Is it a Ship, Mars Mission I, a Biscuit, IPO, or Cyber Attack ...?

No!

It's a 3rd year student nurse, 

several in fact

launched 

on their careers.

It is quite a poignant life changing and affirming moment for everyone involved. Of course, there are instances were qualification is problematic, but this is about the +ve.

For the student of course, this represents a great achievement and the realisation of the responsibilities that suddenly apply. This is tempered by preceptorship as mentor and sign-off mentors remind and reassure.

Our students have jobs and this is heartening to hear. They really are off and up-and-running.

There are graduation celebrations and parties to follow for them, but this past week I wondered about another way to signify this literally professional defining event. A way that accompanies and yet transcends the final page 'sign-off' that clearly does carry volumes of meaning and learning.

There was a fleeting thought that I shared: should I form an arch with the student's mentor for the student to pass through? A laugh.

Heaven forbid that this week and day should be for any student an anticlimax. Speaking of heaven there are of course pledges out there. Which also includes:

Nursing is an art;

and if it is to be made an art,

it requires as exclusive a devotion,

as hard a preparation,

as any painter's or sculptor's work;

for what is the having to do with

dead canvas or cold marble,

compared with having to do with the

living body - the temple of God's spirit?

It is one of the Fine Arts;

I had almost said

the finest of the Fine Arts

- Florence Nightingale, 1868.

http://www.florencenightingaleexhibit.com/

As I would like to pass on the (twinned-)baton that is Hodges' model, could there be a form of words that can reflect the entry of a new nurse into our midst; an exchange of words that captures the moment for the student, the mentors, nursing and the public we care for and with?

This may seem twee, archaic, a nod to times of formality, the sense of duty, vocation and hierarchy. This wouldn't be about hierarchy, experience yes. It would be reflexive, a dialogue between these 'professionals' that acknowledges the student's rite of passage, the present moment and the collective future of nursing, of caring and their position in time and the professions' values.

Critical Thinking - Gaining knowledge: Beginners + Experts = audience?

Clearing through books last month with several bound for the charity shops I came across Critical Thinking in Nursing: An Interactive Approach, by Rubenfeld & Sheffer, with the following table (p.30):

	BEGINNERS	EXPERTS
Ways of:
Gaining Knowledge	Assigned readings and asking authorities	Multiple written and verbal sources, and experience
Thinking	Dualistic	Relativistic
Using rules	Context free	Situation dependent
Looking at situations	Narrow	Broad

The table is not remarkable in its theme, but it is a useful prompt for Hodges' model and future studies. The concepts listed might help illustrate how Hodges' model can support learning. In addition to having an individual focus the model can consider any situation, hence the claim that the model is 'situated'. As stated previously person centeredness is not a given. It does not follow, nor is it achieved just because 'person centered' features several times in care philosophies and policies. The person must be put at the center of the model and then each of the domains considered together with the spiritual dimensions.

I'm also reading a nursing informatics book (posts and review to follow) that discusses casuistic ethics, that is case-based reasoning. While the utility of casuistry is debated in nursing, the need to consider the individual is always paramount. A prime example of the focus on the individual is the programme Inside the Ethics Committee on BBC Radio 4. Central to ethics are the frequent dilemmas that arise in health and social care, the difficult moral choices and dichotomies that must be faced. The model can be used in a context free way, that is considering rules in general; and also employed in specific contexts, such as a best interest meeting for a person recently moved into a residential care facility and distressed by the experience.

There are many dichotomies that can be identified in the basic model, and to a certain extent they reflect the dualistic thinking of the beginner as they build an understanding of particular fields of health care. As learners progress they integrate the concepts they encounter and are then able to associate these and relate them to prior learning, the current case and generate hypotheses that may also be predictive. Hodges’ model can frame and help represent student encounters be they narrow or broadening (recognising patterns). Gaining knowledge may need particular attention by the student (mentor and lecturer) in terms of the student's strategies for creating and protecting opportunities as a beginner and competent practitioner.

As a sign-off mentor I’ve become acutely aware – as required - of a learner’s level of skills and knowledge. What is their level of competence? What is their level of situational awareness? How are they progressing through their learning according to previous mentors and their own goals, learning objectives and evaluation? The concept of emotional intelligence is not new and still has the attention of researchers. Perhaps this could also inform questions for research into Hodges’ model as students elaborate their initial representations of nursing care, skills and knowledge through their course and ongoing as experts. Is emotional intelligence central to compassion in nursing? Encompassing all of these ‘ways’ in the table is reflection. This is not just for reflective practice but an ability to critique one's own practice and that of others.

The table is also helpful at this time considering future content and content types and the potential audience of a new website. The challenge is to emulate the table above in the way it reduces, simplifies very complex educational matters. Yesterday afternoon I was able to attend a very helpful two hour research clinic in Lancaster, following this I must (still) reduce the above questions and also recognise my own biases.

Rubenfeld & Sheffer (1994) Critical Thinking in Nursing: An Interactive Approach. 1st Edition, Lippincott Williams and Wilkins.

Jordan JNC Conference: Mental health and stigma, Student nurse's aptitude and the MDGs

There were a great many fascinating talks at the conference in Amman. The following caught my attention:

Dr Heyam Dalky on Perception and Coping with Stigma of Mental Illness: Arab Families' Perspectives

Since I trained in the late 1970s there has been a marked positive change in the social stigma associated with medical and mental health conditions. People are by and large more enlightened regards epilepsy for example. Although perhaps some of the progress can be related to medication, medicine management and community follow-up. Mental health professionals and services are aware of the potential damage that a diagnosis of 'schizophrenia' can inflict on young adults. Despite any sense of progress I might see, there is much still to be done as campaigns such as Time To Change attest.

