PBL semester 1

Advantages of working in groups (5)

1. Better decision making
2. Superior resources
3. Enhanced learning
4. Enhanced creativity
5. Member satisfaction

Disadvantages of working in groups (3)

1. Conflict potential
2. People problems
3. Requires more time, energy and resources

Synergy

A state where the collaboration of group members produces better results than what would have been expected by the sum of the skills of the individuals

Components of group communication (3)

1. Theory: clear, systematic, and predictive explanation of a phenomenon (helps understand why there is success/failure)
2. Strategy: method/guideline/technique used for dealing with problems that arise
3. Skill: specific ability that helps group engage to achieve common goal (requires communication skills)

Effective strategies and skill is based on theories.

Stages of group development (5)

1. Forming
2. Storming
3. Norming
4. Performing
5. Adjourning

What are group norms?

* Expectations concerning what is acceptable/unacceptable
* Express ethical standards
* Help group function efficiently
* Enhance productivity
* Ensure group survival

Explicit vs. Implicit norms

Explicit norms = written or stated verbally and shared with all members

Implicit norms = rarely communicated but still expected, harder to understand

Categories of norms (4)

* interaction (how members communicate i.e using words like “we”)
* Procedural (how group operates i.e silencing phone)
* Status (level of influence/power among members + how it is earned i.e leader sits at table head)
* Achievement (Quality/quantity of work expected i.e everyone shows up on time)

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Constructive vs non constructive conformity

Constructive = alerts to problems that may prevent group from meeting goal

Deconstructive = resistance to norms without regard for group interest.

Categories of motivation (4)

1. Meaningfulness (shared feeling of pursuing worth task)
2. Choice
3. Competence
4. Progress

Group member needs (3)

1. Inclusion
2. Control
3. Affection

Group Task roles (7)

1. Coordinator
2. Info provider
3. Opinion provider
4. Questioner
5. Clarifier
6. Analyzer
7. Implementer

Group Social maintenance roles (5)

1. Harmonizer
2. Motivator
3. Supporter
4. Gatekeeper
5. Team builder

Best group members have:

Flexibility, assertiveness

Disruptive group behaviours (6)

1. Dominator
2. Obstructionist
3. Attacker
4. Egoist
5. Support seeker
6. Non-participant

Steps of the PBL process (6)

1. Problem presented to group, terms reviewed and hypothesis generated
2. Learning issues and information sources identified by group
3. Information gathering and independent study
4. Knowledge acquired is discussed and debated critically
5. Knowledge applied to problem in a practical way and hypotheses confirmed or refuted
6. Reflection on the content and process of learning occurs

PBL framework

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Concept mapping

* organize information
* contain links
* cluster data
* visually demonstrate relationships between data.

How does concept mapping help nursing students?

If nurses can visually see a plan that organizes thoughts and actions they do much better in responding or reacting.

* guide for critical thinking
* Logical flow of thought and planning

What are narratives?

Stories, experiences, feelings, worries and perspectives of individuals

Narrative competence

Ability to acknowledge, absorb, interpret and act on stories and plights of others

Narrative medicine

Medicine practical with narrative competence (humane and effective medical practice.)

Ways to deal with a troublesome group member

* Accept
* Confront
* Exclude

Extrinsic vs intrinsic motivation

Extrinsic = comes from external sources

* boss, teacher coach friend family member or role model

Intrinsic = rewards that come from internal sources inherent in a particular way

* pride, personal accomplishment.

5 fundamental patterns of knowing

* Emancipatory knowing
* Ethical knowing
* Personal knowing
* Aesthetic knowing
* Empirical/scientific knowing

Emancipatory knowing

* human capacity to be aware and critically reflect on the social, cultural and political status quo
* How it came to be that way
* Inequities embedded in social and political institutions
* Changes needed for fair and equitable conditions for all

Ethical knowing

* focused on matters of obligation
* What ought to be done
* Moment to moment judgements
* What is good right and responsible
* Morally behaving in practice
* Importances, loyalties and priorities

Personal knowing

* inner experience of becoming whole, aware genuine self
* Knowing self and self in relation to others

Aesthetic knowing

* deep appreciation of the meaning of a situation
* Inner resources that transform experience
* Expressed through actions, bearing, conduct, attitudes, narrative, and interactions

Empirical knowing

* grounded in science
* Objective truths
* Scientific competence
* Competent action grounded in scientific knowledge including theory

Knowing refers to…

Ways of perceiving and understanding the self and the world.

* ontological
* Dynamic
* Changing

Process

Praxis

All patterns of knowing integrated in a way that supports social justice

Patterns gone wild

Distortion when knowledge is not integrated within whole of knowing

* knowledge developed in isolation without consideration of all patterns of knowing = uncritical acceptance, narrow interpretation, partial use of knowledge
* emancipatory removed = extreme political standpoint unjustly imposed on others
* Empirics removed = control and manipulation
* Ethics removed = rigid doctrine and insensitivity to rights of others
* Personal knowing removed = isolation and self distortion
* Aesthetics removed = indulgence in self serving expressions, lack of appreciation for fullness of meaning in context.

