1 00:00:01,170 --> 00:00:03,710 Welcome to Digication Scholars Conversations. 2 00:00:03,949 --> 00:00:05,380 I'm your host, Jeff Yan. 3 00:00:06,130 --> 00:00:10,610 In this episode, you will hear part one of my conversation with Sharyl Toscano, 4 00:00:11,060 --> 00:00:15,480 professor at the School of Nursing at University of Alaska Anchorage. 5 00:00:16,160 --> 00:00:20,140 More links and information about today's conversation can be found on Digication's 6 00:00:20,259 --> 00:00:22,069 Twitter, Facebook, and Instagram. 7 00:00:22,660 --> 00:00:26,090 Full episodes of Digication Scholars Conversations can be found on 8 00:00:26,099 --> 00:00:27,630 YouTube or your favorite podcast app. 9 00:00:29,930 --> 00:00:32,439 Welcome to Digication Scholars Conversations. 10 00:00:32,610 --> 00:00:34,010 I'm your host, Jeff Yan. 11 00:00:34,800 --> 00:00:37,069 My guest today is Sharyl Toscano. 12 00:00:37,800 --> 00:00:42,400 Professor at the School of Nursing at University of Alaska Anchorage. 13 00:00:43,000 --> 00:00:43,790 Hello, Sharyl. 14 00:00:44,200 --> 00:00:44,580 Hi. 15 00:00:45,460 --> 00:00:45,960 Hi, Jeff. 16 00:00:46,690 --> 00:00:47,170 Welcome. 17 00:00:47,570 --> 00:00:56,150 Uh, I have been a, um, we've had, we've shared a, uh, a friend and colleague, 18 00:00:56,210 --> 00:00:58,440 Paul Wasco, I think, for many years. 19 00:00:59,100 --> 00:01:04,400 Um, Paul Wasco is also a Digication Scholar, um, uh, we'll, we'll put a link 20 00:01:04,400 --> 00:01:11,110 to his, uh, episode, um, um, in, in our, in our show notes, um, and we've had a 21 00:01:11,120 --> 00:01:17,019 long, um, partnership with University of Alaska Anchorage, um, and, uh, I 22 00:01:17,020 --> 00:01:21,809 have heard a lot of, um, uh, good things about you and what you're doing in the 23 00:01:21,809 --> 00:01:27,710 School of Nursing, um, and we got to, Uh, we met, um, and did some work together 24 00:01:27,710 --> 00:01:32,050 recently and I was just so drawn by what you do that I thought we should really 25 00:01:32,060 --> 00:01:36,160 have you come and speak with us and tell people a little bit more about your work. 26 00:01:37,820 --> 00:01:38,050 Thank you. 27 00:01:38,760 --> 00:01:44,840 So, um, Sharyl, would you, Mind telling us just a little bit of, perhaps just even 28 00:01:44,840 --> 00:01:50,259 a little bit on, of, of where you come, where you're from and, um, maybe starting 29 00:01:50,259 --> 00:01:54,050 from, you know, sort of, you know, where you grew up and then, you know, tell us 30 00:01:54,050 --> 00:01:56,170 a little bit of how you got to Alaska. 31 00:01:57,649 --> 00:01:58,190 Okay, great. 32 00:01:58,700 --> 00:02:03,630 I grew up in Massachusetts, Pepperell's sort of a small town outside of Boston. 33 00:02:04,300 --> 00:02:11,165 Um, I, growing up, I knew I wanted to be a teacher or a nurse because 34 00:02:11,195 --> 00:02:16,965 the, uh, job prospects were sort of solid in, in both, in both, um. 35 00:02:17,595 --> 00:02:19,765 You achieved both dreams at the same time. 36 00:02:20,314 --> 00:02:21,045 Yeah, exactly. 37 00:02:21,514 --> 00:02:27,725 So, ironically, I became a teacher of nursing, but, um, I went, yeah, I got, I 38 00:02:27,725 --> 00:02:32,825 went to school in Massachusetts and then I, Traveled a bit because my husband is, 39 00:02:32,875 --> 00:02:38,225 was in the Marine Corps, so we ended up in Hawaii, uh, which was my first job 40 00:02:38,275 --> 00:02:47,495 teaching nursing and then moved back to Vermont, probably to get back my New 41 00:02:47,495 --> 00:02:51,655 England heartiness so I could move to Alaska because having moved from Hawaii. 42 00:02:52,320 --> 00:02:56,230 Um, from Massachusetts where it's cold to Hawaii where it's super warm 43 00:02:56,239 --> 00:03:02,029 back to Vermont and then here to Alaska where I've been since 2011. 44 00:03:03,509 --> 00:03:04,870 So what brought you to Alaska? 45 00:03:04,920 --> 00:03:07,289 Was it because of the teaching position or? 46 00:03:08,635 --> 00:03:10,955 Um, it's sort of the lifestyle, actually. 47 00:03:10,955 --> 00:03:14,405 I, I, you can kind of teach nursing anywhere because 48 00:03:14,405 --> 00:03:16,095 there's a bit of a shortage. 49 00:03:16,735 --> 00:03:20,245 And so I was more drawn to the lifestyle, I think, in Alaska 50 00:03:20,615 --> 00:03:26,925 where, um, my kids were young and we're a sort of outdoorsy family. 51 00:03:28,125 --> 00:03:30,935 Well, Alaska is certainly a big Anchorage is sort of a, the Anchorage is sort of a 52 00:03:30,935 --> 00:03:37,005 city, but, um, you know, the university is really close, maybe 15 minutes from my 53 00:03:37,005 --> 00:03:39,185 house, but The mountains are even closer. 54 00:03:39,525 --> 00:03:43,515 So it's kind of a, a nice living situation, I think. 55 00:03:44,595 --> 00:03:45,735 Yeah, that's, that's great. 56 00:03:45,745 --> 00:03:54,564 Now, in addition to, um, teaching, um, you also are still practicing as a nurse, too. 57 00:03:55,120 --> 00:03:59,070 Yeah, I teach at Alaska Native Medical Center, which is also about 10 minutes 58 00:03:59,090 --> 00:04:07,290 from where I live, and I work in the NICU mostly as a bedside RN, um, 59 00:04:07,320 --> 00:04:09,030 and sometimes I work on pediatrics. 60 00:04:10,380 --> 00:04:15,039 I've worked as a nurse practitioner for about 10 years earlier in my career, 61 00:04:15,060 --> 00:04:18,380 and now I'm more focused on education. 