The Problem with Distance Education

Can you guess what possibly impacts distance learning more than anything else? 

Here are some hints:

Can I help you with anything? 

Show me what you are struggling with . . .

Let me demonstrate how these devices complement the patient’s needs.

As a team, the four of us could work together and make discoveries!

Did you guess it? That's right, the IRL dilemma.           

Introduction

Lack of real-life contact plagues potential outcomes of distance learning (DL). Students are not able to access needed resources otherwise available physically at colleges, universities, and hospitals. Additionally, technology, administration, and instructional methods can inhibit learning (Valentine, 2002). Educators likewise are confined to a silicon screen and keyboard less than two feet from their faces. These factors may seem a bit fundamental. Yet, it is these fundamentals that articulate many of the limitations found in DL. For this post, distance education or DL is defined by online teaching and learning. There are other forms of DL (Nasseh, 1997) but today’s distant learning processes are corrugated and weaved through mediums such as notebook computers, iPads, and smartphones.

As a nurse working at my hospital, I function as an interdisciplinary trainer, a nurse-mentor, and an observer of work performance/competencies. Our nurses are confronted daily with a barrage of challenges: changes in policy, documentation requirements, and the slow grinding transition to a statewide electronic medical record. These complexities however important (and they are important) plague the quality and quantity of work nurses perform. Did you notice I did not even mention issues of direct treatment with our patients? That is another subject for another blog. This post is going to focus on the challenges distance learning faces as students and teachers strive to overcome deficits produced by the lack of face-to-face contact in the DL education setting. 

In my opinion, DL is vastly undervalued, especially considering its potential when all the shortcomings have been identified, elucidated, and addressed. Only recently we have faced a nursing shortage that is projected to widen over the next twenty years as the healthcare needs of an aging and growing population expands its wings (AACN, 2012). How do we solve this problem? That is yet to be determined. It is clear however that DL is one component in the equation (ECU, 2012). The educator, student, community, and teaching facilities will all have to adapt to the fluid needs of information exchange and skills development in this off-campus environment. One example demonstrates that teleconferences effectively help post-graduate nurses problem-solve in focus groups (MacIntosh, 2008). Teleconferencing also helps improve communication between the learner and educator as context, inflection, and body language illuminate the process (Adegbola, 2011).

As we learn from our successes and failures, quality of education improves (Jones, 2008). We become more flexible, adaptable, as we grow and enable others. One thing I have learned over the years: The only thing that doesn't change is change itself. One thing we may not realize is the efficacy of DL even in the face of its deficits. Online educated students perform better than those receiving face-to-face instruction (Chaney, Chaney & Eddy, 2010). If we can identify the indicators that denote quality education online as well as those found in face-to-face instruction, we can shape a DL experience that can simulate the benefits of a hybrid learning experience (Chaney et Al., 2009). Some of those indicators address time and location restrictions, increased access to education, allowing students to personalize and "own" their learning experience, and connecting a variety of like-minded professionals otherwise unlikely to network so readily (Chaney et Al., 2009).  

One simulation that I am highly anticipating is online team-based collaboration between two or more disciplines. Pennsylvania State University recently completed a study that included nursing and medical students working together in a series of workshops problem-solving safety, selecting care processes, improving performance and safety (Penn State, 2009). If this method could be formatted to reflect Penn State's outcomes, the potential could be critical to education and professional practice. Other disciplines, i.e., dieticians, rehabilitation therapists, social workers, and psychology could formulate an amalgam of ideas, interventions, and outcomes potentially altering the course of healthcare. This apears to me to be a grandiose idea. But when we consider Ford, Edison, and William Penn, it is from their small seeds of dreams and imaginations that today's innovations have blossomed.

I hesitated to post on my blog since I am concerned that my beliefs which, do not always fall within mainstream expectations (in healthcare and elsewhere) may hinder my career development. Recently, I began to re-appreciate the freedoms still inherent to our country" principles after traveling back east and touring our nation's capital. I have decided to go ahead anyway and express myself (thank you 1st amendment)! I hope this post offers rumination of ideas and actionable considerations for those reading. This blog is one way I connect to the larger community and hopefully offer something useful to others (Yang, 2009). It has been a while since my last update and apologize for that. I am finishing up the last few classes of my nursing master's program and an assignment provided the opportunity and incentive to dust off the blog. 

Please consider how you can improve our world and take some action working through your personal offerings. You never know where it may lead . . . .

References

 AACN, (2012). Nursing Shortage. American Association of College of Nursing. Retrieved from www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage

 Adegbola, M. (2011). Taking Learning to the Learner: Using Audio Teleconferencing for Postclinical Conferences and More. Creative Nursing, 17(3), 120-125.

