It’s said that every great teacher should periodically take an opportunity to reflect on their inspiration for the teaching and learning process. I am so excited to share my updated philosophy with you!
Author Archives: kitwbdr
Remembering 9/11: The “Second” Responders
9/11. 12 years later, the tragic terror on American soil needs few words to describe the horror, heartbreak, and tenacity of our people.
On today, while many of us remember exactly where we were and what we were doing, let us not forget the numerous untold stories.
These aren’t the usual stories that may come to your mind.
These aren’t the stories of the multiple families seeking loved ones.
These aren’t the stories of the individuals racing down the streets of NY crouching in allies head to knees praying for an escape.
These aren’t the stories of multiple firefighters, many of whom lost their lives in an American Horror Story come alive.
By no means, do I negate the level of importance of these stories, but today, relevant to what I prepare to do everyday, the stories I pose you to reflect on are those of the “second” responders.
Not those who were able to flee to the scene to battle a treacherous feat (though able and willing), but those who were frantically preparing for the most unexpected “CODE ORANGE” and “Mass Casualty Drill” they’d only rehearsed in mock drills. EU’s clearing patients and redistributing triage to assess an insurmountable number of casualties. Staff nurses preparing and reprioritizing levels of anticipated care. Charge nurses motivating and leading staff while coordinating care and services. Senior nursing management activating system level alerts and distributing emergency staff and supplies. Nurses stepping up, taking charge, and sharing their strength. The “Second” responders who made condolence calls to family across the states and international seas. Those who not only raced to care for a wound or fracture, but who lived the experience aside from the dust and fog in a stalk yet frantic and noisy yet eerily silent environment.
On September 11, 2001, I was working as a nurse at New York Downtown Hospital in the Labor and Delivery Unit. The hospital is four blocks away from the WTC. I was in the operating room preparing for a C-section when I heard a loud boom. A few minutes later, the charge nurse ran in and told us that the WTC was on fire. A code yellow (disaster code) was announced and all of the staff prepared for the traumas. I called home and told my family that I would not be coming home that night. When the second plane hit, we again heard another big boom. We watched everything from the window. We saw the WTC in flames and debris falling from the building. When the first building collapsed, the whole hospital shook and was surrounded by a black cloud. It was very scary. The patients were crying and I thought it was the end.
There was a horrid toxic smell penetrating the hospital.
I had a pounding headache and felt nauseous…Everyone was stressed. We had a tremendous influx of patients in the ER. Many people sought refuge in the hospital, trying to escape the falling debris and choking dust. We triaged many pregnant women who were outside during the attack. They had minor injuries but all were emotionally traumatized. Thankfully, all the babies were unharmed.
All of us stayed the night in the hospital, taking turns sleeping and working…Excerpt from original article: 9/11 reflections: Jeanne Giorlando-nurse works through the night. (2011, September 01). Staten Island Advance. Retrieved from http://www.silive.com/september-11/index.ssf/2011/09/911_reflections_jeanne_giorlan.html
While I remember exactly what high school class I was in and what it felt like when I witnessed the second tower hit and collapse on television, it is now with much maturity and lived experience as a Pediatric Intensive Care Nurse how 9/11 resonates with me.
Today, while I remember the tragedy of 9/11, I salute our frontline nurses–life’s “Second Responders”
Nurses Killed on September 11
Touri Bolourchi, 69, retired nurse, passenger aboard United Airlines Flight 175
Lydia Bravo, 50, occupational health nurse at Marsh & McLennan Companies, Inc.
Ronald Bucca, 47, fire marshal, New York City Fire Department
Greg Buck, 37, firefighter, New York City Fire Department, Engine Company 201
Christine Egan, 55, community health nurse visiting from Winnipeg, Manitoba, Canada
Carol Flyzik, 40, medical software marketing manager, passenger aboard American Airlines Flight 11
Debra Lynn Fischer Gibbon, 43, senior vice president at Aon Corporation
Geoffrey Guja, 47, lieutenant, New York City Fire Department, Battalion 43
Stephen Huczko, 44, police officer, Port Authority of New York and New Jersey Police Department
Kathy Mazza, 46, captain, Port Authority of New York and New Jersey Police Department, and commanding officer, Port Authority Police Training Academy
Michael Mullan, 34, firefighter, New York City Fire Department, Ladder Company 12
Creating An “Easy” Care Map
…as if there is such a thing?!
That’s what she said.
Care maps can be very confusing for the new nursing professional. While some background in nursing diagnoses, care management and planning, nursing interventions, and rationales is needed prior to “mapping”, this tutorial presents an easy “how-to” format when putting together all the student’s abstract ideas onto paper.
Tools Updated!
