Exploring new nurse teachers’ perception and understanding of reflection: An exploratory study

"Nursing and speech and language students' perspectives of reflection as a clinical learning strategy in undergraduate healthcare education: A qualitative study"

AIM

The aim of this study was to explore nursing and speech and language students' perspectives of reflection as a clinical learning strategy during years three and four of their undergraduate education programmes.

BACKGROUND

Reflection is recognised as a core student learning activity which is widely used in undergraduate healthcare education for clinical practice. Studies indicate that structured models and frameworks do help novice students to develop the process of reflection-on-practice particularly in years one and two. However, there is limited research on healthcare students' perspectives of reflection as a clinical learning strategy in the latter years of their undergraduate healthcare education (years 3 and 4).

DESIGN

A qualitative descriptive design was used.

METHODS

Using a self-reporting method whereby students respond to a series of questions posed by the researchers, data were collected from nursing (n = 20) and speech and language students (n = 26) in one university in Ireland and analysed using thematic analysis.

RESULTS

The findings from both nursing and speech and language students were similar. Three themes identified included: description of reflection, undertaking reflection and contribution to clinical learning. Most students expressed beneficial effects of reflection for personal and professional clinical learning. Some students reported negativities to the written reflections, expressing a preference for more diverse and less structured strategies and more face-to-face reflective discussions with clinical educators.

CONCLUSIONS

Whilst the benefits of reflection for clinical practice are well versed in this study, the authors suggest that academic and clinical educators employ more diverse and innovative reflective tools for healthcare students who are at a more competent level of their undergraduate education programme. Further interprofessional research in relation to different clinical reflective strategies for healthcare students in years three and four of their undergraduate education programmes is warranted.

Exploring the needs and experiences of educators in facilitating use of the Bass Model of Holistic Reflection

Health professionals are required to reflect on practice to evaluate and improve care in rapidly changing health care environments. This study explored the professional development needs of educators facilitating development of reflective capacity in midwifery students using the Bass Model of Holistic Reflection. Thirteen midwifery academics at two Australian universities took part in the study conducted in three phases. Phase 1 identified the learning needs of educators described as 'understanding the building blocks of reflection'; 'practical application of the model, and 'assessment of reflective capacity'. Phase 2 involved an Intervention including development of a reflective practice tool kit and delivery of a two-day workshop. Phase 3 evaluated the experience of educators using the resources and four themes emerged: 1) 'Educators value a reflective practice toolkit'; 2) 'A toolkit builds confidence and trust in the model through promotion of deep personal reflection'; 3) 'Effective use of the model is key to achieving consistency in application by educators; and 4) 'Deeper understanding of the model promotes transformation of practice'. This paper confirms the importance of developing resources for educators, that support reflective pedagogy when implementing models of reflection into curricula.

Triggers for reflection in undergraduate clinical nursing education: A qualitative descriptive study

BACKGROUND

Reflection is a key component of effective teaching in baccalaureate nursing education. However, there are limited empirical studies into the factors which trigger reflection in undergraduate clinical nursing education.

OBJECTIVES

This study aimed to explore reflection triggers in undergraduate clinical nursing education with a specific focus on verbalized reflection in spoken dialogues.

METHODS

This qualitative descriptive study was conducted in 2017-2018. Participants were seventeen clinical nursing instructors, 32 nursing students, and nine newly graduated nurses who were purposively recruited from four universities and two hospitals in Iran. Data were collected via 26 in-depth semi-structured face-to-face interviews with clinical nursing instructors and newly graduated nurses and four focus group discussions with students. Conventional content analysis was used for data analysis.

RESULTS

Reflection triggers fell into the following four main categories: conscious comparison of actions, confrontation with influential realities, emotional and moral involvement in patient care, and demanding accountability.

CONCLUSION

This study suggests triggers for reflection in clinical nursing education. Instructors' use of reflection triggers can help students reflect on their actions and practice.

Effects of an evidence-based practice education program using multifaceted interventions: a quasi-experimental study with undergraduate nursing students

BACKGROUND

Although Evidence-Based Practice (EBP) should be introduced early on in nursing education to develop students' independence and self-learning ability, there are few such courses for undergraduate nursing students in Korea. This study examined the effects of the EBP education program for undergraduate nursing students (EBP-EPUNS) on nursing students' knowledge, skills, attitudes, competencies, and future use of EBP.

METHODS

A quasi-experimental study design with pre-test, intervention, and post-test was used. The participants were 44 nursing students (experimental: 22, control: 22). A 20-h long EBP-EPUNS consisting of 5-step EBP components was provided through 8 sessions spread across 4 weeks.

RESULTS

An independent t-test and a repeated-measures ANOVA showed that the experimental group had statistically significant higher post-test scores on EBP knowledge (p < 0.001), skills (p < 0.001), attitudes (p < 0.001), competencies (p < 0.001), future use of EBP (p = 0.001), and critical thinking (p < 0.001), compared to the control group.

CONCLUSION

The EBP education program was effective in improving the knowledge, skills, attitudes, competencies, and future use of EBP among nursing students. Hence, we recommend the EBP education program as a general education course for undergraduate nursing students to promote needed proficiency in EBP.

