May 22, 2024 • 33 mins
Join Jeff Yan and nursing professor Sharyl Toscano from the University of Alaska, Anchorage, as they dive deeper into the vital role of reflective storytelling in nursing education.
Discover the benefits and challenges of integrating reflection into curriculums, and how it can transform student experiences and patient care.
Sharyl also shares her incredible insights from working with indigenous populations in Hawaii and Alaska.
Tune in for an eye-opening conversation showcasing narrative's power in learning and practice! 🌿✨
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#NursingEducation #ReflectiveStorytelling #IndigenousWisdom #HealthcareInnovation #DigicationScholars
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:02):
Welcome to DigicationScholars Conversations.
I'm your host, Jeff Yan.
In this episode, you will hear part twoof 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.
(00:23):
Full episodes of Digication ScholarsConversations can be found on
YouTube or your favorite podcast app.
If it becomes busy work, to be honest,I, I, I tell people, I'd rather you then
don't ask them to reflect because nowthey have this really negative association
with a reflection and they're like,Oh, you know, I don't want to do this.
This is boring.
(00:44):
Oh, this is, this is just you.
I actually heard about, I heard astudent say this and I was so sad by it.
They said when, um, theywere advising another student
actually, I overheard this.
They said, Basically, the professorwants you to stroke their ego.
(01:08):
Oh, my.
And, and you can see why though, right?
They would think that.
Because they are saying, the professortaught you a bunch of stuff this semester.
At the end they are saying,what did I, what did you learn?
If you say, I learned all the stuff youtaught me, hey, that's the right answer.
(01:28):
Wow.
Right?
That's sad, right?
Yeah.
Yeah.
That's sad.
That is not exactlywhat you're looking for.
That's when I like,
please stop asking them to reflectbecause you are really actually, um,
if anything, you, you push them furtherinto the hole of that they will never
get out of, you know, because if that'show they think about this section,
(01:49):
um, it, it becomes Not only busy work,it actually was for your benefit.
It wasn't even for them, like,it wasn't even busy work just to,
all right, we have to get it done.
It was more like a, oh, well, youjust needed, needed some reassurance
that you've done it for you.
Yes.
Isn't, you know, sometimes I getwith the essentials, oh, that's
(02:12):
just for accreditation, which itis a great way to show that you've
met the standards, but that's notreally the point of the assignment.
That's just sort of one of the.
Extras, right?
That, oh, because, you know, when yougo through accreditation for different,
you know, whatever program, you haveto show examples of student work.
Um, so, yes, I, you know, I, I do,I tell the students, well, yes, it
(02:35):
is a great example of the work thatyou've done here, but that's not really
why that we do the assignment, um,
uh, because we can pull thatwork together in other ways.
The portfolio is just a nice way to do it.
But the key point to the assignmentis actually that one of the reasons
(02:56):
it made me think of doing this is,uh, I saw students, particularly more
recently, you know, um, we've kind ofpassed our golden years in nursing,
I think, going into a different era.
But, you know, they just, Um, They justgo through school and they, I don't, there
(03:16):
wasn't seeing a lot of acknowledgementof what they'd accomplished.
They're just like, I justneed to get through school.
I just need to get through school.
And I wasn't really that student.
I love school.
Like school was, I'm still in school.
Right.
So I obviously just
You never left.
Yeah.
I
love school.
And so I wanted to kind of leave themwith some appreciation for the, like, show
them what they've actually accomplished.
(03:36):
So this, this project actually kind of,you have to review everything that you've
done for the, across the whole program.
And they're doing it rightbefore they graduate.
And most students will share at theend, they're like, well, this, you
know, I wasn't really excited aboutthis to begin with, but I really
feel like I've done, I didn't realizehow much I'd actually accomplished,
(03:57):
how much I'd actually done here.
And so they do that right before.
I love that.
I, I do wish that More people allowstudents to have more opportunities
to do that more frequently and early.
Um, but this idea in my mind of, um,not just any students, any, any humans,
(04:22):
anyone to have the, to get given sometime and space to say, here is a body of
Work or body of things that you've done.
It doesn't have to be work, right?
It could be play, it could be otherkinds of, you know, experiences
and achievements and whatnot.
(04:42):
The ability for someone to have thetime and space to just go, here's a
body of things that you've, you've done.
Um, some people, you know, think ofit as sort of integrated learning.
But I, I think that there's,I, I love that, but I also
think that there is a, um,
(05:06):
a really interesting, almostlike neurological model that
gets structured around your selfworth and your sense of self.
And so
to me, every time that You know,anytime that someone gets a chance to
(05:30):
say, Hey, let's take a look at yourbody of work, or you have to present
your body of work, maybe not in thelike, like formal presentation, but
more like telling a friend, tellinga new person that you never know
about, you know, doing a podcast.
That, that it, it sort of buildsadditional like neuro, like, you
(05:56):
know, connections in your, inyour brain that says, ah, that's
the kind of person that I am.
This is how I, this ishow I do life, you know?
Yeah.
I think that's amazing.
I think that's a, what a giftthat you, you give your students.
Just kind of flip the lens a little bit.
(06:19):
Yeah.
Yeah.
I think it's, I think it's wonderful.
This is why I, I, I I wish that peoplemake that a bigger part of life in
general, so it's not like, Oh, well,now that you're graduating, look what
you've done in this last four years.
But I always feel like, you know,what happened this week, you know?
(06:39):
I
feel like when you have adolescence,you could have like, Those are
your parenting successes, right?
Well, that's how
you keep yourself sane.
Um, can we, would you mind if weswitch the topic for a moment?
I, I know that you also work with,um, I mean, there's been a, uh,
(07:04):
um, a pattern of you working withnatives, the native population.
Yeah.
Sounds like first in, in, uh, Well,it's definitely in, in, in both in
Hawaii and Alaska, but maybe elsewhere.
So have you that,
um, For indigenous, mostlyjust Hawaii and Alaska.
Yeah.
(07:24):
And can you tell us alittle bit more about that?
What is that?
What does that mean?
What is the work?
What is it like?
What did you do?
Um, yeah, so in , um, you, inHawaii I worked the, um, Hawaiian
population, but also AmericanSamoa, Tonga, um, other populations.
(07:45):
Um, I was more the health center there.
I was more in the, um.
