Newer New Jersey work-based learning teachers during the COVID-19 pandemic: school safety regarding ventilation, trainings, and awareness of government agencies resources.

New Jersey (NJ) Safe Schools Program (NJSS) provides code-required trainings for NJ teachers supervising students in work-based learning (WBL) experiences. During the COVID-19 pandemic, increased use of chemical cleaning, sanitization, and disinfectant products (CSDPs) led to ventilation and other health concerns. NJSS conducted two surveys of newer NJ WBL teachers between October 2021 and June 2023, with a follow-up in fall 2022 for those who completed initial surveys before summer 2022. This study focused on questions regarding workspace ventilation; respirator and CSDPs trainings; awareness of government resources for safety and health (S&H); and demographics. Over 65% of participant classrooms have operable windows or ventilation systems, while 13% of school salons have ceiling fans. Half of participants didn't receive training on handling CSDPs, although 90% were aware of government S&H resources. Data suggested teachers have well-ventilated workspaces and are aware of different resources available, which is important to continue post COVID-19.

Evaluating the process of practice enhancement for exclusive breastfeeding (PEEB): a participatory action research approach for clinical innovation.

BACKGROUND: Despite the known benefits of exclusive breastfeeding, global rates remain below recommended targets, with Ireland having one of the lowest rates in the world. This study explores the efficacy of Participatory Action Research (PAR) and Work-Based Learning Groups (WBLGs) to enhance breastfeeding practices within Irish healthcare settings from the perspective of WBLG participants and facilitators. METHODS: Employing a PAR approach, interdisciplinary healthcare professionals across maternity, primary, and community care settings (n = 94) participated in monthly WBLGs facilitated by three research and practice experts. These sessions, conducted over nine months (November 2021 - July 2022), focused on critical reflective and experiential learning to identify and understand existing breastfeeding culture and practices. Data were collected through participant feedback, facilitator notes, and reflective exercises, with analysis centered on participant engagement and the effectiveness of WBLGs. This approach facilitated a comprehensive understanding of breastfeeding support challenges and opportunities, leading to the development of actionable themes and strategies for practice improvement. RESULTS: Data analysis from WBLG participants led to the identification of five key themes: Empowerment, Ethos, Journey, Vision, and Personal Experience. These themes shaped the participants' meta-narrative, emphasising a journey of knowledge-building and empowerment for breastfeeding women and supporting staff, underlining the importance of teamwork and multidisciplinary approaches. The project team's evaluation highlighted four additional themes: Building Momentum, Balancing, Space Matters, and Being Present. These themes reflect the dynamics of the PAR process, highlighting the significance of creating a conducive environment for discussion, ensuring diverse engagement, and maintaining energy and focus to foster meaningful practice changes in breastfeeding support. CONCLUSION: This study highlights the potential of WBLGs and PAR to enhance the understanding and approach of healthcare professionals towards breastfeeding support. By fostering reflective and collaborative learning environments, the study has contributed to a deeper understanding of the challenges in breastfeeding support and identified key areas for improvement. The methodologies and themes identified hold promise to inform future practice and policy development in maternal and child health.

Countering technostress in virtual work environments: The role of work-based learning and digital leadership in enhancing employee well-being.

Virtual work has been highlighted as an important business trend nowadays. Technostress caused by information and communication technology threatens employee well-being in a virtual context. We integrate insights from the Job Demands-Resources theory to explore the impact of technostress on employee well-being and examine work-based learning and digital leadership capability as buffers of this negative impact via the attenuating effect of work exhaustion. We collected multi-wave survey data from 300 virtual employees to test the theoretical model. Results revealed a significant negative impact of technostress on employee well-being. However, work-based learning and digital leadership capability buffered employees' well-being from this negative effect by reducing their work exhaustion. Our findings extend our understanding of work design and shed light on how to cope with virtual work demands.

A tool for clarifying expectations in undergraduate research experiences.