62 00:04:19,899 --> 00:04:25,030 The bedside nursing, I do per diem, but that experience definitely informs 63 00:04:25,030 --> 00:04:30,330 my teaching because I, one of the focus of my teaching right now in the 64 00:04:30,330 --> 00:04:36,364 capstone is, I mean, there's been a call for more self care for nurses, 65 00:04:36,765 --> 00:04:42,114 uh, they've had some increased stress recently, uh, increased work, uh, you 66 00:04:42,124 --> 00:04:48,655 know, work assignments and, um, even lack of access to supplies and materials 67 00:04:48,655 --> 00:04:51,274 that used to be readily available. 68 00:04:51,655 --> 00:04:55,124 So, I think being, you know, practicing in nursing in the setting, 69 00:04:55,124 --> 00:04:58,044 I'm, you know, I have more current. 70 00:04:58,284 --> 00:05:02,744 experience of what the new nurses will be graduating into, what kind of 71 00:05:02,744 --> 00:05:04,944 environments they'll be exposed to. 72 00:05:06,145 --> 00:05:10,224 Um, you know, when I graduated, primary nursing was sort of the 73 00:05:11,534 --> 00:05:14,145 standard, uh, way that we practiced. 74 00:05:14,145 --> 00:05:18,825 And with, How things with the shortages, they're actually seeing team nursing 75 00:05:18,835 --> 00:05:21,945 start to come back, which, you know, we haven't really focused on that 76 00:05:21,955 --> 00:05:25,234 in education, uh, quite some time. 77 00:05:25,354 --> 00:05:29,014 So how do you, how do you prepare students for returning to this 78 00:05:29,084 --> 00:05:32,174 environment that is very different than the one that I was educated 79 00:05:32,175 --> 00:05:33,564 for and the one that I practiced in? 80 00:05:33,634 --> 00:05:33,854 So. 81 00:05:34,345 --> 00:05:35,005 Interesting. 82 00:05:35,194 --> 00:05:35,494 Yeah. 83 00:05:36,524 --> 00:05:41,965 Um, one of the things that I remember being so impressed by 84 00:05:41,974 --> 00:05:47,445 you is that you have, um, a really strong focus in storytelling. 85 00:05:48,720 --> 00:05:54,930 Um, tell us a little bit more about that, because that's, by the way, I am, I love 86 00:05:54,980 --> 00:06:01,810 that, but I often find that, you know, it's these intersections of someone who's 87 00:06:02,310 --> 00:06:07,930 Uh, you know, teaching in a healthcare environment, you know, and nursing, but 88 00:06:07,930 --> 00:06:15,299 you are taking storytelling as this sort of amazing learning tool, this amazing, 89 00:06:15,340 --> 00:06:20,570 amazing ways for one to express oneself and merging them together, you know? 90 00:06:21,389 --> 00:06:21,679 Yeah. 91 00:06:21,680 --> 00:06:22,859 And that's sort of changed. 92 00:06:23,425 --> 00:06:29,115 Recently, I've always used my practice or clinical stories in my teaching, but 93 00:06:29,115 --> 00:06:34,345 something I've been doing more recently is having the students reflect on their 94 00:06:34,345 --> 00:06:41,365 experience and tell their story where they connect it with, there's a nurse theorist, 95 00:06:41,645 --> 00:06:48,625 um, Watson, and she has these Cerative, um, as part of her theory of nursing. 96 00:06:48,625 --> 00:06:51,655 So the students will focus on one of the Ceratives. 97 00:06:52,585 --> 00:06:55,135 And connect that with something that's happened in their clinical 98 00:06:55,305 --> 00:06:56,895 clinical experience and match up. 99 00:06:57,275 --> 00:06:58,645 You know, 1 of them is being present. 100 00:06:58,965 --> 00:07:03,965 And so how was that care to us demonstrated in this 101 00:07:04,495 --> 00:07:05,464 encounter with the patient? 102 00:07:05,464 --> 00:07:07,034 Or how was it not demonstrated? 103 00:07:07,034 --> 00:07:11,514 So the students can sort of reflect and how they might bring 104 00:07:11,514 --> 00:07:13,675 that in in a future experience. 105 00:07:13,725 --> 00:07:15,175 That might look similar. 106 00:07:17,534 --> 00:07:22,695 But the important part is that they're, you know, when they're having clinical 107 00:07:22,695 --> 00:07:27,215 experiences or patient experiences, not just as a student, but once they graduate, 108 00:07:27,224 --> 00:07:31,955 that they're reflecting on those and bringing what they learned from those 109 00:07:31,955 --> 00:07:33,664 experience into the next encounter. 110 00:07:34,305 --> 00:07:41,825 Um, we're, we're hope we're hoping that that will help the longevity of the nurse. 111 00:07:42,375 --> 00:07:45,625 And I don't like the word resilience because I feel like sometimes. 112 00:07:46,975 --> 00:07:50,265 Saying someone's resilient is sort of rewarding a breaking, broken system. 113 00:07:51,385 --> 00:07:55,095 And so I would like a scenario where nurses are thriving 114 00:07:55,095 --> 00:07:56,155 because they're supported. 115 00:07:56,725 --> 00:08:00,025 And, um, I'm not sure when you say resilience, it's 116 00:08:00,025 --> 00:08:01,465 usually they survived, right? 117 00:08:02,125 --> 00:08:04,214 And that's sort of rewarded. 118 00:08:04,224 --> 00:08:08,735 But, um, that if, if they're using these tools or they're really 119 00:08:08,735 --> 00:08:14,515 reflecting on their experience and not really judging it, but, you know, 120 00:08:14,515 --> 00:08:16,465 taking the learning points from that. 121 00:08:16,835 --> 00:08:21,215 Story or that experience into the next one, they might approach the 122 00:08:22,025 --> 00:08:23,445 scenario a little bit differently. 123 00:08:24,224 --> 00:08:27,465 And, um, in the student case, oftentimes when they first start 124 00:08:27,465 --> 00:08:30,895 writing their stories, they tend to be a bit judgy, right? 125 00:08:30,905 --> 00:08:34,664 Because, you know, they're coming from this, they're coming from this sort of 126 00:08:34,715 --> 00:08:38,574 textbook place where, you know, everything is supposed to look a certain way. 127 00:08:39,384 --> 00:08:41,444 And then they enter the clinical environment. 