Javier Leiva – Blog


Category: General

SBAR: Situation, Background, Assessment, Recommendation

SBAR is a technique that helps facilitate communication mainly used by health care workers. See the following paragraph from SBAR Communication Helps Nurses (Minority Nurse, 2015):

The SBAR communication method relies on standard steps which a nurse can fine-tune with experience. The acronym stands for the steps needed – situation (state what is going on very briefly); background (relevant information about medications or prior diagnosis); assessment (what you think is going on and needed); and recommendation (what are you asking the physician to do – change medication or reassess patient, etc.).

Let’s see it in action in this example originally published on SBAR Nursing: a How-to Guide (Rivier University, 2016):

“Dr. Jones, this is Deb McDonald RN, I am calling from ABC Hospital about your patient Jane Smith.”


“Here’s the situation: Mrs. Smith is having increasing dyspnea and is complaining of chest pain.”


“The supporting background information is that she had a total knee replacement two days ago. About two hours ago she began complaining of chest pain. Her pulse is 120 and her blood pressure is 128 over 54. She is restless and short of breath.”


“My assessment of the situation is that she may be having a cardiac event or a pulmonary embolism.”


“I recommend that you see her immediately and that we start her on O2 stat. Do you agree?”

But SBAR can also be used to document decision-making processes. That is what Adam Braus proposes in his book Leading change at work. The technique allows to clearly describe an issue, explain the relevant details, summarize metrics that will help inform the decision, and finally make and explain the decision.

Thinking that it could be helpful to me, I put the technique to the test. Here is the result:


I am consistently gaining weight.


Like many other people, I started working remotely when the COVID-19 pandemic started, at the beginning of 2020. I had been careful about my nutrition and doing regular exercise for years. The uncertainty and new situation of the pandemic made it difficult to keep eating healthy, but at least I kept running regularly for some months. Later that year, around October, I got injured and completely stopped exercising for a while. I have not recovered the level of activity since.


I’ve lost the good habits I had been practicing for years, and I need to get back on track.


Getting back to good habits seems impossible, so I need to get started and then progress little by little. I’ll begin exercising again regularly, even if it’s not a lot. Years ago, I only started running when I felt my body was asking for it after my hiking pace had consistently increased for some time. I think it would be a good idea to have the same approach this time. Simultaneously, I’ll try to get back to better nutrition habits. As being very strict from the beginning is hard, I’ll start by increasingly reducing sugars and other junk food.

Simple, right? Looking at it from the outside, I’m sure it can even feel stupid: are you getting fat? Stop eating and start exercising! But things are often not that easy when we have to assess and decide about ourselves, no matter if personal or professional. SBAR seems pretty intuitive to me, and it can help see some clarity when in need. Now, the next thing I need to do is drinking a glass of water instead of grabbing that piece of chocolate that suddenly showed up in my mind.

The Prosci Adkar Model for Change Facilitation

Pamela Witter delivered one of the 2020 CEhp Fundamentals 101 webinars yesterday. The webinar title was Building Change Thinking into Healthcare CE Programming, and it was full of good ideas.

One of the tools that I found more useful was the ADKAR Model for facilitating change. Jeff Hiatt, the founder of Prosci, developed this model, which is simple but practical.

ADKAR stands for:

  • Awareness: do you know if a change is needed, and WHY?
  • Desire: being aware of WHY making that change WILL HELP YOU is the only way to want it.
  • Knowledge: do you know HOW to make the change?
  • Ability: are you ABLE to do it, considering the answer to the previous question?
  • Reinforcement: once done, how able will you to MAINTAIN the new situation?

Pamela shared an ADKAR Assessment template that helps analyze each of these elements and score it from 1 to 5. The elements with the lower scores are the barriers you need to overcome to make the change possible. In the image below, the person is lacking the necessary knowledge to make the change. The solution? Acquiring more knowledge 🙂

Author: Pamela Witter

Homelessness Myths

I started reading The Librarian’s Guide to Homelessness, by Ryan J. Dowd. Evan Kozierachi recommended me Dowd’s newsletter some months ago, and I followed his advice. It’s excellent, so I am recommending it to you know.