Articulating clear and achievable expectations is fundamental to both education and organizational management. In this article, we provide a simple intervention for clarifying expectations-and establishing that these expectations have been understood-which proved beneficial both to community college interns and to their internship mentors in biotech-related undergraduate research experiences. Internship mentors were asked to utilize a simple Expectation Clarity Tool to outline the expectations, success metrics, baseline assessments, and training strategy and support that would be foundational to their intern's project. These included expectations around conceptual, technical, performance, and professional skills and behaviors. Concurrently, but independently, community college interns were asked to complete the same type of exercise as a way of identifying gaps in their knowledge and understanding of their mentor's expectations and their internship project. The mentor's completed Expectation Clarity Tool was then shared with their intern. As a result of completing this relatively simple intervention, the majority of mentors reported that it increased their confidence as a mentor, taught them a new mentoring skill, changed how they will mentor trainees moving forward, and positively impacted their relationship with their trainee. On the intern side, the majority of interns reported that engaging in this intervention, both as an independent exercise and in obtaining their mentor's completed Expectation Clarity Tool, increased their confidence as an intern and positively impacted the success of their internship.

Evidence of learning in workplace-based assessments in a Family Medicine Training Programme.

BACKGROUND:  Learning portfolios (LPs) provide evidence of workplace-based assessments (WPBAs) in clinical settings. The educational impact of LPs has been explored in high-income countries, but the use of portfolios and the types of assessments used for and of learning have not been adequately researched in sub-Saharan Africa. This study investigated the evidence of learning in registrars' LPs and the influence of the training district and year of training on assessments. METHODS:  A cross-sectional study evaluated 18 Family Medicine registrars' portfolios from study years 1-3 across five decentralised training sites affiliated with the University of the Witwatersrand. Descriptive statistics were calculated for the portfolio and quarterly assessment (QA) scores and self-reported clinical skills competence levels. The competence levels obtained from the portfolios and university records served as proxy measures for registrars' knowledge and skills. RESULTS:  The total LP median scores ranged from 59.9 to 81.0, and QAs median scores from 61.4 to 67.3 across training years. The total LP median scores ranged from 62.1 to 83.5 and 62.0 to 67.5, respectively in QAs across training districts. Registrars' competence levels across skill sets did not meet the required standards. Higher skills competence levels were reported in the women's health, child health, emergency care, clinical administration and teaching and learning domains. CONCLUSION:  The training district and training year influence workplace-based assessment (WPBA) effectiveness. Ongoing faculty development and registrar support are essential for WPBA.Contribution: This study contributes to the ongoing discussion of how to utilise WPBA in resource-constrained sub-Saharan settings.

Perspectives and Attitudes of Newer New Jersey High School Teachers towards Cleaning, Sanitizing, and Disinfecting Consumer Products Used in School Classrooms.

During the COVID-19 pandemic, there was an increased reported use of chemical cleaning, sanitizing, and disinfecting products (CSDPs), which created public concerns about negative health consequences for both children and adults in public schools. A subset of newer teachers shared experiences regarding safety and health (S&H) while working in school-based settings through a series of online surveys. Surveys were provided to teachers who completed work-based learning supervisory trainings provided by the New Jersey Safe Schools Program between October 2021 and June 2023. The participants answered questions focusing on CSDPs purchased for school use, their attitudes towards CSDPs, their use of personal protective equipment, and symptoms employees may have had due to CSDPs. A total of 205 teacher participants successfully completed the surveys. Over 25% of the teachers did not know where their CSDPs originated from, as they were provided by the school. Most participants "sometimes", "not often", or "never" read labels for CSDP ingredients or looked them up on healthy product apps. The participants (60%) tended to wear gloves while cleaning/disinfecting but did not wear masks. A third of the participants experienced respiratory health problems after working at school. Overall, the data suggest that more education on S&H regarding CSDPs needs to be provided to New Jersey teachers.

Which factors influenced the adoption of interprofessionality in health based on the reports of the PET-Health Interprofessionality projects in Brazil? A document analysis.

