Reflections on roles

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On Tuesday,  we had a thought-provoking conversation on roles of the educator in a networked world by Stephen Downes. If you missed this discussion, you may still  access it on the course website ECI831.  There was a emphasis on open learning and learner autonomy. Downes discussed that course content is merely a tool to support learning rather than the object of learning. Learning occurs by engagement and activity within an authentic learning community. Given this perspective, the role of the educator will change. The discussion focused on a variety of roles such as:

  • the learner
  • the collector
  • the alchemist
  • the programmer
  • the salesperson
  • the convener
  • the co-ordinator
  • the designer
  • the coach
  • the agitator
  • the facilitator
  • tech support
  • the moderator
  • the critic
  • the lecturer
  • the demonstrator
  • the mentor
  • the connector
  • the theorizer
  • the sharer
  • the evaluator
  • the bureaucrat

During the discussion I could see myself in these roles at various times. In the role of the learner, as a co-creator of knowledge, learning through sharing of ideas– as a Registered Nurse and clinical instructor I see this as a life-long role as one cannot know everything in healthcare. Since this class has started, I have become a collector. I now live by google reader, have downloaded Evernote on the iPad, and now cannot live without delicious. I am  a coach as I see myself raising the bar and encouraging the third year nursing students to practice at the new graduate level, with this I take the role of facilitator as I keep pushing the students to take on a bit more responsibility as they move up to caring for 4 patients. Each week I am a critic as I take their assignments and review if they have completed all of their research, if they have come up with appropriate nursing diagnoses, understand the reason why the patient is receiving a particular medication or why a specific lab value is out of range. I am becoming better at being a sharer as I am passing links to other sites with nurses on my Facebook group, TechnologyNurse or on Twitter.

As the picture shows above, as nurses we do wear many hats and as nurse educators we seem to just add to that number. Stephen stated that these roles are being blown up and that the role of the teacher will not be the same in ten years…I think that as nurses we are looking and trying to figure out what exactly that will look like. It will definitely be interesting to see what changes come about. A person can always find someone who does not welcome change but I think given the acuity of patients, how much information students need to know to practice safely in our healthcare environment we need people to take on each of these roles and excel. So which role will I focus on? I feel most comfortable as the coach.


So I sent the link out for my final project…

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I have been working on my final project for a while. During this time I have received wonderful support. Nurses from the heart failure clinic will be reviewing and commenting on the site- the only problem is that one is not able to sign in to NING. I phoned her and went over how to sign in to the platform over the phone but it did not work. I was thinking that maybe it would have to do with the firewall at her place of employment?? She is going to try to access the NING site from home to see if that works. Has anyone else had this experience? If so what have you done to correct this? One other participant has signed on and they do work at the same place. Any suggestions would be greatly appreciated! Thanks in advance…

As my final project is developing a site where patients, family members, friends and health care providers could come together to discuss issues, questions, treatments about heart failure as well as a place where patients and family members could share stories if they wish, I focused the health related information to someone newly diagnosed with heart failure. Topics included describing what heart failure is, managing symptoms, how to track symptoms, diet considerations (low sodium/salt), taking medications, emotional health of living with a chronic condition. I will also include topics such as losing weight, weight loss procedures, advanced health care directives. If you knew someone with heart failure- what information would like to know?

Based on research, signs and symptoms was ranked the most important topic for learning followed by prognosis, risk factors, medications, general information, diet, psychological factors and activity (Boyde et al., 2009b). These findings were supported by Nahm et al. (2008) who found the heart failure patients wanted to have up-to-date information on research findings, medications and laboratory tests, rather than general information about heart failure. Patients liked to have immediate access to information in order to verify if they are still following the recommendations as prescribed (Boyde et al., 2009a) and found it useful to continue web-based communication over long periods (Delgado et al., 2003). Caregivers want equal access to web-based information to help their loved ones and to provide better care (Nahm et al., 2008; Piette et al., 2008). When given access the Web-based applications, caregivers reported that the program was helpful in providing assistance and additional information about heart failure (Piette et al., 2008).

