Report Merja Ylönen, Ikali Karvinen, Bodil Tveit & Olav Fanuelsen

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1 1 Report Merja Ylönen, Ikali Karvinen, Bodil Tveit & Olav Fanuelsen CHRISTIAN and DIACONAL VALUES IN HEALTH CARE EDUCATION INTERNATIONAL BENCHMARKING PROJECT BETWEEN DIACONIA UNIVERSITY OF APPLIED SCIENCES AND DIAKONHJEMMET UNIVERSITY COLLEGE Diaconia University of Applied Sciences (Diak, Finland) & Diakonhjemmet University College ( DUC, Norway) This Benchmarking project is based on close interaction between two higher education institutions called Diaconia University of Applied Sciences (Diak, Finland) and Diakonhjemmet University College (DUC, Norway). The project is supported by the Finnish Higher Education Evaluation Council. 1. Benchmarking participants Diaconia University of Applied Sciences is a national-level UAS with a special national-level duty as an educator and developer for the church sector in Finland. Diak also educates experts in the humanities. Diak cooperates closely with the civic society.the values guiding the work at Diak are Christian love for one s neighbour, social justice, open interaction and effective work. Diak has about 3000 students in its campuses in the South, West, East and North of Finland. ( Diakonhjemmet University College (DUC) is an accredited church based college in Norway. The college has about 2200 students and a staff of 160. It has two campuses; in Oslo and in Sandnes. The college gives education in a variety of subjects and areas, mainly in health and social services and church based diaconia. The programs are on the bachelor and master level, and the college has a PhD-program as well. The core values of the college, within the frame of the church tradition, are: service (diaconia), competence, equality, openness and courage. ( Although Diak and DUC have had cooperation for several years and they have a similar mission as an educator and developer in their countries of origin, they have not benchmarked their functions or education in formal manners before. Furthermore, both institutions are members of Network of European Universities Involved in Teaching and Research of Diaconia. Diak and DUC have fruitful cooperation in education, research and development work. 2. Overall objectives and target The overall objective of this benchmarking project is to develop benchmarking as a tool for better self-evaluation in both organizations. The project aims to discover the best practices of Nurse and Diaconal nurse education in their various functions of training. Furthermore, it aims to discover the best way to cooperate with the working life partners. The focus is on the diaconal profile/values in these two institutions. In the beginning this project was focused on studying mainly the meaning of Christian values in the training in partner organizations. Later on it became evident that this concept was too narrow to capture the current reflection of values that exist among students, teachers and working life partners. Through the process of development the scope was partly expanded / modified to cover a more general question of the meaning of values in nursing education in modern society.