128 00:08:41,655 --> 00:08:44,084 And they see things happening maybe a little bit differently. 129 00:08:44,324 --> 00:08:48,085 And initially there's, they can be a bit judgy about what, you know, the 130 00:08:48,085 --> 00:08:49,285 nurse there with should have done. 131 00:08:50,434 --> 00:08:56,005 Um, and so we kind of, I kind of pull these apart, these, these narratives 132 00:08:56,045 --> 00:09:00,304 that they write and I'll say, well, how can we look at this from a 133 00:09:00,304 --> 00:09:02,605 strength based appreciative inquiry? 134 00:09:04,475 --> 00:09:08,105 And so what are the facts of this or the without judgment, either 135 00:09:08,204 --> 00:09:11,155 Positive or negative without judgment. 136 00:09:11,165 --> 00:09:12,245 What's happening here? 137 00:09:12,305 --> 00:09:16,055 And then we try to connect it to, um, we bring in a little 138 00:09:16,055 --> 00:09:17,384 nonviolent communication. 139 00:09:17,384 --> 00:09:24,704 We try to bring in, um, the other or the student, like, what are their feelings and 140 00:09:24,704 --> 00:09:28,824 then connect the feeling they're having to a need that's either met or unmet. 141 00:09:30,665 --> 00:09:32,365 This goes back to nonviolent communication. 142 00:09:32,415 --> 00:09:36,145 Um, that's pretty long standing popular, popular book. 143 00:09:36,900 --> 00:09:40,830 Um, but this approach, what I'm hoping is it helps. 144 00:09:42,190 --> 00:09:44,630 We have lots of ways that we communicate in healthcare. 145 00:09:44,770 --> 00:09:47,900 You know, um, we have a SBAR. 146 00:09:47,900 --> 00:09:50,880 I pass the baton, all these little acronyms for different 147 00:09:50,880 --> 00:09:54,119 kinds of information and how you convey it, but none of it 148 00:09:54,119 --> 00:09:57,140 really gets at needs or feelings. 149 00:09:57,499 --> 00:10:00,200 And I feel like that's what leads to nurses burnout. 150 00:10:01,180 --> 00:10:06,175 And so, Working with appreciative inquiry, strength based approach, non 151 00:10:06,194 --> 00:10:11,515 violent communication, and then this kind of Watson's caring, um, framework, 152 00:10:12,305 --> 00:10:20,624 I'm hoping, um, that, that will help give students the tools they need to 153 00:10:20,624 --> 00:10:25,884 thrive when they enter practice instead of surviving or, um, because we, we 154 00:10:25,884 --> 00:10:30,425 tend to lose nurses, you know, Sometimes within the first year, you know, 155 00:10:30,445 --> 00:10:32,175 they leave the professional together. 156 00:10:32,475 --> 00:10:37,255 And so, we're really looking for tools that, that can support them. 157 00:10:38,744 --> 00:10:44,785 I love what you said about this, a very specific kind. 158 00:10:45,065 --> 00:10:49,704 Um, you, you've gone a lot deeper to talk about reflection than oftentimes 159 00:10:49,704 --> 00:10:51,605 I have with, you know, other people. 160 00:10:52,175 --> 00:10:55,465 Because it's sort of, sometimes people talk about reflection and 161 00:10:55,465 --> 00:10:58,604 they just go, well, You know, I just ask my students to reflect. 162 00:10:58,604 --> 00:10:59,285 I believe in it. 163 00:10:59,884 --> 00:11:01,795 And I go, yeah, so do I. 164 00:11:01,944 --> 00:11:03,744 But what does your reflection look like? 165 00:11:03,824 --> 00:11:06,264 And then they just go, well, I just ask students to reflect. 166 00:11:07,104 --> 00:11:10,274 And, and I go, well, I don't know. 167 00:11:10,314 --> 00:11:12,534 For me, it has never worked for me. 168 00:11:12,535 --> 00:11:14,885 But I just say, go reflect. 169 00:11:15,584 --> 00:11:21,214 Um, I, you know, what's so interesting, we have a lot of overlap on this. 170 00:11:21,634 --> 00:11:26,045 I made a presentation, actually, a presentation in Alaska. 171 00:11:27,400 --> 00:11:32,439 to it had at University of Alaska Anchorage a number of years ago, and 172 00:11:32,439 --> 00:11:34,520 we were talking about reflection. 173 00:11:34,569 --> 00:11:39,280 And I was trying to figure out how do you, how to 174 00:11:41,389 --> 00:11:46,189 break down reflection in a really simple generic way that is really 175 00:11:46,189 --> 00:11:47,999 easy for anyone to just pick up. 176 00:11:48,040 --> 00:11:54,960 I don't want it to be a very overly scholarly, um, you know, Sort of thing 177 00:11:55,050 --> 00:11:59,369 because I want the students ultimately to be able to do it and I want the 178 00:11:59,369 --> 00:12:02,569 students to understand it So I don't want to faculty members to take this and 179 00:12:02,569 --> 00:12:06,499 then get to the to the students and then there's a bunch of theories behind it. 180 00:12:06,519 --> 00:12:12,669 I just wanted to boil it down to something and I Had this very beginning phase of 181 00:12:12,669 --> 00:12:18,879 the framework, which I think has some overlap with what you do, which is We 182 00:12:18,879 --> 00:12:28,045 break down Um, uh, the the sort of the Just, just two faces of the reflection. 183 00:12:28,545 --> 00:12:32,045 One is, um, storytelling. 184 00:12:32,595 --> 00:12:39,605 Um, and then the other is, um, um, through conversation, find significance. 185 00:12:40,114 --> 00:12:44,144 Um, and, um, and it sounds like it's a little bit like what you 186 00:12:44,144 --> 00:12:47,854 are doing, but you're, what you said was, I think it's better. 