Violence in the medical workplace

Photo by https://www.flickr.com/photos/sandeepachetan/

Nursing is notorious as being one of the most violent occupations, but for a field that is devoted to healing and caring, why would there be any reason to resort to violence?

Seattle Times (2011, July 12) published a feature by reporter John Ryan, of KUOW News, stating that nurse’s aides have the most violent jobs; in particular, those who work at Western State Hospital and care for psychiatric patients with a criminal history. Although most nurses will never work with patients from this demographic, there are other patients that predictably resort to violence.  Such patients include:

• Those that are confused either due to memory loss or a physiological imbalances such as low blood sugar
• Intoxicated or drugged patients
• Situationally angry patients or family members

Of all medical professionals, emergency room (ER) staff see more patients that exhibit aggressive tendencies than any other medical specialty.  The American College of Emergency Physicians (Fact Sheet, n.d., para. 3) attributes this imbalance to several reasons, most of which are due to the primary function of an ER; acute care. Reasons listed include, “increased numbers of gang members in urban areas, increased use of alcohol and other intoxicating agents, and increased use of Emergency rooms for temporary holding of psychiatric patients.”  In a study conducted by Fernandes et al. (1999), “over 50% of emergency department health care workers report being physically assaulted in the course of a year and 90% had been verbally abused at least once a week.”

For the above reasons, many hospitals and emergency departments have implemented training as a way for employees to recognize the initial signs of aggression and learn how to handle violent situations.  The Centers for Disease Control and Prevention (Workplace Violence, n.d.) has a nice online training module that teaches important strategies to avoid and reduce workplace violence.  Ways to stay safe include removing jewelry that can be grabbed, facing patients at all times, and knowing all exit options.  Also, learning how to diffuse situations of mounting tension is an important strategy for this and most training modules.

In my own experience as an emergency room nurse, I have received training to avoid and protect myself from violence.  Some of my training included:

• Safety in numbers.  People who are on the verge of becoming violent often back down when they are outnumbered.  
• Violence begets violence.  Do not argue with someone who is losing control.  It is unproductive and unhelpful.  
• Assume the worst.  Until rapport has been established, every patient could be potentially dangerous.  Know your patients and pay close attention to characteristics that may jeopardize your safety.  
• Watch yourself.  Some patients, when scared, become hitters, biters, spitters, and kickers. Remain vigilant and keep a safe distance when possible.

In summary, although I found training helpful, experience is still the best teacher. In my experience, I found that the most common form of physical violence stems from elderly, confused patients, who suffer from a form a dementia. These patients, in particular, need a calm environment and extra time to help them keep control.  When placed in an unfamiliar, chaotic setting, they can become scared and sometimes, resort to lashing out.  Fortunately, not all patients with dementia act this way and even patients who are fully cognizant, often need short amounts of information, with repetition if necessary.  

Lastly, and most importantly, for patients who cannot maintain control, medical workers need to recruit the help of others so that medical care can be provided and injuries can be avoided.  

References

Fact Sheet. (n.d., para. 3).  In The American College of Emergency Physicians. Retrieved from http://newsroom.acep.org/index.php?s=20301&item=30010

Fernandes, C. M., Bouthillette, F., Raboud, J. M., Bullock, L., Moore, C. F., Christenson, J. M., & ... Way, M. (1999). Violence in the emergency department: a survey of health care workers. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne, 161(10), 1245-1248.

Workplace Violence Prevention for Nurses. (n.d.). In The Centers for Disease Control and Prevention. Retreived from http://www.cdc.gov/niosh/topics/violence/training_nurses.html

Seattle Times ( July 12, 2011 http://seattletimes.com/html/localnews/2015584122_apwaworkplacesafety1stld.html)

John Ryan, KUOW News.

Reflection

• Surprising aspects about how people learn

As I wrap up my current studies of learning theories and styles, what I found most surprising was how well the learning theories explained how I learn, and that one theory could not be used for all types of learning.  I found behaviorism applicable to the way children begin learning, as veritable “blank slates”; whereby knowledge is gained by experience through the senses (timeline, n.d.).  I also found that as much of the world has changed the way information is sent, received, and displayed, the philosophy of connectivism explains how learning occurs through internet resources and networks (invention-of-the-internet, 2010).  People with internet access use various nodes or resources to connect with people or computers in order to find information. This is especially apparent when people use the internet to find Blogs and Wikis that, although may not have the traditional stamp of “peer reviewed”, hold valuable insights that should not be dismissed.

