Content area
Purpose
This paper aims to examine uncertain situations with potential for learning in care work. While the dominant learning strategy in elderly care is lecture-based education, learning from and during daily care work routines is crucial and suitable. However, little is known about the potential for learning in daily work in elderly care.
Design/methodology/approach
This paper is based on a doctoral study conducted in Danish nursing homes. Shadowing care workers led to the construction of care work vignettes, which were analyzed and validated in analytic dialogues with field practitioners. Here, a selected vignette forms the empirical base for analyzing uncertainty through the lens of Dewey’s philosophy of learning.
Findings
The results suggest labeling uncertain situations as noisy, as they are sensorily felt, prompting doubt and perplexity and, hence, reflection and learning. Noisy situations cause breakdowns in action experienced as a tension that triggers reflection, often with colleagues, alongside work. A critical discussion draws attention to silent situations that proceed undisturbedly, according to routine, and, hence, often without reflection. To handle uncertainty, either noisy or silent, care workers must be considered as learning actors. Space and time for reflection are mandatory.
Originality/value
By focusing on uncertainty in care work, this study contributes to the understanding of workplace learning potential by clarifying the characteristics of situations useful for systematic exploration and collaborative learning from specific instances in work.
Introduction: need for learning in times of demanding challenges
This paper examines the potential for workplace learning from uncertainty and explores the characteristics of work situations that can be understood as uncertain, as well as how workplace learning can contribute to handling these situations. This study was conducted in the field of care work as a representative field for discussing workplace learning related to uncertainty.
Amid the backdrop of multiple pressing demands, there is heightened attention from both the political and public spheres to provide adequate, accessible and sustainable quality care for older people [European Economic and Social Committee (EESC), 2022]. In most Western countries, the elderly care sector struggles with financial constraints and lack of health-care workers on the one hand and an aging population and a growing number of older people in need of complex care on the other (Ellström and Ellström, 2018; Lundmark et al., 2020). This complicated combination has been described as a “care crisis” (Hansen et al., 2022; Tronto, 2013; Wrede et al., 2008) and is creating pressures for the continuing professionalization and quality development of elderly care.
A wide range of organizational, managerial and educational initiatives have been launched in response to this care crisis (Kamp and Hvid, 2012). However, when it comes to enhancing competences at the workplace, it remains unclear what types of learning activities yield the most successful results in elderly care (Hauer et al., 2017). While the dominant learning strategy in this sector is lecture-based training for selected staff (Dewing, 2010), care workers prefer and appreciate learning from and during daily work routines (Choy and Henderson, 2016; Ellström et al., 2008). Hence, while learning in elderly care is mostly facilitated as something that takes place away from the workplace and is taught through training sessions or study days (Dewing, 2010), practice-based learning experiences have been identified as critical for care workers to gain expertise to ensure delivery of quality care (Choy and Henderson, 2016).
These contextual characteristics underscore the significance of adopting a workplace learning approach that directly engages with work tasks and is integrated into the workday as both structured and incidental processes. Incidental learning is frequently referred to as informal learning to distinguish it from formal learning occurring in classroom settings, courses and seminars (Eraut, 2004; Hager, 2004, 2011; Marsick and Volpe, 1999; Marsick and Watkins, 2001). Informal learning situates and incorporates learning within daily work activities, which allows employees to acquire the necessary knowledge and skills while actively contributing to a shared goal and collaboratively addressing work-related challenges (Hager, 2004). In this manner, learning is an integral part of everyday work routines and the execution of daily tasks (Marsick and Volpe, 1999), which leads to the embeddedness of learning and knowledge into the job itself as an essential requirement for job performance (Nevalainen et al., 2018). This means that informal learning happens during “crucial moments of necessity” within the practical context, where problem-solving—and not learning—is the primary goal (Manuti et al., 2015).
