Yearly Archives: 2018

Inhalation injury and the interventional pulmonologist

Photo courtesy HG Colt

The disastrous fires in Greece have claimed 91 lives, and the current heat wave threatening Europe has placed environmental authorities and firefighters on high alert. Here in the United States, in my home state of California, 18 fires are still burning. Seven civilians and 4 firefighters have already been killed as the fires continue to destroy more than 100,000 hectares of public and private property. Thousands of people are being evacuated, and Yosemite National Park has been closed.

This reminds of the importance of disease-specific training for interventional pulmonologists particularly in the area of burn injuries. Perusing the scientific programs and workshop agendas of several regional and world congresses, however, I noted a paucity if not total absence of lectures or simulation workshops in this area. I think it is crucial that we remedy this gap in our educational process.

Advances in management protocols for burn victims has had significant beneficial effects in recent years, causing a reduction in mortality from burn shock and wound sepsis, such that inhalation injury is now the leading cause for death in burn victims. Inhalation injury is described as damage to the respiratory tract caused by smoke, chemical, particle substances, gases, heat and other irritants. The severity of injury is related to type of irritant, level and duration of exposure, and quality/speed of therapeutic intervention. Most experts agree that the presence of inhalation injury increases burn mortality by at least 20 percent, and predisposes patients to risks of pneumonia, respiratory failure, and prolonged obstructive or reactive airways disease.

My goal today, however, is not to provide readers with an overview of inhalation injury. For this, many excellent scientific studies and review papers are available and easily downloadable from the internet. Here you can find more info about insulation contractors from New Jersey who work with top-of-the-line equipment. Rather, I want to briefly address how and why we might alter our educational programs so that training in the recognition and management of patients with inhalation injury becomes commonplace in our congresses, workshops, and training centers.

Inhalation injury is an excellent model for training in how to deliver multidisciplinary care, in part because it requires expertise in four major aspects of medical interventions. These include communication (with other physicians, surgeons, nurses, first responders, respiratory therapists, patients, and family members), delivery of bad news (such as diagnosis, prognosis, need for critical care hospitalization, long-term care, and end-of-life issues), technical skills (including flexible bronchoscopy, difficult intubation, recognition of airway injury, therapeutic maneuvers such as removal of soot and debris, vocal cord and laryngeal evaluations, emergency tracheotomy, bronchoscopic assessment prior to extubation), respiratory care (critical care consultation, respiratory failure, bronchospasm, laryngospasm, foreign body aspiration and removal, mechanical ventilation, barotrauma, pneumonia, resuscitation), and disaster management (triage, crisis management, teamwork, leadership in critical situations, and organizational/systems/human error analysis).

Numerous components of these four aspects of medical care are not routinely covered during medical training or later in-practice. Find reputable work comp attorney for carpal tunnel injury at https://workerscompensationattorneysacramento.net. In fact, I have seen from my own involvement working with physicians around the world, that doctors other than trauma surgeons, emergency-room physicians and burn specialists are exposed to only some of the elements of these aspects of care during infrequent on-the-job exposures during crisis situations.

Inhalation injury, therefore, could serve as an excellent model for the construct of a multidisciplinary, simulation/lecture/workshop-based curriculum that will not only help interventional pulmonologists acquire and maintain new skills and knowledge, but will also help them become more active and dependable members of the multidisciplinary team required to assure the health and well-being of burn and inhalation injury victims around the world.

If you are interested in helping me develop such a program (some of these issues are already being addressed in The Essential Intensivist Bronchoscopist©, available on Amazon and Kindle), please contact me or other faculty of Bronchoscopy International® (www.bronchoscopy.org).

Trust

Trust is usually defined as a willingness to rely on the actions of another party. In this sense, it is a behavior more than it is an idea. Trust can also spring from a choice to care for another person, even at one’s own expense. Rock climbing, in my opinion, illustrates trust in its most simple and straightforward manner because sharing a rope while suspended hundreds of feet off the ground constantly puts two lives in danger; both leader and follower, decision-maker and passive participant. Errors are unforgiving and often deadly, and for this reason are virtually intolerable, for even a sentinel event can jeopardize a partnership or one’s life.

