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#5 tip for teachers – dealing with questions in class

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Controlling the class

If you are new teacher of nursing, you will be faced with the idea of how much interactivity you wish to have in class. Will you simply stand there and lecture while the students take notes? (like a “talking head”) Do you build in some small group activity? Do you continue talking even if nobody is paying attention? What do you do to get their attention, or do you care? Do you ask questions? how do you handle questions from the students?

The traditional lecture style in which the students sit quietly and take notes  was named the “Banking Method” by Paulo Freire (an early guru of mine) and it is still alive and well, aided by PowerPoint – you can’t stray too far from the plan when there is a PPT for the subject of the day.

What if nobody is paying attention?

To me, that indicates profound disrespect. We’ll cover getting the students attention, another time. For that matter, we’ll talk about what they are doing instead of paying attention – primarily checking FaceBook and texting – in detail in a future blog.

General principle: A student’s question is never simply a question. it is a reality-check for you. Does the student’s question follow logically from what you just said? does it indicate that the person was paying attention or failed to comprehend something?  In an undergrad program, does the question ( and answer) fit a “generalist” frame, worth spending class time on?

never actually answer a question if you can avoid it.

never actually answer a question if you can avoid it.

never actually answer a question if you can avoid it.

It’s not about what you know, it’s about what the class learns. if the student was paying enough attention to ask a good question, repeat it for the whole class, and give it time to sink in.

Here is a way to maximize student participation in questions: Pair the students up if you need to, tell them to take a minute to discuss, and then poll the whole class for possible answers.

If you are new to teaching you sometimes need to answer questions to establish the idea that yes, you do know something about this subject; but the job is to get the whole class over the fence, not just the two or three most articulate ones….. and this is a way to engage a larger number.

If the student asks a poorly-informed question, never deliver a put-down. Never use sarcasm. ever.

Here are a few “types” of students to notice.

the squirmer

The squirmer sits in the front row of the class and is constantly raising their hand to participate. If you ask the class a question, the squirmer will blurt out the answer before the rest of the class has figured out the question. The squirmer will get to class early and show you some special thing they found which was above and beyond the assigned reading for the class.

assessment of the squirmer?

probably has studied like crazy and is desperate for recognition as to the work they have done.  BUT – disrupting the class  in a subtle way – they are preventing anybody else from answering a question; they are trying to make it a one-person class. some teachers get into the habit of stating the next lecture point as a question-that-is-not-meant-to-be-answered – are you one of those? If so, you may wish to reconsider……

variation of the squirmer: the e-squirmer. This is a person who uses email, texting and IM to ask questions out-of-class, and is disappointed that you don’t answer right away ( the idea that you may be asleep at 0300 on a Sunday morning does not seem to cross their mind). Do the whole faculty a favor, and resist the urge to respond to anything immediately. there are limits to your instant e-availability! Set limits on e-communication, and stick to them

PEARL OF WISDOM – intervention with the squirmer  take them aside and tell them ” There is no question in my mind that you are the star of this class. From now on, you are forbidden to answer any question. Instead, use your right hand to pull your earlobe three times in a row. I will wink at you to acknowledge that you know the answer, but from now on the policy will be to only call on you at the end of the little mini-discussion.”

The dreamer

This one is probably along one edge of the class, near an electrical outlet. The laptop is set up, and he is probably looking at FaceBook or checking email. He is there-but-not-there. assessment: find ways to engage this person in class. call on them by name, yes it’s an old trick from sixth grade but it reinforces the need to participate. Re-arrange the chairs so that students working in groups need to face each other and interact. Consider a clear policy as to when personal computing is okay or not. (this is tricky. If you are lecturing from PowerPoint, often the students become accustomed to having their own copy in front of them). Realize that whenever students have a smartphone in class, they are texting each other, probably about your lecture style.

For me, I walk around as I talk during lecture class and I notice what’s on the screen and whether the person is paying attention.

the kibitzer

the back row of the class will often be taken up by four or five really intelligent students who sit their with their arms folded, muttering to each other as you lecture.

yes, they are laughing, and yes, they are laughing at – you.

assessment: sometimes this is a bright subgroup of students. Each of them thinks they could be more exciting than you if only they were the teacher. Don’t take it personally. If that is the case, you can often leave them alone and they will do okay.

deer-in-the-headlights

There will be a group of students who actually are there to clarify what they read and to put it into perspective and context. This is the group to which your lecturing should be directed. When you are planning out the lecture, close your eyes and pretend that one of these students is sitting right there, and plan as if you are speaking to that specific student.

Restate:

For a beginner faculty member, it is easy to direct your teaching to the brightest students in the class; it is easy to focus on those aspects of nursing care that are sophisticated and cutting-edge which you yourself learned in graduate school. In an undergraduate program, this is always a mistake new teachers make.