How can information be analyzed?

* The order it was originally produced in (Primary, secondary, tertiary)
* By person providing info (author)
* Based on audience

How can information be organized?

* fiction or non fiction
* Subject (math, English etc.)
* Based on media (DVD, CD etc.)

URL

An address unique to every article, document, media file etc.

* tells the audience what the info is about

Domain names

3 letter endings on the URL that indicate which organization is sponsoring the article

(.com .ca .gov .edu etc.)

Popular, scholarly and trade resources

Popular:

* magazines, popular books etc. intended to entertain the audience

Scholarly:

* journals etc. created/formed by professionals for academic and research purposes

Trade:

* combination of both popular and scholarly resources that can benefit practitioners wanting to improve their business

Primary resource

* the original copies that have not been altered
* I.e evidence in a crime scene

Secondary resource

* summarize the original
* Interpret + analyze the information
* I.e scholarly papers, journals, and magazines

Tertiary resource

* things like the index that is being used to organize the primary and secondary resources
* Do not provide any additional information or interpretation.

How is asking a question beneficial to research?

1. Questions require answers
2. Give a way of evaluating answers (helps to decide which information will be useful)
3. Clear open ended question calls for research and thinking (makes research and writing more meaningful.)

Brainstorming

Method of shared problem solving in which all members of a group spontaneously contribute ideas.

Concept mapping

A process focused on a topic, in which group or individual brainstorming produces a visual graphic that represents how the creators thinks about a subject topic

Strategies to narrow a concept

* specify time
* Specify place
* Specify population
* Specify viewpoint

Database

Collection of data arranged for ease + speed of search + retrieval

Records

Building blocks of databases

* describes information sources

Fields

Building blocks of records sections

* sections of records where info started

For keyword searching, more info = ?

And less info = ?

More info = less precision

Less info = more precision

Catalog

Systematic list of books, merchandise or the like that is available in or from a source

categories of publishers

* commercial
* University presses
* Associations, societies, businesses, industries
* Governments and intergovernmental (United Nations)
* Web publishers

Determining usefulness of a source

1. Objectivity: goals for the publication, any biases, is it valid
2. Quality: organization, grammar and spelling, graphic use accurate information
3. Coverage/currency: date of publication, current info, revised
4. Relevance: answers research question, appropriate for research topic

CRAAP tool

Currency, relevance, authority, accuracy, purpose

Plagiarism

Using the words or ideas of someone else as your own without citing the source

When to cite

1. When using a sources factual information or data
2. When quoting someone’s words
3. Summarizing, paraphrasing or using ideas and opinions of others
4. Using a sources structure, strategy, method or procedure
5. Mentioning another persons work.

How to build an essay

* outline
* Intro
* Body paragraphs
* Conclusion

Elements of an effective thesis

* concise
* Clear
* Specific
* Arguable

Income + social status and health

* lower income = poorer health
* Material deprivation, psychological stress, poor coping behaviours and lack of support

Social support networks and health

* practical, informational, emotional, affirmational
* Strong social support linked with positive health outcomes

Education + literacy in health

* direct = not being literate, can’t read safety instructions
* Indirect = not using the right resources lack of awareness and lack of info
* Poor health literacy

Employment + working conditions and health

* unemployment and job insecurities can lead to material and social deprivation, psychological stress and turning to coping behaviours.

Physical environment and health

* Built and natural environment
* Directly effects health

Biological and genetic factors of health

* Hereditary can be influenced by other factors the determine how genetic factors express themselves.

Individual health practices and coping skills

* Risk behaviours can be coping strategies used to deal with living circumstances

Healthy child development and health

* early childhood development plays an important role is SDoH
* Shapes future behaviours, health, well-being, skill development.

Health services

* like quality and accessible primary care, hospital care, long-term care, home care, public health services all have and impact on the health status of an individual

Race and health

* Gender and race based inequality
* Experience many disadvantages compared to non Racialized groups

Culture and health

* cultural factories influence access to and understanding of health promotion and illness management
* Culture and immigration can affect multiple other SDoH

Gender and health

* Gender is the socially determined roles
* Influences all social determinants of health

Levels of prevention

1. Primary prevention
2. Secondary prevention
3. Tertiary prevention

Primary prevention

Activities that protect against a disease before signs and symptoms occur (prepathogenesis stage of disease)

* i.e immunizations, reduction of risk factors such as smoking

Secondary prevention

Activities that promote early detection of disease once pathogenesis has occurred so that prompt treatment can be initiated.

* i.e preventative screening for cancer (pap test, testicular self-examination)

Tertiary prevention

Activities that are initiated in the convalescence stage of disease and are directed towards minimizing residual disability and helping people to live productively with limitations.

* i.e a cardiac rehabilitation program after myocardial infarction or eye exercises/physical therapy after eye surgery.