Another aspect that I found surprising when researching learning theories is the idea that instructors can assist learners through extrinsic motivators.  It is a concept that I initially disregarded because I thought all motivation for learning had to be from within or intrinsic. To a large extent, I still believe that intrinsic motivation has to be present but with encouragement, modeling, and teaching methods, instructors can help students get through times of motivational ebbs.   

• My personal learning process

This course has helped me reflect on my own learning style and has change some of my preconceived notions.  I used to think I was primarily a kinesthetic learner in that if I tactically learned information, I better understood it.  I have come to find that that is not always the case because much of what I learn is not kinesthetic.  For instance, I can learn about the circulatory system by reading about it and constructing new knowledge based on my understanding of anatomy and physiology.  For a deeper understanding, I can see visual representations of the circulatory system with color coding to represent veins and arteries.  In addition, I can listen to the sound of normal versus abnormal heart sounds, and finally, I can feel pulses to differentiate between strong or thready ones.  Given this holistic approach, I now understand that I need information presented in context and in different modalities.

• The connection between learning theories, learning styles, educational technology, and motivation

Most of us use technology in one capacity or another to learn.  Since learning theories help explain the ways people learn, learning styles describes the modalities in which learning occurs, and motivation is the underlying assumption or necessity for learning; technology can be used as a tool to learn.  The above terms have the commonality of how learning occurs in modern society; how information is presented, what instruction is appropriate, and who is the target audience.  Since more learning institutions and corporations need training, Instructional designers can choose which theory best meets instructional goals, which modality or learning style is most suitable, and what tactics can keep learners motivated.

• Learning theories applied to the field of instructional design

Instructional designers need a tool belt, so to speak, of methodologies to teach computer based or online learning.  Learning theories are on the belt.  Given that not all learners are the same; each has their own experiential framework, basis of knowledge, preferences for learning, and personal interests; instructional designers need have learning theories to help understand why:

- learners are so different

- variety is needed in any learning environment

Learners come in all shapes, sizes, cultural backgrounds, ages, and experiences.  Some readily participate while others need more encouragement or baiting.  Some learners enjoy listening to podcasts, others enjoy reading a well written article, and there are those who enjoy being creative; by designing a slideshow or other format.  In actuality, most learners enjoy variety and content can be designed to help keep learners interested and engaged.  Instructional designers use learning theories and styles when creating material that is appropriate for content and audience composition.  For example, young or resistant learners may need more scaffolding or cognitive support as they become more independent in their learning endeavors.    

In summary, the learning theories provide a framework for designing the training materials and curricula catered to the learning goals of knowledge seekers.

References

Flash Media Program: "Timeline of the History of Learning". Retrieved from http://mym.cdn.laureate-media.com/Walden/EDUC/6115/01/mm/tec_timeline.html

The invention of the internet (2010). Retrieved from http://www.history.com/topics/inventions/invention-of-the-internet.

Fitting the Pieces Together

• Now that you have a deeper understanding of the different learning theories and learning styles, how has your view on how you learn changed?

When reviewing my thoughts on the different learning theories and styles, I am still in agreement with some of my initial ideas but have revised others.  Initially, I stated that I felt most of my learning was based on the theories of behaviorism and constructivism.  Today, I still believe that the foundation for early learning develops through reinforcement of behaviors and that habits form through repetition. This is because children do not start with a large knowledge base or previous experiences from which to draw inferences.  As children mature, they soon build a groundwork of knowledge and at a fairly early age, can add new learning experiences to it. This style of learning through building personal truths follows the constructivist epistemology (Ormrod, Schunk, & Gredler, 2009, p. 184).  

