Nursing & Democratic People’s Republic of Korea

This post is one of curiosity and interest in a socialist country that is largely a mystery of what occurs in everyday life. How is the healthcare system, what sort of technology and resources are available, what training do the nurses receive, is it hospital or university based? This post is not based on any knowledge other than searches from the internet and healthcare databases (Cinahl, Embase and Medline). It is also not a political post, so please add helpful and insightful resources focusing on healthcare into the comment’s section to build on the below resources. If anyone has any links to nursing schools in North Korea it would be amazing to hear about nurse training.

Search terms: Nursing and (North Korea or Democratic People’s Republic of Korea).

The formal searches yielded only one relevant article. Many articles exist but they focus on ethical and political viewpoints. Google search was more successful, but it is the unknown of the quality or true picture they provide. See below for resources.

WHO Stats:

  • Health System: Free access for all
  • Life Expectancy: Male 67/Female 74

Remember its very easy to get caught up in ‘our health system is the best’ mentality. When we look outside our own walls, there are some healthcare systems where the principles of ‘healthcare for all’ exist. An example is the Cuban healthcare system and also the work they do in training healthcare professionals in other nations. DPRK 360 provide a different perspective to North Korea, than portrayed in the media.

BBC Panorama: Inside North Korea (2017)

Resources

Barrett, J. (2011). The North Korean Healthcare System: On the Fine Line Between Resilience and Vulnerability.

Cha, J. (2015). Scenes from a North Korean Hospital. The Guardian.

DPRK 360. (2018) A different perspective to North Korea.

Kim, H. K., Lee, O. J., & Baumann, S. L. (2011). Nursing Practice with Families Without a Country. Nursing science quarterly, 24(3), 273-278. [abstract]

Kim, S. (2016). Comparison of North and South Korea Nursing Workforce Training System and Integration Plan. Advanced Science and Technology Letters. Vol.132 (Healthcare and Nursing 2016), pp.233-236.

Wikipedia (2017). Health in North Korea.

Wikipedia (2017). Pyongyang Maternity Hospital.

World Health Organisation. (2018). Democratic People’s Republic of Korea.

NNEC2018 Notes & Thoughts (Day 2)

Session: Changing World, Change in Clinical Practice

Focus: Overcoming the theory-practice gap

Research translation: slow process of change, translation of evidence

Deimplementation of Practice

The transition from hospital nurse education to Tertiary (university) sector.

Nurse researching and impact by Florence

Difficulty staying up to date through impact of information overload: volume of research, guidelines.

Value of systematic review- to make research manageable. Resources such as:

Resources

Donaldson, M. S., Corrigan, J. M., & Kohn, L. T. (Eds.). (2000). To err is human: building a safer health system (Vol. 6). National Academies Press.

Greenhalgh, T. (2014). How to read a paper: The basics of evidence-based medicine. John Wiley & Sons.

Greenhalgh, T., Howick, J., & Maskrey, N. (2014). Evidence based medicine: a movement in crisis?Bmj348, g3725.

Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients’ careThe lancet362(9391), 1225-1230.

McGlynn, E. A., Asch, S. M., & Kerr, E. A. (2003). Quality of health care delivered to adults in the United States-Reply. New England Journal of Medicine349(19), 1867-1868.

Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015). Towards understanding the de-adoption of low-value clinical practices: a scoping reviewBMC medicine13(1), 255.

 

Session: Educating With The Brain in Mind

Sustainable transformational processes: thinking, practice and culture.

Neuroscience & collaboration (Rock & Cox, 2012): The SCARF® model stands for

  • Status,
  • Certainty,
  • Autonomy,
  • Relatedness and
  • Fairness

Challenge/support framework (Mariani, 1997).

The way the brain forms thoughts by Kahneman: System 1 and 2 (Thinking, fast and slow)

Resources

Kahneman, D. (2011). Thinking, fast and slow. Macmillan.

Mariani, L. (1997). Teacher support and teacher challenge in promoting learner autonomyPerspectives: A Journal of TESOL Italy, XXIII (2). 

Rock, D. (2010). The neuroscience of leadership (Doctoral dissertation, Middlesex University).

Rock, David, and Christine Cox. “SCARF in 2012: Updating the social neuroscience of collaborating with others.” NeuroLeadership Journal 4, no. 4 (2012): 1-16.

