Biomedical subjects

Nigel King

Publications and source records attributed to Nigel King.

8 recordsLinked to original sources

PubMed2007

Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning.

OBJECTIVE: To develop a model linking the processes and outcomes of workplace learning. METHODS: We synthesised a model from grounded theory analysis of group discussions before and after experimental strengthening of medical students' workplace learning. The research was conducted within a problem-based clinical curriculum with little early workplace experience, involving 24 junior and 12 senior medical students. RESULTS: To reach their ultimate goal of helping patients, medical students must develop 2 qualities. One is practical competence; the other is a state of mind that includes confidence, motivation and a sense of professional identity. These 2 qualities reinforce one another. The core process of clinical workplace learning involves 'participation in practice', which evolves along a spectrum from passive observation to performance. Practitioners help students participate by being both supportive and challenging. The presentation of clear learning objectives and continuous periods of attachment that are as personal to the student(s) and practitioner(s) as possible promote workplace learning. CONCLUSIONS: The core condition for clinical workplace learning is 'supported participation', the various outcomes of which are mutually reinforcing and also reinforce students' ability to participate in further practice. This synthesis has 2 important implications for contemporary medical education: any reduction in medical students' participation in clinical practice that results from the patient safety agenda and expanded numbers of medical students is likely to have an adverse effect on learning, and the construct of 'self-directed learning', which our respondents too often found synonymous with 'lack of support', should be applied with very great caution to medical students' learning in clinical workplaces.

Attitude of Health Personnel↗

PubMed2005

Interprofessional relationships and collaborative working: encouraging reflective practice.

A challenge for those involved in the education and professional development of health and social care practitioners is to find ways of encouraging and enabling them to critically reflect upon complex collaborative situations and consider how they might improve interprofessional relationships. To meet this challenge, we piloted and developed a reflective exercise derived from methods used in personal construct psychology (Hargreaves,1979; Salmon,1994), which has proved to be useful in three overlapping areas; research, professional development, and classroom teaching. To illustrate the technique, this paper presents a case study of one district nurse who used the method to help her examine complex interprofessional relationships when providing long-term community care. The reflective technique (which uses arrow-shaped cards displayed on large visual layouts) was found to provide a rich description of the individual's relationships. By employing the visual displays the district nurse was able to explore the meanings of professional identity and roles in terms of professional relationships, and to consider her intentions and actions within a complex multidisciplinary situation.

Cooperative Behavior↗

PubMed2005

Clinical teachers and problem-based learning: a phenomenological study.

AIM: To explore how clinicians perceive their roles in problem-based medical education, and how closely those perceptions link to the curriculum they teach. METHOD: All 14 general physicians in a teaching hospital took part in 6 semistructured discussions, which were analysed phenomenologically. RESULTS: Third year clinical teaching was described in terms that bore little relation to problem-based learning (PBL). Teachers placed great importance on the social dimension of professional learning. They expressed strongly positive affects towards learners and their learning that they found hard to express as PBL tutors. Their narratives of education were remarkably divorced from modern day clinical practice. CONCLUSIONS: Problem-based method lacked some important conditions for professional teaching and learning. Traditional apprenticeship is unsustainable under present day conditions of practice. There is a need for new educational methods that help the learner to build a professional identity through social interaction with practitioners.

Curriculum↗

PubMed2005

'Now nobody falls through the net': practitioners' perspectives on the Gold Standards Framework for community palliative care.

The Gold Standards Framework (GSF) seeks to facilitate consistent and high quality community palliative care through a set of guidelines, mechanisms and assessment tools. The present study set out to examine practitioners' perspectives on the GSF during its first national roll-out. Two general practices that had adopted the GSF were recruited in each of four geographical areas, and each matched as closely as possible with a non-GSF practice. Sixty-eight semi-structured telephone interviews were carried out with general practitioners and district nurses in 16 selected practices, along with the GSF facilitator and up to four other 'stakeholders' in each area. Analysis revealed that the majority of GSF participants felt that the framework had strengthened their provision of community palliative care. In particular, communication within primary health care teams and co-ordination of services improved, aspects which were better in the GSF practices than in the matched non-GSF practices. Practitioners felt there was more consistency of care, with a reduced likelihood that individual patients would 'slip through the net'. The most common areas of concern were in relation to the workload associated with the role of the GSF co-ordinator. Implications for the development and effective implementation of the framework and for further research are discussed.