Research interest in crucial moments for learning has followed a pragmatic idea that learning does not originate from individuals alone, but from interactions with situations triggering uncertainty (Dewey, 1916; Elkjaer and Simpson, 2011; Farjoun et al., 2015). From this learning perspective, this paper contributes to pragmatism-informed studies that consider the situation as the unit of analysis (e.g., Revsbæk and Beavan, 2024; Simpson and den Hond, 2021). Situations ripe for learning are thus characterized by letting the situations “speak” and focusing on participants’ opportunities for inquiry. The primary object of this paper is to add to the discussion of workplace learning as inquiry into uncertainty by examining the characteristics of situations within the realm of care work to unfold the potential for learning within these situations. This paper addresses the following research questions:
The remainder of this paper is structured as follows: First, the theoretic framework to understand uncertain situations as triggers for inquiry and learning is elaborated, drawing on the American pragmatist John Dewey (1916, 1922, 1934). Second, the context, data and methods for the study and the paper’s analysis are then presented. A narrative vignette is analyzed as a representative of an uncertain situation in care work, which is followed by a critical discussion of the findings. The discussion delves into ethical concerns, organizational conditions and care workers as learning agents. After presenting the conclusions, the implications for practice and research and the limitations of the study are discussed.
Theoretical framework: Exploring uncertainty as learning trigger
To navigate the exploration of learning potential in uncertain situations, this paper extracts insights from John Dewey’s influential works Democracy and Education (1916), Human Nature and Conduct (1922) and Art as Experience (1934).
Uncertainty as theoretical construct
John Dewey’s theory of learning places the concept of experience at its core and views experience as both a process and result of learning. According to Dewey (1916, p.157), experiences—and, by extension learning—are initiated when something is perceived as incomplete and open, which gives rise to a situation fraught with uncertainty and complexity, thus triggering a sense of “perplexity, confusion, doubt.” Such situations are marked by an interruption in the flow of actions and the uncertainty about what responses could help to resume the flow. The disturbance prompts a series of questions: What caused the interruption? How can the flow of actions be restored? What actions can, hopefully, navigate the situation?
The discomfort of such situations acts as a catalyst, Dewey (1916) claims, that motivates individuals to transcend their perceived powerlessness in the situation and seek a resolution for how one could move on. This impetus triggers a reflective stance aimed at comprehending the problematic nature of the situation so one can formulate hypotheses of what might, as Dewey (1916) says, alleviate the tension and resolve the situation. This process resembles a dramatic rehearsal, Dewey (1922) claims, in which we try out potential actions in our minds before acting. We imagine how our responses might work, and, consequently, we play out the scenarios in our minds, taking in what happens as a response to what we (intend to) do. The process of taking in and playing out, according to Dewey (1934), is an aesthetic appreciation through which we seek to understand and value the involved sensuous impressions. This dramatic rehearsal, Dewey (1922) claims, occurs first in thought and second in action, culminating in the evaluation of various competing courses of action as we determine which actions might serve best in the situation.
Demarcation of impressions and of senses
This aesthetic appreciation involves assessing the degree of alignment between the impressions derived from the situation (what is sensed? what is at stake?) and the (re)actions undertaken in response to the situation (what happens because of different responses?). Because all actions, as Dewey (1922, p.10) writes, represent “an invasion of the future, of the unknown,” imagining the value of a response is a prospective and moral matter. This imagining, in Dewey’s (1916) view, is triggered by the discomfort experienced, commencing with a sensation that activates the process of reflecting on what is sensed. According to Dewey (1934), aesthetic appreciation and understanding implies rhythmic cycles of intakes and outflows of what is sensed and what can be imagined and enacted.
Uncertainty results in powerlessness, so it often becomes unbearable to manage alone. Such situations are ripe for shared inquiry with others, so one can evade the sense of unease and tension and, after a process of inquiry, potentially restore the flow of actions. Through shared inquiry, Dewey (1934) states, an individual perceived experience of uncertainty can transform into social care for the situation.
Context, data and methods
This paper reports on part of a doctoral study of workplace learning conducted in Danish municipal elderly care that explored how learning occurs and is enhanced in nursing homes and the associated school of vocational education and training (VET). The project was developed in collaboration with an elderly care department and the VET school, a social and health-care college responsible for initial and advanced vocational education and training of the largest professions in the field. In Denmark, elderly care is highly regulated by national laws and quality standards and is financed and organized by the municipalities in various settings, including home help, health and activity centers and residential nursing homes. Similarly, VET is nationally regulated, with two educational programs for social and health-care helpers and social and health-care assistants. Both professional groups work alongside each other in the nursing homes, although their authority and responsibilities differ. In this paper, the term “care worker” is used without distinguishing between the two professions. Nurses and therapists are also employed, and in some municipalities, doctors are connected to the nursing homes and health centers. These professional groups did not participate in the present study.