I am only one chapter into the book, but I feel every word teaches me something new. Powerful pages. The author shares a list of what he calls the ten (plus one) homeless myths:

  1. People are homeless for a long time.
  2. Most homeless are mentally ill.
  3. Most homeless people are addicts.
  4. Most homeless people are unemployed.
  5. Most homeless people are old men with long beards.
  6. Most homeless people are stupid and/or uneducated.
  7. Homelessness can happen to anyone.
  8. Homeless people know they are homeless.
  9. Homeless people like libraries because libraries are warm and dry.
  10. Homeless people are nothing like you and me.
  11. Homeless people are just like you and me.

1 and 5 are very connected. Only about 10% of the homeless are what he calls people who experience chronic homelessness. This is the old men with long beards we are used to thinking about when we think about homelessness. The other 90% is people that don’t look like homeless: people that often have a job (4) and a degree (6). Part of them are homeless for a short term, and others a little more but manage to get out of it despite issues like addiction or illness (not all, but part of them: 2 and 3).

10 and 11 can seem contradictory, but they are not. They are not like you (assuming you are not experiencing homelessness) and me (I’m not, fortunately) because you have probably not been through the issues that have taken them to that place in life: abuses, long-term unemployment, the loss of a child, etc. Events that modify the way people see life, and that you can’t understand if you haven’t experienced. At the same time, they are just like you and me: they have dreams, love people, like to be loved, they went to the school when being kids, had friends (7), fell in love… they don’t see themselves as homeless people the same way you don’t see yourself as the three-bedroom house guy (8).

I’ve been thinking about this fragment for the last 24 hours:

Next time you see some ragged soul with a cardboard sign panhandling on the side of the road remember: […] thinking that homeless people are totally different than you is wrong and dangerous.

Finally, 9:

A library card is one of the few attributes that fully defines who is a member of the community. […]

“I was born in this town. Some guy who just moved to town yesterday can get a library card, but I can’t. I mean, did I stop being part of this community when I got evicted?

So much to process for only one chapter. Eager to learn about the next sixteen.

5 Ideas to Encourage Caregivers Publishing Activity

Sonal Chandratre was one of the speakers at the Rural & Community Medical Educators Virtual Conference 2020. She titled her talk How do We Publish Without Doing Research?, and the aim was to identify opportunities that go beyond the peer-reviewed, data collection-involved type of publications. Here is a screenshot from her presentation to clarify what that means:

After the talk, I shared how in library sciences is very common to write about the tools we use, processes, books (reviews), etc. I also said that blogs are often an excellent tool for those less formal publications.

The discussion part of the session included some excellent ideas to encourage physicians and other caregivers to write and publish more. I made a little list of them, with some brief comments and resources added:

  1. Writing Clubs: identify a common interest, set up small groups, develop ideas, make a calendar, and start writing and publishing. This idea reminded me of two projects I’ve been part of: Thinkepi (Library and Information Sciences specialists) and Tradiling (Translation and Language specialists). A writing club in the medical field: The Pegasus Physician Writers at Stanford. Another useful resource: American Medical Writers Association.
  2. Bulletin board to share for a few days/weeks the latest publications made by the organization caregivers. It can include posters.
  3. Publications expo/conferences: once or twice a year, set up an area where authors share their latest works, leading to discussion, new ideas, and more publications.
  4. Writing courses: they can answer to different goals, and the design can be very different among them. I think it can be a good idea to link them to other initiatives, like the Writing Clubs or the Publications expo/conferences. A couple of examples: Fundamentals of Healthcare Writing (Society for Technical Communication) and Foundational Skills for Communicating About Health (University of Michigan).
  5. Incentives: points that convert to money (for caregivers) or credits (for students) after a certain period of regular publishing activity, or some published items.

