By Maurice de Greef, Tinie Kardol, Katarina Popovic, Rosemarie Klein, Dieter Zisenis, Sarah Dury, Lise Switsers, Liesbeth de Donder, Margherita di Paolo, Daniela Grignoli, Anja Machielse, Wander van der Vaart, Sara Marsillas, Erkuden Aldaz & Alvaro García.
In order to train professional or volunteer caregivers and informal carers in experience a new way in caregiving a basic foundation for the training is needed. This can be provided by the development of an education model. This paper describes the Education Model for ‘SEE ME’.
Figure 1 shows the Education Model for SEE ME. Basic foundation is the process of amplition, which will be accomplished by using the educational methodology of learning guidance and counselling. This will be realised the facilitation of a transformative learning process, which is based on critical, experiential, and situational learning using social comparison and capabilities.
The eventual goal of training the concept of “SEE ME’ among caregivers is to experience a new way of giving (complementary) care with older adults and their relatives and managers. Basic idea is that they really ‘see’ the client her- or himself and that they are aware of their competencies, possibilities, needs and wishes. In order to achieve this most of the time it is necessary to renew the professional way of caregiving. The consortium of ‘SEE ME’ would like to strive one possible goal for all the different actors in addition to the reinforcement of the positive states.
Therefore, the ultimate goal of the training is based on amplition. First of all the consortium would like to optimize the way of living of the older adults. This can be achieved to increase all good things and to remove possible barriers. So positive states have to be reinforced, which refers to amplition thinking. But the caregivers cannot achieve this only by themselves. They have to cooperate intensively with older adults and their relatives, their colleagues and the management of the nursing home (or comparable place where the clients live). This means you don’t speak in terms of ‘us’ and ‘them’, but in terms of ‘all of us together’. Everyone with his own expertise as an older adult, relative, colleague, and manager can do something to increase the well-being and meaningful life of the older person. Together this ‘team’ would like to be on the same page in order to increase the living conditions for the older person. The basic foundation for this training and the ultimate goal has its roots in the process of amplition in cooperation with the involved actors (see figure 1).
Basic educational methodology: Learning guidance and counselling
In order to achieve a process of amplition an educational methodology is needed (see figure 1). This is rooted in the concept of learning guidance and counselling of Klein and Reutter (2005). The ‘learning guidance and counselling concept’ of Klein and Reutter (2005) is an orientation and structure-giving design framework for enabling self-organised learning in a (new) learning/teaching culture. It represents a response of organised adult education to the social demands of lifelong and self-organised learning. As a conception, it wants to give adaptation and context-specific modification impulses for different action contexts of adult education.
The learning guidance and counselling conception must therefore be contextualised in organisation and target group specific concepts. The learning guidance conception does not claim to be completely new, nor to be ‘modern’, but is a combination of known bodies of knowledge about adult learning in the organisation and thus forms connections to known and proven professional knowledge. As a concept, it can be described in terms of its underlying pedagogical stance, which can be summarised in action-guiding principles (orientation-giving design framework) and in core elements (structure-giving design framework).
The choice of the term ‘learning guidance concept’ is intended to preserve the openness for context-specific conceptualisations (e.g. cultural, social, political) and the associated conceptual concretisations.
The guiding principles of the conception are:
- Orientation on participants
- Orientation on heterogeneity and diversity
- Orientation on participants learning interests and needs
- Orientation on participants biography
- Orientation on participants competences
- Orientation on dilemmas
Core elements are for instance – depending on the learning environment and conditions:
- Learning diary (to monitor the learning experiences during the learning process)
- Learning conferences
- Learning guidance consultations (e.g. one to one with the train the trainer)
- Learning resource pool / free resources for learning
- Competence balancing
- Exercises on learning biography and individual learning approaches (to reflect on the learning process)
- Reflexions about learning and double-faced feedback culture among the peers
- Evaluation of learning outcome and learning results
- Lively learning methods and tools
Way of working: Transformative Learning inspired by critical, experiential and situational learning based on social comparison and capabilities.
