Today I decided to put on Stanford's Clinical Anatomy Podcast while I was tidying up my room. It helped me review a lot of things I had memorized for one midterm or another, which was great. If you can't easily explain it, then you do not really know it. To make help learn look for a lot of different ways to take information, and multiple ways for committing it to memory. I love podcasts and reading, and now I'm becoming much more disciplined about doing making notes after I do either of those things.

Getting back to the Stanford's Clinical Anatomy podcast, I really liked the video Anatomy of the Human Thorax. At one point the professor draws the pleural reflection, lobes of the lung, and  heart on the torso of a male adult.

What a great way to visualize and study the anatomy. Many students struggle becoming comfortable with some of their assessment techniques, because they read about it but do not always get the chance to practice. If at all possible finding a family member, partner, or REALLY good friend that might let you do this could help a lot. This is may be quite hard, but I remember my auscultation skills and ability to do a manual blood pressure after convincing a lot of friends to let me practice on them.

Another thing I realized from these lectures was the act of drawing out information, especially anatomy, can have incredible effects on memory. Whether you are an artist or not, every clinician that is studying should spend time drawing anatomy. It forces you to develop a familiarity with the anatomy, and you can practice identifying and naming the different parts. No one speaks in a strong clinical manor without practice. Even though it may not be the best language for patients, knowing and understanding anatomy is extremely important for quality nursing care and greatly improves the chance of strong inter-professional collaboration and trust.

Clearly these nurses did not need my advice on leadership or management, but they were interested in hearing how digital tools might help them work towards their ends. This to me is fascinating, and I've been feel for the last 4-5 months that digital tools (social media - I'm really trying to avoid this term) are increasingly of interest and moving towards the mainstream in healthcare.

While I was slotted next to an excellent hospital communications specialist Brady Wood, this is not where I hope social media is most exciting in healthcare. I'm continually pushing for it to be recognized as a tool for patient education, collaboration, knowledge translation, and other important work of health care providers. I've never launched a website in hopes of self-promotion or awareness, generally I've been more interested in the impact of sharing ideas and information with others and providing a way for others interested in similar topics to be find me and connect.

If you are interested in hearing the talk you can watch it below. I trimmed a lot of the earlier discussion because the audience was not mic-ed so it is hard to hear.

Big Idea: Preventable noise can easily be reduced and may benefit patients. This may not be the most original or ground breaking paper, but I think it is an issue we often overlook, and one I hope gets more attention. I would love if we all had a better understanding of how are patients are sleeping, since I know how deeply lack of sleep impacts me, even when I'm relatively healthy.

Evidence: This article is an editorial article discussing findings for a research paper

Quotable:

• "42% of the 92 pa­tients with noise data reported noise­related disruptions of sleep."
• Most commonly report causes of noise were: staff conversations, roommates, alarms, intercom and pagers

So What?

Sleep is a vital process for restoring mentally and physiologically restoring the body. I've often wished it were possible to get a nice visualization of what phase of sleep is in so that I could decide if it was really a good time to go in and introduce myself. Hospitals often operate at their own convenience rather than focusing on patient preference. Hopefully more interest in this area will lead to quality studies of the impact of noise reduction strategies, sleep- and preference-based modification of morning routines, and other interesting interventions to help improve patient recovery and mood.

Steven Lewis - President of Access Consulting Ltd

Adjunct Professor of Health Policy, Faculty of Health Sciences at Simon Fraser University

 
At the Canadian Nursing Students' Association National Conference in Saskatoon, I had the opportunity to sit down with Steven Lewis after he gave a presentation on how nurses can strengthen their professional voice. A fascinating individual who has worked in health care policy for much of his career, he has had many unique roles that give him a distinctive perspective on healthcare. He is a well known healthcare policy writer and analyst. In this short interview, I ask him about he began getting involved in large scale health system projects and how he would advise nurses and nursing students to begin getting involved.

Resources

• Drummond Report
• Improving access to emergency care: addressing system issues
• Steven's parody of Dos Equis commercials about american healthcare

Here are some of the quotes that really stood out to me.

