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This chapter explores the way in which a culture of educational technology-related policy and curriculum change has arguably resulted in minimal improvement in teaching and learning. Moreover, it is argued that such a culture of change has instead simply increased teacher disengagement and thereby resulted in teachers being erroneously labelled by policy actors, administrators and technology enthusiasts as ‘resistant’ to change, ‘luddites’ and ‘risk averse’. Accordingly, this chapter challenges these simplistic labels, and offers a more critical perspective of how and why teachers (dis)engage with technology.
CRITICAL QUESTIONS
What are some of the key reasons teachers’ practice has not significantly changed as a result of increased digital technology access and use?
What are some approaches schools and teachers can adopt to begin exploring new ways of teaching and learning through digital technologies?
The problem of technology-related change
For decades digital technologies have been heralded as great beacons of hope for new and improved teaching and learning. However, despite signii cant investment and policy initiatives, both in Australia and internationally, there has been little change in the fundamental practices or outcomes of schools, teaching or learning. For instance, over the past decade, there has been widespread installation of interactive whiteboards (IWBs) in classrooms largely supported by school-based initiatives. Also, an increasing number of one-to-one laptop and tablet programs have been supported by state and federal initiatives such as the Digital Education Revolution. These and other technology initiatives have exploded into schools but failed to revolutionise education or dramatically improve student learning.
Over the past century, numerous key technologies (including digital technologies) have been introduced into education. For the most part, each of them has been expected to revolutionise teaching and learning. However, it is generally accepted that neither dramatic reorientations nor changes in education have happened. Yet, while use of technology over the last 100 years has not resulted in a revolution, several key improvements and advancements in educational access and equity have resulted. The critical focus of this chapter is to look beyond the hype of technology and media over the last century and, instead, critically consider the significance of the changes over time in terms of how we understand teaching and learning with technology today.
To explore this issue, the chapter examines what we have labelled as three ‘ages’ of technology integration: pre-digital, personal computer and the internet. While these three ages are described, it would be a mistake to assume that this is the only interpretation of a history of technologies in education. Depending on your geographic location, socioeconomic situation, cultural background, literacy and other variables, the history you and your family and community experience is different. For example, internet connectivity and the ensuing changes to education opportunities was available in metropolitan areas years prior to rural communities, and even today is problematic in remote areas. This chapter presents one interpretation by looking at three significant changes in technology provision in education. The technologies of each age were not adopted in education as expected, but they presented a range of benefits. These expectations and benefits will be discussed in relation to some key influencing social trends and beliefs about learning of the time. The chapter concludes by considering how a critical view of digital technologies over time informs our understanding of teaching and learning.
This chapter examines three important equity themes that impact on the educational use of digital technologies – gender, digital divide and rurality. The chapter begins with the issue of gender, since the under-representation of female students in digital technologies subjects in upper secondary school education and the resultant under-representation in university education and the ICT industry has been an enduring problem. This is despite numerous research studies and different types of affirmative action strategies being undertaken. These include programs such as school-based ICT clubs for girls and special events targeting the recruitment of girls or industry-based programs and initiatives to address the ongoing difficulties with adequate female recruitment. Following this is a section on the digital divide, and the concluding section examines issues associated with rurality and digital technologies in education.
CRITICAL QUESTIONS
Why is gender under-representation in ICT/digital technology subjects important?
What are the key factors leading to gender disparity and how can it be redressed?
What is the ‘digital divide’ and is it an issue we need to worry about in Australia?
How does rurality impact on equity, and how can we plan for it in digital technology access and outcomes?
Gender and digital technologies
The gender divide
Unfortunately the gender disparity reported in digital technology-related school subjects over a decade ago continues unabated (Anderson et al., 2005; Lyons et al., 2012).
Computers started appearing in Australian schools during the 1970s but for a long time the uptake was slow. Now, in 2015, many schools have more computers than students, representing a big investment in digital technologies. Quite rightly, teachers and parents sometimes ask whether the investment is worth it – has it helped students learn better? You may think this would be an easy question to answer – just assess whether students doing a particular learning task with computers achieved better results than other students doing the same task without computers. However, it is not that easy because, first, it is difficult to measure learning and, second, there are so many factors that influence a student’s learning. As a result, it is nearly impossible to determine with certainty whether using the computer made the difference. Nevertheless, research into whether using digital technologies improves learning, and under what conditions, remains a worthwhile undertaking.
