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Findings: Blogging was not found to be a useful tool for developing reflection or ... Conclusions: The research indicates the potential of using blogging as a tool ...
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Public and private blogging during placements: perspectives of occupational therapy students Carina Wiid, Cathy McCormack, Alison Warren, Sherrie Buckley, Mairead Cahill Background: Occupational therapy students complete practice education placements as part of their degree programmes. Sufficient support during these placements is vital since the transition from the classroom to clinical practice can present many challenges. Ensuring support can be difficult, given that these placements occur across a wide geographical area. Blogs were identified as a possible innovative way of providing distance support and a study was undertaken to examine the usefulness of this tool in occupational therapy practice education. Methods: A descriptive investigation of a private blog at Trinity College, University of Dublin, and a public blog at the University of Limerick was conducted during one practice education placement. An online survey was used to capture quantitative and qualitative data on the students’ experience of blogging during practice education. Findings: Blogging was not found to be a useful tool for developing reflection or clinical reasoning skills by this student sample, but was found to be beneficial for peer support and learning. Conclusions: The research indicates the potential of using blogging as a tool for peer support and learning. Further research on its application and the use of other social media in healthcare education is required. Key words: n online support n educational technology n allied health occupations n distance learning Received 14 June 2012; accepted for publication following double-blind peer review 24 January 2012

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ccupational therapy practice education (fieldwork) provides students with the opportunity to ‘apply the knowledge and skills they have learned in the academic setting to the clinical practice setting which fosters a process of professional acculturation’ (Thomas and Storr, 2005). Practice education is widely seen as vital for the professional development of occupational therapy students; it is a compulsory requirement of all occupational therapy degree programmes accredited by the World Federation of Occupational Therapists, which stipulates that each student must complete a minimum of 1 000 practice education hours. The demands placed on students to perform in real-life practice environments can present challenges and students can experience high levels of anxiety during the transition from the academic student role to that of practice education student (Wooster, 2004). Students often require significant support and guidance to move from the classroom to the practice environment and such support can be difficult to provide, given that practice education placements can be located in disparate practice

settings in multiple geographical locations. Many students report feelings of separation and isolation (Thomas and Storr, 2005); this is of particular concern for education providers, given that the quality and quantity of support on site can vary from one placement site to the next (Wooster, 2004). The practice education teams at the Trinity College, University of Dublin, and the University of Limerick were interested in exploring innovative methods of supporting students while they were on their practice education placements. Students at both universities complete placements at locations throughout the Republic of Ireland and abroad, so distance from campus and from their peers and their practice education support staff is an unavoidable reality for many of them. Mindful of this situation, the practice education teams were particularly interested in investigating the potential of information and computer technology (ICT) to provide support to diverse students at multiple locations, particularly since the literature shows that most students are digitally literate when they enter university (Ladyshewsky and Gardner, 2008).

International Journal of Therapy and Rehabilitation, February 2013, Vol 20, No 2

Carina Wiid is Occupational Therapist, Acute Care, Our Lady’s Hospital, Navan, County Meath, Republic of Ireland; Cathy McCormack is Practice Education Coordinator at the Discipline of Occupational Therapy, School of Medicine, Trinity College, University of Dublin, Republic of Ireland; Alison Warren is Regional Placement Facilitator, Limerick University Republic of Ireland; Sherrie Buckley is Occupational Therapy Manager, St Patrick’s University Hospital, Dublin, Republic of Ireland; Mairead Cahill is Practice Education Coordinator in Occupational Therapy, Department of Clinical Therapies, University of Limerick, Republic of Ireland Correspondence to: Carina Wiid E-mail: carinawiid@ gmail.com

