Tools for Knowledge and Learning: A Guide for Development and Humanitarian Organisations

Journal Club Article: Ramalingam, B. (2006). Tools for knowledge and learning: A guide for development and humanitarian organizations. London: Overseas Development Institute.

Background

“No one should be dying or suffering because knowledge that already exists in one part of the world has not reached other parts. It is up to each of us to take the responsibility to ensure the knowledge flows easily to where it is needed” (Geoff Parcell, Learning to Fly, 2006).

The application of learning and knowledge based strategies derived from learning from lessons of the past and from elsewhere, to then overcome the challenges and boundaries of time and space.

Strategies of the Learning Organisation

A Holistic View of Knowledge and Learning Tools

  • Organisational contexts: Strategic alignment, management behaviours, institutional pressures, funding cycles, historical evolution.
  • Relationships and collaborations: within and across organisation – via networks, ICTs, communications plans; core functions; support functions.
  • Organisational knowledge: Forms and locations; creation, sharing, storage, use; key activities and tools; relevance, how the message is packaged and communicated.

Five Competencies Framework (Collison & Parcell, 2001)

Aim: “To work out how well they are performing against organisationally established criteria for knowledge and learning, and to identify goals and priorities for improvement. The competency framework works on the principle that effective knowledge and learning is based on improving performance in:

  1. Strategy Development
  2. Management Techniques
  3. Collaboration Mechanisms
  4. Knowledge Sharing and Learning Processes
  5. Knowledge Capture and Storage.”

Knowledge Audits: Taking a systematic and strategic approach to knowledge and learning can help to integrate the diverse activities of an organisation, and facilitate more productive processes of knowledge sharing and dialogue between internal and external stakeholders.

Social Network Analysis: a research technique that focuses on identifying and comparing the relationships within and between individuals, groups and systems in order to model the real-world interactions at the heart of organisational knowledge and learning processes.

Most Significant Change (MSC): the process involves the collection of significant change (SC) stories emanating from the field level, and the systematic selection of the most important of these by panels of designated
stakeholders or staff.

Outcome Mapping: As development is essentially about people relating to each other and their environments, the focus is on people.

Visioning

A facilitator supports use of imagination to think of the ideal workspace, organisation and what the 5 year plan looks like,

Management Techniques

The SECI Approach

“There are four key processes through which tacit and explicit knowledge interact, namely, socialisation, externalisation, combination and internalisation. Together, these processes make up the SECI principles.

  • Socialisation allows to share tacit knowledge
  • Externalisation converts tacit into explicit knowledge
  • Combination combines different types of explicit knowledge
  • Internalisation converts explicit into tacit knowledge.”

SECI model of Knowledge creation.

Lewin’s Force Field Analysis

“Force Field Analysis was developed by Kurt Lewin (1951) and is widely used to inform decision making, particularly in planning and implementing change management programmes in organisations.”

 Activity Based Knowledge Mapping

“Is a tool which enables knowledge inputs and outputs to be
linked in a systematic fashion to ongoing organisational activities and processes – from office mail to strategic reviews.”

Other resources are also discussed.

Team Collaboration

“Team development has been described in terms of five stages, beginning with a simple ‘membership’ group, and working through ‘confrontation’ to a ‘shared-responsibility’ group (Bradford and Cohen, 1998). Bradford and Cohen suggest that the different stages of groups differ in terms of the following characteristics:

• Atmosphere and relationships
• Understanding and acceptance of goals
• Listening and information sharing
• Decision making
• Reaction to leadership
• Attention to the way the group is working.”

Communities of Practice

Action Learning Sets

Six Thinking Hats

Mind Maps or Concept Mapping

Social technologies for collaboration

Knowledge Sharing & Learning

  • Storytelling
  • Peer programs
  • Challenge sessions
  • How to guides
  • Blogs
  • Reviews and retrospects
  • Intranet resources

Additional Resources

Collison, C., & Parcell, G. (2001). Learning to fly: Practical lessons from one of the world’s leading knowledge companies. Capstone Ltd. [GoodReads]

Davies, R., & Dart, J. (2005). The ‘most significant change’(MSC) technique. A guide to its use.

