The Sim Cafe~
Leading Through Mindfulness: Esmira Yusufova's Holistic Approach to Healthcare Simulation and Mindfulness
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Disclaimer/ Innoivative Sim Solutiuons Ad/ Intro:Join our host, Deb Tauber, as she sits down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation. Sit back, tune in and learn something new from The Sim Cafe. This week's podcast is sponsored by Innovative Sim Solutions. Are you interested in the journey of simulation accreditation? Do you plan to design a new simulation center or expand your existing center? What about taking your program to the next level? Give Deb Tauber from Innovative Sim Solutions a call to support you in all your simulation needs. With years of experience, deb can coach your team to make your simulation dreams become reality. Learn more at www. innovativesimsolutions. com or just reach out to Deb Contact today. Welcome to the Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host, Deb Tauber, and co-host Jared Jeffries as they sit down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation. Sit back, tune in and learn something new from the Sim Cafe.
Deb Tauber:Welcome to another episode of The Sim Cafe. Today we're so fortunate to have Esmira Yusufova. Thank you for being a guest, and why don't you tell our listeners a little bit about your background before we get started?
Esmira Yusufova:Thank you for having me here, Deb. So my background is in nursing. I've been a registered nurse for 15 years and I've always been interested in holistic nursing really empowering the patient to take care of their health. So I am a holistic nurse, certified holistic nurse, and my other passion was education. So right away when I joined nursing force I had a lot of positions where I was the educator and currently I'm a professor at SUNY Downstate. I run simulations and simulation is my other big passion.
Deb Tauber:Great, great. Now, Esmira, can you share your journey into nursing and how you got into healthcare simulation specifically?
Esmira Yusufova:Sure. So I joined nursing with an understanding that I'll be teaching. My parents are both teachers. That's what I knew and I always had this passion. But I never imagined simulation as my path. I didn't even understand what that was, and they were just building a simulation lab and they said well, you're creative, you're going to be the director of the center. I said I don't even know what simulation means. What do you mean? I'm going to be the director, I just want to be a professor here. They're like oh no, it's not debatable. So I was placed as the head of the simulation center that was being built and I said please, can I have some training? I really don't know what I'm doing here. They said, of course, I was sent to Drexel in January 2020. I guess it was the last Drexel course in person. And then COVID hit. So I went to Drexel and everything was open to me. I like, oh, this is simulation. Okay, there are rules, there are regulations, you know, there is a way to do it. So I came back really empowered and turned on my creativity, turned on my mannequins and start practicing from there. And so we had no scenarios, so I had to get creative.
Esmira Yusufova:Also, my background is in home care. So I was like, oh, we need a home care case. So I came up with an idea. I created a little case with the students to, you know, do a little scavenger hunt, assess their client's home. It was just so much fun. Like we put little mice, we bought them on Amazon, put them around the corners, because in New York having little creatures in apartments is very common, so students had to navigate through that and we made little bedbugs, put them out. I know, but it's so common in home care, we wanted to make it as realistic as possible. So it was a fun, fun little case I made. And there were other cases that I created as well, but that one, that one, was a lot of fun because you know I'm home care and that's something I enjoy and we don't do too many home care cases in simulation, I noticed.
Deb Tauber:Yeah, interesting, very interesting. Now I think one of the things you're very well known for in the simulation community is neurographic care. Why don't you explain that a little bit to our listeners, in case they don't know what it is, and we can talk about some of the other things that you do that are very interesting.
Esmira Yusufova:Yes, so I didn't know this growing up, but apparently I'm very artistic. It came out a little later in life and so during 2020, it was a very pivotal year for me. When we were all stuck at home during COVID, I was kind of bored, to be honest. So I started exploring different modalities healing modalities for myself, my family and I speak Russian, so I tend to go to Russian you know Russian authors and Russian psychologists for information. So I stumbled upon Neurographica. It is a healing modality, an art modality developed by Dr Pavel Peskarov. He's an engineer and also a psychologist, so what this art form does is through drawing. It's a very.
