When your planned curriculum doesn't match lived curriculum

I had just finished teaching a long class on complex wound care yesterday and as I reflect back I felt a slight disconnect between the prescribed lesson plan and what actually occurred during class.  The planned curriculum was not flexible and did not allow for the rich discussions and multitude of questions that I encountered.  The lesson plan that I had to follow was laid out in a very structured manner.  Although relatively simple, it did not take into account my student’s previous experiences and what questions came out from our lecture. 

I felt the eyes and faces of the students before me- thinking, rationalizing, and trying to understand how this new content fits into “their” world.  I remember when I first learned this concept in nursing school. It seemed so overwhelming.  I tried to incorporate stories from my own practice.  Then I remembered what an old instructor told me when I had difficulty with hearing lung sounds.  "Stop and listen".   This seemed to calm me and lift some of the tension I sensed. 

http://www.thecollegiateblog.org/wp-content/uploads/2012/09/medical-school.jpg

As I reflected on this one particular class, I could not help but wonder how I could have approached the class differently.  Did I stop enough to listen to the questions and concerns? How could I integrate the planned lesson plan with the lived curriculum before me? How do I continue to follow the planned curriculum while still respecting all of the stories and diverse backgrounds that my students came with? How do I create a unique backdrop in which the students felt like they belonged and were heard?

Through some research, I discovered Ted Aoki, “the most prominent curriculum scholar of his generation in Canada” and who left a legacy that many curriculum theorists revere.  In his article “Legitimatinglived curriculum: Towards a curricular landscape of multiplicity”, he summarizes a few important areas.   Educators ought to be aware of the differences between lived and planned curriculum. 

• Experiencing differences in kind in the tension between the master story and the daily stories

• Experiencing pedagogic reaching as a mode of becoming 

•  Pedagogic reaching as a letting go and a letting be 

• Pedagogic listening as a responding to other 

• Hearkening to the call of the calling

(Aoki,Ted T. 1993, p. 264).

Throughout this course I intend to read more from the works of Ted Aoki, and other experts that offer more explanation, research, and enlightenment.  In the meantime, I will continue to reflect on my own role and the identity that I am creating as an educator. 

Has this type of situation happened with you? What have you done after that class?

Reference:

Aoki, T. T. (1993). Legitimating lived curriculum: Towards a curricular landscape of multiplicity. Journal of Curriculum & Supervision, 8(3), 255-268. Retrieved from http://search.ebscohost.com.proxy.lib.sfu.ca/login.aspx?direct=true&db=ehh&AN=9511050991&site=ehost-live

Design Thinking Paradigm on Patient Teaching

Patient teaching is a vital part of our nursing duties: to educate patients about medications, diet, exercise, complications, and recovery.  There are many areas around patient teaching that need improvement.  This article Educating Patients: Understanding Barriers, Learning Styles, and Teaching Techniques has helped identify a few of the common issues that arise during patient teaching.  I analyzed this article using the Design Thinking Paradigm

(Empathize- Define- Ideate- Prototype- Test) 

1. Empathize: Does the article reflect needs?

            The article begins by describing why educating patients has become such a challenge in hospital practice.  The article helps identify the growing concern amongst many health care providers: too much information, not enough time.   Patients are being discharged from the hospital sooner and less prepared to deal with the changes to their health.  The article also identifies the multitude of barriers that exist within patient teaching.  There is a sincere understanding of the issues that exist in our health care system. 

2. Define: Does author define problem clearly?

         The author L. Beagley describes the problem clearly: In order to effectively educate clients, health care providers must have an understanding of the principles of (adult) learning.  (Beagley, 2011).  The author proceeds to list and describe the various barriers to learning such as literacy, culture, language, and environmental barriers.  For example: low literacy could mean a client could read and write in certain contexts, but low health literacy means a client cannot understand specific terminology specific to health related topics.  

3.      Ideate- what is author’s recommendations to the problem?

         The author concludes that nurses learn about the different learning styles (visual, auditory and kinesthetic) before starting their teaching.  She also advises nurses to be aware of all barriers that can affect patient’s ability to learn.  She suggests being more aware of personal biases and prejudices that affect nurses’ attitudes and judgements.   However, she introduces the ideas but does not provide sufficient evidence to help support her conclusions or recommendations. 