187 00:12:48,364 --> 00:12:53,300 Um, it's uh It's got a little bit more of that, you know, really 188 00:12:53,540 --> 00:12:57,829 thinking about the language in which we use to, to, uh, uh, approach it. 189 00:12:58,490 --> 00:13:02,069 Um, so hopefully I'll, I'll borrow that a little bit, uh, as well in 190 00:13:02,069 --> 00:13:08,469 the future, but I, I like this a lot because, um, sometimes I find that 191 00:13:10,560 --> 00:13:18,050 by breaking it down into those two faces, you can hold off on the judgment 192 00:13:18,079 --> 00:13:22,224 part of it, whether it's, You know have positive negative judgment or in your 193 00:13:22,224 --> 00:13:27,874 case a nonviolent version of it You can hold off on that and just understanding 194 00:13:27,874 --> 00:13:32,405 what happened just to just to get a sense of I'm not even looking at whether 195 00:13:32,405 --> 00:13:37,644 it Works just what happened first and then being able to remove myself 196 00:13:37,654 --> 00:13:43,125 from already coming to conclusion And then try to say, we laid it all out. 197 00:13:43,245 --> 00:13:46,825 Now let's take a look at what's so significant about all of this. 198 00:13:47,505 --> 00:13:53,764 Um, and, um, and I love what you said about the non violent language of, you 199 00:13:53,765 --> 00:13:58,984 know, form of communication and to use that as a basis of looking at this. 200 00:13:59,505 --> 00:14:04,695 I'll tell you what, if I ever You know, need to be taken care of by a nurse. 201 00:14:04,695 --> 00:14:07,045 I want to be taken care of by you or any of your students. 202 00:14:10,885 --> 00:14:20,495 Um, can we talk a little bit about this idea of, um, you had said that 203 00:14:22,085 --> 00:14:27,595 nurses, you, you've been focusing quite a lot on self care for nursing. 204 00:14:29,185 --> 00:14:29,785 Um, 205 00:14:31,960 --> 00:14:37,130 And that they often get burned out, you know, as soon as they 206 00:14:37,130 --> 00:14:40,880 basically get into the job situation. 207 00:14:41,620 --> 00:14:47,300 And I think that this is the case for a number of, um, number of fields. 208 00:14:47,340 --> 00:14:48,410 Education is another. 209 00:14:48,880 --> 00:14:49,650 That's like that. 210 00:14:49,730 --> 00:14:52,180 A lot of people train to be a teacher. 211 00:14:52,240 --> 00:14:59,010 They have this passion that they want to help, um, young children learn, but 212 00:14:59,010 --> 00:15:05,409 then a year into it, they realize how tough it is and some of the things that 213 00:15:05,740 --> 00:15:10,589 they still like and love a lot of the pieces of it, but there are enough other 214 00:15:10,589 --> 00:15:12,060 pieces that makes them want to quit. 215 00:15:14,430 --> 00:15:16,689 What is, can we talk about that a little bit? 216 00:15:16,730 --> 00:15:21,339 Because I think that's a, that's a serious issue in society, isn't it? 217 00:15:22,140 --> 00:15:22,560 Yeah. 218 00:15:22,760 --> 00:15:24,240 What causes that in nursing? 219 00:15:24,260 --> 00:15:25,670 What do you think causes it in nursing? 220 00:15:26,089 --> 00:15:30,739 Well, I think, I think they're so focused and I was talking to a student 221 00:15:30,760 --> 00:15:32,289 about this actually just yesterday. 222 00:15:32,820 --> 00:15:37,840 Um, you know, she was expressing how in the class, um, where they're 223 00:15:37,840 --> 00:15:41,550 doing some of these activities, she's really interested in them and, 224 00:15:41,709 --> 00:15:43,389 you know, her appreciation for it. 225 00:15:43,620 --> 00:15:46,840 But then in the very next breath, she says, I just don't have time right now. 226 00:15:47,530 --> 00:15:51,559 So she's like, maybe I'll have time, you know, when school's 227 00:15:51,579 --> 00:15:52,790 done, or maybe I'll have time. 228 00:15:53,370 --> 00:15:57,400 And I said, well, you'll, you will never have time unless you make space for it. 229 00:15:58,040 --> 00:16:01,839 Um, I said, and you know, and that's why we're, We're focused on this so that 230 00:16:01,839 --> 00:16:04,550 you can practice integrating this now. 231 00:16:05,150 --> 00:16:10,129 Uh, and, and I could kind of give the example of, you know, even if I'm on the 232 00:16:10,129 --> 00:16:13,449 way to a delivery, we talk about sort of a little bit of mindfulness or it, 233 00:16:13,769 --> 00:16:16,229 I don't really push any one strategy. 234 00:16:16,229 --> 00:16:18,359 I kind of introduced them to multiple strategies. 235 00:16:18,849 --> 00:16:23,550 Um, I think the telling the story is definitely like kind of unifying piece of 236 00:16:23,560 --> 00:16:29,045 that, but, you know, it explains these, if I'm headed to a delivery, I actually use 237 00:16:29,045 --> 00:16:33,315 that as a mindful moment because I have to walk all the way out the NICU, down the 238 00:16:33,325 --> 00:16:38,284 hall, find the room, and then even setting up the equipment before the baby comes. 239 00:16:38,585 --> 00:16:43,294 It's, it's, you do everything in the same steps every time and it's a way to focus. 240 00:16:43,924 --> 00:16:48,885 Like everyone's focused on it, but if you don't use those moments that you 241 00:16:48,895 --> 00:16:57,644 have to kind of center yourself or do some self care, I think nurses or other 242 00:16:57,644 --> 00:16:59,154 health professionals can kind of just. 243 00:16:59,535 --> 00:17:06,825 Push it past, um, and it builds up, you know, or even, you know, you know, 244 00:17:06,825 --> 00:17:08,224 saying they don't feel something. 245 00:17:08,224 --> 00:17:13,375 There's a lot of, um, things that nursing students, nurses or health care, anyone 246 00:17:13,375 --> 00:17:19,560 in health care really is exposed to probably more in one, you know, one 247 00:17:19,560 --> 00:17:23,189 small stretch of time that somebody else would be exposed to an entire lifetime. 