Educational needs during the team supervision intervention

The supervisees’ educational needs were examined during team supervision using follow-up inquiries. This was done to explore and identify the possible changes in these during the intervention. The following chapter focuses on addressing the second study aim (see chapter 3).

During team supervision, the majority of the respondents (45.8% - 63.6%) in all wards shared the perception that the development of work was important. Most of the respondents were also extremely willing to participate in education (40.9% - 58.3%), and the average number of in-service education sessions within and outside the organisation during a six month period was 1 – 2 times.

The variety of in-service education within and outside the organisation in which the supervisees had participated during the intervention was versatile. Respondents had participated in in-service education organised on different organisational levels (i.e. ward, clinic, hospital district), but also in national, extensive training days for different professional groups (e.g. nurses, assistant nurses, ward secretaries) or specialities (e.g. anaesthetic nurses, ophthalmology nurses, ICU and paramedics) and international conferences. The foci of education were as follows:

- managerial and leadership training (e.g. growth in leadership and change, total quality management), - current topics of medicine in one’s speciality (e.g. neuro-surgical emergencies, cataract patients’ day

surgery),

- nursing and patient care (e.g. ethical issues and values of nursing, primary care, supporting patients in crisis and debriefing, multi-cultural nursing, caring for dying patients),

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- quality related training (e.g. projects on quality improvement, customer services, services by telephone), - targeted computer training (e.g. laboratory services, economy follow-up, rota planning),

- protection of privacy (e.g. documentation and confidentiality)

- occupational safety and health issues (e.g. violence against health care professionals, management of catastrophic situations in hospital organisations and civil defence, gas and electricity safety) and

- collaboration (e.g. human relations and problems, team membership, developing a work community).

The variety of in-service education served for different functions and purposes on the participating wards and only in rare cases the respondents rated the benefits of education as useless or superficial.

Computer training was rated as extremely important since staff used a variety of computer systems to operate a number of services and actions in hospital organisation, but providing assistance for colleagues was also very common. Occupational safety issues were another important topic. The respondents who had received in-service education on safety issues mentioned their improved feelings of safety and the practical nature of the information acquired. Managerial training was rated as beneficial. Participants, ward managers, described the support for their leadership tasks, assistance in finding strategies for intensifying the ward’s operations, clarification of financial matters and assistance in understanding the factors regulating the operations in the clinic. Education on the current topics of medicine had provided important information about the newest treatment courses, increased and up-dated the staff’s knowledge of medicine, but also improved motivation and stimulated their everyday work. The benefits of the education on nursing and patient care were described from several perspectives. Participants reported that their knowledge and understanding had deepened, their capacity to encounter and support patients had improved and that the in-service education had stimulated the practice by creating new ideas for further elaboration. The training days for different professionals served to support the practitioners’ professional identity and increased their strengths, but also gave wider and new perspectives on professional issues. The international conferences were described as highly beneficial and important as they improved the appreciation for one’s work, gave new knowledge, possibility to exchange experiences, and thus activated and increased motivation for work. The low benefit of in-service education was related to education that was ‘too idealistic in practice’ or ‘too vague’ in content.

The sufficiency of in-service education was assessed by the respondents through the possibilities to participate in education during working hours, adequacy of education and its content in terms of coping with one’s work, relevance of the topics to one’s educational needs, consistency of the in-service education and satisfaction with education (see Appendix 3.) During the team supervision intervention no significant changes were evidenced in the supervisees’ assessments on wards B, C and E (inquiry I mean of sum 45.3, SD 8.5 → inquiry III mean of sum 45.8, SD 9.4, p= .236) or on wards A and D (inquiry I mean of sum 51.5, SD 11.3 → inquiry V mean of sum 51.4, SD 7.6, p= .848). (Table 16)

Table 16. Sufficiency of in-service education

Inquiry I Inquiry II Inquiry III Inquiry IV Inquiry V Total mean SD mean SD mean SD mean SD mean SD sum mean

---ward B 46.8 10.0 49.5 7.7 43.2 8.5 - - - - 139.5 46.5

ward C 46.4 5.9 46.9 11.4 49.9 8.6 - - - - 143.2 47.7

ward E 42.8 10.4 48.8 10.2 42.8 10.2 - - - - 134.4 44.8

---( total ) 45.3 8.5 48.2 9.9 45.8 9.4 - - - - 139.3 46.4

---ward A 54.8 9.9 51.8 8.4 48.5 9.3 52.0 5.9 53.3 8.8 260.4 52.1 ward D 46.7 11.9 50.4 8.4 49.8 2.3 49.6 8.2 48.7 4.8 245.2 49.0 ---( total ) 51.5 11.3 51.2 8.2 49.0 7.2 51.0 6.9 51.4 7.6 254.1 50.8 ---wards B, C and E) statistical significance: between ---wards .703, factor. 236, factor and ward .250, wards A and D) statistical significance: between wards .257, factor .848, factor and ward .170

