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Digication Scholars Conversations...
Welcome to Digication
Scholars Conversations.
I'm your host, Jeff Yan.
In this episode, you will hear part one
of my conversation with Sharyl Toscano,
professor at the School of Nursing
at University of Alaska Anchorage.
More links and information about today's
conversation can be found on Digication's
Twitter, Facebook, and Instagram.
Full episodes of Digication Scholars
Conversations can be found on
YouTube or your favorite podcast app.
Welcome to Digication
Scholars Conversations.
I'm your host, Jeff Yan.
My guest today is Sharyl Toscano.
Professor at the School of Nursing
at University of Alaska Anchorage.
Hello, Sharyl.
Hi.
Hi, Jeff.
Welcome.
Uh, I have been a, um, we've had, we've
shared a, uh, a friend and colleague,
Paul Wasco, I think, for many years.
Um, Paul Wasco is also a Digication
Scholar, um, uh, we'll, we'll put a link
to his, uh, episode, um, um, in, in our,
in our show notes, um, and we've had a
long, um, partnership with University
of Alaska Anchorage, um, and, uh, I
have heard a lot of, um, uh, good things
about 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
recently and I was just so drawn by what
you do that I thought we should really
have you come and speak with us and tell
people a little bit more about your work.
Thank you.
So, um, Sharyl, would you, Mind telling
us 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
from, you know, sort of, you know, where
you 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's
sort of a small town outside of Boston.
Um, I, growing up, I knew I wanted
to be a teacher or a nurse because
the, uh, job prospects were sort
of solid in, in both, in both, um.
You achieved both dreams at the same time.
Yeah, exactly.
So, ironically, I became a teacher of
nursing, but, um, I went, yeah, I got, I
went to school in Massachusetts and then
I, Traveled a bit because my husband is,
was in the Marine Corps, so we ended up
in Hawaii, uh, which was my first job
teaching nursing and then moved back
to Vermont, probably to get back my New
England heartiness so I could move to
Alaska because having moved from Hawaii.
Um, from Massachusetts where it's
cold to Hawaii where it's super warm
back to Vermont and then here to
Alaska where I've been since 2011.
So what brought you to Alaska?
Was it because of the
teaching position or?
Um, it's sort of the lifestyle, actually.
I, I, you can kind of teach
nursing anywhere because
there's a bit of a shortage.
And so I was more drawn to the
lifestyle, I think, in Alaska
where, um, my kids were young and
we're a sort of outdoorsy family.
Well, Alaska is certainly a big Anchorage
is sort of a, the Anchorage is sort of a
city, but, um, you know, the university
is really close, maybe 15 minutes from my
house, but The mountains are even closer.
So it's kind of a, a nice
living situation, I think.
Yeah, that's, that's great.
Now, in addition to, um, teaching, um, you
also are still practicing as a nurse, too.
Yeah, I teach at Alaska Native Medical
Center, which is also about 10 minutes
from where I live, and I work in
the NICU mostly as a bedside RN, um,
and sometimes I work on pediatrics.
I've worked as a nurse practitioner for
about 10 years earlier in my career,
and now I'm more focused on education.
The bedside nursing, I do per diem,
but that experience definitely informs
my teaching because I, one of the
focus of my teaching right now in the
capstone is, I mean, there's been a
call for more self care for nurses,
uh, they've had some increased stress
recently, uh, increased work, uh, you
know, work assignments and, um, even
lack 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 nurses
will be graduating into, what kind of
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.
So how do you, how do you prepare
students for returning to this
environment that is very different
than the one that I was educated
for and the one that I practiced in?
So.
Interesting.
Yeah.
Um, one of the things that I
remember being so impressed by
you is that you have, um, a really
strong focus in storytelling.
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 healthcare
environment, you know, and nursing, but
you are taking storytelling as this sort
of amazing learning tool, this amazing,
amazing ways for one to express oneself
and merging them together, you know?
Yeah.