The study was conducted with a pragmatic, abductive methodology, driven by instances of breakdowns (Alvesson and Kärreman, 2007). “Breakdowns” are situations in research when something experienceable disrupts the preceding course of action and thought, leading to confusion and even despair. Breakdowns are thus (another) way to describe what happens in uncertain situations. In this approach, reflexivity is triggered by a breakdown, and the tools for inquiry are the researcher’s and/or research participants’ impressions, ideas and theories.
Based on empirical material (impressions) and theoretical insight (ideas and theories), breakdowns can be cultivated collaboratively, which can lead to the elaboration of both empirical analysis and theoretical frameworks (Alvesson and Kärreman, 2007). In this study, to foster an abductive process, nine analytic workshops were organized to explore the data, results and theoretical insights related to learning occurrences in daily work collaboratively. Each workshop involved ten participants representing various roles across the two organizations: trainees, supervisors, care workers, teachers, managers and consultants. Data from the workshop were documented in fieldnotes, posters, pictures, audio recordings, written evaluations and audio recorded evaluation interviews with six workshop participants (see Table 1).
The data for the workshops were generated using the method of “shadowing” (Czarniawska, 2007; McDonald and Simpson, 2014), which involved closely observing and following the daily care work and interactions of care workers, trainees, internship supervisors and residents in public nursing homes. Shadowing was also conducted in the school to observe the interactions of teachers and trainees. In total, 45 shadowing activities were conducted, ranging from a few hours to most of a workday (see Table 1). These observations encompassed a variety of activities, including everyday care work, teaching, formal and informal staff meetings and trainee supervision. Through shadowing, the researcher had the opportunity to be immersed in everyday practices and organizational processes as they unfolded at microlevels in various locations throughout the observed timespan (McDonald and Simpson, 2014). The data from the shadowing activities were documented in fieldnotes and reflection logs, resulting in a total of 45 fieldnote documents and 500-page reflection log. The primary focus of observation was to identify the types of problematic issues the involved actors encountered in their everyday work, how they addressed these issues, and the interactions they engaged in regarding these matters.
The extensive collection of shadowing data provided the cornerstone for crafting narrative vignettes, which formed the basis for analyzing the integration of learning and the potential for workplace learning in everyday work. Vignette research aims to “bring out the particularity or singularity of a certain phenomenon or event while at the same time providing access to a more general or universal meaning” (Agostini et al., 2024, p.2). Vignettes are short case scenarios that are shared with knowledgeable research participants (e.g., during interviews) to evoke their understandings, values and experiences on contextualized and sensitive subjects (Bain, 2024; Hughes and Huby, 2012; Sampson and Johannessen, 2020). They often depict situations that have a transformational impact on the researcher—they do something to and with him or her—and are written in a manner that authentically reflects the experience, aiming to immerse the reader in the scenario (Agostini et al., 2024). The goal is to illuminate what was significant to the researcher and, consequently, to delve into the meaning and resonance of the experience rather than striving for precision and objectivity. Vignettes usually portray situations that mirror the research participants’ practice, offering a typical scenario they might encounter in their work (Bain, 2024). They are often written in the third person (he/she/it/they) to comprehend second-person experiences and to avoid imposing the researcher’s own first-person perspective (Agostini et al., 2024).
In this study, initial vignettes underwent analysis through the analytic workshops to qualify and validate the vignettes. This is known as “resonance reading” and enable a process of communicating a co-experiential experience of the vignette itself (Agostini et al., 2024). Here, participants were prompted to describe the illustrated situation from their own perspective, what the vignette made them think of, what resonated with them and how the vignette could be improved. This was an iterative process of communicative validation through which the vignettes were enriched and condensed. In this study, the purpose of validation was twofold: first, to gain a deeper understanding of situations prompting learning in everyday care work and education, and second, to explore how the analysis of vignettes could be done collaboratively.
This paper’s analysis of learning-inducing situations in care work was based on a single vignette, selected as it has proven qualified and valid to foster dialogue about the dynamics of learning in care work. The following section delves into one such vignette developed from a care work scenario where uncertainty was apparent. The purpose was to bring out the particularity of the phenomenon of uncertainty in a singular event and, hopefully, to provide insight into a more general meaning of situations potential for learning in work (Agostini et al., 2024).