We have known for years that handwritten prescriptions are unsafe. A reasonably aggressive date should be set in this round after which handwritten prescriptions will not be accepted by pharmacies. 2015 seems reasonable.

The government should provide incentives that lead to improved access and quality of care. The move to create family health teams (FHTs) was the right one. Larger practice groups provide better care and inter-disciplinary groups that include nurse practitioners, dieticians, pharmacists and other clinicians provide better care more cost effectively.

Today, newly qualified physicians receive an OHIP billing number automatically. A rookie doctor bills the same rates as a world renowned expert in an academic medical centre. Both of these policies need to be reconsidered.

These statements aren't in and of themselves great. The arguments and rationale they put around them is what makes them interesting.

The article does a great job in asking the Ontario Medial Association what it needs to consider and how patient care could be improved. This got me thinking about what do nurses need to consider in our collective negotiations that we currently won't or don't? Please don't think this means I think nurses should make less, but what is really of value to nurses and to our patients? Would getting a $2.00/hour wage really benefit everyone- not really. It does feel nice and it might help me get - but what would really improve the work environment and patients?

I've never been a collective agreement negotiator, so I do not really have a great understanding of how these negotiations work. I wondering how creative the conversations are? Could you find out the total cost of designed raise, e.g. 2.5%, then look at what could be purchased by not spending that on salaries. Instead could the collective agreement include a guarantee of certain staffing levels, the ability to work in community, or perhaps paid time to work on research or quality initiatives in my organization?

The OMA and physicians have a much stronger bargaining position in some respects, because the are not employees of the hospital. Changes to policies of a organization (or "system") are not necessarily include in nurses collective bargaining agreement discussions the way that EMRs or electronic ordering has to be with physicians due to the different relationship.

As we continue to live in a system that needs overall improvement how do we use our collective bargaining system to negotiate for improved healthcare. It is not possible to create health in an unhealthy environment, so I do not see it as a separate issue. Unless we are satisfied with treating illness and trying to be well compensated while doing it we will never get there, we all have to approach the table differently.

This marked my 6th attendance of CNSA's National Conference. Year after year it is my favourite conference to go to, the energy and excitement is refreshing.

As many of you know I am no longer a student. This year I was privileged to be asked by the Expert Commission to meet with the board of directors of CNSA and to ask attendees about their thoughts on health care transformation. Without a doubt it was a fantastic conference, and the students' responses and thoughts were inspired.

Beyond getting the chance to speak with students I also got to hear some of their fantastic speakers. This year the keynote speech was by Steven Lewis, a Canadian health policy expert - who gave a great talk about developing a professional voice.

To anyone that has not been to a student nursing conference I highly encourage you to attend! You will without doubt be excited by the imaginative and first-rate effort the students bring to make it happen, and hopefully it it will reignite or inflame your passion for the profession and the future of healthcare.

Care Challenge is a platform designed to support nursing innovation. By offering prizes of project funding to help nurses get their ideas off the ground, or by providing media production to get recognition and further expand the project. Not only does the website offer to help, it offers a platform for nurses to share their ideas with the global nursing community. This will hopefully inspire others and lead to connections between nurses and ideas that can change the world.

Disclaimer: Sanofi (sponsor of Care Challenge) is a client of mine - so please judge the initiative with this in mind. However, know that I started working with them advising them for free because I think the platform is needed in nursing and healthcare, but I'm sure you know that I like sharing ideas.

One way that this is changing is the expanding role of case management in healthcare. This can be done using patient navigators as well as a variety of healthcare professionals (nurses, social workers, physiotherapists, etc.). One of the biggest challenges to this is the that there is no formal profession for this, but the role can have significant impacts on patient outcomes and satisfaction. However, the National Case Management Network (NCMN) is trying to change that.

Recently I had the opportunity to meet with Joan Park (President) and Victoria Hadden (Project Manager, Communications). Currently in growth mode it is great to talk with them about communication and growth strategy. It was great to get the change to talk with them about all the work they are doing, and their upcoming conference.