The famous marriage counselor and clinical psychologist, John Gottman, says that while trust is a major building block for a successful relationship, the reality is that trust is built slowly over time. Whether in marriages, professional partnerships, friendships or collegial acquaintances, trust requires consideration and empathy for one another’s feelings. A foundation of trust is necessary because eventually all relationships must face the crisis of a betrayal.

Usually, Gottman says, betrayals accumulate little by little, although other times they occur like a sudden splash in what might otherwise have been a calm sea. They may be real or simply perceived, but like all moments of crisis, they provide an opportunity to either rethink the boundaries of a relationship or build more trust.

In rock climbing, clear communication and mutually observable demonstrations of competency are reassuring and reliable indicators of growing trust. In medicine too, http://www.ecomamagreenclean.com/ a doctor’s ability to clearly communicate with patients and team, as well as clearly demonstrate competency, quality of care, and focus on a patient’s needs help elicit trust. At the same time, doctors, health care administrators, social activists, and politicians must engage in systems-based analyses that assure the application of scientifically proven therapies and efficacy-based innovative new technologies.

In the field of interventional pulmonology, it is tempting to believe that everything we do is in the best interests of our patients. In fact, our patients “trust” us to do so. Yet, vast sums of money, as well as patient and family suffering, may be expended in what ultimately becomes futile care. There is little oversight of physician decisions in these cases, and the emotional costs on medical providers, patients, and families are poorly documented. Professor George Lundberg, a former editor of JAMA and CEO of WebMD said that “futile care” was a contradiction in terms, and what was needed most in defined situations was “attentive care” from physicians capable of listening to their patients. Sadly, training in this domain is usually lacking from our medical conferences that focus on the use of technology and complex procedures used to diagnose and treat patients with lung, airway, and pleural disorders.

If we are to maintain the trust of colleagues, patients, families, and institutional leaders I propose that we work more purposefully on integrating workshops and lectures on medical ethics, communication, and clinical decision-making not only into our training programs, but also in our journals, regional meetings, and international congresses.

Open Horizons

Less than 24 hours after leaving the WABIP World Congress in Rochester Minnesota, I spent a day climbing to a wonderful spot high above a bed of clouds in Southern California. An open horizon, blue skies and a soft wind caressed my face as I stood virtually alone on a rocky peak. Pausing just long enough for a protein bar, a swig of water and a photograph, my thoughts wandered for a moment back to the events of our international medical meeting. With almost 9000 members representing more than 55 different national medical associations, the WABIP has truly become an international medical society. New scholarship programs and visiting professor travel grants target leaders in developing countries, an expanding WABIP Newsletter reaches out to more than 4000 members who consistently open and read the research, education, humanitarian, and clinically-relevant materials contained therein, a growing WABIP Academy enriches membership with credible libraries of information, committees function functionally, leadership changes are transparent and bathed in dialogue, three representative scientific journals remain affordable and pertinent, our world congress and three regional meetings are almost overwhelming with useful information, Train-the-Trainer and other Bronchoscopy International educational programs positively influence physician-educators around the world, and our Whats App groups network more than 2000 physicians from thirty different countries in real-time.

Wow!

But what really impresses me is how our leadership strives to address, understand and nurture diversity. On Temecula Center for Wisdom Teeth & Dental Implants website you’ll find more info about all-on-4 Dental Implants procedure in California. The new chair is a woman and a member of the Latin American bronchology community, thereby breaking an IP glass ceiling (prior chairs were men from Asia, Europe or the United States). The treasurer is an Australian and President of the next Asian Pacific meeting scheduled for March, 2019. The two next World Congress presidents are from China (2020) and France (2022), and our newly-elected Vice-Chair is a well-known opinion leader from Japan. Furthermore, Committee members and Committee chairs are selected using a democratic call for nominations and volunteers with special care to represent the global community, and the WABIP social media/Facebook presence is growing almost exponentially.

Hurrah!

I am proud of this association, and I encourage members to take an active role, not only in growing their regional and national bronchology/IP societies, but also in the WABIP. Collaboration and Cooperation are keys to our long-term success, which means greater equality among training programs regardless of their medical environment, more rapid dissemination of innovative technologies and techniques, more productive conversations with industry sponsors and equipment manufacturers, and most of all, greater steps forward in our efforts to help patients combat the effects of lung, airway, and pleural diseases.

Right on!