Some of the recommendations/suggestions I have from reading this article

• Create/ perform Learning style checklist prior to teaching
•  Nurses are educated on various learning styles (visual/auditory/kinesthetic)
• Give examples of personal biases and prejudices and how to manage them
• Give examples of various questions (questionnaire or form) to help patients identify their motivation for rehabilitation
• Can there be a nurse that follows up after the teaching to follow up?
• Patient participation to help create their own learning goals
•  Examples of low health literacy and proper levels of written materials should be given

4.        Prototype: new program, protocol, procedure or policy

            One of the ideas that I have regarding this is to create a form or tool to help assess learning styles and what teaching strategies would best match that style.  For example if someone has difficulty hearing- a form would be given with simple pictures.  I believe that nurses are already doing this in some form or another but to put an actual step (procedure) to follow will help ensure consistency amongst all health care providers.

What are your thoughts? 

Building trust ...

This weekend we attended "The Mane Event" where we were able to observe the art of horse training.  I felt like I was in a whole new world: a very unique culture in which I could not understand the language.  A brief description of the event from the website states: 

" The Trainers Challenge is an unique opportunity to see 3 trainers put their skills to work to show the public their abilities and methods of training an unbroke horse. This is NOT the way these trainers would normally start a colt, what they do in the 3 days of the Challenge they might take 30 – 60 days or more to get the horse really working well at all of the different skills they are training into the colts. This Challenge is meant to be a venue to educate the public that there are more than one or two ways that you can start a colt and succeed at getting a quiet broke horse. " 

In one particular challenge, I witnessed the bond that the trainer created with the horse.  The colt was following the trainer around with respect and ease.  There was no tension or fear.  Once that trust was built, it was quite easy for him to ask the colt to perform a new skill.  I was impressed!  During the trainer's challenge, I immediately could relate to my own job as a nurse.  I would have to build trust within minutes of meeting a patient and inquire and probe deeply into their medical and personal history.  I would have to ask these clients to disclose information that they may not be comfortable to share with anyone else. What did this trainer do that gained the horse's trust so quickly? What do I do in my own practice that is effective? 

I make eye contact, I listen, I validate, and give time for the patient to respond.  I think that the horse trainer was able to do this as well.   Now it may not happen each and every time, but I do believe once trust is achieved, is is easier to navigate the difficult questions.  

One thing I learned from the trainer's challenge was not to push too fast or too soon.  Many times in nursing we have a small window of time to accomplish a lot of things, and rushing around is part of our job.  I would like to slow down more and not push my agenda on the patients.  

So here is my question to you:  what do you do to build trust in your workplace or personal life?? 

Go with the flow...

image from: http://www.lifedreaming.me/wp-content/flow1.gif

This weekend's rich discussion around vitality and flow has really got me thinking.  Mihaly Csikszentmihalyi's theory of flow was new to me.  Although after describing, analyzing and reflecting over the concepts in our group discussion, I felt like it was obvious: People are happiest when they have achieved a state of flow- or an intense mastery, joy and satisfaction with the tasks at hand.  

It was easy to see how athletes and artists could achieve that optimal level.  However, in nursing it looks and sounds a bit different.  I tried to visualize how flow could look like in a hospital or classroom setting.  Does "flow" occur when all of my various nursing interventions (e.g. giving medications, mobilizing a weak client, listening to concerns, teaching a patient)  align with the client's exact needs?  Or if there is a reciprocal exchange of gratitude between myself and the patient?  Or is "flow" in a classroom full of nursing students when one student is able to comfortably demonstrate learned skills with ease and confidence? 

I wonder- how does flow "look" or "feel" in our own small activities of daily living?   I am curious about what I can do consistently to help create or enhance this optimal level. 

Lots to think about! What do you think? 

Am I fully present?

My 2 year old son called "Mommy" about six times before I finally looked up from my phone. I was updating my to-do list.  Groceries, cooking dinner, laundry, answer work emails, readings for school, bath time... Some days it seems like that list goes on forever.  I felt bad as I realized my toddler was trying to show me his art work.  Immediately I felt a pang of guilt. I had a very busy week and my quality time with my son was limited.  My mind was distracted as I try to watch him draw his impressive scribbles.  