Earl, S., Carden, F., & Smutylo, T. (2001). Outcome mapping: Building learning and reflection into development programs. IDRC, Ottawa, ON, CA.

Ramalingam, B. (2005). Implementing Knowledge Strategies: From Policy to Practice in Development Agencies. ODI Working Paper 244, London: ODI.

#Unconference: Journal Club

Journal Club Article: Carpenter, J. P., & Linton, J. N. (2018). Educators’ perspectives on the impact of Edcamp unconference professional learningTeaching and Teacher Education73, 56-69.

The Unconference or Edcamp

“Similar to other unconferences, Edcamps reject many traditional conference elements such as advance agendas and pre-planned presentations in order to avoid limiting participants’ creativity, collaboration, and engagement.”
Educator Professional Learning Development
“Many educators, scholars, and policy makers concur that educator professional learning is key to the improvement of teaching and student learning.”
Research Aims
1. What were participants’ perceptions regarding the impact of Edcamps on their educational practice?
2. What were participants’ perceptions regarding the impact of Edcamps on their students’ learning?
3. What factors did the participants identify as hindering and supporting their use of what they learned at Edcamps?
Participants
Survey sent 4-8 months post participation in an Edcamp.
  • Survey participating educators (N= 105), of which 88% were female.
  • Interview and focus group participants (N= 18), of which 55.6% were female.

The female ratio was consistent with the US education workforce.

Results

  • n=96 (91.4%) of respondents indicated that they had changed their practices as result of their Edcamp participation. Most commonly described changes were use of technology and use of new instructional strategies.
  • Perceived that those changes had some kind of positive impact on student learning, although this impact was not always quantifiable in terms of traditional measures of student achievement such as test scores.
  •  Teacher collaboration increased following Edcamp participation, particularly collaboration facilitated through technology among members of a professional learning network (PLN).
  • Participation provided new experiences for students and enabled students to gain new skills.
  • n=65 (61.9%) of participants reported that they encountered some type(s) of obstacles, barriers, or challenges as they tried to use what they learned via their Edcamp experience.

Limitations

Self reporting method, also the fact the educators participated in the Edcamp may indicate a motivated sample of educators.

Conclusions

“Participants overwhelmingly asserted that they had changed their practices as a result of their participation in Edcamps.

The Edcamp model appeared to positively affect teaching and learning while respecting the participants’ motivations, autonomy, experiences, and ultimately their professionalism and capacity to engage in complex intellectual work.

Those who organize and facilitate education conferences could apply our findings to identify new possibilities for conference structure and format.”

Reference

Carpenter, J. P., & Linton, J. N. (2018). Educators’ perspectives on the impact of Edcamp unconference professional learningTeaching and Teacher Education73, 56-69.

Good and Bad Studying by Barbara Oakley

These rules form a synthesis of some of the main ideas of the course–they are excerpted from the book A Mind for Numbers: How to Excel in Math and Science (Even if You Flunked Algebra), by Barbara Oakley, Penguin, July, 2014.

