informal learning in the ABW, overall both genders gave high ratings on satisfaction. A significant relationship was found between informal learning and well-being but not between informal learning and health. Further research is needed to investigate whether informal learning actually takes place in the activity-based office, using a bigger sample and variety of ABW:s, to clear out if the relation between informal learning and well-being is causal.

This thesis offers a rethinking of the role for education as critical workplace pedagogy in complex problems of health care. Taking the case of paediatric diabetes, the study explored how health-care professionals learn the work of supporting children, and their parents, to self-manage the condition. By reconceptualising work problems as sociomaterial learning struggles, this research contributes new understandings of informal professional learning in everyday health-care provision. Data were generated through fieldwork in an outpatient clinic. Particular challenges of supporting self-management in this case were the difficulties of balancing policy aspirations for empowerment with biomedical knowledge about risks to immediate and long-term health. Tracing the materialisation of learning as it unfolded in moments of health-care practice showed professionals handling multiple and contradictory flows of information. Particular challenges were posed by insulin-pump technologies, which have specific implications for professional roles and responsibilities, and introduce new risks. A key insight is that professionals were concerned primarily with the highly complicated perpetual discernment of safe parameters within which children and their parents might reasonably be allowed to contribute to self-management. Such discernment does not readily correspond to the notion of empowerment circulating in the policies and guidelines intended to enable professionals to accomplish this work. As a result, this thesis argues that the work of discernment is obscured. Learning strategies evolve, but could be supported and extended by explicit recognition of the important work of learning as it unfolds in everyday practices of supporting self-management in paediatric diabetes. Most importantly, workplace pedagogies could be developed in ways that attune to the profound challenges and uncertainties that are at stake in these practices.

Thesis (Ph.D.) - Carleton University, 2007. / Includes bibliographical references (p. 210-228). Also available in electronic format on the Internet.

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The purpose of the study is to contribute to knowledge about physical education teachers' understanding of health and how the view of health can be related to theories about health. The theories used in the study are the salutogenic and pathogenic perspective and KASAM. Four physical education teachers participated in a qualitative interview study. The result showed that the physical education teachers have similar views on health in the current society. However, the view on health has changed since the teachers' upbringing until today. The result showed that students today are more sedentary than before, and spontaneous sports have almost disappeared. The physical education teachers hung out with friends while doing physical activity during their upbringing, and therefore did not consider that physical activity has a positive effect on health. The physical education teachers spoke of a salutogenic perspective on health when describing their upbringing and used a more pathogenic language about their health today and about young people today. The physical education teachers want to teach about and in health to prevent health-related diseases. The results showed that health in physical education is often defined as theoretical, and that the purpose of the physical part of physical education is to improve fitness and reduce the students' sedentary behavior. / Syftet med studien är att bidra med kunskap om idrottslärares förståelse av hälsa och hur hälsosynen kan relateras till teorier om hälsa. Teorierna som används i studien är det salutogena och patogena perspektivet och KASAM. Fyra idrottslärare deltog i undersökningen genom en kvalitativ intervjustudie. En idrottslärare arbetar på låg- och mellanstadiet, två på högstadiet och en på ett gymnasium. Resultatet påvisade att idrottslärarna har en snarlik syn på hälsa i det nuvarande samhället. Synen på hälsa har dock förändrats sedan lärarnas uppväxt tills idag. Resultatet påvisade att eleverna i dagens samhälle är mer stillasittande än förr och att spontanidrotten nästintill har försvunnit. Idrottslärarna umgicks med vänner samtidigt som de utövade fysisk aktivitet under deras uppväxt, och tänkte därför inte på att den fysiska aktiviteten gjorde gott för hälsan. Idrottslärarna talade om ett salutogent perspektiv på hälsa när de beskrev sina uppväxter och använde ett mer patogent språk om deras hälsa idag och om ungdomar i dagens samhälle. Idrottslärarna vill undervisa om och i hälsa för att förebygga hälsorelaterade sjukdomar. Resultatet påvisade att hälsoundervisningen ofta definieras som teoretisk och att den fysiska delen undervisningen är till för att förbättra konditionen och minska elevernas stillasittande.

Les systèmes de santé "apprenants" (SSA) présentent une approche complémentaire et émergente aux problèmes de la recherche translationnelle en couplant de près les soins de santé, la recherche et le transfert de connaissances. Afin de permettre un flot d’informations cohérent et optimisé, le système doit se doter d’une plateforme intégrée de partage de données. Le travail présenté ici vise à proposer une approche de partage de données unifiée pour les SSA. Les grandes approches d’intégration de données sont analysées en fonction du SSA. La sémantique des informations cliniques disponibles dans les sources biomédicales est la résultante des connaissances des modèles structurelles des sources mais aussi des connaissances des modèles terminologiques utilisés pour coder l’information. Les mécanismes de la plateforme unifiée qui prennent en compte cette interdépendance sont décrits. La plateforme a été implémentée et testée dans le cadre du projet TRANSFoRm, un projet européen qui vise à développer un SSA. L’instanciation du modèle de médiation pour le projet TRANSFoRm, le Clinical Data Integration Model est analysée. Sont aussi présentés ici les résultats d’un des cas d’utilisation de TRANSFoRm pour supporter la recherche afin de donner un aperçu concret de l’impact de la plateforme sur le fonctionnement du SSA. Au final, la plateforme unifiée d’intégration proposée ici permet un niveau d’expressivité suffisant pour les besoins de TRANSFoRm. Le système est flexible et modulaire et le modèle de médiation CDIM couvre les besoins exprimés pour le support des activités d’un SSA comme TRANSFoRm. / Learning health systems (LHS) are gradually emerging and propose a complimentary approach to translational research challenges by implementing close coupling of health care delivery, research and knowledge translation. To support coherent knowledge sharing, the system needs to rely on an integrated and efficient data integration platform. The framework and its theoretical foundations presented here aim at addressing this challenge. Data integration approaches are analysed in light of the requirements derived from LHS activities and data mediation emerges as the one most adapted for a LHS. The semantics of clinical data found in biomedical sources can only be fully derived by taking into account, not only information from the structural models (field X of table Y), but also terminological information (e.g. International Classification of Disease 10th revision) used to encode facts. The unified framework proposed here takes this into account. The platform has been implemented and tested in context of the TRANSFoRm endeavour, a European project funded by the European commission. It aims at developing a LHS including clinical activities in primary care. The mediation model developed for the TRANSFoRm project, the Clinical Data Integration Model, is presented and discussed. Results from TRANSFoRm use-cases are presented. They illustrate how a unified data sharing platform can support and enhance prospective research activities in context of a LHS. In the end, the unified mediation framework presented here allows sufficient expressiveness for the TRANSFoRm needs. It is flexible, modular and the CDIM mediation model supports the requirements of a primary care LHS.