The role of reflective practices in enabling final year nursing students to respond to the distressing emotional challenges of nursing work

Learning from a situation of discomfort - a qualitative study of physiotherapy student practice in mental health

Purpose: This qualitative study aimed to explore how physiotherapy students learn during practice as physical activity mentors for mentally ill individuals. The practice took place in an everyday environment without the presence of a supervisor.Methods: Information was collected through three focus group interviews with 16 students in their second year of study. The data were analyzed using thematic analysis, based on a sociocultural learning perspective.Results: Three main categories summarize the students' experiences. 1) Experimenting and adapting the activities. The students were challenged through communication and relationship-building, and they had to adapt the activities to the clients' state of mind; 2) Experiencing clients breaking social and cultural codes. The students felt responsible for ensuring the clients did not draw unwanted attention to themselves, which forced them to explore creative solutions; and 3) Learning from situations of discomfort. The students learned from having to cope with unpredictable and embarrassing situations without a supervisor present.Conclusions: Practice as physical activity mentors for mentally ill individuals can stimulate students' learning through reflection in and on action. To avoid stigmatizing behaviors, process experiences and enhance learning, we suggest a frequent and standardized access to supervision.

Anxiety, mental illness, learning disabilities, and learning accommodation use: A cross-sectional study

BACKGROUND

Nurse educators require a robust understanding of nursing students' attributes to meet their learning needs and support their success.

PURPOSE

This research seeks to understand the proportion of nursing students with self-reported medically diagnosed anxiety, mental illnesses (MI), learning disabilities (LD), and utilized learning accommodations (LA), and determine how these students compared to a normative sample regarding studying and test-taking anxiety.

METHOD

A secondary analysis of quantitative cross-sectional data that included the Academic Success Inventory for College Students (ASICS) tool. First-year students were surveyed (4-6 weeks after program start, and students in years 1 through 4 were surveyed at the end of both academic terms.

RESULTS

At program start, 21% were diagnosed with anxiety, 16% with MI, 2% with a LD, and 6% accessed LA. By fourth-year these proportions were 23%, 22%, 8% and 13% respectively. Alarming proportions of respondents exhibited anxiety related to test-taking compared to the ASICS normative sample with large effect sizes (Anxiety h = 0.884; MI h = 0.601; LD: h = 2.094; LA h = 0.725).

CONCLUSION

To support students, we highlight a need for early identification and tailored support, enriched faculty knowledge, faculty introspection and willingness to adapt, and time for relational and individual pedagogy.

A unique program for nursing students to enhance their mentalization capabilities in relation to clinical thinking

While nurses strive to provide optimal patient-centered care, this is not always straightforward, as some cases are more emotionally charged than others - depending on the patient's mental, emotional, and physical state, and on the nurses themselves. Therefore, in order to provide accurate therapeutic responses while maintaining their own personal well-being, nurses must develop strong mentalization capabilities. We present a unique program for nursing students, specifically targeted at enhancing their mentalization abilities as part of their communication skills for dealing with emotionally charged situations. In the program, he students first learn to identify what leads them to experience increased emotional loads and how this affects their mentalization processes. Next, they learn alternative coping patterns for their benefit, enabling their own emotional regulation while providing optimal care for their patients. Conducted in small groups, this holistic four-year program is led by experienced clinical nurses and psychologists; the learning is based on actual experiences encountered by the students during their clinical experience.

Improving Attitudes and Perceptions About End-of-Life Nursing on a Hospital-Based Palliative Care Unit

Nurses play an integral role in high-quality patient care. Thus, their skills in providing end-of-life care should be assessed and continually enhanced. Education intended to improve end-of-life skills must address the affective/emotional component of nursing care. Evidence demonstrates that emotional engagement and resilience among health care providers are correlated with improved quality outcomes and, conversely, that burnout and stress negatively affect patient safety. Addressing the emotional needs of health care providers is critical to improving quality throughout the health care system. An evidence-based workshop was implemented among direct care staff on a hospital-based palliative care unit, with the goal of fostering emotional engagement to improve staff perceptions and attitudes about caring for patients at or near the end of life. Although perceptions about quality of death were not affected by this intervention, there was a significant improvement in attitudes about end-of-life nursing care. Qualitative feedback also reflected appreciation for small group discussions and opportunities to debrief with peers away from the unit. This intervention reflected the value of emotional engagement in educational efforts to improve end-of-life nursing care.