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Research Computer-based communication has been found to be an efficient way to increase social connectedness and collaborative exploration of information between students (Graham and Scarborough, 1999). The use of web-based tools in practice education has been widely noted (Alexander, 2006; McLoughlin and Lee, 2008; Greenhow et al, 2009; Ravenscroft, 2009) and blogs in particular are regarded as powerful tools for informal learning (Boyd and Ellison, 2007; Mason and Rennie, 2007). A blog (from ‘web log’) is a website that presents dated entries in reverse chronological order, similar to an online diary (Efimova and Fiedler, 2004; Schmidt, 2007). Blogs encourage interaction and collaboration within an online community and can be public or private (Grassley and Bartoletti, 2009). Blogging has been found to encourage students’ natural tendency for reflection and analysis (Williams and Jacobs, 2004). Online reflective activities have been shown to increase the amount of time students spend on reflective activities and to take more responsibility for their own reflection than traditional classroom reflective activities (Morgan et al, 2006). Hramiak (2009) and Wolf (2010) found that blogs supported personal reflection by students on their professional development and experiences while they were on practice placements. Tan et al (2010) showed that blogging was a good strategy for promoting clinical reasoning in fieldwork education. Kerawalla et al (2008) found that blogs helped to create a community of practice. Dickey (2004), Wooster (2004), Maag (2005), Ladyshewsky and Gardner (2008) and Derdall et al (2010) demonstrated that web-based discussions, facilitated by blog use, can ease the transition to clinical practice and help alleviate feelings of isolation by providing of peer support. Since the literature demonstrated the benefits of blogs in education generally and practice education specifically, and given their ability to allow people to exchange information without space and time constraints (Godwin-Jones, 2008), the practice education teams at both universities identified this ICT tool as the one they wished to investigate in an occupational therapy practice education context. A descriptive investigation into occupational therapy students’ use of a private blog at Trinity College (through the university’s virtual learning environment) and of a free access public blog at the University of Limerick (through www.blogger.com) was started. The purpose of this study was to evaluate both forms of blog from the student perspective to investigate their influence on 80

promoting reflection and clinical reasoning, and access to peer learning and support during practice education.

Methods This research consisted of a descriptive investigation into the use of an information and computer technology (ICT) tool called a blog to support students during their practice education placements. Trinity College used a private blog through the university’s virtual learning environment (VLE), which includes online learning sites Campus Pack and Moodle. The University of Limerick used a free access public blog through www.blogger.com. Trinity College’s blog included specific tasks and deadlines, and was moderated by practice education staff. Learning objectives were set to link theory to practice and to encourage the development of reflection skills and clinical reasoning ability. The University of Limerick used reflective questions to promote student discussion and reflection. Staff moderated the blog to comment on and monitor student postings. An online survey captured quantitative and qualitative data on students’ experience of blogging during practice education. This research instrument was piloted with two former students (one from each university), both of whom already had blogging experience.

Setting and timescales Upon completion of their placement, each student was sent an e-mail from the project’s e-mail address, containing a uniform resource locator (URL) link to an anonymous online research survey (using SurveyMonkey). Completion of the survey was voluntary and consent was assumed by completion.

Participants Convenience sampling was used in a population of junior sophister students (third-year students following a four-year undergraduate honours degree programme) at Trinity College, and finalyear students (of a two-year graduate entry master’s degree programme) at the University of Limerick. The sample size of 76 was made up of 48 students from Trinity College and 28 students from Limerick. The inclusion criteria were that: n Participants from Trinity College had to be registered as junior sophister students on the occupational therapy programme and complete

International Journal of Therapy and Rehabilitation, February 2013, Vol 20, No 2

Table 1. Venue for internet access, frequency of blog access, tasks during access to the blog and preference for contributors to blogs Venue for computer access with internet Answered question

25

Omitted question

2

Home or residence

Internet café

Practice education site

All

84%

4%

4%

4%

Frequency of blog access Answered question

21

Omitted question

6

Every day

Weekly

Monthly

Once

Not at all

0.0%

28.6%

28.6%

38.1%

4.8%

Tasks carried out during access to the blog Answered question

19

Omitted question

8

Read other students’ postings

Wrote a blog post

Commented on other students’ postings

73.7%

36.8%

0.0%

Preference for contributors on blog Answered question

23

Omitted question

4

30.4%

4.3%

56.6%

8.7%

Entirely student generated

Prompted and responded by staff

Combination of student and staff

Other

their ten-week practice education placement in full n Participants from the University of Limerick had to be registered as final-year students on the occupational therapy programme and complete, in full, their nine-week practice education placement. The following were excluded: n Any student who did not complete the full practice education placement within the specified time frame n Any student not registered as a junior sophister student on the occupational therapy programme at Trinity College or as a final-year student on the occupational therapy programme at Limerick. Participants were recruited through a classroom information session at each university, where the background, purpose and methods of the research project was explained to each student cohort. These classroom sessions were completed before practice education placements started. These were followed up with a recruitment e-mail from a generic project e-mail address, which included an attached participant information leaflet reiterating the background,

