Grounded scholar

Right now, there is too much focus on myself when I am teaching. I want to make a change!

After participating in a workshop held by The Centre for Teaching and Learning at Malmö University (about student-centeredness) I made a promise to myself and now it is time for me to embody it. Stop the talking and start making it into a real shape. I want to model with clay and I want to create digital visualizations of “real life” patient scenarios.

Two things inspire me. First, I participated in yet another workshop held by The Centre for Teaching and Learning at Malmö University, this time on the topic storytelling. Secondly, at a rhetoric lecture some years ago, I learned that what we remember from a lecture is the stories that are told and I do believe that is a truth!

Usually, when I lecture in acid-base balance I tell the students a story about when I was working in Copenhagen at a Thoracic Intensive care unit and we used a medicine called Diamox (which is an example of a specific carbonic anhydrase inhibitors who slow the acid-bace balance down). My other “story” is when the football player Henke Larsson broke his leg in 2006 (which is an example of acid-bace disorder, putative respiratory alkalosis). Thinking of it, this is NOT the stories I want my students to remember!

I want them to remember stories about different patients’ symptoms and treatments. I want them to remember how the amazing human body compensate for the disorders and I want them to remember how they as nurses’ can prevent the acid-bace disorder to happen. I want them to remember “real” patients!

My idea builds upon enhancing student-centeredness since I will give them the patients´ stories and I want them (the students) to give the answers. By recording stories and edit, those into short movies (eBites) I hope to keep the students interest and attention. After watching an “eBite” I will encourage the students to discuss with each other about for example the patient’s symptoms and suggested treatment. I would like the student to have different stories to discuss and at the end of the lecture present their discussions and answers for one another.

In conclusion, I want to enhance student-centeredness by using storytelling.

This spring I got an excellent offer to participate in a “Grounded scholar” at Malmö University. The grounded scholar will be an ongoing activity during 2017/2018 containing of,

  • Six whole day seminar sessions
  • Identification of outcomes and outputs (e.g. conference papers, learning and teaching materials etc.)
  • Tutorial support
  • Discussion based seminars
  • Dissemination conference/publication
  • Explore the concept of the ‘blended HE professional
  • In-seminar time to develop scholarly outputs

I am super excited and tomorrow I will present this idea about storytelling for my colleagues. Let me get back to you regarding the process of this project.

Photo: Pixabay

Lady Fortune

I have absolutely no intention to be disrespectful and I fear that my English skills is my shortcoming. Despite of this, I feel an urge of sharing my thoughts and I will try to express myself carefully.

It turns out, that in my research area there is a huge gap. I found peer-reviewed articles from the early 1990 were they (the researchers) literally went to the patients and asked them how it was to undergo a colonoscopy and how they (the patients) perceived it. Since then… not much has happened in the field. A handful of articles, but not many, have included the patient in studies about their (the patients) experiences of the gastrointestinal procedure. Remarkable! How is this gap even possible in the year of 2017? Now I feel like I am disrespectful… I’m not! Astonished, yes I admit… The need of efforts and considerations of how to bridge the gap of knowledge is most important.

At first I blamed the doctors, and that this chasm was caused by deficient knowledge or perhaps, lack of acceptance for descriptive qualitative research methods. This assumption of mine is unfair, unclear and not pertinent to discuss further. Dear doctors, I beg your pardon!

Nurses are familiar with different research traditions and are used to move between quantitative, mixed-methods and qualitative methodology.

Now I hold my own sisters, the nurses, responsible for it… or actually, I don’t. Who am I to have complains? I haven’t played a part in a lot of research have I? A lot of excellent endoscopic nursing research has been conducted in areas such as; documentation, communication, decontamination, screening, sedation, bowel preparation and so on…

Nevertheless, “someone” forgot to ask the patients about there experiences.

It turns out, I feel like Lady Fortune and I believe that my qualitative research skills can come in handy now when I’m about to do this thesis. Future contributory research should focus on designing qualitative studies, with conscientiously described methodology, that present patient-derived data, in order to further increase the knowledge about what patients’ experiences during colonoscopy (Brown et al, 2015; Tierney et al, 2016).

References
Brown S, Bevan R, Rubin G, Nixon C, Dunn S, Panter S, Rees CJ, (2015) Patient-derived measures of GI endoscopy: a meta-narrative review of the literature. Gastrointest Endosc, 81(5), 1130-1140.

