Education Delivery Resources

This is part III of organising posts from this blog into grouped resources for the nurse educator, and the focus is on the delivery of education (Part I: The Nurse Educator Role and Part II: Adult Learning Theory).

Subject intended learning outcomes (SILOs) are explicit statements of what a learner is expected to achieve, and to what standard or level of achievement (Biggs and Tang, 2011). When creating nurse education and training in the workplace, simulation centre or higher education setting, the importance of designing intended learning outcomes are vital. ILOs are central to the design of teaching and assessment so should be part of the initial planning phases.

Education Delivery

Choosing the delivery method of the learning activity and any related tasks provides a stage for effective teaching and engagement from the participants perspective. The nurse educator needs to consider the best method/s for delivering content. Here are some education delivery focused resources:

The below links are to the resources focusing on the educator role and education theory.

 

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.

 

 

 

 

 

Educational Challenges of Interprofessional Practice Education

What Is Interprofessional Learning?

Interprofessional practice education (IPE) has been defined by the Centre for Advancement of Interprofessional Education (CAIPE) as two or more professions “learning with, from and about each other to improve collaboration and quality of care” (Barr, 2002).

In order to improve outcomes across healthcare through collaboration there is the need to “learn with, from, and about each other” (World Health Organization, 2010).

WHO (2010) framework for interprofessional education and collaborative practice key messages are:

  • “Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.
  • Interprofessional education is a necessary step in preparing a collaborative practice-ready health workforce that is better prepared to respond to local health needs.
  • Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care” (pg 7).

 

The Players

Nursing, medical, allied health (physical therapist, pharmacy, social work, speech and language) and this is within the hospital environment, the next level is how to then collaborate between the hospital with community services.

IPE occurs formally and informally, from a clinical practice view, we have likely experienced the debrief of a clinical incident within the workplace (Nisbet et al. 2007).

Educational Challenges

One of the main questions from an educational perspective will be to consider what IPE learning should focus on (O’Keefe, Henderson & Chick, 2017). Is it the procedural (technical skills) or soft skills (non-technical skills) that are key learning? There will be the need for education faculty to be trained in delivering IPE (Watkins, 2016).

There is an identified need in healthcare for experiential learning opportunities, set in the clinical environment and not just in the simulation laboratory or higher education settings, (Shrader et al, 2018). Difficulties of delivering IPE in the higher education, such as logistics of collaboration around busy schedules, resources, accreditation and varied assessments (O’Keefe, Henderson, & Chick, 2017). To deliver within the clinical environment these factors need to be considered to ensure effective training focuses on improving consumer outcomes, collaboration and evidence based practice.

 

IPE Barriers

  • Professional silo’s, not to breakdown but connect.
  • Understanding each professions roles and responsibilities.
  • Scope of practice.
  • Difficulties of delivering IPE in higher education.
  • Traditional workplace hierarchy of top down approach, the collaborative IPE challenges these values and beliefs in order to change culture.
  • Interprofessional feedback process across different professions and skill mix. Skilled and structured feedback is required to maintain trust and enquiry in a safe environment.
  • Resources to deliver quality simulation, both technical and non-technical skill training.
  • Learning from mistakes and shared learning in the no-blame culture of healthcare.

Essential Components For IPE

Steven et al. (2017) identified these essential components from IPE education programs:

  1. Knowledge for practice,
  2. Skills for practice,
  3. Ethical approach,
  4. Professionalism,
  5. Continuing professional development (CPD),
  6. Patient-centered approach,
  7. Teamwork skills.

The Future

The recognition for collaborative practice and improved consumer outcomes through dedicated IPE programs delivered by specific IPE faculty (Bridges et al, 2011).

There will be a need for interprofessional competencies as IPE in the education and the workplace occurs, and how these fit into specific regulatory requirements will have to be considered (Englander et al, 2013).

References

Ausmed (2018). Position Statement: Interprofessional Continuing Education.

Ausmed (2018). Interprofessional Education in Healthcare – Exploring the Benefits.

Ausmed (2018). Meeting the Challenges of Interprofessional Collaboration.

Barr, H. (2002). Interprofessional Education: Today, Yesterday and Tomorrow. CAIPE and LTSN Centre for Health Science and Practice.

Bridges, D., Davidson, R. A., Soule Odegard, P., Maki, I. V., & Tomkowiak, J. (2011). Interprofessional collaboration: three best practice models of interprofessional education.