Working in the military, you know,which is its own, um, culture.
Uh, so mostly I worked with students.
And one of the things that was reallyunique in Hawaii that I noticed is no one
in Hawaii says, why aren't you a doctor?
(08:06):
Which, nursing is And so muchso that sometimes when students
weren't successful, they wereactually happy because they
actually didn't want to be a nurse.
And I was expecting all thisdisappointment, you know, when
they're, when they actually werelike, Oh, thank goodness, you
know, cause they actually didn't.
(08:27):
Didn't want to do it.
So that was a big, big
culture.
Is it just a general culture?
I
think it's something unique about whenI was in Hawaii, it was just very much,
you know, other places people oftensay, well, why aren't you a doctor?
Why?
You know, it's like a, but not there.
Like nursing is very respected.
And so, it was kind of a very uniqueexperience while, while I was there.
(08:50):
Um, but definitely like the storytellingthat we've been talking about is very
integral to both Hawaiian and very muchso in the Alaska Native population.
And I would say I've worked more closelywith the Alaska Native population
like here because I've been withthe, the, the hospital since 2012.
So, um, and with fam working a lotwith families and So when, when
(09:17):
families come in for health care,like Anchorage is a hub, and so we
get families from a lot of the ruralvillages that will come to the hub.
Whereas on the adult side of the,of the hospital, sometimes you get
patients from the hubs, but there'smore access to adult care at the
other hubs that aren't Anchorage.
And so, you know, when you thinkabout, um, You know, a lot of things
(09:41):
we've been talking about as far as thenonviolent communication, it's, it's
a very non-confrontational culture.
And so, um, often, and it's nothierarchical like the hospital, the
hospital is owned by the people.
So the patient is the owner,it's a customer, owner is
(10:03):
the word that he Mm-Hmm.
is used.
And so it really changes the dynamic inthe hospital because, you know, somebody
who's, you know, doing housekeeping or,um, you know, is at their desk or, you
know, even the provider, they all mayown the hospital, you know, the owner.
And so all of these sort of, um, levelsof hierarchy, for me, I've noticed is
(10:25):
really nice because that's removed.
And so I feel like Like
this is the This is the big boss, and thenyou're the second and the third big boss.
Right.
I, I don't
feel that as much there.
And, and so, um, but the stories, likeoften I would bring students over to
(10:46):
the hospital too sometimes, and I woulddisappear, like literally for 40 minutes.
They'll say, well, where were you?
And I was like, well, Ijust, Got the greatest story.
You just, if you go into a room and youstart talking to an elder and you just
hear the most amazing stories because, um,the culture there is amazing storytelling.
Um, you know, once it was about thelast time that this person was in
(11:09):
the hospital was actually when shewas a young girl and it was during
the earthquake, the big earthquake.
And so, but it's a different way of doinghealth assessment because Before I went
into the room, the patient was um, veryanxious and the nurses were having trouble
(11:30):
providing care.
And then I sat down and talkedwith her and I figured out where
the anxiety was coming from.
She was sort of thinkingback to her last time.
It's a different hospital.
They actually built a new hospital,but for her, all these things had
happened the last time she'd beenThey call it the native hospital.
That's their name for it.
But, um, and so I don't know, it'sjust, I don't know if that answers your
(11:55):
question, but it's a very different wayof, it's more of a narrative medicine
approach that I would take with, um,my patients at the hospital where I
try to figure out the story as opposedto like coming in with a, you know,
checklist of what are your symptoms?
You're not going to get very far.
If you approach health in that way,um, or I've seen people approach
(12:19):
education where they have this listof things they're going to go through
to educate as opposed to, um, sort ofintegrating it into your daily care.
Yeah, it's been a giftto work with the Colt.
I just, um, it's one of the, it's probablythe best hospital I've worked for, I
(12:41):
think, uh, as far as just the population.
And, um,
I don't know, it's just, it'sjust been a real gift to work
there.
I think that is so amazing.
Um, I can, I can see why you arewired the way that you are and
what draw you to all of this work.
(13:02):
Um, do you think that there issomething, what are some of your
observations in terms of, you know,you talk about storytelling, right?
It's a big part of the culture, it's abig part of the ability to tell these
amazing stories and, and have gatheredso many stories, but only we all have
(13:25):
lots of lived experience, but we don't,at least in sort of the, the sort of
mainland, you know, Western culture,you know, we don't think of these as
stories, we don't collect them, we, wejust sort of, it happened and that was
it, maybe it's more like the, you know,you tell people at a bar, you know, like,
but, but, you know, But there are manycultures where stories are treasured.
(13:53):
You collect them like you are,you know, like, like people
collect certificates, you know.
Um, and I don't want to say,it's not the vain way of saying,
hey, I just have a certificate.
It's just like, you really value them.
They are useful.
It can come in, in handy at somepoint in your life, you know.
(14:14):
I think there is something so beautifulabout that, that we are almost kind
of, for some reason have missed theboat on, you know, like I see a lot of
students, for example, going to schooland I'm talking even K 12 schools, right?
(14:35):
Um, where you had talked about, you know,NVC being used in certain models, right?
In the more mainstream sort oftraditional school model, I see students,
including students coming, you know,I'm sure coming to your classes,
(14:56):
where they go, I have an assignment.
Tell me what I need to do.
Tell me what the expectation is.
How do I get an A on this?
Right.
I'll do it.
Not only do I, when I do it, I'll doa good job at following all of those
things, but the second that I submitit to you, or hit the submit button,
(15:18):
whatever, you know, whether it's apaper or technology, it doesn't matter.
The second I do that, I'm done.
Right.
I don't think about it ever again.
It's not part of the story that I keep.
In fact, I get to forget it.
Right.
Now I've done it, so you grade it, andthen it will exist as a some kind of
(15:40):
percentage in my grades, and that's it.
I think that's a, there's something therethat, that makes me feel really sad about
because that narrative, that accumulativesort of narrative, that body of work,
um, is so incredibly powerful and useful.
(16:02):
Where, when I think about these veryfragmented, fragmented Pieces where
the person does it in almost like avery short term, short memory game.
You just kind of do it and then youjust don't think about it anymore.
It's
almost like, um, to me, itfeels like a waste of time.
It feels like that time just got lost.
(16:22):
Because you didn't get much out of it.
