Blog 10: The future of Health Education

When I started my Professional Masters in Education at Queens I new that I wanted to focus my assignments and personal research around online education. At the college where I teach there has been an initiative to increase the number of course offerings online in order to better accommodate students of all ages and career stages. This past week I was asked to teach a health course that I have had the privilege of teaching 8 times before, the only difference is that this time it will be online.

Teaching a health course online seems increasingly logical to me. For the most part how the body reacts to outward threats and stimulations is a predictable pattern of events that requires a level of memorization in order to build an understanding of what is happening. The part that is not as straight forward is teaching the soft skills that are easily implemented in a classroom setting. How will I be able to focus on the critical skills of group work, critical thinking and problem solving, innovation, communication and intercultural skills when the physical barrier of a screen is between all of us?

When looking through resources it appears that this may be a time for creativity in teaching to come into play. Teaching.ca has some amazing suggestions about how best to implement these soft skills into programming. Taking advantage of the platform I will have access to will be fundamental, ensuring that students are engaging in discussion boards, bouncing ideas off of one another and pulling from their available resources to do so will allow for group work to flourish. Looking at different options for cross discipline learning, where the students I am working with pair up with students from other programs to run large scenarios that are constructed online could allow for improved critical thinking, problem solving and communication across all disciplines. When it comes to cultural care, an online platform could allow for some amazing opportunities. By reaching out to cultural community leaders I can have guest experts available to answer questions and give advice on how best to provide care in a culturally competent way.

While there are certainly barriers to online learning the opportunities are also endless. By utilizing technology we as educators will be able to provide education for students regardless of where they are located or what point of their career they are in. This will help to improve access for everyone to higher education and prevent education deserts for those in remote areas of the country.

Resources

https://teachonline.ca/tips-tools/beyond-course-content-teaching-core-skills-online

Blog 9 The Future of Care

Just over 100 years ago the leading cause of death was bacterial infections. Things have changed. Health care has evolved and we now have antibiotics in order to prevent illness caused by bacteria. This is difficult to believe, modern medicine which I would argue came into being around the time of penicillin, has only been a practice for roughly 100 years. In this time we have focused on reacting to disease in order to treat people when they have become sick, however in order to ensure continued health and improvement a shift in how things are done is needed.

Alexander Fleming the discoverer of Penicillin Image from: https://en.wikipedia.org/wiki/Penicillin

Today more than 38 million people die from chronic disease each year which is the leading cause of death far outpacing infectious diseases. What is unique about this is that with proper programming and initiatives these deaths could be preventable. The illness’ we are discussing are typically cardiac disease, uncontrolled diabetes and respiratory diseases. It is estimated that in Canada 33% of our health care costs go towards the treatment of chronic illness. As such I would argue it is time for a shift in how we educate health care workers. By continuing to focus on reactive medicine and how to treat acute changes to the body it is necessary for us to begin focusing education more on the chronic diseases that people are faced with every day and how these illness’ affect their lived experiences.

By focusing on chronic illness in the education of health care workers we can better prepare them for the realities of the system they are entering. Someone with a passion for emergency medicine may be shocked to learn that more often then not the patients that will be treated are those seeking relief from the symptoms of their chronic condition. How then do we educate students on this new reality of care? How can we solidify the adage “an once of prevention is worth a pound of cure”?

One of the largest barriers to overcome is cost. The difficulty that preventative programming typically runs into has to do with the price of the programming. It is often difficult to measure the benefits of these programs as they do not showcase in the short term. If we were to implement a program now that partnered every citizen with a personal trainer once a month in order to guide them through physical fitness it could be argued that instances of diabetes and cardiac disease would be decreased and as such the cost on the health care system would be drastically decreased, but these affects won’t be seen for decades.

As a health educator the importance of focusing on chronic disease management and treatment for students is clear. The goal now will be to modify curriculum to address the challenges that these illness’ present to our system, and engage students in a way that allows for creative responses to these new challenges.

Resource

https://www.ivey.uwo.ca/healthinnovation/blog/2019/05/from-reactive-to-proactive-examining-the-rise-of-chronic-disease-on-a-global-scale/

Blog Post 8: Ways of Knowing

Healthcare has undergone a renaissance in the past few decades. Gone are the anecdotal remedies of the witch doctors and here to stay is the evidenced based practice approach to care… sort of. When considering the education of future health care workers it is important to focus on what constitutes knowing. Throughout this post we will explore the traditional way of knowing something and how it contrasts with the scientific approach.

