Askarrutuksesta osaamiskeskukseksi : sairaalaopetuksen muutoskehityksen tarkastelu kehittävän työntutkimuksen viitekehyksessä

Abstract

This study focussed on the provision of basic education at Finnish hospitals for pupils with illnesses requiring a hospital stay. It examined, in particular, how the principles, practices and methods of organising hospital teaching have changed and developed. The following four main research questions were addressed: (1) What stages can be observed in the historical development of hospital teaching? (2) What is the purpose of hospital teaching, and how are the activities and practices involved therein? (3) How did the development of work activities progress during the projects? (4) What are the possible preconditions for hospital teaching as a centre of expertise? The methodology of this study was based on developmental work research. The present state as well as historical development of hospital teaching were analysed in order to interpret the objects of work in hospital teaching. The research data included documents related to the history and statutes of hospital teaching and inquiries and interviews, which were produced through national hospital teaching development activities from 2005 to 2014. The data were analysed using qualitative content analysis. The development activities, adoption of new methods and expansion of work activity were discerned using the expansive learning cycle model and the zone of proximal development. The development needs of hospital teaching, as well as the ways to meet these needs, and the operating conditions for centre of expertise activities were analysed using the human activity system (HAS) model of developmental work research. The statutes that govern teaching and teachers’ job description were interpreted inconsistently in the work activities of hospital schools. There was a conflict between, on the one hand, the potential of the curriculum and hospital teachers’ competences and, on the other, pupils’ right to an education and need for support. These areas were not reconciled in the operational framework of provider-driven teaching arrangements, the principles of providing education, and the collective agreement for teachers. The work orientation of the hospital schools was the result of the structures of interest group cooperation and interaction competence as well as of the workplace community’s own internal operating culture. The schools that committed to the development activities featured the following characteristics: structures that support workplace learning, co-design and continuous evaluation; broad-based participation, supportive leadership, and experience of a consultative work approach and of education for pupils in outpatient care. The renewal requires that we examine and reconcile the parties and chains of actors responsible for the wellbeing, upbringing, education, and rehabilitation of children and adolescents. Development and new ways of working must start from a holistic idea of what is best for the pupil – not from the aim to adapt new statutes to an old operating model. The structures of development work must be based on school-specific guidance, the evaluation of leadership, and the committed participation of all members. The development must be linked to change theories and implemented based on research. The main idea of development is to increase the ability to perceive the workplace community’s basic task holistically, through collective and individual development. In addition, the aim is to maintain the sensitivity to notice needs for change in time and to create models for resolving challenges for change through collaborative planning.