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I work as an informal clinical teacher in the emergency department (ED). My philosophy of teaching and learning is largely shaped by my experience in that role and the environment in which I work. As a clinical expert and leader in the emergency department my philosophy is built around the idea that a chain is only as strong as its weakest link. If we wish to provide excellent, evidenced based and compassionate care within the often chaotic and time limited environment of ED, every member of our nursing team must be supported. As a novice teacher my philosophy of teaching and learning is a work in progress and explores how I view the role of the learner, my beliefs about teaching and the goals I have for students.


Reflection on my experience has demonstrated that the process of learning is heavily influence by the learner’s previous experience and an awareness of the physical and emotional environment in which the learner is immersed. Learners bring with them their own personal experience and expertise. Demonstrating to learners that their previous experience is valued is an important component of building trust with the learner in order to facilitate learning. Acknowledging the value of their experience helps to build trust and the foundations of a relationship on which learning can occur. Take for example a nurse with ten years of pediatric care experience coming to work in the ED. When I introduce them to the staff in the department, I emphasize their previous expert experience in pediatrics and how it is of value to our team. This acknowledges to the nurse that I value their experience and demonstrates respect.


Having an awareness of the learning environment is another key concept in how I view learning. The environment heavily influences a learner’s readiness and ability to successfully receive and process information. Working in the often high-pressure, high emotion and time limited ED environment many potential learning opportunities can occur, but learners can be negatively affected by these environmental stressors making it difficult to actively participate in the learning process. An example in my daily practice is when a nurse identifies a knowledge gap in their practice during a patient resuscitation. Ensuring that the nurse has time to emotionally debrief, ensuring they have had time for self reflection and a nourishment break before discussing their learning needs are essential in helping learners have a positive learning experience and be prepared to actively participate in the learning process.


My principles of teaching are heavily influenced by my experience as an expert clinical nurse the emergency department. I teach because I believe that empowering and educating other nurses improves their clinical skill, our teams working environment and ultimately provides the best possible care to our patients. As an expert clinical nurse, teaching involves the sharing of my expertise through reflecting on my own experience and identifying how I can best translate this knowledge or skill to the learner. I believe that teaching is a process that I “do with” my peers as learners. Acknowledging to students that I don’t have all the answers and demonstrating to them the process that can be used to critically think through situations, identify resources and find solutions is a key method in my teaching philosophy. This use of role-modeling learning behaviours demonstrates to students my passion for learning, fosters trusts and helps to build positive relationships between myself as a teacher and the learners I work with.


As a novice teacher one of the most important lessons I have learned is the importance of being perceptive to a student’s emotions. Once after a critical incident in our trauma room, I spent a great deal of team working through the case with a new nurse who had struggled throughout the event. I thought I had used excellent teaching methods in asking what they wanted to review, using different resources to address learning needs the nurse identified and working through the patient case from the basic pathophysiology, to process and possible outcomes. The next day my clinical educator reviewed with me that the nurse had felt overwhelmed and my attempts to facilitate learning had actually created more distress for the nurse involved. She emphasized with me the importance of developing my own emotional intelligence and being perceptive to the implicit feedback and cues from learns as to their readiness to learn. As a teacher we are often viewed as an authority figure, and learners may not feel comfortable in explicitly stating that they are unprepared to learn. It is therefore important for teachers to observe for non verbal cues and be perceptive the needs and emotions of learners and adapt our teaching approach based on these cues. Developing my own emotional intelligence is an important element to my personal philosophy of teaching and learning.


As a teacher in the clinical setting the ultimate goal of my teaching is in the building of nurses’ self efficacy over time. Observing nurses become more confident and independent in their practice while providing high quality care to our patients as they journey from novice to expert practitioners demonstrates to me the impact I have has as a teacher. As a teacher my success is measured in my contribution to building a knowledgeable and effective team of nurses who can provide high quality care in the emergency department.


My philosophy of teaching and learning acknowledges the value of learner’s previous experience and identifies the importance of building learning environment in which students feel safe. I consider teaching to be an interactive process I “do with” the learner that is directed by implicit and explicit feedback received from students and that the effectiveness of teaching is measured in the building of self efficacy among learners. Nursing in the emergency department requires a wide range of knowledge and skills and the ability to function within a dynamic interdisciplinary team. As a team we are only as strong as our weakest link and my role as a teacher in this complex learning environment is to facilitate learning among all team members.

