‘I beg your pardon?’ Nurses’ experiences in facilitating doctors’ learning process – An interview study

Abstract

Objective

Working alongside specialized palliative care nurses brings about learning opportunities for general practitioners. The views of these nurses toward their role as facilitator of learning is unknown. The aim of this study is to clarify the views and preferences of these nurses toward their role as facilitator of physicians’ learning.

Methods

Qualitative study based on semi-structured interviews. We interviewed 21 palliative care nurses in Belgium who were trained in the role of learning facilitator. Data were analyzed using Grounded Theory principles.

Results

First all interviewees shared the conviction that patient care is their core business. Secondly two core themes were defined: nurses’ preferences toward sharing knowledge and their balancing between patient care and team care. Combining these themes yielded a typology of nurses’ behavioral style: the clinical expert-style, the buddy-style, the coach-style and the mediator-style.

Conclusions

Palliative care nurses’ interpretation of the role as facilitator of general practitioners’ learning diverges according to personal characteristics and preferences.

Practice implications

Asking clinical expert nurses to become a facilitator of other professional's learning requires personal mentoring during this transition. Nurses’ preferences toward practice behavior should be taken into account.

Introduction

Most palliative patients prefer to be cared for at home by their general practitioner (GP) until death [1]. To tackle this complex task, GPs need a set of palliative care competences [2], [3]. A recent review of palliative care education in Europe shows that not all medical schools have a mandatory undergraduate palliative education: in only 47% of the countries palliative care is taught as a subject (mandatory or optional) [4]. Furthermore in Belgium, where our study was done, the offer of continuing medical education (accounting for the lifelong learning of physicians) shows to be insufficient to train GPs in palliatieve care [5]. Therefore GPs have difficulties maintaining palliative care competences. In many countries GPs can appeal to specialized nurses from palliative home care teams (PHCTs) to support them when care becomes too complex or exceeds their own competences [4]. Besides being supported in the delivery of patient care, GPs state to learn through this collaboration [6]. They mention to gain new knowledge by asking on-the-spot advice. Furthermore they state to acquire practical skills by performing technical tasks (e.g. handling a syringe driver) together and under the supervision of the PHCT nurses. This ‘learning by doing’ is also called workplace learning (WPL). Literature on WPL describes characteristics of the learner (who is learning?), the learning context (the practice environment where the working and learning takes place), the learning process (which learning activities are used?), and the learning facilitator (from whom has been learned or who is helping the learning process?) [7], [8], [9], [10], [11], [12]. To have an effective learning process, ideally the learner needs the willingness to learn, has to be aware of his own learning needs and needs to seize learning opportunities actively [10], [13], [14], [15]. Since most of the WPL occurs during daily work activities, the practice organization should ideally offer a wide range of challenging activities and opportunities to learn, while providing time and space for reflection [8], [10], [11], [16], [17]. The learning process is often unscheduled, informal and implicit or encompasses the use of tacit knowledge, therefore it can be hypothesized that not all learning opportunities are seized [9]. It might be hypothesized that making the implicit learning more explicit (by introducing the role of a learning facilitator) could make it more efficient. The learning facilitator can be any colleague on the work floor. He can help the learner with his needs assessment, solve problems jointly, share materials and resources and give feedback [8], [14], [18], [19]. Essential for facilitators is the need to be skilled (both as an expert in the job and as a facilitator) and motivated to act as a facilitator. PHCT nurses are trained and experienced palliative care experts. They are however not trained for the role of learning facilitator for physicians. Since GPs indicate the collaboration with PHCT nurses to be a learning moment, it is worthwhile to explore the views of the nurses toward their role as facilitator of GPs’ learning. Introducing this new role in their daily task must be done with respect to their views.

The aim of this study was to

• Describe the views and preferences of PHCT nurses toward sharing their knowledge and expertise with GPs.

• Describe the views and preferences of PHCT nurses toward the balance between care for the patient and care for the team.

• Describe how these views and preferences influence the uptake of a role as facilitator of GPs’ learning.