During the learning guidance a transformative learning process will be realised (see figure 1). Under the influence of Habermas, Mezirow states that there are three types of learning: instrumental (1), dialogic (2) and self-reflective (3). The third one deals with meaning and changing the perspective and it is in the focus of the transformative learning theory. According to Merriam and Cafarella (1999) transformational learning is in fact learning by becoming aware of your own situation. One becomes aware of his or her situation by reflecting on it. Mezirow (1991) describes this process as one in which interpretations are used in order to develop new interpretations for guidance of future actions. One uses earlier experience as a kind of “framework” in order to obtain new insights, to change his or her daily activities and his or her daily practice. According to Mezirow this learning process seems to focus on a solution for the learner.
More concrete important steps to make are (Merriam and Cafarella, 1999):
- Disoriented dilemma: what didn’t work out as I hoped to be?
- Self-study: how does that relate to my action and me as a person?
- Critical test of assumptions: what are my failures and can be changed?
- Recognition of the same process: how are others dealing with this?
- Orientation on options: what can I do differently?
- Formulation of an action plan: how am I going to do this in practice?
- Reintegration in life: how do I ensure that these actions will be part of my life?
These steps seem to be seven important steps in order to accomplish a process of transformation learning.
But before one can start the process of transformative learning it seems to be necessary to stimulate the interest of reflection on the current situation of caregiving. In SEE ME, the expertise of the various partner organisations from several European countries is utilised. Against the background of different life situations for old and very old people and the different framework conditions and structures for the care and provision of old people in the respective partner countries, we start from a person-centred concept of support, care and provision for old people. In such a concept, the focus is on the life situations, potentials, resources, self-determination, and self-empowerment of the older people. At the same time, the necessary concrete needs for support and care are taken into account. The older people, their relatives and friends, professional carers and volunteers in the care organisations work together to enable a meaningful life in old age even with increasing need for care. This self-image applies both to older people living independently in their own homes and to the design of the necessary infrastructure in the living environment, in the residential neighbourhood, as well as to all different forms of housing and living in residential communities, in outpatient and inpatient care. The education model aims at appreciating the diverse expertise and positive models, concepts and practice implementations in care and at the same time reflects the existing barriers and limits, which can relate to the structural framework conditions, the organisational context and the working conditions as well as to the necessary competences of the caregivers.
Based on the idea of amplition it seems to be necessary to create an openness to reflect in collaboration with others in order to reinforce the positive state and to get on the same page with all the actors involved. Therefore we would suggest to start with a first step before the seven steps called the ‘Stimulation of interest’ in order to create openness for reflection. This first step seems to be comparable with the first step of the model of the transformative learning process, but still with this extra step we would like to give more attention to the interests of the participants themselves.
According to Raemdonck (2006) self-directedness in learning for adult learners seems to be important. So goals and elements of the learning process needs to be formulated in interaction with the learner him- or herself. This refers to the process of transformational learning. In seven different steps the learner learns how to change his or her daily situation. Accordingly learning seems to be “learner-centred”. The learner determines what has to be changed and how it should be changed. He or she formulates his or her own goals and possibilities to change the actual situation. Of course, guidance of a teacher or a supervisor is needed in order to stimulate the use of these seven steps and the belonging reflection. But learner in transformative learning is not any learner, it is someone who is able to (self)critically reflect on assumptions and critical discourse and to validate a best judgement (Mezirow, 2006). Mezirow considered critical reflection to be the distinguishing characteristic of adult learning, and saw it as the vehicle by which one questions the validity of his world-view (Cooper, 2014).
To be concluded the (volunteer) caregiver has to be motivated to use any kind of self-perception in order to learn to transform the daily work.
The initiation of transformative learning processes must take into account two perspectives: on the one hand, the individual and/or collective learning process as a process and, on the other hand, the goal of the process, the transformation. In the opinion of the consortium of SEE ME a recourse to the learning theoretical approaches of transformative learning that keeps both variants in view – the consideration of individual transformative learning processes as well as collective ones – could also be made fruitful for the question which organisational and, if necessary, political transformation processes to be shaped. In this context, O’Sullivan’s variant shows possibilities to intervene in an anticipatory and formative way through criticism of existing conditions and thus not only to react to changes” (Zeuner, 2010).
