Lecturers' experiences of facilitating guided group reflection with pre-registration BSc Nursing students

A systematic scoping review of group reflection in medical education

BACKGROUND

Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician's professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate 'protected time' for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study.

METHODS

A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion.

RESULTS

1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections.

CONCLUSIONS

Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.

Improving nurses' knowledge, attitude, and performance in relation to ethical codes through group reflection strategy

BACKGROUND

The most basic responsibility of nurses that even precedes their therapeutic role is respect for professional ethics in providing clinical care. The present study was conducted to determine the effect of group reflection on the knowledge, attitude and performance of nurses in relation to ethical codes.

METHODS

The present blinded, before-after, educational trial was conducted on 86 nurses working at a general hospital in the south of Iran who were randomly divided into a intervention (n = 44) and a control (n = 42) group. Data were collected before and after the intervention using three tools, including a knowledge test, an attitude rating scale and a performance questionnaire. In the intervention group, the intervention given consisted of four sessions of group reflection, and the control group received a single lecture on ethical codes.

RESULTS

The mean changes in the nurses' score of knowledge after the intervention compared to before differed significantly in both intervention and control groups (P < 0.001), but there was no significant difference between the two groups in terms of the mean changes in the score of knowledge (2.73 ± 3.45 in intervention group vs. 2.57 ± 3.36 in control group, P = 0.83). Although the mean score of attitude differed significantly between the intervention and control groups in the posttest (34.7 ± 8.44 in intervention group vs. 29.95 ± 9.09 in control group, P < 0.014), the two groups were not significantly different in terms of the mean changes in the score of attitude in relation to ethical codes before and after the intervention (P < 0.14). Moreover, the two groups were significantly different in terms of the mean changes in the scores of performance in the two stages (9.07 ± 16.84 in intervention group vs. 0.67 ± 20.01 in control group, P < 0.001).

CONCLUSION

Group reflection can improve the knowledge, attitude and performance of nurses in relation to ethical codes. Although lectures can help improve nurses' knowledge and attitude in this area, they have no significant effects on their performance.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (No: IRCT2016070317546N6, registration date: 10 October 2016), https://www.irct.ir/trial/16112.

Reflective writing pedagogies in action: a qualitative systematic review

OBJECTIVES

Reflective practice is a core value of nursing education and emphasizes the self as a source of learning. Writing and reflection are often viewed as inseparable. The goal of this qualitative meta-study is to explore the mechanisms writing stimulates to promote learning transformation for nursing students in both clinical and classroom contexts.

METHODS

A literature search using the CINHAL, Medline, ERIC, and Academic Search Complete databases, using systematic methods, identified 26 papers and dissertations which gathered narrative data from nursing students in pre- and post-registration undergraduate courses.

RESULTS

Three themes were found describing: 1) Evolving through time and space to reflect; 2) Surfacing and absorbing; and 3) Trust, judgement, and social desirability in the feedback process.

CONCLUSIONS

Transformative learning is promoted through forming a bond with faculty during the writing process to normalize emotions, create critical self-awareness, and providing a safe, non-judgemental space to reflect on their practice and their learning.

Reflective practice during action learning in management development programmes

Purpose

This study aims to investigate the aspects that influence reflective practice during an action learning approach to management development programmes (MDPs).

Design/methodology/approach

A narrative inquiry approach was used to gather interview and pictorial data from 16 participants who had attended an action learning oriented MDP. Data were translated into interpretive stories using McCormack’s lenses, which were further analysed using thematic analysis.

Findings

Two key themes emerged: dealing with emotions and practising reflection. Participants initially found reflecting uncomfortable, but showed courage by persevering. Participants had to learn how to reflect and set aside time for it, while valuing support and guidance from their action learning facilitator.

Research limitations/implications

The findings and recommendations may not be relevant to all types of action learning as action learning forms and contexts differ.

Practical implications

Reflective practice is the responsibility of both the participant and the action learning facilitator. Participants need to create the time and space to learn, be fully present during reflection, practice mindfulness and have the courage to be uncomfortable while reflecting. Action learning facilitators could encourage reflection by creating a safe learning environment, selecting a diverse action learning team, designing reflection time into the MDP and helping participants apply reflection tools.

Originality/value

Reflective practice enhances learning; yet there is a need to better understand reflective practice in an action learning context. This study provides empirical evidence of the aspects that influence the reflection process and outcomes as well as practical guidelines to participants and facilitators on how to promote reflection.

Guided group reflection: A question of organisation and support for baccalaureate nursing students: Part1

This paper focuses on an innovation and development of a guided reflective approach currently offered at a university in Ireland. Significant collaborative structures and processes were created and implemented in providing guided protected reflective time for fourth year pre-registration BSc Nursing and Midwifery students. This initiative is explored within a case study approach. Undergraduate preregistration programmes aim to develop practitioners towards becoming fit for purpose, compassionate and competent in meeting global health care needs. In the current educational literature, there is much about reflection from a theoretical learning stance. Minimum attention has been given to the practicalities surrounding the structures and processes providing learning spaces where reflection can flourish. Reflective practice offers learning opportunities to guide the development of self and practice critical for future learning. Guided reflection is described as an appropriate learning strategy influential in sense making for practice for final year pre-registration BSc undergraduate students.