Final Pearl of Wisdom

Direct your teaching to the middle of the class – they are the ones who can benefit from an in-person explanation. Force yourself not to spend too much in-class time with the top students. They will do fine without your help!

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part 1: Secrets of a Nurse’s Brain – six steps to success at clinical practice, or anywhere!

Shhhhhhh…..

I don’t normally share the deepest secrets of my trade with just anybody.

But you?  you are special!

pull up a chair and listen closely….. I will reveal to you a mystery of life which will change your destiny….. if you can handle it….. after this your nursing school trajectory will be brighter and happier….. and while you are at it, subscribe to this blog. At the bottom, you can click on a “Share” button to help your friends. Don’t you want them to do well too?

9781632100085-SOTG-Nepalt.indd

The back cover of my book. If this were a bookstore, you would read the back of the book-decide to buy. Find this on Amazon at https://goo.gl/PGTW30

 

 

Oh, and buy my book. It’s a novel I wrote to convey what it is like to work overseas in a missionary hospital. It’s not a sugarcoated version – the medical details are extremely accurate and well researched. It’s not the usual textbook but some schools have added it to the Global Health reading list. There is a love story of course!

Skills are more than psychomotor by nature

Okay, so I teach beginner nurses how to be a nurse. We start with well-meaning intelligent kids and turn them into professional persons. When people think about the skills nurses need to have, they list things such as giving a shot or doing a dressing change.  Using sterile technique and doing the Five Rights of medication administration.  Close your eyes and picture a nurse at work, and this is the image that comes to mind. These are the psychomotor skills, hands-on things we do for people.

It’s just as important to learn how to juggle time, set priorities and estimate workload, but these are “soft skills” – and a behavioral scientist might argue that since these can’t be demonstrated, they do not exist….. now – an educational paradox exists.

The Road Map to Success

The key to learning these skills is to learn how to use a Nurse’s Brain, what I also call a road map, and to incorporate it into your daily life.  If you are not now doing this, it will be the biggest single revelation of your trip through nursing school.

Simplest version of instructions

This is part of teaching a new nurse how to prepare. Depending on your curriculum, the faculty will tell you ” go to the hospital the day before and learn about your patient.” A less experienced faculty member might leave it at that, and set you loose. Nobody tells you how much is “enough,” but a less experienced faculty will reserve the right to criticize you when you didn’t do it right.

Long ago I learned that beginners need to be shown how to prepare and given a specific description of what this entails. Effective prep is a skill in and of itself.  Here goes.

Here is how to prepare

You will read the chart for all kinds of things – the diagnosis, allergies, meds, etc.  your school will give you a template as to things you are looking for. look up each med the person is receiving. that sort of thing.

BUT, in addition to this – when you read the chart, you find the specific list of interventions and activities for the day. they will be always be somewhere, in the old days it would be found in the “Kardex”.

Six Steps to actualize it into reality and answer the question “what do nurses do all day?”

1) Start with the “Doctor’s Orders” (which aren’t really “orders,” we just call them that…we carry them out but that is not done blindly) a typical list goes like this:

allergies: none known

diet: NPO

v.s. q 4 h

activity OOB to chair TID

midline w > d dressing to abdominal wound q 8 h

I & O

foley catheter to bedside drainage

veno-dyne boots to LEs while in bed

pain med PRN

IV D 5 NS at 125/hr

that sort of thing. okay, this was simple enough. your job is to make it happen

2) The next step is to assign a specific time to each activity. so you make a piece of paper that looks like this:

0700

0730

0800

0830

0900

0930

10 00

1030

1100

1130

you can make a template for this, and there are lots of examples of sample Brains out there….

3) next, take all the items on the first list, and add them to the second:

0700 – nurses report, find out who the nurse is.

0730 – take vital signs, ask about pain, assess dressing, check venodyne boots and IV site, look at catheter

0800 – mouth care ( since he is NPO),

0830

0900 – ask about pain med again,

0930 -dressing change

10 00 – get OOB to chair, check I & O,

1030

1100

1130 – take vital signs again (it’s four hours since the ones you took this morning)

4) next, go through the list again, and add stuff that is assumed to be needed, according to the routine of the unit

0700 – attend nurses report, find name of staff nurse also covering your patient

0730 – take vital signs, ask about pain, assess dressing, check venodyne boots and IV site, look at catheter

0800 -look at IV site q 1 h

0830 – bathe patient

0900 – ask about pain med again, -look at IV site q 1 h, give 0900 meds if any

0930 -dressing change, ask about pain if the patient got some med in advance

10 00 – get OOB to chair, check I & O, -look at IV site q 1 h

1030

1100 – write DAR note in patient chart, complete ADL checklist

1130 – take vital signs again (it’s four hours since the ones you took this morning), report off to staff nurse

0700 – attend nurses report, find name of staff nurse also covering your patient

 5) next, add some details that might not be obvious. put a box next to each item so that you can check it off when it is done.