The Program of Education through Work - Health (PET-Health) Interprofessionality is one of the strategic actions of the "Plan for the Strengthening of Interprofessionality" in healthcare in Brazil. Based on the experience of the program, this paperexamines the aspects that impact the adoption and strengthening of interprofessional education and collaborative practices, and issues recommendations for the strengthening of interprofessionality as a guiding principle of training and working in healthcare. This is a document analysis of partial reports from the six- and 12-months of execution of 120 PET-Health Interprofessionality projects in Brazil. The data were analyzed based on content analysis and the categories elaborated a priori. The aspects that impact the adoption and strengthening of interprofessionality in training and working in healthcare, and future recommendations, were organized in the relational, processual, organizational, and contextual dimensions, according to the framework by Reeves et al. The PET-Health Interprofessionality expanded the understanding of elements of interprofessional education and practice and showed that the discussion must take on a more political, critical, and reflexive character. The analysis points to the need for continuity of teaching-learning activities as a strategy to foster interprofessional capacity in healthcare services and consequent strengthening of the Unified Healthcare System in Brazil.

Characterization and analysis of the proposals submitted to the PET-Health Interprofessionality in Brazil: advancements and future directions.

The Program of Education through Work for Health (PET-Health), with a focus on interprofessionality, is one of the actions of the Plan for the Strengthening of Interprofessional Education in Brazil. This research aimed to systematically analyze the characteristics of the proposals submitted to the public notice of the PET-Health Interprofessionality specifically in relation to the theoretical-conceptual and methodological alignment of interprofessional education (IPE). The study is a qualitative document content analysis. We analyzed one hundred and twenty projects submitted to the selection process from institutions participating in the PET-Health Interprofessionality. Content analysis followed three steps: pre-analysis, exploration of the material, and treatment and interpretation of results. Seven categories were identified: a) alignment with the theoretical-conceptual frameworks of IPE, b) curriculum changes, c) faculty development with a focus on IPE, d) articulation among objectives, actions, and results expected related to IPE, e) strategies for monitoring and evaluation, f) involvement of users/families and community, and g) development of collaborative competencies. We conclude that while some advancements have been made, there remains a need for more in-depth discussion in Brazil to ensure the development of competencies capable of assuring more integral, resolute, and safer healthcare services, with capacity to (re)signify user-centered care in the planning and delivery of healthcare.

Challenges and opportunities of evaluating work based interprofessional learning: insights from a pediatric interprofessional training ward.

Introduction: Interprofessional collaboration among healthcare professionals is fostered through interprofessional education (IPE). Work-based IPE has demonstrated effectiveness within interprofessional training wards. We developed the Interprofessional Training Ward in Pediatrics (IPAPED) and employ a combination of established assessment tools and a newly created IPAPED questionnaire, directed at to assess both students' learning experiences and program structure. This paper presents the development and analysis of the psychometric properties of the IPAPED questionnaire. Methods: Nursing trainees and medical students participated in IPAPED. The IPAPED questionnaire was developed to complement established instruments, based on IPE frameworks. Interprofessional collaboration and communication were represented in subscales in part 1 of the questionnaire. Part 2 focused on the IPAPED program itself. Statistical analyses included calculation of internal consistency for part 1 and exploratory factor analyses for part 2. Results: All IPAPED participants between November 2017 and November 2022 completed the questionnaire (n = 105). 94 of 105 questionnaires were analyzed. Internal consistency for part 1 was low (Cronbach's α <0.58). Exploratory factor analyses revealed three distinct factors: teaching and learning material, interprofessional learning facilitation and professional guidance by nurses on the ward. Discussion: Our results illustrate the challenge of performing high quality, theory based evaluation in a work-based setting. However, exploratory factor analyses highlighted the opportunity of focusing on both learning facilitators and staff on the wards to ensure a maximum learning output for participants. Developing program-specific questionnaires to gain insight into local structures has the potential to improve work-based IPE formats.

