In nursing we often ask students to create mind maps in order to try and link the diagnoses with treatments with diagnostics with psychosocial factors…. in order to create a better understanding of the links between a variety of different factors within the persons life and through their health care experience. These mind maps are individual to the students and specific to each patient. They help the students to see the links between all of the factors and develop critical thinking skills around possible outcomes or relationships between health challenges and outcomes.

I am not an artist myself and my mind maps tend to look awful, like a 3 year old drew them, but I have so much fun drawing them.

Now I can make great mind maps without worrying that my students are making fun of me thanks to Mindomo! http://www.mindomo.com/

Oh and here are some great mind-mapping guidelines

http://www.informationtamers.com/WikIT/index.php?title=Buzan%27s_mind_map_guidelines_in_practical_use

Examples of Concept Maps

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Objective

In the PIDP 3240 course text ‘Teaching Naked’ Bowen indicates that quality and specificity of information have become increasingly important, he goes on to state that phone applications are like little slices of the internet that provide a compromise between unlimited and targeted information (2012).

I am an instructor with the BScN program at VCC College, I mostly instruct in the clinical setting and I am aware of the need for students and myself to easily access information quickly and effectively. For this purpose there are some smart phone apps that may help us access accurate information in a timely manner such as, Davis’s Drug Guide, Nursing Central, Lab Values Reference Guide, Mosby’s Nursing etc. Many of these apps are offered to the students for a free period with a textbook purchase so why wouldn’t we encourage their use?

Reflective

I actually use my phone to communicate with my students in the clinical setting, since I can sometimes be in a room behind the curtains with one student and their pt. observing a skill, sometimes the other students cannot locate me, so they will text me and I can respond in the moment without taking the focus away from the other student/client.

Apart from using the phone to communicate there is also a variety of informational apps (Davis’s Drug Guide, Mosby’s Nursing Apps etc.) and educational gaming apps. I personally have the Davis’s Drug Guide app and the Up to Date app on my phone and use it quite often in the clinical setting. I hope that I am providing a good example of practice where I do not rely on my memory but instead look up information that is both current and accurate.

However I do worry that allowing the use of smart phones for access of information may be viewed by staff as inappropriate for a few reasons, firstly it is difficult to determine if the student is actually using the phone to access information and not just socializing, secondly there would be concerns about using the phone in a variety of rooms and possible cross contamination and a third concern could be about patient confidentiality, after all most smart phones are equipped with a camera and a microphone…. these are just a few concerns that immediately come to mind when contemplating the use of smart phones in the educational/clinical setting.

Interpretive

I was actually unaware of the variety of apps as I have mainly been utilizing information seeking apps on my phone; however there are numerous articles that provide overviews of medical apps and their uses in the clinical settings. For instance Mosa, Yoo and Sheets performed a systematic review of the available medical apps and found that they could be categorized into the major headings of diagnostic, drug information, clinical calculations and literature search engines (2012).

Bowen has also provided some information on gaming style apps, Bowen states that using games and gaming apps can be a novel approach to teaching as games are really just a constant stream of problem solving and assessment (2012). Bowen provides an example of this called the Virulent game (http://gameslearningsociety.org/virulent_microsite/) in which players can see how viruses replicate within the human body (2012).

Robb and Scellenbarger have written and article on engaging students with cell phones in the classroom; they have created some interesting learning activities that incorporate the use of cell phones in the classroom (2012). Robb et all usually perform these activities with students separated into small groups and have them come back to the larger group for discussion, one activity is called ‘Goolge it’ in which students are presented with a topic and they must ‘Google it’ review the information that they have found and discuss this with the class.

A second activity called ‘text a friend’ allows for students who may be shy to text in questions or comments on the provided topic for the instructor and the other students to assist in clarifying, the instructor of course does not disclose the identity of the texter (Robb et al, 2012).

The third activity that Robb et al suggest is called ‘survey says’ where the students can download an app such as Polleverywhere, Let’sGoVote, SMSpoll, Text the Mob, Socrative, or iVotedthat which allows them to use their cell phones like a clicker (2012). Questions can be posed in the class and students can electronically and anonymously cast their vote for the correct answer.