Chaney, B., Dorman, S., Eddy, J., Glessner, L., Green, B., & Lara-Alecio, R. (2009). A Primer on Quality Indicators of Distance Education. [Abstract]. Health Promotion Practice. 10(2):222-231. Doi: 10.1177/1524839906298498

 Chaney, D., Chaney, E. & Eddy, J. (2010). The context of distance learning programs in higher education: Five enabling assumptions. Online Journal of Distance Learning Administration. 8(4). Retrieved from www.uncg.edu/oao/PDF/5%20Assumptons%20OJDLA.pdf

Jones, L. (2008). Learning from success: the flexibility of distance learning. [Abstract]. British Journal Of Healthcare Assistants. 2(8), 394-397.

MacIntosh, J. A. (2008). Focus groups in distance nursing education. Journal of Advanced Nursing, 18(12), 1981-1985

Nasseh, B. (1997). A Brief History of Distance Education. Ball State University. Retrieved from www.seniornet.org/edu/art/history.html

Penn State, (2009). Collaborative Program Emphasizes Team-Based Learning Between Nursing and Medical School Students. Pennsylvania University: College of Health and Human Development. Retrieved from http://www.hhdev.psu.edu/news/2009/10_8_09_macy_grant.html

Valentine, D. (2002). Distance Learning: Promises, Problems, and Possibilities. Online Journal of Distance Learning Administration. 5(3). Retrieved from http://www.westga.edu/~distance/ojdla/fall53/valentine53.html

Yang, S. (2009). Using blogs to enhance critical reflection and community of practice. Educational Technology & Society, 12(2), 11-21. Retrieved from www.ifets.info/others/download_pdf.php?j_id=43&a_id=928

The Skinny on Obesity

Here is a great new video series from UCTV that gets it when addressing the obesity epidemic our country is facing. The series does not have all the answers but it does touch on most of the core issues that prevents physical health and wellness. We need to tap into the biological mechanisms that optimize our health and drive away . . . so have fun watching. I will add the rest as they are released.

Part 1:

Part 2:

Is the U.S. Healthcare system the best?

The simple answer is no. The U.S. healthcare delivery system can be separated into two areas to further clarify this answer: acute care and prevention.

The first: In the arena of trauma, acute onset of illness, and other unexpected or unanticipated emergent situations, our healthcare system can be very efficient and effective. We excel at moderating mechanical, chemical, structural, and functional acute dysfunctions such as 3^rd degree burns, drug overdoses, and fractures as just a few examples. There are very complex strategies designed to address large-scale events such mass injuries (think freeway pile-up), terrorist attacks, and natural disasters (CDC, 2012). 

The second, prevention: That is another story. The answer is complex and convoluted due to the great array of involved parties, opinions, and perspectives. What we do know is allopathic medicine does not generally consider optimizing naturally occurring biologic homeostatic mechanisms to moderate the vast myriad of physiological dysfunctions.

What appears to be happening with America’s collective health problems that are associated with complex symptoms such as obesity, heart disease, and cancer is a comorbidity co-occurring with accepted standard treatment modalities. Pathways commonly used in allopathic treatment may precipitate the problem. They shortsightedly target clinical manifestations of underlying condition(s). This type of symptom response does not address etiological factors and the treatment may cascade dysregulation to other systems.

Two examples: depression and heart disease. Antidepression medication and statins are two of the most commonly prescribed drugs in the U.S. (DeNoon, 2011). The overall data concerning efficacy of anti-depression medication is only 50% (Moncrieff, 2005). That means that 50% of people taking antidepressants are receiving no clinical benefit. Circadian rhythms, diet and environment all play important roles in depression and rarely are part of the treatment process when a 25-dollar copay will suffice. They also play important roles for statins.

Speaking of statins: A closer look at this preventive measure elucidates no reduction in mortality rates for healthy people of any age that have what is currently determined to be high cholesterol by allopathic standards (Ifti, Jackson, Ramsay & Wallis, 2001). Moreover, in this large meta-analysis mortality rates increased by 1% over a ten year period compared to placebo. The PROSPER trial demonstrated that statin use does not increase survival rates in the elderly population (Blauw et Al., 2002) which is a particularly vulnerable population that may be placed at higher risk for physical complications due to the known alterations of statins on cognitive function, muscle degeneration (MasterJohn, 2005), and mood disorders (Kaplan, 2010)

So no, we have a long way to go when it comes to prevention. Perhaps we need to look to our past, our bodies, and our environment for answers to health questions.

