To SWIM?

  by  JD Hancock 

Last night, in EC&I 831 we had a guest speaker, George Siemens who introduced us to the acromyn SWIM in open online courses. SWIM stands for sensemaking wayfinding information model. Sensemaking is  a process of making connections, however it is more than connecting the dots, it is also about learning which dots are important to focus on and which dots are not important (considering dots as pieces of information).  As previously discussed, I would like to develop an open community for patients with heart failure and their caregivers so that they may have the opportunity to share their knowledge and experience with each other. Health care professionals would also be part of the group and will be able to share their knowledge and experience with the patients and caregivers as well.  Sensemaking and wayfinding is an important aspect to consider. I am looking at further advancing the Theory of Online Social Support by Sheryl Perreault LaCoursiere when I eventually write my comprehensive exams and develop a proposal for my research (still very much a work in progress).

The Theory of online social support was developed by LaCoursiere to describe the process of online social support through interpersonal relationships with other persons who are mostly unknown to each other. The theory includes the four concepts of nursing’s metaparadigm which consists of nursing, person, environment and health. Nursing comprises the thoughts and behaviors of the nurse who engages in online social support activities. The person is represented by the individual or groups of individuals, who seek online social support and engage in health-seeking behavior. The environment is virtual as it includes cyberspace and online environments. Health is viewed as a dynamic process that fluctuates over time and may include both chronic or acute health conditions that may affect the health status or health perception of the individual.

The two focal concepts of the online social support theory include online social support and linking. Online social support is defined as the “cognitive, perceptual, and transactional process of initiating, participating in, and developing electronic interactions to seek beneficial outcomes in health care status, perceived health, or psychosocial processing ability”(p. 66) and is represented as a trajectory that considers health status in relation to support needs.

Linking is the second focal concept and is defined as the “conscious and/or unconscious process of relating and weaving emerging awareness to previously learned thoughts or information” (p 67). It is described as a process similar to navigating a web page. Information and thoughts are sorted and retrieved as needed when situations occur over time. The individual builds a collection of information which provides support through transactions with other individuals in the online group and by the nature of the information itself.

I believe that by exploring coherence, it will help to further advance this theory

Thinking inside of the box?

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Reading the article by Tom Haymes I am struck how similar my experience is to what he is talking about in the article. I agree that most people do not approach technology in the same way as I envision its use. For example when I tell others about my research interests, I usually receive a puzzled stare or will be told to pick another topic that relates more to nursing. For me, nursing and technology go hand in hand. I am constantly trying new things- I started using chat rooms 7 years ago to do post-conferences with students. I found these to be effective as traditionally post-conferences were done at the end of a twelve hour shift when people are tired, hungry and just wanted to go home. So I used the chat room for the the course and had the students meet with me online at a pre-arranged time. This worked well as students were more energetic, actively participated, and used websites to provide others with additional information about the topic for discussion. I found that students who did not speak up regularly in the small group shared more with others and better yet, I had a copy of the transcript to record what was said.

So now if you fast forward several years, I have not seen much uptake with technology in the area in which I work. Those that use technology do use it and look for ways use to use tools. Those that do not use it, simply do not and do not see the need to change their practice. We have a variety of tools available for practice, so why are we not effectively using them? Haymes states that one possible reason is the fear of failure. In order to help academics to overcome this fear, Haymes provides the following three strategies:

1) make users aware of the technology
2) make the technology easy to use
3) once in use, the technology must become essential to their lives, work etc

I agree with his strategy as obviously people are not going to use it if they do not know about it. If the technology is not easy to use, then why would you every expect anybody to use it? Once it becomes part of your life, technology really does become essential to daily living (I know that I spend most of my day on the computer). The biggest area that needs to be changed is the reluctance to face change which Haymes addresses in the article. This is what I see as the biggest threat to technology uptake. For example we have the technology to do classes online yet I am still required to drive 5 hours for each class. The reason given is that a big part of the program is meeting face to face. My question to you is if I am able to use videoconferencing or Skype are we not meeting face to face? I can see you, can you see me? Maybe not if you are thinking inside of the box.