248 00:17:23,199 --> 00:17:27,659 Like your, it's not you, it's not the same level, but you're exposed to so 249 00:17:27,659 --> 00:17:33,010 much, you know, kind of trauma, you know, just, and so if you just kind 250 00:17:33,010 --> 00:17:34,670 of squash that down and you don't. 251 00:17:35,030 --> 00:17:36,630 You know, it's like, Oh, I'm just hardcore. 252 00:17:36,630 --> 00:17:37,190 I can't. 253 00:17:38,520 --> 00:17:38,740 Yeah. 254 00:17:38,740 --> 00:17:40,379 You think they will break you down. 255 00:17:40,430 --> 00:17:40,780 Right. 256 00:17:41,120 --> 00:17:41,230 Yeah. 257 00:17:41,230 --> 00:17:43,610 Or you'll just, you'll leak all the time. 258 00:17:44,280 --> 00:17:48,659 These are, these are, I've heard a lot of people talk about this indirect or 259 00:17:48,679 --> 00:17:50,830 secondary trauma that you get, right? 260 00:17:51,200 --> 00:17:53,420 Just be exposed to it and 261 00:17:55,870 --> 00:17:59,600 Could could lead to that because you are witness of something things 262 00:17:59,620 --> 00:18:01,130 sometimes don't go well, right? 263 00:18:01,130 --> 00:18:06,840 And the part of that appreciative approach that I've tried to you know 264 00:18:07,130 --> 00:18:11,190 Particularly, you know students you get to the final semester and there tends 265 00:18:11,190 --> 00:18:15,150 to be a certain mindset, you know, there's I Don't think this is specific 266 00:18:15,150 --> 00:18:19,650 to nursing students, but sometimes it can be You know, a certain kind of focus 267 00:18:19,960 --> 00:18:23,220 and I kind of try to tell him, what if you flip that focus and just tried to 268 00:18:23,220 --> 00:18:28,480 focus on from an appreciative approach, like where, where are the strengths, 269 00:18:28,670 --> 00:18:30,680 where are, where is the success? 270 00:18:30,739 --> 00:18:35,059 And I think if you don't do that, like a unit, an entire unit can just 271 00:18:35,089 --> 00:18:38,160 become very negative all the time. 272 00:18:38,200 --> 00:18:39,760 Like just focus on the negative. 273 00:18:39,770 --> 00:18:41,790 They almost can't pull themselves out. 274 00:18:42,390 --> 00:18:47,200 Um, You know, they might even be trying to throw every strategy at it. 275 00:18:47,220 --> 00:18:49,080 You know, I'm in my current work space. 276 00:18:49,780 --> 00:18:54,240 You know, I think there's so many, a lot of people have left after COVID. 277 00:18:54,789 --> 00:18:59,740 Um, a lot of new, new graduates, lots of great energy, really good 278 00:18:59,740 --> 00:19:01,570 excitement, but not the same support. 279 00:19:01,579 --> 00:19:06,270 You know, when I graduated, I had probably seven or eight senior nurses. 280 00:19:06,685 --> 00:19:07,745 And there was maybe three of us. 281 00:19:08,544 --> 00:19:13,235 Well, there's like maybe three senior nurses and the majority of 282 00:19:13,235 --> 00:19:18,344 the shift is new, you know, and so, you know, that's sort of a struggle. 283 00:19:18,365 --> 00:19:24,134 But if you focus, if you don't focus at all on what's going well or where the 284 00:19:24,134 --> 00:19:28,544 opportunities are, and you're always focused on what's not going well. 285 00:19:29,210 --> 00:19:33,950 Um, I think you, you kind of just kind of continue down that road, 286 00:19:33,960 --> 00:19:38,870 but we don't really, we haven't in the past really given people 287 00:19:38,890 --> 00:19:42,549 the tools to change that focus. 288 00:19:43,710 --> 00:19:46,540 Um, you know, and when I do. 289 00:19:47,570 --> 00:19:48,550 NVC. 290 00:19:48,570 --> 00:19:50,649 At first, the student's like, Oh, this is easy. 291 00:19:51,189 --> 00:19:56,489 And when they actually try to do it, and they, and I'm actually having them discern 292 00:19:56,489 --> 00:20:00,049 the difference between joy and happiness, like they're not the same feeling. 293 00:20:00,400 --> 00:20:02,029 And they were like, well, what difference does it make? 294 00:20:02,909 --> 00:20:07,639 Because when you look at the other side of it and you're looking at anger, it's 295 00:20:07,639 --> 00:20:11,660 not, you're not angry, you're frustrated or you're, and so when you're looking 296 00:20:11,660 --> 00:20:17,350 at what you need to do to Resolve that need, figuring out that difference 297 00:20:17,350 --> 00:20:20,760 between, you know, anger and frustration, even though it might feel the same 298 00:20:20,760 --> 00:20:23,659 initially, it becomes really important. 299 00:20:23,719 --> 00:20:28,249 And I think they kind of get it the more, the more we go through the semester. 300 00:20:28,249 --> 00:20:30,929 And some of them have started to use it in their preceptorship, 301 00:20:32,169 --> 00:20:36,850 but it's, um, it is something that looks easy, but does take practice. 302 00:20:37,420 --> 00:20:42,250 For those of us who don't know what NVC is, um, could you tell us a little 303 00:20:42,250 --> 00:20:47,955 bit more so that we can Yeah, it's a pretty old, um, is Marshall Rosenberg. 304 00:20:47,955 --> 00:20:49,315 I might get his name wrong. 305 00:20:49,785 --> 00:20:56,264 Um, uh, it's been used, you know, it's used a lot in Waldorf schools for kids. 306 00:20:57,164 --> 00:20:58,964 It's a really useful technique. 307 00:21:00,430 --> 00:21:03,830 For that, uh, but it's also used in counseling. 308 00:21:03,830 --> 00:21:08,010 It's used in war-torn countries when you're, they've used it when negotiators 309 00:21:08,010 --> 00:21:12,450 go in and they'll use NVC, um, in different camps where they bring kids 310 00:21:12,479 --> 00:21:15,649 from different, um, countries together. 