purpose and methods of the project. The University of Limerick students were asked to complete one original entry a week and to comment on at least one other student’s entry; blogging was not compulsory but it was encouraged. The Trinity College students had to complete specific tasks intended to link theory with practice throughout their practice placement. Twenty-seven participants were recruited, 17 from Trinity College and ten from the University of Limerick. However, not all participants answered every question so the results do not necessarily reflect the views of all 27 respondents.

Ethical approval Ethical approval was sought and granted from the St James’s Hospital and Federated Dublin Voluntary Hospitals joint research ethics committee and the education and health science ethics committee at the University of Limerick.

Findings Data collected from closed-ended questions in the survey was coded and entered into SPSS

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Research Peer support: Table 3

Table 2. Preference for public or private blog

Comments included:

Answered question

22

Omitted question

5

Private

No preference

Public

63.6%

36.4%

0.0%

‘[Blogs] should be focused on supporting each other, through discussion.’

Table 3. Peer support Was the blog helpful in accessing peer support? Yes

No

Neutral

36.4%

27.2%

36.4%

Table 4. Peer Learning Did the blog support peer learning? Helpful

Not helpful

Neutral

45.4%

36.4%

18.2%

version 16.0 (SPSS Inc, Chicago). Because of the small sample size, descriptive statistics were used to present the data. T h e e l e c t r o n i c s u r vey, w h i c h u s e d SurveyMonkey, had a response rate of 39.7% (n=27). Of the participants, 63% (n=17) were from Trinity College and 37% (n=10) from the University of Limerick. The results do not include all 27 participants as some students chose not to answer some questions. Table 1 shows the venue for internet access, frequency of blog access, tasks carried out during access to the blog and preference for contributors to blogs.

Private or public blog: Table 2 Concern and reluctance was expressed regarding the use of the blogs. ‘The information being discussed in the blogs can be sensitive and examples given are from our interactions with clients .... This can have serious implications within a public domain.’ ‘People are likely to be more honest if they know that there is no chance of their educator seeing it.’

Almost one third of students who responded did not know whether the blog was private or public. The majority of students reported the private or public nature of the blog would not affect their use of this media. ‘I was used to using Facebook etc and so wasn’t afraid of the blog.’ 82

‘[It would be better] if facilitators every now and again posted something like “any concerns I can help with, or other classmates could help with?” as on this placement there were many issues and concerns for a lot of people and even having a forum to let off a bit of steam and get some constructive advice back would have been of benefit.’ ‘It felt like an extra thing that you had to do on top of an already heavy workload. With Facebook and e-mail, I was able to communicate with other students and we helped each other out; for me, the blog was not needed.’

Peer learning: Table 4 Comments included: ‘Good to see what other people were doing.’ ‘[It was good for] learning about assessments used [by other students].’ ‘[It] would be a good means to share experiences, if it was more user friendly.’

The comments on the survey showed that the blog added to workloads during placements. Students suggested other ways to make use of the blog, including space where issues could be discussed and practical information shared; an example was ‘how to manage the studentsupervisor relationship’. They commented on the moderating style and lack of familiarity with blogging as barriers to use.

