| 1. |
- Josefsson, Karin
(författare)
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Municipal elderly care : implications of registered nurses' work situation, education, and competence
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Registered nurses (RNs) are key figures in municipal elderly care. It is a challenge to create necessary conditions that enable them to provide quality nursing care. These studies aimed to increase insight into RNs work conditions in municipal elderly care, and to compare RNs working solely in dementia care (DC) with RNs working in general elder care (GC). The specific aims were to describe RNs’ perceptions of: (I) their work situation, regarding demands, influences, and social support, as well as RNs characteristics; (II) violence and threats directed at them, other staff, and care recipients, as well as access to prevention measures and routines for handling violence and threats; (III) their education and competence development; (IV) their needs for knowledge, possibilities for competence development, supervision, organisation of RNs’ development, financial support, competence utilisation, and managers’ competence. A descriptive and comparative design was used. The setting consisted of 60 special housing with subunits in a large city in the middle of Sweden. A total of 213 RNs participated, with a response rate of 62%. Of those, 95 (45%) worked in DC and 118 (55%) in GC. A structured questionnaire, designed for these studies was used. Study I showed on average high time pressure in both groups. Greater knowledge and higher emotional and conflicting demands were found in DC. The majority reported greater opportunities to plan and perform daily work tasks than to influence the work situation in a wider context. On average, there was a high level of support at work from management and fellow workers. Study II indicated that RNs had witnessed and experienced a high degree of indirect threats, direct threats of violent acts, and violent acts, with care recipients also subject to threats and violence. The RNs in DC had greater access to education in managing threats and violence, and routines for managing violence and a door with a lock to their working unit. Study III revealed that RNs possessed a broad range of formal competence. On average, the RNs had 18 years of work experience as an RN. The majority lacked a Degree of Bachelor in Nursing. Few had adequate specialist competence. RNs in DC were willing to invest more in competence development whereas RNs in GC were more motivated to invest in competence development by seeking another position and by attaining a greater authority to make important decisions at work. Study IV showed that, on average, the RNs did not lack or hardly lacked knowledge in the examined domains. RNs in GC lacked knowledge of dementia, falls, and fall injures to a greater extent than RNs in DC. RNs in DC perceived greater possibilities for competence development at work. Most RNs, especially in GC, requested a better organisation for competence development. The majority of RNs had no supervision. Although the utilisation of the competence of RNs was high, RNs used their highest competence about half of the working hours. The employers’ financial contribution to RNs’ continuing education was poor. Conclusions drawn from the studies are: (I) RNs’ time pressure needs to be decreased and their influence on decisions increased. (II) Violence occurs equally frequently without any difference between DC and GC. More often, RNs in DC are offered education on how to manage violence and threats, and have routines for management of violence. Therefore, municipal authorities should increase staff education for management of violence and creating safety routines. Violence needs to be taken seriously with a ‘zero tolerance’ attitude. (III) It is important to develop the RNs’ competence and increase the utilisation of their competence. It is also essential to increase the number of RNs who have specialist competence. (IV) Better organisation and greater possibilities for RNs’ competence development is needed. Employers need to make a greater financial contribution to RNs’ competence development. RNs also need supervision. When combined, high demands and low control in the work situation form the most critical combination for the health of RNs. This may lead to sick-absenteeism and staff turnover. Thus, RNs’ time demands should be decreased, violence be minimised, and influence in decision-making increased in both groups. Further research is required on RNs’ competence development, family conditions, leisure, health, their ‘ideal work’, and the concept of general elder care.