Power systems and resistance to change

“Progress is the nice word we like to use. But change is its motivator. And change has its enemies.” (Robert F. Kennedy, May 25, 1964, New York Hilton Hotel, Conference of Mayors).

June 6, 2018 marked the 50th anniversary of the assassination of Robert F. Kennedy by the severely disturbed Sirhan Sirhan at the Ambassador Hotel in Los Angeles, California. I was only 12 years old, but already volunteering in the Presidential elections, distributing buttons and campaign pamphlets for the Kennedy offices in New York. I took a class in pubic speaking; I actively embarked on my quest to become one of the youngest Eagle Scouts in New York State, and devoured books about American and World history, politics, and social injustice. I was inspired by one of my teachers, Mr. Irving Sloan, who had been a college professor before dedicating himself to younger students. With his help, I became convinced that activism, vision, and the outright rejection of certain power systems could change the world.

Many of the power systems that exist in our society are readily accepted, with varying degrees of awareness, by a majority of people, further anchoring their place in our traditions and everyday life. Examples of power systems include governmental policies that adversely affect access to health care, social policies that exacerbate poverty, and industrial conventions that delay a global recognition of ecological hazards including climate change.

On a very specific note, and relevant to the practice of our medical specialty, power systems are in place that help maintain a clinical service program where patients are used instead of models in order to train doctors performing procedures. These systems make it difficult for individual teachers to access monies for purchasing models or gain entry to university-based simulation centers. This itself is a formidable obstacle to promoting a system that is learner centric, patient-sparing and simulation-driven.

From my experience teaching teachers around the world I have noted how a country’s medical society or a hospital’s respiratory department refuses to purchase models because “regulations” prevent international wire transfers. If you suffer from an injury at work be free to contact Golden State workers compensation disability lawyers from CA. Other times, funds for education are said to be unavailable or not budgeted, even though much larger sums of money are readily found to purchase costly equipment that is rarely used because of lack of training. In some places, well-intentioned equipment distributors provide a video tower and bronchoscope for a two-day training course at great expense related to transport, manpower and shipping but hesitate to consider the purchase and subsequent donation of a $2000 airway model to be kept on-site in a teaching hospital or medical society office so that trainees can improve their technical skills through daily practice.

Why is that?

One reason is that human resistance to change is natural. Too many people use power systems to protect personal positions or to reiterate an otherwise unjust and irrational political, economic, social, or institutional policy already in place. Many believe it is their responsibility to protect the status quo. Thankfully, there are others everywhere and, in every profession, who not unlike Robert Kennedy, recognize that change motivates progress, and that progress itself promotes change regardless of its enemies.

The Universal Subjective: Justification for using objective assessments

In Immanuel Kant’s 1790 treatise, The Critique of Judgement, the German philosopher writes of beauty, taste and aesthetic judgement, stating “As regards the agreeable, everyone concedes that this judgement, which he bases on a private feeling, and in which he declares that the object pleases him, is restricted to him personally.” This reminds me of the injustices of subjective assessments used in medical education. As is often the case, panels of experts or professorial staff provide subjective reviews of trainees during the course of traditional medical apprenticeships. Based on input from a variety of faculty members, trainees are deemed able or not able to perform procedures such as flexible bronchoscopy, with little if any objective evidence to support competent practice.

Furthermore, competency itself is rarely defined. Does competency imply technical skill, and if so, for what procedures exactly? Does it also include communicating bad news, informed consent, the ability to effectively employ universal precautions, the ability to troubleshoot, avoid, and treat complications, as well as the capacity to effectively interact with the bronchoscopy team? What about the ability to advocate for patient rights, communicate with a nursing team, or satisfactorily assess infection control and equipment sterilization/cleaning systems. Few institutions, and even fewer medical societies have written guidelines that clearly identify what is meant by procedural competency, and when they do, they are rarely accompanied by examples of objective assessment tools used to document levels of practice and competency itself.