And that's sort of changed.
Recently, I've always used my practice
or clinical stories in my teaching, but
something I've been doing more recently
is having the students reflect on their
experience and tell their story where they
connect it with, there's a nurse theorist,
um, Watson, and she has these Cerative,
um, as part of her theory of nursing.
So the students will focus
on one of the Ceratives.
And connect that with something
that's happened in their clinical
clinical experience and match up.
You know, 1 of them is being present.
And so how was that care
to us demonstrated in this
encounter with the patient?
Or how was it not demonstrated?
So the students can sort of
reflect 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, not
just as a student, but once they graduate,
that they're reflecting on those and
bringing what they learned from those
experience into the next encounter.
Um, we're, we're hope we're hoping that
that will help the longevity of the nurse.
And I don't like the word resilience
because I feel like sometimes.
Saying someone's resilient is sort of
rewarding a breaking, broken system.
And so I would like a scenario
where nurses are thriving
because they're supported.
And, um, I'm not sure when
you say resilience, it's
usually they survived, right?
And that's sort of rewarded.
But, um, that if, if they're using
these tools or they're really
reflecting on their experience and
not really judging it, but, you know,
taking the learning points from that.
Story or that experience into the
next one, they might approach the
scenario a little bit differently.
And, um, in the student case,
oftentimes when they first start
writing their stories, they
tend to be a bit judgy, right?
Because, you know, they're coming from
this, they're coming from this sort of
textbook place where, you know, everything
is supposed to look a certain way.
And then they enter the
clinical environment.
And they see things happening
maybe a little bit differently.
And initially there's, they can be a
bit judgy about what, you know, the
nurse there with should have done.
Um, and so we kind of, I kind of pull
these apart, these, these narratives
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 this
or the without judgment, either
Positive or negative without judgment.
What's happening here?
And then we try to connect it
to, um, we bring in a little
nonviolent communication.
We try to bring in, um, the other or the
student, like, what are their feelings and
then connect the feeling they're having
to a need that's either met or unmet.
This goes back to
nonviolent communication.
Um, that's pretty long
standing popular, popular book.
Um, but this approach, what
I'm hoping is it helps.
We have lots of ways that we
communicate in healthcare.
You know, um, we have a SBAR.
I pass the baton, all these
little acronyms for different
kinds of information and how
you convey it, but none of it
really gets at needs or feelings.
And I feel like that's what
leads to nurses burnout.
And so, Working with appreciative
inquiry, strength based approach, non
violent communication, and then this
kind of Watson's caring, um, framework,
I'm hoping, um, that, that will help
give students the tools they need to
thrive when they enter practice instead
of surviving or, um, because we, we
tend to lose nurses, you know, Sometimes
within the first year, you know,
they leave the professional together.
And so, we're really looking for
tools that, that can support them.
I love what you said about
this, a very specific kind.
Um, you, you've gone a lot deeper to
talk about reflection than oftentimes
I have with, you know, other people.
Because it's sort of, sometimes
people talk about reflection and
they just go, well, You know, I
just 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, I
just ask students to reflect.
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.
to it had at University of Alaska
Anchorage a number of years ago, and
we were talking about reflection.
And I was trying to figure
out how do you, how to
break down reflection in a really
simple generic way that is really
easy for anyone to just pick up.
I don't want it to be a very overly
scholarly, um, you know, Sort of thing
because I want the students ultimately
to be able to do it and I want the
students to understand it So I don't
want to faculty members to take this and
then get to the to the students and then
there's a bunch of theories behind it.
I just wanted to boil it down to something
and I Had this very beginning phase of
the framework, which I think has some
overlap with what you do, which is We
break down Um, uh, the the sort of the
Just, just two faces of the reflection.
One is, um, storytelling.
Um, and then the other is, um, um,
through conversation, find significance.
Um, and, um, and it sounds like
it's a little bit like what you
are doing, but you're, what you
said was, I think it's better.