311 00:21:15,649 --> 00:21:20,530 They've used NVC, but essentially, um, the elements are essentially there's 312 00:21:21,150 --> 00:21:25,380 everyone has universal needs, no matter where you're from, no matter what culture. 313 00:21:26,100 --> 00:21:26,480 And. 314 00:21:27,455 --> 00:21:32,865 If you can identify or match up your feelings with your needs, so you 315 00:21:32,865 --> 00:21:35,235 have feelings when your needs are met and feelings when your needs 316 00:21:35,235 --> 00:21:41,365 are unmet and just making that connection, um, and not judging 317 00:21:41,375 --> 00:21:43,214 anybody for causing those feelings. 318 00:21:43,214 --> 00:21:45,645 Like, they're your feelings, right? 319 00:21:46,454 --> 00:21:48,585 And then the 2nd part of that is to make. 320 00:21:48,850 --> 00:21:49,689 Requests. 321 00:21:49,810 --> 00:21:52,929 So you know, you have a feeling and a need that's matter 322 00:21:52,929 --> 00:21:54,370 unmet, and you make a request. 323 00:21:55,430 --> 00:21:57,790 But that request is a request. 324 00:21:57,790 --> 00:21:58,689 It's not a demand. 325 00:21:59,260 --> 00:22:05,020 So you have to also be open to, well, no, , it's the answer to your request, which is 326 00:22:05,025 --> 00:22:06,340 a little tricky in the healthcare setting. 327 00:22:06,340 --> 00:22:09,350 So we talk about that because you, there are situations 328 00:22:09,350 --> 00:22:10,460 where we can't say no, right? 329 00:22:12,290 --> 00:22:12,439 . Yeah. 330 00:22:12,499 --> 00:22:14,170 Um, and then. 331 00:22:14,710 --> 00:22:17,930 And the, but the appreciation piece I think is even more important that you're, 332 00:22:18,430 --> 00:22:23,450 when you're showing appreciation using the model, you're saying specifically 333 00:22:23,740 --> 00:22:25,310 your feeling and your met need. 334 00:22:25,320 --> 00:22:28,479 So the person who you're giving that appreciation to is also getting really 335 00:22:28,480 --> 00:22:35,070 specific feedback about what it was specifically that they did to, um, you 336 00:22:35,200 --> 00:22:37,000 know, for you to show this appreciation. 337 00:22:38,139 --> 00:22:42,159 You know, cause oftentimes when we get thanks or we don't really know 338 00:22:42,159 --> 00:22:43,909 what it was exactly that we did. 339 00:22:44,310 --> 00:22:48,360 And so if you're going to continue that behavior showing that really specific, 340 00:22:48,610 --> 00:22:55,260 you know, I felt this way and when, uh, you met this need, um, I did. 341 00:22:55,270 --> 00:22:58,860 Hopefully that person will continue, um, to do that 342 00:22:58,890 --> 00:23:00,739 specific behavior on the future. 343 00:23:01,939 --> 00:23:06,370 Uh, when, when that's not communicated, particularly when it's an unmet 344 00:23:06,400 --> 00:23:10,590 need, you know, they really don't know what they're doing over time 345 00:23:11,510 --> 00:23:12,830 and that never gets resolved. 346 00:23:13,325 --> 00:23:22,235 But this idea of just, you know, in our, in sort of the modern American, 347 00:23:22,725 --> 00:23:31,195 you know, families today, this idea of being able to just identify one's 348 00:23:31,205 --> 00:23:38,394 feelings is, um, is not a, is not a skill that we can take for granted. 349 00:23:39,404 --> 00:23:49,715 In fact, um, that's probably, uh, why there is such a huge, um, Huge industry 350 00:23:49,725 --> 00:23:53,365 in, uh, in therapy today, right? 351 00:23:53,705 --> 00:24:01,165 We are not able to either identify or process these feelings and acts in, 352 00:24:01,625 --> 00:24:11,914 acts to, to, um, to address, you know, feelings of, you know, hurts or, um, anger 353 00:24:12,014 --> 00:24:17,504 and, you know, especially the negative feelings, but also the positive ones. 354 00:24:18,364 --> 00:24:20,699 It's a really fun, um, game. 355 00:24:20,729 --> 00:24:23,570 I started using this game with my kids, but I use it with the students. 356 00:24:23,840 --> 00:24:26,190 You know, we had one face to face. 357 00:24:26,310 --> 00:24:30,010 Most of my classes are asynchronous online, but um, we had one, a 358 00:24:30,010 --> 00:24:34,220 few face to face sessions and the students kept wanting to play Grok. 359 00:24:34,220 --> 00:24:36,789 And Grok is sort of this, just a card game. 360 00:24:36,909 --> 00:24:39,710 It has a stack of feelings cards and a stack of needs cards. 361 00:24:39,710 --> 00:24:44,200 There's all these sort of games you can go through, um, using the cards. 362 00:24:45,660 --> 00:24:49,304 But you know, I start, then they wanted to play Play Grok over 363 00:24:49,304 --> 00:24:54,985 and over because it's just a very concrete way to, to use the model. 364 00:24:55,635 --> 00:24:58,825 But I remember when I was, I used to use it with my daughter when she was younger. 365 00:24:58,825 --> 00:25:02,634 I remember one day she came home and she was really young, you know, not, um, she 366 00:25:02,634 --> 00:25:08,485 might have been maybe seven or six and a half or something, but, and she was really 367 00:25:08,485 --> 00:25:14,720 upset with her dad and she said, Mama I need to Grock and she came and she got 368 00:25:14,720 --> 00:25:18,830 the cards and she went, she went over to him and she says, you know, she lays down 369 00:25:18,830 --> 00:25:20,570 her feelings cards and her needs cards. 370 00:25:20,970 --> 00:25:25,610 And so it's a really, um, with younger kids in particular, it's really, um, they 371 00:25:25,610 --> 00:25:30,239 get it, you know, they just naturally know how to use it, you know, as they get 372 00:25:30,240 --> 00:25:32,789 older, they kind of roll their eyes and they're like, you're doing that thing. 