Vignette and analysis
The following section presents an analysis of a vignette, a short case story of everyday care work. In the vignette, we meet two employees at a nursing home who are discussing care work learning experiences and, at the same time, must enact care work:
Mette, an internship supervisor, and Maja, a trainee, are in the nursing home office for a supervision meeting. They engage in a discussion regarding the recently completed morning routines, aiming for Maja to reflect on and gain insights from her work experiences. Mette asks her several questions and Maja answers. While they are still discussing, Birte, a resident they have just helped with her morning routines, makes her way to the office door. Mette and Maja catch sight of her through the door window and hear her moaning. Her sounds intensify, gradually building to a crescendo that edges to a scream. She cries continuously. Mette swings the door open and directs her attention to Birte: “Please be patient, Birte. We’ll attend to you shortly.” Despite Mette’s reassurance, Birte wails persistently. It is hard for Mette and Maja to continue their supervision meeting. Their conversation is disrupted, and it is challenging to stay on track with the discussion. Mette asks Maja to address Birte. Maja hesitates, expressing her concerns: “Do I really have to? I find it quite challenging. Can we prevent someone from going to the bathroom?” Mette acknowledges the difficulty, replying, “It’s indeed a tough situation.” Maja continues her deliberation: “Yes, what if she genuinely needs to use the bathroom? Urinary tract infections can cause frequent urination. We have run a test, but we have still not received the answer.” Mette replies: “I believe it’s more psychological. She might not actually need to use the bathroom.” Maja reflects: “That’s true. Considering her semi-lateral paralysis, her brain function is affected, and she may not be able to delay her needs. But what should we do right now?” Mette suggests: “Let’s consult Christina. She might have some ideas or perspectives.” She reaches for the phone and dials the number of their colleague Christina. She agrees to come to the office. She mentions that she had just helped Birte to the toilet and says, “It was the same situation this weekend. I suggest that we talk to our manager and colleagues about it during our upcoming staff meeting.”
I analyze this vignette as an illustrative example of an uncertain situation. First, I analyze two characteristics—noisiness and complexity—related to the first research question: What are the characteristics of uncertain situations? Second, I analyze two aspects—the process of reflection, evaluation and interpretation and the practices of aesthetic appreciation and social inquiry—related to the second research question: How does workplace learning contribute to handling uncertain situations? Insights from the collaborative analyses contribute to nuance the analysis.
Noisiness of the situation
The vignette illustrates that the resident’s mood and expressions significantly affect the care workers. They attend to her signals and try to understand the situation. Why is Birte moaning and screaming? What should they do to help her? The situation is literally noisy because of Birte’s screaming, but it is also metaphorical noisy, as the care workers’ senses and flow of action are affected. According to the Oxford English Dictionary (2024), “noise” stems from the Latin “nausea”, meaning seasickness. For care workers, noise can be seen as a state of metaphorical seasickness that mirrors a state of dizziness and unease triggered by the situation. Noise is related to disturbance and uproar, dissonance and inharmony, to harsh and unpleasant events. In the vignette, noise reflects a characteristic of a type of situation where the ground is shaken, the flow of action has been disrupted, and the situation is unsettled.
As the situation unfolds, Birte’s sighs and complaints provide sensory data, as Dewey (1916; 1934) calls them, triggering the senses of the care workers. The care workers grapple to use this sensory data as information that can help them understand what is happening. However, the data in the situation appear vague and unresolved, as is often the case, according to Dewey, in uncertain situations. It proves challenging to interpret and determine Birte’s intentions, symptoms and needs, as well as to identify the actions that can effectively alleviate her distress. The situation remains unsettled, which, as Dewey (1916) notes, engenders confusion, discomfort and even paralysis for those involved. The noise creates a sense of perplexity and doubt. The two professionals are uncertain about what to do, how to respond appropriately to Birte’s needs, or how to proceed with the supervision meeting they had set out to conduct. It proves challenging to determine what the matter is, and, as Dewey (1916) mentions, what the most appropriate actions would be to ensure a careful flow of communication.
Complexity of the situation
At first glance, the problem might appear to be straightforward, with an obvious solution: a resident is expressing a need and asking for help; the professionals should simply assist her. Birte is clearly in distress and explicitly requests their help. However, the collaborative analysis by several care workers revealed that what seems simple on the surface often conceals a more complex reality. As Dewey (1922) notes, any situation presents multiple possible understandings of the problem and various courses of action, each with competing effects.
In this case, the professionals discuss whether Birte might need to urinate due to a possible infection or if her perceived need could be the result of brain damage sending inaccurate signals. The insights from the collaborative analysis highlight how prior experiences with this specific or other residents often influence how care workers approach a situation. This situation, like many others, is layered with complexity. Helping a person with semi-lateral paralysis who might also have a urinary tract infection, while ensuring she feels safe, presents a complex professional-ethical dilemma. The care workers’ reflections suggest that the immediate solution—helping Birte to the toilet—might not alleviate her distress: There is something deeper that needs to be understood and explored.
