In our professorship 'Learning Strategies' of the Fontys Secondary Teacher Training College Tilburg, we stress the importance of practitioner research for the professional development of teachers. To investigate our own beliefs, we started a project in which teachers learned to do practitioner research in their own schools. There were two questions we were interested in: 1) Which elements of the program are suitable to help teachers to learn do their own practitioner research? 2) What knowledge do teachers create in doing practitioner research? Several authors mention the benefits of practitioner research performed by teachers (Loughran et al, 2004; Zeichner & Noffke, 2001; Cochran-Smith & Lytle, 1999; Cochran-Smith, 2005; Huberman, 2002; Anderson & Herr , 1999; Robson, 1993, 2002; Onstenk, Kallenberg & Koster, 2007). Doing their own research would increase their professionalism as teacher. Although the relevance of practitioner research is stressed by many authors, not many teachers in the Netherlands are already actively doing practitioner research. Among other causes, the lack of experience in how to do practitioner research might be a barrier. We developed a program for teacher practitioner research, consisting of seven group sessions. In each session, attention was paid to theoretical backgrounds (formulation of a research question, choosing methods, obtaining and analyzing data, reporting on the findings) and to practical implications (participating teachers were advised by each other and by the supervisor). Most teachers worked together in a couple on their research project. The supervisor kept notes about difficulties and experiences of the teachers during the process and interviewed the teachers after they finished their research project. The answers to our research questions are: 1) The theoretical parts of the program were necessary for teachers to obtain knowledge about the (systematic) approach of research. The practical help of the supervisor was crucial during the process as the teachers were insecure about applying their newly obtained research knowledge in practice and needed help to do so. 2) Teachers obtained knowledge about performing practitioner research as well as knowledge about the problem they investigated in their school practice. Furthermore, they mention personal benefits such as 'another look at my profession', 'renewed motivation' and 'new insights'.
Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.
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