Does practice-based learning matter in a pandemic?

News headlines reporting staff shortages, exhaustion and burnout in the NHS and care homes are now commonplace in the ongoing challenges of the COVID-19 pandemic. In the midst of such a time, does practice-based learning matter?
 

Gibbs¹ asserts that it is difficult to learn simply by experiencing a practice situation but rather, to fully learn and progress, reflection is vital. This is a movement from ‘doing’ to ‘learning by doing’. Gibb’s Reflective Cycle promotes ‘learning by doing’ but also enables the provision of support through naming feelings about a practice situation, and using feelings as a guide to learning: emotional support and learning happening hand in hand.
 

Pre-pandemic, reflective debriefing sessions (based on Gibb’s Reflective Cycle) were taking place in a small number of care homes in Lothian, Scotland, to facilitate practice-based learning and staff support around palliative and end of life care. These sessions, led by Dr Jo Hockley, a nurse academic and specialist nurse in palliative care, facilitated care home staff to remember a resident who died recently, describe the events leading up to their death, reflect on what they felt went well and what didn’t go well, and what might have been done differently. Through this process, new learning helped them identify what needed to change and affirmed what was working well.
 

With the outbreak of the pandemic, with funding from the Chief Scientist Office Rapid Research in COVID-19 programme, these sessions moved online. Due to the emotional toll of high numbers of deaths, the focus of sessions became predominantly about support, with learning becoming secondary. Care home staff found these 45-minute Online Supportive Conversations and Reflective Sessions (OSCaRS) helpful.² As a result, the Edinburgh and Lothian Health Fund gave us a grant to establish a team of NHS-based facilitators to deliver OSCaRS in more care homes across Lothian.
 

NHS-based facilitators attend bespoke education sessions on the dying process, pain and symptom control, and communication specific to death and dying in care homes alongside hands-on learning on group facilitation.

 

As the shock of the early days of the pandemic has subsided, emotions have become less acute and the balance between learning and support in OSCaRS has shifted back again to practice-based learning.
 

As Kirsty McBeth, an NHS Lothian Clinical Practice Facilitator and OSCaRS facilitator says:

As well as grappling with the balance between learning and support as OSCaRS have evolved, new challenges have emerged as the pandemic continues: increased staff shortages and recruitment challenges in care homes; changing priorities of NHS care home support teams, with OSCaRS facilitators being pulled back into the COVID vaccination programme to administer booster jabs. As a result, opportunities to deliver OSCaRS with NHS-based facilitators in the last couple of months have reduced, alongside care homes needing to cancel if they don’t have enough staff. The pressures are real. Many aspects of care home work cannot wait e.g. assisting someone to the toilet or administering pain relief. But, the question remains, does practice-based learning matter in a pandemic?
 

The British Geriatrics Society recommends that ‘All members of a care home MDT, including those employed by both the NHS and care homes, should undergo specific training in the care of older people’ and end of life care is highlighted as a specific area where support is required.³
 

OSCaRS, with appropriate funding for dedicated NHS staff time, can provide a time-efficient package to achieving this recommendation in relation to palliative and end of life care. Care homes also need appropriate funding for staffing levels that allow them time to reflect on their practice as an essential part of their work to enable them to develop professionally and personally. Governments across the UK need to dedicate appropriate funding.
 

It may seem counterintuitive and even counterproductive to stop ‘doing’ for a moment and ‘learn by doing’ through reflection. But at what cost? The effect of the pandemic on the health and social care sector has been cataclysmic. The broken system needs to be reimagined. Does practice-based learning through reflection matter in a pandemic? We say yes. It is a moral imperative to allow staff time for continued learning in a pandemic, not only to progress, but also for the health and social care sector to survive in new forms.

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References

1. Gibbs G. (1988) Lear3ning by Doing: A Guide to Teaching and Learning Methods. Further Education Unit, Oxford Polytechnic, Oxford.
2. Johnston, L. Hockley, J. Watson, J. Shenkin, S. (2021) Online Supportive Conversations and Reflection Sessions (OSCaRS): A Feasibility Study with Care Home Staff during the Pandemic International Journal of Practice Based Learning in Health and Social Care (Accepted in press).
3. British Geriatrics Society (2021) Ambitions for Change: Improving healthcare in care homes