During the transformative learning process three ways of learning will be explicitly used, to mention:
- Critical learning or expansive learning (by Klaus Holzkamp, 1996a, 1996b). Holzkamp developed his ‘subject-oriented’ learning approach within a critical analysis of traditional comprehensions of learning. The central question in his approach is, when and why people learn. He argues: we learn when it is justified for ourselves i.e., when we declare it subjectively reasonable. Subjectively reasonable means: ‘I need it, it is useful for me!’ This means: We are ready to learn when we are not able to solve a problem or a new challenge with our present experiences and knowledge. Then – according to Holzkamp – and only then, when our expertise is not sufficient, we engage into a ‘learning loop’. The following applies especially to adulthood: For us adults it is not about acquiring a subject per se, but it is about living our life better, with more or higher quality – while ageing it might be about maintaining the quality of our life as much as possible. Learning makes sense when it improves or maintains the own quality of life.
- Situated learning (including social, cultural and other contexts): The starting and reference points for learning are always practical applicable situations. Based on these applicable situations, the specific competencies that the (volunteer) caregiver needs in order to manage better the work situation have to be identified. Hence, learning is embedded in the diverse situational contexts that arise at work. The real learning environment makes it possible to work on realistic problems and authentic situations. This ensures that the application context becomes clear to learners and that the transfer outside the concrete learning situation is successful. Situated learning aims to make learning possible and to ensure that knowledge is not only acquired in a situational and working context but can also be related to new problems (Stein, 1998). In this a connection can be made to Intellectual Output 1: the case studies.
- Experiential learning: Experiential learning refers to an active way of learning or in other words to learning by doing. One learns by reflection on the things one does. So the experiments in practice lead to new insights. Basic foundation of experiential learning has been defined by Kolb (Loo, 2002). This learning cycle includes four different stages. The (volunteer) caregiver has a concrete experience during work (first stage) and reflects by observation if the experience is successful or not (second stage). In a next step the (volunteer) caregiver thinks about the possibilities improve the practice at work during a new possible experience (third stage). Eventually one starts a new active experimentation (stage 4) in order to have a new concrete experience.
During the three ways of learning it is important that one takes notice of his or her own capabilities and tries to compare this with other. This social comparison can possibly lead to new insights in order to learn and improve daily practice of the (volunteer) caregiver.
Education principles for learning environment
process in order to motivate the learner and to create a safe learning environment. Additionally, this guidance is of importance at the end of the training when the learner has to transfer the learned knowledge, skills and attitude to his or her daily work. During this learning process one pillar is a stable important factor and that’s the learner him- or herself (pillar 2 in figure 2). In this case the (volunteer) caregiver who creates his or her own learning process during a learner-centred learning environment. Thirdly, the last pillar are the learning activities and -materials (see figure 2), which are especially importance during the second phase of the learning process when the (volunteer) caregiver tries to internalise new knowledge, skills and attitude.
During the training for the caregiver for each pillar several demands must be taken into account.
1. Demands of pillar 1: The facilitator (in the model referred as teacher respectively as learning guide and counsellor):
- must realise that support of the learner is needed
- must realise that things can be done differently and how it should be done (based on the insights of the SEE ME model)
- must create a safe environment in which the learner can express self-sensitive information (like failures) and can be vulnerable
- knows how a learning process looks like, going up and down and adjusts guidance accordingly
- provides ‘comparable others’ to mirror the learner
- old ways to work in order to improve the process of caregiving (by using transformational learning within 7 steps and adding a step concerning a system-oriented reflection and adding critical steps concerning circumstances in addition to critical learning and expansive learning)
- uses humor as much as possible
- will not instruct but discuss
- stimulates learning by doing
- also becomes conscious about his or her own ideas and visions and makes these explicit
- orientates on the learners and on what they already know and do
- will tolerate uncertainty and be flexible by promoting reflections and posing questions
- shows empathy in order to help in the process
- should be able to adapt the reflection process to the profiles of the learners (background, educational level, etc.)