It was very useful then to revisit the historical development of thought in stigma. Dr Dalky also shared global insights into stigma perception within families by citing research in a range of countries; for example, in Jordan, Morocco, Sweden, Germany, China, Malaysia, and Ethiopia.

Within Hodges' model the individual, as in the self, is given a pivotal and yet mobile place (transferable from the top of the model to the center) this led me to the concept of self-stigma (Corrigan, 2009) as I draft a paper on h2cm, case formulation and diagrams.

In her presentation Dr Dalky notes:

• Link and Phelan (2001) defined stigma as the co-occurrence of the components of: 
• labeling, stereotyping, separation, status loss, and discrimination.
• “self-stigma” or “stigma perception,” is the extent to which individuals believe others stigmatize them because of who they are.

They say travel broadens the mind and listening to this presentation you really see the difficulties, objectives and aspirations that not only practitioners share but families and our clients too.

Heyam F. Dalky, PhD, RN, Jordan University of Science & Technology, Irbid, Jordan
 

Ever since my engineering aptitude was measured in the mid 1970s by predicting the movement of a series of gears I've always held a special place for aptitude and attitude, as reflected here on W2tQ.

Mrs. Maxie Andrade, et al. presentation Aptitude Towards Nursing: Is it Measurable? highlighted a central challenge within nurse education.

Nurse training represents a major personal investment for the student (their family too in many cases), the educational institutions and societies concerned. As a sign-off mentor I assess third year students on their final placement. This is a great responsibility that is usually a privilege, but it can be a frustration at the loss entailed for a failing student.

Mrs Andrade defined aptitude:

Is a condition, a quality or a set of qualities in an individual, which is indicative of the probable extent to which one will be able to acquire under suitable training some knowledge, skill or composite of knowledge, understanding and skill

Ref: Mangal S L. General Psychology. Fifteenth reprint. New Delhi: Sterling Publishers Pvt. Ltd; 2008.

The main questions:

Do nursing students possess the required ability (aptitude) to become an effective nurse?

What abilities do we really expect from nursing students?

The development of a tool to measure aptitude was described, reviewing the literature. Are there any existing tools within nursing? What exactly should a tool measure? Statistics and results were listed. This was a very interesting presentation and of particular interest to me.

Mrs. Maxie Andrade, Asst. Professor, Manipal College of Nursing Manipal, Manipal University


There was also a reminder of the time left to achieve the Millennium Development Goals [MDGs] c/o Prof. Hester C. Klopper's keynote: The nursing education tipping point: Forces of change. 

Less than 1,000 days and that was last month.

One thing I noticed and a sign of the issues in the Eastern Mediterranean is that the JNC conference website has proved unavailable at times. It is accessible as I post this.

Andrade M. Perceptions of health care consumers, deliverers and nurse educators on nurses, nursing practice and nursing education system. Manipal University, Manipal: 2010. (Dissertation work).
Andrade M. Choice of nursing career: Pleasure or pressure. International Journal of Nursing Education. 2012; 4(1); 42-44. 
Corrigan, P.W., Larson, J.E., Rüsch, N. (2009). Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry. 8(2): 75–81.

Jordanian Nursing Council 4th International Nursing Conference “The Tipping Point: Creative Solutions to Health and Nursing Challenges”

Well, I arrived in Amman for this conference at midnight and have not been this far east before. It is certainly different and there is much to look forward to.

I panicked slightly in Istanbul briefly reading the boarding time on my e-ticket as the flight time. So, I was looking for 1920, but the flight was 2020 and not yet displayed.

The hotel Le Meridien is excellent, my driver last night and the staff are very friendly. I was told on the 35 minute trip from airport to hotel that events nearby have impacted on tourism. People have had to seek other work as many tourist offices have closed. At breakfast it does give you pause to wonder about what is happening not all that far away.

I've not checked the conference venue yet. There's a reception this evening and workshops ongoing through today. I opted for:

4

15:00-18:00

Nicola McHugh, MSc, MA, RN

Understanding and Using Research in clinical Nursing Practice

In preparation we've been asked to read:

Seers, K. et al., (2008). A randomised controlled trial to assess the effectiveness of a single session of nurse administered massage for short term relief of chronic non-malignant pain. BMC Nursing, 7:10 doi:10.1186/1472-6955-7-10. http://www.biomedcentral.com/1472-6955/7/10

Two workshops are recorded - an approach to consider for the future - as with using Skype.

Although only two days long there are a great range of concurrent sessions, amongst them:

• Differences in Perception Between Nurses and Patients Related to Patients’ Health Locus of Control Ayman M. Hamdan-Mansour
• Fostering Global Citizenship in Nursing Education: The Role of the United Nations Mary E. Norton 
• Aptitude Towards Nursing: Is it Measurable? Maxie Andrade 
• Comparison of Structure, Process, and Outcomes of Healthcare Service Provision between Advanced Community Nurse Practitioner and General Nurse Practitioner Noppawan Piaseu
• Development of a Multimedia Computer -Assisted Learning with Integrated Content of Anatomy and Physiology for Enhancing Nursing Students’ Skills on Physical Examination in Adult: Head and Neck Examination Chularuk Kaveevivitchai
• Assessment of Nursing Students' of Azad Islamic University of Saveh' Perception about Importance of Caring Behaviors Based on Caring Model of Watson Lida Nikfarid

My presentation is tomorrow afternoon and on Wednesday I'm chairing a session.

More to follow on this and some reading ...