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| 2. |
- Anderbro, Therese
(författare)
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Behavior change intervention and fear of hypoglycemia in type 1 diabetes
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Individuals with type 1 diabetes require lifelong insulin supply as well as behavioral adjustments for good treatment result. Only a minority reach the goal for glycemic control set in order to reduce the risk of severe long-term complications. Interventions based on cognitive behavior therapy (CBT) have been proposed to improve diabetes-management, but evidence for its efficacy in adults with poorly controlled type 1 diabetes is sparse. One common barrier to optimal diabetes-management is fear of hypoglycemia (FOH), especially in those who have experienced severe hypoglycemic episodes. Thus there is a need for a valid and reliable instrument to assess individuals who are affected by FOH. It is also vital to identify factors associated with FOH in order to find targets for interventions to reduce fear.Aim: The overall aims of this thesis were to evaluate a CBT intervention for poorly controlled individuals with type 1 diabetes and to explore fear of hypoglycemia in an effort to gain deeper knowledge of possible targets for interventions to reduce FOH.Methods: All four studies applied quantitative designs. Study I was a randomized controlled trial in which a cognitive behavioral intervention was evaluated on poorly controlled adult persons with type 1 diabetes. Study II was a psychometric evaluation of a Swedish version of the Hypoglycemia Fear Survey (HFS) in a survey study in adult persons with type 1 diabetes. Studies III and IV were cross-sectional survey studies employed on adults with type 1 diabetes exploring disease-specific, demographic, (studies III and IV) emotional and psychosocial factors (study IV) related to FOH.Results and conclusions: Study I: The intervention group receiving CBT showed significant improvements in HbA1c, diabetes related distress, well-being, FOH, perceived stress, anxiety and depression as well as frequency in self monitoring of blood glucose. Study II: A three- factor solution was found for the Swedish version of the HFS with the dimensions Worry, Behavior and Aloneness. Cronbach’s alpha for the total scale was 0.85 and varied between 0.63 – 0.89 in the subscales. Convergent validity was also supported with moderate correlation between Swe-HFS and Swe-PAID-20. The Swe-HFS seems to be a reliable and valid instrument to measure FOH in adults with type 1 diabetes. Study III: Seven hundred and sixty- four persons (55%) responded to the questionnaire. The HFS-Worry subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, hypoglycemic symptoms during hyperglycemia and hypoglycemic unawareness. The HFS-Aloneness subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, frequency of mild hypoglycemia, HbA1c, hypoglycaemic unawareness and visits to the emergency room because of severe hypoglycemia. FOH proved to be more prevalent in females. Frequency of severe hypoglycemia was identified as the most important factor associated with FOH. Study IV: A total of 469 (61%) persons responded to the questionnaire. The HFS was significantly associated with The Anxiety Sensitivity Index, the Anxiety subscale of Hospital Anxiety and Depression Scale and Social Phobia Scale. Together with the disease-specific factors the regression model explained 39% of the variance. Support for a positive association between FOH and anxiety was present and previously identified gender differences were confirmed. Differences between the subgroups on factors associated with FOH were found that may have implications in developing interventions
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| 3. |
- Barman, Linda, 1972-
(författare)
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Striving for Autonomy : Health sciences teachers’ enactment of policy
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract This thesis explores how teachers within the health sciences enact education policy. The questions address how teachers’ choices related to the design of courses and curricula are made in the light of reforms that emphasise standardisation and transparency. Employing a hermeneutical framework teachers’ enactment were regarded as a meaning-making process shown through reason and action. In line with the interpretative approach, the two research projects were performed with qualitative methods. The first research project (study I and II) concerned how teachers’ understood and carried out changes in course design related to the implementation of outcome-based education and the European Bologna Process. For that purpose, course material and interview data was analysed. The second research project (study III and IV), was conducted to deepen the understanding of findings from the first project. A group of teachers who conducted major changes related to previous reform was chosen and studied with a narrative approach when they engaged in the development of teaching and learning. In particular, the teachers’ development of assessment criteria of students’ clinical competencies was studied over one year. A body of literature report on how teachers conceptualise teaching and learning. Based on those studies there has been an emphasis on supporting teachers’ shift in views regarding teaching and learning. Related to recent reforms in higher education, it is however suggested that teachers are less free to decide upon educational matters, and hence individual teachers’ deepened understanding are not enough for development of practice to occur. The findings in this thesis suggest that wide interpretations of education policy in combination with pedagogical knowledge may benefit educational development in practice. Teachers were found to approach outcome-based education when introduced as policy in four different ways, with outcome blind, technocratic, pragmatic or ideological approach. These approaches were related to student-centred learning to more or less extent, and to greater or lesser autonomy in the decision-making related to course design. The studies showed how teachers’ experience a tension between bureaucratic demands and what is emphasised through teaching and learning theory. For some teachers this meant that theoretical constructs were applied in instrumental ways and that pedagogy equated the bureaucratic and rational standards involved in quality control. The findings suggest however, that learning and development can be promoted through education policy but that teachers’ local practices should be supported.