“This always works for me. In my experience the best approach is… Every time I do this, that happens”

These are the catch phrases of anecdotal evidence. We as a species have developed to place a lot of value in our perceived connection between two things. In an article by Michael Shermer for Scientific American this is explained by the fact that having a perceived positive correlation between two things is rarely harmful. However in an age of research studies and new interventions it is not only important but necessary for us to change the way we think.

By focusing on clinical trials and blind studies we as care providers and consumers of health care can ensure we are utilizing treatments that have shown the greatest outcomes for the most people. In a scientific approach to knowing, the goal is to overcome our programming of accepting correlation as causation and to look at what actually causes something to happen. This is typically accomplished through blind research studies. This means that the researcher does not know which group of participants has the intervention being researched applied and which group has the control being applied. In a medication trial this would mean two groups of participants, one group has the current best medication treatment while the other has the new perceived better medication.

After the trial period the data and outcomes are collected by the researcher and they can then state which of the two groups had better outcomes. Only after the outcomes have been calculated does the researcher learn which group had the new medication. In this way we prevent our own personal bias from influencing the results, it also prevents researchers from leaving out results in order to make the numbers look better for their new approach.

By working with students and showcasing the importance of scientific evidence we can help them to access the most appropriate research when forming their own opinion about care plans. Further we can work with patients and the public to help everyone become more comfortable with scientific thinking.

Resources

https://www.scientificamerican.com/article/how-anecdotal-evidence-can-undermine-scientific-results/

Blog Post 7: How Technology Affects Health Provider and Patient Relationships

Prior to my current role I worked in a small town emergency department, I distinctly remember an elderly couple coming in dressed to go to a wedding. They had stopped by quickly because the husband was having some stomach pain for the past couple of days. The couple was convinced, after consultation with Google that he was having an abdominal aortic aneurism. I stopped what I was doing at triage and said I can pretty much guarantee you have not been having a AAA for the past few days. The couple became offended and asked how I could possibly know that. My response, you would have been dead by now. I am not proud with how I approached this situation, I should have taken more time to explain to the patient and his wife why their Google search was misleading, however I was in the middle of a 12hr emergency department shift and had been hearing about patients self diagnosis for Google all day.

If we are to teach healthcare to students online I feel one of the most important things we can do is address the growing trend in patients using online resources to research conditions or symptoms. This is done prior to, during and after their appointments with the health care team. Gone are the days of blind trust and adherence to what the doctor orders. Now that people have access to more medical knowledge then ever before, it is important that we all learn how best to interpret the information we can access.

A 2017 research paper by a group of researchers in Australia explored the affects of patients use of Dr. Google on the healthcare provider and patient relationship. Interestingly opposite to the common thought amongst researchers and practitioners patients that stated they often used web based resources when looking for information about symptoms and diagnosis reported a better relationship with the health care team.

It is important to note that the research did identify that patients are not always accessing the correct information online and as a result have different expectations from the team then what can be delivered. A suggestion from the researchers was that a more collaborative approach to resources should be considered. If health care professionals can point patients to reliable and accurate information it can help prevent patients from accessing misleading resources that can hinder their care.

It is an increasingly exciting time in health care as more and more resources become available for treatment. When we look at teaching future health care workers in an online format, it is clear that an understanding of the current relationship between the internet and health care is important. By focusing on this relationship we no only help patients navigate the system but also help students understand the types of resources that are available for their patients.

Resources

Lee, K., Hoti, K., Hughes, J. D., & Emmerton, L. (2017). Dr Google Is Here to Stay but Health Care Professionals Are Still Valued: An Analysis of Health Care Consumers’ Internet Navigation Support Preferences. Journal of medical Internet research19(6), e210. https://doi.org/10.2196/jmir.7489

Blog Post 6: The History Of Nursing in Canada part 2

Throughout the 1970’s the standard for nursing education was for it to be completed on site at a hospital. Nurses often lived in residences next to the hospital where they would complete their training and live together, when not on shift. These nurses were paired with a more senior staff member and shown how to complete all of the tasks that were expected of a nurse each day. This was a tradition held over from the very beginnings of nursing education where skills were passed down from one nurse to another.

In the 1980’s nursing became recognized as an accredited profession in need of standardization across the profession, this was done in order to protect not only the nurses from performing skill that they may not have been taught but also their patients. Schools in order to ensure all nurses had the same expectations of practice began to drift away from the hospitals and were set up in hospitals and universities. In 1984 the expectations and curriculum for the Baccalaureate programes in Nursing began.

Today, the standard of a Bachelors degree remains the entry requirement for a Registered Nurse. Of note a Registered Practical Nurse completes a two year college diploma for their entry to practice. The primary difference between the two roles has to do with how acutely ill a patient is, with Registered Nurses being responsible for the more unstable patients.