10 Rules of Good Studying

  1. Use recall. After you read a page, look away and recall the main ideas. Highlight very little, and never highlight anything you haven’t put in your mind first by recalling. Try recalling main ideas when you are walking to class or in a different room from where you originally learned it. An ability to recall—to generate the ideas from inside yourself—is one of the key indicators of good learning.
  2. Test yourself. On everything. All the time. Flash cards are your friend.
  3. Chunk your problems. Chunking is understanding and practicing with a problem solution so that it can all come to mind in a flash. After you solve a problem, rehearse it. Make sure you can solve it cold—every step. Pretend it’s a song and learn to play it over and over again in your mind, so the information combines into one smooth chunk you can pull up whenever you want.
  4. Space your repetition. Spread out your learning in any subject a little every day, just like an athlete. Your brain is like a muscle—it can handle only a limited amount of exercise on one subject at a time.
  5. Alternate different problem-solving techniques during your practice. Never practice too long at any one session using only one problem-solving technique—after a while, you are just mimicking what you did on the previous problem. Mix it up and work on different types of problems. This teaches you both how and when to use a technique. (Books generally are not set up this way, so you’ll need to do this on your own.) After every assignment and test, go over your errors, make sure you understand why you made them, and then rework your solutions. To study most effectively, handwrite (don’t type) a problem on one side of a flash card and the solution on the other. (Handwriting builds stronger neural structures in memory than typing.) You might also photograph the card if you want to load it into a study app on your smartphone. Quiz yourself randomly on different types of problems. Another way to do this is to randomly flip through your book, pick out a problem, and see whether you can solve it cold.
  6. Take breaks. It is common to be unable to solve problems or figure out concepts in math or science the first time you encounter them. This is why a little study every day is much better than a lot of studying all at once. When you get frustrated with a math or science problem, take a break so that another part of your mind can take over and work in the background.
  7. Use explanatory questioning and simple analogies. Whenever you are struggling with a concept, think to yourself, How can I explain this so that a ten-year-old could understand it? Using an analogy really helps, like saying that the flow of electricity is like the flow of water. Don’t just think your explanation—say it out loud or put it in writing. The additional effort of speaking and writing allows you to more deeply encode (that is, convert into neural memory structures) what you are learning.
  8. Focus. Turn off all interrupting beeps and alarms on your phone and computer, and then turn on a timer for twenty-five minutes. Focus intently for those twenty-five minutes and try to work as diligently as you can. After the timer goes off, give yourself a small, fun reward. A few of these sessions in a day can really move your studies forward. Try to set up times and places where studying—not glancing at your computer or phone—is just something you naturally do.
  9. Eat your frogs first. Do the hardest thing earliest in the day, when you are fresh.
  10. Make a mental contrast. Imagine where you’ve come from and contrast that with the dream of where your studies will take you. Post a picture or words in your workspace to remind you of your dream. Look at that when you find your motivation lagging. This work will pay off both for you and those you love!

10 Rules of Bad Studying

Excerpted from A Mind for Numbers: How to Excel in Math and Science (Even if You Flunked Algebra), by Barbara Oakley, Penguin, July, 2014

Avoid these techniques—they can waste your time even while they fool you into thinking you’re learning!

  1. Passive rereading—sitting passively and running your eyes back over a page. Unless you can prove that the material is moving into your brain by recalling the main ideas without looking at the page, rereading is a waste of time.
  2. Letting highlights overwhelm you. Highlighting your text can fool your mind into thinking you are putting something in your brain, when all you’re really doing is moving your hand. A little highlighting here and there is okay—sometimes it can be helpful in flagging important points. But if you are using highlighting as a memory tool, make sure that what you mark is also going into your brain.
  3. Merely glancing at a problem’s solution and thinking you know how to do it. This is one of the worst errors students make while studying. You need to be able to solve a problem step-by-step, without looking at the solution.
  4. Waiting until the last minute to study. Would you cram at the last minute if you were practicing for a track meet? Your brain is like a muscle—it can handle only a limited amount of exercise on one subject at a time.
  5. Repeatedly solving problems of the same type that you already know how to solve. If you just sit around solving similar problems during your practice, you’re not actually preparing for a test—it’s like preparing for a big basketball game by just practicing your dribbling.
  6. Letting study sessions with friends turn into chat sessions. Checking your problem solving with friends, and quizzing one another on what you know, can make learning more enjoyable, expose flaws in your thinking, and deepen your learning. But if your joint study sessions turn to fun before the work is done, you’re wasting your time and should find another study group.
  7. Neglecting to read the textbook before you start working problems. Would you dive into a pool before you knew how to swim? The textbook is your swimming instructor—it guides you toward the answers. You will flounder and waste your time if you don’t bother to read it. Before you begin to read, however, take a quick glance over the chapter or section to get a sense of what it’s about.
  8. Not checking with your instructors or classmates to clear up points of confusion. Professors are used to lost students coming in for guidance—it’s our job to help you. The students we worry about are the ones who don’t come in. Don’t be one of those students.
  9. Thinking you can learn deeply when you are being constantly distracted. Every tiny pull toward an instant message or conversation means you have less brain power to devote to learning. Every tug of interrupted attention pulls out tiny neural roots before they can grow.
  10. Not getting enough sleep. Your brain pieces together problem-solving techniques when you sleep, and it also practices and repeats whatever you put in mind before you go to sleep. Prolonged fatigue allows toxins to build up in the brain that disrupt the neural connections you need to think quickly and well. If you don’t get a good sleep before a test, NOTHING ELSE YOU HAVE DONE WILL MATTER.