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| 4. |
- Bos (Sparén), Elisabeth, 1958-
(författare)
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A good learning environment for nursing students in primary health care
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Clinical learning is a key part for developing nursingursing education. Previous studies concentrated on hospitals as placement sites. Research results reported in this dissertation identify factors that encourage good learning environments in primary health care (PHC) placements.Aims and methods: The overall aim of the present research was to identify factors that promote good clinical learning environments in PHC settings. Clinical learning environment was investigated from students 'and supervisors' perspectives and their perceptions of the clinical part of nursing education in PHC settings. The present research implemented three quantitative studies (I, II, III) and one qualitative study (IV). In study I investigated district nurses’ (DNs’) student supervision experiences in PHC units before and after implementation of a new supervision model; 98 of 133 DNs (74%) responded to a questionnaire before and 84 (65%) respondes after implementation. In study II validated the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES+T) scale. In study III investigated students’ motivation, total satisfaction, and experience of professional role models associated with dimensions in clinical learning environments. In studies II and III collected data from undergraduate nursing students (n=356) using the CLES+T scale. In study IV interviewed six focus groups with 24 supervisors (DNs); these data provided understanding of student supervision in PHC units.Results: Study I revealed significant need for a new supervision model in PHC units. Supervisors had difficulties staying updated on changes in nursing curricula and experienced insufficient support from universities. They felt that they had to set aside time from their regular duties and get permission from unit managers to supervise students. The supervisors felt confident in the supervisory role, but few had formal educational and academic credentials. After the new supervision model implementation, several supervisors were more satisfied with the supervision organization. The model implementation resulted in improvements within PHC units. Study II confirmed good internal reliability in the CLES+T scale and demonstrated that the five-factor model within the scale is the best-fit model. Supervisory relationship was the most important factor and it strongly correlated with these factors: (i) pedagogical atmosphere and (ii) premises of nursing. Supervisory relationship was moderately correlated with the role of the nurse teacher, and leadership style correlated with PHC units. Study III revealed a statistically significant association between (i) students’ motivation, total satisfaction, and experiences of professional role models and (ii) five dimensions of clinical learning environments. The satisfaction factor had a statistically significant association (effect size was high) with the dimensions; this clearly indicated that students experienced satisfaction. Supervisory relationship and pedagogical atmosphere particularly influenced students’ satisfaction and motivation. Study IV revealed three themes related to supervisors’ experiences during student supervision in PHC units: abandonment, ambivalence, and sharing the holistic approach. Supervisors felt abandoned by their managers, colleagues, and nurse teachers rom universities. They were proud to be DNs and willing to share experiences with students – yet torn between being students’ supervisors and patients’ nurses.Conclusion: This dissertation reports six main factors for good learning environments in PHC units. Supervisors must be prepared and engaged, and students must be motivated. A close, reflective supervisory relationship is one of the most important factors for learning in PHC units. Successful supervision requires clear structure and organization. Adequate support and resources from PHC units are needed for supervisors. Collaboration and liaison between universities and PHC units are needed to link theoretical and practical parts of nurse education. PHC-unit circumstances contribute to holistic nursing care, which is an important factor for student learning. Furthermore, the CLES+T scale was shown to be a reliable tool to use for evaluating PHC settings as clinical learning environment.