It's sort of the what'son the test phenomenon.
Yeah, right.
You study for a test.
At the end of the test, you justkind of like, you just really go,
I did well on the test, but youreally just, even if someone asks you
that same thing again in like threedays, you'd be like, I have no idea.
I knew it three days ago, by the way.
(16:45):
I've had these as an, you know, as aneducator, I've had these, you know,
classes where I've, you know, I've beenlike, I feel like you're, I'm on fire,
you know, I have these great storiespulling out all these concepts and ideas.
And, you know, the studentsare engaged and then.
Always at the end of the class,somebody will say, so which,
what if that is on the test?
I'm just
like, oh
(17:05):
my gosh, you know, it's always kills me.
Yeah.
What do you think are some of the, itseems like that you're very in tuned
(17:26):
with what students are doing these.
I mean, you talked earlier about sortof going from, uh, you know, nursing has
changed, you know, you're talking aboutteam nursing and things that you weren't.
That you said, you know, that's not howI was trained or how I practiced before.
Um,
(17:48):
and of course that probably means that,you know, you also have to now change
in how you teach your students and newskills, new ways of teaching and learning,
and then you had talked about certain, youknow, sort of, you know, need to, Figure
out how to take care of themselves anddealing with burnouts and stuff like that.
If, you know, it's sort of like avery like, you know, sky view level
(18:13):
looking at nursing education right now.
What are some of the, what do youthink some of the big, um, either
where some of the hurdles but alsosome opportunities are in advancing?
You know, the field and making, I loveyour vision of, Hey, they shouldn't
even have to be resilient becauseit implies that something's wrong.
(18:35):
They have to just survive it.
But how do they naturallyjust kind of thrive it because
it's just an enjoyable thing.
Well, by the way, I think that it'sprobably correct me if I'm wrong, but
I think people, most people want to gointo nursing because they, they, they
can get joy out of helping other people.
(18:55):
That's a
common, yeah.
Right.
Or they've had some life experiencethat has brought them close and
they've recognized all that.
How important
that would be to bringit to another person.
Yeah.
You know?
Yeah.
That's such, these are such worthy, like,root level, like, directions, you know?
(19:16):
So what happened and how dowe, like, what are some of the
opportunities now that you see?
Maybe team nursing is part of the thing?
I don't know.
I mean, I don't know enough about it.
Can you tell us more?
Well, for that, I'm hoping that, Ithink the team structure happened
during, you know, The pandemic,like it was a necessity because
(19:37):
you just didn't have the people.
So you, you know, my personalphilosophy is that the, you know,
that's not the model that's actuallygoing to be the best moving forward.
But sometimes you have to drop backto these survival modes where the
emphasis might be safety, efficiency,you know, you, you, and you, you
(20:00):
lose some of those other aspirationsduring times of, you know, extreme.
Circumstances, but sometimes I thinkon the admin side or the hospital side,
they see the cost savings of those now.
Right?
And so,
well, because you've cut somecorners, so there's some savings.
(20:22):
You have to realize that the cornersyou cut, someone's paying for it.
There's a different cost somewhere.
And so there's always this, um, youknow, there's that side that they want,
you know, more nurses, cheaper nurses,you know, there's, and there's been
less unionization of nurses comparedto the past where, you know, that those
sort of things are kept in balance.
(20:44):
So I think right now there's, you know,and I'm not, I'm not in the sort of
Nurse Management Arena, but there'sdefinitely this sort of conflict
between, you know, staffing ratio.
There's been legislation tryingto regulate staffing ratios of
nursing and there's always beenlots of lobbyists that come out.
(21:07):
In many states, it hasn't been successfulconvincing, you know, the consumer that
this is going to somehow make their careworse because, you know, I don't think
they understand, um, That when you havea nurse who has too many patients that
that's actually what is driving yourcare, not necessarily that, you know,
(21:30):
they're sending in these arguments andabout, you know, this is decreasing
their access because it's You know,the provider will only be able to take
care of this number of patients, but,you know, in health care, it's hidden.
Quality is hidden, right?
You don't know.
Your surgeon might, you know,be nice to chat with or, but you
(21:50):
really don't know the quality ofsurgeon that he or she is, right?
And in the other areas,Quality is not as hidden.
You know, if you buy a dress andit falls apart in a week, like, you
know, that that was not very good.
You know, if you have poorquality healthcare, you might
not know ever, or that might not.
(22:11):
You might not realize it for, for years.
It's too late.
Yeah.
And so anyway, I'm kind of got offon tangent, but there is this sort
of things happen during pandemictime that are emergency and you know,
there was legislation and thingsthat allowed for that to happen,
like changing some of the rules.
And now as we're starting to get back intothose, those rules are, they're changing.
(22:36):
We don't need those rules anymore.
Um, I think sometimes they're lookingat the cost difference, but I think
that students do have to be preparedfor, um, what they might see.
You know, are they going tobe asked to kind of function
in a more team like scenario?
And that's more whereyou're task oriented.
So instead of having the care forone patient, uh, which is kind of
(22:59):
somewhat of a safety nut, because youhave somebody who has eyes on them.
what's physical therapy doing, what'sspeech doing, what are the docs
doing, what, you know, the nursesusually has eyes on all of that.
Um, so there divide more in tasks.
So this person's doing medications,this person's doing procedures.
Um, we're delegatingall this to CNA or LPN.
(23:20):
Um, Probably, it's more like the systemwhen I very, like 1994, you know, it
was myself, a new grad, I would have 10patients, the LPN would have 10 patients
and really at the time, the LPN, althoughI, you know, I, she, I was, she was
(23:41):
really in charge of me, if, if, to behonest, because she had, you know, she'd
been in nursing for 40 years and, youknow, um, um, But as far as the licensing
agreements and things that they could do,you were sort of not their supervisor,
but you were sort of the lead of the team.
So there was this kind of strangedynamic there when, um, they were really
(24:03):
extremely, so I'm not dismissing thevalue of LPNs because I learned a ton
and I wouldn't be the nurse I am todaywithout the LPNs that I worked with.
But back then, um, Theacuity was very different.
We had patients that don'teven stay overnight anymore.
So you'd basically out of those 10patients, one or two would be sick and
(24:25):
the rest were sort of your standardpost op, um, patients that nowadays
go home, like you don't even see them.