The profession however continues to grow, with the development and institution of Nurse Practitioners (Master Trained Nurses) who’s education focuses around caring for patients with interventions and making diagnosis’.

Final it is also possible to undertake a Doctoral level education for Nursing. Often with a focus on how the role of a nurse can continue to develop and make changes to the health care system.

Nursing is an exciting field to study as it is in a continual state of change. With roots in tradition and an eye towards change the profession continues to develop and find the niche it can serve within the health care field.

Resources

Click to access History.pdf

The History of Nursing Education in Canada

When looking into the history of nursing one quickly becomes aware of the women who is deemed the founder of modern day nursing Florence Nightengale. Florence is credited with changing the profession of nursing from one that was only suitable to nuns and the elderly, to one that was a respectable and open career choice for women. While it is possible to spend numerous posts exploring Florence’s contributions to health care for the purposes of this blog we will be focusing on how nursing became an organized vocation within Canada and the educational requirements in the early days of the profession.

Nursing Symbol
The lamp is a universal symbol of nursing. It is synonymous with Florence Nightengale and the late nights she would spend caring for the ill.

In 1874 the first Dr. Theophillus Mack opened the first hospital training school in Canada in St. Catherines Ontario. This lay hospital (differing from a religious hospital) was opened with the assistance of two nurses who had trained under Florence Nightengale. In the first annual report Dr. Mack stated that “all the most brilliant achievements of modern surgery are dependent to a
great extent upon careful and intelligent nursing” (Baker et all 2012). It was clear from very early in Canada’s history that in order to have effective health care with positive outcomes there would need to be a focus on quality education for nurses.

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The first graduating class of 1878 from the Mack Educational Hospital.
https://www.flickr.com/photos/lac-bac/17209591426

The education for lay nurses differed from that of the nuns in the religious orders. The most notable difference was the amount of focus given to religious rituals and prayer. While still part of the lay nurses education it was not as focused upon as in the religious hospitals.

Instead novice nurses in the Mack Educational Hospital would start their education by shadowing. Paying close attention to what senior nurses were doing in order to learn through observation. The next phase of their training would be to perform care themselves while being observed by more senior staff. Interestingly the final stage of nursing education involved shadowing a pharmacist in order to learn about the different types of medication being used and given to patients.

This focus on skills and being directly supervised has remained a vital component of nursing education up to the modern day. Interestingly legislation was just recently passed in Canada to allow registered nurses prescribing rights to certain medications, some 140 years after the first nursing education showed an emphasis on medication knowledge.

Nursing continues to develop as a profession and is regularly adapting the way in which new nurses are trained in order to best prepare new graduates for the responsibility of caring for people. In the next blog post we will explore what a nurses education looks like today and how the entry to practice requirements have changed in the past 40 years.

Resources

The Evolution of Education for Professional Nursing in Canada from the 17th to the 21st Century Retrieved from: https://www.casn.ca/wp-content/uploads/2016/12/History.pdf

Blog Post 4 – John Snow 2.0

In the previous blog post we explored the beginnings of epidemiology and how it began a transition in our understanding of how illness is spread. Through out this post we will explore how far our understanding of illness progression has come and how modern day epidemiology looks. Thanks to continuous education and the access modern technology gives us we are able to respond to and more quickly treat serious diseases then ever before. Thanks to the foundation set by our predecessors we are able to ensure the health of more people now then ever before.

Something happened this past week, maybe you have heard of it Novel Coronavirus. My original plan was to discuss epidemiology at a later week however the time seemed far to appropriate to discuss it.

This map is slightly outdated at the time of publishing this blog. Canada now has 4 confirmed cases one of which is in the city I work, London Ontario. What has been interesting about this virus from an epidemiology standpoint is that this type of virus has never previously caused infection in humans. Nearly every human becomes ill with a coronavirus at one point of their lives or another (the common cold) however this strain of virus had never previously caused infection in humans hence Novel Coronavirus.

Thanks to health education and our understanding of diseases process’ the global medical community has been able to respond quite well to this new virus. Proper precautions for health care workers have been taken because we know that this type of virus is passed through droplets (saliva and mucous often from sneezing or coughing). Patients with symptoms have been isolated from others in order to prevent vulnerable populations (Young, Elderly, Immuno-compromised) from contracting the virus.

Amazingly the global community appears to be working very well together to combat this new medical threat and already companies and universities are attempting to develop a vaccine against this virus.

Compared to the labour intensive process that John Snow would have undergone in the 1850s attempting to identify which well water supply is getting people sick we are now able to track the spread of illness faster and respond to it more appropriately then ever before.

