The Stress Curve (Yerkes and Dodson Law)

Background History

“Yerkes-Dodson law from 1908 to the present. In its original form, the law was intended to describe the relation between stimulus strength and habit-formation for tasks varying in discrimination difficultness. But later generations of investigations and textbook authors have rendered it variously as the effects of punishment, reward, motivation, drive, arousal, anxiety, tension or stress upon learning, performance, problem-solving, coping or memory; while the task variable has been commonly referred to as difficulty, complexity or novelty, when it is not omitted altogether” (Teigen, 1994).

Stress Curve By Yerkes and Dodson 1908

OriginalYerkesDodson

Pressure & Performance

There are four main influencers related to pressure and performance:

  1. Skill Level.
  2. Personality.
  3. Trait Anxiety.
  4. Task Complexity.

The perception of stress from the individual can trigger the innate fight or flight response.

For The Educator

  • Remember stress can be both a negative and positive experience. This stress theory can link to ’emotional intelligence’ of the individual, well-being and potential for burnout.
  • Simulation sessions can be set up to challenge the learner along the stress curve. The educator must be aware of how they can positively or negatively influence the learners experience.
  • The environment can also impact on stress and perceived threats (culture, unsafe workplace such as violence).
  • For the educator. the question when to challenge the learner and when to step back is very difficult and will require regular review and feedback from the learner and the wider nursing team. Its good to provide a challenge, with the required supports but dropping the learner into an unsupported situation may backfire and effect confidence. Also learners (nurses) are people and have personal lives and so sometimes private life issues means the level of stress the person is experiencing renders learning negligible. This is the time to step off the learning curve, give an extension and put supports in place and to regroup at an appropriate time. Provide a personal approach to learning, not one fitted around traditional university semester timetables.

Keywords: Resilience, mindfulness, stress curve; burnout; Yerkes and Dodson Law.

References

Gibbons, C., Dempster, M., & Moutray, M. (2008). Stress and eustress in nursing students. Journal of Advanced Nursing, 61(3), 282-290.

Intensive (2017) Training for Stress.

Selye, H. (1956). The stress of life.

Teigen, K. H. (1994). Yerkes-Dodson: A law for all seasons. Theory & Psychology, 4(4), 525-547.

Watson, R., Gardiner, E., Hogston, R., Gibson, H., Stimpson, A., Wrate, R., & Deary, I. (2009). A longitudinal study of stress and psychological distress in nurses and nursing students. Journal of Clinical Nursing, 18(2), 270-278.

Wikipedia (2017) Yerkes-Dodson Law.

Tag Team Simulation: Journal Club

Journal Club Article: Levett-Jones, T., Andersen, P., Reid-Searl, K., Guinea, S., McAllister, M., Lapkin, S., … & Niddrie, M. (2015). Tag team simulation: An innovative approach for promoting active engagement of participants and observers during group simulations. Nurse education in practice, 15(5), 345-352. [abstract]

Rationale for the Study

The authors state that “when simulations are conducted in large groups, maintaining the interest of observers so that they do not disengage from the learning experience can be challenging. We implemented Tag Team Simulation with the aim of ensuring that both participants and observers had active and integral roles in the simulation.”

Background 

“However, in nursing programs, where there may be hundreds of students, resource limitations often lead to simulations being conducted as group activities. Evidence suggests that when this happens, learners who take on an observer role instead of being an actual participant in the simulation, can lose interest and disengage from the learning experience” (Kettlewell, 2012; Harder et al., 2013).

The importance of active participation in education and simulation is highlighted. However, in simulation an observing role from watching through one way glass, auditorium or via video conference is part of increasing engagement and providing an alternative view or ‘lens’ from the non-active members. Learning can occur from this observation aspect, but the authors highlight the issue of a passive role, less immersion and boredom ensuing.

One of the most innovative parts of this article is that the idea was taken from performative theatre. It’s really interesting to take ideas from other professional fields and try them in the nursing environment and take some risks and consider new approaches to education delivery.

Tag Team Simulation (TTS)

“TSS is designed for groups of approximately 20 learners, with each participant and observer having a specific, active and integral role in the simulation.

  1. The narrator/director (the educator).
  2. The protagonist  (leading character- trained simulator actor, student or educator).
  3. The actors (the students).
  4. The audience (active observers).
  5. The set ( an authentic learning environment with high level of fidelity).
  6. The play (simulation scenario)

One of the unique features of TTS is that there are no formal scripts. The TTS play is comprised of a prologue, two acts, an intermission, a debrief and an epilogue.”

Results

The Satisfaction with Simulation Experience Scale (SSES) was used to measure student’s perceptions.