Reference

Oakley, B. (2014) A Mind for Numbers: How to Excel in Math and Science (Even if You Flunked Algebra). Penguin. [Goodreads blurb]

Additional Learning Resources

Why We Became Nurse Educators (Journal Club)

Journal Club Article: Evans, J. D. (2018). Why We Became Nurse Educators: Findings From a Nationwide Survey of Current Nurse Educators. Nursing Education Perspectives39(2), 61-65. [abstract]

Background: The need to build the nurse faculty workforce and resolve the persistent shortage of educators led to a study of nurse educator recruitment and retention. The shortage of nurse educators is a barrier to building the nursing workforce.

Aim: The study was designed to ask teaching nurse faculty what they believed would be effective strategies in the attraction, recruitment, and retention of nurse educators through a sample of national nurse faculty.

Method: This descriptive study used an online survey questionnaire. Participants were recruited through email requests to the deans and directors of 841 accredited associate (ADN), baccalaureate (BSN), master’s, and doctoral degree programs at schools and colleges of nursing across the United States. 940 nurse educators teaching at all levels were asked to rate the effectiveness of attraction, recruitment, and retention strategies.

The survey consisted of demographic questions and three Likert type scales that asked respondents to rate the effectiveness of attraction, recruitment, and retention strategies. Open-ended questions in each section allowed participants to expand on their answers.

This article reports on responses to one of the survey’s open-ended question; a content analysis was conducted to develop a narrative description about why respondents chose nursing education.

Results: Nurse educator’s chose education roles to:

  • teach in a stimulating yet flexible work environment,
  • hoped to influence the profession,
  • had been influenced by educators, and
  • sought change and challenge in their careers.

Conclusion: “Faculty find nursing academia satisfying and rewarding, but noncompetitive compensation and unsatisfactory work environments can eclipse satisfiers.”

Keywords: Healthy Workplace; Nurse Faculty Recruitment; Nurse Faculty Retention; Nurse Faculty Shortage; Nursing Education; Workforce.

Dialogue: The Art of Thinking Together

Book Club: Isaacs, W. (2008). Dialogue: The art of thinking together. Crown Business. [GoodReads review]

This book was suggested as part of preparation for participating in an Unconference. The purpose for this resource was to maximise the limited time, within a group of people with an interest in education but who were not known to each other, so to enable conversation and dialogue to occur in the one day timeframe. 

Dialogue is about “shared inquiry, a way of thinking and reflecting together”(pg. 9). 

This inquiry can involve telling stories and the ability to think and talk together. How we think does affect how we talk, with relation to our held memory and emotions.

“Dialogue is a practice for deliberately and consciously evoking powerful conversations like these” (pg 70).

The aim is to create mutual respect, coordination and connection within a group of people.  

  1. Listening
  2. Respecting
  3. Suspending
  4. Voicing 

Why is this important, well dialogue occurs in all walks of life. This approach can be used to work together, resolve conflicts (be warned this is not an easy process, the book provides many examples of dialogic discussion) and solve problems. The aim is to empower and create new ways of thinking and working together.

3 Levels of action in a dialogue (pg. 29-30):

  1. Produce coherent actions: do what we say,
  2. Create fluid structures of interaction,
  3. Provide an environment for dialogue to occur.

Path to Dialogue

Purpose of Dialogue

  • determine what is the problem?
  • In the world of information overload, dialogue can determine what truly matters to us?
  • Build capacity for new behaviour.
  • Learn to inquire together.