Robb et al do advise that ground rules should be set about use and etiquette before bringing cell phones into the classroom (2012). They further advise that students who do not have a smart phone be grouped together with other students who do (Robb et al, 2012).

Decisional

I am pleased to have found out how many more uses there are for smart phones in the clinical setting apart from accessing information. Of course as previously mentioned, there are some concerns with the use of smart phones such as patient confidentiality, contamination of phones and cross contamination of patients, possible inaccurate information within an app etc (McNeil & McArthur, 2015; Koehler, Vujovic & McMenamin, 2013; Philippi & Wyatt, 2011).

Many of the articles I read addressed these concerns but there was not clear decision on how to best maintain confidentiality or cross contamination. When I am first starting out the semester I take some time to address the use of cell phones and explain to the students that they should only be used for accessing information, they are supposed to disable their cameras as well when they are in the clinical setting and turn their phones to silent. For the most part I have found that the students do not abuse the privilege of using their phones but I think I may want to develop a proper policy and review with them at the beginning of the term.

As for whether the information provided on their apps is valid I tend to advise the students to purchase apps from the major textbook companies rather than using a free app that is not verified. I also review with them about the “Health on the Net” (HON) (https://www.healthonnet.org/) symbol that signifies the information found on the website has been peer reviewed and is credible. In their article McNeil et al also provide a ‘CRAAP’ test for mobile apps, which instructs the reader to determine if the information is current, relevant, from a source of authority, is accurate and determine the purpose of the information ie: is the site trying to sell something? (2015). I like this CRAAP test and am planning to provide access to this article for my students.

Additionally there are questions about phone etiquette, ensuring that students are using the phones for learning rather than socializing and there may be students who do not own or have access to a smart phone. I believe, as Robb et al indicated, a discussion of smart phone use and establishing classroom/clinical policies is a must at the beginning of the term. I am hoping to have a dedicated discussion with my students this term about proper phone etiquette in the clinical setting (2012).

One final note, I also hope to introduce my students to some of the medical/clinical learning games and I hope to implement some of Robb et al’s learning activities such as ‘Google it’, ‘Survey Says’ and ‘Text a Friend’ (2012).

References

Bowen, J. (2012). Teaching naked: How moving technology out of your college classroom will improve student learning. San Francisco: Jossey-Bass, a Wiley imprint.

Koehler, N., Vujovic, O., & Mcmenamin, C. (2013). Healthcare professionals’ use of mobile phones and the internet in clinical practice. Journal of Mobile Technology in Medicine, 2(1).

McNiel, P., & McArthur, E. (2015). What’s app-ropriate for your clinical practice? Mobile apps have great potential for use in patient-centered care, follow-up, and improving health outcomes. Clinical Advisor, 80-88.

Mosa, A., Yoo, I., & Sheets, L. (2012). A Systematic Review of Healthcare Applications for Smartphones. BMC Medical Informatics and Decision Making, 67-67.

Phillippi, J., & Wyatt, T. (2011). Smartphones In Nursing Education. CIN: Computers, Informatics, Nursing, 29(8), 449-454.

Robb, M., & Shellenbarger, T. (2012). Using Technology to Promote Mobile Learning. Nurse Educator, 37(6), 258-261.

Reflective Learning a Change in Paradigm

Over the last 30 years, a relatively short period of time in the entire existence of a profession, nursing education has moved from a positivistic and behaviorist paradigm towards a more qualitative approach based on emancipatory philosophies and critical social theory (CRNBC, 2012; Pierson, 1998). Only since 2007, here in British Columbia, have nurses been required to attain a baccalaureate degree to practice as an RN (CRNBC, 2012). The shift towards a baccalaureate level minimum was fueled by the need for critical and innovative thinking nurses (Fakude & Bruce, 2003; Pierson, 1998; Taylor-Haslip, 2009). It is no longer enough for a nurse to know what to do and how to do it, they must also know why; in knowing why the nurse can critically evaluate his or her actions and make changes in his or her practice and/or advocate for change within the system (Fakude & Bruce, 2003; Pierson, 1998; Taylor-Haslip, 2009).The move towards critical reflective practice has made for changes in the structure and approaches of nursing educational programs; critical reflective practices are now the cornerstone of nursing education (Fakude & Bruce, 2003; Pierson, 1998; Taylor-Haslip, 2009).

