Dementia and life long learning… another reason to head back to school.

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Being a nurse in Gerontology, and a child of parents with dementia, memory and learning has a different meaning to me. Everyday I teach nurses about the normal aging process and specifically how dementia, the loss of memory and learning is demonstrated in those around us.

I am heartened to learn that participating in life long learning has been shown to help older adult increase their overall level of activity and actually improve memory functioning. This is another reason to encourage our students to continue along a path of life long learning.

“The researchers also suggest that reduced mental stimulation may lead to a decrease in cognitive functioning as people grow older.   An enriched environment, whether through a formal university program or self-directed learning, has an important role in active aging and helping older adults compensate for cognitive and emotional decline. “

 

…..as for forgetting the kettle? I am not going to tell you the number of times that I come into my kitchen and find my cup with a dry tea bag in it! A good “work around” that I have developed that prevents me from forgetting about the kettle is to stand and make a pot of tea… then head off on whatever I thought I was going to do… if I remember…

 

The age old art of telling stories for a new generation

Digital storeytelling is a return to the age old learning strategy of storey telling with a generational multimedia application. I have used storey telling as a educational medium for years. Sharing experiences and case studies as a storey engages students. Digital storeytelling crosses generations and encourages those of us not in computer sciences or other technical fields to explore the world of digital media as a platform for our learning community.

 

What is the definition of a nurse?

 

It was my 35th nursing reunion this last weekend. Okay, you can do the math. Not one of us is as young as we used to be. As I observed my classmates I began to wonder. What is it that makes a nurse stay in nursing for 35 years despite public outcries of short staffing, poor wages or long hours. It is definitely not the cap, now yellowed and dusty. Nor is it the gold pin that lies locked in the safety deposit box.

The new generation of nurses don’t want to work full time (something about quality of life), our pension sucks, the public has higher expectations for care and weekend nightshifts are always short due to sick calls.

We had the largest turnout yet, 30/50 graduates attended and of those many of us are still working full time in nursing. Is it because we are just poor accountants and unable to balance our budgets? No, it is because nursing defines us.

So, what is a nurse? Regardless of wither we have gained or lost weight, husbands, or children. Regardless of what life has thrown at us and this time, more than a few have experienced the battle against Cancer to emerge victorious, even if only temporarily.

It is our passion for life that defines us as a nurse.

Ever worked a nightshift on a full moon?Are you a victim of Confirmation Bias?

18azlo1delz86jpg-1Many people believe in the lunar theory. This is a solid belief that the phases of the moon influences the behaviour of human beings. Some state that the as humans are comprised of water it is the pull of the moon on large bodies of water. Some state it is a result of the increase in positive ions as a result of the full moon.

Talk to any nurse, police officer, or teacher and they will have multiple stories of horrendous shifts experienced during a full moon. Of note, there is no data to support this concept but I know many rational/critical thinking nurses who adhere to this belief with almost religious fanaticism. So what makes them think this way?

Confirmation bias.

What is a confirmation bias? The description that resonates with me the most is “it is a glitch in our thinking that causes to us to make questionable decision and reach erroneous conclusions”. A confirmation bias is a “limitation in our thinking — a flaw in judgment that arises from errors of memory, social attribution, and miscalculations”. Remember PIDP 3100? Merriam and Bierema on page 223, discuss assumptions and preconceptions? As humans we all come with many assumptions and preconceptions. These assumptions and preconceptions form the basis of our thought processes. Confirmation bias occurs when the decision we make is based on our assumptions and preconceptions and not necessarily on logical information.

 

Humans love to hang around like-minded humans. We prefer to be with people who agree with us, who hold the same thoughts as us. By surrounding ourselves with people who agree with us, who hold the same thoughts as us it re-enforces our belief that we are right and enables us to dismiss valid, logical views. Gang mentality comes to mind when I think of this. One of the most extreme examples I can come up with is ISIL. How else can we justify the thoughts patterns that lead rational humans to perform such horrendous acts against humanity?

A confirmation bias that occurs daily in nursing is: The new generation of nurses don’t want to be nurses. All they want are the management, leadership or informatics roles. They don’t place the same value on bedside nursing. They don’t see the value in holding a patient’s hand.

I recently interviewed a brand new nurse for a frontline position. During the interview I asked the following question, “where do you see yourself in 5 years?” this gives me an idea as to the nurse’s plan for learning and development as well as an idea of where they ultimately want to work, i.e. critical care, emergency etc. On this occasion the nurse replied very quickly that she plans to be a nurse manager (my job). It was really hard not to leap to all sorts of conclusions about the younger generation not be willing to “do time in the trenches” etc. I put my assumptions aside and asked her why? She replied calmly that she is very aware that she does not have the desire to do frontline nursing but has found that she has skills in business and management. Did I give her the job? I will admit that I didn’t. She did not meet my unit’s need for a clinical nurse. Did I fall victim to confirmation bias? Perhaps.

For the purpose of the discussion I would like to have you share some of the confirmation bias that occur in your profession or classroom. How as an educator can you avoid falling into the trap of these biases?

https://en.wikipedia.org/wiki/Lunar_effect

http://io9.gizmodo.com/5974468/the-most-common-cognitive-biases-that-prevent-you-from-being-rational

Merriam, S., & Bierema, L., (2014), Adult Learning; Linking Theory and Practice,

           San Francisco, Jossey-Bass

 

What is the intellectual standard in nursing?… and why have them.