And so when implementing some ofthis team based, that's when it
becomes really stressful becauseyou have extremely sick patients.
Um, and you just, it's very stressful.
(24:47):
When you start being responsible for morethan say, I think, uh, in Peds anyway,
it's like four in the NICU, we have three.
Um, but on some of the adult floors, theycan see six to eight, maybe more patients.
So if you think about that in anhour, they're supposed to touch
base with that patient every hour.
So if you have six to eightin an hour, You're just
(25:08):
constantly running around, youknow, yeah, you can't, yeah.
Yeah.
So it's really, um, you, you know, it's,Nursing, uh, nurses are costly, I suppose,
but it also costs more to close the unit.
So there's all these kindof cost drivers there.
Um, but I think one of the biggerthings is to give nursing, new
(25:31):
nurses, a voice of when it's unsafe.
And so how do they, howdo they express that?
And, um, You know, what are therules and regulations around that?
Like, you can't abandon a patient.
If you show up and you get an assignmentthat's unsafe, you can't leave
because that's abandoning a patient.
And many, many of the boards of nursing,you can get disciplined for that.
(25:51):
So, so it's how do they documentthat unsafe assignment without
having consequences to their license?
And how do they make changewithin the system they're in?
Um, sort of in a productive way.
Um, so kind of focusingon some of those tools.
(26:12):
By the way, coming sort of fullcircle, I, I feel like that those
tools that we're talking about.
Uh, the kind of reflective storytellingand conversational, you know, sort of
tools that you're preparing with yourstudents, nonviolent way of communicating
those things, ways to be able to, to,to do things without judgment and not
(26:35):
blaming to, you know, in any specificpeople or a person and just being able
to calmly go in and look at a situation.
Yeah.
Yeah.
Yeah.
And I can see like, as soon as you flipit, when you're not attacking the person.
And you're saying, you know,I'm feeling really scared.
You know, if you start off withthat, the manager is like, what?
(26:57):
You know, instead of you did this,this, and this, I was like, I'm, I'm
putting me into this position.
I've
said that I'm, I'm scared.
And they're like, okay.
Their ears open.
Right.
When you,
But it does require that they also sharea little bit of their vulnerability.
Because when you're using any ofthe storytelling or NBC, you, you,
(27:21):
you are a little bit vulnerable.
So that takes a little practiceto be open to that when, you know,
sometimes your first instinct isto just You know, keep quiet and
practice is in fact, what's so healthythough, you know, like in a, in the case
of you be then being able to do it withyou in a, in an education environment
(27:45):
in a class where, you know, they arehopefully safe from themselves, from
you, from their, their colleagues sothat you can, they can practice that
because I think it is a skill, isn't it?
It's a skill that youpractice enough that.
You'd then be able touse that in a situation.
(28:06):
And by the way, this iskind of amazing to me.
Because people talk about
reflection in this, as thisvery nebulous, abstract concept.
That it's like, if you've done it, ordone it well, or experienced it, you
(28:30):
know it, and you feel great about it.
And you learn from it.
And that's kind of it.
But if you haven't, you know, Ihave no way to tell you what it is.
Um, it's like telling someone aboutriding a bicycle or swimming or love,
you know, like, yeah, I don't knowhow to describe it, but you actually
just kind of created a very solid,
(28:55):
um, Example of how that reflectiveskill can really be used in a, in
a very productive practical way inhow do you confront situations with
this case, even with the actual skillof doing the confrontation itself.
(29:18):
But just mentally, first of all,how do you confront that situation
when you're like, I'm scared, I'm indanger, I'm in, uh, you know, I, this
is not fair or this is not right?
Because it may not be in nursing, right?
Um,
I really feel like that there's a lotthat, well, I certainly have learned
a lot, but I think that a lot of ourlisteners will learn from this in how,
(29:42):
for me, a very, a very advanced setof, um, topics that you've discovered,
sort of one after the other, thatI really feel like that whether I'm
teaching in a STEM program or in a.
You know, in the arts or humanities, Icould borrow a lot of what you are saying,
(30:09):
um, and use it very positively for sort ofgeneral, you know, education and pedagogy.
I really do.
I think that it's, you know,you've created, you've lent us a
really beautiful insight to this.
Um, I especially love this thing that atthe end that you said, I don't even think
that you thought you, you, you, you didit on like sort of like deliberately,
(30:34):
but I was like, wait, hold on a minute.
So all of those communicationand processing skills that you
have students do, which is in.
You know, the way that you teachthem how to reflect could be
used, in fact, to communicatewith someone to solve a problem.
So it's no longer this abstract, just,you reflect and you feel great, and then
you now go home and get a better sleep.
(30:56):
It's more like, no,literally, I'm in trouble.
I needed to go in and talk tosomeone about something, and I'm
using, borrowing some of the skillsto go in and do that communication.
I think it's lovely.
That's my hope that they'll use it.
Well, Sharyl, I feel likethat, um, there's much more
(31:16):
that we can learn from you.
And I hope that, um, weget to do that again soon.
Um, but today I think this is agood, um, first chapter of Sharyl
and her wisdom from nursing.
Um, but really like, I think there's somuch to unpack, you know, your experience
with, um, You know, um, Native Alaskan,especially now, you know, all of these
(31:41):
kind of, um, I mean, I haven't thoughtabout a culture that is, you know, based
on, that is so, has so much, plays somuch value on narrative, for example.
That's a, that's a, that's a, thatjust opens up so many possibilities
in my mind, like, right away.
(32:02):
Um, so, we gotta talk more.
But, um, for today, wewill, we will pause for now.
Uh, hopefully we can, wecan talk more again soon.
And, uh, Sharyl, I, Ican't thank you enough.
Um, you've, uh, this is, thisis, this is incredible for
me as a learning experience.
(32:23):
Um, I, I appreciate you so much.
Thanks, Jeff.
It's been fun.
Thanks.
All right.
Take care.
Coming up next, we'll be chattingwith Kyle Hewson, Vice Chair and
Clinical Associate Professor inthe Doctorate in Physical Therapy
program at Stonybrook University.
Here's a quick preview.
(32:44):
So the idea that They put up aPowerPoint that they did in their
first year with two or three people.
