Interpersonal learning in groups: an investigation

People and teams matter in organizational change: professionals' and managers' experiences of changing governance and incentives in primary care

OBJECTIVES

To explore the experiences of governance and incentives during organizational change for managers and clinical staff.

STUDY SETTING

Three primary care settings in England in 2006-2008.

STUDY DESIGN

Data collection involved three group interviews with 32 service users, individual interviews with 32 managers, and 56 frontline professionals in three sites. The Realistic Evaluation framework was used in analysis to examine the effects of new policies and their implementation.

PRINCIPAL FINDINGS

Integrating new interprofessional teams to work effectively is a slow process, especially if structures in place do not acknowledge the painful feelings involved in change and do not support staff during periods of uncertainty.

CONCLUSIONS

Eliciting multiple perspectives, often dependent on individual occupational positioning or place in new team configurations, illuminates the need to incorporate the emotional as well as technocratic and system factors when implementing change. Some suggestions are made for facilitating change in health care systems. These are discussed in the context of similar health care reform initiatives in the United States.

Reflective practice groups for nurses: a consultation liaison psychiatry nursing initiative: part 2--the evaluation

This paper outlines an evaluation of reflective practice groups (RPG) involving nurses and midwives from three clinical nursing specialties at Redcliffe and Caboolture Hospitals, Queensland, Australia. The groups were facilitated by the consultation liaison psychiatry nurse and author using a process-focused, whole-of-group approach to explore clinical narrative in a supportive group setting. This was a preliminary evaluation utilizing a recently-developed tool, the Clinical Supervision Evaluation Questionnaire, along with externally-facilitated focus groups. Nurses and midwives responded favourably to RPG, reporting a positive impact on clinical practice, self-awareness, and resilience. The majority of participants considered RPG had positive implications for team functioning. The focus groups identified the importance of facilitation style and the need to address aspects of workplace culture to enable group development and enhance the capacity for reflection. Evaluation of the data indicates this style of RPG can improve reflective thinking, promote team cohesion, and provide support for nurses and midwives working in clinical settings. Following on from this study, a second phase of research has commenced, providing more detailed, longitudinal evaluation across a larger, more diverse group of nurses.

Reflective practice groups for nurses: a consultation liaison psychiatry nursing initiative: part 1--The model

In the present study, we outline the evolution of a process-focused reflective practice group (RPG) model for nurses working in clinical settings. The groups were initiated at Redcliffe and Caboolture hospitals by the consultation liaison psychiatry nurse and author. An associated article provides an evaluation of these RPG. The literature review identifies the key themes and theories on which the model is based, and the article outlines the process and practicalities of facilitating RPG in critical care, midwifery, and oncology specialties over a 3-year period. The model proposes that the effectiveness and sustainability of RPG arises from adequate preparation and engagement with prospective participants. Group rules, based on principles of confidentially, supportiveness, and diversity, were collaboratively developed for each group. Facilitation utilized a group-as-a-whole approach to manage process and stimulate reflection. While the purpose of RPG was a reflection on interpersonal aspects of nursing, contextual workplace issues were frequently raised in groups. Acknowledgement and containment of such issues were necessary to maintain clinical focus. The literature highlights facilitator credibility and style as crucial factors in the overall success of RPG, and it is proposed that reflective practice as a process-focused model for groups succeeds when nurse facilitators are trained in group process and receive concurrent supervision.

Using psychodynamic small group work in nurse education: closing the theory-practice gap?

This paper illustrates the role of psychodynamic small group work in integrating theory and practice for nursing students. Psychodynamic work with individual patients and small staff groups is established in some areas of medical and nursing practice although not widely used in general nursing. Clinical material which was brought to two group supervision sessions by student nurses on clinical placement is presented in this paper and discussed using a psychodynamic perspective. A critical review of psychodynamic small group work and a position paper is presented in this paper to argue that using a psychodynamic approach in nurse education may address the theory-practice gap for student nurses by allowing them to reflect on the emotional issues arising in clinical placements. The paper illustrates how supervision can assist students to integrate theory and practice. It is suggested that reflecting on feelings in small group work with student nurses with a tutor or supervisor who works psychodynamically may help students integrate their theoretical and practical learning. Understanding the theory-practice gap from a psychodynamic perspective may help nurse tutors in their personal tutor work to integrate theoretical and practical learning for students and thereby support students in providing good quality care for their patients.