References

Blauw, G., Bollen, E., Buckley, B. Cobbe, S., Ford, I., Gaw, A., Hyland, M., Jukema, J., Shepherd J, Kamper, A., Macfarlane, P., Menders, A., Norrie, J., Pakcard, C., Perry, I., Stott, D., Sweeney, B., Twomey, C., and Westondorp, R. (2002). Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. [Abstract]. Lancet. 23;360(9346):1623-30. Retrieved April 21, 2012 from www.ncbi.nlm.nih.gov/pubmed/12457784?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

CDC, (2012). Emergency Preparedness and Response. Centers for Disease Control and Prevention. Retrieved April 21, 2012 from//www.bt.cdc.gov/disasters/

DeNoon, (2011). The 10 Most Prescribed Drugs: Most-Prescribed Drug List Differs From List of Drugs With Biggest Market Share WebMD. Better Information. Better Health. Retrieved April 21, 2012 from www.webmd.com/news/20110420/the-10-most-prescribed-drugs

Ifti, U., Jackson, P., Ramsay, L., and Wallis, E. (2001). Statins for primary prevention: at what coronary risk is safety assured? [Abstract]. British Journal of Clinical Pharmacology. 52(4):439–446. doi: 10.1046/j.0306-5251.2001.01478.x Retrieved April 21, 2012 from www.ncbi.nlm.nih.gov/pmc/articles/PMC2014585/

Kaplan, A. (2010). Statins, Cholesterol Depletion—and Mood Disorders: What’s the Link? Psychiatric Times. 27(11). Retrieved April 21, 2012 from www.psychiatrictimes.com/mood-disorders/content/article/10168/1743257

MasterJohn, C. (2005). Statins Fry Your Brain and Scramble Your Memory Like an Egg A Review of Statin Drugs Side Effects and the Misguided War on Cholesterol by Dr. Duane Graveline, M.D. Self-Published, April 2005. Cholesterol-and-health.com. Retrieved April 21, 2012 from www.cholesterol-and-health.com/Statin-Drugs-Side-Effects.html

Moncrieff, J., (2005). Efficacy of antidepressants in adults. [Abstract]. British Medical Journal. 331(7509): 155–157. doi:  10.1136/bmj.331.7509.155

What about public health?

Please consider this post in light of a preventive perspective targeting multiple etiologies and not correlations. This is not meant to disrespect all the great work public heath has been and is currently providing* 

The major causes of disease and death (DaD) in the 21^st century have never been scientifically proven although outcomes have been correlated and mistakenly identified as causes. This is one of the greatest mistakes in public health and medicine today (Taubes, 2012). It can be speculated that major causes of DaD are the standard American diet (SAD), iatrogenic comorbidity (Starfield, 2000), and toxic environmental factors (Walsh, 2010). Perhaps the greatest influence is our biological mismatch (Kruse, 2012). Our lives no longer synchronize with the Earth’s cyclical rotations affecting great influence on our collective behavior. Hormone, immunity, and metabolic functional alterations can result from mismatches with natural circadian rhythms (O’Connor, 2012), food availability cycles (Kruse, 2012), and seasonal sunlight temperature fluctuations all correlating with DaD (Hastings Maywood & Reddy, 2003).

Public heath has made great strides reducing pathogenic morbidity. Unfortunately, the factors mentioned above are not considered when attempting to moderate major diseases resulting from these influences. As a result, cardiovascular disease, cancer, and respiratory infections are free to develop and reveal themselves as top killers in our country (Leading Causes of Death, 2012). Public health and modern healthcare can provide invaluable service to their constituents by targeting pathways that optimize immunity, increase longevity, and improve health status by replacing methods that facilitate further disruption of our physiologic mechanisms. The disturbing effects on our homeostatic ability (MacDonald & Monteleione, 2005) in addition to perpetuating a dysfunctional healthcare system (Starfield, 2000) needs serious consideration.

One public health strategy used to reduce pathogenic disease is to regulate food production and distribution. Preventive practice in this area has fallen through the cracks. Animals and plants mass produced for consumption are now adulterated with pesticides, hormones, antibiotics, and genetic modifications. These are all factors influencing our epigenetic predisposition. Autism is now found in 1 of 54 boys and 1 of 252 girls (CDC, 2012). Genetics can only take so much responsibility. Environmental influences that predispose us to disease and death should be a major consideration for public interest.  How public health choses to move forward must include looking backward. What we consider causes are often merely symptoms.

References

CDC (2012). Autism Spectrum Disorders (ASDs). Retrieved March 31, 2012 from http://www.cdc.gov/ncbddd/autism/index.html

Hastings, M., Maywood, E., and Reddy, A. (2003). A clockwork web: circadian timing in brain and periphery, in health and disease. [Abstract]. Nature Reviews Neuroscience. 4:649-661. Retrieved March 31, 2012 from www.nature.com/nrn/journal/v4/n8/abs/nrn1177.html

Kruse, J. (2012). Why perspective Matters? Cellular theory of relativity. Living an Optimized Life. Retrieved March 31, 2012 from http://jackkruse.com/why-perspective-matters/

Leading Causes of Death, (2012). Centers for Disease Control and Prevention. Retrieved March 31, 2012 from www.cdc.gov/nchs/fastats/lcod.htm