Boyde, M., Tuckett, A., Peters, R., Thompson, D., Turner, C., & Stewart, S. (2009). Learning for heart failure patient (The L-HF patient study). Journal of Clinical Nursing, 18, 2030-2039. doi:10.1111/j.1365-2702.2008.02716.x
Boyde, M., Tuckett, A., Peters, R., Thompson, D., Turner, C., & Stewart, S. (2009). Learning style and learning needs of heart failure patients (The Need2Know-HF patient study). European Journal of Cardiovascular Nursing, 8, 316-322. doi:10.1016/j.ejcnurse.2009.05.003
Delgado, D., Costigan, J., Wu, R., & Ross, H. J. (2003). An interactive Internet site for the management of patients with congestive heart failure. Canadian Journal of Cardiology, 19(12), 1381-1385.
Heart failure. (n.d.). In heart and stroke foundation. Retrieved September 29, 2010, from the World Wide Web:
Heo, S., Moser, D. K., Lennie, T. A., Riegel, B., Chung, M. L. (2008). Gender differences in and factors related to self-care behaviors: A cross-sectional, correlational study of patients with heart failure. International Journal of Nursing Studies, 45, 1807-1815. doi:10.1016/j.ijnurstu.2008.05.008
Munhall, P. L. (2007). Nursing research: A qualitative perspective. Sudbury, MA: Jones and Bartlett Publishers.
Nahm, E., Blum, K., Scharf, B., Friedmann, E., Thomas, S., Jones, D., & Gottlieb, S. S. (2008). Exploration of patients’ readiness for an eHealth management program for chronic heart failure: A preliminary study. Journal of Cardiovascular Nursing, 23(6), 463-470.
Piette, J. D., Gregor, M. Share, D., Heisler, M., Bernstein, S. J., Koelling, T., & Chan, P. (2008). Improving heart failure self-management support by actively engaging out-of-home caregivers: Results of a feasibility study. Congestive Heart Failure, January February, 12-18.
Strömberg, A., Dahlström, U., & Fridlund, B. (2006). Computer-based education for patients with chronic heart failure: A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life. Patient Education and Counseling, 64, 128-135. doi:10.1016/j.pec.2005.12.007
Westlake, C., Evangelista, L. S., Strömberg, A., Ter-Galstanyan, A., Vazirani, S., & Dracup, K. (2007). Evaluation of a web-based education and counseling pilot program for older heart failure patients. Progress in Cardiovascular Nursing, Winter, 20-26.

My NING site

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For my final project, I am working on developing a NING site for patients with congestive heart failure. It has been an exciting week- first I will share with you my experiences with NING . It was really easy setting up the account. You do have 3 options to choose from- I went with the basic format but added other features such as the ability to set up groups. My first hurdle was choosing the name of the network. I would never have guessed how difficult this could be as I wanted it to be easy to find, as it is hard to have anybody participate if they cannot find you. At the same time I did not want it to be too restrictive so that others would not want to check it out. The other issue was that I did not want it to be too similar to groups already in existence so that patients and family members would not think that I am receiving support from a particular association. In the end I chose the name Saskatchewan Heart Failure Network.  It is limiting from the standpoint of will others who live outside of Saskatchewan want to participate? I am not sure but hope to find out eventually. I would ultimately like to have this site up and running but will require ethics approval first.

Now back to the site- as I had access to the basic format (and no programming skills) I chose one of the available backgrounds which happens to be a cork board. It is okay, would not be my preferred choice for a background but given the other selections it is the easiest to read and follow. Attaching videos is really easy and similar to what you do on wordpress.

I have started two groups- one for patients with heart failure, the other for family members and friends who also may want to share their story. A third group was also set up for just general questions. As well I started several discussion postings on various topics such as what is heart failure, medications, diet, monitoring etc. In each of these discussion postings I have provided an overview of the topic with links to websites. I have tried to keep with as many Canadian resources as possible and particularly Saskatchewan based for relevancy. I also started a forum on medications- this was started as so many patients do not take medications as scheduled due to side effects.