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| 5. |
- Edelbring, Samuel, 1969-
(författare)
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Technology in education, necessary but not sufficient : understanding learning with virtual patients
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- With the rapid technological development and the broadening access to computers over recent decades, several technological innovations have emerged in medical education, including virtual patients. Students’ use of virtual patients is proposed to fill gaps in clinical exposure, and train clinical reasoning. However, higher education faculties have been slow to adopt new technology as a regular part of curricula. Virtual patients and similar technologies have either been implemented by enthusiastic teachers or by university policy directives. A possible reason for the low uptake of virtual patients in curricula is a lack of a clear understanding of how their use contributes to student learning. The four studies described in this thesis address learning with virtual patients from three perspectives: the student perspective on learning with virtual patients; the course integration perspective; and the individual study strategy perspective. A mixed methods approach was used given the overarching interest to seek understanding and clarification of student learning with virtual patients. Data were gathered by research interviews with medical students during clerkship, and by questionnaires in clerkship preparatory courses. Interview data was analysed by a phenomenological approach, and scales were formed from questionnaire responses which were analysed cross-sectionally for the four teaching hospitals affiliated with the medical programme at Karolinska Institutet. Use frequency, students’ perceived benefit of virtual patients, their wish for more guidance on using virtual patients and, wish for more assessment and feedback on virtual patient work were targeted in the questionnaires. Furthermore, the students’ preferences of study strategies were analysed in relation to the virtual patient activity using regulation strategy scales from the Inventory of Learning Styles devised by Jan Vermunt. The findings suggested that virtual patient learning activities offer possibilities of applying biomedical knowledge to clinical cases in a way that was engaging and supported decision-making. Furthermore, the virtual patient learning activities were perceived as having an intermediate function between textbook learning and learning with actual patients. The consequences of integration strategies in the course context were influential for how students perceived the benefit of learning with virtual patients. Intensity of processing of virtual patient cases, and presenting cases for other students were associated with high perceived benefit of virtual patient learning activities. Students’ self-regulation abilities were also associated with perceived benefit of the virtual patient learning activities, although to a lesser extent than the influence of the course context. The technology of virtual patients provides possibilities that enhance student learning, and should thus be a necessary part of education. However, this research show that an educational integration strategy is needed that supports students’ active processing of virtual patient cases.
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| 6. |
- Eriksson, Lilly
(författare)
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Participation and disability : a study of participation in school for children and youth with disabilities
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Participation in everyday life is vital to a child's development and well-being and is a basic human right. One definition of participation is engagement in life areas. The objective of this study is to investigate participation in school activities of children and adolescents with disabilities; the study focus on personal factors and factors in the environment, which are closely related to participation. Data were collected in a large survey and a smaller observational study. In the survey, students, parents, teachers, and special education consultants responded to statements about participation and factors related to participation such as autonomy, interaction, availability, support, and environment. In the observational study, participation was observed during various school activities during an entire school day and after school. Children were interviewed about their school day, friendships, and autonomy. The results revealed that participation is multidimensional, with an emphasis on personal experiences, interactions, and context. The theoretical assumption of the International Classification of Functioning, Disability, and Health (ICF) states that the body, participation, and the environment are related. The research results proved this assumption and support the multidimensionality of the participation construct. As indicated in previous research, children and adolescents with disabilities show a lower degree of participation in school than their peers. Participation seems to be more related to autonomy and interactions with significant others than to disability type and general environment. A closer look at various school activities reveals that children with disabilities primarily have a lower degree of participation in math, practical subjects, and science. Being included and having many friends, who provide emotional support, facilitate participation. While, frequently receiving support from teachers and assistants lowered participation. This indicates that there is a relation between support and participation: providing too much support during class can be detrimental to class participation, whereas a good social support network of other children is vital. In this thesis, participation is measured in two ways: by participation frequency and by participation intensity. By counting the number of activities that children participate in, and how often they participate in these activities, a measure of an individual's average participation is obtained, that is, participation frequency. This measure depends more on internal rather than contextual factors, and it changes more often because of internal rather than contextual changes. Intensity measures of participation refer to the amount of involvement within a specific situation, and are contextually dependent. Involvement change based on the situation and the individual's present state. Participation is personal - it is about feeling good about what you are doing and feeling competent in using available opportunities. Participation is dependent on interaction with significant others. Participation for children with disabilities also depends on being provided with necessary support. Participation frequency seems to be less dependent on support than participation intensity. The fact that intensity seem to be more dependent on support and context, short-term interventions facilitating participation within situations are probably the most fruitful way to enhance participation.