Fresh Air

This post is a brief celebration. Not a big one, because there are still eleven active wildfires in Oregon (plus a lot of others in neighbor states), but a celebration anyway. When we woke up today, Bend had a 434 AQI (hazardous), but it dropped to 25 (good) in the evening. It looks like we survived the smoke apocalypse, after all. YAY!

I can’t even believe it, and I am very much looking forward to going for a run tomorrow morning and have a deep breath of fresh air.

A positive thing out of this experience: I’ve discovered a great blog about weather and climate issues that I want to recommend: Cliff Mass Weather Blog. Mass predicted what was going to happen today and explained why smoke is so hard to predict.

Update (9/19/2020): I went for that run first thing in the morning. It felt so good! I took a picture in the same place I took another one three days ago when we were better after having stayed above the 500s for a few days. It was the planet Earth again, today. Here are the two pictures put together:

Update (9/20/2020): it was cloudy yesterday. As it was beautifully sunny during my new morning run, I couldn’t resist creating another picture. Here it is!

The First D in the ADDIE Framework: Design

ADDIE is an instructional design framework that stands for Analyze, Design, Develop, Implement, and Evaluate. I am going to focus on D (Design).

Note: this is a summary of the MLA course Guide to Instructional Design Basics.

When designing any learning experience, we need to identify the learning outcomes first. They should be measurable, so we can later determine if the instruction was adequate. We must design the learning experience to meet these outcomes.

To create learning outcomes, there is available the Bloom’s taxonomy:


  • By the end of the session, students will be able to use operators and filters to refine database searches (apply)
  • By the end of the session, students will be able to design a program that allows the robot to escape a maze (create)

Once you have identified the outcomes, the orientation session can be designed using Gagne’s 9 events.

  1. Gain the attention of the students
  2. Inform learners of the objectives (learning outcomes)
  3. Stimulate recall of prior learning
  4. Present the content
  5. Provide learning guidance
  6. Elicit performance (practice)
  7. Provide feedback
  8. Assess performance
  9. Enhance retention and transfer

Besides preparing a slide-based presentation or other informative, engaging material for the session (4, Present the content), it’s often a good idea to also work on a handout that can help with retention and transfer (9). After the session, evaluation is critical to design more effective learning programs in the future.

Do you Kill your Dead Friends?

Sorry about the title. I wasn’t sure what was the best way to put it. I am not talking about physically killing a dead friend. First of all, because it’s a friend, and people don’t usually kill friends (I mean, it happens, but). Secondly, you can’t kill someone who is no longer alive.

I am talking about people whom you are friends on online social platforms, and they die. What do you do with them? Do you keep them on your friend’s list or accept the reality and let them go?

When the first of my Facebook friends passed away, I wondered what I should do. I put some thought on it, and finally decided to keep her. One thing is the person goes; a different one is that you actively delete them. Besides, she was not only a Facebook friend but someone I truly loved. Simply erasing her avatar from my list seemed too hard; it felt like killing her again. It would have probably been easier if she had only been a Facebook friend.

That was in 2015. Since then, another five Facebook friends have passed away (plus another different four from LinkedIn that I am aware of). In some cases, people for whom I also had a lot of affection. Like the first time, I decided to keep them after wondering a bit. 

But I am getting old, and, if I keep being around, I suppose this will be happening more and more often. I don’t want to end up owning an online cemetery. Today I decided I was ready to let my friends go and pressed the killing button. They will remain alive in my memory, which I guess is where they’re supposed to be now.

Smoke Apocalypse in Oregon

The fires keep burning Oregon, but fortunately for us, they have not reached Bend so far. The forecast says we are in extreme danger, though. Let’s hope for the best.

But as it was expected, we have been under a heavy smokey condition since Friday. I am inside, wearing a mask, and my eyes burn. Doors and windows are closed, but we can still feel the smoke it’s finding its way to sneak inside.