Adding to this complexity, participants in the collaborative analysis pointed out the influence of the supervisor–trainee relationship in the vignette in which the trainee’s learning is a shared goal; however, as supervisors observed, it is challenging to maintain a focus on the trainee’s learning as the supervisors are often torn between attending to the needs of the residents and those of the trainees. Given a lack of resources to meet the residents’ needs, they often put aside their primary goal of supporting trainee’s learning, although they take pride in fostering a high-quality learning environment. The supervisors have found that they must constantly fight for the right to prioritize trainees’ learning. These competing priorities amplify the situation’s complexity and contribute to making it, as Dewey (1916) describes, stuck and unsettled.
In the vignette, the supervisor uses the situation as a learning opportunity for the trainee as she asks the trainee to address Birte. During the collaborative analysis, supervisors noted that they frequently seek to capitalize on emerging situations to trigger the trainees’ learning at work. However, handling such an unsettled situation could put significant pressure on the trainee, particularly when the supervisor herself lacks a clear solution. This approach presents challenges, as the trainee must navigate a situation where an ideal course of action is difficult to model.
Process of reflection, evaluation and interpretation
The vignette illustrates how Mette and Maja engage in a reflective process, contemplating their observations and considering potential actions in response to Birte’s distress. As Dewey (1916) suggests, uncertainty is here a catalyst for reflection and problem-solving, driving Mette and Maja to deliberate on the best course of action to resolve the situation. The care workers reflect on the unique aspects of the situation that shape their approach to Birte’s care. They consider a range of factors, including her possible medical needs, her psychological and physiological condition and the consequences of their actions. Their reflections involve complex ethical and practical questions, such as whether it is appropriate to deny a person access to the toilet and how best to assist someone with semi-lateral paralysis.
Through these discussions, they formulate various hypotheses to address Birte’s discomfort. They consider whether she might genuinely need to urinate due to an infection or if her brain damage is creating non-physiological needs. These reflections are informed by their professional knowledge and prior experiences, thus creating a framework that can guide their actions in similar situations involving residents with semi-lateral paralysis or with increased needs to urinate. The process of reflection and evaluation, grounded in theoretical frameworks, is crucial for navigating the uncertainty of the situation and determining the most appropriate course of action.
However, their theoretical framework offers different openings for interpretation and courses of action; in fact, the framework seems to add to the complexity of the situation, as neither of the perspectives seems manageable in practice. They face a challenge that the answer is not as straightforward in practice as it seems in theory; the answer, too, is characterized by uncertainty and ambiguity, and the solution seems hard to find.
Practices of aesthetic appreciation and social inquiry
The vignette illustrates the process by which Mette and Maja engage in interpreting the sensory impressions they receive from Birte. As they try to understand what they are experiencing, they face the challenge of aligning their impressions with appropriate responses, which is a process Dewey (1934) refers to as aesthetic appreciation. Given the vagueness of Birte’s primarily bodily communication, this alignment becomes particularly difficult; however, it is through this aesthetic appreciation that the care workers evaluate the harmony between their perceptions and the actions they take in response. Through dramatic rehearsals (Dewey, 1922), they can try out different courses of thought and action.
Dewey (1916) emphasizes that situations are perpetually in flux, offering little opportunity for pause and thorough assessment. This state of constant change demands that Mette and Maja continuously adapt and respond, without the luxury of complete reflection or resolution. Their attempts to maintain focus on their supervision meeting is repeatedly disrupted by Birte’s escalating cries. Despite Mette’s initial reassurance of Birte and the brief exchange with Maja about how to proceed, the situation remains unresolved, thus creating an environment of persistent uncertainty.
This ongoing uncertainty provides a catalyst for shared inquiry, as Dewey (1934) suggests. Mette and Maja recognize that they cannot fully address the situation on their own, which leads them to seek input from their colleague Christina. This act of seeking assistance is not merely a practical decision; it reflects Dewey’s notion that uncertainty can evolve into a social concern. By involving Christina and later considering the input of their manager and other colleagues, they transform an individual problem into a collective issue, thereby distributing the emotional burden and fostering a collaborative environment.