4 Principles of Dialogue

  1. Participation
  2. Unfolding
  3. Awareness
  4. Coherence

Learn to Listen

  • Prepare to listen
  • Learn to be present
  • What are you thinking?
  • Use reflective listening, see how others are experiencing the situation
  • Listen together

Listening Together

  • Respecting boundaries, but not being passive
  • Wholeness of the conversation
  • Awareness, the ability to suspend directions/opinions using reflection in action
  • Foster enquiry
  • Voice

The Environment

  • The container: for a rich field of interaction
  • Psychological safety

Keywords: Dialogue; Dialogic: Listening; Respect; Voice; Change Management

References

Argyris, C. (1977). Double loop learning in organizationsHarvard business review55(5), 115-125.

Argyris, C., & Schon, D. A. (1974). Theory in practice: Increasing professional effectiveness. Jossey-Bass.

Bohm, D., & Peat, F. D. (2010). Science, order and creativity. Routledge.

Isaacs, W. (2008). Dialogue: The art of thinking together. Crown Business. [GoodReads review]

Isaacs, W. N. (1993). Taking flight: Dialogue, collective thinking, and organizational learningOrganizational dynamics22(2), 24-39.

Yacavone, M. (2010). A Summary of… David Kantor’s Four-Player Model of Communication.

‘Do not interrupt’ Bundled Intervention to Reduce Medication Interruptions.

Journal Club Article: Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017). Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility studyBMJ Qual Saf, bmjqs-2016.

Aim: Evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.

Method:parallel eight cluster randomised controlled study. Nurses were informed that the study was a direct observational study of medication administration and preparation tasks. Nursing staff were blinded to the study aim focused on interruptions and at baseline were blinded to the intervention. Only intervention ward staff were informed of the intervention subsequently.

Use of real time collected data using the Work Observational Method by Activity Timing Software (WOMBAT).

Setting: 4 wards in 1 hospital. Over 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications.

Intervention: Wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders.

Outcome Measures: 

  1. Primary outcome was non-medication-related interruptions during individual medication dose administrations.
  2. Secondary outcomes were total interruption and multitasking rates. A survey of nurses’ experiences was administered.

Intervention: The ‘Do not interrupt’ intervention comprised five ‘bundled’ elements:

  1. Wearing of a ‘Do not interrupt’ medication vest by nurses when preparing and administering medications,
  2. Interactive workshops with nurses regarding the purpose of the intervention to reduce non-medication-related interruptions and to identify local barriers and enablers to intervention use (eg, where to store vests),
  3. Brief standardised education sessions with clinical staff (eg, doctors, allied health),
  4. Patient information, which included why nurses were wearing a vest, and a request not to interrupt nurses during medication administration unless their concern was serious and urgent, or related to their medication. Patients were informed of other nurses and staff from whom to seek help if required,
  5. The use of reminders such as posters and stickers to inform health professionals, patients and visitors not to interrupt nurses during medication rounds for safety reasons.

Results: Baseline characteristics for control and interventions wards were similar.  Due to the observational approach of the study, the impact on influencing behaviours must be considered.

  • At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed.
  • A significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards.
  • Medication
  • The intervention more effective reducing interruptions from other nurses, no substantial impact from patient interruptions.
  • Intervention ward nurses reported that vests were time consuming, cumbersome and hot.
  • Only 48% of nurses indicated that they would support the intervention becoming hospital policy.
  •  There was reduction in multitasking rates in the intervention wards compared to control wards.

Discussion: The main aspect was the reduction of interruptions (30%) which potentially (as reduction in medication errors was not measured) translates to a reduction in medication administered errors (MAEs) of 1.8%.

This study was conducted in a paper system, so the impact of electronic medication administration records (eMARs) on reducing medication errors needs to be considered.

If visual aids such as vests are not a preference for nurses, also the infection control issue moving around the ward then educating nurses to deal with interruptions is advocated.

Resources

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administrationJournal of Clinical Nursing24(21-22), 3063-3076.

Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errorsArchives of Internal medicine170(8), 683-690.