Discussion The popularity and usefulness of blogging as a student support and educational tool is highlighted in the literature (Herring et al, 2005; Hourigan and Murray, 2010). However, this study of the usefulness of blogs for occupational therapy students in Ireland found that the students did not find using the blog during practice education as beneficial as first hoped by the placement support staff. Students did not see the blog as a useful for the

International Journal of Therapy and Rehabilitation, February 2013, Vol 20, No 2

Strongly agree 0%

Strongly agree 0%

Strongly disagree 9%

Strongly disagree 9% Agree 27%

Agree 32%

Disagree 41%

Neutral 23%

Disagree 41%

Neutral 18%

Figure 1. The blog developed reflection skills: students’ answers

Figure 2. The blog developed clinical reasoning skills: students’ answers

development of reflective and clinical reasoning skills; instead, it was viewed as a burden because of the additional work it required because of the way it was structured in this study. Students indicated that they would have preferred a private blog and that they would have been more positive about taking part had the blog been private rather than public.

be time consuming, which needs to be taken into account. It is interesting to note that Bartholomew et al (2012) raised the point that the greatest danger is when students stop writing on the blog in that they distance themselves from support, not that they will post inappropriate or unprofessional comments.

Peer support using Facebook

Reflection

The blogs were intended to provide students with an opportunity for peer support. There was some evidence of this in the results, although students said that they preferred to use Facebook (www. facebook.com), which is intend to be open and public. This finding conflicts with the results as more than half of the students preferred blogs to be private. The need to moderate and monitor informal support such as Facebook and the potential to use these for educational purposes need to be investigated. Facebook is often raised as a method for promoting learning, and guidelines have been established to promote its use professionally (Kashani et al, 2010). It is essential that higher education institution (HEI) staff and anyone involved in the professional education of students reinforce professional behaviour that maintains the confidentiality of clients, placement settings and practice educators while any e-learning resource is being used. The monitoring of any e-learning resource to promote peer support and the sharing of information by HEI staff can go some way towards ensuring that students adhere to codes of professional conduct, such as the Association of Occupational Therapists of Ireland’s code of ethics and professional conduct (2008). However, monitoring e-learning resources can

Granberg (2010) reports that a major setback during educational blogging is that, unless blogs have a clear aim and pedagogical design, students seldom find blogs offered for reflection useful. This was evident in the inclusive results of this study regarding the use of the blogs to promote reflection. Wopereis et al (2010), in a study of student teachers, found that the blogs, although useful for reflection on critical incidents, did not lead to deep reflection. There is a need for student-led methods of reflection and new methods of reflection should be considered by HEIs to promote the development of reflective practice habits (Jindal-Snape and Holmes, 2009) and to improve clinical reasoning abilities. It would be useful for future research to explore reflective methods that are interactive and electronic, as well as written forms.

Tutor role The findings of this study need to be considered in light of certain limitations. These could include the effects of the e-moderating style on student engagement and participation in the blogs. As with Derntl and Graf’s (2009) study, the results need to be interpreted by acknowledging the influence of the blogging guidelines

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Research and facilitation provided by the instructors on the perception of the use of the blogs. The two blogs attached to the universities had different aims and e-moderation. The Limerick e-moderators posed reflective questions weekly related to the student’s blog postings to promote discussion and reflection. The Trinity College e-moderator facilitated discussion and reflection by posting a number of electronic activities, called e-tivities, throughout the placement. The e-tivities were directive, requesting responses as well as comments on classmates’ posts in some instances. From the results, students were not clear about how the different e-tivities fitted together and built on each other; they were also unclear about the purpose or potential value that using the blog could hold for them. This could have influenced participation in a negative way and may explain the poor response rate to the survey. Some of this issue could be addressed through ensuring students are familiar with the blogs, as advocated by Packham et al (2006), through comprehensive education sessions with clear information on the blogs’ management and expectations. The e-moderator’s facilitation skills can enhance communication within the VLE (Packham et al, 2006). The results from this study were inconclusive as just over one half of respondents expressed a preference for both students and staff to contribute to the blog. Asterhan (2011) suggests that e-moderators should be actively involved in online discussions, especially in remote, asynchronous settings. However, too much e-moderator intervention may hamper students’ enthusiasm to contribute. In addition, the role and frequency of involvement of the e-moderator needs to be clear as Chu et al (2012), in a study investigating the use of blogs with information management students, found that supervisors who commented infrequently or not at all on students’ blogs limited communication and was not perceived as helpful.