 

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Intellectual standards are a guideline or principle for rational thought. In nursing we use what we call the “nursing process”. The nursing process is our thought guideline, intellectual standard. It provides nurses with a consistent, accurate process to ensure that all clinical decisions are sound.

We are taught the nursing process early on and it is embedded into every clinical nursing decision. In one article it is referred to as the language of nursing. It is how we communicate in depth information that is significant to nursing care. The nursing process is put into a care plan that is individualized for that specific person. It promotes critical thinking.

 

  • Assessment – what are the facts, findings about the patient’s problem.
    • Patient is tired and grumpy, having difficulty with thought organization.

 

  • Diagnosis,- in nursing it is a clinical judgment about health conditions.
    • This is different from a medical diagnosis, which is a list of diseases based on clinical diagnostic procedures. For examples a nursing diagnosis is: sleep deprivation.

 

  • Plan, – what do you plan to do, for years we call them nursing interventions.
    • For example; Encourage patient to practice sleep hygiene techniques such as adhere to a regular bedtime routine, no watching television in bed, no late night eating, minimal alcohol intake. Discourage early morning get ups for schoolwork. A key must for the plan is that the nurse and the patient must agree and collaborate with the plan.

 

  • Implementation, – How is this plan going to be implemented. This is the action part of the plan.
    • For example; patient will no longer get up every morning at 0600 to do 2 hours of schoolwork, daily prior to going to work or do schoolwork late at night . Patient will adhere to a regular bedtime routine and quit watching television in bed. Patient will be in bed with lights out by 10 pm daily.

 

  • Evaluation, – The nurse does an evaluation based on conversation with the patient as well as nursing observations. A date must be stated for day of evaluation. Usually positive as we like to avoid the negative.
    • For example; Within one week the patient will voice feelings of energy, of being rested. Patient will no long voice feelings of fatique.

So why have an intellectual standard? Imagine if nurses did not have a concise pattern of  communication to communicate the plan of care to each other. Use of a consistent pattern prevents illogical and haphazard care planning.

http://www.nursingprocess.org/Nursing-Process-Steps.html

http://www.criticalthinking.org/pages/critical-thinking-and-nursing/834

 

 

 

 

Sunshine and Unicorns?

Appreciative Inquiry:

Appreciative inquiry attempts to use ways of asking questions and envisioning the future in order to foster positive relationships and build on the present potential of a given person, organization or situation. The most common model utilizes a cycle of four processes, which focus on what it calls:

  1. DISCOVER:The identification of organizational processes that work well.
  2. DREAM:The envisioning of processes that would work well in the future.
  3. DESIGN:Planning and prioritizing processes that would work well.
  4. DESTINY(or DEPLOY): The implementation (execution) of the proposed design.[15]

I use appreciative inquiry during

  • Performance reviews, focus on the positive, focus on what that individual does everyday to make a difference.
  • Job interviews, I ask how I would know that I am doing a great job. What does a great job look like? Ask a prospective employee what does the applicant see as a great performance?
  • At work, I ask daily of my co-workers,- what is the best thing that happened to them last week, today.. etc.
  • At school, read the rubric, connect with the instructor, seek feedback, find out what a 5/5 looks like.
  • At home, ask your spouse, what was the best thing that happened to them today.
  • Bring the concept of positivity back into your life… it works!

http://www.gervasebushe.ca/the_AI_model.pdf

http://www.centerforappreciativeinquiry.net/more-on-ai/the-generic-processes-of-appreciative-inquiry/

Learning how to learn

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By now, we can all recite Malcolm Knowles’ Androgogical principles for Adult learning by heart.

We have had challenging conversations about learning styles, learning preferences, what kind of environment to create that best promotes learning.

But what if you weren’t taught to learn but instead were taught the subject. Make sense? I truly believe that the ability to learn to learn comes from within each of us.

To learn we need:

 Aspiration

Each of us needs to see the benefit of learning. We need to aspire to be a learner. Being a learner is a humbling role, fraught with challenge, angst, time juggling (it used to be known as time management but truly? All we do is juggle and bargain with ourselves for those precious moments earmarked as learning or school). Those of us who will excel, have aspiration for greater opportunities. (thinking with my appreciative inquiry hat on J)

Researchers have found that shifting your focus from challenges to benefits is a good way to increase your aspiration to do initially unappealing things.

Self-Awareness

As a learner, we need to be self-aware; of our learning preferences, our personality type and especially our self-assessment of our skills. I would love to say that I perform phenomenally everyday. Realistically I have moments of brilliance altered with “over average performance”. By focusing on my benefits and opportunities I am able to realistically aspire toward greatness. I am aware that it won’t happen everyday, but a few more days a week would be awesome.

Curiosity

Be curious. Be curious to your potential. If you are curious as a learner your world will naturally expand. You will be the self-determined learner who seeks knowledge in everything you do.

Changing Your Inner Narrative

UNSUPPORTIVE
SELF-TALK
  SUPPORTIVE
SELF-TALK
I don’t need to
learn this.
  What would my future look like if I did?
I’m already fine at this.   Am I really? How do I compare with my peers?
This is boring.   I wonder why others find it interesting.
I’m terrible at this.   I’m making beginner mistakes but I’ll get better.
FROM “LEARNING TO LEARN,” MARCH 2016 © HBR.ORG
 

Erika Andersen is the founding partner of Proteus International and the author ofGrowing Great EmployeesBeing StrategicLeading So People Will Follow, and the forthcomingBe Bad First.

A version of this article appeared in the March 2016 issue (pp.98–101) of Harvard Business Review.