From electronic health records to twitter?

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This week I had an opportunity to begin a discussion on the use of technology in nursing by looking at current uses of electronic health records and telehealth and to explore the use of social media in health care. These nursing students were encouraged to bring their laptops to class in order to gain experiences in using tools such as YouTube to find a video about a specific medical treatment or reading the twitter feed of RNchat By actively finding information on the internet through the use of a variety of websites and using tools such as YouTube, Facebook, Twitter we were able to begin the discussion of critiquing, analyzing, and evaluating these tools. The students were able to identify their ethical responsibilities when using these tools with patients. Several students joined health care group discussions which will only lead to further collaborative discussions. We have only begun the journey towards the 21st Century Literacies but it is a start…

QR codes

I believe that QR codes should be used more frequently in health care. QR codes should be embedded into patient teaching handouts with links to additional (and credible) websites. I believe that QR codes should also be on packaging for foley catheters, nasogastric tubes, and suction catheters. This would be helpful to new grads as with a click of the button you could link to the nursing procedure manual where you would be able to review a list of the supplies required, along with the procedure.

These codes could be embedded throughout the hospital- think of the fun! It would definitely serve as a means for providing additional information- maybe it could link to a map of the hospital or provide information about courses available within the district.

In fact making this code was quite easy- I did not link this to a website, rather it will just repeat the same message as posted here.

Simulation in education

High fidelity simulation has been used in nursing education for many years. These computerized mannequins allow the participant to hear heart sounds, breath sounds, bowel sounds, and feel pulses. An operator is the voice of the patient and can relate any concerns. The participant is able to see how the mannequin responds to their interventions, as patient status may change as a result. Currently, most literature is focused on having a student complete a specific learning situation, focusing on a specific goal for the scenario. This can relate to a learning situation in which an IV medication needs to be given or a checklist needs to be completed. I feel that if we are truly trying to simulate the “real world” we should be making use of a multi-patient scenario in which the student will need to assess, diagnose, plan, implement and evaluate for several patients with complex needs. Communication, delegation and time management will be the focus of the scenario.

As with any simulation, much of the learning will occur during the debriefing process. This will be the opportunity to discuss what went well, if anything could be done differently by focusing on theory and how it was put into practice. As with any simulated experience, the scenario would take about 20 minutes with debriefing lasting an hour give or take.

Here is an example of a simulated experience- it is a good example of the process and the nerves that may arise for the participants.

In the spirit of Sharism, I am excited to read your thoughts on the use of multi-patient scenario.

The impact of social networks

As I reflect on the TED talks by Nicholas Christakis and Clay Shirky each speaker exlpores how social networks develop. Social networks primarily have developed for people to make a connection with others. In the TED talks, it was discussed how some parties may feel threatened by the power of a social network. This appears to be changing as instituions turn to the public to help solve current problems. This week it was reported that gamers solved a puzzle related to the molecular structure of a key protein that will help in the development of new anti-viral drugs. The gaming site was developed for people to make a contribution to science by solving puzzles competitively. Way to go and congratulations!

Thank you to all who responded

Thank you to all in eci831 for your valuable comments. It would seem like my questions are shared by others and is a hot area for discussion by many different groups and organizations. For those interested in exploring the issue about privacy and confidentiality related to patients/patient care, there is an article in Sunspots that discusses many concerns related to social media and privacy. The article also discusses other related potential problem as a breaching a duty of loyalty of an employer, possible defamation/libel and others. Above all, as Registered Nurses we are required to promote and uphold our ethical standards which includes preserving the dignity of patient and understanding the ethical and legal considerations in maintaining confidentiality in electronic forms of communication is essential. The CNPS also has policy statements about this issue. I continue to look forward on your comments about this area as it so important as we need to start the conversation and include patients in this discussion.