444 second year nursing students submitted the surveys from a population of 536 giving a response rate of 83%.

“The results of an independent sample t test revealed that those who participated in the simulation experience (the actors) reported slightly higher satisfaction with the simulation experience than observers (audience). However, the difference was not statistically significant on the SSES or any of the three subscales.”

Take Home Messages from the Article:

  • Simulation observers can lose interest and disengage from the learning experience.
  • Tag Team Simulation ensures that both participants and observers have equally active and integral roles in simulation.
  • A Tag Team pain simulation implemented with second year nursing students revealed no significant difference in satisfaction scores.

Summary

The holy grail for the perfect education approach continues, but this is a reasoned approach to the very real challenge of large group sessions and how to improve the educational approach. One question that I would like to know in regards to nurse training, relates to the increasing deregulation on the number of nursing enrollments in higher education and universities and the impact on the quality of education (I presume this is becoming a global phenomena with the predicted global nursing shortage?). Many simulation courses provide a 1:6 or 2:6 instructor to participant ratio for a quality learning experience. Is this article just responding to changing times and the stretch on nurse education resources?

Keywords: Tag Team Simulation; TTS; Simulation;active participation

Reference

Levett-Jones, T., Andersen, P., Reid-Searl, K., Guinea, S., McAllister, M., Lapkin, S., … & Niddrie, M. (2015). Tag team simulation: An innovative approach for promoting active engagement of participants and observers during group simulations. Nurse education in practice, 15(5), 345-352. [abstract]

Minecraft & Gamification

Now I am not a gaming person but for skills of the future I have decided for my own personal development, that my aims for the coming 12- 24 months are to engage in gaming environments (Minecraft to start) and also learn some basic coding skills. Hopefully you find these resources useful when starting out, if you know of any others please post them in the comment section at the bottom of this post. When I somehow find some spare time to commence coding I will create a post with links to any of the resources I have used (I aim to learn using open access resources so it will all be free).

For those in school education, there is also a Minecraft Education edition that promotes an online world with collaboration and problem-solving in an immersive environment.

Keywords; gaming, immersive, problem-solving, collaboration, Minecraft.

Resources

DigMinecraft (2017) Getting started in Minecraft.

Minecraft (2017) Minecraft Official Site.

Minecraft Education Edition (2017) What is Minecraft Education.

Wikipedia (2017) Minecraft.

Team Emergency Assessment Measure (TEAM)

Purpose

Development of a tool to measure teamwork performance in medical emergencies (TEAM measurement tool).

Background

The focus in healthcare on the importance of patient safety and developing safer healthcare systems. Reducing preventable errors in healthcare requires a culture of change. Errors are multi-factorial, but can be attributed to technical and non-technical skills as well as organisational issues. “The determinants of effective team performance include technical and nontechnical skills such as leadership and teamwork” (Cooper et al., 2010).

Key Performance Factors

  • Leadership skills
  • Team performance
  • Technical Skills
  • Task management
  • Non technical skills
  • Communication
  • Situational awareness
  • Environmental awareness

Findings

Study findings from the primary study found “TEAM was found to be a valid and reliable instrument and should be a useful addition to clinicians’ tool set for the measurement of teamwork during medical emergencies. Further evaluation of the instrument is warranted to fully determine its psychometric properties”.

Keywords: teamwork; situational awareness; training; debriefing; human factors.

References

Cooper, S. J., & Cant, R. P. (2014). Measuring non-technical skills of medical emergency teams: an update on the validity and reliability of the Team Emergency Assessment Measure. Resuscitation, 85(1), 31-33.

Cooper, S., Cant, R., Porter, J., Sellick, K., Somers, G., Kinsman, L., & Nestel, D. (2010). Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM). Resuscitation, 81(4), 446-452.

Monash University (2017) TEAM.

Monash University (2017) TEAM measurement tool.

Workplace Training: Informal Learning?

Workplaces as Centres of Inquiry

Workplace learning and experiences are often seen as informal and subsequently ‘informal learning’ occurs. Billet (2002) states that an educational workplace pedagogy exists, and that learning does not just occur in schools and higher education. Workplace education delivers structured goal-directed activities and work practice relevancy so this ‘informal’ tag is actually incorrect. Learning is deemed as being “interdependent between the individual and the social practice” (Billet, 2002). This structuring of learning experiences is shaped and directed towards sustaining the continuity of current practice.

“Workplace practices and affordances, are dynamic, as their tasks, goals, interactions, participants and relations are likely to be constantly changing” (Billet, 2002, pg. 64).