Resources

http://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/coronaviruses/

Blog Post 3 – You know nothing John Snow

As we continued to explore how understanding and education around health care has developed it is inevitable that we will discuss the advent and initiation of epidemiology.

Epidemiology is the study of illness’ and how they are transmitted from the environment to people or from person to person. Keep in mind that illness was originally thought of as divine will and as such humans were only able to prevent illness by keeping the supernatural powers happy.

In 1853 the father of modern field based epidemiology John Snow was attempting to discover why different outbreaks of cholera were occurring in London England. John Snow focused on those who were getting sick, where they lived and what they had in common. His research led to one of the most famous maps in epidemiology.

Looking at this map (now known as a spot map) the black dots represent the households where people had symptoms of cholera. There is a clear concentration around pump A. John Snow did further research and learned that pump B was avoided due to the water being “contaminated” and pump C was to inconvenient for most peoples. As a result pump A was the primary source of drinking water for nearly everyone who had symptoms of cholera. John snow effectively identified the pump as a source of illness and took steps to prevent illness in the population in the future. Thus began modern epidemiology.

Fresh water is an excellent source for bacterial growth, and with John Snows research being completed nearly 50 years before the microscope the only way medical minds were able to predict what would be causing wide spread illness was with spot maps like that of John Snows showing the common denominator between the sick.

It can be argued that John Snow was not only the father of epidemiology but also one of the forefathers of evidenced based medicine.

Rescources

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section2.html

https://www.theguardian.com/science/sifting-the-evidence/2013/mar/15/john-snow-epidemiology-today-cholera

Post 2: Lets Go Back, Way Back

Since the dawn of humanity we have been under attack from all angles. Tens of thousands of bacteria, virus’, fungi, nematodes and other organisms have found ways to attack our bodies and use the resources found on and in them for their own survival.

While we as a species have been fighting illness for as long as we have existed, what helped to develop our modern form of health care? This post will explore a euro-centric approach to early Greek health care and how it has influenced our modern medical system.

Prior to the wide spread adoption of philosophy and the physiocratic school of thought the prevailing belief around illness was that of supernatural cause and affect. It was the Greeks who started to make the link between the physical world, human interaction with that world and health outcomes. This revolution in thinking has been documented as early as the 6th century BCE. Once the thought around health changed from “things happen to me due to supernatural causes” to “the action I take upon the physical environment have direct health consequences to me” the ancient Greeks paved the way for a more in depth exploration of health and how to improve it.

The defining factor of health in ancient Greece was an individuals and communities diet. Diet did not refer simply to what someone would eat, but instead applied to their entire lifestyle. Doctors would need to consider the season, the winds, the amount of wine consumed, the water, the amount of exercise or hard work and many other factors when assessing health. While some of these factors seem strange to us now from a modern medical perspective others speak true to our current understanding of factors that affect health.

The above chart showcases the four fluids that ancient greeks associated with the body. Health was a balance between theses fluids while illness was seen as an imbalance in any one of them.

The current approach to health care is to promote healthy communities. By doing so we consider the environment in which a person lives and external factors when attempting to make a plan of care for them. This individualized look at health care is considered a new philosophy around health care. However, parts of this approach to care were practiced in ancient Greece. It is interesting to note that as many as 2600 years ago humans were learning that a healthy environment is a key factor in overall human health. After all this time it continues to be an area in which we can improve.

Resources

Yannis Tountas, The historical origins of the basic concepts of health promotion and education: the role of ancient Greek philosophy and medicine, Health Promotion International, Volume 24, Issue 2, June 2009, Pages 185–192, https://doi.org/10.1093/heapro/dap006

Question:

What major or minor aspects of your environment do you feel can be altered to best improve your health?

Blog Post 1 – Learning to Care

Thanks for joining me!

Over the next few months I will be exploring a topic that is near and dear to me. As a registered nurse it is always interesting to see how much health education has changed in the 10 years that I have been involved in the profession of caring for others. What is more fascinating are the stories that more senior nurses and other health care professionals share about their time as novices and what there education looked like.

The central theme around this blog will be to look at how we trained health care workers in the past, how we are currently educating health care workers, and the goals that have been laid out for future education. My hope for this blog is that health care workers will be able to appreciate where different bodies of knowledge have developed from and for non health care workers to be able to learn about the education that goes on behind the scenes of the health system.

This should make for an interesting learning opportunity for all of us as we explore an area that will touch everyone’s life at one point or another. From early witch doctors to modern nuclear medicine, the advent and initiation of epidemiology to the discovery of synthetic medications, there is more information now than ever for health care professionals to learn and the way in which they learn it is changing as well.