- should be learning guides and counsellors, which means a new role in order to design learning environments and facilitate learning situations and processes. With the learners they demand shared responsibility for the learning process. They offer connectable knowledge and methods for planning, structuring and evaluating learning processes. They establish transparency of learning processes and stimulate reflection phases.
- also must be able to reflect on this by themselves
- has to have skills in ‘letting you discover’ rather than giving you answers (questions instead of answers)
- must stimulate the use of the seven steps of Mezirow and the relevant reflection (as mentioned before).
- must recognize the importance of experience in the learning process: (“how the experience relates with the new learning and how its interpretation can change by learning”)
- become an agent of social change and adult education and accepts responsibility for fostering democratic social change.
2. Demands of pillar 2: The participant (in this case the (volunteer) caregiver):
- is aware of the current situation of caregiving
- has the possibility to learn, to change and to adapt
- has willingness to ‘open up’
- creates and spends time to reflect
- dares to experiment with behaviour
- opens his or her mind and is realistic: “what can I really contribute to give meaning?”
- reflects and improves the daily work by collaboration
- take parts in peer learning and small learning circles (learning from each other)
- has an openness to self-reflection
- has practical needs (such as time, more practical or quotidian inquiries).
- is responsible for his or her own learning process (determination in for example ‘Reason/motive/cause for learning (Why?)’, ‘Aims of the learning process (Where to?)’, ‘Content of the learning process (What?)’, ‘Learning paths (How, in which way, with which means, with which media?)’ or ‘Checking the learning success’).
- focuses less on cognitive, intellectual knowledge content and more on raising awareness of the fundamental attitudes, the prerequisites and enabling structures for a meaningful life in old age and reflecting on the actual options for action in the respective work contexts
- focuses not only on their individual competences, but above all about a critical reflection of the concrete working conditions and all actors in care (emancipatory guidance and counselling of learning)
- has a sense of need/self-motivation to change
- has a willingness to share one’s own lived world with others
- has a strong need for change and the willingness to invest
- knows the benefit and necessity of learning
- must take a constructive and positive approach to the learning process (and not negative!)
- formulates his or her own goals and possibilities to change their actual situation
- seek within his- or herself tools for a critical analysis (critical reflection)
- contributes to co-creation and participation
- experiences the constraint (a crisis) as an opportunity to answer to the question: what are my failures and can be changed?
- can analyse existing challenges in care holistically and includes structural and organisational needs for change in the transformative learning process
3. Demands of pillar 3: The learning activities and –materials:
- have to connect seamlessly with the world of the other
- provide structure in how to endure the learning and reflection process
- provide examples of behaviour and ‘others’ that are balanced (not steering) and tailored to the learner
- are motivational and stimulate and reward the learner
- are brief, clear and facilitate reflections
- may combine time for activity and reflections
- are based on an ‘outside the box’ – innovative perspective
- includes the needs to transform the reflection into practice
- support the self-organisation of the learners
- are challenging and attractive
- are need- and interest-oriented
- are close to the situated learning approach (and real working situations)
- link to existing competences and to the dilemmas and challenges identified by the learners themselves
- are suitable both for individual learners’ engagement with the topic and for a discourse in the learning group
- enable the identification of actual options for action
- should suit different learning styles and levels of the learners
- must be supportive, confirming and challenging to the reflection process
- must offer reflective experiences outside the comfort zone of the participants
- need to build self-confidence and to achieve a new understanding
- has to convince the participants that the efforts are paying off and that the investments in learning yield demonstrable improvements (what’s in it for me)
- should be co-created with the learners to activate the reflection process, so they are tailored on each learner
- should be considered as life history of the participants (referring to the person they’re taken care of), so their socio-cultural environment should be respected
- include a collection of different best practices to answer to these questions: “how are others dealing with this, what can I do differently, how do I ensure that these actions will be part of my life
- includes possibly gamification in order to talk about daily and own experiences
- includes a focus on appreciative inquiry (what is going good, explore everybody’s ideas, from a positive way, further a dream, where do you want to go, and further to what is not going well and how we can improve the dreams).