The vignette demonstrates how the discomfort and tension felt by Mette and Maja compel them to reach out and share the situation with others. This sharing is a crucial step in transforming personal uncertainty into a matter of collective inquiry. Christina’s response, including her advice to discuss the situation further with their manager at an upcoming staff meeting, exemplifies how social inquiry can effectively address complex situations. By pooling their experiences and perspectives, the care workers are better equipped to find a resolution that aligns with both the practical needs of the moment and their broader professional responsibilities. Care workers can harness the power of social inquiry to navigate the complexities of the situation through a collaborative process. This approach not only helps alleviate their immediate discomfort but also creates a framework for continuous learning, which is essential in the ever-changing context of caregiving.
Discussion
The following discussion explores the potential for learning from uncertainty in caregiving, considering ethical concerns, organizational conditions and the role of care workers as learning agents.
Exploring workplace learning potentials through uncertainty
Analysis of the vignette prompts deeper reflection on workplace learning potentials. How does uncertainty contribute to the professional development of caregivers and care practice? The presented vignette depicts a disruption in the usual sequence of events that leads to tensions and uncertainties. I propose labelling such situations as “noisy” due to their troublesome nature. These situations present challenges that demand collaborative reflection and offer valuable opportunities for workplace learning that closely mirror the challenges encountered in daily care work. How the care workers navigate these uncertainties offers insights into a process of reflection, evaluation and interpretation that showcases continuous learning across their different levels of experience.
The discussion of learning from daily work routines resonates with previous findings suggesting that practice-based continuing education is the (most) suitable and critical mode of learning for those working in elderly care (Choy and Henderson, 2016; Ellström et al., 2008), thus aligning with theories emphasizing the integration of learning directly into work task–related challenges (Eraut, 2004). The vignette illustrates informal learning within the daily activities of the care workers as they address the resident’s distress. Their engagement in reflection, evaluation and interpretation contribute to a shared goal of delivering quality care, which underscores how learning is intrinsic to job performance (Nevalainen et al., 2018). Despite the prevalence of lecture-based education in elderly care (Dewing, 2010), the value of incidental learning during daily routines is highlighted as we look at the experience of the care workers.
Ethical considerations
Delving into whether to deny an older person access to the bathroom raises broader ethical questions regarding dignity, autonomy and duty of care that warrant attention beyond this analysis. How the older person’s distress affects her overall well-being and how the care workers’ response might affect her sense of worthiness as a human are critical considerations. It is noteworthy that not all care situations are equally noisy; some flow smoothly without significant concerns. However, dignity, autonomy and care quality remain crucial in all care situations. Care Ethicist Nel Noddings (2010) recommends that care workers should not restrict their efforts to improve the quality of care solely to situations when problems arise. The care ethical perspective offers a critical stand to Dewey’s pragmatic alliance with problems and problem-solving. A problem-based approach to care work, Noddings (2010) warns, might reduce the other person’s reality to that of a data subject for analysis, study and interpretation—that is, the care worker might lose track of the human behind the problem.
Building on this critique, it is inadequate to limit the learning potentials to situations that are palpably felt as noisy. A care ethical approach emphasizes learning from more subtle situations alongside disruptive ones to ensure a holistic understanding of caregiving dynamics. I suggest naming such situations “silent” to highlight their fine-lined expression that requires care workers to listen harder, be more present and take their impressions more seriously. Labeling these types of situations (which are the most dominant types in care work) as silent contrasts them to more impressive noisy situations and entails, as Noddings (1984, 2010) points out, expanding one’s bodily responsiveness, sensitivity and engagement to often vague expressions of the specific other.
Organizational conditions for learning from uncertainty
Recognizing everyday work situations as either noisy or silent underscores the importance of fostering an environment that leverage these situations for learning. Studies have shown an emphasis on production in elderly care settings, where routine tasks take precedence, leaving limited room for more creative and innovative learning processes (Ellström et al., 2008; Møller and Rohwedder, 2024). The current study underscores the necessity of critically examining how issues and tasks are conceptualized and managed, particularly when navigating uncertain circumstances. This calls for a departure from conventional problem-solving methods toward innovative approaches tailored to manage care work tasks effectively (Ellström et al., 2008). Prioritizing reproductive learning has implications for the availability of spaces and time slots designated for structured knowledge sharing among care workers. Typically, care workers only share what they need to know to do their work better in informal meetings throughout the workday (Ellström et al., 2008). These momentary, unplanned encounters emerge in daily work routines as “talks-to-go” that, despite their spontaneous character, are valuable for care workers (Møller, 2021). They provide a platform to capture and communalize what is experienced as uncertain, often with noisy characteristics, in the work practices, so they offer the possibility for joint inquiry into the uncertainty of emerging situations in everyday work. However, when only conducted in informal collegial situations, the quality of inquiry remains hidden and potentially poor.
