Stefano Bonometti1, Livia Cadei2
1 University of Insubria-Varese (ITALY)
2 Catholic University of Milan (ITALY)
Abstract
The research aims to answer two questions: a) how adult education impacts professional and social development of the health professions and b) are there forms of resistance to the rationalization and privatization of care services? The action-research covered over two years with a sample of 50 Health Care Assistants (Ats Brescia - Italy), engaged in the role of internship guides for students of the three-year degree for Health Assistants. Identity and professional practices are investigated through two training stimuli: redefine the evaluation form of the internship and articulate the section of
competence; use emotion cards to reflect back on identity and social issues.
Keywords: Learning careers, professional identity, health professionals
The multiple processes of globalisation, the economic crisis of national health systems, the progressive ageing of the population challenged the traditional competences of health professionals.
Several studies (EC, 2020; WHO, 2015) about these roles show the particular attention of the scientific community to these issues. Health Care Assistant is a particular professional figure in the Italian socio-health context, who works mainly in the public sector, for prevention services, health education, epidemiology and vaccinations. Access to this role requires a three-year academic training and a national qualification, and then a public competition to work in the National Health Services.
The transformation of the social and health context has required an updating of the competences of the professional profile of the health assistant, starting from the initial academic training.
Some new needs typical of the globalised society (Bauman 2000; Sennet 2008), more and more intercultural approaches (Appadurai 1996), complex and of risk (Beck 2009) guide the definition of the new competences: to pay attention to the experiences of illness (to care) and not only to health services (to cure); to an increase in patients who remain in their own homes and need care at home;
to patients from foreign countries with different habits and cultures who require new attention and communication methods; to the ageing of the population estimated in Italy at 6.5% of the total population (Eurostat, 2019), which highlights the intertwining of relationships between family, residences for the elderly and specialist care; to an increase in ethical issues that intertwine the daily choices of care; increasingly multimedia and web-based communication channels; to popular
movements around the advantages/disadvantages of vaccinations.
These transformations require, certainly in the Italian context, an updating of the competences concerning the professional identity of the care professions and in particular for the Health Care Assistant. An update that requires not only technical skills but also transversal skills and a transformation of the habits of mind of the profession.
99 Methodology
The research path is part of the action research perspective applied to the field of organizational learning with the intention of promoting new knowledge, activating a change in practices. As indicated by Darwin (2011) action research is intertwined with Activity Theory
(Engeström, 2000) and this allows us to promote learning development and innovation of practices and at the same time allows us to enter into a historical-ethnographic vision to better understand reality. We are inspired by the Change Laboratory’s methodology (Virkkunen & Newnham 2013;
Sannino & Engestrom 2017).
The design of the research carried out actions with the participants to achieve new
professional skills and a meta-path of experimentation on the effectiveness of methodologies and devices for learning. The proposal developed over the two-year period 2018 and 2019, involving 50 Health Care Assistants from the Agency of Health Protection (ATS). Each participant acted as a trainee mentor and welcomed trainees into their service for a duration of approximately 4 weeks.
The proposed training pathway intertwined two learning goals for the health worker-tutors (experts), corresponding to the double stimulation: first, to innovate the tutorship processes, updating the toolbox; second, to reflect and transform the professional identity. Following the double
stimulation model that characterizes the progress of the Change Lab, we can outline a scheme that interweaves the primary and secondary stimuli with the phases of the research:
Phase A: the first stimulation provided by the need to change the internship evaluation form;
the second stimulation gave by the competence rubrics that go to change the overall frame on evaluation and design.
Phase B: the first stimulation provided by rethinking evaluation as a practice to be included in the ongoing phase of training: the second stimulation gave by the use of emotion cards, which reconfigured the educational relationship by repositioning it at a higher level of complexity. The research intervention through the Change Lab can be represented according to an analytical grid as proposed by Sannino and Engeström (2017):
Table 1: Sannino & Engestrom’s Analytical Grid N. stage of
intervention CONTRADICTION CONFLICT OF
MOTIVES FIRST AND
100 The training course included a first phase (2018) in which the aim was to transform the
internship evaluation form that the tutor had to fill in regarding the student's performance. The conflict that starts this first process is to have an effective and at the same time quick tool. The qualitative leap occurs when the competence rubric (a scale describing the level of mastery of the competence) is introduced. This introduces an imbalance in the tutors, as they measure themselves, activate a mirroring process, from which the possibility of reflecting on their own professional identity arises.
The second part (Phase B) takes place in 2019 and the conflict that starts the process is on the one hand the need to carry out a deep assessment of competences and on the other hand the need to develop a quality design of the practical traineeship in a short time. In this case, the second stimulation was driven by the introduction of the emotion cards that allowed the quality leap and the resolution of the conflict. This led to strengthening the sense of group among the tutors and the initiation of a sense of community of practice.
Results
The methodological framework allowed to reposition historically the development of the professionalism of the Health Care Assistant. This emerged from the comparison between the training received by the tutors and the current training offered by the university, and the transformation of the professionalism required in the 80s-90s and that required in the current context.
The research highlighted three central aspects concerning the training of professionals in social and health contexts. The first one induces to think that when one deals with the training of others in the care profession, it follows an action of reflection on one's own professionalism. In our course on the theme of tutorship, the participants activated and increased a process of reflexivity on their own professional identity. This process is the outcome of the second stimulation and is the expected result of the aims stated in the project. The participants developed a habit of mind of self-tutorship, of permanent attention to their own professionalism.
The second aspect confirms the centrality of the social dimension in the learning processes.
The possibility of exchanging information, comparing different perspectives and negotiating, in order to find a new shared plan, leads to the elaboration of new competences and patterns of behaviour.
This is a process that requires the respect of some important steps, such as the recognition of criticalities and contradictions, a facilitating role by the counsellor/teacher, the evolution of stimuli to activate a proximal zone of development.
Finally, the third aspect concerns the participants' feeling of perceiving themselves as a community of practice. The tutors, during the proposed training course, were involved not only as individual practitioners, but were urged to confront each other and seek solutions together. This process progressively strengthened the feeling between them, they redefined a common territory, a new border space in which they rediscovered themselves as a mutual resource. Within this proximal space of improvement, they have positioned a common commitment, a shared language and updated their repertoire of skills.
Conclusions
The world of social and health work is constantly evolving. It requires an updating of technical skills but increasingly a development of relational, reflective and ethical skills. This is possible if health and care professionals develop a professional identity centred on continuous learning through self-tutorship. This means knowing how to take care of oneself and one's professionalism through processes that follow two lines: an internal one, centred on reflexivity on the professional self; an external one, centred on confrontation and open dialogue with other operators. The balanced intertwining of the two tendencies creates a tension towards the continuous improvement of one's
101 own professionalism, a perception of well-being in the working contexts and greater equity in the services provided to the recipients.
This qualitative research shows the validity of experiential and relational approaches for
learning in care work contexts, at the same time, it shows the limitation of being focused on a specific territorial case. This requires further investigation and confirmation.
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