Tierney M, Bevan R, Rees CJ, Trebble TM, (2016) What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care. Frontline Gastroenterol, 7(3), 191-198.

Photo: Pixabay

Wait a minute…

Yesterday I thought a lot of patient experience vs patient satisfaction and I felt I was going in circles – round and round and round. Made me dizzy! Today, I come to think of it again… The thing is, I think I got it… Funny enough, it was my dysfunctional marriage (2017) that gave me the final clue.

Early in life many of us learn to lower our expectations in an attempt to reduce the chances of getting disappointed, right? It’s kind of a life hack – to go around with not too high expectations and then when you least expect it to happen, it surprises you, and – voilà! – suddenly you’re extremely happy and satisfied. Just because you had no expectations and this experience was more then you expected 🙂 If you for example have high hopes and expectations on your marriage and believe it’s going to be like in the romantic comedy films, then you (sadly) probably going to experience something else and be terribly disappointed.

Consider these two scenarios:

  1. The patient is an anxious younger woman and she expect the colonoscopy to be painful and embarrassing and in the end it turns out to be quite “OK” since the sedation made the pain go away and also added a bit of amnesia. Given those circumstances, we can suspect the experience of the colonoscopy in this case to be over expectations and a pretty “good” experience. We have a satisfied patient.
  2. The patient hasn’t heard anything negative about colonoscopy and has a strong believe in the health care system. There will be no need for sedation since the patient is a calm elder male. Under the procedure, at the end of it, he gets nausea and hypotension due to visceral pain. It all goes away in 2-3 minutes but the patient ends up with a feeling of betray and loss of control. This patients experience was not align with the expectations and it ended up with an unsatisfied patient.

The conclusion: The satisfaction is closely connected with the expectations of the experience. Research on satisfaction much include both expectations and experiences meanwhile research on experiences can “stand alone”. Regarding my choice, the focus must be on the experience instead of satisfaction!

You made it clear to me, Stefan. Thank you for marrying me 16 (long) years ago!

Reference
My dysfunctional marriage (ongoing) Real life marriage. Yours 4ever and ever… and ever, until death do us part, Sweden.

Photo: Pixabay

New dimensions

Still trying to adapt to my “new” life as a PhD student. The hardest part is to prioritize which “task of the day” I’m should lay hold of. There are so many of them… so how do I select them in a good, structured and effective way? I find myself doing list of what I’m about to do… spending time to organize my tasks instead of actually do them. But I’m doing “things” all the time, every day of the week and still… it is not enough. Every so often, I think I’m on the wrong path but then I remember that the path never is straight forward. The path is supposed to be winding and that the path is the journey and that the process have to take time… and then I’m back in my loop again, trying to figure out what to do next. Maybe a blog post…?

Earlier I wrote about six dimensions of quality, according to the report “Crossing the quality chasm”. Today I’ve learned about new dimensions but this time it is regarding “Patient satisfaction”. Ware et al. (1978) argued for 8 dimensions of patient satisfaction in a proposed taxonomy:

  • Art of care
  • Technical quality of care
  • Accessibility/convenience
  • Finances
  • Physical environment
  • Availability
  • Continuity of care
  • Efficacy/outcome of care

It amaze me that some truths still remains. The taxonomy is complex and two weeks ago I got the suggestion or may I say an advice not to center my attention towards patient satisfaction and instead focus on patient experiences since it is an “easier” topic to define and thereby study. I’m in an early stage of my research and now, I have the opportunity to choose, so obviously I’ve been thinking a lot of this ever since.

I looked attitude up on the internet and is says “A settled way of thinking or feeling about something“. Our expectations is “A strong belief that something will happen or be the case“. My instant thought is that this must be very individual, I mean which attitude and what expectations we have. And then we experience something “An event or occurrence which leaves an impression on someone” and perceive it “A way in which something is regarded, understood, or interpreted“.  Again, extremely individual how an event is interpreted by my attitude. So were does satisfaction fit into all this? The internet says that satisfaction is “A fulfillment of one’s wishes, expectations, or needs, or the pleasure derived from this“. I don’t know about this pleasure thing according to my research topic, colonoscopy, but definitively needs. This is align with Cleary & McNeil (1988) who states that patient satisfaction builds upon the individuals needs. So, is a patient satisfied if their individual needs are fulfilled? Then I have to identify which needs are the most common to patients undergoing a colonoscopy in order to know if the patients is satisfied with the experiences from the procedure, right? Easy Peasy!