Esmira Yusufova:There are logics to these drawings. There's a stepwise drawing and you create these abstract drawings, but they help you transform your emotions, your thinking, your perspectives. So I used it a lot for myself when I was not too sure. You know we were living in that. We were not sure what was going to happen during COVID. We were all in limbo and there was a lot of unknowns. So through art, I helped transform my thinking. You know my limiting beliefs, and so one day I was thinking, oh, if I could just use it for myself, why can't I use it with my students. So I brought it to my classroom.
Esmira Yusufova:I was teaching a leadership class and a lot of students were ambivalent about being registered nurses. They didn't really understand what it's meant to be a registered nurse, or they were scared I can't remember too well at this point. So I said, okay, next class we're drawing. They're like sure we're drawing in class. I said, yeah, this is a voluntary activity. If you don't like to participate, you don't have to, but if you want to, we're going to draw. And when you draw in Neurographica, you have a theme, so you create a theme. So in this case, the theme was becoming a registered nurse. So I walked the students through the drawing and it helped them transform their thinking around becoming a registered nurse. How do I know this? You really don't know in the moment, but later on a student reached out and sent me a beautiful message on LinkedIn saying Professor, thank you so much. That art we did together really helped me. I was like, wow, this makes a difference. So from that time on, I really tried to incorporate it when I can. So from that time on, I really try to incorporate it when I can. It works well.
Esmira Yusufova:If you think about scenarios we run, sometimes students. They don't want to be in that scenario. Let's say somebody had a loss. I actually had a student like this. She just recently lost her father to CHF and then she has to come and be being a CHF case and provide care to a client who is experiencing CHF exacerbations. It is obviously traumatizing for that student. I did not use neurographica with the student but it would have been a great starting point in a pre-brief to really let her explore her feelings around CHF or maybe loss, and then perhaps participate in this scenario. She opted out of the scenario and that was allowed in that school.
Esmira Yusufova:But in those cases sometimes when we run scenarios, sometimes People get very emotional. You know, maybe they didn't do it so well I know myself when I was a Drexel. It still haunts me to this day. I didn't do exactly one step properly in the simulation and I was like, oh my God, how could I do that? I'm a registered nurse, I should have known better. But it happens Under stress we forget. What we're supposed to do. And that's the whole point of simulation is to practice. So when you face it in an actual patient scenario you can act accordingly. But long story short, in neurographic it can be applied in the pre-sim or it could be applied as a debrief. When we have all those emotions, neurographica really helps you draw it out and look at your emotions from a different perspective.
Deb Tauber:Now, what kind of media do you use? Do you use pencils or paints or crayons, or what kind of the author suggests?
Esmira Yusufova:that we use some form of markers. So I love Sharpies. I think I shop for Sharpies everywhere I go and they're always in my bag with me. So Sharpies are the best, but you can also use pencils. It is much harder to do it with like oil or paint, because it requires a little more precision. In Neurographica you literally do like a catharsis movement. You draw a random thing on paper and then you turn that randomness into a beautiful art and if you think about it, if you look at Neurographica pictures, they look like neuronal connections. I also like to call them spider webs, but that's just my interpretation. So it helps connect the neurons of our brain and create new ones, new pathways, so we're able to see the situation from a different angle, to explore our feelings and really to turn them into art.
Deb Tauber:Very interesting, very interesting. Now, Esmira, I think one of the things that's very interesting that you also do is you're interested in tarot cards and astrology, which are interesting in and of itself. Why don't you tell us a little bit about how you got interested in that and how you learned to do it?
Esmira Yusufova:Yeah, back to 2020,. As I was exploring these modalities, I ran into a school, an astrology school in Russia, and it was a four-year, four-year study and she promised that we're going to graduate, there's going to be a diploma, and I said, okay, another diploma, why not? But all jokes. So I signed up for a school in Russia and learned about astrology Astrology. The way I use it in my life is it helps me understand who I am. First and foremost, because through astrology, we look at a natal chart. What that means is the screen of the sky, the moment we are born. It's so important to know the exact moment we are born and where we are born. That dictates our, if you want to say, fortune, or our future or our life path and who we are through planets. So I start exploring myself. I never understood why. I felt a certain way and I was like, oh, that makes so much sense. And then, through astrology, I learned how to dress myself. We have Venus in our chart and it helps, guides how we should dress. I looked at yours and I think our Venuses are the same, so I can give you a few tips later. So really, it helps me understand who I'm talking to. You know who is in front of me and what drives that person, so we can have a good conversation.