Westbrook, J. I., & Ampt, A. (2009). Design, application and testing of the Work Observation Method by Activity Timing (WOMBAT) to measure clinicians’ patterns of work and communication. International Journal of Medical Informatics78, S25-S33.

The Applicability of Community of Inquiry Framework (Journal Club)

Journal Club Article: Smadi, O., Parker, S., Gillham, D., & Müller, A. (2019). The applicability of community of inquiry framework to online nursing education: A cross-sectional studyNurse education in practice34, 17-24.

Background

The lack of rigorous evidence based research to guide e-learning in higher education, which is especially relevant with the rapid adoption of e-learning, which is often part of a blended learning approach (Garrison, 2011).

“While discussion forums and video conferencing are very common in online courses, LMS also include a range of more interactive features and advanced functions such as customized learning pathways, collaborative content, peer interaction and assessment workshops, file sharing, real-time messaging, and wiki forums. However, according to Christie and Jurado (2009), these interactive features are not widely used by the course designers. Shea and Bidjerano (2009b) report that designers of online courses and educational providers are often confused about how to integrate new technologies into online learning environments in ways that will enrich student learning.”

The Community of Inquiry Framework

“The Community of Inquiry framework originated in the work of Dewey (1938), Peirce (1955), and Lipman (2003). Garrison et al. (2000) broadened and adapted the Community of Inquiry framework for e-learning education by viewing it through the lens of social, cognitive, and teaching presences.”

Community of Inquiry framework (Garrison et al., 2000):

  1. Social Presence
  2. Cognitive Presence
  3. Teaching Presence

Study Aim

The projects aims were to explore the following questions:

1. What is the awareness and knowledge of Australian nursing educators about the CoI framework?
2. What is the participants’ attitudes on the applicability of the CoI framework to online nurse education courses?

Study Design

An online survey tool which was divided into three sections:

  1. Demographic information,
  2. The applicability of community of inquiry presences,
  3. Awareness and knowledge of  Community of Inquiry.

Participants: Nurse educators from 34 higher education universities providing nurse education to international students.

Limitations: The survey tool was an adaptation of a validated tool. The limited response from using an online survey approach.

Results

From 138 respondents from a possible 1201 (response rate 11.5%):

    • The current used mode of teaching is blended learning (BL) (83%).
    • Nurse educators ranked BL as the best suited teaching mode for nursing education (90%).
    • Ninety percent (90%) of the participants are involved in curriculum design.
    • (90%) of the participants viewed instructional design and framework as significant to build an online course.
    • However, (70%) declared they don’t use explicit theoretical framework to guide the design/evaluation of online education.
    • Participants highly ranked the three core concepts of CoI framework as applicable for online nursing education.
  • (20%) of the participants are familiar with CoI framework, of them (79%) are likely to recommend CoI framework to a colleague.

Summary

“This study has shown the perceived importance of instructional design and theoretical framework to build an online courses for nurse educators using blended learning. Since Community of Inquiry framework has been shown to improve student satisfaction and decrease attrition in non-health disciplines, the implementation of Community of Inquiry framework in nurse education should be investigated more. Community of Inquiry provides a comprehensive framework relevant to face-to-face, blended, and online education with the potential to embed numerous technology-linked interventions within a Community of Inquiry framework.

These results provide the impetus for further investigation of factors influencing the development of online nurse education including the specific consideration of CoI frameworks.”

Keywords: Community of inquiry; Online education; Theoretical framework; Blended learning; E-learning

Reference

Smadi, O., Parker, S., Gillham, D., & Müller, A. (2019). The applicability of community of inquiry framework to online nursing education: A cross-sectional studyNurse education in practice34, 17-24.

IRIS Cricoid Pressure Trial & Deimplementation (Journal Club)

Journal Club Article: Birenbaum, A., Hajage, D., Roche, S., Ntouba, A., Eurin, M., Cuvillon, P., … & Menut, R. (2018). Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial. JAMA Surgery.