MacDonald, T. and Monteleione, G. (2005). Immunity, inflammation, and allergy in the gut. [Abstract]. Science. 25(307) pp.1920-1925. DOI: 10.1126/science.1106442

O’Connor, A. (2012). Really? The Claim: Your Body Clock Can Determine When You Get Sick. New York Times. Retrieved March 31, 2012 from well.blogs.nytimes.com/2012/02/27/really-the-claim-your-body-clock-can-determine-when-you-get-sick/

Starfield, B. (2000). Is US Health Really the Best in the World? The Journal of American Medical Association. 284(4):483-485. doi: 10.1001/jama.284.4.483

Taubes, G. (2012). Science, Pseudoscience, Nutritional Epidemiology, and Meat. Retrieved March 31, 2012 from http://garytaubes.com/2012/03/science-pseudoscience-nutritional-epidemiology-and-meat/

Walsh, B. (2010). Environmental Toxins. Time Magazine. Retrieved March 31, 2012 from www.time.com/time/specials/packages/article/0,28804,1976909_1976908,00.html

Startling Autism Data

Well, the CDC just published the new numbers of our birth rate and autism 1:88. We have changed our environment so much. Look at what we are doing to our kids. Here is a report from FoxNews and a link to the CDC.

An excerpt for your tastebuds:

For 2008, the overall estimated prevalence of ASDs among the 14 ADDM sites was 11.3 per 1,000 (one in 88) children aged 8 years who were living in these communities during 2008. Overall ASD prevalence estimates varied widely across all sites (range: 4.8–21.2 per 1,000 children aged 8 years). ASD prevalence estimates also varied widely by sex and by racial/ethnic group. Approximately one in 54 boys and one in 252 girls living in the ADDM Network communities were identified as having ASDs. Comparison of 2008 findings with those for earlier surveillance years indicated an increase in estimated ASD prevalence of 23% when the 2008 data were compared with the data for 2006 (from 9.0 per 1,000 children aged 8 years in 2006 to 11.0 in 2008 for the 11 sites that provided data for both surveillance years) and an estimated increase of 78% when the 2008 data were compared with the data for 2002 (from 6.4 per 1,000 children aged 8 years in 2002 to 11.4 in 2008 for the 13 sites that provided data for both surveillance years). Because the ADDM Network sites do not make up a nationally representative sample, these combined prevalence estimates should not be generalized to the United States as a whole. 

HEALTHY DIETS AND SCIENCE: Low levels of zinc may be a risk factor for diabetes and heart disease

HEALTHY DIETS AND SCIENCE: Low levels of zinc may be a risk factor for diabetes and heart disease

Cinnamon, Which type should we be eating?

I have been looking into cinnamon since it is proclaimed to be very healthy. Did you know there are a few types of cinnamon? We will cover the two most used forms, ceylon and cassia.

Here are some of my findings:

There are two general types of cinnamon, cassia and ceylon cinnamon. A distinction in taste can be made between the two types. The important point is that ceylon cinnamon contains low levels of coumarin (a potential liver and kidney toxin). By contrast, cassia cinnamon contains high levels of coumarin up to 63 times more than Ceylon cinnamon powder. On the other hand, cassia cinnamon sticks consisted 18 times more coumarin compared to Ceylon sticks. So get some ceylon cinnamon in your cupboard, especially the powder form.

It is almost impossible for us to distinguish between the two types of cinnamon in powder form. I believe ceylon cinnamon is harder to find. A recent example occurred when I went to Clark's Organic Foods grocery store and their employees did not even know about ceylon cinnamon.  So, the distinction is not commonl even among proclaimed healthophiles. Starbucks uses cassia from China, and I have not found cinnamon labeled as ceylon in any brick and mortars anywhere yet. Hopefully, that will change . . .

The situation is different when distinguishing cinnamon in the stick form. Cassia cinnamon has a relatively thick layer of the bark and is rolled into a stick. The cross-section of a Ceylon cinnamon stick looks more like a cigarette: several thin layers of bark rolled haphazardly, making its cross-sectional view appear more compact.

The origin of the cinnamon is not generally indicated on the package. If it is made in China or India, chances are it is cassia. Ceylon is usually grown in Sri Lanka, Seychelles, and Madagascar. So dump the cassia and find some ceylon cinnamon. It is better for your kidneys, liver, and packed full of antioxidants to maintain and improve your (intra/extracellular) health. If you would like to delve deeper into the complexities associated with cinnamon including nutrient content just review these two great resources, whfoods.com and Marksdailyapple. They both elucidate the many benefits of cinnamon nutritionally, medically, and provide interesting contrast between the two.

Brick and mortar update: I just found organic ceylon cinnamon sticks from Sri Lanka at Cost Plus WorldMarket.


Ceylon Cinnamon:

Cassia Cinnamon: