May 15, 2024 • 33 mins
This week, Jeff Yan sits down with Sharyl Toscano, a professor at the School of Nursing at the University of Alaska Anchorage.
Dive deep into the multifaceted world of nursing and uncover powerful insights on:
- Storytelling in Nursing: Explore how sharing and reflecting on personal clinical experiences can shape compassionate care.
- Nonviolent Communication in Nursing: Learn how empathetic communication can transform patient interactions and team dynamics.
- 💪 Strength-Based Approach in Nursing: Shift your focus to what’s working well and leverage strengths to improve patient care and work environments.
Here is our earlier conversation with Paul Wasco: https://podcast.digication.com/episodes/ep-4-you-matter-your-story-matters-part-2-paul-wasko
Some terminologies used in this conversation:
NICU stands for Neonatal (Newborn) Intensive Care Unit (NICU)
SBAR stands for Situation, Background, Assessment, Recommendation
NVC stands for Nonviolent Communication (https://www.cnvc.org/)
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Welcome to DigicationScholars Conversations.
I'm your host, Jeff Yan.
In this episode, you will hear part oneof my conversation with Sharyl Toscano,
professor at the School of Nursingat University of Alaska Anchorage.
More links and information about today'sconversation can be found on Digication's
Twitter, Facebook, and Instagram.
(00:22):
Full episodes of Digication ScholarsConversations can be found on
YouTube or your favorite podcast app.
Welcome to DigicationScholars Conversations.
I'm your host, Jeff Yan.
My guest today is Sharyl Toscano.
Professor at the School of Nursingat University of Alaska Anchorage.
(00:43):
Hello, Sharyl.
Hi.
Hi, Jeff.
Welcome.
Uh, I have been a, um, we've had, we'veshared a, uh, a friend and colleague,
Paul Wasco, I think, for many years.
Um, Paul Wasco is also a DigicationScholar, um, uh, we'll, we'll put a link
(01:04):
to his, uh, episode, um, um, in, in our,in our show notes, um, and we've had a
long, um, partnership with Universityof Alaska Anchorage, um, and, uh, I
have heard a lot of, um, uh, good thingsabout you and what you're doing in the
School of Nursing, um, and we got to, Uh,we met, um, and did some work together
(01:27):
recently and I was just so drawn by whatyou do that I thought we should really
have you come and speak with us and tellpeople a little bit more about your work.
Thank you.
So, um, Sharyl, would you, Mind tellingus just a little bit of, perhaps just even
a little bit on, of, of where you come,where you're from and, um, maybe starting
(01:50):
from, you know, sort of, you know, whereyou grew up and then, you know, tell us
a little bit of how you got to Alaska.
Okay, great.
I grew up in Massachusetts, Pepperell'ssort of a small town outside of Boston.
Um, I, growing up, I knew I wantedto be a teacher or a nurse because
(02:11):
the, uh, job prospects were sortof solid in, in both, in both, um.
You achieved both dreams at the same time.
Yeah, exactly.
So, ironically, I became a teacher ofnursing, but, um, I went, yeah, I got, I
went to school in Massachusetts and thenI, Traveled a bit because my husband is,
(02:32):
was in the Marine Corps, so we ended upin Hawaii, uh, which was my first job
teaching nursing and then moved backto Vermont, probably to get back my New
England heartiness so I could move toAlaska because having moved from Hawaii.
Um, from Massachusetts where it'scold to Hawaii where it's super warm
(02:56):
back to Vermont and then here toAlaska where I've been since 2011.
So what brought you to Alaska?
Was it because of theteaching position or?
Um, it's sort of the lifestyle, actually.
I, I, you can kind of teachnursing anywhere because
there's a bit of a shortage.
(03:16):
And so I was more drawn to thelifestyle, I think, in Alaska
where, um, my kids were young andwe're a sort of outdoorsy family.
Well, Alaska is certainly a big Anchorageis sort of a, the Anchorage is sort of a
city, but, um, you know, the universityis really close, maybe 15 minutes from my
(03:37):
house, but The mountains are even closer.
So it's kind of a, a niceliving situation, I think.
Yeah, that's, that's great.
Now, in addition to, um, teaching, um, youalso are still practicing as a nurse, too.
Yeah, I teach at Alaska Native MedicalCenter, which is also about 10 minutes
(03:59):
from where I live, and I work inthe NICU mostly as a bedside RN, um,
and sometimes I work on pediatrics.
I've worked as a nurse practitioner forabout 10 years earlier in my career,
and now I'm more focused on education.
(04:19):
The bedside nursing, I do per diem,but that experience definitely informs
my teaching because I, one of thefocus of my teaching right now in the
capstone is, I mean, there's been acall for more self care for nurses,
uh, they've had some increased stressrecently, uh, increased work, uh, you
(04:42):
know, work assignments and, um, evenlack of access to supplies and materials
that used to be readily available.
So, I think being, you know,practicing in nursing in the setting,
I'm, you know, I have more current.
experience of what the new nurseswill be graduating into, what kind of
(05:02):
environments they'll be exposed to.
Um, you know, when I graduated,primary nursing was sort of the
standard, uh, way that we practiced.
And with, How things with the shortages,they're actually seeing team nursing
start to come back, which, you know,we haven't really focused on that
in education, uh, quite some time.
(05:25):
So how do you, how do you preparestudents for returning to this
environment that is very differentthan the one that I was educated
for and the one that I practiced in?
So.
Interesting.
Yeah.
Um, one of the things that Iremember being so impressed by
you is that you have, um, a reallystrong focus in storytelling.
(05:48):
Um, tell us a little bit more about that,because that's, by the way, I am, I love
that, but I often find that, you know,it's these intersections of someone who's
Uh, you know, teaching in a healthcareenvironment, you know, and nursing, but
you are taking storytelling as this sortof amazing learning tool, this amazing,
(06:15):
amazing ways for one to express oneselfand merging them together, you know?
Yeah.
And that's sort of changed.
Recently, I've always used my practiceor clinical stories in my teaching, but
something I've been doing more recentlyis having the students reflect on their
experience and tell their story where theyconnect it with, there's a nurse theorist,
(06:41):
um, Watson, and she has these Cerative,um, as part of her theory of nursing.
So the students will focuson one of the Ceratives.
And connect that with somethingthat's happened in their clinical
clinical experience and match up.
You know, 1 of them is being present.