Background: 

Cricoid pressure or Sellick’s maneuver (first described by Dr. Sellick in the 1960’s) aims to reduce the risk of regurgitation. The technique involves the application of pressure over the cricoid cartilage with the thumb and 1-2 additional fingers, to to occlude the esophagus and prevent regurgitation of stomach contents into the upper airway.

Study Aim:

Does the cricoid pressure prevent pulmonary aspiration in patients undergoing rapid sequence induction of anesthesia?

Study Design:

A randomized, double-blind, noninferiority trial conducted across 10 academic centers. Patients undergoing anesthesia with rapid sequence intubation (RSI) were enrolled from February 2014 until February 2017 and followed up for 28 days or until hospital discharge. 3472 patients were assigned to cricoid pressure (Sellick group) or a sham procedure group. Mean age was 51 years and 51% were men. Inclusion: all adults; Exclusion: pregnancy.

Key Results: 

Primary measure of pulmonary aspiration, occurred in 10 patients (0.6%) in the Sellick group and in 9 patients (0.5%) in the sham group.

Secondary Measures:

  • No significant difference in pneumonia, length of stay and mortality.
  • The Cricoid (Sellick maneuver) group had significantly longer intubation time (median, 27 vs. 23 seconds).
  • Longer intubation time >30 seconds, Cricoid 47% vs Sham 40%; P <.001.
  • Comparison of the Cormack and Lehane grade (Grades 3 and 4) in Cricoid (10%) vs Sham (5%; P <.001).
  • All suggests an increased difficulty of tracheal intubation in the Cricoid (Sellick) group.

Summary: 

Investigators summary: “the results failed to demonstrate the noninferiority of a sham procedure in preventing pulmonary aspiration compared with the cricoid pressure. Mortality, pneumonia, and length of stay did not differ significantly between groups, and differences in intubation time and laryngoscopic exposure suggest more difficulties in the Sellick group”.

Nursing Clinical Questions:

  • Is cricoid pressure needed if there is no harm prevention and gives inferior views of the airway?
  • This study population was in theatre, can the results be transferred into the pre-hospital, ED or ICU populations (and in pregnancy)?
  • Should nurses use the evidence base to encourage the deimplementation of ‘ritualistic’ practice? See below in Deimplementation Resources.
  • Should nurses just refuse to perform a non-evidence based procedure?

Additional Resources:

Recommended Viewing on Cricoid: Cricolol by John Hinds on Vimeo.

Deimplementation Resources

Rogers, E. M. (1995) Diffusion of innovations. (5th ed.) Simon and Schuster, New York, USA. [summary article]

Nursing Education Network. (2017) Deimplementation of Practice.

Nursing Education Network. (2016) Human Centred Design.

 

 

 

 

 

Barriers to using research findings in practice: The clinician’s perspective

Journal Club Article: Funk, S. G., Champagne, M. T., Wiese, R. A., & Tornquist, E. M. (1991). Barriers to using research findings in practice: The clinician’s perspective. Applied Nursing Research4(2), 90-95. [abstract]

In 1991, Funk and colleagues highlighted the progress made in the quantity, quality and new areas of nursing research being instigated.  This paper produced the BARRIERS scale, which has been used as a validated tool to further investigate research in nursing in different settings and countries.

Aim: To determine clinicians’ perceptions of the barriers to using research findings in practice and to solicit their input as to what factors would facilitate such use.

Method:  Questionnaires to 5000 selected full time working nurses based on five educational strata (those with diplomas, associate degrees, bachelor’s, master’s, and doctoral degrees). 40% completion of the questionnaire.

Nice touch part: “Each questionnaire included an individual packet of coffee and a letter inviting the recipient to take a few moments to relax and complete the questionnaire”.

BARRIERS scale: 28-item scale requires respondents to rate the extent to which they think each item is a barrier to nurses’ use of research to alter or enhance their practice. Responses are circled on a 4-point scale (I, to no extent; 2, to a little extent; 3, to a moderate
extent; and 4, to a great extent).