Englander, R., Cameron, T., Ballard, A. J., Dodge, J., Bull, J., & Aschenbrener, C. A. (2013). Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine, 88(8), 1088-1094.

Hunt, S. (2007). Participatory community practice: Developing interprofessional skills. Focus on Health Professional Education: A Multi-Disciplinary Journal, 8(3), 71.

O’Keefe, M., Henderson, A., & Chick, R. (2017). Defining a set of common interprofessional learning competencies for health profession students. Medical teacher, 39(5), 463-468.

Nisbet, G., Thistlethwaite, J., Moran, M., Chesters, J., Jones, M., Murphy, K., & Playford, D. (2007). Sharing a vision for collaborative practice: the formation of an Australasian interprofessional practice and education network (AIPPEN). Focus on Health Professional Education: A Multi-disciplinary Journal, 8(3), 1.

Shrader, S., Jernigan, S., Nazir, N., & Zaudke, J. (2018). Determining the impact of an interprofessional learning in practice model on learners and patients. Journal of interprofessional care, 1-8.

Steven, K., Howden, S., Mires, G., Rowe, I., Lafferty, N., Arnold, A., & Strath, A. (2017). Toward interprofessional learning and education: Mapping common outcomes for prequalifying healthcare professional programs in the United Kingdom. Medical teacher, 39(7), 720-744.

Watkins, K. D. (2016) ‘Faculty development to support interprofessional education in healthcare professions: A realist synthesis’, Journal of Interprofessional Care, 30(6), pp.

World Health Organization. 2010. Framework for action on interprofessional education and collaborative practice. WHO Press.

 

 

 

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.

Artificial Intelligence in The Classroom: A Step Too Far?

Education Approach

This is called the Intelligent Classroom Behavior Management System and is using facial recognition technology system to scan and observe student’s behaviour in the classroom. 7 difference expressions are recognised such as angry, disappointed, happy, neutral, sad, scared and surprised (yet no bored classification!). The system scans the students every 30 seconds so no room for a quick sleep or messing around here.

A.I. Too Far?

Imagine being constantly watched in the classroom. The systems allows greater feedback and classroom awareness, but what about the impact on behaviour and creativity? This has the potential for enforcing expected behaviours and expressions, rather than allowing individuality. All to much like big brother for me, take a read of 1984 by George Orwell. But it will be interesting to see how surveillance and AI is viewed by students and societies across the world. Let’s hope student freedom to learn is the focus and not safety fears.

Resource

Techjuice. (2018). This school scans classrooms every 30 seconds through facial recognition technology.

 

Reflection on Conference Versus Unconference: Notes & Thoughts

My main reflection point is the difference in my motivations for attending, one was it was new and innovative, the other was to submit a research project and update clinical evidence based knowledge. So really they are just two separate entities, although if learning is going on then we should look at ways to enhance delivery and engagement.

Here are some of my thoughts on some of the differences:

  • Structure & Format.

The unconference was a new concept and all about the unknown, whilst the traditional conference was scientific, clinical focused and had a fully structured program. They are chalk and cheese so comparison is so reliant on personal perspective and I think they are so different but maybe there is space in the traditional format to enhance the dialogue and engagement with some open discussion sessions.

  • Preparation

For the unconference, the use of dialogue in communicating ideas was to be used. So pre-reading for myself was Isaacs, W. (1999). Dialogue and the art of thinking together : A pioneering approach to communicating in business and in life (1st ed.). New York: Currency. Then practicing on Trello which was used for the online discussion and resource platform.

  • Room set up: how does this impact on dialogue opportunities.

The traditional is still set up for presenting the powerpoint, with rows of seats and ‘sage on the stage’ stuck behind the lectern. It’s all too passive. Questions from the audience are minimal in this set up and often time runs out to have any discussion. The unconference used a variety of available rooms but all used the circle approach for a safe container for discussion.

  • Active & Engaged.

The passive approach versus the engaged. Time went so fast in the unconference, coffee breaks were missed and the day passed quickly. The unknown really generates excitement. Interesting presentations at the formal approach also got the crowd engaged and discussing. The majority were clinical focused and so followed the usual scientific template, and this may well be the correct way to deliver (I just dont know).

gray owl perching on brown post under blue sky during daytime

  • Who gets to talk, is it across the floor or is the “guru” the only voice?