And so how was that careto us demonstrated in this
(07:04):
encounter with the patient?
Or how was it not demonstrated?
So the students can sort ofreflect and how they might bring
that in in a future experience.
That might look similar.
But the important part is that they're,you know, when they're having clinical
experiences or patient experiences, notjust as a student, but once they graduate,
(07:27):
that they're reflecting on those andbringing what they learned from those
experience into the next encounter.
Um, we're, we're hope we're hoping thatthat will help the longevity of the nurse.
And I don't like the word resiliencebecause I feel like sometimes.
Saying someone's resilient is sort ofrewarding a breaking, broken system.
(07:51):
And so I would like a scenariowhere nurses are thriving
because they're supported.
And, um, I'm not sure whenyou say resilience, it's
usually they survived, right?
And that's sort of rewarded.
But, um, that if, if they're usingthese tools or they're really
reflecting on their experience andnot really judging it, but, you know,
(08:14):
taking the learning points from that.
Story or that experience into thenext one, they might approach the
scenario a little bit differently.
And, um, in the student case,oftentimes when they first start
writing their stories, theytend to be a bit judgy, right?
Because, you know, they're coming fromthis, they're coming from this sort of
(08:34):
textbook place where, you know, everythingis supposed to look a certain way.
And then they enter theclinical environment.
And they see things happeningmaybe a little bit differently.
And initially there's, they can be abit judgy about what, you know, the
nurse there with should have done.
Um, and so we kind of, I kind of pullthese apart, these, these narratives
(08:56):
that they write and I'll say, well,how can we look at this from a
strength based appreciative inquiry?
And so what are the facts of thisor the without judgment, either
Positive or negative without judgment.
What's happening here?
And then we try to connect itto, um, we bring in a little
(09:16):
nonviolent communication.
We try to bring in, um, the other or thestudent, like, what are their feelings and
then connect the feeling they're havingto a need that's either met or unmet.
This goes back tononviolent communication.
Um, that's pretty longstanding popular, popular book.
(09:36):
Um, but this approach, whatI'm hoping is it helps.
We have lots of ways that wecommunicate in healthcare.
You know, um, we have a SBAR.
I pass the baton, all theselittle acronyms for different
kinds of information and howyou convey it, but none of it
really gets at needs or feelings.
(09:57):
And I feel like that's whatleads to nurses burnout.
And so, Working with appreciativeinquiry, strength based approach, non
violent communication, and then thiskind of Watson's caring, um, framework,
I'm hoping, um, that, that will helpgive students the tools they need to
(10:20):
thrive when they enter practice insteadof surviving or, um, because we, we
tend to lose nurses, you know, Sometimeswithin the first year, you know,
they leave the professional together.
And so, we're really looking fortools that, that can support them.
I love what you said aboutthis, a very specific kind.
(10:45):
Um, you, you've gone a lot deeper totalk about reflection than oftentimes
I have with, you know, other people.
Because it's sort of, sometimespeople talk about reflection and
they just go, well, You know, Ijust ask my students to reflect.
I believe in it.
And I go, yeah, so do I.
But what does your reflection look like?
And then they just go, well, Ijust ask students to reflect.
(11:07):
And, and I go, well, I don't know.
For me, it has never worked for me.
But I just say, go reflect.
Um, I, you know, what's so interesting,we have a lot of overlap on this.
I made a presentation, actually,a presentation in Alaska.
(11:27):
to it had at University of AlaskaAnchorage a number of years ago, and
we were talking about reflection.
And I was trying to figureout how do you, how to
break down reflection in a reallysimple generic way that is really
easy for anyone to just pick up.
(11:48):
I don't want it to be a very overlyscholarly, um, you know, Sort of thing
because I want the students ultimatelyto be able to do it and I want the
students to understand it So I don'twant to faculty members to take this and
then get to the to the students and thenthere's a bunch of theories behind it.
I just wanted to boil it down to somethingand I Had this very beginning phase of
(12:12):
the framework, which I think has someoverlap with what you do, which is We
break down Um, uh, the the sort of theJust, just two faces of the reflection.
One is, um, storytelling.
Um, and then the other is, um, um,through conversation, find significance.
(12:40):
Um, and, um, and it sounds likeit's a little bit like what you
are doing, but you're, what yousaid was, I think it's better.
Um, it's uh It's got a little bitmore of that, you know, really
thinking about the language in whichwe use to, to, uh, uh, approach it.
Um, so hopefully I'll, I'll borrowthat a little bit, uh, as well in
(13:02):
the future, but I, I like this a lotbecause, um, sometimes I find that
by breaking it down into those twofaces, you can hold off on the judgment
part of it, whether it's, You know havepositive negative judgment or in your
(13:22):
case a nonviolent version of it You canhold off on that and just understanding
what happened just to just to get asense of I'm not even looking at whether
it Works just what happened firstand then being able to remove myself
from already coming to conclusion Andthen try to say, we laid it all out.
(13:43):
Now let's take a look at what'sso significant about all of this.
Um, and, um, and I love what you saidabout the non violent language of, you
know, form of communication and to usethat as a basis of looking at this.
I'll tell you what, if I ever You know,need to be taken care of by a nurse.
(14:04):
I want to be taken care of byyou or any of your students.
Um, can we talk a little bit aboutthis idea of, um, you had said that
nurses, you, you've been focusingquite a lot on self care for nursing.
(14:29):
Um,
And that they often get burnedout, you know, as soon as they
basically get into the job situation.
And I think that this is the case fora number of, um, number of fields.
Education is another.
That's like that.
(14:49):
A lot of people train to be a teacher.
They have this passion that they wantto help, um, young children learn, but
then a year into it, they realize howtough it is and some of the things that
they still like and love a lot of thepieces of it, but there are enough other
(15:10):
pieces that makes them want to quit.
What is, can we talkabout that a little bit?
Because I think that's a, that's aserious issue in society, isn't it?
Yeah.
What causes that in nursing?
What do you think causes it in nursing?
Well, I think, I think they're sofocused and I was talking to a student
(15:30):
about this actually just yesterday.
Um, you know, she was expressinghow in the class, um, where they're
doing some of these activities,she's really interested in them and,
you know, her appreciation for it.
But then in the very next breath, shesays, I just don't have time right now.
So she's like, maybe I'll havetime, you know, when school's
(15:51):
done, or maybe I'll have time.
And I said, well, you'll, you will neverhave time unless you make space for it.