Anyone that thinks their organization or unit could improve their patient experience through better case management should definitely check out their website and see learn from the organization.

This year I'm excited to be here on behalf of the Canadian Nurse's Association, for the Expert Commission. This means sitting down with the board, and speaking to the national assembly. Most importantly I'm here to listen and engage students, which is reassuring. It means that CNA is taking student's opinions seriously, they value and want input from nursing students. It is encouraging and I hope we can excite students to take up this opportunity and galvanizes students to continue to engage with professional associations throughout their career.

This morning I was able to sit down with the CNSA Board of Directors for brunch to talk about healthcare transformation on behalf of the Expert Commission. It was a great discussion and it was exciting to hear from some of the future change makers in our profession.

Over the next few days I will get the chance to speak with more students and engage a wider audience. I can't wait to continue to hear from more students and to hear the excitement and their thoughts on how to move the health of Canadians forward.

The Article: Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale

Green, S. M. (2011). Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale. Annals of emergency medicine, 58(5), 427-430. Elsevier Inc. doi:10.1016/j.annemergmed.2011.06.009

Big Idea:

The Glasgow Coma Scale was not originally intended to be a ubiquitous neurological scoring system. There is evidence to demonstrate the GSC is confusing, unreliable, and unnecessarily complex, and its manner of common clinical use is statistically unsound. Therefore we should consider using Simplified Motor Scales (SMS) that provide the same information, are easier to remember, are statistically derived and externally valid (p. 428)

Evidence:

This article is an editorial, so it is not primary research. The article references a number of other primary sources of evidence including recently published peer-reviewed literature from well respected journals. Referenced studies indicate the GSC has poor inter-rater reliability, it is not consistently remembered, there are different versions (usually outdated 12-point evaluations), it is inconsistent which prevents prognostic value (p. 428 par 1)

Quotable:

"It is time to abandon the Glasgow Coma Scale (GCS). As discussed below, this ubiquitous neurologic scoring system is confusing, unreliable, and unnecessarily complex, and its manner of common clinical use is statistically unsound." p. 427

"Some traditionalists will no doubt object to the blasphemy of "dumbing down" the GCS, but why tolerate pointless complexity?" p. 428

"The GCS is intellectually appealing to health care providers in that it creates apparent order out of disorder. It ambitiously tackles the enormous complexity of human neurologic response and organizes (oversimplifies) it into a tangible, appealing yardstick that cannot fail to impress with its seeming accuracy and precision. We want to believe that medicine can be this objective, and thus we tolerate the delusion." p. 429

So What?

This article was fascinating to me for two reasons. First, as a student I remember trying very hard to memorize the GCS and found it difficult, but thought I was the problem. Second, working in a simulation lab now I find it interesting to see how students do tend to want black and white answers. It is fascinating to step back and see the dialogue that happens in the literature as evidence evolves and researchers have to push for change, not an easy thing to do. As an educator I wonder how we make this apparent to students, since we have to mark them on something and they want very defined and specific answers, yet their knowledge will hopefully and should always be changing (read: evolving) with new evidence.

When you have an idea there are two things you can do, take action or do nothing. Most people with innovative ideas or thoughts on how to make things better choose the latter, because there are many reasons people come up with to not do anything. One of the things that holds people back is the fact that they can't do things perfectly or they think it won't be good enough.

Looking back at the first interview of Nursing Ideas with Doris Grinspun I cringe a little bit. I recorded it with my Macbook at the time and you can hear the laptop fan spin up when it got a bit to hot. The we bite at the time was pretty rough around the edges, there are also typos and bad grammar in almost every post. If I was a teacher and had to grade Nursing Ideas I would have given myself a D- if I was feeling a bit generous. Today, I'd probably say it is up to a B-. This may because I try to be a harsh critic to my own work, but also because I see a lot of ways I can improve it. From sound, editing, lighting, web design, layout and the list goes on, there are all sorts of other things I want to change. However, Nursing Ideas has always been my sandbox. A place that I could experiment try things out and hopefully make something that was interesting.