The emergency department (ED) is a fast paced, unpredictable, high-pressure critical care nursing environment. Providing the best possible care to patients relies on dynamic, high performance teams of healthcare staff. Leadership in the ED has a well documented influence on the building of teams, improved patient outcomes and enhanced job satisfaction (Boamah, et al, 2018; Sarcevic. 2011). I believe that the development of a leadership philosophy is important in my role as a leader in the ED in order to empower me to inspire and motivate my team so we can continually adapt to the unpredictable nature of the ED. A leadership philosophy is a personal system of principles specifically chosen to guide decisions which provides improved self confidence and can improve effectiveness as a leader (Calvert, 2017).


My personal leadership philosophy views leadership as a continuous repeating cycle of engagement, effective communication and self reflection. This paper will explain three principles of my philosophy of leadership through the description of each principle, support for each principle in current literature and its application in practice.


The first principle of my leadership philosophy is the importance of engaging followers. Engagement is a key assumption of andragogy as adult learners must be involved in planning, ready to learn and internally motivated (Kaufman, 2003); thus, ensuring an individual’s engagement is essential in order to be an effective leader in my role. Adult learners need to be informed of why learning is important to them personally (McCauley, Hammer & Hinojosa, 2017) therefore engaging followers and helping them to develop intrinsically motivated reasons to follow is the core principle of my leadership philosophy. I use this principle daily in my leadership practice. Simple tasks such as asking a nurse to take on an extra patient in their assignment are better supported by staff when they understand why they are being asked to extend their workload. In larger projects such as changes to patient flow models in the department identifying to team members the benefits to their own practice and rational for the changes help to engage team members in becoming motivated. Employees who are engaged are demonstrated to be more productive, more efficient and enjoy work more (Engelbrecht, Heine & Mahembe, 2017) demonstrating the importance of engagement in my leadership philosophy.


The second principle of my leadership philosophy is effective communication. Communication is a process where individuals create and use information to relate to one another and their environment using both verbal and nonverbal methods (Ruben & Gigliotti, 2016). As leaders and followers communicate over time a relationship is built on the interpretations and messages sent and received creating a foundation for communication in the future (Ruben & Gigliotti, 2016). This highlights the importance of communication in my leadership philosophy, as the relationship that I build with my team when I communicate will be the basis for future communications. I believe in the importance of role modeling effective communication skills with my team which means that developing my own skill as a communicator including a situational awareness of communication methods is an essential tool in my leadership. Some examples include; closed loop direct communication and making eye contact with team members in resuscitation (Mo et al, 2019), identifying and preparing for challenging conversations (Patterson, Grenny, McMillan & Switzler, 2012), and encouraging critical thinking and inquiry through the open-end questions (Van Quaquebeke & Felps, 2018). Effective communication is a key trait of good leaders (DuBois et al, 2015) and an important concept in my leadership philosophy.


The final principle in my leadership philosophy is reflection. A simple definition of reflection by Boud, Keogh & Walker 1985 (cited in Ette, 2017) describes reflection as “an important human activity in which people recapture their experience, think about it, mull over & evaluate it.’ (p.19). Reflection in nursing practice is a required element in order to maintain professional registration and identify areas for professional growth (College of Nurses of Ontario, 2019). Practicing self reflection not only allows me to build my individual competencies as a nurse, but further enhances my leadership abilities. Reflective practice aides in the development of emotionally capable nurse leaders (Horton-Deutsh & Sherwood, 2008). Being a reflective leader means that leaders can be flexible, reflect and adapt to a situation and apply the different leadership traits needed for different situations (Reardon, Fite, Boone & Sullivan, 2019). Through reflection I am a more contextually aware leader; knowing that leadership behaviours must be adapted to the situational factors (Oc, 2018). This is necessary working in the emergency department due to the dynamic leadership environment which requires frequent adaptation in order to meet the needs of patient, families and team members. The concept of self reflection also encourages me to evaluate how I have engaged and communicated with staff, creating the continuous cycle of engagement, communication and self reflection that is my leadership philosophy.