Um, I said, and you know, and that'swhy we're, We're focused on this so that
you can practice integrating this now.
Uh, and, and I could kind of give theexample of, you know, even if I'm on the
way to a delivery, we talk about sortof a little bit of mindfulness or it,
(16:13):
I don't really push any one strategy.
I kind of introduced themto multiple strategies.
Um, I think the telling the story isdefinitely like kind of unifying piece of
that, but, you know, it explains these, ifI'm headed to a delivery, I actually use
that as a mindful moment because I haveto walk all the way out the NICU, down the
hall, find the room, and then even settingup the equipment before the baby comes.
(16:38):
It's, it's, you do everything in the samesteps every time and it's a way to focus.
Like everyone's focused on it, but ifyou don't use those moments that you
have to kind of center yourself or dosome self care, I think nurses or other
health professionals can kind of just.
(16:59):
Push it past, um, and it builds up,you know, or even, you know, you know,
saying they don't feel something.
There's a lot of, um, things that nursingstudents, nurses or health care, anyone
in health care really is exposed toprobably more in one, you know, one
(17:19):
small stretch of time that somebody elsewould be exposed to an entire lifetime.
Like your, it's not you, it's not thesame level, but you're exposed to so
much, you know, kind of trauma, youknow, just, and so if you just kind
of squash that down and you don't.
You know, it's like,Oh, I'm just hardcore.
I can't.
Yeah.
You think they will break you down.
(17:40):
Right.
Yeah.
Or you'll just, you'll leak all the time.
These are, these are, I've heard a lotof people talk about this indirect or
secondary trauma that you get, right?
Just be exposed to it and
Could could lead to that becauseyou are witness of something things
sometimes don't go well, right?
(18:01):
And the part of that appreciativeapproach that I've tried to you know
Particularly, you know students you getto the final semester and there tends
to be a certain mindset, you know,there's I Don't think this is specific
to nursing students, but sometimes itcan be You know, a certain kind of focus
and I kind of try to tell him, what ifyou flip that focus and just tried to
(18:23):
focus on from an appreciative approach,like where, where are the strengths,
where are, where is the success?
And I think if you don't do that,like a unit, an entire unit can just
become very negative all the time.
Like just focus on the negative.
They almost can't pull themselves out.
Um, You know, they might even betrying to throw every strategy at it.
(18:47):
You know, I'm in my current work space.
You know, I think there's so many, alot of people have left after COVID.
Um, a lot of new, new graduates,lots of great energy, really good
excitement, but not the same support.
You know, when I graduated, I hadprobably seven or eight senior nurses.
And there was maybe three of us.
(19:08):
Well, there's like maybe threesenior nurses and the majority of
the shift is new, you know, and so,you know, that's sort of a struggle.
But if you focus, if you don't focus atall on what's going well or where the
opportunities are, and you're alwaysfocused on what's not going well.
(19:29):
Um, I think you, you kind of justkind of continue down that road,
but we don't really, we haven'tin the past really given people
the tools to change that focus.
Um, you know, and when I do.
NVC.
At first, the student'slike, Oh, this is easy.
(19:51):
And when they actually try to do it, andthey, and I'm actually having them discern
the difference between joy and happiness,like they're not the same feeling.
And they were like, well,what difference does it make?
Because when you look at the other sideof it and you're looking at anger, it's
not, you're not angry, you're frustratedor you're, and so when you're looking
(20:11):
at what you need to do to Resolve thatneed, figuring out that difference
between, you know, anger and frustration,even though it might feel the same
initially, it becomes really important.
And I think they kind of get it the more,the more we go through the semester.
And some of them have started touse it in their preceptorship,
(20:32):
but it's, um, it is something thatlooks easy, but does take practice.
For those of us who don't know whatNVC is, um, could you tell us a little
bit more so that we can Yeah, it's apretty old, um, is Marshall Rosenberg.
I might get his name wrong.
Um, uh, it's been used, you know, it'sused a lot in Waldorf schools for kids.
(20:57):
It's a really useful technique.
For that, uh, but it'salso used in counseling.
It's used in war-torn countries whenyou're, they've used it when negotiators
go in and they'll use NVC, um, indifferent camps where they bring kids
from different, um, countries together.
They've used NVC, but essentially, um,the elements are essentially there's
(21:21):
everyone has universal needs, no matterwhere you're from, no matter what culture.
And.
If you can identify or match up yourfeelings with your needs, so you
have feelings when your needs aremet and feelings when your needs
are unmet and just making thatconnection, um, and not judging
(21:41):
anybody for causing those feelings.
Like, they're your feelings, right?
And then the 2nd part of that is to make.
Requests.
So you know, you have a feelingand a need that's matter
unmet, and you make a request.
But that request is a request.
It's not a demand.
So you have to also be open to, well, no,, it's the answer to your request, which is
(22:05):
a little tricky in the healthcare setting.
So we talk about that becauseyou, there are situations
where we can't say no, right?
. Yeah.
Um, and then.
And the, but the appreciation piece Ithink is even more important that you're,
when you're showing appreciation usingthe model, you're saying specifically
your feeling and your met need.
(22:25):
So the person who you're giving thatappreciation to is also getting really
specific feedback about what it wasspecifically that they did to, um, you
know, for you to show this appreciation.
You know, cause oftentimes when weget thanks or we don't really know
what it was exactly that we did.
And so if you're going to continue thatbehavior showing that really specific,
(22:48):
you know, I felt this way and when,uh, you met this need, um, I did.
Hopefully that person willcontinue, um, to do that
specific behavior on the future.
Uh, when, when that's not communicated,particularly when it's an unmet
need, you know, they really don'tknow what they're doing over time
(23:11):
and that never gets resolved.
But this idea of just, you know, inour, in sort of the modern American,
you know, families today, this ideaof being able to just identify one's
feelings is, um, is not a, is not askill that we can take for granted.
(23:39):
In fact, um, that's probably, uh, whythere is such a huge, um, Huge industry
in, uh, in therapy today, right?
We are not able to either identify orprocess these feelings and acts in,
(24:01):
acts to, to, um, to address, you know,feelings of, you know, hurts or, um, anger
and, you know, especially the negativefeelings, but also the positive ones.
It's a really fun, um, game.
I started using this game with mykids, but I use it with the students.
(24:23):
You know, we had one face to face.
Most of my classes are asynchronousonline, but um, we had one, a
few face to face sessions and thestudents kept wanting to play Grok.