Check out the “Best Works“ page to find links to documents including sample syllabi, grading rubrics, assessment and evaluation tools, outcomes and objectives, previous Power Point presentations, and much more.
“Love what you do, or leave what you do!”
The Human Connection
So I know Nurses Week is over and today is Mother’s Day, but one of my colleagues suggested this video during a discussion thread on building moral imagination in nursing students.
When someone looks at you and says, “Hey, I could give that shot, I can so be a nurse.” They have no idea, we don’t just perform tasks, we treat the people behind the illness.
AACN “A Slice of NTI”–Las Vegas
Continuing Education is a HUGE deal to me. I can’t fathom doing what I do everyday as an ICU nurse and not having an abundance of knowledge in my “bank” to pull from when I face the weird, wacky, and unexpected. Some would say this essentially the role of the hospital to keep employees up to date. Adult Learner advocates would say it is absolutely the role of the nurse to take ownership of continued learning opportunities. Sounds a lot like the classroom v. clinical integration responsiblity debate doesn’t it?
Anywho, SLCH takes pride in their nurses and has a conference fund available to all their nurses for continuing education. Last year I joined the American Association of Critical Care Nurses (AACN) and went to the National Teaching Institute in Orlando, FL. I was hooked. 10,000 other nurses who do the same things you do all in one place is empowering! So where did NTI lead me this year? Well, the grand-mama conference is in Boston, MA and just a little bit out of my budget for this year, so, “Slice” it was!
MGM in Vegas! What a “GRAND” opportunity?! Let’s just say I don’t take these traveling and learning opportunities lightly. I’m always privileged with someone thinks enough of me to invest their time and money in this case in my education. “Slice” was a bit different from the “Big Momma” in that it’s just 3 days, about 3-400 people and jam-packed with expert knowledge.
I got to attend lectures from experts on Sepsis, Alarm Fatigue, Compassion Fatigue (my passion), and the list goes on and on.
Each session concluded with an expert panel Q&A which was extremely valuable. Next year the “Big Momma” is in Denver, CO. I’m already planning and crossing my fingers as I submit an Abstract to present on Pediatric Respiratory Distress. Wish me luck!
And lastly, it is Vegas!
Nurses Week – BJC Today
So it’s a small accomplishment, but I was asked to do a web interview for the BJC Today newspaper. Of all the things I talked about regarding how I value nursing, I’m really proud of the one quote they decided to feature:
Building Moral Imagination
Moral imagination is a complex issue to face for a “new” nursing student. It’s something many nursing students don’t consider when they want to “do” nursing, yet more often it is why society values the nursing profession for its caring and compassionate attributes. I can remember in my Adult I clinical, my instructor would often state, “Imagine if this patient was your Mom, or your sister, or the person you cared for most in the world. How would you hold their hand for the IV? How would you approach them with a foley catheter?”
THAT STUCK
What she was alluding to in an indirect way was what Benner, et al. (2010) in Educating Nurses: A Call for Radical Transformation, describes as “moral formation.” Furthermore, I can remember from my nursing ethics course the inner discord I felt amongst myself, my peers, and my close family with difficult ambiguous ethical cases we would discuss. In reality, I’m sure most educators and nurses would agree teaching the skill of moral imagination is very difficult to relate to students. Benner, et al (2010) describes an approach when teaching moral imagination: She, “Keeps her views on the case in the background; instead, she draws out students’ hidden biases as she helps them articulate their own views, their understanding of their role as professionals, and their responsibility to the patient and the family” (p. 172). I think this is essential not only for educators facilitating an ethics course, but throughout nursing content as we integrate both hard science with the disciplines of humanities and social sciences to build a profession that is based on the Nightingale principle of caring. Discussed are three strategies for helping students develop moral imagination in the classroom, online, and clinical settings.
Classroom
Benner, et al. (2010) refer to learning how to dance as analogous with moral “formation”—they both are relational to the skill, the setting, and the partner or “patient and family” that you interact with. “Students are formed by all they do, all they read, all they perceive and interpret, and in all models of practice—not only in the context of what they think or know intellectually, but also in terms of their taken-for-granted assumptions and expectations” (Benner, et al., p. 166). Taking this principle to the classroom, I envision a room divided where all students can see each other and there is open dialogue in a risk-free environment. Presenting the students with a recent case that has been publicized in the media is often a preference of mine because there are often already biases set by students based on their morals, values, and the way information is presented to lay people. I think these multiple perspectives help round out the students social knowledge base as they come back to what Benner calls their, “professional value”, or “social contract”. Instructors who embrace this method of facilitating ethical discussions face the challenge of “stumbling” through mistakes and the risks that come with teaching “on the fly”—without lecture slides or a complete layout for the day’s content. Educators and nurses are often viewed as experts by studetns, and should be prepared to come to the table with resources and personal stories of conflict to share with students.