Attitude of Health Personnel↗

PubMed2004

Family carers' experiences of out-of-hours community palliative care: a qualitative study.

Carers' feelings of uncertainty and anxiety can be particularly acute out-of-hours, when they may not have access to familiar sources of professional help and advice. The present study used qualitative semi-structured interviews to explore carers' experiences of out-of-hours care and support services. Fifteen bereaved carers in the Calderdale and Kirklees area were interviewed, and the interview transcripts analysed thematically. In general, carers felt well supported out-of-hours, especially by the nursing services. They appreciated opportunities to develop some degree of personal relationship with those they saw out-of-hours. However, in some cases problems were apparent. These were associated with poor provision of information, inadequate communication with carers, difficulties in accessing night-sitter services, or the inflexibility of services. The findings underline the importance of primary care practitioners taking an anticipatory approach to community palliative care.

After-Hours Care↗

PubMed2003

An out-of-hours protocol for community palliative care: practitioners' perspectives.

Much of palliative care takes place in the patient's home. Out-of-hours service provision can be an area of concern. With the aim of improving this service, the former Calderdale and Kirklees Health Authority introduced an out-of-hours protocol for palliative care in the community. After 1 year the authors examined the experiences of primary care practitioners in using the protocol. Twenty district nurses and 15 GPs from 25 general practices in Calderdale, Huddersfield and North Kirklees took part in the study, which involved face-to-face group and individual telephone interviews. Practitioners felt that the out-of-hours protocol had made a positive contribution to palliative care in the community and that the out-of-hours handover form played a key role in improving communications and the coordination of services. For many participants, the protocol encouraged a more anticipatory approach to care and enabled better access to drugs and to specialist advice. The main areas of concern related to updating patient information on the handover forms, and to shortcomings in the support offered to carers. Future developments should address these issues. Although recognizing the dangers of generalization from research of this type, the findings offer encouragement to others considering similar schemes.

Attitude of Health Personnel↗

PubMed2003

Professional identities and interprofessional relations: evaluation of collaborative community schemes.

Despite the widespread support for integrated community care in the U.K., interdisciplinary working between health and social service staff remains complex and tentative. This paper represents the findings of an evaluative research study of two collaborative community nursing schemes at differing stages of project development within West Yorkshire, England. The studies set out to explore in depth the ways social and health care professionals construe their identity and relationships within the changing context of collaborative projects. The research adopted a constructivist phenomenological approach, conducting focus groups with social workers and district nurses; supplemented by in-depth individual interviews. Using template analysis enabled the researchers to explore themes and issues generated from the groups and individuals. A number of areas associated with professional identity and the development of roles in response to changing situations were identified as pertinent including; role ambiguity, role erosion and extension. In cases where joint working required a reconstructing of professional identity, individuals were constrained by their personal meanings, organizational arrangements and public perceptions. Implications for research and practice are discussed.

Community Health Services↗

PubMed2002

"You can't cure it so you have to endure it": the experience of adaptation to diabetic renal disease.

In this study, the experience of adaptation to diabetic renal disease was examined from a phenomenological perspective. Twenty patients attending a diabetic renal clinic were interviewed in depth. Through the use of a template analysis approach, a set of strong themes relating to changes in lifestyle was identified: changes in the nature of involvement with the medical system, coping strategies, and hopes, fears, and expectations. Almost all participants attempted to construct a "good adaptation" in the face of the uncertainties surrounding their condition by adopting a stoic and fatalistic stance. This is discussed in the context of the claim that contemporary society holds emotional self-expression rather than stoical endurance to be the appropriate response to suffering.

Adaptation, Psychological↗