Even just to show them how advancedthey've become in some of their
presentations by the third year, youknow, they have this and that, and they're
just, their references are awesome.
And they're able to pullin a video or something.
So just, and they feel so much morecomfortable because they say, Oh, I
(33:07):
was such a nervous person that firsttime I had to get up 80, 80 students.
You know, so, so it's kind of neat.
You know, that.
See you next time!
Welcome to DigicationScholars Conversations.
I'm your host, Jeff Yan.
In this episode, you will hear part twoof 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.
(00:23):
Full episodes of Digication ScholarsConversations can be found on
YouTube or your favorite podcast app.
If it becomes busy work, to be honest,I, I, I tell people, I'd rather you then
don't ask them to reflect because nowthey have this really negative association
with a reflection and they're like,Oh, you know, I don't want to do this.
This is boring.
(00:44):
Oh, this is, this is just you.
I actually heard about, I heard astudent say this and I was so sad by it.
They said when, um, theywere advising another student
actually, I overheard this.
They said, Basically, the professorwants you to stroke their ego.
(01:08):
Oh, my.
And, and you can see why though, right?
They would think that.
Because they are saying, the professortaught you a bunch of stuff this semester.
At the end they are saying,what did I, what did you learn?
If you say, I learned all the stuff youtaught me, hey, that's the right answer.
(01:28):
Wow.
Right?
That's sad, right?
Yeah.
Yeah.
That's sad.
That is not exactlywhat you're looking for.
That's when I like,
please stop asking them to reflectbecause you are really actually, um,
if anything, you, you push them furtherinto the hole of that they will never
get out of, you know, because if that'show they think about this section,
(01:49):
um, it, it becomes Not only busy work,it actually was for your benefit.
It wasn't even for them, like,it wasn't even busy work just to,
all right, we have to get it done.
It was more like a, oh, well, youjust needed, needed some reassurance
that you've done it for you.
Yes.
Isn't, you know, sometimes I getwith the essentials, oh, that's
(02:12):
just for accreditation, which itis a great way to show that you've
met the standards, but that's notreally the point of the assignment.
That's just sort of one of the.
Extras, right?
That, oh, because, you know, when yougo through accreditation for different,
you know, whatever program, you haveto show examples of student work.
Um, so, yes, I, you know, I, I do,I tell the students, well, yes, it
(02:35):
is a great example of the work thatyou've done here, but that's not really
why that we do the assignment, um,
uh, because we can pull thatwork together in other ways.
The portfolio is just a nice way to do it.
But the key point to the assignmentis actually that one of the reasons
(02:56):
it made me think of doing this is,uh, I saw students, particularly more
recently, you know, um, we've kind ofpassed our golden years in nursing,
I think, going into a different era.
But, you know, they just, Um, They justgo through school and they, I don't, there
(03:16):
wasn't seeing a lot of acknowledgementof what they'd accomplished.
They're just like, I justneed to get through school.
I just need to get through school.
And I wasn't really that student.
I love school.
Like school was, I'm still in school.
Right.
So I obviously just
You never left.
Yeah.
I
love school.
And so I wanted to kind of leave themwith some appreciation for the, like, show
them what they've actually accomplished.
(03:36):
So this, this project actually kind of,you have to review everything that you've
done for the, across the whole program.
And they're doing it rightbefore they graduate.
And most students will share at theend, they're like, well, this, you
know, I wasn't really excited aboutthis to begin with, but I really
feel like I've done, I didn't realizehow much I'd actually accomplished,
(03:57):
how much I'd actually done here.
And so they do that right before.
I love that.
I, I do wish that More people allowstudents to have more opportunities
to do that more frequently and early.
Um, but this idea in my mind of, um,not just any students, any, any humans,
(04:22):
anyone to have the, to get given sometime and space to say, here is a body of
Work or body of things that you've done.
It doesn't have to be work, right?
It could be play, it could be otherkinds of, you know, experiences
and achievements and whatnot.
(04:42):
The ability for someone to have thetime and space to just go, here's a
body of things that you've, you've done.
Um, some people, you know, think ofit as sort of integrated learning.
But I, I think that there's,I, I love that, but I also
think that there is a, um,
(05:06):
a really interesting, almostlike neurological model that
gets structured around your selfworth and your sense of self.
And so
to me, every time that You know,anytime that someone gets a chance to
(05:30):
say, Hey, let's take a look at yourbody of work, or you have to present
your body of work, maybe not in thelike, like formal presentation, but
more like telling a friend, tellinga new person that you never know
about, you know, doing a podcast.
That, that it, it sort of buildsadditional like neuro, like, you
(05:56):
know, connections in your, inyour brain that says, ah, that's
the kind of person that I am.
This is how I, this ishow I do life, you know?
Yeah.
I think that's amazing.
I think that's a, what a giftthat you, you give your students.
Just kind of flip the lens a little bit.
(06:19):
Yeah.
Yeah.
I think it's, I think it's wonderful.
This is why I, I, I I wish that peoplemake that a bigger part of life in
general, so it's not like, Oh, well,now that you're graduating, look what
you've done in this last four years.
But I always feel like, you know,what happened this week, you know?
(06:39):
I
feel like when you have adolescence,you could have like, Those are
your parenting successes, right?
Well, that's how
you keep yourself sane.
Um, can we, would you mind if weswitch the topic for a moment?
I, I know that you also work with,um, I mean, there's been a, uh,
(07:04):
um, a pattern of you working withnatives, the native population.
Yeah.
Sounds like first in, in, uh, Well,it's definitely in, in, in both in
Hawaii and Alaska, but maybe elsewhere.
So have you that,
um, For indigenous, mostlyjust Hawaii and Alaska.
Yeah.
(07:24):
And can you tell us alittle bit more about that?
What is that?
What does that mean?
What is the work?
What is it like?
What did you do?
Um, yeah, so in , um, you, inHawaii I worked the, um, Hawaiian
population, but also AmericanSamoa, Tonga, um, other populations.
(07:45):
Um, I was more the health center there.
I was more in the, um.
Working in the military, you know,which is its own, um, culture.
Uh, so mostly I worked with students.
And one of the things that was reallyunique in Hawaii that I noticed is no one
in Hawaii says, why aren't you a doctor?
(08:06):
Which, nursing is And so muchso that sometimes when students
weren't successful, they wereactually happy because they
actually didn't want to be a nurse.
