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

Exploring the Usefulness of Theory-Guided Reflection During the COVID-19 Pandemic

During 2 massive open online course sessions in 2020-2021, learners shared lived experiences during the coronavirus disease-2019 (COVID-19) pandemic within a framework of theory-guided online discussion. We analyzed 211 COVID-19-related learner narratives from online discussion boards. Themes included sharing concerns and strategies related to patients separated from loved ones, honoring strengths in self and colleagues, valuing shared support among work colleagues, realizing the importance of self-care, voicing concerns about working conditions, and recognizing the impact of theory-guided shared reflection. Themes reflected personal knowing and attributes related to the American Association of Colleges of Nursing Essentials for Nursing Education. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A56.

Moving and Handling Children After Death: An Inductive Thematic Analysis of the Factors That Influence Decision Making by Children's Hospice Staff

Hospices for children and adolescents in the United Kingdom provide care to the bodies of deceased children in specially designed chilled bedrooms called "cool rooms." In an effort to develop resources to support hospice practitioners to provide this specialist area of care, this study aimed to identify the factors that influence decision making when moving and handling children's bodies after death in a hospice cool bedroom. An internet-based survey was sent to all practitioners employed by 1 children's hospice. A total of 94.9% of eligible staff responded (n = 56). An inductive approach to thematic analysis was undertaken, using a 6-phase methodological framework. Three core themes were identified that inform practitioners' perception of the appropriateness of moving and handling decisions: care of the body, stages of care, and method of handling. The complexity of decision making and variation in practice was identified. Practitioners relied on both analytical and initiative decision making, with more experienced practitioners using an intuitive approach. Evidence-based policy and training influence the perception of appropriateness and the decisions and behavior of practitioners. The development of a policy and education framework would support practitioners in caring for children's bodies after death, standardizing expectations and measures of competence in relation to moving and handling tasks.

The lived experience of being an undergraduate midwifery student in the neonatal unit

OBJECTIVE

The objective of this study is to examine the experience of undergraduate student midwives in the neonatal unit.

BACKGROUND

Clinical experience is an essential component of education for the development of competent midwives. Literature has highlighted the pivotal effects of precepting and how it contributes to student experience. Although there is a plethora of research examining undergraduate student midwives' experience, to our knowledge this is the first study exploring their experience in the neonatal unit.

DESIGN

Based in phenomenology, eight semi-structured interviews were conducted producing rich data.

METHODS

Following informed consent and ethical approval, post transcription, the data were coded using Colaizzi's (1978) framework.

RESULTS

Significant themes and sub-themes emerged such as course design, environmental experience, sources of stress and preceptor experience. The student experience very much depends on the preceptor, how busy the environment is and if appropriately staffed.

CONCLUSIONS

Based on these findings there are suggested recommendations including adjusting the timing and length of the placement and how to improve the environment based on the preceptor-student relationship. Also, suggestions on how consistency and communication can be improved are proposed.

Reflection as a learning strategy for the training of nurses in clinical practice setting: a scoping review

OBJECTIVE

The objective of this review is to identify and map the tools and approaches used for reflection as a learning strategy for nurses and nursing students in clinical settings.

BACKGROUND

Several types of reflection interventions exist to develop nurses' reflective competencies in clinical practice. This scoping review mapped the available literature on the use of reflection in the education of nurses and nursing students in clinical settings. Three questions guided the review: i) What tools and approaches for reflection have been reported? ii) What levels of reflection have been identified (low/descriptive, middle/application, or high/evaluative)? iii) What outcomes of reflection have been reported?

INCLUSION CRITERIA

Studies investigated nursing students or nurses working in clinical settings involved in patient care, and described reflective interventions and definitions of reflection, descriptions of the contents reflected on, measurement instruments, and outcomes of interventions.

METHODS

MEDLINE (PubMed), Emcare (Ovid), MEDLINE (Ovid), ERIC (ProQuest), CINAHL (Ovid), and Web of Science databases were searched for full-text studies published in English, Danish, Swedish, or Norwegian. Studies from any country and published from 2007 to September 2020 were eligible for inclusion. The review followed the JBI methodology for scoping reviews and was based on an a priori protocol. Two independent reviewers assessed studies against the inclusion criteria and extracted data. Inclusion for review was determined according to the pre-determined eligibility criteria and consensus between researchers. Data were extracted using a standardized data extraction table and results were summarized narratively with accompanying tables.