Effectiveness of a peer-mediated intervention on job and social skills for students with intellectual disability: a pilot study.

Building foundational job and social skills for high school students with intellectual disability (ID) is critical for post-school employment success. Unfortunately, students with ID often experience limited opportunities to learn and hone these skills while in school. One way to build job and social skills are through a peer-mediated intervention (PMI) in a work-based learning experience (WBLE). A multiple-baseline design across participant dyads with generalization probes was used to investigate the effects of implementing a PMI on job and social skills for students with ID in a WBLE. Results showed that participants demonstrated improvements in job task independence and social interactions. Furthermore, social interaction quality improved after implementing the PMI for most dyads. Limitations and implications for future research are discussed.

Evolution of the feedback conversation in anaesthesia education: a narrative review.

Over the past century, education has been a core component for improving patient safety. The initial focus was developing a curriculum and an assessment process. In recent decades, the value of work-based learning has come to the fore. Learning from work, or experiential learning, requires reflection, which is critically dependent on external feedback. Conceptions of feedback have moved from a transactional information transfer from the supervisor to the trainee to a learner-centred and collaborative process occurring in a complex socio-cultural environment. In this narrative review we describe the evolution of the feedback conversation, provide a model synthesising the core concepts of feedback, and offer some guidance for the development of effective feedback in anaesthesia education.

Learning as a way of achieving quality improvement in long-term care: A qualitative evaluation of The Story as a Quality Instrument.

AIM/OBJECTIVE: This study aimed to evaluate the use of the narrative quality instrument 'The Story as a Quality Instrument' (or SQI) for learning as a way of achieving quality improvement. BACKGROUND: Learning is a widespread aim in long-term care. If professionals share detailed information about their views on the quality of care, they can see it from each other's perspective and create a new joint perspective that may generate a broader meaning in total. One useful source for learning and improvement is the narratives of older adults. These narratives enable reflection and learning, which encourages action. In care organizations, there is a drive to find methods that can be used to facilitate learning and encourage quality improvement. DESIGN: A qualitative evaluation design. METHODS: Data collection was performed in 2021-2022 at six field sites of four large care organizations providing long-term care to older adults in the Netherlands. At each field site, SQI was applied: an action plan was formulated in a quality meeting and, 8-12 weeks later, the progress was evaluated in a follow-up meeting. The data collected was participants' responses during focus groups: the verbatim transcripts of both meetings and the observation reports of the researchers. 46 participants took part in the quality meetings and 34 participants were present at the follow-up meetings. The data was analyzed using thematic analysis. RESULTS: The results are mechanisms that help learning, participant responses, and practical challenges and conditions. Four mechanisms became visible that encourage learning among participants for achieving quality improvements: in-depth discussions, exchange of perspectives, abstraction, and concretization. The participants listed several outcomes regarding individual learning such as change of attitude, viewing older adults more holistically and the realization that possibilities for working on quality improvement could be just a small and part of everyday work. Participants learned from each other as they came to understand each other's perspectives. The added value lay in getting insights into the individual perceptions of clients, the concrete areas for improvement as an outcome, and getting a picture of the perspectives of diverse people and functions represented. Time was found to be the main challenge when applying SQI. CONCLUSIONS: SQI is deemed promising for practice, as it allows care professionals to learn in their workplace in a structured way from narratives of older adults in order to improve the quality of care.

Factors Influencing Effective Communication between Stakeholder Groups during DVM Work-Based Learning Program in Bangladesh.