Esmira Yusufova:And in class sometimes I use astrology. I'll just be like as a joke oh, whoever is an Aries, why don't you guys go finish first? So in astrology, Aries is always striving to be number one, and then students laugh, whoever is into astrology, and some look at me like what is she talking about? But it's just a conversation starter. I used it in simulation a few times at Columbia University. We run a simulation. We have a Hawaiian patient who has CHFX reservation, but her background plays a role. You know, she's from Hawaii, she practices Hopanopono, which is a prayer, and her birthday falls in the Aries season. So sometimes in the simulation I'm the voice of the patient. I'd be like oh yeah, I'm an Aries. And then some students would be like oh yeah, me too. Or they're like I don't know what that means, but OK, does that need to be incorporated into your care? So it's really interesting to see how students can take that information and personalize care as well, especially if they really understand what it means to be an Aries.
Esmira Yusufova:So just cool little situations. Same thing with tarot. As I start exploring astrology, I also run into tarot, took courses again with a Russian teacher, again with a Russian teacher, and it again helps me explore situations. Especially if I'm not sure how to make a choice, I'll use my deck. You know I have many of them. You can see behind me the whole selection and just it guides me in what to expect from my situation, like for today. I pulled the cards and I was like, oh okay, I know how this is going to go, so just the guidance for me.
Deb Tauber:Why don't you tell me when you pulled the card? What did it say?
Esmira Yusufova:So I pulled the cards and they're all from Major Arcana. That means they're very powerful and they're impactful. So it's the card of lovers, the wheel and the emperor. So I knew that we were going to have some kind of connection here and perhaps this, this podcast, is going to be a little bit of a turning point for me, and the emperor is that I'm in control and this information really needs to be shared and so that a lot of people can hear about it and can incorporate their own practices into their simulations and into their nursing practice and not be afraid right, right now, the other thing that you do, um, is your chair of the mindfulness special interest group.
Deb Tauber:Why don't you tell us a little bit about this special interest group how it got started, what when you meet, what your role is with that?
Esmira Yusufova:Yeah, I joined the mindfulness group at SSH because I saw the word mindfulness, I was like I need to be there. And so Dr Edwin Azaba was the chair at the moment and so I attended a few of his meetings and then I suggested that we draw neurographica. And he's like, of course, let's do it. And so I led my first. What I do the way I run the meetings is I invite people who are also into mindfulness and simulation. We had a speaker come and talk to us about her simulation center and how they incorporated mindfulness activities with the nursing students there.
Esmira Yusufova:I led another neurographic session. In fact we were invited to lead the workshops at the last meeting into IMSH 24. And so I led a few workshops on Neurographica and it was very well received. And my colleague led yoga sessions my coach here. Colleague-led yoga sessions, my coach here. What else did we do? So we invite people. Our last meeting I invited the holistic nurse, who is not into simulation but she practices mindfulness. So she led us through a beautiful meditation, mindfulness meditation, and then she showed us a few Tai Chi moves which were actually very challenging to do, and so if anybody is interested in simulation and mindfulness and incorporated it in any way, please reach out to me. I would love to have you and be our speaker.
Deb Tauber:Thank you, thank you. I know I've used some breathing strategies in my pre-briefing with learners and just giving them, you know, having them prior to starting the simulation do some deep breaths and then communicate to them that if during the simulation they start to get anxious, that they can go ahead and ground themselves utilizing those breathing techniques, and it was very effective.
Esmira Yusufova:Yes, thank you for bringing that up. We actually do use that as well. I always tell my students, especially the freshmen well, they're not freshmen, but the first year the students who take fundamentals is their first nursing course and they've never been exposed to simulation. So with them especially, I always tell them you're safe here, you know, let's close our eyes if you're comfortable, let's take a deep breath in you're going to do well, if you need to step out of the simulation, know that you can. You can take a time out, and so giving all those ground rules ensure psychological safety. But also, a student knows that it's okay to breathe and I tell them, if you're pressured in the simulation, just breathe. To tell your colleague I need a minute. You know, usually they work in groups and they've done it. They're like, okay, I just need a minute to think, and that's totally fine, we don't have to rush through this.