Um, it's uh It's got a little bit
more of that, you know, really
thinking about the language in which
we use to, to, uh, uh, approach it.
Um, so hopefully I'll, I'll borrow
that a little bit, uh, as well in
the future, but I, I like this a lot
because, um, sometimes I find that
by breaking it down into those two
faces, you can hold off on the judgment
part of it, whether it's, You know have
positive negative judgment or in your
case a nonviolent version of it You can
hold off on that and just understanding
what happened just to just to get a
sense of I'm not even looking at whether
it Works just what happened first
and then being able to remove myself
from already coming to conclusion And
then try to say, we laid it all out.
Now let's take a look at what's
so significant about all of this.
Um, and, um, and I love what you said
about the non violent language of, you
know, form of communication and to use
that 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.
I want to be taken care of by
you or any of your students.
Um, can we talk a little bit about
this idea of, um, you had said that
nurses, you, you've been focusing
quite a lot on self care for nursing.
Um,
And that they often get burned
out, you know, as soon as they
basically get into the job situation.
And I think that this is the case for
a number of, um, number of fields.
Education is another.
That's like that.
A lot of people train to be a teacher.
They have this passion that they want
to help, um, young children learn, but
then a year into it, they realize how
tough it is and some of the things that
they still like and love a lot of the
pieces of it, but there are enough other
pieces that makes them want to quit.
What is, can we talk
about that a little bit?
Because I think that's a, that's a
serious 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 so
focused and I was talking to a student
about this actually just yesterday.
Um, you know, she was expressing
how 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, she
says, I just don't have time right now.
So she's like, maybe I'll have
time, you know, when school's
done, or maybe I'll have time.
And I said, well, you'll, you will never
have time unless you make space for it.
Um, I said, and you know, and that's
why we're, We're focused on this so that
you can practice integrating this now.
Uh, and, and I could kind of give the
example of, you know, even if I'm on the
way to a delivery, we talk about sort
of a little bit of mindfulness or it,
I don't really push any one strategy.
I kind of introduced them
to multiple strategies.
Um, I think the telling the story is
definitely like kind of unifying piece of
that, but, you know, it explains these, if
I'm headed to a delivery, I actually use
that as a mindful moment because I have
to walk all the way out the NICU, down the
hall, find the room, and then even setting
up the equipment before the baby comes.
It's, it's, you do everything in the same
steps every time and it's a way to focus.
Like everyone's focused on it, but if
you don't use those moments that you
have to kind of center yourself or do
some self care, I think nurses or other
health professionals can kind of just.
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 nursing
students, nurses or health care, anyone
in health care really is exposed to
probably more in one, you know, one
small stretch of time that somebody else
would be exposed to an entire lifetime.
Like your, it's not you, it's not the
same level, but you're exposed to so
much, you know, kind of trauma, you
know, 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.
Right.
Yeah.
Or you'll just, you'll leak all the time.
These are, these are, I've heard a lot
of people talk about this indirect or
secondary trauma that you get, right?
Just be exposed to it and
Could could lead to that because
you are witness of something things
sometimes don't go well, right?
And the part of that appreciative
approach that I've tried to you know
Particularly, you know students you get
to 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 it
can be You know, a certain kind of focus
and I kind of try to tell him, what if
you flip that focus and just tried to
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 be
trying to throw every strategy at it.
You know, I'm in my current work space.
You know, I think there's so many, a
lot 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 had
probably seven or eight senior nurses.
And there was maybe three of us.
Well, there's like maybe three
senior 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 at
all on what's going well or where the
opportunities are, and you're always
focused on what's not going well.
Um, I think you, you kind of just
kind of continue down that road,
but we don't really, we haven't
in the past really given people
the tools to change that focus.
Um, you know, and when I do.
NVC.
At first, the student's
like, Oh, this is easy.