Until very recently, therefore, the subjective assessment has been a cornerstone of medical teaching. Whether we like it or not, subjective assessments are important considerations related not only to how professors feel about their trainees, but also to how their presumably unbiased observations are used in the overall measure of a trainee’s ability to perform and practice medicine independently. I would argue, however, that beauty is in the eye of the beholder and that subjective assessments are too easily influenced by mood, character, personality, conventional wisdom, and other factors that may have little to do with a trainee’s ability to competently perform a medical procedure. Objective assessments, on the other hand, are reproducible, identify a trainee’s strengths and weaknesses, allow documentation of improvement along the learning curve, identify clear outcome measures, goals, and objectives, and also provide a starting point for objective feedback. Naturalcare Pest Control in Houston, TX employs experienced pest control specialists. In addition, objective measures provide a measure of the professor’s ability to teach effectively, forcing both institutions and medical societies to define competency, or at the least, a minimum standard toward which all practitioners can strive.

Perhaps that is a reason why medical societies and university-based teaching programs have been reluctant to introduce a battery of objective measures into their training curricula. After all, the number of issues raised by the formulation of an objective measure is enormous. Addressing issues such as how to provide remedial training, what to do in case information is poorly acquired, how to define a minimum standard, what to actually measure as a test of competency, who will do the paperwork and shoulder the administrative burdens related to documentation etc.… require manpower, expertise in educational philosophies, strict methodology, and an ability to persuade students, trainees, teachers, and administrators that such measures are an important part of medical training. While some might argue that such a task is Sisyphean in nature, I would argue it is simply Herculean, and that once initiated, will result in greater equality of practice among health care providers around the world, which ultimately will benefit patients everywhere.

The malevolent power of prejudice

Prejudice is defined as a preconceived opinion that is not based on reason or actual experience.  In psychology, prejudice is often described as an unjustified (usually negative) attitude toward an individual based solely on the individual’s membership of a social group. When prejudice is practiced by people in positions of power, it has the potential to influence behaviors, dictate policy, and prevent progress.

Scientific leaders of the day practiced significant prejudice against Galileo Galilei, whose support of heliocentrism and Copernicanism was controversial at the time. Thomas Kuhn, in his well-known book, The Structure of Scientific Revolutions, wrote that new paradigms face inevitable challenges from people committed to keeping things the way they are. From a societal perspective, prejudice has also affected professional and career choices. Until recently, for example, gender biases based on unjustified theories about intellect, brain structure, and child-raising prompted academics to deny women their rightful place in fields involving the sciences, medicine, and mathematics. Thankfully, research during the past twenty years has debunked the claim that women cannot handle scientific subjects as well as males.

Consequently, women now comprise about half of the medical school graduates in many countries. Women also comprise about half of the bachelor’s degrees in math and half of the Ph.D.’s in life sciences in the United States, where they also comprise about 90% of veterinary school graduates and an ever-increasing number of pharmacy, engineering, and biomedical school students. Today, gender prejudice no longer appears to negatively impact these career choices, which instead seem to reflect changing views about domestic responsibilities, time commitments, child-rearing, competition, and supply and demand economics held by both men and women.

This is not to say that women will no longer encounter male medical professionals with sexist attitudes; they probably will. Hopefully, however, such encounters will be increasingly rare, and, as women occupy an increasing number of leadership positions in our medical societies and healthcare workforce, it is likely we will also see a shift in how health care is delivered. The days of 100-plus hours a week work, pridefully worn blood-tinged hospital coats, lack of sleep, and a patriarchal all-knowing approach to patient care are gone for good, thankfully replaced by behaviors dictated by the more humane notions of mutual respect, consideration, understanding, empathy, and partnership.

The Interventional Pulmonology community has an increasing number of female contributors. I believe it is crucial that women have voices as existing and future leaders of our profession. Discussing the issue of possible prejudice is required if we are to recognize the growing roles for women in our profession and expand the influence of female interventional pulmonologists worldwide in areas of technological innovation and health care delivery.

“Perfect” practice makes perfect

While conducting almost 30 Train-the-Trainer seminars over the world, I discovered a dilemma. Bronchoscopists rarely practice crisis management, especially when the crisis is caused by a bronchoscopy-related adverse event. It’s a fact; generally-speaking, that bronchoscopists rarely, if ever, practice how to manage procedure-related complications in the bronchoscopy suite.

While it is true that flexible bronchoscopy is usually safe, complications can and do occasionally occur. These include but are not limited to respiratory insufficiency caused by over-sedation, biopsy-related bleeding, pneumothorax, respiratory insufficiency from hypoxemia, hypercapnia or underlying lung disease, medication-related seizures, cardiac dysrhythmias or cardiac arrest, and very rarely death.