0700 – attend nurses report  ___,

find name of staff nurse also covering your patient ___________

read specific instructions for dressing change and check to see if supplies are in the room _____________

0730 – take vital signs, ______________

and report to staff nurse,____________

ask about pain,______________

assess dressing, _____________

check venodyne boots _________________

and IV site, ______________

look at catheter, ______________

check sacrum and heels,____________

reposition if needed,___________

listen to Bowel sounds____________

and lungs______________.

confirm that ID band is in place________________ (so you will save time later when giving meds).

check call bell and make sure patient knows where it is ___________

0800 -look at IV site q 1 h ______

assess mouth and do oral care ________________

see if any other students need help with turning their patient or incontinence care _____________

doctor’s rounds _____________

0830 – bathe patient ______,

do cath care ___________

complete head-to-toe assessment sheet from School for care plan.___________

ask patient about discharge plan, _______________

assess need for teaching _____________

leave bed in low position after bath __________

0845 – short coffee break _________

report to nurse that you will be leaving for fifteen minutes _____________

check to see doctor’s orders if any new ones were written ___________ check lab results for today _______________

0900 – ask about pain med again, _________________-

look at IV site q 1 h, _____________

give 0900 meds if any. ____________

make sure you took B/P _________before giving meds. ___________

decide what the theme of the DAR note will be. _________________

0930 -dressing change,____________ (follow recipe)  ask about pain if the patient got some med in advance,

10 00 – get OOB to chair,_______________

check I & O,_____________

-look at IV site q 1 h_____________

1030

1100 – write DAR note in patient chart___________,

complete ADL checklist ___________

1130 – take vital signs again (it’s four hours since the ones you took this morning), ____________________

report off to staff nurse _________________

This is the short version. When I first teach people to do this, they may have up to forty items on the list, because they need reminders of everything.  As you can see, the Brain evolves as you add things to it. doing a dressing is more than just doing the dressing – it’s checking the pain med, checking the order, gathering supplies, and negotiating a time. each of these gets their own spot on the checklist.

If your whole clinical group is using something like this, you can plan your work as a team; you can make time to help others; and you learn to share a language as to when each team member needs help or not.

6) During the time at clinical:

http://www.amazon.com/Sacrament-Goddess-Joe-Niemczura/dp/1632100029/the Nurses Brain goes on a clipboard, and you refer to it every fifteen minutes. cross off each item as you do it. at 0900, every item that was assigned a time before 0855 ought to be done. If not, you now know which are the priority items. when something happens during the day, such as a med not in the drawer when you go to get it, you make a note to yourself using this sheet, to recheck later. assign a specific time to every event. which specific time doesn’t matter as long as there is one!

Florence Nightingale herself once said that for a nurse, learning to use pencil and paper was far more important than learning to use a stethoscope. Okay well, we’ll teach you the stethoscope too, but this Brain is what the pencil and paper are for!

There is an old rule that if you get your stuff done, and become known as a person who always completes their tasks, you will be rewarded by being assigned more tasks the next time.  You can not possibly achieve this state of bliss unless you use a checklist. The staff nurses always make snap judgements regarding the students – if you prove to them that you are using this, they will be positively impressed. They hate it when you fail to do something and then also fail to communicate with them. If you’re not going to be able to do something, you can use this tool to estimate what that would be and then tell the staff nurse in advance, which will safeguard the patient from problems. We are all  part of the team!

Using your brain is a key to college – using the Nurses Brain is the key to successful nursing!

tomorrow: part two: checklist culture and your role in quality.  There is a lot of attention being paid to this issue, and if you are the kind of nurse who makes “to-do” lists, you will succeed in nursing and in life.

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Especially for the older nursing student – it’s not about what you know

This is part of a series. click on the button at right, to subscribe to the blog.

Nowadays nursing is a popular choice for older students, whether it’s a person who already has a college degree (and is going for Master’s Entry into Nursing, or MEPN), or an LPN going back to get the degree, or somebody who needs to change careers.

Nursing school is a shock to the system

Regardless of how you got to nursing school, you find yourself back in college, back on the treadmill of studying, exams, seminars, group projects – everything. It’s a shock and a transition. For many, the shock is eased by the fact that you needed to take prerequisite courses before you finally got on the bus through nursing school, and this served to get you back into Study Mode. But it is still a shock as you learn what it is that nurses do.

through it all, there is something not to say.

