John Seely Brown Lecture on Learning in the Digital Age

This is a long video, but if you are in to teaching and learning--it's well worth it.  What John Seely-Brown (JSB from here out) tells us is that not only does our old method of teaching as knowledge transmission, the Cartesian model, not make sense in a world where 90% of what we think we know will be outdated in 5-10 years, but that it actually hurts students who will live and work in a world in constant flux.  My job as a teacher is not to make students learn some laundry list of facts but to help them learn how to teach themselves--how to problem solve, how to collaborate, how to think like a nurse/be a nurse instead of learning about nursing.

I swear to you, and to my instructor reading this ;), I read JSB before this moment, watched a couple of JSB videos on YouTube;  but for some reason today, today I get it.  Here are a few things I'm taking away from this lecture to use in my classroom next semester.

Learning as participation--collaborative processes.  JSB mentions a study from Harvard that noted the single best predictor of academic success was participation in study groups; or even better, the formation of and then participation in study groups.  I can't make my students do it on their own, but I can sure design a classroom that mimics those dynamics.

Make work public.  JSB describes the atelier style desisn studios popular in architecture programs where not only is the work public, but the critique, redesign and problem solving is too.  I'll be doing group critiques of care plans, assessments and pathophysiology papers next semester.  This ties to another JSB nugget, when work is public (not just for the instructor) its quality and quantity increases.

Remixing--JSB refers to this as play that is happening on the web whereby an original piece (movie, play, song, poem, etc) is added to by contributors, commonly as back-story.  I do this all the time on my end when I write case studies, next semester my students will too.  In nursing it will look something like, "here's Mrs. Brown with complications of CAD.  Tell me how she got here."

Lastly, but certainly not least, is a note to myself.  Make your classroom one where problem solving is play, failure is a neccessary part of success, and out of the box thinking is rewarded.  Spend most of your time on the tacit knowledge, the learning to be part, and only go back to the explicit (learning about) when students are stuck.  Provide an atmosphere where learning is continuous, situated and socially driven.  Stop being a sage on the stage, or anything like it, and start mentoring.

Guess I know what I'm doing this summer!

That a-ha moment!

"A discovery is said to be an accident meeting a prepared mind."  Albert Szent-Gyorgyi

One of the few things I do specifically remember from nursing school was this sort of constant, knawing sensation that I didn't really get whatever it was I was supposed to be getting.  I read the material, did well on exams, made excellent grades, but I felt like all I had was a collection of data with no real anchor.  Then, somewhere in my late junior year and under the tutelage of the amazing Barabara Martin--I had an a-ha moment.  It was as though all the discordant pieces of information layed out before me in what I could now see was a complex, interwoven picture and I finally felt like I understood why A led to B led to C.  Mrs. Martin said it was her favorite part of teaching, this visible jolt, when a student started to really make the connections.  Now as an instructor myself, I tell students it will happen for them too--you just have to wait for it and make sure you have prepared well.

I start with this story because, honestly, I thought I was a little beyond lightbulb moments.  Wrong!  I am in my final semester of my Master's program, actually my final weeks, and I feel like I just solved a riddle that will propel and inform my teaching from this point forward.  I've been through 32 hours of coursework learning research, theory, health promotion, curriculum design, and leadership garnering bits and pieces.  I've come to this point knowing that the way I was taught, the way I've primarily been teaching, wasn't really going to cut it anymore; sure I needed to change, not knowing from a practical standpoint how to do that.  Here's what I watched today (yes, literally today) that helped me cross that divide.

John Seely Brown--Learning in the Digital Age

The Nursing Process

"Never try to solve all the problems at once — make them line up for you one-by-one."

— Richard Sloma

One of the most common complaints you hear from nursing students centers around the concept of care planning.  That dreaded task where a student/nurse looks at the patient, tries to figure out what is wrong with him/her and makes a plan to address the issue.  Students tend to think it's a waste of time--they will tell you that "real" nurses don't ever care plan and it teaches them nothing.  Students say a lot of things that don't make sense and this is one of them.  Care planning is just problem solving in disguise--a systematic approach to complex issues allowing time and energy to be well spent and productive.

For some reason, when we frame the process in nursing language it confuses people--so I like to take tangible, "real life" examples and turn them into nursing care plans. 

Step one:  assessment.  What is wrong?  You start by listing everything abnormal and then categorize and prioritize them.  Example:  My house is messy, I'm tired, I'm broke, I'm cranky, I have homework to do.  Let's pretend my biggest concern is having a messy house.  What specifically is messy?  Here's where you need to get down to the nitty gritty--messy isn't descriptive or objective, describe what is actually out of order.  There are toys on the floor, dirty laundry in piles, clean laundry (unfolded) on the table, trash flowing out of the can, etc. 