Deb Tauber:Right right. Do you have a favorite or most impactful simulation story you'd like to share with our learners?
Esmira Yusufova:Yeah, I really love the simulation we run at Columbia. I didn't create it, but I love running it because the client is from Hawaii and I get to create so many stairs. Sometimes she's an herbalist, sometimes she's a world traveler, and so, in any case, and she practices a prayer called Hoponopono. It's basically four sentences. You can look it up, you know. I'm sorry, please forgive me. I love you, thank you, it's just four sentences. And then I had a Hawaiian student and she told me it's not a prayer, it is actually a lifestyle. So that was a really good learning moment for me.
Esmira Yusufova:What I love about this case is that how we pay attention to the spiritual needs of this client, and I really love the topic of spirituality and spiritual care in nursing. And so we explore in the pre-brief what it means to be a registered nurse and what it means to provide spiritual care. So I'm like, oh, why do we even care? You know, and the students will be like, what do you mean? It's part of providing person-centered care. We have to take into account what the patient needs and wants. And so, in this scenario also, the client takes an herbal supplement called Nani Herb, and so I always say, oh, what is that?
Esmira Yusufova:And students, sometimes they don't look it up for pre-sim but during sim I'm like, why don't you take your phones and Google it for me? And they're like, oh, it increases your potassium. I'm like, okay, our client has potassium supplements prescribed and so how does this work together? So it's really awesome to talk about culture and how it impacts health, and then we talk about perhaps making referrals to a chaplain, and so it leads to a really beautiful conversation. And in the debrief as well, because the client in the scenario starts to pray, she just starts to pray, right, whenever she feels unsure, she just prays. And the students I've seen them offer their hand, offer to pray with the client. I've seen a student kneel next to the client and just in those moments I just go like, wow, we are creating a beautiful, beautiful generation of nurses who care, and it really makes me happy.
Deb Tauber:Yeah, thank you. I know in my 25 years in emergency medicine I've had many a time that I've prayed with the patient and when there's nothing else that you can offer, sometimes you can say, hey, you know, what we can do is we can say a prayer, and I don't think I've ever had a patient's family say no to that.
Esmira Yusufova:No, they're always welcoming Right, right and appreciated.
Deb Tauber:So, as far as these tarot cards go, do you do this? You know, set up a thing and do tarot card readings, or do you just if someone wanted to have their tarot cards read by you, would you set up a meeting with them? Yeah, so what?
Esmira Yusufova:I do is I have a lot of decks. I know you can see it, but probably the listeners cannot see it. I collect them, so it's a little obsession at this point. So you get to get a favorite deck anyway. So you have a million cards, but you always use one deck. So what you do is I usually schedule some time with the person and I, even before I meet with them, I pull a card to kind of understand what they're going to ask me, and so I'm more or less prepared. I had a ex-colleague call me one time and before she could say anything, I was like oh, so you're calling about this and that. And she's like how did you know that? I was like oh, so you're calling about this and that. And she's like how did you know that? I was like I don't know, I just already knew.
Disclaimer/ Innoivative Sim Solutiuons Ad/ Intro:And my cards already told me.
Esmira Yusufova:And she was like, okay, this is going to be interesting. So what I do is we schedule a private time and all the readings are private confidentiality. It's not just as a registered nurse. You are, you know, you are responsible, you're ethical. It's in anything else you do. You know reading tarot is also a responsibility and you know, because you are guiding people. At the end of the day, a person is taking your suggestions and it will impact them and they could take your suggestion or they don't have to. This is their choice. There's always a choice. That's what I always like to tell people. But it's a guidance, it's a guidance system, and the way I use it with clients is I answer the question and then I make a suggestion. It's the client's choice to proceed with that suggestion or to proceed with whichever way their heart desires. So those are the tarot cards, but they really speak loudly. I've noticed they've been very loud lately.