Limitations As with all research, there are limitations with this study. The research design assumed that students were digitally literate. Wolf (2010) found that many students may not be as familiar with new media tools as commonly presumed and may not be familiar with using a blog, despite being computer literate. Students’ adeptness with ICT influences their levels of online activity (Packham et al, 2006). This issue was not questioned during the survey but it is interesting that 84

the majority of students use other social networking tools. As mentioned above, moderating style could have influenced the results. There was a low response rate to the online questionnaire. This could be attributed to the timing of the distribution of the questionnaires, as the students were off campus and had several academic deadlines.

Future research This research highlights the need to explore in depth the use of Facebook as an e-learning tool. Facebook is already used widely by the student populations. HEIs and practice educators have a role to play in encouraging and enforcing adherence to professional codes of conduct at all times, and that includes when students are using social media. The role of moderators requires further exploration to get the balance right over the use of prompting; this has both the potential to promote learning through reflection and the risk of inhibiting deep, honest reflection.

Conclusions This study of occupational therapy students’ use of blogs during practice education found that blogs were not an effective tool to promote reflection and clinical reasoning, but effective in providing peer support. The use of blogging in practice education—including its content (structured versus informal), its purpose (reflection versus peer support and learning) and the moderating style (staff versus student)—needs to be further explored to make it more effective as well as reap other benefits noted in the literature. The team at Trinity College are reviewing the structural content, purpose and moderating style of the blog during practice education with a view to continuing the use of this tool. This is opportune given the university’s recent adoption of a new private VLE, Blackboard 9.1 (www. blackboard.com). The team at the University of Limerick have discontinued the use of blogs in practice education for now and are exploring the use of other ways to provide e-learning support, including Facebook. IJTR Acknowledgements: We would like to thank the National Academy for Integration of Research, Teaching and Learning (NAIRTL) for funding this project. Our thanks also go out to the occupational

International Journal of Therapy and Rehabilitation, February 2013, Vol 20, No 2

therapy students of Trinity College, the University of Dublin, and the University of Limerick who took the time to participate in this study.

n Supporting occupational therapy students on practice education placements can be difficult, as placement sites can be widely dispersed. Blogs were seen as a way of providing support and addressing isolation. n Blogs were not effective in developing skills in clinical reasoning or reflection, but were effective in providing peer support. n Students were concerned about client confidentiality, and said they would prefer blogs to be private rather than public. However, they preferred to use Facebook for peer support, even though it is intended to be public. n Education staff should ensure that students adhere to professional codes of conduct at all times, including while they are using social media. n The use of blogging needs to be explored further to make it a better student distance peer support and peer learning tool. Facebook, which is widely used by students, may have potential as an e-learning tool.

productivity. Int J Teach Learn High Educ 20(1): 10–27 Morgan J, Rawlinson M, Weaver M (2006) Facilitating online reflective learning for health and social care professionals. Open Learn: J Open Distance e-Learning 21(2): 167–76 Packham G, Jones P, Thomas B, Miller C (2006) Student and tutor perspectives of on-line moderation. Educ Train 48(4): 241–51 Ravenscroft A (2009) Social software, Web 2.0 and learning: tatus and implications of an evolving paradigm. J Comput Assist Learn 21(1): 1–5 Schmidt J (2007) Blogging practices: an analytical framework. J Comp Mediat Commun 12(4): 1409–27 Tan SM, Ladyshewsky RK, Gardner P (2010) Using blogging to promote clinical reasoning and metacognition in undergraduate physiotherapy fieldwork programs. Australasian J Educ Tech 26(3): 355–68 Thomas A, Storr C (2005) WebCT in occupational therapy clinical education: implementing and evaluating a tool for peer learning and interaction. Occ Ther Int 12(3): 162–79 Williams J, Jacobs J (2004) Exploring the use of blogs as learning spaces in the higher education sector. Australasian J Educ Tech 20(2): 232–47 Wolf K (2010) Bridging the distance: the use of blogs as reflective learning tools for placement students. High Educ Res Dev 29(5): 589–602 Wopereis I, Sloep P, Poortman S (2010) Weblogs as instruments for reflection on action in teacher education. Interact Learn Environ 18(3): 245–61 Wooster D (2004) An exploratory study of web-based supports for occupational therapy students during level II fieldwork. Occup Ther Health Care 18(1/2): 21–29