Pharmacy Students' Utilization of an Online Tool for Immediate Formative Feedback on Reflective Writing Tasks

Objective. To assess pharmacy students' perceptions of the benefits and utility of a novel online reflective-writing tool. Methods. After completing a required Academic Writing Analytics (AWA) workshop, Master of Pharmacy students submitted a reflective writing assignment in the AWA web application. A six-item survey was administered to students prior to and immediately after using AWA. Results. Sixty students volunteered to participate in the study; however, only 39 students provided a pseudonym that allowed their pretest and posttest to be matched. A comparison of students' responses on the pretest with those on the posttest, which was administered four weeks after the workshop, suggest a noticeable increase in agreement with AWA's benefits as an effective, online tool for improving their reflective learning skills. Conclusion. This novel online tool has the potential to assist pharmacy students with self-critiquing and improving their reflective writing assignments prior to submission. Furthermore, as the elements of reflection are transferable, this tool has the potential to be used in other educational contexts.

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.

Reflection and peer feedback for augmenting emotional intelligence among undergraduate students: A quasi-experimental study from a rural medical college in central India

BACKGROUND

Professionalism is the foundation of the doctor-patient relationship with emotional competency at its core. This competency is based on emotional intelligence (EI), contributing to effective work performance. As EI is reasonably new in health professions education in India, this study was conducted to assess the effect of reflection and peer feedback on EI scores among undergraduate medical students and explore facilitating and hindering factors for augmenting EI.

METHODS

This pre- and post interventional study was conducted among 94 final-year (Part I) medical students from a rural medical college in Central India. Baseline assessment of EI scores was done using a self-reported validated EI scale, and then, a mini-workshop was conducted to sensitize students on EI and to train them in writing reflection and giving peer feedback. Between the pretest and posttest, students were asked to write weekly reflection and take monthly feedback from the "peer" of their choice. Posttest assessment was done at 1 week, 1 month, and 3 months. Force-field analysis was undertaken with 10 students each with highest and lowest EI scores to assess facilitating and hindering factors.

RESULTS

There was a significant improvement (P < 0.0001) in the EI scores at each subsequent time point from baseline. Students who were male, from nuclear families and considered themselves spiritual had significantly higher median EI scores. Students reported self-motivation, social support, and openness to learn new things as enabling forces for augmenting EI. Hindering factors were time constraint and lack of mutual trust in the relationship between students.

DISCUSSION

Based on the findings, it can be concluded that personal introspection methods such as self-reflection and peer feedback help to improve the EI of undergraduate students. Therefore, it is imperative that the students are trained in these skills for building their emotional competencies.

Reflective Responses Following a Role-play Simulation of Nurse Bullying

A qualitative exploratory design was used for this study to evaluate role-play simulation as an active learning strategy. The context for the role-play was bullying in nursing practice. Following a simulation, 333 students from five college campuses of three universities completed a reflection worksheet. Qualitative thematic findings were personal responses, nonverbal communications exhibited, actions taken by participants, and the perceived impact of bullying during the simulation. Role-play simulation was a highly effective pedagogy, eliciting learning at both the cognitive and affective domains.

The personal tutor as a role model for students: humanising nursing care

This article explores how nurse academics in one British university uphold and role model the humanising framework developed by Todres et al (2009) . It gives a brief overview of nurse education in the UK. Next it outlines the nature of the personal tutor role. It then offers an overview of the humanising framework, its background and embodiment in the undergraduate nursing curriculum. It explores how nurse academics role model humanisation and how this influences and impacts on students' ability to live and apply the humanising dimensions of nursing to enhance patients' lived experience of care. It concludes with examples of how this encourages positive meaningful relationships between students and tutors.