RESULTS

Seventeen articles were included; nine quantitative studies and eight qualitative studies. Findings are presented separately due to varying study designs and outcomes. Most studies used physical tools and reflective dialogues in clinical settings. Some tools included specific questions for participants to reflect on, while others included open questions or no questions. Reflective approaches included lectures, workshops, or reflection with supervisors or peers in clinical settings. None of the 17 studies included the same combination of tools and approaches. Measurement of reflection was varied across articles, and there was a lack of standardization in how reflection outcomes were classified.

CONCLUSIONS

Interventions, tools, approaches, and the measurement of nurses' reflection in clinical settings are highly varied, and none of the included studies had the same combination of elements. The studies indicate that reflection skills are achieved potentially according to the tools and approaches used, and the foci for reflection. There is little agreement among the research community on how best to assess the measurement and quality of reflection. It is recommended that future studies are explicit on the classification of low-, middle-, and high-level reflection according to standardized criteria.

A participant perspective on collaborative reflection: video-stimulated interviews show what residents value and why

The potential of reflection for learning and development is broadly accepted across the medical curriculum. Our understanding of how exactly reflection yields its educational promise, however, is limited to broad hints at the relation between reflection and learning. Yet, such understanding is essential to the (re)design of reflection education for learning and development. In this qualitative study, we used participants' video-stimulated comments on actual practice to identify features that do or do not make collaborative reflection valuable to participants. In doing so, we focus on aspects of the interactional process that constitute the educational activity of reflection. To identify valuable and less valuable features of collaborative reflection, we conducted one-on-one video-stimulated interviews with Dutch general practice residents about collaborative reflection sessions in their training program. Residents were invited to comment on any aspect of the session that they did or did not value. We synthesized all positively and negatively valued features and associated explanations put forward in residents' narratives into shared normative orientations about collaborative reflection: what are the shared norms that residents display in telling about positive and negative experiences with collaborative reflection? These normative orientations display residents' views on the aim of collaborative reflection (educational value for all) and the norms that allegedly contribute to realizing this aim (inclusivity and diversity, safety, and efficiency). These norms are also reflected in specific educational activities that ostensibly contribute to educational value. As such, the current synthesis of normative orientations displayed in residents' narratives about valuable and less valuable elements of collaborative reflection deepen our understanding of reflection and its supposed connection with educational outcomes. Moreover, the current empirical endeavor illustrates the value of video-stimulated interviews as a tool to value features of educational processes for future educational enhancements.

BSc nursing & midwifery students experiences of guided group reflection in fostering personal and professional development. Part 2

Reflective practice is a learning strategy supporting preregistration nursing and midwifery students in meeting everyday clinical practice challenges. This paper reports on a development and innovation evaluation using a qualitative approach exploring students' experiences of guided group reflection organised during fourth year undergraduate internship. Data were collected through student feedback and interviews using a descriptive approach. Three categories emerged from the findings; beginnings for reflective learning, engaging in reflective learning and being a reflective practitioner. Students reported that guided group reflection provided positive opportunities for enhancing confidence. Students demonstrated understanding of reflection and valued reflective time within the closed group structure, which fostered personal and professional development. Findings support the benefits of the established collaborative guided group reflection structures. Guided group reflection is described as a valuable learning strategy on the journey of becoming a nurse in an ever-demanding health care practice world.

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.

Bounce back- bounce forward: Midwifery students experience of resilience

Resilience is considered a vital characteristic and has gained attention in midwifery practice and education. In particular, midwifery students face challenges during their education in both academic and clinical components of the program. There is need for greater understanding and strategies to develop resilience in the midwifery student population. The aim of this study is to gain insight into how midwifery students conceptualise resilience, and explore how education might support the development of resilience. A focus group was conducted as part of a broader study underpinned by a concept analysis methodology to explore the students understanding of resilience. Participants included six third year midwifery students from one university. Thematic analysis was used to analyse the data. Four key themes were identified. Resilience contextualised to midwifery was triggered by exposure to adversity; resilience was identified as the ability to bounce back and move forward, and was seen to be important for midwifery students. The concept of resilience appears to play an important role in student success. Evidence suggests resilience can be developed and education providers have a role to foster student's resilience. Findings offer strategies to strengthen resilient behaviour for the midwifery student population and provide a basis for further research.