And I was expecting all thisdisappointment, you know, when
they're, when they actually werelike, Oh, thank goodness, you
know, cause they actually didn't.
(08:27):
Didn't want to do it.
So that was a big, big
culture.
Is it just a general culture?
I
think it's something unique about whenI was in Hawaii, it was just very much,
you know, other places people oftensay, well, why aren't you a doctor?
Why?
You know, it's like a, but not there.
Like nursing is very respected.
And so, it was kind of a very uniqueexperience while, while I was there.
(08:50):
Um, but definitely like the storytellingthat we've been talking about is very
integral to both Hawaiian and very muchso in the Alaska Native population.
And I would say I've worked more closelywith the Alaska Native population
like here because I've been withthe, the, the hospital since 2012.
So, um, and with fam working a lotwith families and So when, when
(09:17):
families come in for health care,like Anchorage is a hub, and so we
get families from a lot of the ruralvillages that will come to the hub.
Whereas on the adult side of the,of the hospital, sometimes you get
patients from the hubs, but there'smore access to adult care at the
other hubs that aren't Anchorage.
And so, you know, when you thinkabout, um, You know, a lot of things
(09:41):
we've been talking about as far as thenonviolent communication, it's, it's
a very non-confrontational culture.
And so, um, often, and it's nothierarchical like the hospital, the
hospital is owned by the people.
So the patient is the owner,it's a customer, owner is
(10:03):
the word that he Mm-Hmm.
is used.
And so it really changes the dynamic inthe hospital because, you know, somebody
who's, you know, doing housekeeping or,um, you know, is at their desk or, you
know, even the provider, they all mayown the hospital, you know, the owner.
And so all of these sort of, um, levelsof hierarchy, for me, I've noticed is
(10:25):
really nice because that's removed.
And so I feel like Like
this is the This is the big boss, and thenyou're the second and the third big boss.
Right.
I, I don't
feel that as much there.
And, and so, um, but the stories, likeoften I would bring students over to
(10:46):
the hospital too sometimes, and I woulddisappear, like literally for 40 minutes.
They'll say, well, where were you?
And I was like, well, Ijust, Got the greatest story.
You just, if you go into a room and youstart talking to an elder and you just
hear the most amazing stories because, um,the culture there is amazing storytelling.
Um, you know, once it was about thelast time that this person was in
(11:09):
the hospital was actually when shewas a young girl and it was during
the earthquake, the big earthquake.
And so, but it's a different way of doinghealth assessment because Before I went
into the room, the patient was um, veryanxious and the nurses were having trouble
(11:30):
providing care.
And then I sat down and talkedwith her and I figured out where
the anxiety was coming from.
She was sort of thinkingback to her last time.
It's a different hospital.
They actually built a new hospital,but for her, all these things had
happened the last time she'd beenThey call it the native hospital.
That's their name for it.
But, um, and so I don't know, it'sjust, I don't know if that answers your
(11:55):
question, but it's a very different wayof, it's more of a narrative medicine
approach that I would take with, um,my patients at the hospital where I
try to figure out the story as opposedto like coming in with a, you know,
checklist of what are your symptoms?
You're not going to get very far.
If you approach health in that way,um, or I've seen people approach
(12:19):
education where they have this listof things they're going to go through
to educate as opposed to, um, sort ofintegrating it into your daily care.
Yeah, it's been a giftto work with the Colt.
I just, um, it's one of the, it's probablythe best hospital I've worked for, I
(12:41):
think, uh, as far as just the population.
And, um,
I don't know, it's just, it'sjust been a real gift to work
there.
I think that is so amazing.
Um, I can, I can see why you arewired the way that you are and
what draw you to all of this work.
(13:02):
Um, do you think that there issomething, what are some of your
observations in terms of, you know,you talk about storytelling, right?
It's a big part of the culture, it's abig part of the ability to tell these
amazing stories and, and have gatheredso many stories, but only we all have
(13:25):
lots of lived experience, but we don't,at least in sort of the, the sort of
mainland, you know, Western culture,you know, we don't think of these as
stories, we don't collect them, we, wejust sort of, it happened and that was
it, maybe it's more like the, you know,you tell people at a bar, you know, like,
but, but, you know, But there are manycultures where stories are treasured.
(13:53):
You collect them like you are,you know, like, like people
collect certificates, you know.
Um, and I don't want to say,it's not the vain way of saying,
hey, I just have a certificate.
It's just like, you really value them.
They are useful.
It can come in, in handy at somepoint in your life, you know.
(14:14):
I think there is something so beautifulabout that, that we are almost kind
of, for some reason have missed theboat on, you know, like I see a lot of
students, for example, going to schooland I'm talking even K 12 schools, right?
(14:35):
Um, where you had talked about, you know,NVC being used in certain models, right?
In the more mainstream sort oftraditional school model, I see students,
including students coming, you know,I'm sure coming to your classes,
(14:56):
where they go, I have an assignment.
Tell me what I need to do.
Tell me what the expectation is.
How do I get an A on this?
Right.
I'll do it.
Not only do I, when I do it, I'll doa good job at following all of those
things, but the second that I submitit to you, or hit the submit button,
(15:18):
whatever, you know, whether it's apaper or technology, it doesn't matter.
The second I do that, I'm done.
Right.
I don't think about it ever again.
It's not part of the story that I keep.
In fact, I get to forget it.
Right.
Now I've done it, so you grade it, andthen it will exist as a some kind of
(15:40):
percentage in my grades, and that's it.
I think that's a, there's something therethat, that makes me feel really sad about
because that narrative, that accumulativesort of narrative, that body of work,
um, is so incredibly powerful and useful.
(16:02):
Where, when I think about these veryfragmented, fragmented Pieces where
the person does it in almost like avery short term, short memory game.
You just kind of do it and then youjust don't think about it anymore.
It's
almost like, um, to me, itfeels like a waste of time.
It feels like that time just got lost.
(16:22):
Because you didn't get much out of it.
It's sort of the what'son the test phenomenon.
Yeah, right.
You study for a test.
At the end of the test, you justkind of like, you just really go,
I did well on the test, but youreally just, even if someone asks you
that same thing again in like threedays, you'd be like, I have no idea.
I knew it three days ago, by the way.