“I already know everything I need to know, I am simply here to get the credential, sit for the NCLEX, and get a job. I don’t want to hear about all this theory. Just tell me what I need to do to pass the exam.”

(yes, I have heard actual students say those exact words.)

I would be the first to admit that getting a job is an okay motivation for choosing nursing, though it takes more cleverness right now than it did a year or two ago ( and yes, the job market will improve in a year or two, by the time you graduate). But if you repeat this statement in front of a faculty member, don’t be surprised if they raise an eyebrow… or two. Usually the response will be “Oh Really?” but that is not what the faculty member is thinking…….

What the faculty knows, that you don’t know

Here is why. Nurses are not paid for what they do, nurses are paid for how they think. This is such an important motto, it ought to be a tattoo (which is of course, the best way for The Youth of Today to study it).  Oh yes, we are teaching you how to insert a foley catheter, how to prepare a medication, how to start an IV, and a pile of other skills. But the skills in and of themselves do not compose the nurse. Don’t get me wrong – you need to be excellent at those skills and more. But, you need to learn how to think about patients in a wholistic manner, and also learn when not to do the skill, or when & how to change the way you do it to fit a given situation. this is the thinking part. Assessment-Plan-Intervene-Evaluate. A nurse is not a Junior Doctor; no matter how much we teach you about medicine that is only part of the nurse’s role.

for the older student

It’s possible that your faculty member may not be familiar with the term “Role Socialization” – but that doesn’t mean you can ignore this concept. Some people look at it and focus on the socialization part – thinking that maybe we mean you should be friends with your classmates. No, that is not even remotely what it means. Role socialization is the way a sociologist would describe the process of becoming a Nurse with a capital N.

Ask Yourself: How would a real nurse deal with whatever situation you are now facing?

The flip side of the coin

Here is a hint: if you ever want to impress your faculty member, ask them “How am I doing with role socialization?” and see what they say. They will most likely be impressed at the sophistication with which you are approaching the work.

If you are having difficulty getting it, the lack of role socialization will show up in your work. When you do patient care, you will miss things that you shouldn’t, and people will give you negative feedback about your “priority setting.” Or else, “lack of caring behavior” – which is of course, a dagger to your heart. A nurse’s number one job is to “care.” – we’ll go into that at some future date.

One solution? just do a websearch on the term.  You will find that there is a whole other universe out there among nursing scholars. The process of role socialization, and it’s success or failure, is a strong current in nursing education. Most of the links to it are to be found in scholarly journals. Looking for a research project?

One small Jedi mind-trick that real nurses use

Here is one tip: if a patient ever asks you a question, resist the urge to give them the answer. Always continue the dialogue by asking a followup question to clarify what ever they just said.

Boys vs Girls

I have two daughters. My wife and I, being children of the sixties, thought we would raise them in a gender-neutral way. Yes, we taught them to enjoy sports and boisterous play, such as throwing a football and go camping, and (later) to drive a stick. I built them a sandbox and got them a toy dump truck and a toy back hoe. But, even without our prompting, the two young ladies would spend time playing with dolls, doing hairplay with each other, and the like. To have kids is a fascinating experience in how girls learn to be girls and boys learn to be boys. Gender roles. the best example of socialization. Hey, I didn’t create the system, I simply bow to the fact that it exists.

Just for Men

Now, for the male student:

There are special challenges in role socialization for men who enter nursing. My best advice is to find the book “You Just Don’t Understand: Women and Men in Conversation” by Deb Tannen. Yes, it was published twenty years ago.  But it is still a classic. It’s a guide to clear communication when gender roles are different. It’s kind of book you can pick up and read from randomly yet you still will get something out of it. And on Amazon, you can get a copy for less than a dollar, plus shipping and handling.

Whenever I have a male student who is having trouble adjusting to nursing school, I lend them this book. Right now, I have no copies left…… hmmmmmm…..

Just one excerpt:

JUDGMENTS ABOUT WHY PEOPLE TALK AND DON’T TALK.

“For girls, talk is the glue that holds relationships together. Boys’ relationships are held together primarily by activities: doing things together, or talking about activities such as sports or, later, politics.” (pg. 85)

“Women and men are inclined to understand each other in terms of their own styles because we assume we all live in the same world. [A] young man in [Thomas Fox’ college] writing class noticed that his female peers refused to speak with authority. He imagined the reason to be that they feared being wrong. For him, the point was knowledge, a matter of individual ability. It did not occur to him that what they feared was not being wrong, but being offensive. For them, the point was connection: their relation to the group.” (pg. 179)

If that hasn’t whetted your appetite, I don’t know what will…… remember, it’s not about what you know, but how you think….

Do you know anybody who needs to read this? click on the “share” links below and send it along. Let’s take it viral.

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