This study aimed to review the existing communication systems between the universities, placement providers, and students during the DVM final year work-based learning (WBL) program in Bangladesh. The intention was to identify what factors impact the effectiveness of the communication system and to explore ways to enhance communication to better support the program. A questionnaire was used to collect details about the WBL program and the communication systems from all universities in Bangladesh. The questionnaire was completed on paper at a meeting of the National Veterinary Dean Council and online with a member of each university's WBL coordination team. A summary of the current WBL programs in Bangladesh was produced. Focus group discussions were used to collect more detailed information about the communication systems and were held via Zoom with recent graduates (n = 16) and placement providers (n = 7). Effective means of communication between all stakeholders were identified as an initial letter, phone calls, and spot visits by teachers. However, the frequency of formal communication before and during placements was variable and the ways of providing feedback on the communication systems were insufficient. These issues sometimes undermined the student learning experience. Suggestions for improvements included increased resourcing, greater use of online communication systems, and a national committee to oversee WBL. Other ways to motivate placement providers included a better honorarium and continuing education courses. The results suggest that existing communication systems for veterinary WBL in Bangladesh are not completely satisfactory. Measures are needed to improve communication to optimize the student learning experience and capitalize on the many benefits of the WBL program for all stakeholders.

Medical students remote consulting from home and from the health centre: A survey of prevalence and supervisor perspectives.

PURPOSE: A shift to remote consulting characterised the early stages of the COVID-19 pandemic in general practice which resulted in significant changes in the delivery of medical education. It is unclear whether these changes have been sustained and how they are perceived by faculty. METHODS: We surveyed a defined population of GP practices during April 2022 with questions to elicit estimates of medical student involvement in different types of remote consultation and supervisor ratings of their confidence in supervising different modalities of remote consultation. We performed thematic analysis on free text responses from a 'resistance to change' perspective. RESULTS: A response rate of 96% (n = 115) was achieved. Analysis of quantitative data identified that a significant proportion of student consultations were remote, however there was a large variation between practices. Supervisor confidence was lowest for students consulting from home. Thematic analysis identified ways in which clinical supervisors may perceive the innovation to be at odds with their overriding commitments to safety, simplicity and quality. CONCLUSIONS: Remote consultations form a significant proportion of medical student activity in many practices. Some supervisors are reluctant to supervise medical students consulting from home and our findings suggest ways of addressing this so that the benefits of the innovation can be harnessed.

An analysis of the role performance and characteristics of an ideal clinical tutor: Perspectives from undergraduate diagnostic radiography students in KwaZulu-Natal.

INTRODUCTION: Work Integrated Learning (WIL) is an essential core component for undergraduate students pursuing the Radiography profession. Clinical tutors in WIL placements assist students in acquiring the skills and knowledge required to register and practice as a Diagnostic Radiographer. Importantly, the characteristics of clinical tutors have been reported to impact students' experience in the clinical work environment. METHODS: An explorative-descriptive qualitative research design was employed. Using the non-probability purposive sampling method, 15 Diagnostic Radiography students studying at a Higher Education Institution in South Africa participated in the study. Semi-structured interviews with open-ended questions were used as the data collection tool and data was analyzed by the application of Thematic Analysis. RESULTS: The findings are suggestive that students prefer a clinical tutor who is knowledgeable within the field in order to facilitate learning within the clinical sector of Radiography, as well as to better integrate theory into practice. Furthermore, students prefer a clinical tutor who is empathetic, understands and respects students. The Table of Themes emerged from the conceptual framework under Carl Rogers' Theory of Facilitation (Rogers, 1979) which gives rise to three conditions of learning that must be provided by a clinical tutor. CONCLUSION: The emerging characteristics from the study strongly correlate with other studies performed internationally. The relevance of students' relationships with their clinical tutors was regarded as a crucial factor influencing students' work integrated learning placement experience. According to the findings, one of the most important drivers of a successful work integrated learning experience is the clinical tutor's attitude towards the student. IMPLICATIONS FOR PRACTICE: Improvement of the practice of clinical tutors within WIL placements and enhanced awareness of clinical tutors on how they impact students during clinical practice.

Culture and language coaching for bilingual residents: the first 10 years of the CHiCoS model.