Empathy and nurse education

It is widely accepted that the ability of nurses to empathise with their patients is a desirable quality. There is however little discussion of the implications of this for nurse educators. This article reviews the nursing and counselling literature related to empathy. We begin with an exploration of different perspectives of empathy; from its behavioural and measurable characteristics to its less tangible, intuitive qualities. By drawing upon both policy and research, it is clear that patients want empathic and emotionally competent nurses. Nurse educators therefore have a responsibility to provide an education that engenders empathic understanding. We explore the implications of these findings for nurse education, identifying key areas for consideration in the preparation of emotionally skilled, empathic student nurses.

Group clinical supervision in pre-registration nurse training: the views of mental health nursing students

In 1994 the Department of Health recommended that nurses be introduced to the process of clinical supervision during pre-registration training. In response to this recommendation, the now defunct English National Board (ENB) stated that: "It will be a requirement that all students of pre-registration nursing programmes receive preparation in what to expect from clinical supervision" (ENB, 1995, p. 4). Despite the fact that no further guidance was issued there is an emerging body of literature exploring this area. This paper reports findings from the initial phase of a three-year prospective longitudinal study examining students' experiences of group clinical supervision undertaken as part of their pre-registration training. In this part of the study 32 mental health nursing students participated in focus groups in which they discussed their expectations of clinical supervision. Content analysis of the data produced five major categories: 'the nature of clinical supervision'; 'roles and responsibilities'; 'staying safe and doing no harm'; 'being in a group'; and 'being a student'. The findings suggest that the idea of supervision is attractive to students, although there are significant anxieties both about supervision in general and of group supervision in particular.

The use of the nominal group technique as an evaluative tool in the teaching and summative assessment of the inter-personal skills of student mental health nurses

Nominal group technique is a semi-quantitative/qualitative evaluative methodology. It has been used in health care education for generating ideas to develop curricula and find solutions to problems in programme delivery. This paper aims to describe the use of nominal group technique and present the data from nominal group evaluations of a developing module which used novel approaches to the teaching and assessment of interpersonal skills. Evaluations took place over 3 years. Thirty-six students took part in annual groups. Analysis of the data produced the following themes based on items generated in the groups: role play, marking, course content, teaching style and user involvement. Findings indicate that students valued the role play, feedback from service users and emphasis on engagement and collaboration elements of the module. The areas which participants found difficult and desired change included anxiety during experiential practice, the "snap shot" nature of assessment and the use of specific interventions. Indications are also given regarding the impact of changes made by teaching staff over the 3 year evaluation period. The findings support themes within the existing literature on the teaching of interpersonal skills and may to some extent point the way toward best practice in this area. The paper discusses these findings and their implications for nurse education.

Group supervision in facilitating learning and teaching in mental health clinical placements: a case example of one student group

Clinical supervision has become an essential component in nursing practice. This paper explores the experiences of two small groups of Finnish Registered General Nurse students receiving supervision during a clinical placement in mental health care (N = 23). Both groups worked in similar clinical placements, with one group receiving group supervision, the other individual supervision. Students reported that group supervision was a positive experience and a good alternative to the traditional supervision they had received earlier. Group supervision allowed students to begin to address their fears and anxieties over their ability to deal with the unfamiliar emotional and psychological demands of practice. Eighteen students reported that the staff nurse mentor was most important in helping them better understand the core concepts and practice of nursing. All the students who thought that nurse teacher was important in this regard came from the group supervision group.

Parent-nurse interactions: care of hospitalized children

BACKGROUND

An essential component of quality nursing care is nurses' ability to work with parents in the hospital care of their children. However, changes in the health care environment have presented nurses with many new challenges, including meeting family-centred care expectations.