This chapter examines why digital technologies are used in schools, and how that use may improve learning. It refers to what has been learned from research, and describes how teachers may use a critical and evaluative framework to guide their decisions about when, and how, to use these technologies. In particular it discusses the concept of meaningful uses of the technology. The aim of the chapter is to help you with decisions you need to make about when, and how, to use digital technologies to support the learning of your students.
Outline why interprofessional leadership is required.
Describe the leadership skills required to facilitate interprofessional practice.
Discuss the development of interprofessional leadership within the interprofessional practice context.
Key terms
capabilities
dementia
leadership
Leadership
Some are born to leadership; some achieve leadership; others have leadership thrust upon them.
Marie’s letter to Malvolio in Shakespeare’s Twelfth Night
Introduction
Historically health service provision has worked on a hierarchical system of leadership in which the doctor has been seen to be the lead both legally and ultimately in practice for any decisions about a patient’s care. However, practice is starting to change. In 2000, in Canada, the legislation changed to ensure that any health professional could be nominated as leader and is then legally responsible for the care of the individual.
Why has this move away from doctors always being legally responsible happened? In many situations the doctor is not always present or reachable, for example, in remote, rural locations and some community settings. As Australia has an increasingly ageing population, there are not enough doctors and other health care professionals to service their needs. This has led to the realisation that new health care models and ways of working need to be developed.
Understand the principles of person-centred care of a person with dementia.
Understand who is the person in person-centred care.
Discuss approaches aimed at achieving person-centred care.
Understand the principles of relationship-centred care of a person with dementia.
Discuss the importance of the interprofessional team to collectively identify remaining abilities and the care pathway for the individual.
Key terms
interprofessional practice (IPP)
patient-focused care
person-centred care
relationship-centred care
Introduction
In this chapter, we discuss two key concepts involved in the care of patients with dementia: person-centred care and relationship-centred care. In addition to explaining the meaning and origins of person-centred care as a term, key emphasis is placed on principles and achievement of person-centred care. We also discuss the specifics of those with dementia that need consideration and the benefits of providing person-centred care in dementia patients. Relationship-centred care is explained in the context of interplay between collaboration, communication and relationships, and key interactions involved in dementia patients are also highlighted. We discuss relationships between various stakeholders involved in care of patients with dementia from the perspective of the agency theory. The chapter concludes with a consideration of interprofessional practice (IPP) in the provision of patient-centred care in dementia and the interprofessional team work is illustrated in a case study.
Examine the competencies and capabilities required for interprofessional practice.
Discuss the relevance of context for working in an interprofessional manner.
Explain specific capabilities required in dementia care.
Explain the Model of Interprofessional Practice and Education – Dementia.
Key terms
capabilities
competencies
dementia
evaluation
interprofessional
interprofessional education (IPE)
personhood
Introduction
In 1978, the World Health Organization stated:
Given that effective health care requires the services of personnel with different competencies, it is essential that trainees should have appropriate experience of such cooperative endeavours and have the ability to work towards a common goal, to communicate and share responsibility.
As community members, students and/or practitioners, we have all worked in many team environments for example, the workplace, sport, committees, community services, and group assignments where people with varying skills and knowledge come together to jointly achieve a goal or provide a service. Within health settings, team practice is common where a group of professionals for example, nurse, social worker, oncologist, pharmacist and radiographer manage the care of a specified number of patients as a coordinated group. However, very few of these experiences can be described as interprofessional.
Respectful working relationships with shared decision making, shared leadership and shared learning are the hallmarks of interprofessional practice (IPP). In addition to specific professional competence, other skills are required: the ability to work collaboratively; to take responsibility for your own actions and the actions of the team as a whole; to take a leadership role or follow the lead of others depending on circumstances; and the ability to provide a consistent service while under pressure.
Discuss the drivers and imperatives for changing the way health care is provided.
Define interprofessional education and collaborative practice.
Discuss how interprofessional education and practice can respond to the imperatives and drivers in changing health contexts.
