Digging For Dinosaurs: Change Idea

Presentation: Digging For Dinosaurs

Resource: Brown, C. E. (2012). Digging for Dinosaurs Contest: A Novel Strategy to Engage Nurses in Questioning Practice.

Change Management Strategy:  used a competition format to drive interest and engagement for ideas on removing ritualistic practices.

A strategy to engage nurses in practice change and the translation of evidence into practice.

Change ideas for nurses to reflect on clinical practice:

  • Why am I doing it this way????
  • Does it add value?
  • Improve quality of care?
  • Improve satisfaction?
  • Improve productivity?
  • Improve communication?
  • Improve motivation?

The aim was to aid nurses driving the change, engagement in research and evidence based practice.  Support is required from senior nurses to assist in the literature review process and any subsequent research projects. Setting up a project and completing ethics can be a time consuming process that the clinical nurse may require assistance.

This project is a great way to engage staff and encourage questioning of practice and aiding translation of evidence.


Brown, C. E. (2012). Digging for Dinosaurs Contest: A Novel Strategy to Engage Nurses in Questioning Practice.

Brown, G. H. (1993). The sacred cow contest. The Canadian Nurse89(1), 31-33.

Person-Centred Care Practice Development in Dementia

Person centred care has been promoted as best practice in dementia care, but the concept is still poorly defined. Four core themes, with the acronym (VIPS), have been described by Brooker (2006):

  • V –Valuing people with dementia and those who care for them
  • I – Treating people as individuals
  • P –Looking at the world from the perspective of the person with dementia
  • S – A positive social environment in which the person living with dementia can experience relative wellbeing.

The gold standard to aim for, but difficult to achieve? The important aspect for the hospital system to consider, is the interface where the chronic and acute care sections meet. Does the acute care sector meet the needs of chronic patients and provide opportunity for maintaining their independence and personal locus of control, or are admission/discharge targets the focus of ‘quality’ care? Individuals with dementia are likely to have higher risk for complications such as delirium, pressure sores, frailty, incontinence and risk of falls. Are extra specialist resources available to support such a high risk group within an acute care admission? Can acute care be delivered outside the hospital utilising an alternative healthcare model? Is it time to reconsider how health care is and will be delivered in the future? So many important questions for the acute care sector to consider in the drive for personalised healthcare.

The acute hospital setting is reliant on standardisation and checklists, but where do they fit in with person centred care? Do they provide a minimum standard or are too generalised and miss out marginal patient populations, such as elderly with dementia? So many questions, but hopefully the below resources will assist in answering person-centred care issues for delivering focused care for dementia populations.

Free Online Understanding Dementia Course

Understanding Dementia from The University of Tasmania


Brooker D. (2006) Person-centred dementia care: making services better. London: Jessica Kingsley Publishers.

Nilsson, A., Rasmussen, B. H. and Edvardsson, D. (2013), Falling behind: a substantive theory of care for older people with cognitive impairment in acute settings. Journal of Clinical Nursing, 22: 1682–1691.

McCormack, B., Dewing, J., & McCance, T. (2011). Developing person-centred care: addressing contextual challenges through practice development. OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 3.

McCormack, B., Manley, K, & Garbett, R. (2008). Practice Development in Nursing. [sample here]

McCormack, B., Henderson, E., Wilson, V., & Wright, J. (2009). Making practice visible: the workplace culture critical analysis tool (WCCAT). Practice Development in Health Care, 8(1), 28-43.

McCormack, B., Manley, K., Kitson, A., Titchen, A., & Harvey, G. (1999). Towards practice development–a vision in reality or a reality without vision?. Journal of Nursing Management, 7(5), 255-264.

Harvey, G., Loftus‐Hills, A., Rycroft‐Malone, J., Titchen, A., Kitson, A., McCormack, B., & Seers, K. (2002). Getting evidence into practice: the role and function of facilitation. Journal of advanced nursing, 37(6), 577-588.

McCance, T., McCormack, B., Dewing, J., (May 31, 2011) “An Exploration of Person-Centredness in PracticeOJIN: The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 1.

Nursing Education Network. (2017).  Developing person-centred care: addressing contextual challenges through practice development.

Nursing Education Network. (2017). Practice Development in Nursing.


Fibonacci Numbers

Patterns, recurrance and mathematics. Not the usual source of inspiration for a post, but something intrigued me around the Fibonacci sequence and the links to nature, the body and the universe. One to mull over, although I have yet to work out in what context this may be used. Maybe just relate when watching the Da Vinci Code?

Fibonacci Sequence in Nature 

The Magic of Fibonacci Numbers

Fibonacci Numbers & The Human Body

Golden Number.net (2012). Fibonacci numbers and DNA

Park, A. E., Fernandez, J. J., Schmedders, K., & Cohen, M. S. (2003). The Fibonacci sequence: relationship to the human handJournal of Hand Surgery28(1), 157-160.

Persaud, D., & O’Leary, J. P. (2015). Fibonacci Series, Golden Proportions, and the Human Biology.

Wikipedia (2018) Fibonacci Numbers.

Learning to Unlearn


To move into new domains of learning and knowledge there is a need for revolutionary thinking to be confident enough to rise to the challenge of moving into the unknown. Education from school to university and then into workplace, is normally planned and structured around a developmental trajectory as a persons skills, knowledge and experience increase. But what about the future and learning, if we don’t know the skills or knowledge that we will require, how do we unlearn any irrelevant information? This could be termed as a deimplementation process of learning. The process of unlearning becomes an important process in our learning skills repertoire.