ProblemIn the US, there are neither professional standards nor adequate formal training opportunities related to physician use of non-English languages, the most common of which is Spanish. To achieve safe, effective health care for culturally and linguistically diverse patients, the medical profession needs clear standards for physician language use and proven culture and language training models that include validated assessment of linguistic proficiency. InterventionThe authors describe the first decade of an innovative culture and language coaching program for bilingual (Spanish-English) pediatric residents, including the model's evolution and outcomes, as well as recommendations for implementing similar programs elsewhere. Over 10 years, the model has grown from a central innovation-the professional culture and language coach (CLC). The CLC provides 1:1 in-visit support and post-visit coaching to individual residents during three years of continuity clinic experience in a Spanish-language setting (Clínica Hispana de Cuidados de Salud-CHiCoS). They also provide a range of supplementary learning activities (e.g., simulations, immersion rotations, mock testing) and periodic formal assessment of language proficiency. Foundational program elements include cultural and linguistic humility, variations in language, pragmatic linguistics and trans-languaging, the inseparability of culture and language, health literacy, and a flat teaching hierarchy ("all teach, all learn"). ContextCHiCoS has been implemented continuously since 2009 in the primary care clinic of a stand-alone academic pediatric hospital in the Midwest, where pediatric residents have their continuity clinic experience over three years of residency. ImpactFifty-six residents have participated, reporting improved language skills, cultural knowledge, and ability to care for Spanish-speaking patients. Sixty-eight percent of residents not qualified bilingual upon program entry passed a validated physician language assessment by graduation. Spanish-speaking patients seen by CHiCoS residents and faculty reported higher satisfaction, trust, and communication scores than those seen in non-bilingual areas of the same clinic (p < .05 for all scores). The program increased bilingual faculty six-fold and changed attitudes and practices related to language supports throughout the residency program. Lessons LearnedCulture and language coaching provides effective preparation and assessment of bilingual physicians, leading to improved care for culturally and linguistically diverse patients. Our model offers an example for developing similar approaches for a variety of clinicians throughout health care. Such approaches should include professional standards for non-English language use, training supports customized to bilingual learners' proficiency levels, and a focus on integrating practical cultural and linguistic skills to achieve safe, effective clinical communication.

Pain Interventions for people with dementia: a quasi-experimental study.

BACKGROUND: Due to the complexity of the provision of care for people with dementia, pain assessment and management is still considered to be lacking. An optimal way to support frontline staff in providing pain assessment and management for people with dementia living in nursing homes has not yet been identified. The success of supporting interventions seems dependent on contextual factors in the nursing homes. This study, therefore, analyzes the feasibility of a nurse-led training intervention, using repeated on-site case studies, in modifying pain intensity and frequency in people with dementia. METHODS: Using a quasi-experimental design, we undertook a multi-center study of nurse-led training in pain management, with subsequent on-site case studies. Healthcare workers from 3 nursing homes assessed pain in 164 residents with dementia over 147 days. We used mixed-effect growth curve models with spline regression to analyze the data. RESULTS: We found that on-site case studies support frontline staff with pain management and assessment. Repeated reflection in case studies led to significantly longer pain free intervals (from 4.7 at baseline to 37.1 days at second follow-up) and decreased frequency of pain events (OR 0.54 at first follow-up and 0.43 at second follow-up). However no trends regarding pain intensity could be found. Therefore, on-site case studies may be valuable for improving pain frequency and pain-free intervals over time. CONCLUSION: This feasibility study shows the potential of on-site support for frontline nursing home staff. On-site case studies may also affect health outcomes in people with dementia. However, the complexity of dementia care necessitates the management of a broader range of needs. TRIAL REGISTRATION: The study was retrospectively registered on the tenth of January 2017 with the German registry of clinical trials (DRKS00009726).

Identifying Benefits, Challenges, and Options for Improvement of Veterinary Work-Based Learning in Bangladesh.

