To adequately deal with the challenges faced within residential care for older people, such as the increasing complexity of care and a call for more person-centred practices, it is important that health care providers learn from their work. This study investigates both the nature of learning, among staff and students working within care for older people, and how workplace learning can be promoted and researched. During a longitudinal study within a nursing home, participatory and democratic research methods were used to collaborate with stakeholders to improve the quality of care and to promote learning in the workplace. The rich descriptions of these processes show that workplace learning is a complex phenomenon. It arises continuously in reciprocal relationship with all those present through which both individuals and environment change and co-evolve enabling enlargement of the space for possible action. This complexity perspective on learning refines and expands conventional beliefs about workplace learning and has implications for advancing and researching learning. It explains that research on workplace learning is itself a form of learning that is aimed at promoting and accelerating learning. Such research requires dialogic and creative methods. This study illustrates that workplace learning has the potential to develop new shared values and ways of working, but that such processes and outcomes are difficult to control. It offers inspiration for educators, supervisors, managers and researchers as to promoting conditions that embrace complexity and provides insight into the role and position of self in such processes.
While digitalisation requires facilities management (FM) organisations to change at an increasing rate, little is known about the mechanisms that create ownership and enable individuals to implement changes in everyday FM practice. In this study, these mechanisms are explored from a stewardship perspective. The purpose of this paper is to provide insights in the dynamics of organisational change in FM by analysing how stewardship behaviour leads to change.A process model for implementing organisational change is constructed, based on existing theoretical insights from stewardship and intrapreneurship literature. The model is evaluated in a case study through analysis of critical events. Interviewing was the key data collection method.The process model gives an event-driven explanation of change through psychological ownership. Analysis of multiple critical events suggests that the model explains intra-organisational as well as inter-organisational change. The case data further suggests that, compared to intra-organisational change, tailored relational and motivational support is more important for inter-organisational change because of the higher risks involved. Job crafting emerged as an unanticipated finding that offers interesting prospects for future FM research.The process model offers guidance for leaders in FM organisations on providing tailored support to internal and external employees during periods of organisational change.Stewardship and intrapreneurship are combined to provide insights on organisational change in FM. The study demonstrates how intrapreneurial behaviour and stewardship behaviour can be linked to create innovation within and between organisations.
Nationwide and across the globe, the quality, affordability, and accessibility of home-based healthcare are under pressure. This issue stems from two main factors: the rapidly growing ageing population and the concurrent scarcity of healthcare professionals. Older people aspire to live independently in their homes for as long as possible. Additionally, governments worldwide have embraced policies promoting “ageing in place,” reallocating resources from institutions to homes and prioritising home-based services to honour the desire of older people to continue living at home while simultaneously addressing the rising costs associated with traditional institutional care.Considering the vital role of district nursing care and the fact that the population of older people in need of assistance at home is growing, it becomes clear that district nursing care plays a crucial role in primary care. The aim of this thesis is twofold: 1) to strengthen the evidence base for district nursing care; and 2) to explore the use of outcomes for learning and improving in district nursing care. The first part of this thesis examines the current delivery of district nursing care and explores its challenges during the COVID-19 pandemic to strengthen the evidence base and get a better understanding of district nursing care. Alongside the goal of strengthening the evidence for district nursing care, the second part of this thesis explores the use of patient outcomes for learning and improving district nursing care. It focuses on nurse-sensitive patient outcomes relevant to district nursing care, their current measurement in practice, and what is needed to use outcomes for learning and improving district nursing practice.