From the organisation viewpoint comes the focus on becoming ‘learning organisations’, but maybe this could be supported with seeking new logic and a process of unlearning. “Unlearning is not about forgetting. It’s about the ability to choose an alternative mental model or paradigm” (Bonchek, 2016). The skill is recognising mental models that are no longer relevant or effective. This reflexivity of working with uncertainty could be benefited by utlising already well used practices such as self reflection, which could focus on considering any of our biases we hold and allowing change to occur as we move forward.

This post was inspired by the Twitter conversation below, thanks to @precordialthump.

Keywords: Unlearning; Reflexivity; Transformation; learning.


Bonchek, M. (2016).Why the Problem with Learning is Unlearning. Harvard Business Review.

Klein, E. J. (2008). Learning, unlearning, and relearning: Lessons from one school’s approach to creating and sustaining learning communitiesTeacher Education Quarterly35(1), 79-97.

McGregor, A. (2018). Unlearning: The key to the unlock 21st Century problems? International Teacher Magazine (ITM).

Gaming Addiction: Disorders Due to Addictive Behaviours

As education continues with an increasingly e-learning approach to delivery, its worthwhile to consider some of the precautionary aspects. Gamification and social media may enhance and offer different learning opportunities but the potential to create or exacerbate disorders due to addictive behaviours from gaming addiction, will need to be considered when delivering the e-learning approach and consideration of the well-being of students. Patterns of gaming behaviour when interfering with normal daily activities, and any changes in physical or psychological health will need to be monitored.

World Health Organisation: International Classification of Diseases (ICD)

Disorders due to addictive behaviours from gaming addiction:

“Gaming disorder is defined in the draft 11th Revision of the International Classification of Diseases (ICD-11) as a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences” (WHO, 2018).


Symptoms to monitor:

  • impaired control over gaming (frequency, intensity, duration)
  • increased priority given to gaming
  • continuation or escalation of gaming despite negative consequences


Some questions around gaming:

  • Keen gamer or problem with addiction, at what point is too much and does age/maturity need to be factored into the guidelines?
  • How does a sensible mix of connectivity with social media, gaming, work and social time look?
  • The developing technology such as augmented reality (AR), simulation technology and virtual reality (VR). How will they be introduced and controlled?

A quick Google Scholar search using ‘gaming addiction’ shows there are plenty of research papers on this topical subject.


Petry, N. M., & O’brien, C. P. (2013). Internet gaming disorder and the DSM‐5Addiction108(7), 1186-1187.

Woodward, A. (2018). The World Health Organization Identifies Gaming Disorder as a Mental Health Condition. Futurism.com

World Health Organisation. (2018). Gaming Disorders.




Health Target Measures & Education

When a measure becomes a target, it ceases to be a good measure” – Marilyn Strathern.

Nurse education is not only about the theoretical aspects of education and translational learning, but is measured by clinical outcomes, benchmarking, quality care and subsequent targets to achieve. Education can be difficult to measure, grades are the common method, but what about personal growth and development, or achievement through adversity, these are measures we likely don’t capture in results or evaluations but are they not as/more important as a grade in learning?

It is therefore important for the nurse educator to continually asses and review the bigger picture. Revisit the aims and objectives of the education you deliver and see if the chosen outcome measures paint the full picture. As workplace training increasingly utilises an e-learning approach, consider if this is the ideal way to learn in “hands-on” professions across healthcare. Ask yourself, is the completion percentage your target or are the learning aspects of a learning topic the priority? Compromise is likely to be part of the education role, often due to resources, time allocation and the volume of yearly clinical competencies that must be completed.

Guideline on Developing A Guideline

When developing guidelines and protocols for quality measures, the use of checklists is a common aspect in healthcare best practice delivery (Pronovost, 2013). What may become lost in the wordy guideline or protocol is the main key safety or focus points. Ensure these key points are at the start of the document to drive home the safety measure. Remember that the number of guidelines in your healthcare organisation is likely increasing all the time and this provides an explosion of information that healthcare professionals need to know and access.  But this is information overload territory for the bedside nurse, instead of knowing guidelines inside out, due to the shear volume of number and size of these documents it is just not possible. Knowing which guidelines exist and where to locate are the essential focus points. Maybe a Google Glass type device will be a necessity for accessing time critical information in the future. Why not explore how many actual guidelines and policies your organisation has, it will likely surprise you.

Example of A Checklist With Human & Resource Factors  

Intubation Checklist (front)



Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., … & Kistnasamy, B. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent worldThe Lancet376(9756), 1923-1958.

Pronovost, P. (2013). Enhancing physicians’ use of clinical guidelinesJAMA,310(23), 2501-2.

White, T. (2015) Medical student’s startup uses Google Glass to improve patient-physician relationship. Stanford Medicine.

Wikipedia (2018) Goodhart’s Law.



Healthcare Access For All

In the current climate of privatisation of healthcare systems, it’s good to remember some of the positive aspects of ‘health access for all’ approaches. It’s possible that in the future, this model of care will no longer exist, hopefully not. So let us remember the philosophy of the NHS, welfare state and Nye Bevan.

As a global outlook on access for all, take at look at the List of Countries with Universal Health Care.


Keywords: Equality; inequality; NHS; access for all; welfare state.


Wikipedia. (2018). Aneurin ‘Nye’ Bevan.

Wikipedia. (2018). List of Countries with Universal Health Care.

Wikipedia. (2018). National Health Service.