Health promotion

Directed towards increasing the level of well-being and self-actualization

* enabling people to increase control over and improve their health

Health promotion from nursing perspective (5)

* Health promotion addresses health issues in context
* Supports holistic approach
* Requires long term perspective
* Is multisectoral
* Draws on knowledge from social, economic, political, environmental, medical, and nursing sciences

Passive vs. Active health promotion

Passive: public health efforts to maintain clean water systems

Active: depends on individual becoming personally involved in adopting a proposed program of health promotion

3 approaches to health promotion

1. Medical approach
2. Behavioural approach
3. Socioeconomic approach

Medical approach to health promotion

* stability orientation to health
* Mostly dominated by western perspective
* Health problems are primarily psychological risk factors
* Ensures populations remain healthy through medical intervention of physiological risk factors
* Disease fighting

Behavioural approach to health promotion

* focuses on decreasing behavioural risk
* Change in lifestyle (i.e smoking)
* Primarily impacted by Lalonde
* Advocates for health promotion and disease prevention
* Includes more preventative and healthy behaviours

Socioeconomic approach

* states that health is closely linked to socioeconomic factors, such as workplace environment and other SDoH
* Upstream health promotion
* Other factors to address before the person gets sick
* Tied to social structures, i.e poverty
* Unhealthy physical and social environments

Disease

* failure of persons adaptive mechanisms to counteract stimuli and stresses adequately
* Leads to a functional and structural disturbance
* Diagnosable disorder
* Can cause physical symptoms (doesn’t need to)
* Specific prognosis and treatment plan
* Not a social construct (testable/provable)
* I.e flu, Alzheimer’s, cancer, diabetes

Illness

* disease or period of sickness affecting body or mind
* Physical condition of feeling unwell
* Subjective condition
* Unlike disease, it is not diagnosable and is based on social constructs

Evidence-informed decision making (EIDM)

* using best available research evidence into decision making process
* Research applied and interpreted into each clinical judgement and care scenarios

Evidence based medicine (EBM)

Supports client care decisions with best available evidence

Model for evidence informed decision making

4 factors determine clinical expertise


1. Clinical state, setting and circumstances
2. Patient preferences and actions
3. Research evidence
4. Health care resources

These plus clinical expertise make up the sources of evidence

Evidence from research

* most relevant, high quality quantitative or qualitative evidence available.
* Research findings from a variety of disciplines and sectors

Clinical state, setting and circumstances evidence

* severity of the illness/disease
* Setting (acute care, public health)

Patient preferences and actions as evidence

* clients views about health care options (related to personal values and experiences, culture, degree of aversion to risk, health care insurance and resources, accuracy of information at hand, and family)

Health care resources as evidence

* financial resources
* Human Resources (personnel/staff)
* Materials

clinical expertise

* clinical skills
* Past experiences

Steps of EIDM

1. Define

* create a focussed answerable question from practice situation, based on information needs)


2. Search

* use pre-processed research evidence that’s trustworthy and relevant


3. Appraise: thoroughly evaluate research sources


4. Synthesize: determine and interpret recommendations from literature for practice


5. Apply: integrate and apply research results to patient/target population

* also think about other parts of EIDM model


6. Implement: decide and plan on how to implement the research into practice
7. Evaluate: effectiveness of the implementation efforts.

PICO questions

Are used to be very specific about the question we want to ask. It is very useful in preparing nurses to conduct a search of research evidence

PICO stands for

* Patient or Population
* Intervention
* Comparison
* Outcome

Used for quantitative questions

PS questions

When context or experience questions are best answered by qualitative research

PS stands for

* Patient/Population
* Situation

Background question

* general, fills in gaps in knowledge
* I.e how does the brain work?
* I.e What is type 2 diabetes? How is type 2 diabetes managed?

Foreground questions

* Specific question
* How is visual information processed for a partially blind patient

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Tips to tell the difference between qualitative and quantitative data

Qualitative:

* broader title
* Uses statistics more-so to support rather than as its prime evidence

Quantitative:

* narrowed title
* Uses terms such as “random sampling” “control group”
* Contains numbers in results sections

Hierarchy of quantitative research

Starts at top of pyramid:


1. Practice guidelines
2. Systematic reviews (including meta analyses)
3. Randomized controlled trials (RCTs)
4. Cohort-Analytic studies
5. Case control studies
6. Cohort studies
7. Case studies
8. Ideas, editorials, expert opinions

Purpose of the 6s pyramid

To find the best research evidence with the least amount of time and effort.

Pieces of the 6S pyramid

By starting at the top of the pyramid you find the highest quality and synthesized research evidence first


1. Systems
2. Summaries
3. Synopses of syntheses
4. Syntheses (systematic reviews)
5. Synopses of single studies
6. Single studies

Systems (6S pyramid)

Electronic systems that can be sophisticated enough to link patient records and to prompt practitioners about guidelines for care.

* not accessible unless in an institution
* Full database and policies and procedures as outlined by the hospital that is being looked at