Deb Tauber:Very interesting. The other thing that sets you apart is your chair of the virtual simulation special interest group for INASCL. Yes, yeah, tell us a little bit about that group, what they're doing, um in in that work.
Esmira Yusufova:so INASCL . I love IN axel, I've joined right away. And um, so I got involved and became the. I start joining the virtual reality groups because for my research, I became interested in virtual reality, especially that I said how can we teach spiritual care in a more creative way? I said, oh, I've never seen a virtual reality case that teaches spiritual care. So I said, ok, perhaps that's going to be my research project.
Esmira Yusufova:So I joined a virtual reality group and Lisa was the chair at the moment. I came to her meetings. There was a lot of sharing of information, networking, and I really got to love the group. And then Elisa needed to step down and I was the co-chair at some point I don't remember when I became a co-chair and then, when Elisa stepped down, I became the chair. So I'm currently the chair, and the way I run those meetings now is I invite people who have a background in virtual reality.
Esmira Yusufova:A lot of I've noticed a lot of nurses are actually opening up their companies and I invited at least three registered nurses who run virtual reality companies and programs. So they came and explained to us how their programs can benefit the nursing students. They always tell us you know little tidbits about virtual reality. Who else did we have? We also had a few meetings on, like, how to apply for grants. We also had a few meetings on how to apply for grants. Again, if you're interested in virtual reality or just how to run virtual realities, please join the group. We have monthly meetings every second Monday of the month and we usually have a guest speaker. And if you want to be a guest speaker again, please reach out to me. Perhaps my LinkedIn could be put in the description or, through Deb, you can always reach me.
Deb Tauber:Yeah, yeah. Now where do you see virtual reality in nursing education, since you're pretty involved with it, you know, pretty involved with it.
Esmira Yusufova:I love it for the fact that you can do it on your own, your own pace, and you can do it as many times as you please. And it's very consistent. So you know if in the mannequin scenario, I can change the patient and make them an herbalist one time if I feel like it, and the next time they're a world traveler In virtual reality. It's a pretty consistent story and you get to repeat your skill set. And I also like the fact that it teaches the effective, so we know that you can learn empathy in virtual reality. So that's really helpful.
Esmira Yusufova:Because it is expensive to hire SPs and so having a virtual reality and then running those conversations multiple times is beneficial because, let's be honest, just from having a one-time conversation with an SP, it's not enough. And but SPs if you run the simulation five times, the cost, it adds up. But with VR, what I see is once you purchase the program and the equipment, then you can use it as many times as you want and the return on your investment is much greater. And then you don't need to schedule with anybody because your student can just get in there whenever. Much greater, and then you don't need to schedule with anybody because your student can just get in there whenever, let's say, they're bored at home at 10 pm, they could run their simulation scenario. They're not bound by time or space. Well, they do need some space to function, but you know there's more freedom in that.
Deb Tauber:Right, right Now, kind of follow up with our final question what advice would you give to others in healthcare on incorporating their personal interests or hobbies into their professional life?
Esmira Yusufova:To be honest, I was, I felt, split for many years, and what I mean by that is that I had this esoteric side to me, this artistic side, and then I had this healthcare scientist side to me, and I wasn't quite sure how to merge the two. It took me a while to get comfortable speaking about my interests outside of healthcare and how it can be incorporated in healthcare. So what I would suggest is to get comfortable with yourself first, and once you discover who you are, then you can bring your whole self to whatever you are doing in healthcare, be it simulation, be it something else. But you have to get comfortable with what you're doing and you have to get comfortable talking about what you're doing before you fully incorporate it into your healthcare practice.
Deb Tauber:Thank you. Is there anything else that you want to add for our listeners?
Esmira Yusufova:Thank you. I just thank you for listening and thank you for having me here and please reach out to me. I would love to chat with anybody who resonates with any topics that I mentioned during this interview.
Deb Tauber:It's been a pleasure and an honor and I thank you for what you're doing. Thank you so much, Deb. I appreciate it. Thank you and happy simulating.
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