Session: Technology and online learning

  • CPD,
  • readiness to learn
  • core competencies
  • alignment between objectives and content (standardisation)

Resources

Blended Learning

Blended Synchronous Learning

Bower, M., Kenney, J., Dalgarno, B., Lee, M. J., Kennedy, G. E., Carter, H., … & Hedberg, J. (2013). Blended synchronous learning: Patterns and principles for simultaneously engaging co-located and distributed learnersElectric Dreams. Proceedings ascilite.

Prensky, M. (2001). Digital natives, digital immigrants part 1On the horizon9(5), 1-6.

Session:  Undergrad Systematic Review on Appraisal 

4 Themes of the review:

Systems Approach

 

Session: Preparing for Practice

  • Self efficacy

Babenko-Mould, Y., Andrusyszyn, M. A., & Goldenberg, D. (2004). Effects of computer-based clinical conferencing on nursing students’ self-efficacy. Journal of Nursing Education43(4), 149-155.

  • Preference for online learning & Task value

Artino Jr, A. R., & Stephens, J. M. (2009). Academic motivation and self-regulation: A comparative analysis of undergraduate and graduate students learning onlineThe Internet and Higher Education12(3-4), 146-151.

Some data analysis statistics: Cronbach’s alpha

Session: The Future of Nursing

Changing world of practice and graduate capabilities.

Missen, K., McKenna, L., & Beauchamp, A. (2014). Graduate nurse program coordinators’ perceptions of role adaptation experienced by new nursing graduates: A descriptive qualitative approachJournal of Nursing Education and Practice4(12), 134.

Missen, K., McKenna, L., & Beauchamp, A. (2016). Graduate nurse program coordinators’ perspectives on graduate nurse programs in Victoria, Australia: A descriptive qualitative approachCollegian23(2), 201-208.

Missen, K., McKenna, L., Beauchamp, A., & Larkins, J. A. (2016). Qualified nurses’ rate new nursing graduates as lacking skills in key clinical areas. Journal of clinical nursing25(15-16), 2134-2143.

End of day thought

Social Media: Low #SoMe engagement use across the conference, organisors and attendees included. Set up Symplur conference hashtag https://www.symplur.com/healthcare-hashtags/nnec2018/

 

 

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.

References

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.

Learning to Unlearn

Learn-Unlearn-Relearn

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.

Resources

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).

Mix It Up Book Club: The Classics

Inspiration and thought can come from an array of sources. I have recently tried to make a focused effort on adjusting the balance of healthcare and normal reading material that I read, incorporating the classics onto my ‘to do’ reading list. This approach is part of that work/life balance ethos that can become skewed when all your focus is on studies or completing a work based project. Avoiding that path to burnout is key.

Book Club:

  • Orwell, G. (1945). Animal Farm. New American Library.
  • Orwell, G. (1950). 1984. New American Library.

 

 

 

 

 

 

 

Avoiding the clear political messages, the importance of finding individuality and choice is very real when one considers the way social media platforms may track and direct our focus. Will future generations have a multitude of choice when engaging in life and work in the online world, or will only a handful of multinational corporations exist?

Keywords: Big Brother; Thought Police; Totalitarian Dystopia; Orwellian.

References

Orwell, G. (1945). Animal Farm. New American Library.

Orwell, G. (1950). 1984. New American Library.

Penguin Books (2018). Your Classic Books Reading Challenge.

Wikipedia (2018) Nineteen Eighty-Four.

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)

 

Resources

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.

References

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

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

Wikipedia. (2018). National Health Service.

 

Want Your Graduates to Succeed? Teach Them to Think!

Journal Club Article: Caputi, L. J., & Kavanagh, J. M. (2018). Want Your Graduates to Succeed? Teach Them to Think!. Nursing education perspectives39(1), 2-3. [abstract]

Thinkers and Knowledge Workers

This guest editorial discusses the importance and need for the preparation of new graduate nurses for the complex demands of professional practice they are about to enter. The challenge of the “explosion of knowledge, intensify the need to produce graduates able to succeed in the demanding world of healthcare as thinkers and knowledge workers.” 

The power to think in an age of information technology that brings information overload, add to this the increase in healthcare knowledge, research publications and curriculum content overload, the world the graduate nurse now enters is very different with each passing year and academia needs to deliver appropriate education.

Critical Thinking & Reasoning

The transition shock into practice from undergraduate to qualified nurse and the subsequent responsibilities are well known , with the subsequent impact on turnover rates for newly qualified nurses (Duchscher, 2009). Marry all this with increased inpatient acuity yet decreased length of hospital stay, and the healthcare system is a stressful and challenging work environment. Linking quality care delivery with the competency of the nurses is key, with critical thinking and reasoning, essential components of the preparation-practice gap.