While I may not have everything the way I want. I am always trying to find small ways to improve. Today I'm happy to say one of the things I've been thinking about is updating some of the branding. The original nursing ideas logo was a bad drawing I sketched out on my computer so I'd have something. It was sloppy, but it could work. Recently I finally took the time and invested in a new logo. As I begin to speak to more organizations, publish more articles, and help produce more podcasts for other organization I want to have a brand and site that reflects the quality of people I work with and interview. I have another logo I can use that reflects the older logo, which will be used for a few promotional items I'm working on and podcasts. However, in print and affiliation this is the logo that I'm planning to use for branding Nursing Ideas.

I hope you like it, but more importantly I want to thank you. Thank you for watching and commenting on videos, for sharing videos and telling friends. Nursing Ideas was never meant for me and I can only hope that others get something from it. Hopefully this new logo helps improve the looks of the site. I want you to know I do take it seriously and plan to continue to work on improve the site, recording more podcasts and creating more content.

Accepting that piece of paper was a great honour, but there were a few parts that to me were more exciting. First, seeing my classmates accept their degrees. I was privileged to sit in class with the leaders of nursing that will spread out from that hall and begin to change the face of healthcare. Second, I got to see the new Bachelors of Science in Nursing be awarded to students I had taught, for better or worse, but hopefully better. From stressed out and tired in the lab to well groomed, composed and beaming with pride they made it through the difficulties of a nursing degree. They have every right to be proud.

While it was a great night to celebrate there are two things that I took away from the night. Sitting in the giant hall of a few hundred if not close to a thousand people I realized that only a few handful needed to be there for me. I saw faces of friends, faculty and family that supported me through my education. They are the reason I was being handed a degree. Through tough nights and long weeks they supported me. The best part of accepting that degree was recognizing the incredible role they all played in me getting it.

The other piece that struck me relates to the lack of magic or secret power that comes with that degree. There is no special textbook, no answer key we now are allowed to look in. While we have all just endured a great deal of stress and a large workload it is hardly over, if anything it is just beginning. To me this is what continuing education is all about. Two or three letters rarely give you much power, except if a license is required. However, they do bring a small amount of respect and a large bit of responsibility.

Now we have to start to create the plans for the next semester or chapter of our lives. We have to see the opportunities and the challenges that most need our attention. There will be no rubric  to follow, no teacher giving us constructive criticism. We only have the knowledge we gathered and the ability to learn. Hopefully that preparation will be enough, hopefully it will help us support those around us.

To all those of you who graduated this year, whether a diploma, degree or graduate studies. Congratulations, you deserve to celebrate! Once you are finished I'm excited to see what lies next, the challenges you will take on and the difference you will make.

The Article: Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Big Idea:

Increased interest in implementation science has lead to a number of different theories about how to turn research into practice behaviours. However, each one is a bit different and leaves out key elements. This study was done to compare the different theories, identify overlap between the theories and merge them to close the gaps caused by using only one theory for implementation.

Evidence:

They used a snowball sampling approach to find published theories that have been tested to identify their strengths and what parts of the theory supports implementation. Then they try to link the different theories together by grouping and relabeling things that were redundant or overlapping and pulling appart ideas that were trying to cover unique underlying concepts.

Quotable:

"some estimates indicate that 2/3rds of organizations' efforts to implement change fail." p. 2

The 5 constructs:

- Intervention

- Outer Setting

- Inner Setting

- Individual Characteristics

- Process

So What?

This paper is extremely useful when planning to implement new research and engaging health systems in change behaviours. The constructs presented in the paper help provide useful perspectice and strategies for enabling better implementation and sustained changes.

I would highly recommend this to educators, managers and directors looking to implement change. Students may also find this paper useful for nursing leadership and organizational classes. Nursing leaders and researchers may also benefit from reading this paper for talks on change and ensuring their messaging and research include these valuable perspectices.

Reference:

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. a, & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science, 4, 50. doi:10.1186/1748-5908-4-50 -