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| 7. |
- Gunnarsson, Nina Veetnisha
(författare)
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Parenting children with allergy
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Two general questions directed the focus of this thesis: (1). What are the everyday practical and moral underpinnings of parenting children with allergy? (2). How do particularly mothers retrospectively account for and justify they are responsible parents and moral agents in the interview situation? The overall aim was to explore the everyday practical and interactional strategies used by mothers when they are parenting children with allergy and in such contexts and relations where their parental self and identity may be at stake. The empirical data were based on interviews with parents to schoolchildren who had a food certificate at school, for diagnosed or suspected food allergy. Study I thus aimed at first describe what characterises the population of children with exclusion diet at school, as there was no previous knowledge about why children had exclusion diets and to what extend this was due to parents suspecting allergy. The study aimed specifically to describe health care contacts and diagnostic testing among the children and compare children who had respectively had not been in contact with healthcare professionals for their food-related problems. Results showed that 215 (93%) children had been in contact with healthcare professionals for any allergy, and 196 (85 %) for specifically their food related problems. Among the latter, 157 (68 %) children were doctor-diagnosed, most with a positive allergy test. Those children who had seen a doctor for the food-related problems had more complex and medically severe allergies, but overall characteristics of children’s food symptoms and the reported food items were similar between the groups. Study II focused on the process that parents and particularly mothers engage in when trying to understand their children’s symptoms and problems. The parents’ narratives were reconstructed as narratives, describing the pathways parents take before they decide to seek professional medical aid as well as showing how they construct themselves as responsible parents. Before consulting health professionals the parents have often tried a range of different ways to define, control and manage their children’s various problems. Parents sought medical aid when their own strategies had failed or did not fully work, but their decisions were also formed within a pre-problem context of their moral accountability as parents. In study III mothers accounts of healthcare encounters were explored, and the specific aim was to show how mothers used the interview situation to present, defend and sustain their identities as “good” mothers – when and how they made claims of being responsible parents (moral agency). Additional aim was attempting to explain how variations in mothers’ experiences and presentations, may be formed by mothers different social belongings. The encounter outcomes were presented either as a straightforward account with healthcare as the main responsible agent or as a drawn-out process with disagreement between mothers and healthcare, resulting in different performances of moral agency. Working-class mothers portrayed themselves as dependent on healthcare expertise and made moral claims by negotiating culpability between themselves and healthcare professionals. Upper middle class mothers and mothers with higher levels of education did not generally defend and justify their actions. Instead they appealed to fulfilment of the active mother role. Study IV explored parents, mainly mothers, accounts of the practical and discursive strategies they use to support an ordinary life for their allergic child. This includes how they manage particularly family relations in their accounts of family responsibility and the way they control the information they give about their child to others. An ordinary life was established by making comparisons to what other children without allergies presumably can do (and eat). Parents’ support is about practical and discursive strategies used to create or uphold an ordinary life for their children. In terms of the children’s food problems there is one dominant strategy the parents use, conceptualised as “the food bag strategy”, where the child are given their special foods to bring when participating in different social activities. Parents work out family responsibility by for example telling moral tales, as to legitimatise and justify claims or “demands” on family members understanding and support, and family members inability to do so. Parents’ practical and discursive strategies do not work in a clear-cut direction for the child’s ordinary life and identity; it worked as much against as for the intention of their support. In conclusion, mothers when parenting children with allergy, weave seemingly opposite themes and threads together in their accounts- entwining different moral positions as to show they are responsible, e.g. “good” parents.
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| 8. |
- Hultman, Lill
(författare)
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Live life! Young peoples' experience of living with personal assistance and social workers' experiences of handling LSS assessments from a child perspective
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Act Concerning Support and Services to Persons with Certain Functional Impairments, in which the provision of personal assistance (PA) is included, came into force in 1994. It paved the way for strengthened rights for people with disabilities, in which the overall intention was to give disabled people equal opportunities and enable full participation in society. This thesis explores adolescents’ and social workers’ perspectives on and experiences of personal assistance. The overall aim of this research was to gain empirical knowledge and a deeper understanding of young assistance users’ experiences of living with PA and the social workers’ experience of assessing children’s right to PA and other LSS interventions. In paper I, a grounded theory (GT) analysis showed that the adolescents’ main concern was to achieve normality, which was about doing rather than being normal. The findings underline and discuss the interconnectedness between the different enabling strategies adopted by the adolescents, and to a lesser extent discuss disabling barriers for which PA cannot compensate. In paper II the adolescents describe their experiences of the assessment process which precedes possible access to PA. The content analysis reveals that the adolescents’ participation was determined by the structure of the meetings, in which the assessments tools played a decisive part. The adolescents adapted their behaviour in response. Paper III is based on a phenomenological approach to social workers’ responses to children and young peoples’ ability to participate in meetings and decision making concerning their own support interventions. It reveals difficulties in grasping what participation should be and result in. In paper IV, a GT study, the emerging theory explains how case workers tried to maintain their professional integrity by adopting various strategies. The synthesis of the four studies has resulted in a clarification of how the individual, organizational and societal levels interact through legislation and policy documents, meetings and norms to create certain processes and interactions between the different stakeholders. However, further research is necessary to explore the long-term effects of the current changes to Swedish LSS-legislation regarding both the professional conduct of the case workers responsible for assessing LSS interventions and the consequences of such decisions for assistance users and their families.