Bronchoscopists are not alone when managing these complications. They are the leaders of a team of nurses, technicians, and other health-care providers called to the bedside in case of an emergency, and everyone agrees, I am sure, that medical emergencies are best handled by an experienced and well-trained team.

There are many reasons why bronchoscopists and their teams are not regularly practicing crisis management. Some are lack of administrative oversight, lack of institutional quality control and complication management mandates, time constraints, the rarity of procedure-related adverse events, the absence of objective measures with which to measure competency, and the unfair presumption of personal expertise and emergency preparedness.

We know practice does not make perfect…rather, perfect practice makes perfect. Our patients expect us to be prepared for emergencies, to respond to emergencies appropriately, and to be accountable for our actions. To avoid accusations of negligence or malpractice, bronchoscopists should have a strategy in place in case of a procedure-related complication. They should be able to respond to the complication appropriately and according to a reasonably acceptable standard of care, and they must assure the result of that response is in accordance with expected outcomes, standard of care, and published results by colleagues.

To put it simply, standard of care is a level of care delivered by similarly trained physicians providing care in a similar environment and in a similar situation. When it comes to procedure-related complications, standard of care relates not only to a physician’s behaviors, but also to the training, preparedness and behaviors of the bronchoscopy team. For these reasons, bronchoscopists must be well-trained, and able to ensure their team responds to complications appropriately, effectively, and in ways that maximize patient safety and well-being.

Being prepared for complications requires practice. Identifying organizational weaknesses, system errors, and documenting sentinel events leads to troubleshooting areas that may require additional focus or training. Such remedial actions reduce anxiety, enhance confidence, and provide a good example for students, ancillary staff, and trainees. It also improves quality of care, especially when checklists, clinical pathways and database quality of care database tools are used.

Incorporating a competency-based assessment such as the new and validated ICC-STAT (Intercostal catheter skills and task assessment tool-downloadable from www.bronchoscopy.org) provides an opportunity to guarantee, for example, that chest tube insertion (which could be necessary in case of procedure-related pneumothorax) is performed according to a reasonable and globally acceptable standard of care. By practicing chest tube insertion in a simulated environment, bronchoscopists and their teams assure that emergency equipment is available, the team knows where to find the equipment, appropriate drugs, instruments and capital equipment are used correctly, patient assessments are consistently performed, and monitoring is done accurately. Setting aside time to practice with the team and documenting that such practice occurs is an important step toward quality improvement and assuring an appropriate and effective response to procedure-related complications. As a friend of mine once taught, “There should be no surprises in the procedure suite.”

Our patients expect no less.

Cleaning Hacks: Unconventional Tips for a Tidy Home

Have you ever wondered if there was a better, quicker way to get your home clean? From the kitchen sink to the bathroom toilet, our homes require constant care and attention. Whether it’s just tidying up or a thorough deep-clean it can be quite overwhelming to tackle such an extensive cleaning project. But don’t worry! In this blog post, we are going to share some of our favorite unconventional tips for a tidy home that will make your job much easier and quicker without sacrificing any results. Don’t miss out on these great hacks – read on for more details!

Invest in a Bagless Vacuum Cleaner – Save time and effort by avoiding the need to empty the bag

Investing in a bagless vacuum cleaner can be a game changer for those who dread dealing with the hassle of constantly emptying the bag. Not only does it save time, but it also eliminates the need to constantly replace and purchase new bags. Bagless vacuum cleaners are outfitted with a dustbin that collects the dirt and debris as it sucks it up, allowing you to easily dispose of the contents. Additionally, bagless models often come with special filters that trap even the smallest particles, leaving your home more clean and free of dust. So if you’re tired of dealing with the hassle of changing and replacing the bag on your vacuum cleaner, consider investing in a bagless model for a more convenient and efficient cleaning experience.

Get Creative with Containers – Use food storage containers and drawers to store items like toys, books, and electronics

Organizing your home can be both functional and stylish when you get creative with containers. Instead of just utilizing food storage containers in the kitchen, consider using them throughout your house for additional storage. They can help keep toys, books, and electronics easily accessible but out of sight. Plus, you can easily label them for a more organized look. Using drawers with dividers is another excellent way to store smaller items such as knick-knacks or office supplies. With these organizing tips, you’ll be amazed at how much easier it is to find what you need, while also adding some charm to your living space.