(16:45):
I've had these as an, you know, as aneducator, I've had these, you know,
classes where I've, you know, I've beenlike, I feel like you're, I'm on fire,
you know, I have these great storiespulling out all these concepts and ideas.
And, you know, the studentsare engaged and then.
Always at the end of the class,somebody will say, so which,
what if that is on the test?
I'm just
like, oh
(17:05):
my gosh, you know, it's always kills me.
Yeah.
What do you think are some of the, itseems like that you're very in tuned
(17:26):
with what students are doing these.
I mean, you talked earlier about sortof going from, uh, you know, nursing has
changed, you know, you're talking aboutteam nursing and things that you weren't.
That you said, you know, that's not howI was trained or how I practiced before.
Um,
(17:48):
and of course that probably means that,you know, you also have to now change
in how you teach your students and newskills, new ways of teaching and learning,
and then you had talked about certain, youknow, sort of, you know, need to, Figure
out how to take care of themselves anddealing with burnouts and stuff like that.
If, you know, it's sort of like avery like, you know, sky view level
(18:13):
looking at nursing education right now.
What are some of the, what do youthink some of the big, um, either
where some of the hurdles but alsosome opportunities are in advancing?
You know, the field and making, I loveyour vision of, Hey, they shouldn't
even have to be resilient becauseit implies that something's wrong.
(18:35):
They have to just survive it.
But how do they naturallyjust kind of thrive it because
it's just an enjoyable thing.
Well, by the way, I think that it'sprobably correct me if I'm wrong, but
I think people, most people want to gointo nursing because they, they, they
can get joy out of helping other people.
(18:55):
That's a
common, yeah.
Right.
Or they've had some life experiencethat has brought them close and
they've recognized all that.
How important
that would be to bringit to another person.
Yeah.
You know?
Yeah.
That's such, these are such worthy, like,root level, like, directions, you know?
(19:16):
So what happened and how dowe, like, what are some of the
opportunities now that you see?
Maybe team nursing is part of the thing?
I don't know.
I mean, I don't know enough about it.
Can you tell us more?
Well, for that, I'm hoping that, Ithink the team structure happened
during, you know, The pandemic,like it was a necessity because
(19:37):
you just didn't have the people.
So you, you know, my personalphilosophy is that the, you know,
that's not the model that's actuallygoing to be the best moving forward.
But sometimes you have to drop backto these survival modes where the
emphasis might be safety, efficiency,you know, you, you, and you, you
(20:00):
lose some of those other aspirationsduring times of, you know, extreme.
Circumstances, but sometimes I thinkon the admin side or the hospital side,
they see the cost savings of those now.
Right?
And so,
well, because you've cut somecorners, so there's some savings.
(20:22):
You have to realize that the cornersyou cut, someone's paying for it.
There's a different cost somewhere.
And so there's always this, um, youknow, there's that side that they want,
you know, more nurses, cheaper nurses,you know, there's, and there's been
less unionization of nurses comparedto the past where, you know, that those
sort of things are kept in balance.
(20:44):
So I think right now there's, you know,and I'm not, I'm not in the sort of
Nurse Management Arena, but there'sdefinitely this sort of conflict
between, you know, staffing ratio.
There's been legislation tryingto regulate staffing ratios of
nursing and there's always beenlots of lobbyists that come out.
(21:07):
In many states, it hasn't been successfulconvincing, you know, the consumer that
this is going to somehow make their careworse because, you know, I don't think
they understand, um, That when you havea nurse who has too many patients that
that's actually what is driving yourcare, not necessarily that, you know,
(21:30):
they're sending in these arguments andabout, you know, this is decreasing
their access because it's You know,the provider will only be able to take
care of this number of patients, but,you know, in health care, it's hidden.
Quality is hidden, right?
You don't know.
Your surgeon might, you know,be nice to chat with or, but you
(21:50):
really don't know the quality ofsurgeon that he or she is, right?
And in the other areas,Quality is not as hidden.
You know, if you buy a dress andit falls apart in a week, like, you
know, that that was not very good.
You know, if you have poorquality healthcare, you might
not know ever, or that might not.
(22:11):
You might not realize it for, for years.
It's too late.
Yeah.
And so anyway, I'm kind of got offon tangent, but there is this sort
of things happen during pandemictime that are emergency and you know,
there was legislation and thingsthat allowed for that to happen,
like changing some of the rules.
And now as we're starting to get back intothose, those rules are, they're changing.
(22:36):
We don't need those rules anymore.
Um, I think sometimes they're lookingat the cost difference, but I think
that students do have to be preparedfor, um, what they might see.
You know, are they going tobe asked to kind of function
in a more team like scenario?
And that's more whereyou're task oriented.
So instead of having the care forone patient, uh, which is kind of
(22:59):
somewhat of a safety nut, because youhave somebody who has eyes on them.
what's physical therapy doing, what'sspeech doing, what are the docs
doing, what, you know, the nursesusually has eyes on all of that.
Um, so there divide more in tasks.
So this person's doing medications,this person's doing procedures.
Um, we're delegatingall this to CNA or LPN.
(23:20):
Um, Probably, it's more like the systemwhen I very, like 1994, you know, it
was myself, a new grad, I would have 10patients, the LPN would have 10 patients
and really at the time, the LPN, althoughI, you know, I, she, I was, she was
(23:41):
really in charge of me, if, if, to behonest, because she had, you know, she'd
been in nursing for 40 years and, youknow, um, um, But as far as the licensing
agreements and things that they could do,you were sort of not their supervisor,
but you were sort of the lead of the team.
So there was this kind of strangedynamic there when, um, they were really
(24:03):
extremely, so I'm not dismissing thevalue of LPNs because I learned a ton
and I wouldn't be the nurse I am todaywithout the LPNs that I worked with.
But back then, um, Theacuity was very different.
We had patients that don'teven stay overnight anymore.
So you'd basically out of those 10patients, one or two would be sick and
(24:25):
the rest were sort of your standardpost op, um, patients that nowadays
go home, like you don't even see them.
And so when implementing some ofthis team based, that's when it
becomes really stressful becauseyou have extremely sick patients.
Um, and you just, it's very stressful.
(24:47):
When you start being responsible for morethan say, I think, uh, in Peds anyway,
it's like four in the NICU, we have three.