Formalizing the care worker as learning agent
It is essential to formalize the care worker as a learning agent to address the complexities of care work, particularly when dealing with uncertain aspects of the profession. Although the effectiveness of various learning activities remains uncertain (Hauer et al., 2017), theories of informal learning emphasize the integration of learning within daily work activities (Hager, 2004), which positions the employee as a learning agent who learns while working together with others in solving the daily problems, including in interactions with residents. Eraut (2004) highlights the blend of learning from colleagues and personal experiences that is spurred by both consultation and collaboration. This approach emphasizes learning as facilitated by asking others for advice and by working together with others in specific tasks. Although no one might have the title of trainer or teacher in the workplace context, the idea is that certain more experienced individuals guide others by sharing their higher level of competence or insight (Billett, 2002; Manuti et al., 2015), while others achieve mimetic learning through observation, imitation and practice (Billett, 2014).
The results of the present study, however, problematize the idea of the more experienced as the ones telling, showing and knowing, as it tends to isolate learning to newcomers, such as trainees, students and newly employed. This tendency is reflected in the literature; workplace learning studies often underscore those with less experience as the learning actor. A literature review (Moosa and Shareefa, 2020) found the most repeated keyword co-occurring with “workplace learning” to be “student.” Moosa and Shareefa (2020) also found strong associations with the keywords “curriculum” and “knowledge acquisition” in the descriptions of workplace learning as a process of gaining the canonical knowledge for the specific workplace. Workplace learning, then, is mostly understood as the process for those with less experience to achieving what is already known by the more experienced.
The results of this paper problematize this approach to studying workplace learning. Particularly in the context of care work, the relational encounters with frail individuals in need of care demand continuous reflections of the ethics of care that consider interdependence, dignity and vulnerability (Noddings, 1984, 2010). Positioning experienced care workers as possessors of knowledge fosters expectations and identities that hinder their ability to engage in explorative responses to the unpredictable and uncertain aspects of care work (Møller, 2022). Learning is not only about knowing what is already known. Approached from a care ethical learning perspective informed by Noddings and Dewey, learning is about attending to uncertainty in situations as they emerge throughout the workday.
Referring to Schön (1992), care ethics call for an epistemology of practice that reflects the uncertainty inherent in care work and rejects an overreliance on technical rationality. Complexity, instability and uncertainty are not eliminated or solved by applying specialized knowledge. This paper’s analysis has shown that the theoretical framework might even add to the complexity. Consequently, learning is not (only) about knowing more and knowing the right things, but also about exploring how to relate to the uncertainty of not-(always)-knowing. As Schön would say, care workers must elaborate a sense of the materiality (in this case the older person and the evolving care situation) while leaving time to hear and reflect on what the “material” has to say to you. The impetus for learning is not merely the acquisition of canonical knowledge and recycling what is already known; the trigger for learning is the tensions occurring when habitual ways of working fail to meet the expected outcomes (Brandi and Elkjaer, 2022; Elkjaer and Simpson, 2011).
This paper’s analysis has also shown that care workers might not be able to ask anyone (more experienced) for the right (or any) answers. The present study emphasizes that uncertainty is (and should be) a concern for all care workers, regardless of their level of experience. This underscores the need to formalize the care worker as a learning agent to effectively manage and address uncertainty in care work. Recent work by Wenger-Trayner and Wenger-Trayner (2020) supports this approach by introducing the concept of social learning spaces. These spaces bring people together to make a difference for problems they care about, particularly when they lack definitive answers. Participants engage with uncertainty at the boundaries of their knowledge, while paying close attention to their experiences during these encounters with uncertainty. This approach reflects a collective commitment to addressing the uncertainties associated with the differences the participants care to make—in this case, performing quality care work and enhancing life circumstances for older persons.