AIM OF THE PAPER

To report a research study examining the experiences of parents who interacted with nurses in a hospital setting regarding the care of their children.

METHODS

A qualitative approach was employed for this study. In-depth audiotaped interviews were conducted with eight parents representing seven families. Data collection was completed over a 7-month period in 2001.

FINDINGS

Parents characterized their experiences with nurses caring for their children as interactions, and identified the elements of establishing rapport and sharing children's care as key to a positive perception of the interactions. These elements were influenced by parental expectations of nurses. Changes in nurses' approach were reported by parents as the children's conditions changed.

CONCLUSION

Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.

Student characteristics and subculture trends in interpersonal skills workshops

The aim of this study was to explore the experiences of student nurses when learning interpersonal skills and to examine the impact of small group work. A qualitative methodology was used. The sample comprised 50 student nurses who were undertaking the preregistration diploma course. In-depth interviews were employed to collect the data. The findings indicated that many students resisted learning owing to a range of personal characteristics that influenced the learning process. A student typology was constructed which highlighted four types of student characteristics that emerged from the data. Significant characteristics relating to each type of student behaviour are emphasized. This report also combines the student typology with the emergence of three distinct subcultures that frequently both interrupt and enhance learning. In presenting the subcultures the implications for group work are considered in conjunction with study limitations.

Nursing student-patient relationship: a review of the literature from 1984 to 1998

AIM AND BACKGROUND

The aim of this review is to examine the research of the nursing student-patient relationship for planning an empirical study in this area.

METHODS

A literature search was made focusing on relationship from student and patient perspectives. The sample included 104 articles from 1984 to 1998. The articles were analysed using an inductive analysis of the literature.

RESULTS

The review shows that there has been an increasing research interest in the issue since the 1980s, with the main focus on nursing students. Most of the studies were of a descriptive nature, using both qualitative and quantitative approaches. It seems that the relationship with a patient is an important part of a meaningful learning process, teaching nursing students about the patient's individualised care and promoting their personal and professional growth, confidence and self-esteem. Patients are willing to participate in students' learning process and they tend to benefit from therapeutic and social interaction with students. Instruction has the effect of changing students' attitudes and improving their interaction skills, but it does not affect their feelings of anxiety in novel situations.

CONCLUSIONS

In future empirical research should be based more firmly on theory-based illuminations of the student-patient relationship.

Communicating with terminally ill cancer patients and their families

This qualitative study aimed to investigate whether 4th year undergraduate nursing students raise concerns about communication with terminally ill and dying cancer patients and their families. It focused on factors which could influence students' feelings of insecurity/security when communicating with this group of patients and their families, factors which could influence communication, and whether students felt adequately prepared for this kind of nursing. The research involved interviewing 12 student nurses in their 4th year of their undergraduate education at a Scottish university using content analysis for analyzing the data. Five themes and 13 sub-themes emerged from this analysis. The findings revealed that communicating with terminally ill and dying cancer patients in the acute setting is difficult for student nurses and issues about death and dying tended to be ignored. While it was found that university lectures about death and dying were helpful, lack of support and guidance within the clinical setting was a major concern.

Barriers to learning from reflection: a study of the use of groupwork with post-registration nurses

There are few studies which describe the use of groups to facilitate reflection and even fewer which evaluate the effectiveness of such groups. Much of the literature discussing the techniques used to facilitate reflection suggests that learners willingly engage in such processes and find them enjoyable. This paper reports on a qualitative study of the use of groups to develop learning through reflection on a part-time post-registration diploma programme for nurses. The findings suggest that there are many barriers to learning which must be overcome before practitioners can use the opportunities to reflect on and learn from their experience. It is also contended that such learning may not necessarily be an enjoyable experience. The findings suggest that previous educational experience and the current culture in which nurses and midwives work, impose tremendous barriers to reflecting on, and learning from, experience. In particular these affect the willingness of learners to expose themselves to the judgement of others and their ability to be open to taking responsibility for their own learning. Other barriers to learning in groups are the effects of other group members, their commitment or resistance to shared learning, the ways in which group members interact with each other and facilitation styles.