My personal leadership philosophy views leadership as a continuous repeating cycle of engagement, effective communication and self reflection. Engaging team members builds on the principles of andragogy and encourages motivation so that team members want to follow, creating more effective teams. Role modeling appropriate communication methods not only ensures messages are received, but encourages the development of team members. Practicing self reflection develops nursing skill, builds situational awareness and ensures I evaluate my own efficiency as a leader. In understanding and evaluating my leadership philosophy I am empowering myself to lead through an understating of my core principles.


References


Boamah, S. A., Laschinger, H. K., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing Outlook, 66(2), 180- 189. Retrieved from https://0-www-sciencedirect- com.aupac.lib.athabascau.ca/science/article/pii/S0029655417302749


D Calvert. (2017, January 5). To Lead, You Need a Personal Leadership Philosophy. It’s Not Optional Any More [Web log post]. Retrieved from https://medium.com/@PeopleFirstPS/to-lead-you-need-a-personal-leadership- philosophy-its-not-optional-any-more-9369e008eec7


College of Nurses of Ontario. (2019). Self Assessment. Retrieved from http://www.cno.org/en/myqa/self-assessment/


DuBois, M., Hanlon, J., Koch, J., Nyatuga, B., & Kerr, N., (2015). Leadership Styles of Effective Project Managers: Techniques and Traits to Lead High Performance Teams. Journal of Economic Development, Management, IT, Finance and Marketing, 7(1), 30- 46. Retrieved from http://prosandconrads.com/files/4.pdf


Engelbrecht, A. S., Heine, G. & Mahembe, B. (2017). Integrity, ethical leadership, trust and work engagement. Leadership & Organization Development Journal, 38(3), 368-397. Retrieved from http://repository.uwc.ac.za/xmlui/bitstream/handle/10566

/4069/Engelbrecht_Integrity-ethical- leadership_2017.pdf?sequence=1&isAllowed=y


Ette, L. (2017, January 30). The power of reflection in nursing [Web log post]. Retrieved from https://blogs.bmj.com/ebn/2017/01/30/the-power-of-reflection-in-nursing/

Horton-Deutsh, S. & Sherwood, G. (2008). Reflection: an educational strategy to develop emotionally‐competent nurse leaders. Journal of Nursing Management, 16, 946-954. doi:10.1111/j.1365-2834.2008.00957.x


Kaufman D. M. (2003). Applying educational theory in practice. BMJ (Clinical research ed.), 326(7382), 213–216. Doi:10.1136/bmj.326.7382.213


McCauley, K. D., Hammer, E., & Hinojosa, A. S. (2017). An Andragogical Approach to Teaching Leadership. Management Teaching Review, 2(4), 312–324. https://doi.org/10.1177/2379298117736885


Mo, D., O'Hara, N. N., Hengel, R., Cheong, A. R., & Singhal A. (2019). The Preferred Attributes of a Trauma Team Leader: Evidence from a discrete choice experiment. Journal of Surgical Education, 76(1), 120-126. https://doi.org/10.1016/j.jsurg.2018.06.021


Oc, B. (2018). Contextual leadership: A systematic review of how contextual factors shape leadership and its outcomes. The Leadership Quarterly, 29(1). Retrieved from https://0- www-sciencedirect-com.aupac.lib.athabascau.ca/science/article/pii/

S1048984317300413?


Patterson, K., Grenny, J, McMillan, R, & Switzler, A. (2012). Crucial Conversation: Tools for Talking When Stakes are High (Second Ed.). McGraw Hill: New York.


Ruben, B. D. & Gigliotti, R. A. (2016). Leadership as Social Influence: An expanded view of leadership communication theory and practice. Journal of Leadership and Organizational Studies, 23(4), 467-479. Doi: 10.1177/1548051816641876


Sarcevic, A., Marsic, I., Waterhouse, L. J., Stockwell, D. C., & Burd, R. S. (2011). Leadership structures in emergency care settings: A study of two trauma centers. International Journal of Medical Informatics, 80(4), 227-238. Doi: 10.1016/j.ijmedinf.2011.01.004


Van Quaquebeke, N., & Felps, W. (2018). Respectful Inquiry: A Motivational Account of Leading through Asking Questions and Listening. Academy of Management Review, 43(1), 5–27. https://0-doi-org.aupac.lib.athabascau.ca/10.5465/amr.2014.0537


I'm currently working my way through another course. This course focuses on issues and trends in healthcare and developing skills in academic argument. This course is straining my ability to balance home, work and academic life, but soldiering through and enjoying the subject, if not the format of the course.