And Grok is sort ofthis, just a card game.
It has a stack of feelings cardsand a stack of needs cards.
There's all these sort of games youcan go through, um, using the cards.
(24:45):
But you know, I start, then theywanted to play Play Grok over
and over because it's just a veryconcrete way to, to use the model.
But I remember when I was, I used to useit with my daughter when she was younger.
I remember one day she came home and shewas really young, you know, not, um, she
might have been maybe seven or six and ahalf or something, but, and she was really
(25:08):
upset with her dad and she said, Mama Ineed to Grock and she came and she got
the cards and she went, she went over tohim and she says, you know, she lays down
her feelings cards and her needs cards.
And so it's a really, um, with youngerkids in particular, it's really, um, they
get it, you know, they just naturallyknow how to use it, you know, as they get
(25:30):
older, they kind of roll their eyes andthey're like, you're doing that thing.
So just stop.
Well, they probably haveinternalized those skills now, right?
Yeah.
But the college students,for many, it's new.
Like they, they've learned adifferent way, um, you know, by
saying I feel, but you can start asentence with I feel, and it's still
(25:50):
sort of aggressive language, right?
Cause I, I feel if that's followedby, you know, blaming someone else,
as opposed to, you know, the NVC, youdon't, it's, you're not interpreting
your feelings to anybody else.
Anyway, I've probably gone on aboutNVC a bit too long, but, um, No, it's
(26:10):
not because I, here's what I, um,I wanted to just say how important
some, this discussion I think is, Ithink that there are lots of, um, you
know, I, I, I'm a deep believer that.
When we have many different perspectivesat looking at the world, we get
(26:33):
better at looking at the world.
And
Um, you know, there are educators,education psychologists, there's,
you know, researchers in alldifferent kind of fields.
I've had many of these conversations, youknow, some of them healthcare, some of
them in STEM, you know, they all bring,um, different perspectives on how they
(26:58):
think about reflection, for example.
There are some things that tie us alltogether, like reflection, sometimes it's
storytelling, you know, stuff like that.
I think it's really cool.
But I think that what you have to do.
brought is a really fresh perspective,um, that in many ways, I think it
perhaps is one of the, the moresophisticated way of thinking about
(27:24):
reflection in a very, it doesn'tjust have this or around reflection.
There are literally steps that wecan take that can genuinely get
those feelings processed, get thoseand then experience and really
reflect and get to the significance.
(27:45):
And I think that there's something reallysignificant about this because there are
so many people, scholars, practitioners,have tried for many years to try to
say You know, we want to reflect.
One of the things that I have found thatis, um, that doesn't work is people think
(28:06):
that, what's your reflection prompt?
Because as if that's just silverbullet that I can just say, if you
ask student this prompt, they willsuddenly, they will solve everything.
You know, that would have beenlike saying to a therapist that,
what do you ask your clients?
(28:27):
Well, I just asked him this onething and then everything is done.
It's not like that, right?
There's a lot of depth intolayers of processing stuff.
And you are, in fact, describinga number of those layers in the
scenarios, um, in very concrete terms.
(28:48):
So I love that.
I think that's really wonderful.
I think that that's an area, you know,I'll probably tap you for this, um,
you know, If you don't mind, I'llprobably be like, Sharyl, you know,
that thing that we talked about?
Can we, do you think that we can like,you know, like, can you publish this?
Can you like write about it?
Can you explain it?
Because I, I really think that, um, a lotof people struggle with it because we,
(29:14):
Sort of almost inherently, instinctively,maybe we have experienced it, you know,
but anecdotally, reflection is good.
It's the, it's the gem,it's the spark that we get.
And we want our students to have that, butwe don't know how to get them to have it.
Yeah.
When you say the prompts, it makesme think of every reflection I've
(29:34):
ever been asked to do as a student.
There's always these prompts.
I was like, well, that'snot where my mind's going.
Like, thanks.
And I've, I've always sort of, bendmore toward open-ended, but then
sometimes I could see on the educatorside where you sometimes get back.
There's no emotion.
I sit, you know, I tell thestudents I need to feel something.
(29:55):
It doesn't have to be a good feeling.
But if you've reflected, I should havesome feeling should be in this reflection.
And something from you, like I was talkingto a student the other day and I said,
well, somebody had described this to me.
This isn't my language, but I think itwas an advisor back at BC a long time ago.
(30:15):
She was like, I want toknow what's in your box.
Like so many people tell you what yourbox should look like, but I want to
know what Sharyl's box looks like.
I was like, I'm not so sure you wantto know what my box looks like, but,
but it, that I sort of took that withme in my, You know, as a teacher that I
didn't want to always just have studentsrepeating what I think is what my box is.
(30:38):
I actually do want to know, you know,what, what's unique about, about
their experience and their knowledgerelated to whatever the topic is.
So, in the Capstone course, thenursing Capstone course, we do, um.
They demonstrate the baccalaureateessentials for the nurse, so there's 10.
And for this, we use a lot of reflectionand we're using um, ePortfolio for that.
(31:02):
And it does take a bit to get themgoing because their initial response
is to just define the essential orjust, When this assignment I did
this, or this assignment I did this.
I say, I'm not, the assignmentis just, you know, like a
piece of pottery you made.
If you're.
You know, Potter, likethis is the one you like.
So, you know, you're using it as yourevidence or an example of where you did
(31:26):
this thing, but the reflection shouldreally be about the full essential.
And, you know, how did you think aboutnursing knowledge as a, new student and
how did that change in your experiencesover the time you've been here or the
experiences that you've had and then theystart to, they don't, it's not intuitive.
(31:48):
I don't think they get it right away.
So there's kind of, there's alot of back and forth prompting.
But eventually they really create,they start with their autobiographic
sketch, which are very unique.
We have the most uniquestudents, I think, in Alaska.
Just come from like, some are from ruralvillages, some are like military families,
(32:08):
some are like hardy Alaskans that have,you know, been here for generations.
And many are just from everywhere becauseit's sort of a melting pot, right?
And so you have these reallyunique autobiographical.
Graphic sketches of where they'vecome from and how they ended up in
nursing and then somehow they allsort of relate to their narrative
(32:29):
that's specific to each essentialand how they've, how they've met it.
It's a pretty, it's a pretty big projectand it is 1 of those 1s when you say, how
do you get students to reflect initially?