The Use of Phenomenology in Nursing Education: An Integrative Review

AIM

The purpose of this integrative review was to synthesize research to address two questions about phenomenology in nursing education: How has Husserlian phenomenology been used in nursing education? What is the importance of Husserlian phenomenology in nursing education?

BACKGROUND

Phenomenology is utilized in nursing education to explore the experiences of faculty and students.

METHOD

Whittemore and Knafl's integrative method guided the analysis of the research. Nine articles meeting inclusion criteria were reviewed. Studies addressed faculty student experiences.

RESULTS

The reviewed research revealed that phenomenology is used in nursing education to understand, identify, describe, and explore various phenomena.

CONCLUSION

New knowledge gained from this integrative review about phenomenology is beneficial to nursing education.

Content Analysis of Student Essays after Attending a Problem-Based Learning Course: Facilitating the Development of Critical Thinking and Communication Skills in Japanese Nursing Students

The importance of active learning has continued to increase in Japan. The authors conducted classes for first-year students who entered the nursing program using the problem-based learning method which is a kind of active learning. Students discussed social topics in classes. The purposes of this study were to analyze the post-class essay, describe logical and critical thinking after attended a Problem-Based Learning (PBL) course. The authors used Mayring's methodology for qualitative content analysis and text mining. In the description about the skills required to resolve social issues, seven categories were extracted: (recognition of diverse social issues), (attitudes about resolving social issues), (discerning the root cause), (multi-lateral information processing skills), (making a path to resolve issues), (processivity in dealing with issues), and (reflecting). In the description about communication, five categories were extracted: (simple statement), (robust theories), (respecting the opponent), (communication skills), and (attractive presentations). As the result of text mining, the words extracted more than 100 times included "issue," "society," "resolve," "myself," "ability," "opinion," and "information." Education using PBL could be an effective means of improving skills that students described, and communication in general. Some students felt difficulty of communication resulting from characteristics of Japanese.

Effect of a clinical skills refresher course on the clinical performance, anxiety and self-efficacy of the final year undergraduate nursing students

Although the final year of nursing undergraduate programs that focus on clinical education are planned to prepare nursing students to better transition to the real world of health care service; evidence has shown that this program is not sufficient to reach this end goal. This controlled trial study was to investigate the effectiveness of a basic clinical skills refresher course for nursing students before entering the internship program. The sample consisted of 160 undergraduate nursing students assigned into two groups. The intervention was a three-day refresher course directed by nurse instructors for intervention group focused on 10 basic nursing procedures in the clinical skill lab. The control group did not receive any intervention. The students' anxiety, clinical self- efficacy and clinical skills practice were measured before and after intervention in both groups. The results indicated that the students who took part in the refresher course experienced lower anxiety levels, higher levels of clinical self-efficacy, and have better clinical skills during their internships. The undergraduate nursing curriculum can be strengthened by the basic clinical skills refresher course. This refresher course can bridge the theory - practice gap and provide a better transition from the student to nurse role.

Developing mature empathy among first-year students: The learning potential of emotional experiences

Nursing students’ ability to develop mature empathy requires emotional work, usually associated with caring experiences in relation with patients and next of kin. This article is based on qualitative in-depth interviews with 11 first-year students, and the research questions were: What characterizes situations in a nursing home that evoke strong emotional reactions in first-year students? What is the learning potential of these experiences? Findings show that facing emotionally challenging situations during their first clinical placement in nursing education aroused strong feelings and commitment among the students. The students tried, however, to find ways to handle emotionally challenging situations both with support in scientific literature, as well as from experience. Nurses were important role models, but could also exemplify characteristics of less empathic behaviour. Developing ‘mature empathy’ requires emotional work so that the students learn to adapt themselves to what will be demanded of them as professional nurses. The findings of this and other studies should alert nurses as well as teachers to the importance of helping students develop empathy as part of their learning trajectory in nursing education.