Here's a little paper discussing issues and trends. As usual, a focus on ED nursing and an example of the issues we see in the ED.


How Healthcare Trends Impact Current Issues – Canada’s Aging Population and

Emergency Department Overcrowding


To appreciate the impact healthcare trends have on current issues it is necessary to understand the meaning of the term trend and issue. The relationship between a tend and an issue can be demonstrated through trend of Canadas aging population and its connection to the current issue of emergency department (ED) overcrowding.


A trend is defined by Merriam-Webster Dictionary as “the general movement over time of a statistically detectable change” (n.d.). Being able to define a trend therefore requires proof of an event that has been recorded throughout a period of time. Although evidence of past trends may be used to hypothesise future events, the proof of a trend is historical in nature. An issue is a “vital or unsettled matter” (n.d., Merriam-Webster). Where a trend predicts the future by using historical information to infer future outcomes, issues present a current matter that needs to be further researched or debated in order to anticipate its impact.


The current healthcare trend of Canadas aging population is demonstrated through evidence gathered by Statistics Canada. The percentage of the population over the age of 65 is currently 16.9% of the total population (Statistics Canada, 2017) a trend that has been steadily increasing over the last 40 years and is projected to reach 20% of the total population by 2080 (Government of Canada, 2014). Thus, the aging of Canadas population is a statistically significant trend that is proven through data recorded over time.


Emergency department overcrowding can be considered an issue due to an increasing number of visits and patients spending longer in the ED (Canadian Institute for Health Information, 2017). The vital importance of this issue is highlighted in the negative effects ED overcrowding has on patient care including poor patient outcomes, treatment delays, decreased patient satisfaction and increased cost (Hoot & Aronsky, 2008). Debate occurs due to multiple causes of overcrowding including; lack of acute care beds, lack of alternative level of care (ALC), staffing shortages (Affleck, Parks, Drummond, Rowe, & Ovens, 2013), increasing number of visits (CIHI, 2017) and an increase in the number of Canadian seniors (Health Quality Ontario, 2016; Morley et al, 2018). Evidence overcrowding exists and the debate surrounding potential solutions to better serve patients is what makes ED overcrowding a current issue in healthcare.


The relationship between trends and issues is important as the statistical significance of a trend over time can be evidence for debate on current issues. The statistical trend of an aging population (Statistics Canada, 2017) demonstrates the increased demand being placed on Canada’s emergency departments (CIHI, 2017; Health Quality Ontario, 2016; Morley et al, 2018), potentially worsening the current issue of overcrowding which although multifactorial in nature will be directly affected by an aging population. Awareness of how significant healthcare trends are affecting current healthcare issues should incite policy makers and leaders in healthcare to seek solutions to todays issues before they develop into the trends of tomorrow.


References


Canadian Institute for Health Information. (2017). Emergency Department wait times in Canada continue to rise. Retrieved from https://www.cihi.ca/en/emergency-department-wait- times-in-canada-continuing-to-rise


Government of Canada. (2014). Action for Seniors Report. Retrieved from https://www.canada.ca/en/employment-social-development/programs/seniors-action- report.html


Health Quality Ontario. (2016). Under Pressure: Emergency department performance in Ontario. Retrieved from https://www.hqontario.ca/portals/0/Documents/system- performance/under-pressure-report-en.pdf


Hoot, N. & Aronsky, D. (2008). Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions. Annals of Emergency Medicine, 52(2), 126 - 136. Retrieved from https://www.annemergmed.com/article/S0196-0644(08)00606-9/fulltext

Issue. (n.d.). In Merriam-Webster’s online dictionary. Retrieved from https://www.merriam- webster.com/dictionary/issue


Morley, C., Unwin, M., Peterson, G.M., Stankovich, J., and Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS ONE. 13(8):1-42. doi:10.1371/journal.pone.0203316.


Statistics Canada. (2017). Analysis: Population by Age and Sex, Catalogue no. 91-215-X. Retrieved from https://www150.statcan.gc.ca/n1/pub/91-215-x/2017000/sec2-eng.htm


Trend. (n.d.). In Merriam-Webster’s online dictionary. Retrieved from https://www.merriam- webster.com/dictionary/trend

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