They're just, you know, they want.
The prompts . But if I gave, well,we're also looking for the answer.
What's the right answer?
Right.
(32:49):
Right.
And if you do that too much,they'll all look the same.
Yeah.
And then, and then itdoes become busy work.
And I don't want it to be busy work.
I want, it might be idealistic,but I want them changed from it.
You know?
I want, here's the previewof what's coming up next.
In part two of my conversationwith Sharyl Toscano, professor
at the School of Nursing atUniversity of Alaska, Anchorage.
Welcome to DigicationScholars Conversations.
I'm your host, Jeff Yan.
In this episode, you will hear part oneof my conversation with Sharyl Toscano,
professor at the School of Nursingat University of Alaska Anchorage.
More links and information about today'sconversation can be found on Digication's
Twitter, Facebook, and Instagram.
(00:22):
Full episodes of Digication ScholarsConversations can be found on
YouTube or your favorite podcast app.
Welcome to DigicationScholars Conversations.
I'm your host, Jeff Yan.
My guest today is Sharyl Toscano.
Professor at the School of Nursingat University of Alaska Anchorage.
(00:43):
Hello, Sharyl.
Hi.
Hi, Jeff.
Welcome.
Uh, I have been a, um, we've had, we'veshared a, uh, a friend and colleague,
Paul Wasco, I think, for many years.
Um, Paul Wasco is also a DigicationScholar, um, uh, we'll, we'll put a link
(01:04):
to his, uh, episode, um, um, in, in our,in our show notes, um, and we've had a
long, um, partnership with Universityof Alaska Anchorage, um, and, uh, I
have heard a lot of, um, uh, good thingsabout you and what you're doing in the
School of Nursing, um, and we got to, Uh,we met, um, and did some work together
(01:27):
recently and I was just so drawn by whatyou do that I thought we should really
have you come and speak with us and tellpeople a little bit more about your work.
Thank you.
So, um, Sharyl, would you, Mind tellingus just a little bit of, perhaps just even
a little bit on, of, of where you come,where you're from and, um, maybe starting
(01:50):
from, you know, sort of, you know, whereyou grew up and then, you know, tell us
a little bit of how you got to Alaska.
Okay, great.
I grew up in Massachusetts, Pepperell'ssort of a small town outside of Boston.
Um, I, growing up, I knew I wantedto be a teacher or a nurse because
(02:11):
the, uh, job prospects were sortof solid in, in both, in both, um.
You achieved both dreams at the same time.
Yeah, exactly.
So, ironically, I became a teacher ofnursing, but, um, I went, yeah, I got, I
went to school in Massachusetts and thenI, Traveled a bit because my husband is,
(02:32):
was in the Marine Corps, so we ended upin Hawaii, uh, which was my first job
teaching nursing and then moved backto Vermont, probably to get back my New
England heartiness so I could move toAlaska because having moved from Hawaii.
Um, from Massachusetts where it'scold to Hawaii where it's super warm
(02:56):
back to Vermont and then here toAlaska where I've been since 2011.
So what brought you to Alaska?
Was it because of theteaching position or?
Um, it's sort of the lifestyle, actually.
I, I, you can kind of teachnursing anywhere because
there's a bit of a shortage.
(03:16):
And so I was more drawn to thelifestyle, I think, in Alaska
where, um, my kids were young andwe're a sort of outdoorsy family.
Well, Alaska is certainly a big Anchorageis sort of a, the Anchorage is sort of a
city, but, um, you know, the universityis really close, maybe 15 minutes from my
(03:37):
house, but The mountains are even closer.
So it's kind of a, a niceliving situation, I think.
Yeah, that's, that's great.
Now, in addition to, um, teaching, um, youalso are still practicing as a nurse, too.
Yeah, I teach at Alaska Native MedicalCenter, which is also about 10 minutes
(03:59):
from where I live, and I work inthe NICU mostly as a bedside RN, um,
and sometimes I work on pediatrics.
I've worked as a nurse practitioner forabout 10 years earlier in my career,
and now I'm more focused on education.
(04:19):
The bedside nursing, I do per diem,but that experience definitely informs
my teaching because I, one of thefocus of my teaching right now in the
capstone is, I mean, there's been acall for more self care for nurses,
uh, they've had some increased stressrecently, uh, increased work, uh, you
(04:42):
know, work assignments and, um, evenlack of access to supplies and materials
that used to be readily available.
So, I think being, you know,practicing in nursing in the setting,
I'm, you know, I have more current.
experience of what the new nurseswill be graduating into, what kind of
(05:02):
environments they'll be exposed to.
Um, you know, when I graduated,primary nursing was sort of the
standard, uh, way that we practiced.
And with, How things with the shortages,they're actually seeing team nursing
start to come back, which, you know,we haven't really focused on that
in education, uh, quite some time.
(05:25):
So how do you, how do you preparestudents for returning to this
environment that is very differentthan the one that I was educated
for and the one that I practiced in?
So.
Interesting.
Yeah.
Um, one of the things that Iremember being so impressed by
you is that you have, um, a reallystrong focus in storytelling.
(05:48):
Um, tell us a little bit more about that,because that's, by the way, I am, I love
that, but I often find that, you know,it's these intersections of someone who's
Uh, you know, teaching in a healthcareenvironment, you know, and nursing, but
you are taking storytelling as this sortof amazing learning tool, this amazing,
(06:15):
amazing ways for one to express oneselfand merging them together, you know?
Yeah.
And that's sort of changed.
Recently, I've always used my practiceor clinical stories in my teaching, but
something I've been doing more recentlyis having the students reflect on their
experience and tell their story where theyconnect it with, there's a nurse theorist,
(06:41):
um, Watson, and she has these Cerative,um, as part of her theory of nursing.
So the students will focuson one of the Ceratives.
And connect that with somethingthat's happened in their clinical
clinical experience and match up.
You know, 1 of them is being present.
And so how was that careto us demonstrated in this
(07:04):
encounter with the patient?
Or how was it not demonstrated?
So the students can sort ofreflect and how they might bring
that in in a future experience.
That might look similar.
But the important part is that they're,you know, when they're having clinical
experiences or patient experiences, notjust as a student, but once they graduate,
(07:27):
that they're reflecting on those andbringing what they learned from those
experience into the next encounter.
Um, we're, we're hope we're hoping thatthat will help the longevity of the nurse.
And I don't like the word resiliencebecause I feel like sometimes.