Realising the dream of becoming a nurse: Underrepresented BSc nursing students experiences

BACKGROUND

This paper describes the experiences of underrepresented BSc nursing students in realising the dream of becoming a nurse in one university. In the past ten years, pre-registration nurse education has become established within higher education in Ireland. This development includes promoting access and inclusion of students from traditionally underrepresented groups in higher education. A third of nursing students currently access places on programmes through routes specifically designed for underrepresented groups.

METHODS

A qualitative descriptive study design provided an opportunity for student voices to be heard. Ethical approval was sought and granted. Eleven students were interviewed nearing completion of a four year BSc Nursing programme. Data analysis followed a thematic approach, in generating themes.

FINDINGS

Three themes emerged from the data: taking the first steps; finding a way and getting through. Findings highlight participants' challenges in balancing study, clinical practice and family life in achieving and realising their dream of becoming a nurse.

CONCLUSION

This study illustrates the nature and complexities of participants' experiences throughout the BSc Nursing programmes towards becoming university graduates, eligible for registration as a nurse. Students from underrepresented groups bring rich and diverse life experiences in preparation for and becoming caring practitioners. It highlights the individuality within participants' experiences and draws attention to the value of personalised support for students. An opportunity to encourage the development of emotional intelligence needs to be fostered within nurse education programmes. Creating positive learning environments is critical to supporting student understanding of compassionate patient centred care. Findings have relevance for global curriculum design and structures to support individual student centred engagement. Further research is required to consider how best to support students from underrepresented groups.

Contemplative Activities in Undergraduate Nursing Courses

BACKGROUND

Affective learning is valued in nursing, but it is often difficult to plan and evaluate learning activities in this domain. Contemplative activities can promote learning and are relatively easy to implement. These activities can promote deep, reflective thinking.

METHOD

A variety of contemplative activities were used in undergraduate nursing courses. Students participated in and reflected on a vigil promoting domestic violence awareness. They attended two different art exhibits and related these exhibits to nursing. The students used journals and eportfolios to reflect on the entire nursing program. They participated in breathing exercises and guided imagery meditations.

RESULTS

Students evaluated the activities positively, and their reflections were thoughtful.

CONCLUSION

Contemplative activities can be useful to develop affective competencies. [J Nurs Educ. 2017;56(6):378-382.].

Stress and anxiety among nursing students: A review of intervention strategies in literature between 2009 and 2015

Undergraduate nursing students experience significant stress and anxiety, inhibiting learning and increasing attrition. Twenty-six intervention studies were identified and evaluated, updating a previous systematic review which categorized interventions targeting: (1) stressors, (2) coping, or (3) appraisal. The majority of interventions in this review aimed to reduce numbers or intensity of stressors through curriculum development (12) or to improve students' coping skills (8). Two studies reported interventions using only cognitive reappraisal while three interventions combined reappraisal with other approaches. Strength of evidence was limited by choice of study design, sample size, and lack of methodological rigor. Some statistically significant support was found for interventions focused on reducing stressors through curriculum development or improving students' coping skills. No statistically significant studies using reappraisal, either alone or in combination with other approaches, were identified, although qualitative findings suggested the potential benefits of this approach do merit further study. Progress was noted since 2008 in the increased number of studies and greater use of validated outcome measures but the review concluded further methodologically sound, adequately powered studies, especially randomized controlled trials, are needed to determine which interventions are effective to address the issue of excessive stress and anxiety among undergraduate nursing students.

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.

Reflective practice and its implications for pharmacy education

Pharmacy students require critical-thinking and problem-solving skills to integrate theory learned in the classroom with the complexities of practice, yet many pharmacy students fall short of acquiring these skills.(1-2) Reflective practice activities encourage learning from the student's own experiences and those of others, and offer a possible solution for the integration of knowledge-based curricula with the ambiguities of practice, as well as enhance communication and collaboration within a multidisciplinary team. Although reflective practices have been embraced elsewhere in health professions education, their strengths and shortcomings need to be considered when implementing such practices into pharmacy curricula. This review provides an overview of the evolution of theories related to reflective practice, critically examines the use of reflective tools (such as portfolios and blogs), and discusses the implications of implementing reflective practices in pharmacy education.