Step two:  diagnosis.  Analyze the data to determine what your problem is and why you have it.  The crucial thing here is determining your actual problem, in nursing we have a list to choose from, and identifying its root cause.  It does you no good to name the problem if you then mis-identify the cause.  Example:  my baby is crying.  If I decide to change the baby's diaper but that's not why he's crying, I won't ever solve or improve upon my problem.  Going back to my messy house--let's name our problem impaired kitchen integrity.  Now I have to figure out why--because I have too much stuff, messy kids, I don't put things away when I'm finished with them, too little space?  This is where people really stumble at problem solving--they know what they don't like and they know what they want as an end result but they fail to identify the root cause of the problem.  No organization system is going to keep your closet clean if the real problem is that you don't put things back where they belong.  No amount of income will meet your needs if your real problem is that you spend all your money on luxuries.  Once I determine my cause, my "related to" in nursing terms, I'm ready to plan.

Step three:  planning.  This is a two step process beginning with goal setting.  The easiest way to start is reverse your diagnosis.  If my diagnosis is pain, my goal is no pain.  My diagnosis of "impaired kitchen integrity" so my goal is improved kitchen integrity.  A goal has to be three things:  specific/measureable, realistic, and have a time frame.  I meet specific/measureable by adding outcome indicators--in real language, things that tell me how I know I have improved kitchen integrity; for instance, no dishes left in the sink, table clear of clothing, and floor swept and mopped.  Make sure it's reasonable to achieve and set a time--at the end of each day perhaps.  Part two is the writing of nursing interventions, activities to be done by the nurse to improve or eradicate the root cause of our problem.  Mega important point here--your interventions fix your cause, with the cause fixed the problem improves/disappears.  In this case we might identify the reasons for the clutter on the table, establish a schedule for dishwashing, determine an alternative space for laundry, and teach time saving techniques. 

Step four:  implementation.  This is the easy part, you do what you said you were going to do.

Step five:  evaluation.  The most overlooked of all steps in the process, once you have completed your implementation, enacted your plan, you have to go back and see if it worked.  Did you meet your goal?  If so, great--keep doing what works.  If not, figure out what worked, and what didn't, and modify the plan.  This might include a goal revision if you determine your goal was too far reaching, or maybe you need a little more time to meet it.  The revision might be to change or add interventions if you think you need more or different activities.  It might even require an adjustment to the original diagnosis--which sometimes happens when you realize that you addressed what you thought was the cause and the problem still persists.  As in, "I changed that baby and he's still crying--now what?"

Once you know the steps, not only does care planning for your patients become much easier, you also have a skill you can apply to all areas of your life.  Happy problem solving!

Strength in Numbers

"The human heart tells us that we are more alike than we are unalike."  --Maya Angelou

Have you ever noticed that many of the things you are scared of aren't really as bad as you thought once you see them in the light of day?  Like the creature in the window at night--terrifying and looming in the shadows but just a tree branch when the sun comes up.  My biggest fear--and one that is shared by so many people brave enough to admit it--is that I'm just not enough.  Not smart enough, not pretty enough, not a good enough mother, wife, teacher, friend, nurse, you name it.  It took me the better part of 35 years, a patient husband, some therapy and good meds to figure that out but at least I know now.  But what helped me as much as any of those things was/is talking about it.

I like to talk, I talk all the time--often just to hear my own voice my husband would tell you--but I never talked about my fears.  The first time I remember being really depressed, and acknowledging that I was actually depressed, was my senior year in college.  I was crazy busy, over committed to extra-curricular activities, planning a wedding--oh yeah and trying to graduate from nursing school.  I didn't tell anyone.  I cried myself to sleep, when I could sleep, for days on end.  Stress ate, snapped at people, boo-hooed at commercials and sad songs on the radio but I didn't talk about it.  I was afraid that if I told people I was sinking they would think less of me--they would see that I wasn't enough.

It happened again (or maybe just continued) in the middle of my first year as a nurse.  I hated my job, hated being a nurse, wondered what the heck I had just spent 4 years and many thousands of dollars doing and what was I going to do instead.  Nursing was hard, and scary, and I was sure I would kill someone because I wasn't doing it right.  I didn't tell anyone.  I cried myself to sleep, when I could sleep, for days on end.  Stress ate, snapped at people, boo-hooed at commercials and sad songs on the radio but I didn't talk about it.  I was afraid that if I told people I was sinking they would think less of me--they would see that I wasn't enough.