Work-based learning (WBL) provides relevant contemporary experience of working environments. Potential benefits for students include developing invaluable skills (clinical, personal, cultural, and professional) and gaining greater awareness of the profession and future career opportunities. However, there are also challenges related to running and sustaining a successful WBL program. In the context of this study, WBL refers to external placements undertaken by final-year students. The aims of the study were to identify ways to optimize the benefits while managing the challenges in delivering WBL in a veterinary curriculum. An in-depth study was undertaken at Chattogram Veterinary and Animal Sciences University (CVASU), Bangladesh, where a WBL program has been in place for 20 years. Final-year veterinary students at CVASU were surveyed to ascertain WBL experiences; survey findings were further explored in focus groups with students, recent graduates, faculty, and placement providers. Most agreed that they had sufficient opportunities to observe, assist, and directly handle pet and farm animals with top skills learned, including clinical diagnosis and communication, and recognized the value of learning in professional workplaces. Based on suggested areas of improvement, the following recommendations can be made: carefully selecting placements, adjusting time allocation, improving communication and building strong collaborations with placement providers, allowing students to customize more placements to align with their career preferences, and staffing adequately to arrange placements and manage a WBL program. Overall, results suggest the current WBL arrangements at CVASU are reasonably good, but there are some specific areas for improvement.

Exploring current undergraduate student perspectives on the introduction of the degree apprenticeship scheme in diagnostic radiography - a single institution study.

INTRODUCTION: The first degree apprenticeship programme in diagnostic radiography was launched in March 2020. This route into radiography runs in parallel with 'conventional' pre-registration programmes where students apply to a higher education institution (HEI) and undertake discrete clinical placements. The aim of this study was to explore the perspectives of pre-registration students on the diagnostic radiographer degree apprenticeship route. METHODS: A qualitative approach (online questionnaire) gathered attitudes and opinions of pre-registration students from a single HEI, regarding the degree apprenticeship programme. Participants were pre-registration medical imaging students from all stages of the programme (n = 204). Braun and Clarks's thematic analysis was employed for data analysis. RESULTS: A response rate of 21% (n = 44) was recorded. Four themes emerged from data analysis: (1) misunderstandings surrounding the degree apprenticeship, (2) financial implications and (3) practical experience associated with both degree courses and (4) the experience the pre-registration degree has to offer. CONCLUSION: There was an apparent lack of understanding regarding the degree apprenticeship leading students to misinterpret aspects of the course. Additionally, students highlighted the earning aspect of the apprenticeship to be an advantage in comparison to student debts associated with the traditional pre-registration programmes. Furthermore, students emphasised the advantage of the clinical focus practice associated with the degree apprenticeship. Nevertheless, students who have selected the HEI route still value what the traditional pre-registration degree offers. IMPLICATIONS FOR PRACTICE: As degree apprenticeship programmes become widely available, a greater awareness should, therefore, follow. In the interim, there is scope for HEIs to seek to raise awareness of degree apprenticeship provision. HEIs should seek to allay any concerns and highlight the benefits of having this alternative route into the profession.

Evaluating the use of participatory action research to implement evidence-based guidance on dementia palliative care in long-term care settings: A creative hermeneutic analysis.

BACKGROUND: Dementia affects a large proportion of society and places a significant burden on older people and healthcare systems internationally. Managing symptoms at the end of life for people with dementia is complex. Participatory action research can offer an approach that helps to encourage implementation of evidence-based practices in long-term care settings. METHODS: Three evidence-based guidance documents (pain assessment and management, medication management, nutrition and hydration management) were introduced in three long-term care settings for older people. Data generated from work-based learning groups were analysed using a critical hermeneutic approach to explore the use of participatory action research to support the implementation of guidance documents in these settings. RESULTS: Engagement and Facilitation emerged as key factors which both enabled and hindered the PAR processes at each study site. CONCLUSIONS: This study adds to the body of knowledge that emphasises the value of participatory action research in enabling practice change. It further identifies key practice development approaches that are necessary to enable a PAR approach to occur in care settings for older people with dementia. The study highlights the need to ensure that dedicated attention is paid to strategies that facilitate key transformations in clinical practice.