Discuss the relevance of interprofessional education and collaborative practice in the context of dementia care.
Key terms
collaborative practice (CP)
integrated approach
interprofessional education (IPE)
Introduction
Many factors have precipitated increased interest in interprofessional education (IPE) and collaborative practice (CP). Demographic changes, in particular an ageing population and increased incidence of long-term health issues, require health care teams to work with people with complex care needs. New models of care and technological advances in diagnosis, treatment and rehabilitation practice require specialised knowledge to provide appropriate, safe and cost effective services. And, despite increasing university places for health professionals, the demand for qualified health professionals continues to exceed supply.
This chapter will look at the origins of IPE internationally, and the health care environment in which dementia care is to be provided, and ask: What is it? How was it developed? Why do we need it? What does it look like?
Drivers for changing the way health care is provided
In 2012, Health Workforce Australia published documentation looking to the future of what would be required for the health workforce in 2025. It articulated the need to develop a health workforce that would work towards new models of health care and, therefore, the need to develop new models of education and training. However, this concept is not new. Indeed Flexner (1910) advocated the need to transform medical education, shifting from an idiosyncratic apprenticeship model to a more rigorous systematic biomedical and educational approach.
Describe what dementia is in broad descriptive medical terms.
Describe the impact of dementia on the Australian population in terms of disability burden.
Identify some of the key challenges for individuals and their families and carers throughout the course of the disease.
Reflect on the impact of culture and membership of different special needs groups on the experience of dementia.
Outline how interprofessional ways of working are needed in the care of people with dementia.
Key terms
aged care services
autonomy
communication
culture
dementia
interprofessional
neurocognitive disorder (NCD)
respect
Introduction
Dementia is a life limiting condition. The needs of people living with dementia are at the forefront of the minds of people concerned with receiving, resourcing, managing, providing and evaluating services for older people. In particular, there is an urgent need for health care teams and service providers to respond in innovative ways (Productivity Commission, 2011) to address the ‘mismatch of professional competencies to patient and population priorities’ and the chronic shortfall in health workforces (Frenk et al., 2010 ; Health Workforce Australia, 2012).
As people live longer, the shape of society has changed and is continuing to change; creating both benefits and challenges that humanity has not met before. One of these challenges is the increased prevalence of dementia (Productivity Commission, 2011). Dementia embodies our greatest fears: a living death; cognitive decline; lost abilities; increasing dependence; loss of the person as others know them. While acknowledging that a person with dementia and their families require complex care and support over an extended period of years, perhaps there are lessons to be learned by society about what it means to be human and the real priorities of living and dying.
Articulate the personal and professional attributes that may influence an individual’s practice.
Discuss the course of dementia from health to illness to death.
Discuss the significance of the person’s life lived before the onset of this disease.
Consider the impact of the journey of dementia on family and friends.
Key terms
interprofessional
personality
Introduction
In Chapter 1 , we identified one key aspect of the Model of Interprofessional Practice and Education - Dementia (MIPPE-D) as being personal and professional knowledge. This capability looks at the practitioner as a whole, as well as the client, and recognises not only the professional knowledge that the individual brings to the situation but also their life skills, empathy and personal experiences.
What is personal knowledge?
In the previous chapters of this book, we have emphasised that every client is different and the importance for all health professionals to recognise their client’s journey through life. We have also shown that health professionals need to develop background knowledge and skills to work in a professional and client-centred way.
However, we must also recognise that each professional will have had personal experiences outside their professional background. These will impact on how they see the world, how they react in situations and their values. They may, therefore, have a wide set of life skills that can be put into practice very effectively.
Discuss ways in which the interprofessional approach might assist individuals with dementia and carers at each stage of the dementia journey.
Discuss ways in which individuals with dementia and their carers can contribute to the work of the team at each stage of the journey.
Consider how a big team, consisting of a range of professionals with various roles, might work together, particularly in the middle stages where the person living with dementia is requiring maximum support in the home.
Discuss the issues relating to leadership in team care and how the team might resolve these issues in different clinical settings.