As of now, the Air Quality Index (AQI) in Bend is 408. We reached 529 the two previous days, and it will rise again this evening. Everything above 300 is considered hazardous, and the scale stops at 500, so we have been off the charts for more than two days. We’ll be there again most of the time, at least until next Tuesday. Holy cow! Of course, there is nowhere we can go to breathe some clean air. Everywhere in the State of Oregon is the same, and we wouldn’t even be able to run away by air because all the Redmond flights are canceled.

2020 is a year of learning to put it in some way. We’ve known about infection rates and other pandemic concepts we had never heard of before COVID-19 came to our lives. Now I see myself continually checking the AQI recordsfire perimeter maps, satellite images, etc. Crazy.

On Friday, I put on a mask and went for a short drive. I wanted to take some pictures and shoot a couple of videos. You can see a selection below. Being from Osona, I am used to foggy weather; made of burned trees, wildlife, and structures, not that much, though.

Wildfires in Oregon

When I write this post, there are 38 active wildfires in Oregon, and around 900,000 acres have disappeared under the fire in the last three days. A considerable part of the Cascade Range is burning down.

Source: Oregon Military Department

Last Sunday, we hiked the Tamolitch Trail to the Blue Pool. I assume all that area is gone now. We drove by the Santiam Pass: gone. Some weeks ago, we went to Salem and crossed the beautiful Detroit. The town is not there anymore. More than half a million people are in evacuation zones, which is more than 10% of the Oregon population (around 10% of that total were already evacuated). Awful.

The numbers are devastating, but I didn’t understand the burned acres’ magnitude, so I thought I’d convert it to square km: 3,642.17. That makes 60.35 km (37.5 miles) for each side of the square. Then, as I still know Catalonia a lot better than Oregon, I decided to check what 3.642.17 sq km would look in that area. Here is the result:

I can’t imagine all that area burned down. Every single tree and structure, gone. From Barcelona to Vic to almost Solsona to some point between Igualada and Valls. However, this is what is happening in Oregon (and it will keep going until… I don’t know).

In Bend, we are well so far. We had a lot of smoke on Monday, and the forecast says it will be back even worse tomorrow and for the rest of the weekend. But for now, no fires. I am keeping my fingers crossed so that doesn’t change.

FIRST Lego League Challenge

It’s starting to look like I am going to lead a FIRST Lego League team this fall. I have experience with activities about robotics, but I have never been part of any FLL challenge, so I thought I’d start by gathering some resources to put myself in context.

What I am mostly interested in are experiences and practical information than I can apply when the time comes: how the sessions with the kids are, what details I need to consider, the main mistakes to avoid, and so on. I know the general information about the program because I attended some ORTOP webinars in July.

The Oregon Robotics Tournament and Outreach Program (ORTOP) is recognized as Oregon’s longest running continuum of K-12th grade STEM focused, robotics programs. ORTOP is a trusted non-profit, with more than 18 years of experience implementing and showing successful impact over all FIRST programs in Oregon.  To accomplish its statewide non-profit mission, ORTOP partners with FIRST, an internationally recognized educational foundation as it distributes coach, teacher, and team training programs, hosts tournaments and provides funding support to the most disadvantaged and under-resourced communities and need. These programs are FIRST LEGO League, FIRST Tech Challenge, and FIRST Robotics Competition.

There are some resources that have already helped me so far. The first of them is a blog post written by Ruth Ferland: My Experience Starting a FIRST LEGO League Jr. Team. Ruth has been leading teams for the last couple of years. She explains her experience and shares several links to resources that are going to help me a lot.

Another useful resource is the Youtube channel LEGO Robotics Mr. Hino. Mr. Hino has ten years of experience coaching FLL teams, and some of his videos are relevant for what I am looking for at the moment (some others will for sure help me later).

Also, I have started to take a look at the FIRST Curriculum for Educators. The resources are divided by age, and I see it connects the topic with the NGSS standards. I still need to look further into that one.

It’s just three resources that are helping me know where to start and how to move forward from there. We’ll see where all of it takes the team that I will hopefully be part of very soon.