Learning through work, and the participation and engagement in the social practice is an essential aspect. Just think of the importance of role modelling to set the culture of your workplace environment. Vocational learning is often considered of lower quality than education provided by educational institutions, but with current lifelong learning policies, the role of workplace learning is essential. Workplace participation and sustaining practice are required for positive learning experiences and outcomes. Workplace training can vary between ad-hoc to over structured teaching, which have contributed to some of the negative terms for workplace learning. If we think of the learners motivation to learning, there will likely be a difference in the learners level of engagement of learning in those opportunities chosen by the individual to that of enforced learning (such as mandatory training). Just think to the last time you went to an education event of your choice and compare to one you were ‘encouraged’ to attend, likely you experienced very different motivators. The workplace will have more mandatory training requirements so enthusiasm is likely to be low for such training, as the educator you will need to find a way to make the training meaningful for the participants.

Pathways of learning activities as part of a constructivist approach for skill development are approaches in contemporary work settings. Mentoring and apprenticeships are important learning pathways to navigate workplace practices and learn from experienced practitioners, again part of the social learning experience. Continuity of social practices and the opportunities of unintended learning is a product of these mentorship experiences in the work setting.

Relevancy in Nursing 

Nurse training is forever looking for the right balance between providing higher education and workplace experience for nurse training. Finding the perfect mix of theoretical with the hands on learning experience in the actual clinical setting is the overall aim. The mentor model is an essential part of nurse training in providing learning in the workplace setting. Workplace education is commonly more hands on and has a practical focus, combining theoretical and clinical. With simulation increasingly part of formal educational approaches to nurse training, a more hands on experiential learning approach is being embraced over the traditional ‘sage on the stage’ lecture approach. The multi-disciplinary teamwork and bonding that can occur in workplace training is vital as part of building a positive team culture.

Educator Program Aims

  • Professional growth and change (transformative practice).
  • Personal Change- Reorientation of values of attitudes.
  • Self-esteem linked to workplace confidence.
  • Teamwork and community of practice.

References

Billett, S. (2002). Critiquing workplace learning discourses: participation and continuity at work. Studies in the Education of Adults, 34(1), 56-67.

Harteis, C. & Billett, S. (2008). The workplace as learning environment: Introduction

Debriefing in Simulation Based Learning

Simulation in healthcare is a vital part of the educational approach to learning. For the adult learner this provides problem-centred, relevant and hands-on training (active participation) where past experiences are valued. Simulation training is part of an experiential learning educational approach (Rudolph et al, 2007; Fanning & Gaba, 2007).

So you have your training planned, with level of fidelity, equipment, instructor/s, learning objectives all organised? The next part is to review the breakdown of the session and ask yourself, ‘have I left enough time for the debrief at the end? Instead of leaving a hurried 10 mins at the end of the session, the structure should be more a 50:50 simulation to debrief time frame. The debrief is just as, maybe actually more important for learning and development to take place. Evidence for simulation skill training states that the learning effect maybe lasts 6-12 months (possibly even only 3 months) and should then be repeated, which does question the value of yearly competency training.

The human factors aspect of simulation training provide the task training but the debrief then allows meaning and sense from the training itself, with the adult learner moving towards the key learning objectives and adjusts their performance and actions (Rudolph et al, 2007). Across healthcare and emergency services (including armed forces) the use of critical incident stress debriefing has been formulated to provide a review of facts and perceptions to allow recovery from stress after a traumatic event. In essence the debrief is the reflective practice, and where the learning and development actually occurs.

Debriefing with Good Judgement by Rudolph et al (2007) 

  • Theory of using reflective practice for self-scrutiny.
  • Create a safe, yet challenging environment.
  • The sweet point on the stress curve to challenge the participant but not to breaking point.
  • Environment of trust.
  • Safe environment to make mistakes- this is where the educator can really try to understand the ‘framing’ of the situation from the learners perspective and then provide clarifying education to then eradicate the previous error. Its not a shame and blame situation.
  • Allow the difficult discussions to be discussed, critical judgements are valued as long as the discussion is respectful (advocacy and inquiry approach). This is important in healthcare training to be direct about critical errors observed to then eradicate.
  • Both instructors and participants views are valued in the discussion phases.

advocacy-inquiry

Summary

Rudolph et al (2007) describe the debrief as the ‘heart and soul’ of the simulation experience, so we really need to ensure we follow the debrief with good judgement principles.

References: 

Rudolph, J. W., Simon, R., Rivard, P., Dufresne, R. L., & Raemer, D. B. (2007). Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiology Clinics, 25(2), 361-376.

Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in healthcare, 2(2), 115-125.

Thanks to Chris ‘LITFL‘ Nickson for guiding to these simulation resources.