Presence.  I used to think I understood what that meant.  "Of course I am present, I'm here aren't I?".  I find my mind is often filled with tasks, lists, and upcoming projects.   I recall what Jacqueline, our site supervisor told us on our first week of school.  Set realistic expectations and call in for reinforcements.   I realized I must ask my husband for help.  Delegation is not my strong suit. I like crossing off things on my to-do list. I can't decide if it is because I like doing the work itself or ensuring it is completed to my liking.  It probably is a bit of both.  

I asked myself, "Am I fully present?" How often are we distracted? How many times do we try to multitask and end up with a mediocre product.  This article was meaningful to remind me that life is about enjoying the process as well as the finished product.  I also remember that a focused mind is a more productive mind.  

image from peope-equation.com

And now my son is calling yet again. "Momma, more playtime!!!" 

Week 2: Is Blogging is good for your health?

Hey Jitterbug! 

Here they are: those first day back to school jitters.  I hope I am not the only one that feels like this. Despite all my worry and apprehension, the first week of classes went by without a hitch.  
I was able to meet my fellow classmates and instructors, and immediately I felt like I was in the right place.  The room was full of like-minded individuals with similar goals and passions- and yet from surprisingly different fields of interest. My nerves have subsided and the excitement has kicked in. 

When we were told our first assignment was to create a blog, my first thought was what if I have nothing worth "blogging" about. Honestly, my biggest fear is who will want to read it? 

(small note to self, do not google "reasons not to go to graduate school" after you have already registered for the course) 

http://commons.wikimedia.org/wiki/File%3ABlog_(1).jpg

To blog or not to blog? 

I begin with listing all the reasons blogging is good for my health.  I figure that validating the benefits will provide me some encouragement and motivation.   This always works for me when I am trying to convince myself to hit the gym or wake up early to get some work in.  The pros always outweigh the cons. The article The Social Dimension of Blogging about Health: Health Blogging, Social Support, and Well-being states the following: 

"The public record of one’s experiences created through blogging may serve as a beacon to weak ties with similar histories who are motivated to provide information and emotional support....reasons that blogging might serve as a mechanism to marshal social support from both strong and weak ties and, as a result, foster positive outcomes for bloggers’well-being...."

" Stephen A. Rains & David M. Keating 2011.

I believe that if the target audience is receptive to your blog, the benefits of blogging will be achieved.  It will be a way to journal and reflect on your thoughts,  bolster self-esteem, and find others who may relate to your story or provide another point of view.   

And so it begins....

What? 

This blog was created with the purpose of documenting my personal exploration and journey through the HEAL program.  

Who? 

Hi! I'm Rose. I have been a registered nurse for 9 years.  I work in the PACU (post anesthetic care unit). It's the room where patients wake up after their surgery.  In the past 4 years I have also been teaching nursing students part time.  This is where I discovered my love for teaching and learning.  

In my personal life I wear many hats: a wife, mother of a toddler, sister, daughter, and a friend. I moonlight as an amateur foodie, love to travel, and can read a book in one sitting (time permitting).  I love to try new foods, try new things, and yet my daily activities say that I am a creature of habit.  I am a morning person.  I enjoy pilates,  yoga,  and snowboarding.  Although I have yet to fully embrace my gym membership for all of its benefits.  I will always choose a walk with my dog before a session in the gym.  

When? 

There is no better time than the present.  I am a true believer in the law of attraction. Some call it "the secret".  I believe that fate/luck/chance are just small contributors to one's success.  I try to create my future purposefully and with good intentions. 

Why HEAL? 

I love to learn, and am fascinated by people. I have always toyed around with the idea of doing my masters degree one day. However, I was never truly inspired or motivated until a family crisis shook my values and reminded me about the fragile gift of time. So I went looking for a program that combined my love for education and interest in health promotion.  And here we are today...

What can I contribute? 

I believe that my professional and personal experiences dealing with illness, trauma, pain, joy, recovery, and rehabilitation will be valuable.  With our cohort I would like to share my enthusiasm, a love for learning,  my leadership skills and positive energy.  

What do I want from HEAL? 

Although I teach others about health promotion and about living a healthy life, internally I sometimes feel out of balance.  I understand the basic theory of physical wellness, and illness prevention, and treatment of disease. However in this program, I would like to focus more on my own health promotion journey; to become more attuned to my spiritual, emotional, mental, and physical self.  I hope to learn how to better educate my patients, my students, my family, and most of all, myself.  

I am excited.  I am nervous.  I am humbled.  I am open.