Reflective Journaling as a Tool for Reflective Practice

In nursing education, reflective journals are one of the most widely used methods for critical reflection (Fakude & Bruce, 2003; Pierson, 1998; Taylor-Haslip, 2009). The practice of journaling allows the writer to become a participant observer of their own learning (Fakude & Bruce, 2003; Forneris & Peden-McAlpine, 2006; Pierson, 1998; Taylor-Haslip, 2009). Reflective journals also provide the opportunity for the instructor to enhance his or her understanding of the students’ experiences and the impact of these experiences (Fakude & Bruce, 2003; Forneris & Peden-McAlpine, 2006; Pierson, 1998; Taylor-Haslip, 2009).

Marking Journals: Applying Value to Self-Reflection

In the case of reflective journaling, as with any academic assignment, there is value assigned to the final product. It is important for instructors to recognize that the journal is not an evaluation of the students’ learning, to treat it that way would inhibit true self-expression and self-evaluation resulting in editing to meet the expectations of the instructor (Fakude & Bruce, 2003; Forneris & Peden-McAlpine, 2006; Pierson, 1998; Taylor-Haslip, 2009). Format guides can be used for marking but the expectation is that marks are assigned for format rather than for content (Fakude & Bruce, 2003; Forneris & Peden-McAlpine, 2006; Pierson, 1998; Taylor-Haslip, 2009). Criterion have been developed to assess the students’ level of critical reflection; these should not be used for marking purposes but should rather be used to provide an indication of the students’ level of proficiency allowing for feedback, encouragement and support to promote critical reflective thinking (Taylor-Haslip, 2009). As cited in Taylor-Haslip, the Hatton and Smith reflective criteria, defines four levels of critical reflective writing:

• Level one: Descriptive, student reports events and details environment.
• Level two: Descriptive Reflection, the writer attempts to provide reason but often only looks at one possible factor.
• Level three:  Dialogic Reflection, often written as a narrative internal dialogue, less time is spent reporting events and more time discussing experiences and outcomes.
• Level four:  Critical Reflection will include clear rationales for actions and decisions, taking into account the broader theoretical, historical, social, and political contexts of experience, multiple perspectives are identified and examined (2009).

As previously mentioned, grade value should not be ascribed to the level at which the student is expressing his or her self, the criteria is for the instructor to identify where the student is at in order to provide encouragement, feedback and coaching to improve the students’ ability to critically reflect (Taylor-Haslip, 2009).

Reflective Journaling: Experiences as a Student

Having graduated not that long ago I have had to write my fair share of reflective journals, in fact some of those journals were written for and submitted to W. Pierson, the author cited throughout the above paragraphs. I loved being in W. Pierson’s class, she was one of my favorite instructors, tough but fair! Truth be told though, I hated writing journals for her. Journals were the bane of my nursing program existence, and it wasn’t just me who felt that way, in fact most of my peers were even less inspired to write a journal than I was. I remember thinking that it was all an exercise in futility, I would find a subject describe the event, describe my reaction and discuss different ways of approaching the same or similar situations, the instructor would send it back with a nice comment and would encourage me to keep thinking critically. Perhaps not all my peers received this sort of feedback? But as I saw it, journaling served little purpose, just another hoop to jump through.

Reflective Journaling: Experiences of a Novice Nursing Instructor

So why would I blog about something that I found so trivial and useless in my own education? Well, as a nursing instructor I am now assigning journals and I feel it is imperative that I understand the rationale for and the practice of reflective journaling. I do not want my students to pick up on the fact that I am not fully in support of the practice of journalling; nothing deters a student from putting effort into their assignments more than an ambivalent instructor. But more than anything, since starting to instruct, I now see the value of the reflective journal and I wanted to share my experience, through this blog…. In essence I am creating an electronic critically reflective journal.