The scale is divided into four subscales:

  1. characteristics of the nurse (related to the nurse’s research values, skills, and awareness).
  2. characteristics of the setting (related to the barriers and limitations perceived in the work setting).
  3. characteristics of the research (methodological soundness and the appropriateness of conclusions drawn from the research).
  4. characteristics of the presentation of the research and its accessibility.

Results:  “Insufficient time on the job to implement new ideas was cited most frequently, with lack of support from administration and physicians following closely behind.

The two greatest barriers were the nurse’s not feeling that she/he had “enough authority to change patient care procedures” and “insufficient time on the job to implement new ideas,” both of which are barriers of the setting.

The characteristics of the setting were rated among the top 10 barriers. They included lack of cooperation and support from physicians, administration, and other staff; inadequate facilities for implementation; and insufficient time to read research.”

The characteristics of the nurse in recognising the limits of their knowledge and skills to review and conduct research.

Summary: Nurses need to use and understand research to deliver evidence based practice. Research improves critical thinking and clinical decision making in clinicians. There are numerous barriers that hinder the use of research in the clinical setting, mainly linked to culture and traditional leadership hierarchies.

Limitation: The world and healthcare has changed since 1991, so aspects such as technology and the mass of information may lead to questions of validity for the BARRIERS scale, despite it’s historic use. Take a read of this systematic review by Kajermo et al. (2010). It may also help to understand the drivers of change, which can then be replicated in other settings to increase nurses involvement in research.

Resources

The Barriers Scale. (2018). The BARRIERS to Research Utilization Scale. UNC.edu

Kajermo, K. N., Boström, A. M., Thompson, D. S., Hutchinson, A. M., Estabrooks, C. A., & Wallin, L. (2010). The BARRIERS scale–the barriers to research utilization scale: A systematic reviewImplementation Science5(1), 32.

Journal Club: Defining the key roles and competencies of the clinician–educator of the 21st century.

Journal Club: Sherbino, J., Frank, J. R., & Snell, L. (2014). Defining the key roles and competencies of the clinician–educator of the 21st century: a national mixed-methods studyAcademic Medicine89(5), 783-789.

Background

This paper looks at the challenges of the clinician educator in the medical profession, the challenge of being a clinician and an educator. Defining an educator and the roles they perform in the clinical and educational environments varies considerably in terms of the scope of abilities or competencies.

Aims

  1. Create a consensus definition of what is a clinician–educator.
  2. Understand the domains of competence of being a clinician–educator.
  3. Types of training and preparation is required for the clinician–educator.

Method

Two-phased mixed method study:

  • Phase 1: focus groups using a grounded theory analysis.
  • Phase 2: a survey of 1,130 deans, academic chairs, and residency program directors to validate the focus group results.

Results

Results from phase 1 focus groups:

  1.  Being active in clinical practice,
  2. Applying education theory to education practice,
  3. Engaging in education scholarship.

Results from phase 2 survey:

Domains of competence and core competencies for clinician–educators:
  1. Designs assessment designs programs.
  2. Employs effective communication strategies.
  3. Learning theories and best practice for curriculum development, and conducts evaluations.
  4. Knowledge of education theory and application to education practice.
  5. Leadership in educational programs.
  6. Scholarship: “Contributes to the development, dissemination, and translation of health
    professions education knowledge and practices.”
  7. Uses effective teaching in teaching environments. Develops other faculty members.

Conclusion

Key roles of the clinician-educator: participates in clinical practice, applies theory to education practice, engages in education scholarship and consults on education issues. Identified the need for clinician-educator formal training programs.

Relevance For Nursing

What is interesting in this article is the continued mention of clinical competence or expertise in medical education. In nursing is the higher education setting seen as the source of educational knowledge, research and scholarship? But is higher education too far removed from the clinical environment to understand real world clinical challenges? Is there a different approach to engage both worlds for delivery of evidence based practice?

Resources

ICE Blog. (2014). Defining a Clinician Educator.

Sherbino, J., Frank, J. R., & Snell, L. (2014). Defining the key roles and competencies of the clinician–educator of the 21st century: a national mixed-methods studyAcademic Medicine89(5), 783-789.