Saying someone's resilient is sort ofrewarding a breaking, broken system.
(07:51):
And so I would like a scenariowhere nurses are thriving
because they're supported.
And, um, I'm not sure whenyou say resilience, it's
usually they survived, right?
And that's sort of rewarded.
But, um, that if, if they're usingthese tools or they're really
reflecting on their experience andnot really judging it, but, you know,
(08:14):
taking the learning points from that.
Story or that experience into thenext one, they might approach the
scenario a little bit differently.
And, um, in the student case,oftentimes when they first start
writing their stories, theytend to be a bit judgy, right?
Because, you know, they're coming fromthis, they're coming from this sort of
(08:34):
textbook place where, you know, everythingis supposed to look a certain way.
And then they enter theclinical environment.
And they see things happeningmaybe a little bit differently.
And initially there's, they can be abit judgy about what, you know, the
nurse there with should have done.
Um, and so we kind of, I kind of pullthese apart, these, these narratives
(08:56):
that they write and I'll say, well,how can we look at this from a
strength based appreciative inquiry?
And so what are the facts of thisor the without judgment, either
Positive or negative without judgment.
What's happening here?
And then we try to connect itto, um, we bring in a little
(09:16):
nonviolent communication.
We try to bring in, um, the other or thestudent, like, what are their feelings and
then connect the feeling they're havingto a need that's either met or unmet.
This goes back tononviolent communication.
Um, that's pretty longstanding popular, popular book.
(09:36):
Um, but this approach, whatI'm hoping is it helps.
We have lots of ways that wecommunicate in healthcare.
You know, um, we have a SBAR.
I pass the baton, all theselittle acronyms for different
kinds of information and howyou convey it, but none of it
really gets at needs or feelings.
(09:57):
And I feel like that's whatleads to nurses burnout.
And so, Working with appreciativeinquiry, strength based approach, non
violent communication, and then thiskind of Watson's caring, um, framework,
I'm hoping, um, that, that will helpgive students the tools they need to
(10:20):
thrive when they enter practice insteadof surviving or, um, because we, we
tend to lose nurses, you know, Sometimeswithin the first year, you know,
they leave the professional together.
And so, we're really looking fortools that, that can support them.
I love what you said aboutthis, a very specific kind.
(10:45):
Um, you, you've gone a lot deeper totalk about reflection than oftentimes
I have with, you know, other people.
Because it's sort of, sometimespeople talk about reflection and
they just go, well, You know, Ijust ask my students to reflect.
I believe in it.
And I go, yeah, so do I.
But what does your reflection look like?
And then they just go, well, Ijust ask students to reflect.
(11:07):
And, and I go, well, I don't know.
For me, it has never worked for me.
But I just say, go reflect.
Um, I, you know, what's so interesting,we have a lot of overlap on this.
I made a presentation, actually,a presentation in Alaska.
(11:27):
to it had at University of AlaskaAnchorage a number of years ago, and
we were talking about reflection.
And I was trying to figureout how do you, how to
break down reflection in a reallysimple generic way that is really
easy for anyone to just pick up.
(11:48):
I don't want it to be a very overlyscholarly, um, you know, Sort of thing
because I want the students ultimatelyto be able to do it and I want the
students to understand it So I don'twant to faculty members to take this and
then get to the to the students and thenthere's a bunch of theories behind it.
I just wanted to boil it down to somethingand I Had this very beginning phase of
(12:12):
the framework, which I think has someoverlap with what you do, which is We
break down Um, uh, the the sort of theJust, just two faces of the reflection.
One is, um, storytelling.
Um, and then the other is, um, um,through conversation, find significance.
(12:40):
Um, and, um, and it sounds likeit's a little bit like what you
are doing, but you're, what yousaid was, I think it's better.
Um, it's uh It's got a little bitmore of that, you know, really
thinking about the language in whichwe use to, to, uh, uh, approach it.
Um, so hopefully I'll, I'll borrowthat a little bit, uh, as well in
(13:02):
the future, but I, I like this a lotbecause, um, sometimes I find that
by breaking it down into those twofaces, you can hold off on the judgment
part of it, whether it's, You know havepositive negative judgment or in your
(13:22):
case a nonviolent version of it You canhold off on that and just understanding
what happened just to just to get asense of I'm not even looking at whether
it Works just what happened firstand then being able to remove myself
from already coming to conclusion Andthen try to say, we laid it all out.
(13:43):
Now let's take a look at what'sso significant about all of this.
Um, and, um, and I love what you saidabout the non violent language of, you
know, form of communication and to usethat as a basis of looking at this.
I'll tell you what, if I ever You know,need to be taken care of by a nurse.
(14:04):
I want to be taken care of byyou or any of your students.
Um, can we talk a little bit aboutthis idea of, um, you had said that
nurses, you, you've been focusingquite a lot on self care for nursing.
(14:29):
Um,
And that they often get burnedout, you know, as soon as they
basically get into the job situation.
And I think that this is the case fora number of, um, number of fields.
Education is another.
That's like that.
(14:49):
A lot of people train to be a teacher.
They have this passion that they wantto help, um, young children learn, but
then a year into it, they realize howtough it is and some of the things that
they still like and love a lot of thepieces of it, but there are enough other
(15:10):
pieces that makes them want to quit.
What is, can we talkabout that a little bit?
Because I think that's a, that's aserious issue in society, isn't it?
Yeah.
What causes that in nursing?
What do you think causes it in nursing?
Well, I think, I think they're sofocused and I was talking to a student
(15:30):
about this actually just yesterday.
Um, you know, she was expressinghow in the class, um, where they're
doing some of these activities,she's really interested in them and,
you know, her appreciation for it.
But then in the very next breath, shesays, I just don't have time right now.
So she's like, maybe I'll havetime, you know, when school's
(15:51):
done, or maybe I'll have time.
And I said, well, you'll, you will neverhave time unless you make space for it.
Um, I said, and you know, and that'swhy we're, We're focused on this so that
you can practice integrating this now.
Uh, and, and I could kind of give theexample of, you know, even if I'm on the
way to a delivery, we talk about sortof a little bit of mindfulness or it,
(16:13):
I don't really push any one strategy.
I kind of introduced themto multiple strategies.
Um, I think the telling the story isdefinitely like kind of unifying piece of
that, but, you know, it explains these, ifI'm headed to a delivery, I actually use
that as a mindful moment because I haveto walk all the way out the NICU, down the
hall, find the room, and then even settingup the equipment before the baby comes.