Lecturers' lived experiences of guiding reflective seminars during nursing education

In the present study, reflective seminars were integrated during a three-year nursing programme in Sweden. The specific characteristics of the reflective seminars are built upon a foundation in lifeworld theory and caring science. As teaching in higher education demands an academic degree but not necessarily formal pedagogical education, lecturers involved in reflective seminars are often left without guidance concerning what constitutes a reflective learning activity in nursing education. The aim of the present study is to describe the lived experience of guiding reflective seminars during nursing education from the lecturers' perspective. Eight university lecturers were interviewed. To capture humans' lived experiences, the present study is imbued with the principles of reflective lifeworld research. The result indicates that the reflective seminar includes the need for activity, balance and safety, which is further developed through the following constituents: a foundation in caring science contributes to security; guiding the reflection requires continual vigilance; a lack of trust in oneself inhibits the ability to guide reflection and closeness to the students. In summary, the result indicates that guiding a reflective seminar is an exhausting mission in which the lecturer has to balance the moment according to a multifaceted level. Further development of mentoring and introduction to the assignment are needed.

Addressing ethical concerns arising in nursing and midwifery students' reflective assignments

BACKGROUND

Written reflections on practice are frequently requirements of nursing curricula. They are widely accepted as necessary for improving critical thinking and problem-solving skills. Faculty, are expected to review reflections and provide feedback that helps professional development and facilitates good practice. It is less clear what the actions of nurse educators should be when ethical infractions are revealed in the narratives.

OBJECTIVES

We had two aims: 1) To combine insights from a literature review of empirical and theoretical research related to responding to ethical issues revealed in student reflections with our experiences reviewing the reflections of undergraduate nursing and midwifery students, and 2) to construct and analyze a hybrid case from these insights in order to develop guidelines for nurse educators.

RESEARCH DESIGN

A literature review was conducted using CINAHL, MEDLINE, PsycINFO, SocINDEX and ERIC databases and pertinent key words. A hybrid case was constructed of commonly encountered ethical issues using insights from the literature review and the authors' experiences. The case was analyzed by combining Beauchamp and Childress' principlist approach with Campbell and McCarthy's ethical decision-making tool (Table 1). Participants and Research Context: No human participants Findings: A gap in the literature exists related to addressing ethical issues revealed in student practice reflections. However, a combination of insights from the literature and the authors' experiences facilitated the development of a hybrid case. Subsequent case analysis facilitated the development of a series of guidelines that can be utilized to address a range of issues commonly emerging in the reflections of nursing students during practice experiences.

DISCUSSION

A number of recommendations and guidelines are provided to enable the safeguarding of students and staff and support them in practicing ethically.

CONCLUSION

Structured ethical analysis of a constructed hybrid reflection of commonly revealed ethical issues was useful in developing guidelines for educators.

Students' and teachers' experiences of participating in the reflection process "THiNK"

OBJECTIVES

Reflective journal writing in clinical practice is used as a tool in bachelor programs in nursing. The reflection process THiNK was developed to enhance students' reflection processes. It was tailored to the needs of a nursing programme (in Norway) as former studies showed that many students had superficial level of reflection in their reflective journals, few students applied knowledge to their reflections and some met unprepared in the guided reflection groups. The teachers had inconsistent focus on the importance of reflection as a way of learning. This study aimed to describe students' and teachers' experiences of participation in reflection processes.

DESIGN AND METHOD

The development of THiNK is inspired by educational design research. This study used focus groups to gain insight into students' and teachers' experiences of the reflection processes. Data were analysed using qualitative content analysis.

PARTICIPANTS AND SETTING

The empirical sample included 5 focus groups with 28 students and 7 teachers in a bachelor nursing program at a University College in Norway.

RESULTS

The themes were as follows: stop and verbalise the experiences, stimulate and support the reflection processes and develop a conscious attitude. The students became aware of themselves and their own execution. The teachers and reflection groups were crucial in order to learn to see the complexity of a given situation and helped draw connection between the situation and the theoretical knowledge.

CONCLUSIONS

Enhancing students' professional development requires attention to facilitation skills as well as other contextual factors. Readiness in the culture can be ensured by tailoring frameworks of reflection that replies to students' and teachers' requests. Participating in reflection processes facilitates integration of modes of thinking when dealing with clinical situations.

Facilitating classroom based interprofessional learning: a grounded theory study of university educators' perceptions of their role adequacy as facilitators

The provision of inter professional learning (IPL) within undergraduate programmes is now well established within many Higher Education Institutions (HEIs). IPL aims to better equip nurses and other health professionals with effective collaborative working skills and knowledge to improve the quality of patient care. Although there is still ambiguity in relation to the optimum timing and method for delivering IPL, effective facilitation is seen as essential. This paper reports on a grounded theory study of university educators' perceptions of the knowledge and skills needed for their role adequacy as IPL facilitators. Data was collected using semi structured interviews with nine participants who were theoretically sampled from a range of professional backgrounds, with varied experiences of education and involvement in facilitating IPL. Constant comparative analysis was used to generate four data categories: creating and sustaining an IPL group culture through transformational IPL leadership (core category), readiness for IPL facilitation, drawing on past interprofessional learning and working experiences and role modelling an interprofessional approach. The grounded theory generated from this study, although propositional, suggests that role adequacy for IPL facilitation is dependent on facilitator engagement in a process of 'transformational interprofessional learning leadership' to create and sustain a group culture.