I met with the nurses at the Congestive Heart Failure Clinic in the Regina Qu’ Appelle Health Region and they are very excited about this project as there is such a need. I was told that patients last week were asking if such a site exists. These nurses will be given access to the site and I look forward to their comments and how I can improve it. I will be continuing to develop it throughout the month- ultimately I would like the site to become a place where patients, family members and friends can seek advice, share experiences and stories, support one another and have access to current and relevant information monitored by a nurse.

I have also been asked to share this with the Canadian Council of Cardiovascular Nurses in one of their webinars when I am further along. I will continue to blog about what content I chose for the site as well as about the feedback I receive so I will keep you posted.

On reflection,

thinking? by galo/*, on Flickr
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As I am reading the ECI 831 class blogs (such as Judy’s) and reflecting on last week’s discussion rhyzomatic learning, I find myself considering how we are educating our future nurses.

I am a nursing clinical instructor and have been working with nursing students in a variety of clinical areas for over 10 years. Out of curiosity, I read a book written by a nursing clinical instructor in the early 1900s and was amazed that the book was a carbon copy of what we do today. In this small book, the author stated that a nursing instructor supervised 7-8 nursing students who attended classes, students were able to relate theoretical concepts with patients they were assigned to that week by completing research and submitting written assignments, and listed observational experiences for the students as an off unit experience for part of the shift where they may be able to watch a surgery. This mirrors what we do with nursing students in our current educational program.

This brings me back to last week’s class in which Dave Cormier discussed three different outcomes for our educational system: the workers who show up on time, accept tasks and complete the tasks without understanding them; the soldier who establishes what things we currently need to know and how we will measure this learning and the nomad who is a creative thinker and carves their own path. Each outcome has served a role/function in our learning. For nursing students, they do need to be a worker and show up on time for clinical, accept and complete the tasks they are assigned. This is important for several reasons as patients require care and we need to learn what tasks we need to do in order to do our jobs. Soldiers will always be ever present as they defenders of the status quo established by the SRNA. These soldiers could be me, as the clinical instructor for I am determining what you know and what you need to know. I assume this role as I have learned more through experience and education so that I can monitor you  nursing students for compliance and determine their grade for the course.Despite this role, I strive to encourage the nomad or creative thinker by allowing students to carve out their own path and learn things because they need to learn them. How do I do this? I have the student identify their own learning goals by choosing patients they want to work with, by focusing their written assignments on those areas that they may be weak in such as lab and diagnostic test interpretation or reading ECGs. However no matter how much the nursing student can creatively think about a patient assignment, they are still restrained by the status quo as we still require specific measurable outcomes for each graduate nurse. I believe that nursing can only move towards the rhizomatic learning model by changing how nursing education is done. We do need to move towards more of an open syllabus such as in problem-based learning to continue to further outcomes in health care.

I have included a video on ECGs. I thought it was a good example of the nomad that creative thinker who carves out their own path. The person in this video did not follow the traditional manner in which we teach ECGs and those students who have viewed this do understand the heart better.

If anyone has any ideas on how we can further improve clinical education please let me know. We do bring in technology such as simulation which can be used to teach the worker to understand and obey the system. We use concept maps as a form of measurement to show what research has been done by the student to understand how well prepared they are for the shift so my question would be how can we encourage more nomad learners (please note we do see this and it really does happen at different times as the nursing student will have that light bulb moment and begin to explore things because they want to and feel they need to know them).

From apps to communities of practice

Today I was interviewed by a reporter for the Canadian Nurse who was asking questions about what apps I use on a regular basis. I was ready with my answer as I have used apps such as Lexicomp for information about drugs, apps to check IV drug compatibility, another to help nursing students practice heart sounds, an app to help students use layman’s terms with patient teaching and then I started to share how I am beginning to use Twitter. The interview then centered around my use twitter. I explained my perceived benefits of Twitter and introduced her to hashtags for healthcare. The reporter seemed surprised that I would even mention this and asked why would I use Twitter. My answer was to connect with experts in their fields and to find out what people are talking about, what their concerns are whether it relates to a specific disease process or the latest vaccine. It is a way to start and generate a discussion.  I also tried to lead the discussion towards blogs or social networking sites such as Cloudworks as I believe that sites such as these will be equally as beneficial to nursing, specifically clinical education.