An evaluation of the appropriateness and effectiveness of structured reflection for midwifery students in Ireland

Midwifery students undertaking the undergraduate midwifery education programme in Ireland participate in facilitated reflective sessions that aim to develop their skills of reflecting on and in clinical practice. This paper presents a qualitative evaluation of the appropriateness and effectiveness of the facilitated reflection sessions for pre and post-registration midwifery students in two large Dublin maternity teaching hospitals. The aim was to evaluate structured reflective practice sessions which sought to assist midwifery students to become competent reflective practitioners. Group reflection sessions were conducted weekly in a clinical practice area at the same time each week over one academic year. After the series of structured reflective sessions, midwifery students and facilitating staff were invited to evaluate the reflective process. This evaluation consisted of a self-completion survey to identify the factors that facilitated and impeded student participation in the sessions. Respondents answered a series of questions about the reflective practice sessions and were also invited to enter qualitative data regarding their subjective experiences of the process in free text boxes. The data were then collated into themes by an independent reviewer. The results of the evaluation clearly indicate that midwifery students and facilitators welcomed the opportunity to engage in group reflection sessions as a form of peer support and as a catalyst for learning from clinical practice. Findings suggest that reflective practice can contribute to the development of skilled, self-aware and engaged practitioners.

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.

Embedding evidence-based practice among nursing undergraduates: Results from a pilot study

Evidence-based practice is currently one of the most important developments in health care. Research in nursing science is rapidly growing; however, translating the knowledge based on this research into clinical practice is often hampered, and may be dependent on reflective skills. The aim of this study was to see how undergraduate nursing students in nursing should increase their skills and knowledge related to evidence-based practice through participation in clinical research projects. A qualitative approach was used in collecting and analyzing the data. Students participated in a pilot clinical research project and a received guidance related to their bachelor thesis. After the project was completed, all students filled in a questionnaire. The students' motivation to participate in this study was reported to be high, but they reported low knowledge related to evidence-based practice. All students reported that their attitude towards evidence-based practice changed in a positive direction during their participation in the project. Evidence-based practice influenced nursing practices by putting more focus on critical thinking, increasing pride and giving a sense of ownership in the clinical field. The curricula and the pedagogical perspectives in nursing education can influence the attitude towards evidence-based practice and skills among nursing bachelor students.

Professional Development Needs of Novice Nursing Clinical Teachers: A Rapid Evidence Assessment

The current nursing profession is challenged with a decreasing supply of competent clinical teachers due to several factors consequently impacting the quality of nursing education. To meet this demand, academic nursing programs are resorting to hiring expert nurses who may have little or no teaching experience. They need support during their transition from practice to teaching. Using the systematic approach of a Rapid Evidence Assessment (REA), scholarly literature was reviewed to identify existing professional development needs for novice clinical teachers as well as supportive strategies to aid the transition of experienced nurses into teaching practice. The REA included 29 relevant studies. Findings revealed three main professional development needs for novice clinical teachers and key supportive strategies. Based on these findings recommendations for best practices to support and prepare novice clinical teachers are presented.

El diario del estudiante de enfermería en la práctica clínica frente a los diarios realizados en otras disciplinas. Una revisión integradora

El presente artículo es una revisión integradora de la literatura cuyo objetivo fue identificar, en revistas nacionales e internacionales indexadas en las bases de datos Isi Web of Knowledge, Eric, PubMed, EbscoHost, Scopus, SciELO, Cuiden, Cuidatge y Scirus, en el periodo comprendido entre 1995 y 2011, datos que contribuyeran a determinar cómo la escritura del diario reflexivo ayuda al estudiante de enfermería durante sus prácticas clínicas, así como a establecer diferencias y similitudes con los diarios realizados por estudiantes de otras disciplinas. Se llevó a cabo una revisión amplia de la cual se seleccionaron 54 artículos científicos con base en criterios de inclusión y exclusión, sin descartar ninguna metodología de investigación e incluyendo aquellos que analizaran el diario del estudiante, fueran o no del ámbito de la enfermería. Se concluye que la escritura del diario reflexivo que realiza el estudiante de enfermería durante sus prácticas clínicas tiene beneficios tales como la mejora de la comunicación con el paciente, fundamental para el cuidado. La escritura del diario debería ser incluida en todos los planes de estudio de grado en el ámbito de las prácticas clínicas.

Nurse Educators’ Perspectives on Student Development of Reflection for Psychiatric Mental Health Nursing Practice

Psychiatric nursing, in various parts of the world, including regions of Canada, is recognized as a distinct nursing profession. In psychiatric mental health nursing practice, reflection is considered a foundational skill given the relational nature of nurses’ therapeutic work. Communicating the significance of reflection for practice to students and teaching this intangible skill is challenging for educators. The purpose of this qualitative study was to explore with psychiatric mental health nurse educators their views on how they develop reflective practitioners. Participants’ perspectives and experiences in teaching reflective practice were captured in four themes: building the use of self as an agent of change, building skills of reflection/building the habit of reflection, building a bridge between theory and practice, and building a continuing reflective practice – from student to practitioner. Recommendations include a systematic incorporation of reflection into a curriculum and creating supportive learning environments that facilitate the development of reflective practitioners.