373 00:25:34,235 --> 00:25:35,055 So just stop. 374 00:25:35,395 --> 00:25:38,095 Well, they probably have internalized those skills now, right? 375 00:25:38,095 --> 00:25:39,424 Yeah. 376 00:25:39,425 --> 00:25:41,705 But the college students, for many, it's new. 377 00:25:41,735 --> 00:25:45,875 Like they, they've learned a different way, um, you know, by 378 00:25:45,875 --> 00:25:50,285 saying I feel, but you can start a sentence with I feel, and it's still 379 00:25:50,324 --> 00:25:53,334 sort of aggressive language, right? 380 00:25:53,604 --> 00:25:57,825 Cause I, I feel if that's followed by, you know, blaming someone else, 381 00:25:57,845 --> 00:26:02,634 as opposed to, you know, the NVC, you don't, it's, you're not interpreting 382 00:26:02,634 --> 00:26:04,154 your feelings to anybody else. 383 00:26:06,495 --> 00:26:10,854 Anyway, I've probably gone on about NVC a bit too long, but, um, No, it's 384 00:26:10,854 --> 00:26:15,275 not because I, here's what I, um, I wanted to just say how important 385 00:26:15,645 --> 00:26:26,525 some, this discussion I think is, I think that there are lots of, um, you 386 00:26:26,525 --> 00:26:28,454 know, I, I, I'm a deep believer that. 387 00:26:29,399 --> 00:26:33,760 When we have many different perspectives at looking at the world, we get 388 00:26:33,780 --> 00:26:35,399 better at looking at the world. 389 00:26:36,060 --> 00:26:36,220 And 390 00:26:37,659 --> 00:26:44,340 Um, you know, there are educators, education psychologists, there's, 391 00:26:44,370 --> 00:26:47,360 you know, researchers in all different kind of fields. 392 00:26:47,639 --> 00:26:51,520 I've had many of these conversations, you know, some of them healthcare, some of 393 00:26:51,520 --> 00:26:58,919 them in STEM, you know, they all bring, um, different perspectives on how they 394 00:26:58,929 --> 00:27:00,779 think about reflection, for example. 395 00:27:01,449 --> 00:27:04,479 There are some things that tie us all together, like reflection, sometimes it's 396 00:27:04,479 --> 00:27:06,469 storytelling, you know, stuff like that. 397 00:27:06,760 --> 00:27:07,699 I think it's really cool. 398 00:27:07,929 --> 00:27:09,679 But I think that what you have to do. 399 00:27:09,899 --> 00:27:17,370 brought is a really fresh perspective, um, that in many ways, I think it 400 00:27:17,739 --> 00:27:24,070 perhaps is one of the, the more sophisticated way of thinking about 401 00:27:24,489 --> 00:27:30,344 reflection in a very, it doesn't just have this or around reflection. 402 00:27:30,424 --> 00:27:36,504 There are literally steps that we can take that can genuinely get 403 00:27:38,095 --> 00:27:42,655 those feelings processed, get those and then experience and really 404 00:27:42,655 --> 00:27:44,774 reflect and get to the significance. 405 00:27:45,524 --> 00:27:50,115 And I think that there's something really significant about this because there are 406 00:27:50,174 --> 00:27:56,315 so many people, scholars, practitioners, have tried for many years to try to 407 00:27:56,325 --> 00:27:58,539 say You know, we want to reflect. 408 00:27:58,649 --> 00:28:06,840 One of the things that I have found that is, um, that doesn't work is people think 409 00:28:06,969 --> 00:28:10,229 that, what's your reflection prompt? 410 00:28:10,480 --> 00:28:14,120 Because as if that's just silver bullet that I can just say, if you 411 00:28:14,149 --> 00:28:19,860 ask student this prompt, they will suddenly, they will solve everything. 412 00:28:20,320 --> 00:28:25,490 You know, that would have been like saying to a therapist that, 413 00:28:25,920 --> 00:28:27,320 what do you ask your clients? 414 00:28:27,980 --> 00:28:30,390 Well, I just asked him this one thing and then everything is done. 415 00:28:30,440 --> 00:28:31,790 It's not like that, right? 416 00:28:32,030 --> 00:28:36,300 There's a lot of depth into layers of processing stuff. 417 00:28:37,130 --> 00:28:44,530 And you are, in fact, describing a number of those layers in the 418 00:28:44,530 --> 00:28:48,480 scenarios, um, in very concrete terms. 419 00:28:48,490 --> 00:28:49,259 So I love that. 420 00:28:49,259 --> 00:28:50,720 I think that's really wonderful. 421 00:28:50,730 --> 00:28:56,479 I think that that's an area, you know, I'll probably tap you for this, um, 422 00:28:56,480 --> 00:29:00,495 you know, If you don't mind, I'll probably be like, Sharyl, you know, 423 00:29:00,495 --> 00:29:01,665 that thing that we talked about? 424 00:29:01,735 --> 00:29:05,634 Can we, do you think that we can like, you know, like, can you publish this? 425 00:29:05,644 --> 00:29:06,714 Can you like write about it? 426 00:29:06,715 --> 00:29:07,854 Can you explain it? 427 00:29:08,094 --> 00:29:13,665 Because I, I really think that, um, a lot of people struggle with it because we, 428 00:29:14,110 --> 00:29:19,340 Sort of almost inherently, instinctively, maybe we have experienced it, you know, 429 00:29:19,370 --> 00:29:21,750 but anecdotally, reflection is good. 430 00:29:21,760 --> 00:29:25,220 It's the, it's the gem, it's the spark that we get. 431 00:29:25,739 --> 00:29:29,089 And we want our students to have that, but we don't know how to get them to have it. 432 00:29:29,780 --> 00:29:30,180 Yeah. 433 00:29:30,180 --> 00:29:34,550 When you say the prompts, it makes me think of every reflection I've 434 00:29:34,550 --> 00:29:36,210 ever been asked to do as a student. 435 00:29:36,220 --> 00:29:37,370 There's always these prompts. 