Um, but on some of the adult floors, theycan see six to eight, maybe more patients.
So if you think about that in anhour, they're supposed to touch
base with that patient every hour.
So if you have six to eightin an hour, You're just
(25:08):
constantly running around, youknow, yeah, you can't, yeah.
Yeah.
So it's really, um, you, you know, it's,Nursing, uh, nurses are costly, I suppose,
but it also costs more to close the unit.
So there's all these kindof cost drivers there.
Um, but I think one of the biggerthings is to give nursing, new
(25:31):
nurses, a voice of when it's unsafe.
And so how do they, howdo they express that?
And, um, You know, what are therules and regulations around that?
Like, you can't abandon a patient.
If you show up and you get an assignmentthat's unsafe, you can't leave
because that's abandoning a patient.
And many, many of the boards of nursing,you can get disciplined for that.
(25:51):
So, so it's how do they documentthat unsafe assignment without
having consequences to their license?
And how do they make changewithin the system they're in?
Um, sort of in a productive way.
Um, so kind of focusingon some of those tools.
(26:12):
By the way, coming sort of fullcircle, I, I feel like that those
tools that we're talking about.
Uh, the kind of reflective storytellingand conversational, you know, sort of
tools that you're preparing with yourstudents, nonviolent way of communicating
those things, ways to be able to, to,to do things without judgment and not
(26:35):
blaming to, you know, in any specificpeople or a person and just being able
to calmly go in and look at a situation.
Yeah.
Yeah.
Yeah.
And I can see like, as soon as you flipit, when you're not attacking the person.
And you're saying, you know,I'm feeling really scared.
You know, if you start off withthat, the manager is like, what?
(26:57):
You know, instead of you did this,this, and this, I was like, I'm, I'm
putting me into this position.
I've
said that I'm, I'm scared.
And they're like, okay.
Their ears open.
Right.
When you,
But it does require that they also sharea little bit of their vulnerability.
Because when you're using any ofthe storytelling or NBC, you, you,
(27:21):
you are a little bit vulnerable.
So that takes a little practiceto be open to that when, you know,
sometimes your first instinct isto just You know, keep quiet and
practice is in fact, what's so healthythough, you know, like in a, in the case
of you be then being able to do it withyou in a, in an education environment
(27:45):
in a class where, you know, they arehopefully safe from themselves, from
you, from their, their colleagues sothat you can, they can practice that
because I think it is a skill, isn't it?
It's a skill that youpractice enough that.
You'd then be able touse that in a situation.
(28:06):
And by the way, this iskind of amazing to me.
Because people talk about
reflection in this, as thisvery nebulous, abstract concept.
That it's like, if you've done it, ordone it well, or experienced it, you
(28:30):
know it, and you feel great about it.
And you learn from it.
And that's kind of it.
But if you haven't, you know, Ihave no way to tell you what it is.
Um, it's like telling someone aboutriding a bicycle or swimming or love,
you know, like, yeah, I don't knowhow to describe it, but you actually
just kind of created a very solid,
(28:55):
um, Example of how that reflectiveskill can really be used in a, in
a very productive practical way inhow do you confront situations with
this case, even with the actual skillof doing the confrontation itself.
(29:18):
But just mentally, first of all,how do you confront that situation
when you're like, I'm scared, I'm indanger, I'm in, uh, you know, I, this
is not fair or this is not right?
Because it may not be in nursing, right?
Um,
I really feel like that there's a lotthat, well, I certainly have learned
a lot, but I think that a lot of ourlisteners will learn from this in how,
(29:42):
for me, a very, a very advanced setof, um, topics that you've discovered,
sort of one after the other, thatI really feel like that whether I'm
teaching in a STEM program or in a.
You know, in the arts or humanities, Icould borrow a lot of what you are saying,
(30:09):
um, and use it very positively for sort ofgeneral, you know, education and pedagogy.
I really do.
I think that it's, you know,you've created, you've lent us a
really beautiful insight to this.
Um, I especially love this thing that atthe end that you said, I don't even think
that you thought you, you, you, you didit on like sort of like deliberately,
(30:34):
but I was like, wait, hold on a minute.
So all of those communicationand processing skills that you
have students do, which is in.
You know, the way that you teachthem how to reflect could be
used, in fact, to communicatewith someone to solve a problem.
So it's no longer this abstract, just,you reflect and you feel great, and then
you now go home and get a better sleep.
(30:56):
It's more like, no,literally, I'm in trouble.
I needed to go in and talk tosomeone about something, and I'm
using, borrowing some of the skillsto go in and do that communication.
I think it's lovely.
That's my hope that they'll use it.
Well, Sharyl, I feel likethat, um, there's much more
(31:16):
that we can learn from you.
And I hope that, um, weget to do that again soon.
Um, but today I think this is agood, um, first chapter of Sharyl
and her wisdom from nursing.
Um, but really like, I think there's somuch to unpack, you know, your experience
with, um, You know, um, Native Alaskan,especially now, you know, all of these
(31:41):
kind of, um, I mean, I haven't thoughtabout a culture that is, you know, based
on, that is so, has so much, plays somuch value on narrative, for example.
That's a, that's a, that's a, thatjust opens up so many possibilities
in my mind, like, right away.
(32:02):
Um, so, we gotta talk more.
But, um, for today, wewill, we will pause for now.
Uh, hopefully we can, wecan talk more again soon.
And, uh, Sharyl, I, Ican't thank you enough.
Um, you've, uh, this is, thisis, this is incredible for
me as a learning experience.
(32:23):
Um, I, I appreciate you so much.
Thanks, Jeff.
It's been fun.
Thanks.
All right.
Take care.
Coming up next, we'll be chattingwith Kyle Hewson, Vice Chair and
Clinical Associate Professor inthe Doctorate in Physical Therapy
program at Stonybrook University.
Here's a quick preview.
(32:44):
So the idea that They put up aPowerPoint that they did in their
first year with two or three people.
Even just to show them how advancedthey've become in some of their
presentations by the third year, youknow, they have this and that, and they're
just, their references are awesome.
And they're able to pullin a video or something.
So just, and they feel so much morecomfortable because they say, Oh, I
(33:07):
was such a nervous person that firsttime I had to get up 80, 80 students.
You know, so, so it's kind of neat.
You know, that.
See you next time!
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