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| 9. |
- Ingemarson, Maria
(författare)
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PS – a school-wide prevention programme : effects, core components and implementation.
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- PS is multi-component intervention at the primary prevention level and aims at creating a positive learning environment and decreasing problem behaviours among students in the school years 4-9. During 2009-2012 the programme was both implemented and studied for the first time in a Swedish context. The present thesis comprises four studies of PS and applies a mixed methods approach. The thesis aims to study: 1) If the programme is effective in enhancing the classroom climate, and decreasing problem behaviours among students (Study I), 2) teachers and school staff’s perceptions of programme and implementation (study II and III) and 3) if teacher’s use of praise and clarity of school rules, regardless of programme use, are useful as classroom management techniques, and if there are any differences between classes in terms of disruption (study IV). A quasi-randomized trial was conducted in study I, comprising 3207 students in school grades 5-7 and 188 teachers in 23 schools in the wider area of Stockholm. The participating children and their head teachers answered self-report questionnaires on three occasions: At baseline and one and two years after programme initiation. Degree of implementation in the schools was also measured. Further, a qualitative design with semi-structured interviews and thematic content analysis was used in study II and III. The interviews were conducted in seven PS schools with seven school leaders and 13 school teachers during 2010 and 2011. In study IV, students (n=2266) and classes were divided into two groups, based on teacher ratings of disruptive students in class. Baseline and 12-month follow-up responses were used to perform multiple regression analysis, to compare groups and to investigate possible longitudinal associations. Study I showed no significant effects on students’ problem behaviours and classroom climate at last follow-up. The findings from study II indicated barriers to programme commitment in terms of lack of consensus, collaboration barriers and insufficient process management. It was concluded that leadership, coaching and staff selection need particular attention when implementing a programme like PS, since those factors have been defined as important implementation drivers, both in this study and previously. Study III showed that teachers’ professional identity, programme understanding and experience of change were factors affecting implementation. Ambiguities regarding the boundaries of the social assignment, opposition against the theoretical underpinnings and an unclear core component were identified as implementation barriers. In study IVit was shown that clarity of school rules did not substantially contribute to classroom climate, whereas teacher’s use of praise to some extent did. The hypothesis on weaker associations in the low disruption group could not be confirmed. This thesis cannot provide an answer to the question whether PS is effective or not, since findings indicate that the implementation did not succeed. However, findings in the last study indicate that teacher’s use of praise may contribute to improve the classroom climate. If the PS programme is to be used again there is a need for revisions, and sufficient time for schools to consider programme adoption will be crucial. Aspects of programme implementation are further discussed.