436 00:29:37,370 --> 00:29:39,939 I was like, well, that's not where my mind's going. 437 00:29:39,949 --> 00:29:41,489 Like, thanks. 438 00:29:42,209 --> 00:29:46,595 And I've, I've always sort of, bend more toward open-ended, but then 439 00:29:46,595 --> 00:29:50,425 sometimes I could see on the educator side where you sometimes get back. 440 00:29:51,015 --> 00:29:52,335 There's no emotion. 441 00:29:52,335 --> 00:29:55,115 I sit, you know, I tell the students I need to feel something. 442 00:29:55,125 --> 00:29:56,635 It doesn't have to be a good feeling. 443 00:29:56,635 --> 00:30:02,125 But if you've reflected, I should have some feeling should be in this reflection. 444 00:30:03,820 --> 00:30:08,450 And something from you, like I was talking to a student the other day and I said, 445 00:30:08,450 --> 00:30:10,500 well, somebody had described this to me. 446 00:30:10,500 --> 00:30:15,330 This isn't my language, but I think it was an advisor back at BC a long time ago. 447 00:30:15,670 --> 00:30:17,680 She was like, I want to know what's in your box. 448 00:30:17,810 --> 00:30:21,800 Like so many people tell you what your box should look like, but I want to 449 00:30:21,800 --> 00:30:23,620 know what Sharyl's box looks like. 450 00:30:24,150 --> 00:30:26,620 I was like, I'm not so sure you want to know what my box looks like, but, 451 00:30:26,960 --> 00:30:32,600 but it, that I sort of took that with me in my, You know, as a teacher that I 452 00:30:32,600 --> 00:30:38,100 didn't want to always just have students repeating what I think is what my box is. 453 00:30:38,110 --> 00:30:42,930 I actually do want to know, you know, what, what's unique about, about 454 00:30:42,940 --> 00:30:48,010 their experience and their knowledge related to whatever the topic is. 455 00:30:48,030 --> 00:30:51,900 So, in the Capstone course, the nursing Capstone course, we do, um. 456 00:30:52,925 --> 00:30:56,275 They demonstrate the baccalaureate essentials for the nurse, so there's 10. 457 00:30:56,755 --> 00:31:02,065 And for this, we use a lot of reflection and we're using um, ePortfolio for that. 458 00:31:02,625 --> 00:31:07,715 And it does take a bit to get them going because their initial response 459 00:31:07,715 --> 00:31:11,905 is to just define the essential or just, When this assignment I did 460 00:31:11,905 --> 00:31:13,505 this, or this assignment I did this. 461 00:31:13,505 --> 00:31:18,005 I say, I'm not, the assignment is just, you know, like a 462 00:31:18,005 --> 00:31:19,095 piece of pottery you made. 463 00:31:19,095 --> 00:31:19,535 If you're. 464 00:31:19,735 --> 00:31:22,065 You know, Potter, like this is the one you like. 465 00:31:22,355 --> 00:31:26,255 So, you know, you're using it as your evidence or an example of where you did 466 00:31:26,255 --> 00:31:29,445 this thing, but the reflection should really be about the full essential. 467 00:31:30,135 --> 00:31:36,625 And, you know, how did you think about nursing knowledge as a, new student and 468 00:31:36,625 --> 00:31:41,695 how did that change in your experiences over the time you've been here or the 469 00:31:41,695 --> 00:31:48,295 experiences that you've had and then they start to, they don't, it's not intuitive. 470 00:31:48,295 --> 00:31:49,785 I don't think they get it right away. 471 00:31:49,825 --> 00:31:52,585 So there's kind of, there's a lot of back and forth prompting. 472 00:31:52,955 --> 00:31:56,885 But eventually they really create, they start with their autobiographic 473 00:31:56,935 --> 00:32:00,435 sketch, which are very unique. 474 00:32:00,765 --> 00:32:03,325 We have the most unique students, I think, in Alaska. 475 00:32:04,225 --> 00:32:08,985 Just come from like, some are from rural villages, some are like military families, 476 00:32:08,995 --> 00:32:13,165 some are like hardy Alaskans that have, you know, been here for generations. 477 00:32:13,475 --> 00:32:17,325 And many are just from everywhere because it's sort of a melting pot, right? 478 00:32:18,175 --> 00:32:20,025 And so you have these really unique autobiographical. 479 00:32:20,255 --> 00:32:23,785 Graphic sketches of where they've come from and how they ended up in 480 00:32:23,785 --> 00:32:29,195 nursing and then somehow they all sort of relate to their narrative 481 00:32:29,225 --> 00:32:32,515 that's specific to each essential and how they've, how they've met it. 482 00:32:33,495 --> 00:32:37,525 It's a pretty, it's a pretty big project and it is 1 of those 1s when you say, how 483 00:32:37,525 --> 00:32:39,885 do you get students to reflect initially? 484 00:32:39,885 --> 00:32:43,695 They're just, you know, they want. 485 00:32:44,175 --> 00:32:48,045 The prompts . But if I gave, well, we're also looking for the answer. 486 00:32:48,045 --> 00:32:48,930 What's the right answer? 487 00:32:49,100 --> 00:32:49,450 Right. 488 00:32:49,460 --> 00:32:49,810 Right. 489 00:32:50,325 --> 00:32:52,905 And if you do that too much, they'll all look the same. 490 00:32:53,485 --> 00:32:53,635 Yeah. 491 00:32:53,635 --> 00:32:56,285 And then, and then it does become busy work. 492 00:32:56,285 --> 00:32:57,575 And I don't want it to be busy work. 493 00:32:57,575 --> 00:33:01,445 I want, it might be idealistic, but I want them changed from it. 494 00:33:01,475 --> 00:33:01,685 You know? 495 00:33:01,685 --> 00:33:05,825 I want, here's the preview of what's coming up next. 496 00:33:05,825 --> 00:33:09,455 In part two of my conversation with Sharyl Toscano, professor 497 00:33:09,455 --> 00:33:12,605 at the School of Nursing at University of Alaska, Anchorage.