Bereavement care education and training in clinical practice: Supporting the development of confidence in student midwives

AIMS

To improve the confidence in student Midwives to provide bereavement careto parents following pregnancy loss and perinatal death.

BACKGROUND

The one-day interactive Educational Training Workshop in Bereavement Care (ETWBC) was developed for student midwives in their final year of their B.Sc. Midwifery Degree Programme and those completing a Higher Diploma in Midwifery to help improve their confidence to provide bereavement care in clinical practice.

DESIGN

A longitudinal sequential mixed-methods design was used to evaluate the outcome and processes of participation in the Workshop. This paper reports on the outcome evaluation.

METHODS

Participants completed the study questionnaires at all 3 time points: pre/post workshop and 3 month follow-up. Thirty nine of the 41 student midwives (Higher Diploma and 4th year B.Sc.) participated in the workshop. 97.44% (n = 38) of the participants completed all the questionnaires.

RESULTS

Participation in the ETWBC increased student's midwives confidence (measured using knowledge and skills scales); Bereavement support skills [F(2,72) = 21.150, p < .000, partial eta squared = 0.370] and Bereavement support knowledge [F(1.6,60) = 48.460, p < .000, partial eta squared = 0.567]to provide bereavement care. Improvement in Student Midwives' level of self-awareness of the needs of bereaved parents [F(2,72 )= 20.311, p < .000, partial eta squared = 0.361] and of their own personal needs [F (1.7, 61) = 30.387, p < .000, partial eta squared = 0.458] in relation to providing bereavement support were also found.

CONCLUSION

Participation in the Education Training Workshop on Bereavement Care helped increase student midwives confidence to provide bereavement care to grieving parents and to increase their self-awareness around their clinical practice in this area. The ETWBC is recommended as a brief effective educational intervention for inclusion in Midwifery curricula which could be modified for use with other relevant professional groups.

Critical thinking evaluation in reflective writing: Development and testing of Carter Assessment of Critical Thinking in Midwifery (Reflection)

OBJECTIVE

develop and test a tool designed for use by academics to evaluate pre-registration midwifery students' critical thinking skills in reflective writing.

DESIGN

a descriptive cohort design was used.

SAMPLE

a random sample (n = 100) of archived student reflective writings based on a clinical event or experience during 2014 and 2015.

METHODS

a staged model for tool development was used to develop a fifteen item scale involving item generation; mapping of draft items to critical thinking concepts and expert review to test content validity; inter-rater reliability testing; pilot testing of the tool on 100 reflective writings; and psychometric testing. Item scores were analysed for mean, range and standard deviation. Internal reliability, content and construct validity were assessed.

FINDINGS

expert review of the tool revealed a high content validity index score of 0.98. Using two independent raters to establish inter-rater reliability, good absolute agreement of 72% was achieved with a Kappa coefficient K = 0.43 (p<0.0001). Construct validity via exploratory factor analysis revealed three factors: analyses context, reasoned inquiry, and self-evaluation. The mean total score for the tool was 50.48 (SD = 12.86). Total and subscale scores correlated significantly. The scale achieved good internal reliability with a Cronbach's alpha coefficient of .93.

CONCLUSION

this study establishedthe reliability and validity of the CACTiM (reflection) for use by academics to evaluate midwifery students' critical thinking in reflective writing. Validation with large diverse samples is warranted.

IMPLICATIONS FOR PRACTICE

reflective practice is a key learning and teaching strategy in undergraduate Bachelor of Midwifery programmes and essential for safe, competent practice. There is the potential to enhance critical thinking development by assessingreflective writing with the CACTiM (reflection) tool to provide formative and summative feedback to students and inform teaching strategies.