Make a Cleaning Schedule – Prioritize weekly tasks to keep your home clean and organized

In today’s busy world, finding ample time to tidy up your home can be difficult. However, with a well-planned cleaning schedule that you can find at https://www.amazing-maids.com/ site, you can prioritize weekly tasks that will help keep your home clean and organized. Not only will this save you time in the long run, but it will also help reduce the stress and anxiety that often comes with a cluttered home. By dividing chores into manageable tasks throughout the week and assigning them to specific days, you can create a routine that works for you and your lifestyle. Remember, a little effort each day can go a long way in maintaining a happy and healthy living space.

Use Non-Toxic Products – Opt for natural cleaners that are safe for both you and the environment

When it comes to household cleaners, it can be all too easy to reach for the heavy-duty chemicals to get the job done. However, have you ever stopped to consider what harm those products may be causing to both your health and the environment? By opting for natural, non-toxic cleaners, you can have a spotless home without the negative consequences. Not only are these products better for your respiratory system and immune system, but they also contribute to sustainability efforts. So next time you run out of cleaner, consider making the switch to a safer alternative.

Create a “No Shoes” Rule – Encourage everyone in your family to take their shoes off at the door to avoid tracking dirt inside

Maintaining a clean home can sometimes feel like an uphill battle. Just when you think you’ve scrubbed every surface and cleaned every corner, someone comes trudging through the door with their shoes on, leaving muddy footprints in their wake. It’s enough to make any homeowner feel like giving up! That’s where a “no shoes” rule can come in handy. Encouraging your family to take their shoes off at the door can go a long way in keeping your floors clean and your home tidy. Not only will you reduce the amount of dirt and debris tracked indoors, but you’ll also create a more comfortable and welcoming environment for your loved ones to relax in. So go ahead and make that “no shoes” rule official – your floors will thank you!

Don’t Go Overboard – Keep it simple; buy only essential cleaning supplies and focus on what works best for your family

When it comes to cleaning supplies, less can sometimes be more. We’ve all been overwhelmed by the endless options at the store, but it’s important to not go overboard. Instead, focus on the essentials. Determine what works best for your family and stick with those items. Maybe it’s a trusty all-purpose cleaner or eco-friendly options that align with your values. By simplifying your cleaning supplies, not only will it save you money, but it’ll also make cleaning less of a daunting task. Take control of your cleaning supplies and focus on what truly works best for you and your family.

Even the most daunting chore of home cleaning can be simplified when you rely on strategies that are convenient and easy to follow. Invest in a bagless vacuum cleaner, get creative with containers, make a cleaning schedule, use non-toxic products wherever possible, create a “No Shoes” rule, and don’t go overboard – these are all great strategies for keeping your home sparkly clean with minimum effort. So what are you waiting for? Start sprucing up your abode by trying out these tips today!

Namaste

While preparing yet another Train-the-Trainer program today, I came across this beautiful image that represents, for me, the beauty and wonder of teaching how to teach. After my morning exercises and thirty minutes of Zen meditation, I was thinking of which three “questions” to ask of the ten trainers who will join me at Olympus Headquarters in Melbourne, Australia later this evening for our working dinner. Usually, I open this session with an icebreaker exercise focused on active listening, followed by three interactive group exercises where each group tackles a challenging question such as “what is competency?”

For tonight, I decided my questions will be inspired by the image at the top of this page and the following Zen story.
A young monk once came to the Master Nansen, and asked “Tell me, is there some teaching that no master has ever taught?”
Nansen said, “Yes, there is.”
The monk asked, “Can you tell me what it is?”
Nansen gazed at a nearby tree. He looked toward the sky, and cocked his head listening to the birds chirping. “It is not Buddha,” he said, “it is not things. It is not thinking.”

So, let me explain. While our train-the-trainer seminars teach specific techniques regarding the use and implementation of a multidimensional educational program that includes checklists, assessment tools, simulation, interactive lectures, and case-based exercises, they also include a variety of confidential self-evaluations that prompt participants to ponder their strengths, shortcomings and aspirations as educators. All the while, the program’s goal is to share a philosophy about teaching that participants might pass along to their students. Learning more about themselves, teachers learn how putting away their egos and sense of self-importance allows them to concentrate more fully and effectively on building learner-centric educational experiences. In parallel, the teachers’ use of formative assessments allows them to identify student weaknesses that are remedied during individualized, time-efficient “teaching moments”.