About a year after I had my son I was right back in that same place.  My job was overwhelming before motherhood and got harder after.  I felt guilty when I was at home--I had soooo much work to do; guilty when I was at work--I should be with my baby.  I was failing everyone but I didn't tell anyone.  See a pattern here?  It got so bad that my husband asked me if I'd ever considered hurting myself or my baby.  That was my lowest point.  I finally made an appointment, sought counseling, took an anti-depressant, and started on a journey to recovery.  But, outside of my husband and my doctor, I still didn't tell anyone. 

One day in lecture, mental health lecture fittingly, a student asked if it was normal to consider driving off into the sunset at night and just leaving her life behind her.  It wasn't quite a suicidal ideation but I recognized that tone in her voice that said, "I just can't."  I started talking.  The relief on her face when she realized that she wasn't alone in her fears was payment enough for my disclosure.  She said, "I thought I was the only one" and I realiized that I had too.  I'd never talked about it because I was so certain that the fault lay with me.

That was a watershed moment for me--I'm not the only one!  I started asking questions and-- lo and behold-- all nurses feel terrified that first year, all moms worry they are failing their kids at one time or another!  There is nothing special or unique about me--I'm just as screwed up as the next person! 

I'll be 38 in a few weeks and I still worry, every day, that I'm not enough of something.  What's different now is that I don't see that as an inherent flaw in my personhood, I see it as human nature.  And when I get to feeling like I'm really not enough, I call somebody and talk about it. 

In the long run, we shape our lives, and we shape ourselves; the process never ends until we die. And the choices we make are ultimately our own responsibility.   --Eleanor Roosevelt

We had an incident a few weeks ago in which a group of students decided to try an "easier way" to complete class assignments.  The details aren't important, or for public consumption, but suffice it to say, the term unauthorized collaboration was used in the disciplinary process.  My initial reaction to the event was dramatic and heavy-handed--toss them all out, I said.  But then this niggling voice in my head asked me to think back 15+ years and ask, what would you have done?  I'd like to tell you that I wouldn't have been involved, that I would have heard of the plot and not only refused to participate but have gone to the proper authorities and spilled the beans.  I'd like to tell you that but it wouldn't be true--I don't know what I would have done and thankfully was never forced to decide, but I know enough of myself then to say that I probably would have cheated.  I would have rationalized it, as our students did, as being busy work, unimportant, not really telling of my ability to perform nursing care and of no bearing on my future profession; but I would have cheated.  Does that make me a bad person?  I don't think so, I think it makes me human, flawed, normal.  What's far more important and interesting than the mistake is how you deal with the aftermath.  Do you take responsibility?  Own up to your actions and suffer whatever consequences come your way?  Make the same mistake over and over? 

If I made a list of the top ten things I wish people could figure out--you life is a consequence of your decisions and actions, you are not a victim of random circumstances--would be very near the top.  When you screw up, fix it.  When you take the wrong turn, redirect.  When you do the crime, pay the time--and then don't do it again!

How you learn this lesson, and pass it onto your kiddos is still a work in progress for me.  My son, like many 8 year olds, is a master deflector.  Ask him what he did in school today and he'll tell you about lunch.  Ask him about his homework and he'll show you a cool new dance move.  Ask him about why his behavior clip was moved from excellent to needs improvement in the course of one afternoon and he'll tell you why it's everyone's fault but his.  We've been working on this, but it's hard.  When he starts a sentence with "my friend's were . . ." my immediate response is "what did YOU do?"  When he carves his name into his bed with a kitchen knife and tells me "the dog must have done it" I turn away to stop from laughing and call Daddy in for a turn. 

Ask me how my homework is going and I'll tell you about the new shoes I bought . . .

It really is the little things

The best portion of a good man’s life are his little, nameless, unremembered acts of kindness and love.  --William Wordsworth

One of my favorite job duties happens every Monday morning as I supervise students in the clinical setting. Though I grumble at the notion of getting up early enough to be at the hospital at 0630, being at the bedside with those eager learners, watching them figure it all out, seeing the future of nursing develop right in front of me is such a joy and a priviledge. 

We took care of a gentleman this semester who had suffered a stroke.  After we gave him medications and did a couple of other tasks, I helped the student with his hygiene.  We washed his face and hands, performed oral care, changed his linens and cleaned up his room.  He was essentially unresponsive throughout, certainly not aware of the care we provided.  Just before we left the room I combed his hair.  The student sighed a little and said "I'm not sure that really made any difference."  She couldn't be more wrong.