Perspective on our older people on our wonderful work
Goal: To learn about new perspectives on seeing your client
Possible methodologies and training methods:
- Reflection exercise in different small groups on the sense of meaningful life / meaningful aging in nursing practice and besides what does meaningful life / meaningful aging mean to me personally each other’s work with mentioning best experience with an older client
- Presentation of each caregiver concerning his or her own daily practice with extra attention of a best practice of meaningful care from his or her own institution.
- Interactive lecture concerning SEE ME and competence care (including the movie SEE ME: https://www.youtube.com/watch?v=LDP83gejkoE)
- Reflective exercise after seeing movie of SEE ME with questions:
- What did you notice during the movie?
- Do you recognise your daily work in this movie?
- What do you do to avoid these situations at work? Think about using personal skills or methodologies of working.
- Exercise concerning appreciative inquiry about the cooperation between a caregiver and an older client (in order to compare current situation with future situation)
My work as a caregiver
Goal: To reflect on my profession as a caregiver and to show personal best practices in Europe
Possible methodologies and training methods:
- Elevator pitch in small groups about best experience of working with older people in the last years
- Interactive lecture about the future role of a caregiver
- Possible reflection exercise concerning the basic attitude of a caregiver. Are there possibilities to increase the awareness and competencies to recognise social and meaningful needs (also towards restrictions as time and emotions and openness)? How can you do this?
- A group exercise concerning describing and defining the perfect role of a caregiver (with a perspective of SEE ME) based on the methodology of Team Based Learning
The golden methodology of co-creation
Goal: To learn about the methodology of co-creation and to decide upon topics for the personal action plan as a caregiver
Possible methodologies and training methods:
- Ice-breaker concerning the most important things in the daily work of each caregiver joining the training
- Interactive lecture about co-creation (how to develop activities etc. in cooperation with older people) and flow (how to experience a satisfying feeling and feeling of happiness during the activities and in life) as a process between caregivers and older clients
- To present the innovative working methodology in each institution of care giving. How do you work at the moment as a caregiver concerning the ‘SEE ME’ ideas?
- To develop a tool of how to reveal talents of older clients and how to activate them (although they do not seem to like to join as a passive older client)
- Brainstorming exercise concerning the personal action plan for the upcoming weeks
Goal: To develop an action plan for the upcoming weeks in order to SEE the talents of older clients and use them for new activities for the clients themselves
Possible methodologies and training methods:
- Ice-breaker about your daily routine as a caregiver
- Interactive lecture concerning co-creation and flow
- Development of a personal action-plan and reflection rounds on the action plan using a structured reflection in subgroups
- Evaluation of the transnational training (by an interactive exercise)
Possible activities after the pilot course in other to increase the transfer of the train the trainers and the impact of the SEE ME contents:
A. Possibility of peer coaching in the upcoming weeks in which each caregiver is linked to two other caregivers from two other countries!!
B. Meeting 5: Reflection on my own innovation
(Takes place online after a few weeks of the transnational training)
Goal: To reflect upon the reached goals of the personal action plans and to formulate new actions
Possible methodologies and training methods:
- Possible methodologies and training methods: Reflection concerning each other’s realised milestones and goals (in subgroups and partly in plenary)
- Formulating of future action bullits for daily work in the upcoming months (in subgroups and partly in plenary)
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Zeuner, C. (2010). Welche Potentiale bietet Weiterbildung für die Bewältigung gesellschaftlicher Veränderungen im kommunalen und regionalen Umfeld? (https://docplayer.org/4466122-Prof-dr-christine-zeuner-fakultaet-fuer-geistes-und-sozialwissenschaften.html – (translated with deepl.com). Edmund O’Sullivan is Director of the Transformative Learning Centre and a Professor in the Department of Adult Education and Counselling Psychology at the Ontario Institute for Studies in Education (OISE) at the University of Toronto.