And when they actually try to do it, and
they, 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 side
of it and you're looking at anger, it's
not, you're not angry, you're frustrated
or you're, and so when you're looking
at what you need to do to Resolve that
need, 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 to
use it in their preceptorship,
but it's, um, it is something that
looks easy, but does take practice.
For those of us who don't know what
NVC is, um, could you tell us a little
bit more so that we can Yeah, it's a
pretty old, um, is Marshall Rosenberg.
I might get his name wrong.
Um, uh, it's been used, you know, it's
used a lot in Waldorf schools for kids.
It's a really useful technique.
For that, uh, but it's
also used in counseling.
It's used in war-torn countries when
you're, they've used it when negotiators
go in and they'll use NVC, um, in
different camps where they bring kids
from different, um, countries together.
They've used NVC, but essentially, um,
the elements are essentially there's
everyone has universal needs, no matter
where you're from, no matter what culture.
And.
If you can identify or match up your
feelings with your needs, so you
have feelings when your needs are
met and feelings when your needs
are unmet and just making that
connection, um, and not judging
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 feeling
and 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
a little tricky in the healthcare setting.
So we talk about that because
you, there are situations
where we can't say no, right?
. Yeah.
Um, and then.
And the, but the appreciation piece I
think is even more important that you're,
when you're showing appreciation using
the model, you're saying specifically
your feeling and your met need.
So the person who you're giving that
appreciation to is also getting really
specific feedback about what it was
specifically that they did to, um, you
know, for you to show this appreciation.
You know, cause oftentimes when we
get thanks or we don't really know
what it was exactly that we did.
And so if you're going to continue that
behavior showing that really specific,
you know, I felt this way and when,
uh, you met this need, um, I did.
Hopefully that person will
continue, 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't
know what they're doing over time
and that never gets resolved.
But this idea of just, you know, in
our, in sort of the modern American,
you know, families today, this idea
of being able to just identify one's
feelings is, um, is not a, is not a
skill that we can take for granted.
In fact, um, that's probably, uh, why
there is such a huge, um, Huge industry
in, uh, in therapy today, right?
We are not able to either identify or
process these feelings and acts in,
acts to, to, um, to address, you know,
feelings of, you know, hurts or, um, anger
and, you know, especially the negative
feelings, but also the positive ones.
It's a really fun, um, game.
I started using this game with my
kids, but I use it with the students.
You know, we had one face to face.
Most of my classes are asynchronous
online, but um, we had one, a
few face to face sessions and the
students kept wanting to play Grok.
And Grok is sort of
this, just a card game.
It has a stack of feelings cards
and a stack of needs cards.
There's all these sort of games you
can go through, um, using the cards.
But you know, I start, then they
wanted to play Play Grok over
and over because it's just a very
concrete way to, to use the model.
But I remember when I was, I used to use
it with my daughter when she was younger.
I remember one day she came home and she
was really young, you know, not, um, she
might have been maybe seven or six and a
half or something, but, and she was really
upset with her dad and she said, Mama I
need to Grock and she came and she got
the cards and she went, she went over to
him and she says, you know, she lays down
her feelings cards and her needs cards.
And so it's a really, um, with younger
kids in particular, it's really, um, they
get it, you know, they just naturally
know how to use it, you know, as they get
older, they kind of roll their eyes and
they're like, you're doing that thing.
So just stop.
Well, they probably have
internalized those skills now, right?
Yeah.
But the college students,
for many, it's new.
Like they, they've learned a
different way, um, you know, by
saying I feel, but you can start a
sentence with I feel, and it's still
sort of aggressive language, right?
Cause I, I feel if that's followed
by, you know, blaming someone else,
as opposed to, you know, the NVC, you
don't, it's, you're not interpreting
your feelings to anybody else.
Anyway, I've probably gone on about
NVC a bit too long, but, um, No, it's
not because I, here's what I, um,
I wanted to just say how important
some, this discussion I think is, I
think that there are lots of, um, you
know, I, I, I'm a deep believer that.