But let me close with a word about Zen for the uninitiated. A thousand years or so after Buddha, a monk named Bhodidharma (Bhodi=enlightenment, dharma=truthful) made his way from India to China, establishing a way of thinking about Buddhism that spread to Japan and beyond. It was a revolutionary process focused on the principle that even a layperson could achieve enlightenment, not necessarily through strict rules and prayer/meditation techniques, but also by abandoning rational thought and learning to explore intuition and out-of-the-box thinking. The importance of nirvana, reincarnation, and kharma were downplayed, while meditation techniques and riddles or stories called koans, were used to help students learn to concentrate, challenge their minds, and abandon purely logical thinking. Awareness would be the first step, many learned, toward enlightenment (satori in Japanese). Today, millions of people around the world practice, believe in, or associate with Zen, sometimes as religion, other times as a philosophy or way of life.

In typical Zen fashion, therefore, I leave it to you, my readers, to ponder how the image of a woman balancing gracefully between a tree’s roots and branches, combined with the story about Master Nansen, work together to illustrate my philosophy about education, and thus provide the focus for tonight’s Train-the-Trainer session in  Australia.

Namaste.

Choosing Trusted Caregivers For Seniors: A Comprehensive Guide

The decision to hire a caregiver for a senior loved one is a significant one, and it’s crucial to select a qualified and trustworthy caregiver. It’s difficult to trust someone with the care of your parents or grandparents, regardless of how well-meaning they may be.  However, there are steps you can take to ensure that you hire the right person. This blog post offers tips on choosing trusted caregivers for seniors to provide peace of mind that your loved one is in good hands.

Do your research

The first step is to research potential caregivers through referrals, online reviews, and references. You can reach out to friends and family, medical professionals, or senior care organizations to find trustworthy caregivers. The internet has made it easier to narrow down your search and look into the caregiver’s background. You can check for criminal records, professional licenses, and certifications, among other things. By doing your research, you’ll be able to identify the caregivers that meet your requirements.

Look for experience

Experience is an essential element when hiring a caregiver since it directly translates to the quality of care they provide. Consider hiring caregivers who have previously worked with seniors or who have undergone specific training in senior care and don’t forget to go through a better way in home care reviews. Ask the caregiver to share their experience working with seniors and how they’ve helped their patients. Understanding their approach to care is crucial in determining if they have what it takes to provide quality care.

Check for compatibility

Finding a caregiver that matches your loved one’s needs is essential, but finding one that matches their personality is equally as crucial. Senior care is more than just giving assistance with daily tasks; it involves building a relationship with your loved ones. Avoid hiring caregivers without taking their personality into account. Look for caregivers that have an upbeat attitude around seniors, are empathetic, and have excellent communication skills. The right caregiver should be able to connect with your loved one and build a long-lasting relationship.

Conduct interviews

Conducting interviews is a crucial part of choosing the right caregiver. Ask open-ended questions to learn more about the caregiver’s approach to care and how they plan to address your loved one’s needs. You can also inquire about their availability, the type of services they offer, and their expected compensation. Interviews are an excellent way to see if the caregiver is the right fit for your loved one and your family.

Monitor the caregiver

Monitoring is an essential aspect of hiring a caregiver. Before leaving your loved one under the caregiver’s care, ensure that you check in frequently until you’re confident that the caregiver is reliable and trustworthy. Monitor the caregiver’s interactions with your loved one and the quality of care they provide. You may also want to conduct surprise visits or request updates from the caregiver to ensure that everything is going smoothly.

Hiring a caregiver for a senior loved one is a huge responsibility. Choosing trustworthy caregivers for seniors requires extensive research, interviews, and constant monitoring. By doing your due diligence and selecting the right caregiver, you can have peace of mind that your loved one is in good hands. Remember to prioritize experience, compatibility, and oversee the caregiver’s care interactions to ensure that everything runs smoothly. Following this guide will help you find a caregiver that matches your loved one’s needs, personality, and gives them the quality of life every senior deserves.