It took becoming an instructor for me to see how important reflective journaling is to the development of the critically evaluative nurse. I know my students balk at the idea of journaling and I know that many of the journals I receive have been written in haste the night before they are due; even so, the journals I receive are rich with experiences and filled with meaning. As an outside observer, I only see actions and outcomes, I am not privy to the way in which the student perceives their experience and makes sense of it. When reading a journal though, I get to see their thought process, I get to read about their emotions in response to situations, I can see their uncertainty, read about their questioning of the status quo, it is all there on a piece of paper.

I will provide an example of how useful the insight derived from reading a journal can be forboth the student and the instructor. I am not very proud of this, but being human I do sometimes pass judgment based on appearances. I had a new group of second year students, pretty much a standard mix of nursing students, a variety of age groups and cultures, coming from a variety of different educational backgrounds with a variety of different motivational factors that lead them to this point in their nursing education. There was one young woman in the group that seemed a little out of her element though, she was well groomed, she was mostly quiet but when she spoke there were a lot of ums and ahs, she seemed to wander around the unit aimlessly and she was a bit germ phobic (she would put on patient foot covers over her shoes every morning to protect her footwear). Not exactly the kind of go-getter one would hope to find in a group of second year nursing students. I tried to be unbiased and non-judgmental but I was concerned that she might not be at the level she would need to be at in order to function on this busy eclectic unit.

At the end of the first week I assigned a reflective journal, of course the students all balked, they were concerned that they would have little to write about, so I encouraged them to write about their impressions of the unit, their experiences so far and their feelings about the uncertainties that lay ahead. I generally don’t expect a high degree of reflective thinking in the first journal, I often use the first journal to assess the students’ ability to identify his or her concerns about the clinical setting and to assess writing skills.

The first journal I received was submitted 2 days early, it was from the student I previously described. I was concerned that she had submitted it early and I thought perhaps she had not put a great deal of effort in into the assignment. With lowered expectations I started to read her journal. She wrote about her experiences that week caring for two different clients with communication barriers; one client was hearing impaired and the other client spoke only Chinese. In her journal she discussed how vulnerable her clients must have felt, not only being ill and in hospital but having things complicated by communication barriers. She went on to explain how she had developed a rapport with the hearing impaired client, having pad and pencil ready whenever she went in to see the client. She outlined how she had worked throughout the day with her Chinese speaking client, to develop a sort of sign language that she could use to communicate with the client. She identified that she understood as a student caring for one patient at a time, she had the time and ability to work on developing a rapport with these clients. She went on to discuss the difficulties faced by the nurses on this busy unit and she wondered how difficult it was for them to provide adequate care to all of their clients, let alone special needs clients. She expressed concerns about her future, wondering how she would be able to provide empathic and quality care when she was expected to care for four patients at a time, many of whom, she indicated, may have barriers or complicating factors. She ended her journal by saying she felt that she had made a difference in the lives of the patients she had cared for.

I sure felt like a fool, not only was she sitting at a level four for critical reflection on the Hatton and Smith sacle, she wrote beautifully and her APA formatting was impeccable.  The old adage about judging books by covers came to mind.

It is my practice to meet with each student to review their journal so that I can provide coaching on the critical reflective process and feedback on APA formatting. When I met with this student I told her how impressed I was by her critical reflective journal, I explained that not only was she able to articulate her thoughts and questions but that the degree of empathy with which she framed her observations was incredible.

Afterwards we discussed her aspirations in nursing, she told me it was her hope to become an infection control nurse, a perfect career choice for the germ phobic nurse. We talked about her past experiences, and she explained that many of her instructors had not been supportive so she was questioning if she should continue on. I asked her to hang on through this clinical and see how she felt at the end, because she was intelligent, insightful, and empathic all the things a nurse should be.

And to think, I was almost one of those instructors that failed to see the great potential embodied within this student. In the end she decided to keep on with nursing and I am pleased to tell you that she will be graduating in less than a year.