Tanner’s Clinical Judgement Model

Academia must use a framework to teach clinical reasoning and clinical judgement such as Tanner’s (2006) 4 Step Approach to Clinical Reasoning:

  1. Noticing
  2. Interpreting
  3. Responding
  4. Reflecting

Summary

“The key to new-graduate success and improving patient outcomes might well lie in the way we teach students to think – something to think about.”

KeywordsCritical thinking; Knowledge worker; Reflection; Take the time; Motivation; Think, Think.

 

References

Caputi, L. J., & Kavanagh, J. M. (2018). Want Your Graduates to Succeed? Teach Them to Think!. Nursing education perspectives39(1), 2-3. [abstract]

Duchscher, J. E. B. (2009). Transition shock: the initial stage of role adaptation for newly graduated registered nursesJournal of advanced nursing65(5), 1103-1113.

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursingJournal of nursing education45(6).

Outliers: The Story of Success (Book Club)  

Book Club: Gladwell, M. (2008). Outliers: The Story of Success. Hachette UK. [sample here]

It’s More Than Just Talent

Outliers are “people who are invariably the beneficiaries of hidden advantages and extraordinary opportunities and cultural legacies that allow them to learn and work hard and make sense of the world in ways others cannot” (Gladwell, 2008).

Contributors To Success

    • Practice makes perfect- the 10,000 hours practice rule (Deliberate Practice).
    • The importance of cut off points in the calendar year in sport and schooling, related to age, development and subsequent opportunities.
    • Opportunity: the right time and place, what is happening to the wider world at the time of the person’s key development stages.
    • The impact of legacy.
    • Examples provided of the success stories of Bill Joy, Bill Gates & The Beatles.
    • IQ is not enough. The Terman IQ study of the gifted demonstrates that intelligence does not equal success (Terman, 1959).

Malcolm Gladwell Explains

 

References

Gladwell, M. (2008). Outliers: The story of success. Hachette UK. [sample here]

Kaufman, S. (2009). The Truth about the Termites. Psychology Today.

Nursing Education Network. (2017). Deliberate Practice: Practice like you play.

Terman, L. (1959). The Gifted Group at Mid-Life: Thirty-five Years Follow-up of the Superior ChildStanford University Press.

Wikipedia (2017) Outliers.

Gardner’s Multiple Intelligence Theory

Book Club: Gardner, H. (2011). Frames of mind: The theory of multiple intelligences. Basic books. (review)

Domains of Intelligence

Multiple-intelligence

“The theory of multiple intelligences differentiates intelligence into specific ‘modalities’, rather than seeing intelligence as dominated by a single general ability. Gardner opposes the idea of labeling learners to a specific intelligence. Gardner maintains that his theory should “empower learners”, not restrict them to one modality of learning” (Wikipedia, 2017).

Learning Modalities

  • Active learning
  • Hands on
  • Exploration
  • Questionning
  • Transform understanding
  • Individuality in learning
  • Active assessments

Looks Like Learning Styles

A major criticism of the the theory, is that it is very similar to learning styles theory, and both are missing supporting evidence to support such an educational approach. This lack of empirical evidence is summarised by Waterhouse (2006).

The Educator Role

The end point is to empower the learner, and for the teacher to improve learning situations. Different learning intelligence’s may be considered more relevant in the diverse world of real work-life situations, especially when compared to standardised intelligence and validity of IT tests which can be classified as “mainstream” assessments. Is this a theory which is too hard to measure due to the individualistic and non-tangible aspects or simply lacking in hard evidence?

Supporting Resources

Gardner, H. (2011). Frames of mind: The theory of multiple intelligences. Basic books (review).

Harvard Graduate Scool of Education (2017) Project Zero.

Hattie, J. (2011). Visible Learning for Teachers: Maximizing Impact on Learning. New York, NY: Routledge. (summary).

Northern Illinois University (2017). Howard Gardner’s Theory of Multiple Intelligences. Faculty Development and Instructional Design Center.

Nursing Education Network. (2016) Learning Styles.

Waterhouse, L. (2006). Multiple intelligences, the Mozart effect, and emotional intelligence: A critical reviewEducational Psychologist41(4), 207-225.

Wikipedia. (2017). Theory of Multiple Intelligences.