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Contribution to the Community of Learning

Brian Harrison Nipissing University Instructed by Sue Coffey NSGD-4016 Dec. 3rd, 2020

2 Contribution to the Community of Learning In this paper, I will detail my contribution to the learning community in the class Research in Nursing and Health. The specifics of my contributions will be provided with examples in the appendices of each section pertaining to various areas of contribution. I will justify my requested mark and highlight what I have learned as well as contributed to the course. My focus on the course was to provide additional considerations into the topics that were discussed. I felt that many of these topics have been covered well by the students in our class, so my plan was to make a different point in order to potentially take the conversation into a new area.

Leadership

My leadership for this course was something I considered thoroughly. I had taken courses before that had emphasized leadership, and I had been content to stand by and let the course come to me. This time I was prepared to take a more active role in the course and the group I was assigned. The very first week I organized us on WhatsApp so we could all communicate faster. I began by sending a group email to all the group members and most of the group joined after that. There were some holdouts and I individually responded to their first posts in order to get them into the group. Once in the group chat, I took an interest in guiding the group towards the focus of our postings by answering questions about the postings. I was the final synthesis lead and, in that role, I determined what parts of our group’s responses would be shown to the class at large. I took this role seriously as I made every effort to include the group equally as to ensure everyone’s voice was heard. Appendix A highlights some of my efforts in leadership this semester.

3 Follower role

In the role of the follower, I was more comfortable. This is essentially a continuation of the discussion postings we have done for many classes. While the discussion posting format was the same, the postings were less frequent and more detailed. I enjoyed this format more and I really wanted to rise to the challenge of substantiated postings for my group. I found that areas of my postings that used quality sources and that explored less defined parts of the postings were used more often and I took that as a sign that I was on the right track. My postings tried to tackle the issues that were less clear cut in the descriptions of the posting. I started strong in our group as my information was used quite frequently in our first synthesis posting. In synthesis 2, I felt proud that my PICO question was the one used by the group. I had put a good amount of work into my wording of the question so when it was used, I felt validated. In synthesis 3, I felt our group faced its toughest challenge. In selecting a theoretical framework for the posting, there were many questions in our group chat. This was easily the most effort I had put into our postings. When I saw that my theoretical framework was chosen by that week's group leaders, I was satisfied with the effort I had put in. For examples of my contribution in the role of follower, please see Appendix B.

Utilization of literature

As the focus of the course was on improving our ability to find and appraise the literature that we need to use in order to continue our professional careers, I wanted to make sure that researching literature and using it to its fullest potential here was a focus for me. Since the topic we were covering was very recent, I knew that there may be a dearth of research. One of my focuses in finding research was to try and find the parallels to our current COVID-19 pandemic, with previous research to show that studies have been done that

4 addressed our questions in a different setting. To illustrate this point, during our CINAHL search, I was able to use sources and explain why I used them, as well as my search techniques/integrate sources that were provided prior to COVID-19. For examples of my resources used in chronological order, please see Appendix C.

Evidence of substantive engagement in responses

Following each of our synthesis postings, we were required to respond to 2 different groups' synthesis. In my responses, I felt it was more important to support the positions that these groups had taken rather than find fault with them. My main goal was to bring additional information to the discussion since I feel that this better fosters an environment of learning. For the first synthesis, I wanted to draw from my own experience during this pandemic and discuss the debate of reusing and sanitizing and compare it to what many facilities were doing and extending the life of the PPE beyond the original intended purpose. In synthesis 2, I wanted to share some information about what other places in the world were doing to help stretch the lifespan of our PPE. I referenced a hospital in Boston, MA that had come up with an innovative technique to sterilize and re-use PPE and at a high enough volume to effectively double the N95 supply in the state of Massachusetts. In synthesis 3, I wanted to draw parallels to other infectious diseases that the medical community had battled before. I was able to use an excellent source that had already tackled the ethical question of rushing vaccines without fully tested clinical trials, which is relevant for our rapid pursuit of the COVID-19 vaccine. For my final synthesis response posting, I really wanted to discuss how not everything is in black and white numbers. Highlighting the other costs of COVID-19 was important to me as it is something I am dealing with in my current practice. I made the case that more than just fatalities and complications were at stake here. I also wanted us to consider those who are missing out on

5 other treatments, the cost of our collective mental health deterioration, and the truly sick people that delay going to the hospital for fear of contracting COVID-19.