Continuing Professional Development - reflections from nursing and education

The tradition of engaging in reflective practice for learning is firmly entrenched in the discourse of nursing. This is also the situation for the field of education. This commonality provided the stimulus for this paper. The purpose is to provide an account of the value of reflection as a tool for critical thought in relation to learning through a case study of two Continuing Professional Development (CPD) programmes in different professional contexts (nursing and teaching) and geographical locations (the United Kingdom and Singapore). The authors, who are educators of teaching and nursing practitioners respectively, exchanged narratives of professional experience in order to frame reflections on practice of CPD programmes. They problematised what it means for nurses and teachers to learn, and how this learning might be judged by both the participants and the facilitators of CPD programmes. Adopting a critical and reflexive approach to practice supported the authors' professional learning. One common issue evident from the reflections of practice raised questions in relation to how participants might provide evaluative feedback of CPD programmes in socially desirable ways. This was foregrounded as an important issue to be considered by the authors when designing and facilitating CPD programmes and suggests implications for other educators of nursing and teaching practitioners.

Reflective components in undergraduate mental health nursing curricula: some issues for consideration

After reflective practice took nursing by storm 20 years ago it is timely to re-examine its influence and implementation on undergraduate teaching. Elements of reflection in relation to learning, matters that affect students and teachers in the classroom and on clinical placements, are reiterated. Interpersonal ethical concerns and issues associated with students' emotional responses to the situations on which they reflect also are considered. We have identified a number of elements that must be considered from both the student's and educator's perspectives to ensure safe and appropriate reflection activities are used in mental health-specific or non-specific undergraduate nursing subjects.

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

The development of reflective practitioners is integral to undergraduate nursing degree programmes. This study reports on lecturers' experiences of facilitating guided group reflection with pre-registration BSc Nursing students.The research purposively sampled lecturers (n=7) working in a department of nursing and midwifery at a third level institute in Ireland, all of whom were registered nurses. Using a qualitative research approach, data was collected through audio-taped semi-structured individual interviews. The data were thematically analysed using guidelines developed by Braun and Clarke (2006). Tripartite researcher discussion and further analysis of these initial individual analyses led to consensus regarding the three themes arising from the study. These were: Being a facilitator; Facilitating reflective learning and Creating structure. The discussion centred on: having knowledge and experience to effectively facilitate guided group reflection; the influence of the facilitator's personal philosophy on reflection and adult learning on group facilitation; and finally concerns regarding professional responsibility in response to students' reflective practice accounts.

Critical Care nurses' understanding of the NHS knowledge and skills framework. An interpretative phenomenological analysis

AIMS

This small-scale research study aimed to explore Critical Care nurses' understanding of the National Health Service (NHS) Knowledge and Skills Framework (KSF) in relationship to its challenges and their nursing role.

BACKGROUND

The NHS KSF is central to the professional development of nurses in Critical Care and supports the effective delivery of health care in the UK. KSF was implemented in 2004 yet engagement seems lacking with challenges often identified.

DESIGN

This qualitative study adopted an Interpretative Phenomenological Analysis framework.

METHOD

Data were collected from five Critical Care nurses using semi-structured interviews that were transcribed for analysis.

RESULTS

Two super-ordinate themes of 'engagement' and 'theory-practice gap' were identified. Six subthemes of 'fluency', 'transparency', 'self-assessment', 'achieving for whom', 'reflection' and 'the nursing role' further explained the super-ordinate themes. Critical Care nurses demonstrated layers of understanding about KSF. Challenges identified were primarily concerned with complex language, an unclear process and the use of reflective and self-assessment skills.

CONCLUSIONS

Two theory-practice gaps were found. Critical Care nurses understood the principles of KSF but they either did not apply or did not realize they applied these principles. They struggled to relate KSF to Critical Care practice and felt it did not capture the 'essence' of their nursing role in Critical Care.

RELEVANCE TO CLINICAL PRACTICE

Recommendations were made for embedding KSF into Critical Care practice, using education and taking a flexible approach to KSF to support the development and care delivery of Critical Care nurses.

Encouraging reflection: Do professional development workshops increase the skill level and use of reflection in practice?

Reflection is a way of evaluating best practice and challenging existing norms, while at the same time, considering one’s personal values and assumptions in our personal and professional lives. However, many health practitioners may lack the skills to do this effectively. Through participation in a series of three workshops, practitioners in the Radiation Medicine Program at Princess Margaret Hospital have learned and acquired new skills to encourage reflection and reflective practice in themselves, their colleagues as well as with their students. A pre- and post-course survey was used to ascertain their level of knowledge of reflection and reflective practice. An additional survey at 3 months assessed the frequency of use and ongoing comfort level with reflective practice. Results of the evaluation indicate that the participants’ knowledge of reflective practice has improved their understanding of reflection in clincal practice. They recognize the importance of reflection and anticipate increasing their use of reflection in/on practice. As well, participants have been able to sustain the positive momentum 3 months after the course was delivered.