Prior to teaching I was an ICU nurse.  I love the ICU—all the machines, the gadgets, the numbers, the sickness, it feeds my sense of urgency and importance.  As a new nurse I was particularly focused on learning how to manage patients with all the “stuff” and I remember the first time I really felt like I had it all figured out-- like I had "it".  I was taking care of a pre-op heart transplant patient and, as you can imagine, she was very sick.  She had tubes and IV lines everywhere, monitors galore, medications out the wazoo—I was in heaven.  My night was a perfect ballet of noting this reading, pushing that button, giving that med, running this machine.  I finished that shift, patient taken care of and stable, thinking—I am a nurse.  The next week my manager called me into her office and told me it was time for my evaluation.  Part of the process had been asking my patients about the care they received and one patient chosen was the heart transplant lady.  I thought, jackpot!  I was great that night!  My manager read the words the patient had written, “Jodi was nice, she braided my hair.”  I have to admit, I was devastated.  All that work and all the patient could come up with was braided hair?!  I called my mom in a fit of despair and she imparted to me the wisdom only a mother can give—saying “honey she expected you to do all the other things, isn’t that your job?  She remembered the hair because it was special, and extra, and human.”   

When I tell this story to my students, I do so not to elicit their applause but so that they may take up my challenge.  I challenge them, and  remind myself,  to find the time to hold a hand, reassure a patient during a spinal tap, comfort a mother who’s crying because her baby is sick, tell a joke, say a prayer and yes, braid some hair.  You may not remember it, but your patients will.

Words Matter

“Your reproof I shall never forget: ‘had you behaved in a more gentleman like manner.’  You know not, how those words have tortured me.”

“I had not the smallest idea of their ever being taken in such a way.”

Pride and Prejudice, BBC Production

In the way that it often does, life brought me several reminders of the power of words this week.  Like many people and especially those of us who live in the world of obesity do, I started the New Year with a renewed intention to get healthy—including weight loss.  I’ll write more about that journey as the year progresses (so far I’m doing great) but this story starts in my weekly Weight Watchers meeting.  The theme was “changing from the outside in” -- not quite the beauty comes from within message that we so often hear--the concept being that sometimes we need to change our environment in order to shore up our insides.  The less nice way to say this is “fake it ‘til you make it.”  The leader suggested we start by changing the way we talk to and about ourselves because words matter.

Many overweight people have a very messed up image of themselves, rarely based on what the mirror actually shows.  I have always thought of myself as fat—fat kid, fat teenager, fat adult.  The reality is that, while I had my chubby moments, I didn’t really get “fat” until my late teens.  So why the impression and what does it have to do with words? (yes, I’m getting there)  Throughout my childhood memories are snippets of conversations with well meaning family members regarding my weight; an uncle promising to “work the baby fat off” over a summer of horse riding and farm work, my aunt assuring me that cutting salt out of my diet would help me lose weight (I was 5’6” and a size 7 at the time); and a treasured grandparent offering new clothes in exchange for pounds lost.  Those moments and many more, big and small, helped cement this internal snapshot of a fat girl that remained even when I wasn’t.  Words matter.

I had a student in my office this week asking for help with math.  The first thing she said was “I am so stupid, I always have been.”  Words matter.  We talked about that voice in your head and how to make it stop the never-ending laundry list of your shortcomings and start celebrating your strength.  Words matter.

Even when we are joking, words matter.  In the midst of a frustrating night of homework with my 2^nd grader, a delivery man rang the doorbell.  With a whining and complaining 8 year old yelling from the living room and a dog shooting past me to the great outdoors, I quipped “would you like a kid, heck I’ll pay you to take him and the dog.”  Little did I know said kid had his listening ears on and when I came around the corner he eyed me reproachfully with tears streaming down his sad, sweet face.  “You hate me,” he cried, “you told that man he could take me and you tried to sell my dog!”  A little taken aback at the intensity of his reaction, my first response was to laugh—bad plan.  He forbade me to sit with him and, at my attempts to talk, he angrily pantomimed a zipped lip as he pointed at me.  After a few minutes I explained to him that I was just joking the way parents do, but that I was very sorry I had hurt his feelings.  His response-- “You didn’t just hurt my feelings, you broke my heart.”  Words matter. 

My challenge, to you and to myself, is to choose your words carefully; to be encouraging instead of entertaining, sensitive instead of sarcastic, ever mindful of the power you possess because words matter.