Overall, I feel that my postings were well thought out and did contribute to my group in a helpful way. I think my contribution to the class discussions as a whole were substantive, timely, thought provoking, and well written. I think my postings used good sources that were timely. I think there were one or two responses that may have needed a bit more substance, but overall, I am very happy with my level of contribution in this class. Based on the information I have provided and the parameters of the course. I would assign myself the following scores: Leadership 4.5 Follower role 4.5 Utilization of literature 4.5 Evidence of substantive engagement in responses 4.5 Overall 18 of 20

Appendix A

I had sent an email regarding our communication. Would a WhatsApp group be easier?

… Brian's idea of forming a WhatsApp or Facebook group to coordinate with each other in a faster manner.

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Hi Heather! When you get time we have a nursing WhatsApp group. If you could leave your number here, I will add you.

WHATSAPP communication.

We could either break it up as part by part or if we want more individual work we could each do 1 point of interest through part a, b, and c

Writing one part seems easier than writing 3. So we would need to identify 3 (likely 4 because of group size) and each of us take one, then we need to come up with some questions for each one to complete part a. Part b we would each frame the same 1 area of interest and put it into PICO format. And for part c you need to give rationale as to why you think those questions are important. If we each pick 3 you will get a ton of redundant stuff. And we will have done a lot of overlapping work for no benefit. Doing three times the work instead of a singular focus.

The only thing we should collaborate on is the areas of interest so we don't all pick similar ideas

It seems like you are supposed to incorporate those 2-3 best articles then write a summary of " the science of COVID-19 symptoms" currently

Ashley, what you did looks great. Part d was a lot of writing as you said but overall I like this method of discussion posts more. It's less frequent and more in depth.

Appendix B Synthesis 1

7 Determining the need for the masks in the first place is important. There is evidence that the N95 is not better than surgical masks for droplet (Greenhalgh et al., 2020). Where the N95 becomes vital is in aerosol generating procedures (AGP). What are AGPs and when do nursing home staff come into contact with them (Ross et al., 2020)? There is also evidence that suggests that surgical masks worn all day lose their effectiveness.

Synthesis 2

Old question: Is the N95 facial respirator required to stop the spread of Covid 19? New Question: Is the N95 facial respirator better at stopping the spread of COVID-19 than surgical masks in non-aerosol generating procedures? P- Potential infected individual I- Use of N95 masks C- Use of surgical masks O- Decrease in COVID-19 transmission

Synthesis 3 theoretical framework

An empirical based theoretical framework would be best selected here as empirical research is more based in reality of practice and can account for that is observed beyond simple facts. Empirical has the best chance of determining possible reactions by the main stakeholders to the availability of a fast vaccine. One model that may be successful to use as a basis for the framework would be the increasing vaccination model. This model would begin the framework by addressing the concerns that people have about the safety of the vaccine compared to the ongoing COVID-19 pandemic (Wateska et al., 2018). This would also present an opportunity to factor the availability of the vaccine and how the decision-making process would be altered

8 based on availability (Ngcobo, 2017). The empirical framework may also be used to explore the psychology behind vaccination refusals and how best to address the potential that enough people might refuse the vaccine to cause problems with herd immunity (Phadke et al., 2016).