2 2 3. Methodology, benchmarking networking and materials This benchmarking project was carried out by an international benchmarking group which consists of five members from both institutions three from Diak and two from DUC. Diak was the project administrator. This BM project had three different stages. During the first stage BM institutions submitted a joint application for the Finnish Higher Education Evaluation Council (FINHEEC) to establish the project. During the second stage virtual meetings took place to carry out the project plan. This stage also included BM visits such as the data collection by group interviews. The benchmarking source material was collected by a separate questionnaire. It was formed in the process of several meetings over a twomonth period. All BM team members also got familiar with different written materials including curriculum, study unit implementation plans, operational and pedagogical principles and the institution s strategies of both organizations. The BM project had its own online meeting room ( and online platform for data sharing ( BM visits were planned together and the first visit was hosted by Diak in Finland at the end of February The program consisted of meetings, interviews and general discussions. During the first visit the data gathering questionnaire was developed further after getting the feedback from the first interviews. The second BM visit was hosted by Diakonhjemmet in Norway at the end of April 2012 and it included data gathering in three group interviews. Interviews and other BM source materials There were three group interviews at both institutions including the groups of students, lecturers and working life representatives. The groups consisted of 2-4 members and discussions were held in English. The working life representatives represented widely both private and public actors in the field of social and health care. The interviews were recorded and documented. The interviews took place in a calm and relaxing atmosphere where also refreshments were served. Immediately after each group interview session a short general discussion was held to find the common understanding of the content of the interview. In the end of the interview day there was reflection and self-evaluation to share the first impressions of the interviews and the methodology used. The written BM source materials were mostly in English and they were gathered in February Reading and the process of analysis took place partly before the interviews. The following BM source materials were available for benchmarking: 1) Materials from Diak: Curriculum 2010, Diaconal nursing work elective program, 240 cr; Curriculum 2012, Nursing elective program, registered nurse, 210 cr; Study module in nursing work with the aged; Diak, operational principles; Principles of Action at Diak, RDI principles; Diak, pedagogical principles; Structure Nurse; Structure Deaconess; International Diak 2) Materials from Diakonhjemmet: Curriculum 2009 for Diakonhjemmet University College-Bachelor in Nursing; Plan for module 6: Coping and rehabilitation 15 cr; Plan for module 2: Sykepeie til eldre i institusjon, 15 cr; Plan for module 7: Nursing of patients requiring surgical treatment, 15 cr; Plan for module 3: Verdier og relasjoner i profesjonell praksis, 10 studiepoeng 4. Analysis, results and findings This benchmarking process was not linear, rather it was cyclic consisting of several cycles of development work. It had elements of Action research. Both the process and methods were developed as the process went on. The process of Analysis was reflective and progressive including the cyclic analysis besides the data gathering. Figure 1 shows the main elements of the data gathering and the process of analysis (Appendix 1). The main BM findings are shown in table number 1.

3 3 Table 1. Main results and findings. 4.1 General impressions of the curriculum and interviews 4.2 Remarks by the lectures Diak s findings from DUC - At the first stage of reflective analysis, based on the written materials, the BM team noticed that values were not that much underlined as expected. - The BM group thought that ethics and values were not as concrete or visible at the DUC curriculum or implementation plans as they were in the minds of the students and working life representatives. - The Interview supported the idea of two existing curriculums at DUC: 1) visible and concrete curriculum and 2) hidden/invisible in- practice curriculum. The visible concrete curriculum does not highlight the values or diaconia as such but the invisible in-practice curriculum clearly supports these in action. In practice DUC emphasizes the meaning of values and the role of diaconia in modern society. - Diakonhjemmet is a highly respected training organization among students and working life partners and its reputation is based on the value-based interaction with all actors. - DUC s values are visible in everyday actions: it is a way to be, behave and act, to greet, to smile, to show one s own vulnerability, to keep promises, and to work with high ethical standards: to be Firm + Friendly + Fair. - Lecturers desire to keep good Christian manners and practices in the life of the institution (services at chapel, candles, praying, singing visible signs of the background; and they wish to find ways to transform this tradition into modern language. - Invisible curriculum supports values, there are written values and operational values operational values are even richer and larger DUC s findings from Diak - The actual curriculums are quite explicit on the foundation of DIAK and also the learning outcomes and objectives of the implementation plans include aspects related to the profile such as spiritual development, diaconal nursing work, the role of the Church as promoter of health, the principles of diaconia and pastoral care. - Despite this consistency in the written plans, the first impression after reading through the interviews is that the concept of diaconia is somehow unclear and is interpreted in various ways, some of the understandings are very narrow and others are very broad. - The impression is that this un-clearness is present both in the student interviews and in the interview with working life partners, but it is also the impression that diaconal nursing and the value of Diak is perceived in very positive ways by all the groups. - The values do not seem to be very controversial. The impression is also that they represent something that differs from the ordinary health care/ nursing services and traditions in Finland. - The identity of Diak is often explained through the historical base of the institution, and it may be difficult to grasp how history has been reinterpreted in our time. The widening of pastoral care to more spiritual care may be one example. - The diaconal perspective is given as an input in many modules but one can ask if that is too loose and little for the students to get a picture of what is meant by diaconal nursing. - According to the lecturers the characteristics of the education Diak is offering is that the students receive elements of diaconia during their whole education. It is described as a holistic perspective, but they also get some more specific knowledge about diaconia. It may depend on the teacher s background, because many of them are familiar with the history of the institution. - A close contact with the Deaconess Institute during the education gives also a broader picture of the idea of diaconia. - The teachers selected for the interviews had a different background. The majority seems to share the values of DIAK, which often are described in