My other views of learning have changed as I have studied new theories and their applications. For example, I can appreciate the theory of cognitivism because it emphasises what a person is thinking rather than doing. Learning occurs when information is encoded, stored, and organized in such a way as to make it more accessible (Ertmer & Newby, 1993, p. 58.). I also appreciate how the theory of Social Constructivism describes how much of our learning occurs through interactions with others and the meanings we give to new information (Kim, 2001).  Lastly, I think that Connectivism has made a great impact on how I view modern learning styles. Instead of finding information in discreet places such as hard copy books and journals, computer technology has made it possible to gain knowledge through online resources; be they blogs, wikis, or new contacts.

A final aspect of my reformed understanding of learning is that, although people may believe they have a preferred learning style (visual, verbal, kinesthetic), I think most information is best encoded through more than one modality; that information is stored with context and is thus more meaningful.  As an instructional designer, I plan to create learning environments using various modalities so that learners can build new knowledge as a more meaningful learning experience.

• What have you learned about the various learning theories and learning styles over the past weeks that can further explain your own personal learning preferences?

In regards to myself, I learn best through experience; by applying new information to something meaningful.

Confucius

People learn in different ways, and although some people are very attentive listeners, abstract visualizers, or creative builders, I need a combination of the three learning styles (visual, auditory, kinesthetic) but not for every learning situation.  Dr. Willingham (2008) describes how people can learn in any of the three ways but that some learning needs to occur with the correct modality.  For example, if I want to teach people how to check their blood sugar level, I could simply describe the method but a more meaningful learning environment would include a demonstration.   

In having a better appreciation of my own learning styles, I understand, that not everyone learns or understands in the same way.  Instructional Designers must therefore create learning experiences that appeal to a broad range of learning styles and are appropriate for the content.     

• What role does technology play in your learning (i.e., as a way to search for information, to record information, to create, etc.)?

Technology plays a prominent role in my learning.  In fact, it seems very little of my current learning comes from sources other than computers because I use them for both academic and personal interests.  I also use technology for work related information; as a resource for company related information as well as a tool to help me do my job.  

An important way that I use technology for learning includes information searches either on the world wide web and or through restricted portals such as a university library system. Technology has also changed the way I store important information.  Instead of having reams of paper stored in file cabinets, I store most data on my computer or in a cloud based service such as Google Drive or DropBox. I also use technology for data manipulation such as calculating taxes and balancing home finances. To learn a new skill, I often turn to videos on Youtube and to learn new or evolving perspectives, I network with people through blogs or social websites.  Lastly, I use technology for creativity.   I enjoy taking information or images and presenting them in different formats. This process not only helps fill my need to be creative but also reinforces some of the information I have learned.  

References

Ertmer, P. A., & Newby, T. J. (1993). Behaviorism, cognitivism, constructivism: Comparing critical features from an instructional design perspective. Performance Improvement Quarterly, 6(4),50-71.

Kim, B. (2001). Social constructivism. In M. Orey (Ed.), Emerging perspectives on learning, teaching, and technology. Retrieved from: http://projects.coe.uga.edu/epltt/index.php?title=Social_Constructivism

Ormrod, J., Schunk, D., & Gredler, M. (2009). Learning theories and instruction (Laureate custom edition). New York: Pearson.

Willingham, D. (2008, Aug 21). Learning Styles Don’t Exist [Video file]. Retrieved from: https://www.youtube.com/watch?v=sIv9rz2NTUk

Learning Theory Matrix

Reflections on Connectivism

The following is a reflection on how my connections facilitate learning.  The questions were posed by my instructor and prompt me to consider how I learn in the 21st century given the addition of technology.

How has your network changed the way you learn?

My Network has changed the way I learn because my network has changed.  Before 1990, the World Wide Web, as we know it, did not exist (“History of the Web,” n.d.). We relied heavily on obtaining information from those closest to us.  Our learning network consisted primarily of our family, friends, acquaintances and hard copy educational materials.  To find information, we could either ask those who we deemed as knowledgeable in a particular field or went to the library.