The respondents’ background variables (age, work experience, time in present post and position) were tested through the assessments of the sufficiency of in-service education. The findings showed no significant associations between the background variables and the ratings on wards B, C and E which participated for two years. However, on wards A and D which participated for three years, the ward managers’ and assistant ward managers’ ratings of the sufficiency of in-service education were statistically more significant (inquiry I mean of sum 62.5, SD 5.4 p=.006, → inquiry V mean of sum 60.0, SD 8.7, p= .035) than those of the assisting staff (inquiry I mean of sum 41.5, SD 15.4 → inquiry V mean of sum 50.0, SD 6.8) and nurses (inquiry I mean of sum 52.8 SD 5.1 → inquiry V mean of sum 49.3, SD 6.1) on these wards.

The changes in educational needs initiated through the team supervision intervention were explored with open-ended questions. Many of the respondents perceived these questions to be difficult to answer or peculiar or left the question unanswered (e.g. on ward A every second respondent and on ward C every fifth respondent had described the educational needs arisen during team supervision). The respondents who had answered the question had included a variety of educational needs they had discovered, but they also pointed out that many of these were ‘general’ and ‘chronic’ needs such as computer training or language courses in Swedish and English. In order to find the educational needs that were truly related to the intervention, the questions ‘educational needs arisen’, ‘useful topics of team supervision’ and ‘important unaddressed topics of team supervision’ were analysed in parallel. The educational needs found focused on (a) teamwork, its development and solving the emerging problems, (b) human relations, related skills and problems, (c) strengths at work, increasing the strengths and work motivation, (d) common principles and theoretical perspectives on patient care, (e) case descriptions of patient care and (f) quality related issues. (Table 17)

Table 17. The educational needs arisen during the intervention in light of necessary and unaddressed topics

WARD A WARD B ^(* WARD C WARD D WARD E

Educational needs arisen during team supervision

a) Development of

Useful topics addressed in team supervision

a) Collaboration issues

a) Division of labour on ward a, c) Collaboration between different occupational groups b) Personal relations

d) Factors affecting ward situation – ’putting an end to blaming doctors’

Important topics unaddressed in team supervision

b) Facing difficult and

a) How to deal with problems in human relations

constructively?

b) Skills to manage conflicts and deal with problems in work community

c) Conduct in work group and taking responsibility as an employee

a) Professional coping and enduring pressure in a change process

a, b) Coping with work with different people

*) Different medical topics were heavily emphasised in responses concerning educational needs

On the participating wards every second (wards A, D) or third (wards B, C, E) respondent assessed that the organisation had supported their professional development. The forms of support that were described to promote the development were (a) education, (b) clinical supervision, (c) change in position in organisation and (d) delegation of administrative tasks. The forms of support for participation in education included rota arrangements, financial support, paid leave of absence, part-time non-paid leave of absence or long-term arrangements with shifts allowing part-time studies e.g. in the university. The support for professional development was also related to changes in one’s position from temporary to permanent or long employment contract, and changes in the educational basis or tasks in the position (i.e. switching from an assistant nurse’s position to that of a nurse). Respondents pointed out the challenges of more demanding tasks and the fact that a permanent position gave the best possibility to participate in all forms of education.

However, on every participating ward there were 1-2 respondents who reported no, minimal or ‘detrimental’

support for their professional development. Detrimental support was described as ‘threats’ of discontinuing the posts.

Changes in the plans for professional development were reported on the wards which participated for two years by 8% (I inquiry n=2) up to 13% (III inquiry n=3) of the respondents and on those participating for three years between 32% (I inquiry n=7) by 23% (V inquiry n=5). The changes the respondents reported were concerned with assistant nurses’ plans to study at a polytechnic, nurses’ master level studies at the university (14/24), plans for seeking job openings abroad or in another hospital district (2/24), plans for applying for or quitting an administrative ward manager’s post (2/24), but also decasualization of one’s post, switching from an assistant nurse post to a nurse post (2/24), and receiving clinical research associate’s post (1/24) and switching to another discipline (1/24) were mentioned. However, the respondents who reported changes in their plans did not rate the sufficiency of in-service education as significantly higher or lower compared to those with no changes in their professional career development plans.

To sum up the findings, education and development at work were deemed extremely necessary. The in-service education within and outside the organisation was versatile and served the diverse, but essential needs of the supervisees in their everyday practice. During team supervision, however, changes in educational needs or plans for professional development were not found and the supervisees themselves found it difficult to specify any particular educational needs initiated by the intervention.

5.5. Intensification of the intervention through the supervisees’ continuous work self-monitoring and