Or… Why not choose satisfaction, why is experiences (and for that matter needs) “easier”? Is experiences more single dimensional? Maybe, I don’t have to go all the way around…? Some may define patient satisfaction in the gap between the patient expectation and the actual experience (Beattie et al., 2015). There are many definitions of patient satisfaction and one reasonably definition is made by Maciejewski et al. (1997) who suggests that it represents:

“A patient’s cognitive or emotional evaluation of a health care provider’s performance and the evaluation is based on relevant aspects of the patient’s experience.”

I guess I’m back with patient experience. I realize that yet another task for me, is to define patient experience. One way to consider patient experience is in terms of the determinants (factors) of the experience, its components and/or the outcomes of the actual experience (de Silva, 2013). In the report de Silva refers to a study by Lau et al. (2012) who indicates the need of, not only focusing on the experience but also ask patients about their levels of experience and how they want to see it improved. I believe I’m back again with the outcome – patient satisfaction…

squint-518072_1920
*BIG sigh & rolling my eyes*

References
Beattie M, Murphy DJ, Atherton I, Lauder W, (2015) Instruments to measure patient experience of healthcare quality in hospitals: a systematic review. Syst Rev, 23, 4:97.

Cleary P, McNeil B, (1988) Patient Satisfaction as an indicator of quality for care. Inquiry. 25, 25-36.

de Silva D, (2013) No 18: Measuring patient experience. Evidence scan, The health foundation.

Lau RL, Gandhi R, Mahomed S, Mahomed N, (2012) Patient satisfaction after total knee and hip arthroplasty. Clin Geriatr Med, 28(3), 349-365.

Maciejewski M, Kawiecki J, Rockwood T, (1997) Satisfaction in understanding health care outcomes research. Gaithersburg, Aspen Publishers Inc.

Ware J, et al. (1978) The measurement and meaning of patient satisfaction: a review of the literature. Health Med Care Serv Rev. 1(1), 3-15.

Photos: Pixabay

A siren call

The first course that I participate in, as a PhD student, is a course in psychometric, and it will last the whole semester. I have to travel approximately 1,5 hour to get there since it’s located in another part of the county I live in. I wake up at five o’clock and try to go to bed early (before I fall asleep standing…). I have to say, it is such a positive experience. All the participants are friendly and they seems to be competent in their areas. Not to mention our teachers, who are immensely skilled! I feel blessed to get the opportunity to take part in this course of study.

Yesterday we talked about validity and reliability and today, in the morning, our focus was factor analysis. After lunch we started to practice what we’ve been lectured about. Basically, we sat in front of computers trying to estimate different psychometric tests. It was hard but also lots of fun!

Now and again, during these two days I have felt the urge of laughter, not knowing what to think, what to do or say… Occasionally, I’ve been completely lost. Still, in the middle of this misleading trip of psychometric chaos, I’ve manage to redirect myself, past latent variables and dichotomous items toward the water surface. And guess what I found deep down in the ocean? I found a theory who called for me like a siren from the Greek mythology. Don’t think the siren is a dangerous creature but presumably precarious and definitely challenging. The theory that I discovered is called “Item response theory” (IRT) and these videos will cradle me to sleep tonight… Zzzzz…

Photo: Pixabay

Dangerously tangled

Right now, I aim to enhance my PhD project plan and in this work I’m desperately seeking structure. I have lots and lots of articles (and they’re continuously increasing), on my desk, in my backpack, on the toilet, on the bedside table, even in my laundry. They’re possibly everywhere – all over the place.

Emily Sparkes have done and shared a brilliant infographic in her Twitter account, demonstrating my (and obviously others) dilemma.

Presentation1

How on earth will I ever get this straight? I’ve tried to do numerous of tables in word and several excel sheets but nothing seems to give my an overview of the different pieces and how they fit (or not fit) together. My new strategy is to try mind-mapping. A few years ago I gained acquaintance with Coggle and since then I have a penchant for this excellent and free (!) tool. To structure all the articles is a hard and time consuming work but to my contentment and absolute joy, the use of different colors are now free. This makes my experience surprisingly more pleasant. Hopefully, this mind-mapping will help me unravel my article chaos. I cross my fingers!

Projektplan_Patient_satisfaction

Photo: Pixabay

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