When I started as a clinical instructor with nursing students I was nervous about my role- how do I pick patients for the students? what do I do if the student is not meeting clinical expectations? what should I plan for post-conferences? These and many more questions were running through my mind. Using a social networking site for new clinical instructors would help to answer some of these questions and help me to realize that I was not the only one dealing with a specific situation. Yes, I could have asked a co-worker what worked for them (which is what I did ) but having the ability to start a discussion and share experiences about how we deal with various situations, such as working with an unsafe student with other clinical instructors across the province, country or world who have experience and are willing to share their wealth of information and provide support is needed. To hear many people’s experiences is valuable. We can always look for for information in a journal, however sometimes it is just nice to hear what someone else did in a similar situation. This is where the social networking sites come in. I believe that some may say then establish a group which is private and only available to those who work within the institution- this way the only ones who may access this site would be those who could log into the course management system, however I see there would be many problems with this. Ultimately I would like to see a social networking site for clinical  instructors and those students interested in issues related to clinical education, eventually developing into a community of inquiry. Specific topics such as the ones I mentioned above could be discussed, links could be added by the members so that it could not only be interactive but generalizable as different institutions will have different policies. The key would be to link it to the actual clinical practice of clinical instructors. If someone already knows of such a site- please send it to me.

However the above is not my final project for the course ECI831. For this course, I am working on a NING site for patients with congestive heart failure. I am in the beginning stages with this site. Although the site is pretty easy to set up and start up, I am finding that it is quite restrictive with the backgrounds. This is a big consideration for this patient population as I need to pick one of the four backgrounds that will make it easy to read. The background that I chosen and am working with looks like a cork board. I am not sure if this is the background that I will keep … I am also working on making the site easy to navigate for information that is easy to read. For those visual learners, I have added a great 3D model/video of what happens with congestive heart failure, however it is difficult to understand at times due to the background music so I may delete this video and keep looking for others. I am also working on making a few videos of my own and some fun activities dealing with dietary restrictions. So I will keep you posted on these and other developments. My ultimate goal would be that this site would develop into a community of practice a place where caregivers and patients can come together to problem solve about a particular situation, or find out what specific procedures are like before going to the hospital or discussing the latest research. Ultimately this would be user driven. Sites such as this have been used with this patient population in Europe however patients only have access to this for short periods (less than 6 months) and I would like to open the site for all those interested in congestive heart failure and keep it going. I will provide additional information/research about what information patients with heart failure and caregivers want as well as more about my theory.

Homework, Homework, Homework

Grading Time by wertheim, on Flickr
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When you ask my 4 year niece what she did at school today, she says “play, play, play.” So I thought this title was appropriate for if you asked me what I have been doing for the past week it would be “homework, homework, homework.”

Today was the first day that I realized how much all of the posts, twitter, Facebook, and using delicious have become such a big part of my life. Today at a meeting, a speaker stated that this website is something that I would want to bookmark and I thought why not use delicious? So everything is beginning such a big part of my life and I love delicious

At the beginning of the semester, I was wondering how I could fit it all in and in fact this is still something that I am struggling with! I thought that I could manage my time quite well but this past week I had a quantitative research article to critique in a week and the day that it was due I learned that I had to make may changes. Of course this was also the day that I travel 5 hours to class so by the time I got home it was time to make supper, go to another class and stay up to midnight to complete. I am happy to report that my assignment was submitted 13 minutes prior to the due date! It just shows how much things have changed as I am no longer submitting assignments on paper and I do not remember the last time I was able to submit an assignment after receiving feedback for improvement.

I also wanted to thank everyone for their comments on my skype question. I think it is important to start a discussion.

Tomorrow I will also have a new experience as a reporter would like to interview me about my use of medical apps.

Webtreats 3d Glossy Blue Orbs Social Med by webtreats, on Flickr

I have also been approached by my supervisor to see if I would like to work with her on an open access journal for nursing so this will be an exciting time as we would like to work on this and get something going by spring 2012. Please keep reading my blog for future updates.

I will also have more about my final project to add this weekend.

Thanks for reading!

Would you use skype to seek medical attention?

All Night Long by bitzcelt, on Flickr
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