  

Today, my network still includes the people I talk to and the library, but with the addition of technology (the world wide web), my network has increased dramatically and I am a more independent participant in information acquisition.  Information that once took me hours or days to locate is now available almost instantaneously and this same information “can now reach literally millions of people around the world within a matter of seconds” (Davis, Edmunds, Kelly-Bateman, 2008).   The network I use to gather information will depend on the problem I am trying to solve or the question for which I am trying to find an answer.  When I am at work as a nurse, I can ask my colleagues questions or seek answers via  the intra or internet. For school work, I can find scholarly articles through the online library or seek general information through classmates, instructors, wikis, blogs, or reputable web sites.  In summary, my network has changed the way I learn by making the information I seek, more readily available.

Which digital tools best facilitate learning for you?

When considering the different digital tools that facilitate my learning, the tool I select depends on the reason I need it.  Using a modified Bloom’s Revised Taxonomy (Clark, n.d.) I am better able to categorize my tools:

Remembering: (Recalling data or information) ex. Google Calendar, Evite.

Understanding: (Comprehending the meaning of instructions and problems) ex. Virtual libraries, Youtube, Wikipedia, Google scholar

Applying: (Using a concept in a new situation or unprompted use of an abstraction) ex. Google Docs, Blogger, Freeplane.

Analyzing and Evaluating: (Separating  concepts into component parts, distinguishing between facts and inferences. Making judgments about the value of ideas or materials.) ex. Excel or Google spreadsheet, shopsavvy.

Creating: (Building a new meaning or structure.)  ex. Microsoft Paint, Prezi, Wix.

Collaborating: (working jointly on an activity, especially to produce or create something). Facebook, Skype, Docs.

How do you gain new knowledge when you have questions?

If I don’t personally have the knowledge base to answer my questions, I use different tactics.  Sometimes I simply ask another person; a family member, friend, or coworker.  This is often a very fast way of obtaining information from someone I consider an expert; i.e. a person who has attained a high level of competence in a domain (Ormrod, Schunk, and Gredler, 2009,  p. G-2).  For example, I work at a hospital and one of my coworkers is very knowledgable about the policies and procedures of the hospital, another co-worker is familiar with scenarios that are uncommon, such as what to do when a patient is unable to give consent for treatment.

For other questions, I primarily turn to online resources. The site I use, depends on the situation. Often, I “Google” information whether I am looking for a recipe, a tutorial, or a definition.  For research though, I use scholarly sources that I find through the university library system or Google scholar.  At times, I even use information obtained from Wikis and Bloggers but with caution to verify their expertise or the sources that they cite.   

In what ways does your personal learning network support or refute the central tenets of connectivism?

My learning network supports the tenets of connectivism in many ways.  “Connectivism is a theory that presumes that learning occurs as part of a social network of many diverse connections and ties” (Dembo,  n.d.).  A network can include people we know as well as people we do not know through the use of technology. According to Davis, Edmunds, Kelly-Bateman (2008), since “we can no longer personally experience everything there is to experience as we try to learn something new”, we create networks, or learning “entities”.  

As shown in my “Connectivism” mind-map, I have many sources from which I derive information and the map will continue to expand as my learning increases.  By relying on this network, I support one of the principles of connectivism, “Learning and knowledge rest in diversity of opinions” (Siemens, 2005).  Other principles I support are, “Currency (accurate, up-to-date knowledge) is the intent of all connectivist learning activities and maintaining connections is needed to facilitate continual learning” (Siemens, 2005)  I follow these principles by maintaining a relationship with both my live and online contacts so that I can get information in a timely manner.  

References:

Clark, D. (n.d.) Bloom’s Revised Taxonomy in Big Dog & Little Dog’s Performance Juxtaposition. Retrieved from  (http://www.nwlink.com/~donclark/hrd/bloom.html)

Davis, C., Edmunds, E., & Kelly-Bateman, V. (2008). Connectivism. In M. Orey (Ed.), Emerging perspectives on learning, teaching, and technology. Retrieved from http://projects.coe.uga.edu/epltt/index.php?title=Connectivism

Dembo, S. (n.d.) The networked student...in plain English. In Teach 42 Education and Technology.  Retrieved from http://www.teach42.com/2008/12/06/the-networked-student-in-plain-english/

History of the Web. (n.d.). Retrieved June 8, 2014, from http://webfoundation.org/about/vision/history-of-the-web/  

Ormrod, J., Schunk, D., & Gredler, M. (2009). Learning theories and instruction (Laureate custom edition). New York: Pearson.