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ent: al Developm

Profession MENT OF Continuing AND MANAGE REFLECTION 5 HEALTH: PREVENTION IN MENTAL AGGRESSION DISCUSSION CIPLINARY s AN INTERDIS

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 What would help you to feel more

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too quickly (Healthcare Commission, 2007a). When 17 July 2008 used, seclusion should be terminated at the earliest safe opportunity. Human rights law is dynamic, with new case-law able to affect future interpretation of what clinical might be deemed to bestaff inhuman or degrading treattowards re behaviour (Healthca ment, under Article 3 of the Human Rights Act (Right aggressive health services threatens the iolent and to freedom from inhuman or degrading treatment). across mental Such behaviour is common rights therapeutic law evolves, what is viewed as inhu2007a; 2007b). Asinhuman the clinical Commission, of peopleman or degrading and finanical, social may also change, making challenges safety and well-being possible around the length or conditions of seclusion physical, psycholog as and can have nt, . violence (Dickens and Sugarman, 2008). and environme ces for all concerned of aggression nurses employed cial consequen are at particular risk ly and 64% of Nursing staff the ‘front line’: 46% Pharmacological restraint c services respective e on psychiatri often (Healthcar are If a potentially violent situation continues to escalate, people’s they assault at work and nurs- to the patient. If the age and older of physical medication staff in working been a victim meet thisoral risk, nursing should be offered ing, To person does the not understand agree to take the medication, or if oral reported having 2007a; 2007b). dedicated to n, Nursing time The . Commissio training and aggression spend some nt of violence ing students and manageme prevention,

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Alexander B (2006) Web 2.0: a new wave of innovation for teaching and learning? EDUCAUSE Review 41(2): 32–44 Asterhan CSC (2011) Assessing e-moderation behavior from synchronous discussion protocols with a multi-dimensional methodology. Comput Human Behav 27: 449–458 Association of Occupational Therapists of Ireland (2008) Code of Ethics and Professional Conduct for Occupational Therapists. AOTI, Dublin Boyd DM, Ellison NB (2007) Social network sites: definition, history, and scholarship. J Comp-Mediat Commun 13: 210–30 Bartholomew M, Jones T, Glassman M (2012) A community of voices: educational blog management strategies and tools. TechTrends 56(4): 19–25 Chu SKW, Kwan ACM, Warning P (2012) Blogging for information management, learning, social support during internship. J Educ Technol Soc 15(2): 168–78 Derdall M, Mulholland S, Brown C (2010) Evaluating students’ use of web-based communication during practice placements. Br J Occ Ther 73(10): 457–60 Derntl M, Graf S (2009) Impact of Learning Styles on Blogging Behaviour. Paper presented at the 2009 Ninth IEEE International Conference on Advanced Learning Technologies, Riga, Latvia Dickey M (2004) The impact of web-logs (blogs) on student perceptions of isolation and alienation in a webbased distance-learning environment. Open Learn 19(3): 279–91 Efimova L, Fiedler S (2004) Learning Webs: Learning in Weblog Networks. Paper presented at Web Based Communities 2004, IADIS International Conference, Lisbon, Portugal Greenhow C, Robelia B, Hughes JE (2009) Learning, teaching, and scholarship in a digital age: Web 2.0 and classroom research: what path should we take now? Educ Res 38(4): 246–59 Godwin-Jones R (2008) Emerging technologies: web-writing 2.0: enabling, documenting, and assessing writing online. Lang Learn Technol 12(2): 7–13 Graham M, Scarborough H (1999) Computer mediated communication and collaborative learning in an undergraduate distance education environment. Australasian J Educ Tech 15(1): 20–46 Granberg C (2010) Social software for reflective dialogue: questions about reflection and dialogue in student teachers’ blogs. Technol Pedagog Educ 19(3): 345–60 Grassley JS, Bartoletti R (2009) Wikis and blogs: tools for online interaction. Nurse Educ 34(5): 209–13 Herring SC, Scheidt LA, Wright E, Bonus S (2005) Weblogs as a bridging genre. Information Technol People 18(2): 142–71 Hourigan T, Murray L (2010) Investigating the emerging generic features of the blog writing task across three discrete learner groups at a higher education institution. Educ Media Int 47(2): 83–101 Hramiak A, Boulton H, Irwin B (2009) Trainee teachers’ use of blogs as private reflections for professional development. Learning, Media and Tech 34(3): 259–69 Jindal-Snape D, Holmes EA (2009) A longitudinal study exploring perspectives of participants regarding reflective practice during their transition from higher education to professional practice. Reflective Pract 10(2): 219–32 Kashani R, Burwash S, Hamiliton A (2010) To be or not to be on facebook: that is the question. Occup Ther Now 12(6): 19–22 Kerawalla L, Minocha S, Kirkup, G, Conole, G (2009) An empirically grounded framework to guide blogging in higher education. J Comput Assist Learn 25(1): 31–42 Ladyshewsky R, Gardner P (2008) Peer assisted learning and blogging: a strategy to promote reflective practice during clinical fieldwork. Australasian J Educ Tech 24(3): 241–57 Maag M (2005) The potential use of ‘blogs’ in nursing education. Comp Inform Nurs 23(1): 16–24 Mason R, Rennie F (2007) Using Web 2.0 for learning in the community. Internet High Educ 10(3): 196–203 McLoughlin C, Lee M (2008) The three P’s of pedagogy for the networked society: personalization, participation and