(16:38):
It's, it's, you do everything in the samesteps every time and it's a way to focus.
Like everyone's focused on it, but ifyou don't use those moments that you
have to kind of center yourself or dosome self care, I think nurses or other
health professionals can kind of just.
(16:59):
Push it past, um, and it builds up,you know, or even, you know, you know,
saying they don't feel something.
There's a lot of, um, things that nursingstudents, nurses or health care, anyone
in health care really is exposed toprobably more in one, you know, one
(17:19):
small stretch of time that somebody elsewould be exposed to an entire lifetime.
Like your, it's not you, it's not thesame level, but you're exposed to so
much, you know, kind of trauma, youknow, just, and so if you just kind
of squash that down and you don't.
You know, it's like,Oh, I'm just hardcore.
I can't.
Yeah.
You think they will break you down.
(17:40):
Right.
Yeah.
Or you'll just, you'll leak all the time.
These are, these are, I've heard a lotof people talk about this indirect or
secondary trauma that you get, right?
Just be exposed to it and
Could could lead to that becauseyou are witness of something things
sometimes don't go well, right?
(18:01):
And the part of that appreciativeapproach that I've tried to you know
Particularly, you know students you getto the final semester and there tends
to be a certain mindset, you know,there's I Don't think this is specific
to nursing students, but sometimes itcan be You know, a certain kind of focus
and I kind of try to tell him, what ifyou flip that focus and just tried to
(18:23):
focus on from an appreciative approach,like where, where are the strengths,
where are, where is the success?
And I think if you don't do that,like a unit, an entire unit can just
become very negative all the time.
Like just focus on the negative.
They almost can't pull themselves out.
Um, You know, they might even betrying to throw every strategy at it.
(18:47):
You know, I'm in my current work space.
You know, I think there's so many, alot of people have left after COVID.
Um, a lot of new, new graduates,lots of great energy, really good
excitement, but not the same support.
You know, when I graduated, I hadprobably seven or eight senior nurses.
And there was maybe three of us.
(19:08):
Well, there's like maybe threesenior nurses and the majority of
the shift is new, you know, and so,you know, that's sort of a struggle.
But if you focus, if you don't focus atall on what's going well or where the
opportunities are, and you're alwaysfocused on what's not going well.
(19:29):
Um, I think you, you kind of justkind of continue down that road,
but we don't really, we haven'tin the past really given people
the tools to change that focus.
Um, you know, and when I do.
NVC.
At first, the student'slike, Oh, this is easy.
(19:51):
And when they actually try to do it, andthey, and I'm actually having them discern
the difference between joy and happiness,like they're not the same feeling.
And they were like, well,what difference does it make?
Because when you look at the other sideof it and you're looking at anger, it's
not, you're not angry, you're frustratedor you're, and so when you're looking
(20:11):
at what you need to do to Resolve thatneed, figuring out that difference
between, you know, anger and frustration,even though it might feel the same
initially, it becomes really important.
And I think they kind of get it the more,the more we go through the semester.
And some of them have started touse it in their preceptorship,
(20:32):
but it's, um, it is something thatlooks easy, but does take practice.
For those of us who don't know whatNVC is, um, could you tell us a little
bit more so that we can Yeah, it's apretty old, um, is Marshall Rosenberg.
I might get his name wrong.
Um, uh, it's been used, you know, it'sused a lot in Waldorf schools for kids.
(20:57):
It's a really useful technique.
For that, uh, but it'salso used in counseling.
It's used in war-torn countries whenyou're, they've used it when negotiators
go in and they'll use NVC, um, indifferent camps where they bring kids
from different, um, countries together.
They've used NVC, but essentially, um,the elements are essentially there's
(21:21):
everyone has universal needs, no matterwhere you're from, no matter what culture.
And.
If you can identify or match up yourfeelings with your needs, so you
have feelings when your needs aremet and feelings when your needs
are unmet and just making thatconnection, um, and not judging
(21:41):
anybody for causing those feelings.
Like, they're your feelings, right?
And then the 2nd part of that is to make.
Requests.
So you know, you have a feelingand a need that's matter
unmet, and you make a request.
But that request is a request.
It's not a demand.
So you have to also be open to, well, no,, it's the answer to your request, which is
(22:05):
a little tricky in the healthcare setting.
So we talk about that becauseyou, there are situations
where we can't say no, right?
. Yeah.
Um, and then.
And the, but the appreciation piece Ithink is even more important that you're,
when you're showing appreciation usingthe model, you're saying specifically
your feeling and your met need.
(22:25):
So the person who you're giving thatappreciation to is also getting really
specific feedback about what it wasspecifically that they did to, um, you
know, for you to show this appreciation.
You know, cause oftentimes when weget thanks or we don't really know
what it was exactly that we did.
And so if you're going to continue thatbehavior showing that really specific,
(22:48):
you know, I felt this way and when,uh, you met this need, um, I did.
Hopefully that person willcontinue, um, to do that
specific behavior on the future.
Uh, when, when that's not communicated,particularly when it's an unmet
need, you know, they really don'tknow what they're doing over time
(23:11):
and that never gets resolved.
But this idea of just, you know, inour, in sort of the modern American,
you know, families today, this ideaof being able to just identify one's
feelings is, um, is not a, is not askill that we can take for granted.
(23:39):
In fact, um, that's probably, uh, whythere is such a huge, um, Huge industry
in, uh, in therapy today, right?
We are not able to either identify orprocess these feelings and acts in,
(24:01):
acts to, to, um, to address, you know,feelings of, you know, hurts or, um, anger
and, you know, especially the negativefeelings, but also the positive ones.
It's a really fun, um, game.
I started using this game with mykids, but I use it with the students.
(24:23):
You know, we had one face to face.
Most of my classes are asynchronousonline, but um, we had one, a
few face to face sessions and thestudents kept wanting to play Grok.
And Grok is sort ofthis, just a card game.
It has a stack of feelings cardsand a stack of needs cards.
There's all these sort of games youcan go through, um, using the cards.
(24:45):
But you know, I start, then theywanted to play Play Grok over
and over because it's just a veryconcrete way to, to use the model.
But I remember when I was, I used to useit with my daughter when she was younger.