4 4.3 Remarks by workinglife representatives 4.4 Remarks by students than written ones. - Lectures pointed out that it is important that values are seen and felt also among staff, not only between students and lecturers. - Specific theme days for students and staff are seen as a concrete possibility to create and feel community and trust. - Teachers are well prepared to meet students and staff at clinical area; they are strict, accurate and demanding. They have time to support, discuss and guide more than other teachers from some other institutions. - Diakonhjemmet has a reputation that you must have good grades in order to get in there. - Teachers like to work at Diakonhjemmet because of its small and suitable size, good and high reputation, good quality of training; they know that quality is measured and developed all the time. - The working life partners were well prepared before attending the interviews: they had printed materials about Diakonhjemmet and they were prepared to discuss and ask about the theme. - There is a lot of co-operation and communication between working life and the institution. There are many concrete and common projects that develop nursing in practice. - Working life partners expressed the importance of trusting teachers, students and the institution. - They know at working life that Diakonhjemmet is interested in developing the quality of training and cooperation with working life and students alike. - Students mentioned that structures and concrete actions support developing and learning. For example, there is a priest available when needed; she guides and even takes part in training (too). - A small unit/institution is perceived to be comfortable and cozy. It is important and fine that students know the staff and so it is easy to communicate with all the staff. rather general terms. According to the teachers some students are unfamiliar with the specific Christian base of the institution, and the impression is that most of them do not ask for it. - According to the teachers the specific diaconal values are integrated in the most basic modules. The idea is that the nurse herself should be able to talk to patients about spiritual matters, and not always call for a priest. - It seems that the leadership does too little to support the teachers in their struggle with the diaconal profile. - There is too little time to do research hence also research related to the profile of the College is suffering. Most of the research is organized in a specific research-unit. Nevertheless both teachers and some students attend joint projects organized by the unit. - A specific discussion about the Christian base is from time to time raised. Some students are complaining about the change from a religious focus towards a wider spiritual perspective in care. - According to the working life partners there is a big difference between students from DIAK and other students. The students from DIAK are conceived to have good basic knowledge, but also a more holistic approach which is visible in the way they approach patients and also in the way they reflect and speak about patient situations. - The working life partners feel well informed about Diak s values. - The concept of diaconia/diaconal values seem somehow unclear also amongst the working life partners and they are describing their conception of DIAK s values /profile in quite vague terms using words such as softness, something moral, more deep thoughts, meaning of life, how people die and how they live, marginalization. - According to the working life partners, the students may find it difficult to get enough time to include all these aspects in the care, and sometimes the students meet nurses that do not understand what DIAK is, and have a very stereotypical and old-fashioned conception of DIAK s role and profile. This makes it even more difficult for the students. - The students represented 3 different programs, diaconal nursing (4 years) with not many students and public health nurses and general nurses (3, 5 years) with the same number of students. They take 4 semesters together and then they divide into groups. But according to the students the difference between the programs is not very big and - there are some extra courses for each program, but basically they are the same. You 4