The unconference was varied, some spoke more than others so we will look at everyone’s comments to see if others had a different experience. But discussion came from all participants. The use of storytelling around clinical experiences was a common tool in the unconference. The formal conference was all about the experts, little voice from attendees.

  • Presentation styles

In the unconference, the key trigger presentations set the background, added some ideas and then set the tone for the group discussion. It felt complimentary and then the participants went looking for issues and answers, not the expert providing their summary.

  • Online participation

The unconference offered some online aspects, with uploading of recorded key trigger presentations, active access to the Trello platform. As with most conferences the risk of unreliable wi-fi made for a cautious approach. Its also very difficult to facilitate face to face discussion, with online participants and to integrate the two. One for the future is to learn if better tools are available to meet the needs of online participants.

  • Use of social media tools

Platforms such as Slack, Trello and Twitter were part of the unconference format and so encouragement to engage was provided. Twitter analytics were followed using Symplur as well. For the traditional, individuals were using social media platforms but not much engagement came from the formal bodies.

  • Networking opportunities

No difference but the scale. The unconference is a new collaboration across disciplines so is hopefully the start of an community of practice that flourishes.

  • Learning

Learning occurred in both formats, just on different topics. I am a big believer in motivation and what makes you attend. They were both in my own time, so i had bought into both programs.

This is one persons thoughts, experiences and biases. A wider perspective is needed. In the end, they are delivering different products but it’s good to reflect and consider what learning is occurring and how best to facilitate.

 

Reflection on Conference Versus Unconference

Pre-Attendance Reflection

This week will be a very interesting experience on the educational front as I attend a 1 day unconference and after a formal 3 day clinical focused conference. Leading up to the unconference is really exciting as the day has the usual venue, rooms, an outline of the day but also has online participants. The program is also not filled with presenters, just a few ‘key trigger’ talks and then who knows where the journey goes from there. There are facilitators to guide the process but the content and direction will be driven by the participants. This is so different to anything I have ever experienced before and makes for something really new to engage in as community of healthcare educators. The formal conference has the usual structure of location, rooms, set times for presentations, sponsored sessions and also social networking events. I have a copy of the 3 day timetable and have set out my itinerary of sessions I want to attend so I feel as I know what to expect. I am motivated to attend but am not sure of my level of participation in the formal conference, likely as a receiver of information.

My observation aims during these conferences are:

  • Room set up: how does this impact on dialogue opportunities.
  • The atmosphere.
  • Who gets to talk, is it across the floor or is the “guru” the only voice?
  • Facilitation style
  • Presentation styles
  • Online participation
  • Use of social media tools
  • Networking opportunities
  • Interprofessional healthcare collaboration or traditional hierarchies
  • Feedback from participants
  • Did I learn anything?

I will add my reflections post attendance in a weeks time after the events have finished. ‘Notes and Thoughts’ will be added on topics from the conferences on a day to day basis as well.

Unconference

“An unconference is a participant-driven meeting. The term “unconference” has been applied, or self-applied, to a wide range of gatherings that try to avoid one or more aspects of a conventional conference, such as fees, sponsored presentations, and top-down organization” (Wikipedia, 2018).
The Unconference

Heutagogy: is learning where the focus is learner centred with a self-determined learning approach.

Collaborative Interdisciplinary Unconference 2018

Calling all Educators – Make a difference in ICU Education: A crowd-source organised conference aimed at developing the field of interprofessional critical care education, training, teamwork and patient-centred care with the ANZ Clinical Educators’ Network in collaboration with ANZICS, ACCCN, CICM(ANZ). Physically located in Adelaide, SA.

Follow #unconfed and Symplur conference #unconfed hashtag for social media discussion.

Resources

Budd, A., Dinkel, H., Corpas, M., Fuller, J. C., Rubinat, L., Devos, D. P., … & Sharan, M. (2015). Ten simple rules for organizing an unconference. PLoS Computational Biology, 11(1), e1003905.

Carpenter, J. P., & Linton, J. N. (2018). Educators’ perspectives on the impact of Edcamp unconference professional learning. Teaching and Teacher Education, 73, 56-69.

Nursing Education Network. (2016). Heutagogy and Nursing.

Seeber, I., De Vreede, G. J., Maier, R., & Weber, B. (2017). Beyond Brainstorming: Exploring Convergence in TeamsJournal of Management Information Systems34(4), 939-969.