When we have many different perspectives
at looking at the world, we get
better at looking at the world.
And
Um, you know, there are educators,
education psychologists, there's,
you know, researchers in all
different kind of fields.
I've had many of these conversations, you
know, some of them healthcare, some of
them in STEM, you know, they all bring,
um, different perspectives on how they
think about reflection, for example.
There are some things that tie us all
together, 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 more
sophisticated way of thinking about
reflection in a very, it doesn't
just have this or around reflection.
There are literally steps that we
can take that can genuinely get
those feelings processed, get those
and then experience and really
reflect and get to the significance.
And I think that there's something really
significant 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 that
is, um, that doesn't work is people think
that, what's your reflection prompt?
Because as if that's just silver
bullet that I can just say, if you
ask student this prompt, they will
suddenly, they will solve everything.
You know, that would have been
like saying to a therapist that,
what do you ask your clients?
Well, I just asked him this one
thing and then everything is done.
It's not like that, right?
There's a lot of depth into
layers of processing stuff.
And you are, in fact, describing
a number of those layers in the
scenarios, um, in very concrete terms.
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'll
probably 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 lot
of people struggle with it because we,
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, but
we don't know how to get them to have it.
Yeah.
When you say the prompts, it makes
me think of every reflection I've
ever been asked to do as a student.
There's always these prompts.
I was like, well, that's
not where my mind's going.
Like, thanks.
And I've, I've always sort of, bend
more toward open-ended, but then
sometimes I could see on the educator
side where you sometimes get back.
There's no emotion.
I sit, you know, I tell the
students I need to feel something.
It doesn't have to be a good feeling.
But if you've reflected, I should have
some feeling should be in this reflection.
And something from you, like I was talking
to a student the other day and I said,
well, somebody had described this to me.
This isn't my language, but I think it
was an advisor back at BC a long time ago.
She was like, I want to
know what's in your box.
Like so many people tell you what your
box should look like, but I want to
know what Sharyl's box looks like.
I was like, I'm not so sure you want
to know what my box looks like, but,
but it, that I sort of took that with
me in my, You know, as a teacher that I
didn't want to always just have students
repeating what I think is what my box is.
I actually do want to know, you know,
what, what's unique about, about
their experience and their knowledge
related to whatever the topic is.
So, in the Capstone course, the
nursing Capstone course, we do, um.
They demonstrate the baccalaureate
essentials for the nurse, so there's 10.
And for this, we use a lot of reflection
and we're using um, ePortfolio for that.
And it does take a bit to get them
going because their initial response
is to just define the essential or
just, When this assignment I did
this, or this assignment I did this.
I say, I'm not, the assignment
is just, you know, like a
piece of pottery you made.
If you're.
You know, Potter, like
this is the one you like.
So, you know, you're using it as your
evidence or an example of where you did
this thing, but the reflection should
really be about the full essential.
And, you know, how did you think about
nursing knowledge as a, new student and
how did that change in your experiences
over the time you've been here or the
experiences that you've had and then they
start to, they don't, it's not intuitive.
I don't think they get it right away.
So there's kind of, there's a
lot of back and forth prompting.
But eventually they really create,
they start with their autobiographic
sketch, which are very unique.
We have the most unique
students, I think, in Alaska.
Just come from like, some are from rural
villages, some are like military families,
some are like hardy Alaskans that have,
you know, been here for generations.
And many are just from everywhere because
it's sort of a melting pot, right?
And so you have these really
unique autobiographical.
Graphic sketches of where they've
come from and how they ended up in
nursing and then somehow they all
sort of relate to their narrative
that's specific to each essential
and how they've, how they've met it.
It's a pretty, it's a pretty big project
and 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.
Right.
And if you do that too much,
they'll all look the same.
Yeah.
And then, and then it
does 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 preview
of what's coming up next.
In part two of my conversation
with Sharyl Toscano, professor
at the School of Nursing at
University of Alaska, Anchorage.