Appendix C

Greenhalgh, T., Chan, X., Khunti, K., Durand-Moreau, Q., Straube, S., Devane, D., Toomey, E., & Adisesh, A., (2020). What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? The Centre for Evidence-Based Medicine. https://www.cebm.net/covid-19/what-is-theefficacy-of-standard-face-masks-compared-to-respirator-masks-in-preventing-covidtype-respiratory-illnesses-in-primary-care-staff/

Ross, K., Almuzam, S., Britton, P., Howard‐Jones, A., Isaacs, D., Kesson, A., & Nayda, C. (2020). What risk do aerosol‐generating procedures pose to health‐care workers? Journal of Paediatrics and Child Health. https://doi.org/10.1111/jpc.15127

Stall, N., Jones, A., Brown, K., Rochon, P., & Costa, A. (2020). For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths. Canadian Medical Association Journal (CMAJ), 192(33), E946–E955. https://doi.org/10.1503/cmaj.201197

Ngcobo, N., & Kamupira, M. (2017). The status of vaccine availability and associated factors in Tshwane government clinics. South African medical journal, 107(6), 535–538. https://doi.org/10.7196/SAMJ.2017.v107i6.12149

9 Phadke, V., Bednarczyk, R., Salmon, D., & Omer, S. (2016). Association between vaccine refusal and vaccine-preventable diseases in the United States: A review of measles and pertussis. JAMA : the Journal of the American medical association, 315(11), 1149–1158. https://doi.org/10.1001/jama.2016.1353

Wateska, A., Nowalk, M., Zimmerman, R., Smith, K., & Lin, C. (2018). Cost-effectiveness of increasing vaccination in high-risk adults aged 18–64 years: A model-based decision analysis. BMC Infectious Diseases, 18(1), 52–52. https://doi.org/10.1186/s12879-0182967-2

Appendix D

Excerpt from synthesis 1

The topic of reusing PPE has been a very hot topic at my work as I am sure it has been for everyone else. In an ideal world we would all have the proper PPE to implement best practice of one time use PPE. The reality is we must make due by using PPE beyond its intended duration. In lieu of re-using/sanitizing PPE, many facilities practice extending the life of the masks.

Excerpt from synthesis 2 Hospitals in Boston and the greater New England area addressed their N95 Mask shortage by investing in a large sterilization machine that can sanitize 80,000 masks for re-use per day! (Ostriker, 2020). Even the busiest Boston hospital only uses 1000 masks on an average day (Ostriker, 2020). This means the machine could service the entire state of Massachusetts. This machine became relevant after observing a few different qualities about the masks and the virus itself. The virus can be cleaned of the masks using a variety of methods. However, using

10 alcohol, water, or UV light damages part or all of the mask and compromises the effectiveness of the re-use (Carrillo et al., 2020). The machine in Boston uses a safe, steam clean that does not damage the filtration or the straps making the masks effective to be used again. (Ostriker, 2020). This can effectively double the use nurses would get from N95 masks.

Excerpt from synthesis 3

The ethical question surrounding vaccination requirements that are shortened has been brought up before. When Ebola was becoming a problem in 2014, the researchers working on the vaccine were contemplating participating in random clinical trials which raised the question if the process was not able to be involved in a randomized clinical trial, then is it ethical to push a vaccine (Paternoster, 2018)? This parallels our own concerns about a COVID-19 vaccine. If we are to put a vaccine out that we have not fully tested, are we risking the long term health of the recipients?

Excerpt from synthesis 4

One of the long term effects of COVID-19 that I do not think gets enough attention is the delaying of other procedures. Many patients that I treat have stated that they have had issues with getting surgeries done during the pandemic. We have had to move so many things around and allocate resources judiciously due to COVID that we may be missing the forest for the trees so to speak. In fact, many surgeries are delayed that can have life altering consequences. Surgeries such as cancer surgeries, ablations, joint replacements, biopsies, and others have all been delayed due to either the shrinking availability of operating rooms from the scrutiny of these surgeries and the decisions on their necessity (Spinelli, 2020).

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