Siemens, G. (2005, January). Connectivism: A learning theory for the digital age. International Journal of Instructional Technology & Distance Learning. Retrieved from http://www.itdl.org/Journal/Jan_05/article01.htm.  

Connectivism

May I have your attention please...

There are several theories to how information is processed and encoded but in order for it to be learned, “attention is a prerequisite” (Ormrod, Schunk, & Gredler (2009, p56).  Commodari (2012) contends, “Attention is of key importance in acquiring and developing all cognitive and behavioural skills.”  Additionally, Daniel Goleman (2014), in his NY Times blog, reports that researchers believe attention and cognitive control, “predicts success both in school and work life.”  Maintaining focus can be challenging for everyone and at some point may be considered a deficit when it is lacking.  My goal is not to make a differentiation or clinical diagnosis of attention deficit but to address some of challenges teachers face when trying to keep students focused.

Although the traditional classroom and education system has gone through some changes over the years, teachers in a brick and mortar setting still have to compete with distractions that pull student’s attention away from their studies.  Such distractions include the all too common talking, passing notes, and daydreaming, but a relatively new diversion is electronic devices such as cell phones and games. For some, games and electronic devices are considered an unwelcome disruption but according to Griffiths, (2002), games “provide an innovative way of learning and may hold a student’s attention for longer periods of time." Although games and play based education have been available for some time, very few have made it into the classroom and those that have, are often designed for young students (Castell, & Jenson, 2004).

For those educators who are trying to win the battle over student attentiveness, Herrman, (2011) has provided some practical ideas:

• meet the needs of learners
• remember that enthusiasm is contagious
• use creative teaching strategies to enhance learning experience

Cain, Black, & Rohr, (2009) used a different strategy to increase student attentiveness in a Physiological Chemistry/Molecular Biology course. An audience response system (ARS) was introduced as a means to keep students engaged in lecture material by allowing participants to cast votes when prompted; much the same way as used in audience participation shows like American Idol and Dancing with the Stars.  In the study, students were asked to respond to multiple choice questions via an electronic device.  The study found that the ARS system “improved student motivation and attention during lectures and provided immediate feedback to the instructor concerning student understanding of lecture content."

In sum, as referenced in my online and library sources, education is changing and teachers are facing new obstacles when trying to maintain student’s attention and limit distractions.  These sources are current and relevant in that we are in an age of rapid technological changes that influence every aspect of our lives, including education and learning. One of the greatest challenges for teachers, therefore, will be to keep an open mind about the possibilities that technology and games may have in the classroom and to consider a more interactive approach to the learning process.

Cain, J., Black, E. P., & Rohr, J. (2009). An audience response system strategy to improve student motivation, attention, and feedback. American Journal Of Pharmaceutical Education, 73(2), 1-7.

Castell, S., & Jenson, J. (2004). Paying attention to attention:New economies for learning. Educational Theory, 54(4), 381-397.

Commodari, E. (2012). Attention skills and risk of developing learning difficulties. Current Psychology, 31(1), 17-34. doi:http://dx.doi.org/10.1007/s12144-012-9128-3

Goleman, D. (2014, May 12) Exercising the mind to treat attention deficits [Blog post]. Retrieved from http://well.blogs.nytimes.com/2014/05/12/exercising-the-mind-to-treat-attention-deficits/?_php=true&_type=blogs&_php=true&_type=blogs&_r=1&

Griffiths, M.D. (2002).The educational benefits of videogames, Education and Health, 20(3),47-51. doi:http://dh101.humanities.ucla.edu/DH101Fall12Lab4/archive/files/6070f0882cc89baa5a12992aaea56028.pdf

Herrman, Judith W, PhD,R.N., A.N.E.F. (2011). Keeping their attention: Innovative strategies for nursing education. The Journal of Continuing Education in Nursing, 42(10), 449-56. doi:http://dx.doi.org/10.3928/00220124-20110516-05

Ormrod, J., Schunk, D., & Gredler, M. (2009). Learning theories and instruction (Laureate custom edition). New York: Pearson.