Conclusions
This study explored the characteristics of situations charged with uncertainty in care work and underscored the pivotal role of workplace learning in managing these situations. Drawing on Dewey’s pragmatism, two characteristics of uncertain situations were suggested: noisiness and complexity. Labeling evolving uncertainty as “noisy” highlights the discomfort, emotional turmoil and unease that compel care workers to address and resolve these types of situations collectively. Noisy situations force a learning attitude that enables workplace learning in close relation to daily care work tasks. Nuancing the perspective and drawing on the concept of care ethics developed by Noddings, this paper also directs attention to “silent” situations in care work that may not immediately appear uncertain as they evolve without interruptions and discomfort. A care ethical discussion, however, highlights the need for a reflexive attitude toward the silence to reveal uncertainties hidden in questions of power, dignity and vulnerability.
Addressing how workplace learning contributes to handling uncertain situations, the paper identified two interlinked processes: the process of reflection, evaluation and interpretation, and the process of aesthetic appreciation and social inquiry. These processes are critical for adapting to both noisy and silent situations, and involve thought and action, as well as sense and emotions. Shifting the focus from reproductive learning in routine tasks to more innovative and developmental learning allows care workers to challenge existing problem-solving approaches. Informal talks-to-go during the workday provide valuable learning and knowledge-sharing opportunities among care workers; however, to fully harness the potential of workplace learning, management should facilitate the transition of care workers’ experience-based knowledge from informal into formal learning settings. Designated time and structured knowledge-sharing spaces would empower care workers to collectively address uncertainties in their daily work. Moreover, formalizing care workers as learning agents is imperative for recognizing that learning extends beyond newcomers to experienced care workers.
Implication for research and practice related to limitations of the study
This study has significant implications for both research and practice in the field of care work. However, it is essential to acknowledge the study’s limitations.
This study underscores the critical importance of understanding uncertainty within care work and suggests labeling such situations as noisy. Nevertheless, relying on a single vignette for analysis, although it is co-experientially validated to mirror a typical scenario (Bain, 2024), may not fully capture the entire spectrum of care worker experiences. An elaboration could focus on the empirical analysis of the characteristics and learning potentials of the more subtle and less impressive silent situations. This could add to the particularity of the phenomenon of uncertainty and provide access to a more general perspective of workplace learning (Agostini et al., 2024). Further research should encompass multiple vignettes and diverse case studies to enhance representativeness and provide a more comprehensive understanding of the potentials for workplace learning from uncertainty and the characteristics of situations ripe for learning.
This study highlights the pivotal role of workplace learning in addressing uncertainty in care work. Still, it does not delve into specific strategies for facilitating learning or their effectiveness. Future research should explore various learning approaches and evaluate their impacts on care worker performance. Researchers and practitioners should focus on developing strategies to enhance learning opportunities for care workers, especially in the context of silent situations. Encouraging care workers to adopt a reflexive attitude toward silent situations is essential, and further research could explore the development and effectiveness of reflective practices and tools designed to assist care workers in navigating and addressing uncertainties. This study suggests that care worker identities should evolve from being viewed as mere executors of tasks to being understood as formalized learning agents. Future research should delve into how this shift in identity affects care worker performance and well-being, as well as how it can be effectively integrated into care work settings and educational programs.
Formalizing spaces for knowledge sharing and structured learning sessions within the care work environment is crucial. While this study emphasizes the vital role in supporting workplace learning, it did not extensively explore management strategies for creating a conducive learning environment. Researchers should explore management strategies that promote a culture of learning, knowledge exchange and problem-solving among care professionals. Additionally, this study mainly focused on care worker experiences and would benefit from incorporating a broader interdisciplinary perspective to facilitate workplace learning by sharing uncertainties and learning from one another in interprofessional learning spaces. Recognizing the interdependence between addressing uncertainty and the quality of care delivered to older people is a crucial aspect of this study. It primarily focused, however, on short-term workplace learning opportunities and did not thoroughly examine the long-term effects of enhanced learning on care worker performance, retention or the quality of care. Future research should explore the potential links between enhanced workplace learning, addressing uncertainty and improvements in the quality of care.
Table 1.
List of activities and data material in the background study
| Activities | Participants | Data | Amount |
|---|---|---|---|
| Analytic workshops | Supervisors, trainees, care workers, teachers, consultants and managers | Fieldnotes, posters, pictures, audio recordings and written evaluations | Two sets of three workshops with ten participants |
| Evaluation interviews | Two supervisors, a trainee, a teacher, a manager and a consultant | Audio recordings |
Six participants from analytic workshops |
| Shadowing | Supervisors, trainees, care workers and teachers | Fieldnotes |
45 |
Source: Author
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