I remember one day she came home and shewas really young, you know, not, um, she
might have been maybe seven or six and ahalf or something, but, and she was really
(25:08):
upset with her dad and she said, Mama Ineed to Grock and she came and she got
the cards and she went, she went over tohim and she says, you know, she lays down
her feelings cards and her needs cards.
And so it's a really, um, with youngerkids in particular, it's really, um, they
get it, you know, they just naturallyknow how to use it, you know, as they get
(25:30):
older, they kind of roll their eyes andthey're like, you're doing that thing.
So just stop.
Well, they probably haveinternalized those skills now, right?
Yeah.
But the college students,for many, it's new.
Like they, they've learned adifferent way, um, you know, by
saying I feel, but you can start asentence with I feel, and it's still
(25:50):
sort of aggressive language, right?
Cause I, I feel if that's followedby, you know, blaming someone else,
as opposed to, you know, the NVC, youdon't, it's, you're not interpreting
your feelings to anybody else.
Anyway, I've probably gone on aboutNVC a bit too long, but, um, No, it's
(26:10):
not because I, here's what I, um,I wanted to just say how important
some, this discussion I think is, Ithink that there are lots of, um, you
know, I, I, I'm a deep believer that.
When we have many different perspectivesat looking at the world, we get
(26:33):
better at looking at the world.
And
Um, you know, there are educators,education psychologists, there's,
you know, researchers in alldifferent kind of fields.
I've had many of these conversations, youknow, some of them healthcare, some of
them in STEM, you know, they all bring,um, different perspectives on how they
(26:58):
think about reflection, for example.
There are some things that tie us alltogether, like reflection, sometimes it's
storytelling, you know, stuff like that.
I think it's really cool.
But I think that what you have to do.
brought is a really fresh perspective,um, that in many ways, I think it
perhaps is one of the, the moresophisticated way of thinking about
(27:24):
reflection in a very, it doesn'tjust have this or around reflection.
There are literally steps that wecan take that can genuinely get
those feelings processed, get thoseand then experience and really
reflect and get to the significance.
(27:45):
And I think that there's something reallysignificant about this because there are
so many people, scholars, practitioners,have tried for many years to try to
say You know, we want to reflect.
One of the things that I have found thatis, um, that doesn't work is people think
(28:06):
that, what's your reflection prompt?
Because as if that's just silverbullet that I can just say, if you
ask student this prompt, they willsuddenly, they will solve everything.
You know, that would have beenlike saying to a therapist that,
what do you ask your clients?
(28:27):
Well, I just asked him this onething and then everything is done.
It's not like that, right?
There's a lot of depth intolayers of processing stuff.
And you are, in fact, describinga number of those layers in the
scenarios, um, in very concrete terms.
(28:48):
So I love that.
I think that's really wonderful.
I think that that's an area, you know,I'll probably tap you for this, um,
you know, If you don't mind, I'llprobably be like, Sharyl, you know,
that thing that we talked about?
Can we, do you think that we can like,you know, like, can you publish this?
Can you like write about it?
Can you explain it?
Because I, I really think that, um, a lotof people struggle with it because we,
(29:14):
Sort of almost inherently, instinctively,maybe we have experienced it, you know,
but anecdotally, reflection is good.
It's the, it's the gem,it's the spark that we get.
And we want our students to have that, butwe don't know how to get them to have it.
Yeah.
When you say the prompts, it makesme think of every reflection I've
(29:34):
ever been asked to do as a student.
There's always these prompts.
I was like, well, that'snot where my mind's going.
Like, thanks.
And I've, I've always sort of, bendmore toward open-ended, but then
sometimes I could see on the educatorside where you sometimes get back.
There's no emotion.
I sit, you know, I tell thestudents I need to feel something.
(29:55):
It doesn't have to be a good feeling.
But if you've reflected, I should havesome feeling should be in this reflection.
And something from you, like I was talkingto a student the other day and I said,
well, somebody had described this to me.
This isn't my language, but I think itwas an advisor back at BC a long time ago.
(30:15):
She was like, I want toknow what's in your box.
Like so many people tell you what yourbox should look like, but I want to
know what Sharyl's box looks like.
I was like, I'm not so sure you wantto know what my box looks like, but,
but it, that I sort of took that withme in my, You know, as a teacher that I
didn't want to always just have studentsrepeating what I think is what my box is.
(30:38):
I actually do want to know, you know,what, what's unique about, about
their experience and their knowledgerelated to whatever the topic is.
So, in the Capstone course, thenursing Capstone course, we do, um.
They demonstrate the baccalaureateessentials for the nurse, so there's 10.
And for this, we use a lot of reflectionand we're using um, ePortfolio for that.
(31:02):
And it does take a bit to get themgoing because their initial response
is to just define the essential orjust, When this assignment I did
this, or this assignment I did this.
I say, I'm not, the assignmentis just, you know, like a
piece of pottery you made.
If you're.
You know, Potter, likethis is the one you like.
So, you know, you're using it as yourevidence or an example of where you did
(31:26):
this thing, but the reflection shouldreally be about the full essential.
And, you know, how did you think aboutnursing knowledge as a, new student and
how did that change in your experiencesover the time you've been here or the
experiences that you've had and then theystart to, they don't, it's not intuitive.
(31:48):
I don't think they get it right away.
So there's kind of, there's alot of back and forth prompting.
But eventually they really create,they start with their autobiographic
sketch, which are very unique.
We have the most uniquestudents, I think, in Alaska.
Just come from like, some are from ruralvillages, some are like military families,
(32:08):
some are like hardy Alaskans that have,you know, been here for generations.
And many are just from everywhere becauseit's sort of a melting pot, right?
And so you have these reallyunique autobiographical.
Graphic sketches of where they'vecome from and how they ended up in
nursing and then somehow they allsort of relate to their narrative
(32:29):
that's specific to each essentialand how they've, how they've met it.
It's a pretty, it's a pretty big projectand it is 1 of those 1s when you say, how
do you get students to reflect initially?
They're just, you know, they want.
The prompts . But if I gave, well,we're also looking for the answer.
What's the right answer?
Right.
(32:49):
Right.
And if you do that too much,they'll all look the same.
Yeah.
And then, and then itdoes become busy work.
And I don't want it to be busy work.
I want, it might be idealistic,but I want them changed from it.
You know?
I want, here's the previewof what's coming up next.
In part two of my conversationwith Sharyl Toscano, professor
at the School of Nursing atUniversity of Alaska, Anchorage.
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