Key terms
dementia
evidence-based practice (EBP)
leadership
Introduction
Many of the key messages from this book are about how health professionals should work together in the care of people living with dementia. To summarise some of the key points, we will follow Mary as she travels along a dementia journey, and explore some of the many ways in which professionals can work together to help her on that journey.
Early signs of dementia
Mary, aged 76, lives alone. Her husband died shortly after he retired some 10 years ago and the couple had no children. Mary used to work in an office, but has lost touch with most of her former workmates now. Her one companion is a much loved dog named Freddie, although there is also a niece who visits from time to time. She has been a patient of her GP for over 10 years. She books a regular monthly appointment for a blood pressure check, repeats of her eight medications when necessary and a bit of a chat. She has quite stable diabetes, for which she is taking oral medication, and every three months she has this reviewed under a chronic disease management plan. She has never brought along her niece to these appointments.
Understand the importance of the concepts of self and personhood in the context of dementia.
Demonstrate knowledge of ethical concepts.
Be able to reflect on the impact that cultural understanding may have on giving or receiving dementia care.
Understand that relationships are important in caring for others.
Key terms
autonomy
culture
dementia
ethics
palliative care
value
Introduction
It can be easy to look at ethics as simply following codes or a set of principles that inl uence what people do. Both of these are important but, in a health setting, particularly one involving dementia care, codes and principles may not be enough because they do not adequately take account of the special situation of someone who needs care, especially those who can be challenging to care for.
This chapter discusses some key ethical concepts. It also looks at what might be helpful for carers to understand so they may act ethically towards those with dementia. It shows professionals that ethics influences what they do with the information that they have. It is as necessary a part of an interprofessional and evidence-based practice as sound science, good skills or lived experience.
At a basic level, people need to know about ethics simply to get along with each other, as ethics enters into every interaction that they have with others. In some way or other, at its heart, ethical behaviour must take into account how each person might affect others. This means that people should consider the possible consequences of what they do. But ethics is more than thinking about the possible consequences of actions. Each person needs also to reflect on the reasons for doing things, on what sort of person they want to be and how relationships might be valued and nurtured in even the most challenging care environments.
Outline principles of sound environmental design that enable maximising abilities and support limitations.
Describe the application of evidence-based designs in varying contexts: the home, community, residential care and acute care.
Discuss the application of principles of participatory involvement to the design of buildings for people with dementia.
Discuss how an interprofessional education and interprofessional practice approach may enhance environmental design and participatory engagement.
Key terms
environmental design
interprofessional education (IPE)
interprofessional practice (IPP)
knowledge translation (KT)
Introduction
What do the people who provide care to people with dementia share? Values, attitudes, skills - perhaps; but there is one that they cannot avoid sharing - the building that the person with dementia is occupying.
Environmental design
It seems fair for me to say, after 30 years of working in the field, that the appreciation of the impact of the building on the success of care is somewhat limited. This is not because we lack information on how to reduce the disabilities experienced by people with dementia by designing enabling buildings.
In fact, we have the benefit of a reasonably extensive literature on the subject (Fleming & Purandare, 2010; The King’s Fund, 2012; Garre-Olmo et al., 2012 ; Zuidema et al., 2010 ; van Hoof et al., 2010; Verbeek et al., 2009; Calkins, 2009). The findings from this literature can be organised around 10 principles of environmental design (Fleming & Bennett, 2013) and these have been summarised in Table 10.1 .
Discuss the course of the disease from health to illness to death.
Discuss the importance of acknowledging the social, emotional and spiritual aspects of a person living with dementia.
Discuss the significance of the person’s life lived before the onset of dementia.
Consider the impact of the journey of dementia on family and friends.
Key terms
Alzheimer’s disease
dementia
neurocognitive disorder (NCD)
personality
Introduction
The journey of dementia can be described as follows:
something is not right;
diagnosis;
course;
transitions;
end of life;
life stories;
the family experience.
Mace and Rabins (1981) made four connected statements about dementia:
there is damage to the brain;
the person is still there;
the family is also affected;
there are things we can do.
This chapter will expand on the first three statements and allude to the last.
As health or care professionals, we should always remember that people have lived 60 or 70 years before the onset of dementia it does not define them. Each of us comes in and out of people’s lives in just this small portion. Really we might be a bit important but in the totality we are just a small-bit player.