5 4.5 Common recommendations for the institutions - Students told that there is a possibility to discuss and reflect on your opinions and values which is important too. - There could be an introductory course and discussion about the institution s history, background and values with new staff members and students too. It could serve the whole institution and cooperation in the network. - There could be a stronger value and diaconia visibility in the written curriculum. In the interviews respondents stated very clearly that Christian values and diaconia as a phenomenon are very visible in all Diakonhjemmet s actions but the visibility of these in the written curriculum is less clear. - There could be better tools for Spiritual Health assessment for teaching and clinical practice. apply for one of the three but can change if there are available places in the other program. According to the students the diaconia program is more concerned with values and holistic caring than the others. - The students feel that the college is different from other schools (warmer, nicer) - When asked to describe the values of DIAK the students used terms such as ethics, moral, social marginalized groups, holistic nursing, respect, spirituality, religion, culture, focus on existence. - The students feel that Diak is different from other colleges students think differently from others. - Possibility to choose diaconal themes throughout the program. Some of the students feel that it is too much. Others feel that DIAK has an open profile and open discussions- the atmosphere is not pushing. - Not much focus on critical thinking and political questions. - The curriculums for the nursing elective program and the Diaconal Nursing program are quite identical with the exception of some specific courses in the diaconal nursing program, but the specific program is very much directed towards the work in the church, diaconal offices and parishes and has particular modules where Christianity/biblical studies and church history are involved. It seems that Diak needs to create actions and opportunities for all the students to focus on their values and profile more generally. - The ordinary nursing program seems to be influenced by the overall mission and vision for DIAK in several ways. Nevertheless the students find the basic values of specific care unclear from time to time. Actions could be made to strengthen the integrated outcome of the training towards a more integrated value-based practice. - Diak could profit from a more structured contact with the working life partners through joint research cooperation, seminars and better contact generally. 5

6 6 5. Overview of the results and recommendations In this benchmarking project it became evident that it is very important that educational institutions communicate their values in a way that the surrounding working life community and students understand them. An understandable language is a sign of the respect and expression of willingness for cooperation. Benchmarking participants recommended that church based higher education institutions should open up an extensive discussion about values in healthcare education to find out the modern meaning of diaconia and value based education. As a part of these recommendations the working life representatives desired to see that church based institutions could provide education about holistic spiritual care. The main findings and recommendations are gathered in table number 2. Table 2. Self-evaluation - results, questions and recommendations of the process for the institutions themselves Diak, self-evaluation - Could we create actions and opportunities to make our values visible and tell about them? - How shall we act with and toward working life: shall we take time for cooperation, shall we guide, educate and train students together/in co-operation? How can we show and make working life feel that we respect and appreciate them and their aid and work among our students? - How can we strengthen Diak s image as a reliable and professionally respectable educational organization for example by TOP-working, alumni and mentor actions? - Is this a theme that we could/should study at Diak more? Could it strengthen us strategically and underline Diak s characteristic feature? This could be a good thesis theme for our students too. DUC, self-evaluation - DUC needs to reflect more on how values and the profile can be presented with consistency in the curriculum and plans as this probably helps the institution also to implement values and particularity. - DUC could be more aware of how the profile is conceived by students, teachers and working life partners. Concepts which seem quite clear in the curriculum and plans are interpreted by users of these plans and may transform or develop to a broader picture or a more vague content. This is not necessarily problematic since the fact that concepts and practices are dynamic and a constant matter of discussions and different interpretations can also be a sign of life of the concepts. - DUC needs to reflect on how the curriculum is written with the purpose of communicating to a broad and heterogeneous group of people. The way the profile is presented should reflect the ambition to have a clear profile but still be within the frame of more general/ ordinary nursing programs. The benchmarking project provided Diak with the opportunity to achieve better understanding of the meaning of values in the higher education institution and in health education. It determined further research areas and worked as a map to best practice principles in value based teaching. We noticed that we have many good tools at Diak and we teach those tools to students too they learn to use different kind of ideas and tools at their work. We noticed that there are too few sings and actions at Diak to demonstrate our values the Christian values and ethics. Overall this BM project showed that basic values should be written in documents at all levels especially in the curriculum, implementation plans and study tasks. Also the true meanings of these concepts should be defined and described clearly within our institution and among us. It seems that this BM project gave something for students and working life partners too may be a feeling that they are valued and respected, and that their ideas and comments are important to our institutions. This benchmarking project has close connection to Diak s next auditing process as the next auditing will study the quality assurance of the degree programs. Our institution has valuable experience and recommendations to enhance the quality of health care education at Diak by focusing on the core strategic values of the institution. This benchmarking process was so innovating and inspiring that we shall write a common article about this and arrange an international seminar, 30 th January 2013, dealing with Christian values and hope in nursing.

7 Figure 1. Benchmarking process 7