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| 10. |
- Leifler, Emma
(författare)
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Educational inclusion for students with neurodevelopmental conditions
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Inclusive education is the response to the human rights movement that requested equal rights to general education for all students, independent of their prerequisites and/or disabilities. Inclusion is different from integration, which concentrates on the capacities of an individual to adapt to a given mainstream. Inclusion demands that we change the existing educational environment in order to respond to the diverse needs of all learners. Inclusive education focuses on multiple aspects, such as participation, belonging and academic achievement. Teachers’ attitudes, as well as their experience of working with children having neurodevelopmental conditions (NDC), is well described in the literature as crucial for creating and believing in inclusive values. The prerequisites for general teachers (e.g., professional development, supervision and resources) in mainstream school settings are poor. As the number of children on the autism spectrum and with attention deficit hyperactivity disorder in inclusive settings is increasing, the need for evidence-based strategies to facilitate inclusion has become urgent. Autism spectrum disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are neurodevelopmental conditions associated with deficits that can make life in school harder, e.g., executive dysfunctions or social impairments. Little is known about the practical dimensions of inclusive education from different angles. Furthermore, there is a lack of views and perspectives from the students themselves, whose environment we are aiming to improve. Theoretical frameworks used for the design and interpretation of studies in this thesis are the bio-ecological model by Bronfenbrenner, the bio-psychological framework from the World Health Organization (WHO), the International Classification of Functioning, Disability and Health, the ICF Core Sets and the Human Environment Interaction model (HEI). Objectives: This research examines inclusive practice for students with neurodevelopmental conditions. The overall aim of this thesis is to explore educational inclusion for students with NDC, focusing on how it works in practice and what key elements are essential for the development of more powerful inclusive agendas. For this purpose, four studies were conducted: a systematic literature review (study I), an intervention study for teachers’ learning (study II), an exploratory study of social validity from social skills training (study III) and a multi-perspective study of lived experiences of educational inclusion (study IV). Methods: Study II-IV consisted of a mixed methods design, with qualitative and quantitative methods, including participants with ADHD and ASD (adolescents), their caregivers and professionals (teachers and school management). Participants were recruited from mainstream high and secondary schools. Two of the studies are multi-responder studies. In study III, the responders are students, teachers and school management and in study IV, students, parents and teachers. The triangulation increases the validity through the convergence of information from different participants. Data collection tools are the literature search (study I), questionnaires (study II) and semi-structured interviews and structured surveys conducted through interviews based on the instrument INCLUSIO (study IV). The sample size in study II is n = 26, in study III, n = 20 (students n = 13, teachers n = 5 and school management n = 2) and in study IV, n = 56 (students n = 19, caregivers n = 17 and teachers n = 17). Quantitative data in study II and IV was handled and analyzed with the SPSS (Version 27) and analyzed by descriptive and inference statistics. The interviews in study III were audio-recorded and transcribed verbatim with meaningful concepts extracted from the transcriptions and linked to social validity categories from the work by Wolf (1978) and analyzed through thematic analysis. Results: The results based on the completed data collection show supporting and hindering areas in the school environment. Accommodations in the learning environment is a promising but understudied approach. Effective accommodations for enhancing learning for students on the autism spectrum found in study I are didactical accommodations for completing tasks and assignments, prompting procedures for on-task behavior, social interventions for better functioning and social inclusion and video-modeling for understanding and preparing for different situations in school. Professional development for teachers’ learning towards improved self-efficacy and inclusive skills are effective, despite the lack of long-term perspectives. Training teachers in implementing evidence-based methods in practice can be done by lesson study cycles. Teachers’ knowledge of concrete accommodations rose from the initial phase where assumptions about an improved learning environment can be made. Social skills group training is feasible in naturalistic settings, such as the school environment. There were generalizations of teachers’ as well as students’ skills. Moreover, the whole school’s social environment was developed and improved. Results from study IV demonstrate large discrepancy in some of the areas significant for inclusion in school, e.g., direct instructions and individual support, available resources, the social environment and the responsibility for achievement. Parents and students express lack of sufficient support in the explicit classroom situation, e.g., with tasks and assignments. The teachers evaluated the learning environment as more inclusive than students and parents in most of the examined areas. Similar views and agreements were in the lack of competence among staff. For educational inclusion, most valuable was individual support, followed by functional response to behavioral characteristics and a structured learning environment. Conclusions: As more students on the autism spectrum and other developmental conditions are attending inclusive environments, exploring and evaluating practice from multiple perspectives can ascertain what is working well and what is not. Furthermore, this research indicates how to improve inclusive education and contributes with evidence of how to enhance participation for students with NDC, e.g., by professional development for teachers and social skills group training for students. Our findings show that the students themselves are still regarded as the owners of the problem and the learning environment is not accommodating enough, where especially the psychosocial domain is neglected. In order to adjust the learning environment sufficiently to provide inclusive education, there is a need for further and more extensive competence regarding learners’ characteristics and conditions associated with NDC. In order to provide an equal learning environment for all students, there is a need for inclusive special didactics. This study contributes to stakeholders and educators as well as to the society as a whole in order to further strengthen the inclusive agenda.
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