Aside from this method, at a conference I recently went to, there was a presentation on a neurologic traumatic brain injury patient and they family’s experience for 365 days. The book, “Adam’s Fall, Traumatic Brain Injury, The First 365 Days”, was written by a patient’s father in his own words and his perspective. It was outstanding. The presenter had been in contact with the family and had the father record audible excerpts from the book to be played during the presentation. It was visceral. Almost like family deposition in court. Although this isn’t a viable method for all instructors, this was a highly effective method for providing a “realistic” experience to build discussion from in the classroom setting.
Online
In the online setting, faculty can use group discussion boards to build great conversation around difficult conversations. One strategy could be to have the students pick a case from a list that was important to them, and present the case following an ethical framework to the online group who would act as an “ethical committee”. Students could be provided with both structured questions to respond to as well as have the freedom to explore other feelings and emotions. I think for this assignment in particular having students post web videos of responses could help to capture and relay to others the strong emotional cues, behaviors, and feelings we portray as we discuss difficult decisions.
Clinical
In the clinical environment, an moral imagination activity could be great for the post conference discussion. There’s not often that there isn’t a “hot” case or “interesting” case that most staff have a strong opinion on. A great activity could be observation and discussion with the students. They could have the clinical assignment during the day to observe how nurses interact and discuss the particular case amongst each other. Structured questions to get students thinking could be, How did a nurse’s opinion influence others? Was this good or bad? What do you think formed this nurse’s decision? What possible social situations may the family be facing? The conversation could be limitless with the an outcome for students to build a moral imagination and gain knowledge of the variables and their influences of patient care on a nurse’s professional values and a social contract. “Through engagement with clinical problems and particular patients and patient populations, students broaden their moral imagination, just as they broaden it by literature, nursing knowledge, bioethics, and the ethics of care and responsibility” (Benner, et al., p 167).
Benner, P., Sutphe, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Josey-Bass.
Integrating Classroom & Clinical Learning
Benner, et al. (2010) present several strategies throughout the text, “Educating Nurses: A Call for Radical Transformation”, for integrating classroom and clinical learning. It is interesting that the subject of unfolding case studies emerges here, as I have brought this up previously during a discussion with my collagues on teaching for a “sense of salience”. I will attempt to expound on the unfolding case study along with the addtional strategies of case presentations and imagination.
Strategy 1: Unfolding Case Studies
In reference to integrating classroom and clinical learning, case studies and simulation are great tools and environments for facilitation. Unfolding cases, as Benner, et al. (2010) states, derive from problem based learning (PBL). PBL has been used in the discipline of medicine for several years as a strategy to help students work through the trajectory of a patient’s illness rather than a primary problem diagnosis (Tomey, 2003). In the paradigm case, Benner, et al. describe how Day brings in student’s clinical experiences into the classroom when using unfolding cases. I think an excellent illustration that is made that actually refers back to “who” is responsible and the concept of Adult Learning is when Day describes how she “knows” her students. She identifies during preparation that some students will have prior experiences that help certain topics to hit home and take ownership of learning more, whereas some students may not, and it is her role to integrate clinical learning experiences of the students and their colleagues when utilizing case studies.
Strategy 2: Case Presentations
Another strategy I feel brings together classroom and clinical learning is using a structured case presentation. I can remember in Adult Health I we had an extensive case presentation on the patient of our choice, but then in Peds, we had to do a very structured short 3-5 page case study. This got us prioritizing. This was a clinical assignment and forced us to take our patient’s clinical presentation and go backwards and integrate the disciplines of social sciences, pathophysiology, psychology, growth and development, philosophy and ethics and nursing into a focal plan of care.
Strategy 3: Questioning, Dialogue, and Imagination
Starting with imagination and piggy backing on the case presentation would be to have the student integrate a current patient’s clinical presentation with an related or unrelated current topic from the classroom—sort of a case presentation of an unfolding case study. For the students who may not have patients with presentations of current class discussions, the educator could use critical imagination to help the student see how (unwildingly at times) a patient could develop with a presentation of what they are learning in class. In real-life, this is essentially how patients end up in the ICU from the floors! I think helping the student develop this type of imagination can also help them in anticipating a patient’s trajectory and prioritizing what is important of the plethora of what the diagnoses a patient may have during a hospital admission.
Benner, P., Sutphe, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Josey-Bass.
Tomey, A. M. (2003). Learning with cases. The Journal of Continuing Education in Nursing, 34(1), 34-38.
Brandon Rachal 