Key points

administration is inappropriate, then it may be administered parenterally. This typically involves administration of either benzodiazepine or antipsychotic via intramuscular injection (NICE, 2005). However, the health professional should first draw on de-escalation skills to reason with a person on why they should take the oral medication. If the person refuses and an intramuscular injection is required, verbal skills will be required. As a last resort, the health professional may need to employ physical interventions if the person continues to be aggressive and put themselves and others at risk.

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CONCLUSIONS Therapists have much to learn from nursing colleagues—who have more training and experience in this area—in understanding aggression and its management more effectively. The authors suggest that a key part of this learning process is seeing managements techniques in action. It is important to watch and observe nursing staff on the ward demonstrating effective and ethical approaches to aggression management. One can learn a great deal from role models who develop a good rapport with patients and seem to skilfully defuse confrontational situations. It is also beneficial to make use of pre-existing service training programmes, and inter-professional supervision may also be an excellent learning tool for both parties. There is a need for all health-care professionals working in mental health to have adequate knowledge and understanding of issues around aggression management. Allied health professionals, unlike their nursing colleagues, rarely receive education on theories underpinning aggression and its management during their undergraduate courses. The experiences of this group have also been studied less than nursing and medical colleagues working in psychiatry. The authors aim to address this with a forthcoming national survey of physiotherapists experience of patient aggression in mental health settings. Finally, it is of paramount importance that health-care professionals receive training and education on aggression and its management before they start work on mental health wards. IJTR

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Eleanor Gendle, Editor, International Journal of Therapy and Rehabilitati Bonner G, Lowe T, Rawcliffe D, Wellman N (2002) Trauma for all: Conflict of interest: none

A pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK. J Psychiatr Ment Health Nurs 9(4): 465–73 Collins J (1994) Nurses attitudes towards aggressive behaviour following attendance at ‘the Prevention and Management of Aggressive Behaviour Programme’. J Adv Nurs 20(1): 117–31 Cowin LS (2001) Measuring nurses self-concept. West J Nurs Res 23(3): 311–25 Cowin LS (2002) The effects of nurses’ job satisfaction on retention: An Australian perspective. J Nurs Adm 32(5): 283–91 Cowin LS, Davies R, Estall G, Berlin T, Fitzgerald M, Hoot S (2003) De-escalating aggression and violence in the mental health setting. Int J Ment Health Nurs 12(1): 64–73 Department of Health (1999) Mental Health Act 1983 Code of Practice. Department of Health, London

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