My Reflections on Reflective Journaling

Journals are powerful tools of reflection for students and teachers alike. It has been my experience that as the semester progresses there is a measurable difference not only in the quality of the content but also in the level of insight that is demonstrated. I observe in practice how students approach situatations differently having reflected on their previous experience. I provide based on not only what I observe but on what I have read within their journals. I am now a believer in the power of critical reflective journaling. I wish that I had not so carelessly thrown out all of my journals from my days as a nursing student, I can’t help but wonder how the experiences and learning detailed within them contributed to the nurse I am today.

Now when my students balk at the idea of having to write another reflective journal, I am sure to explain that journaling is about their experiences and their interpretations, the journal is for them to express and reflect. I tell them that I don’t really care what they write about but I do care that they put in a genuine effort, because their journals provide me with valuable insights as to who they are, how they think and what they feel. And I tell them “Please don’t blow this off, there is real value in what you are doing, even though you may not realize it right now. Just trust me on this.”

References

Fakude, L., & Bruce, J. (2003). Journaling: A quasi-experimental study of student nurses?                            reflective learning ability. Curationis, 26(2), 49-55.

Forneris, S., & Peden-McAlpine, C. (2006). Contextual Learning: A Reflective Learning                               Intervention for Nursing Education. International Journal of Nursing Education Scholarship, 3(1).

Pierson, W. (1997). International Journal of Nursing Education Scholarship. Journal of Advanced                  Nursing, 27, 165-170.

Taylor-Haslip, V. (2009). The Use of Guided Refl ective Journals in Clinical Nursing Courses. In                    Transit, 4, 28-39. Retrieved from http://ctl.laguardia.edu/journal/v4/default.htm

Related Articles

• Journaling: A Quasi-Experimental Study of Student Nurses’ Reflective Learning Ability
• Contextual Learning: A Reflective Learning Intervention for Nursing Education
• The Use of Guided Refl ective Journals in Clinical Nursing Courses
• Reflection and Nursing Education

Evolution of the Internet

Over the last 20 years I have seen and experienced, as a student and as an instructor, the evolution of academia through advances in information sharing. My experience as a student began with news groups and e-mail, then with more and more information being archived on the Internet I started to use it as a research tool. I took complete courses on-line, and some where the instructor was in a whole other province. I have submitted the majority of my papers and files via the internet and in fact, I never saw the members of my thesis approval board in person, everything regarding edits and re-writes were vetted across the internet.

I know it is hard to believe, but at the time of its inception the, the actual purpose of the internet  was to share information and knowledge between scholars and researchers, easily and efficiently (Leiner, Cerf, Clark, Kahn, Kleinrock, Lynch, Postel, Roberts, Wolff, 2012). However society and web technology has moved from static to interactive; we are now in the age known as Web 2.0 (Liu, 2010). The internet is still a place to disseminate information, store information and find information; however the use and purpose of the majority of information on the internet seems to be less than academic in nature. The web has become the hub of entertainment and a source of social interaction for most users.

Entertainment or Academia?

Having used the internet as a resource for learning and as a method to maintain social interactions, I was not quite sure how the two would mix as a tool for teaching ? When I was as student none of my courses required the use of social media, however my peers and I found Facebook groups to be a very easy and efficient way to communicate, even if it was to just post where the study group was going to meet. Of course this was not quite using social media as a learning environment. Perhaps this is more of an example of academic socializing? I think many instructors would agree “Social networking is just for entertainment”, as recently as 2012 this was the sentiment expressed by many Michigan State University instructors (Brazelton, Magolda & Renn, 2012).  Nevertheless there are others that think differently and are looking at the potential of using social communication platforms as an extension of the historical classroom and even the contemporary on-line cyber classroom.

The Argument for the use of Social Networks in Academia

Liu, in her paper on using social media resources as tools for learning, examined the current use Web based technology and she noting that many post secondary institutions are using professional Course Management Systems (CMS) such as, Moodle,  Blackboard, Desire2Learn, etc (2010). She points out that these types of computer based systems need maintenance and constant upgrades (Liu, 2010). Liu explains that some social media tools are in fact quite similar to those found within many of the commonly used e-learning platforms (2010). She suggests that if educational system were to use the existing social media platform tools wisely, and integrate them into teaching process, that perhaps institutional financial investments could be cut back (2010).

Liu believes that social media tools may provide learners with novel opportunities to become more independent in their study and research (2010). She reasons that social media might extend the learning environment to the real world and to real life practice; enriching the students learning experiences by providing a parallel channel of knowledge in harmony with the current curriculum (2010). Liu in addition sees the use of social network to build an extended and sustainable community of life-long learning (2010). She believes that a major benefit of using Facebook as a community learning tool is that the members of the group can still access the valuable information collected within even that after the academic semester is over (2010). Liu does caution though that Facebook is not a professional course delivery system and should not be used as a stand-alone educational tool, but that it could be used as a tool for collaboration, and shared learning (2010).

My Role as an Instructor and the use of Social Network Platforms for Learning

Recently I encouraged the group of students I am teaching, to create their own Facebook group. I explained that the group could be used as a platform to share tips and tricks, to ask questions, advice and clarification from their peers. As supported by the literature, I advised that the group would continue long past their training so they could continue to use the space to share information about their challenges, and to provide encouragement and support to one another as they grew within their profession.

I wanted the students to have an environment separate from the classroom and I was not sure about my role as an instructor? It was my hope that the students would develop a community where they felt comfortable to share and to ask advice. My concern was that if I was directly involved in the group the students might not feel as comfortable to share and to ask questions. I wanted them to interact with one another and to problem solve together and I worried that if I was present they would instead ask me for the answer rather than work together to build their knowledge. So I have positioned myself outside of the group as a coach and a mentor, encouraging the students to share their stories and thoughts. When someone shares a great idea in the classroom I advise them to post it in the group, that way they can all see it and refer to it at a later time. It is my hope that this group will function as a parallel channel of knowledge, connecting the student’s classroom learning to real life practice, while providing the students with a sense of autonomy as they guide their own learning.

Moving Forward

In the life of todays professionals dvances in technology are an expected part of life, as an instructor I believe that my role is to be aware of the most up-to-date approaches to teaching. In this instance, the methodologies of how to harness Social networking platforms for academic purposes are not fully developed, so my role is to encourage and support the students to create their own communities of learning. Indeed there are already many student groups, study groups, Institution based groups and faculty based groups that are currently function on Facebook and this trend is likely to continue. It would be interesting to look at the discussions within these groups, categorize the types of information that is exchanged and identify if the students do in fact use the group as a platform for discussion and development of knowledge. Perhaps in the future I may embark on some research to answer these questions, but for now I will continue to encourage my students to make use of Facebook to create their own learning societies. I plan to continue to coach and to encourage from the outside because I truly believe that the students will develop their knowledge more fully if they share their experiences, provide advice and work together to problem solve independent from their instructor.

References

Brazelton, B., Magolda, P., & Renn, K. (2012). Social Media and Reflective Practice in Student                      Affairs. Retrieved from                              http://convention.myacpa.org/louisville2012/documents/program/2012_senior_scholar_social_media.pdf

Leiner, B., Cerf, V., Clark, D., Kahn, R., Kleinrock, L., Lynch, D., Postel, J., Roberts, L., &                      Wolff, S. (2012). Brief History of the Internet. Retrieved from http://www.internetsociety.org/brief-history-internet

Liu, Y. (2010). Social media tools as a learning resource. Journal of Educational Technology                     Development and Exchange, 3(1), 101-114.

Here are some examples of academic based Facebook groups

• https://www.facebook.com/VCCSchoolOfInstructorEducation
• https://www.facebook.com/StudentNurses
• https://www.facebook.com/groups/ubcnursing2015studygroup/

Related Articles

• Social Media Tools as a Learning Resource
• A Brief History of the Internet
• Reflective practice through on-line sharing
• Social Media and Reflective Practice in Student Affairs