An evaluation of process and outcomes from learning through reflective practice groups on a post-registration nursing course

An evaluation of process and outcomes from learning through reflective practice groups on a post-registration nursing course Small groups were set up purposefully on a part-time post-registration Diploma in Professional Studies in Nursing programme to enable students to reflect on and learn from experience. The use of these groups was qualitatively evaluated by the use of in-depth interviews. Although there were many barriers to such learning, some students made significant developments in their critical thinking ability and underwent perspective transformations that led to changes in attitudes and behaviour. These are identified as an increased professionalism, greater autonomy in decision making, more self-confidence to challenge the status quo and make their own judgements, and a less rule-bound approach to their practice. The processes by which these changes occurred are identified as support and challenge within the groups offered by both the facilitators and other group members.

Clinical supervision in mental health nursing courses

The Department of Health (DoH, 1994) advocated the introduction of clinical supervision into mental health nursing practice and suggested that student nurses be prepared in what to expect from this process. The ENB (1995) supported this recommendation but has offered no guidelines on how it is meant to be implemented. This article reports on an educational initiative in which group supervision was implemented within one cohort of preregistration mental health nursing students. The students reported a number of perceived benefits: a greater understanding of the purpose and benefits of clinical supervision; skill development; the opportunity to reflect on practice; and the reduction of stress.

Students' perceptions of their psychiatric mental health clinical nursing experience: a personal construct theory exploration

Personal construct theory and repertory grid technique provides a suitable framework for exploring Registered Nursing students' perceptions of their psychiatric practicum. This descriptive research was designed to understand students' own ways of constructing knowledge during their mental health clinical experience. A constructivist conceptual perspective and George Kelly's personal construct psychology were the theoretical bases of the research. A qualitative case study methodology allowed creation of and reflection on personal construct changes as provided in participants' review of repertory grid ideas about psychiatric nursing. The participants were six Canadian second-year nursing students in a Baccalaureate programme that integrated psychiatric and medical surgical nursing curricula. The following three overarching themes were identified and are used to explain and describe significant features of the psychiatric clinical experience: 1) students' anxiety related more to feeling unable to help than to interactions with mentally ill patients; 2) students' feelings of a lack of inclusion in staff nurse groups; 3) student emphasis on the importance of nonevaluated student-instructor discussion time.

Evaluation of reflective learning in a psychodynamic group of nurses caring for terminally ill patients

The development of a psychodynamic group comprising seven female nurses was studied for 1 year (31 sessions). The group was part of a 1-year postgraduate training in patient-centred nursing. The members of the group all worked on the same unit; none of them left the unit or the group during the study. As the nurse-patient relationship is considered to be crucial for patient-centred nursing, the group sessions focused on the problems which the nurses experienced in their relationships with the patients. The objective of the group-work was to improve the nurses' ability to reflect on these relationships. The purpose of the study was to evaluate the group sessions, concentrating on the characteristics of patients selected for discussions, group process over time, and impact of specific patient characteristics on the group-work. Transcriptions of the tape-recorded group sessions were made for systematic analysis. A category system was developed and validated to rate reflection about the patient, the nurses themselves and the nurse-patient relationship. The results showed that the nurses over-proportionally selected terminally ill patients, as well as patients who were female and within a similar age range as themselves. These results could be due to an identification with these patients, causing increased psychological stress on the nurses. Throughout the year, the nurses' verbal activity and their reflections about their patients increased, whereas their reflections about themselves decreased. The need to withdraw and protect oneself by focusing more on the patient than on oneself might have been a strategy the nurses used to cope with growing stress.

Reflection in groups: contextual and theoretical considerations within nurse education and practice

The action learning group (ALG) has been described as a mechanism to facilitate reflective practice. As a member of such groups, I contend that although a potentially ideal setting for learning, the group may evoke repressed anxiety and distress caused by self-awareness and contact with patients. This, if not contained, will hinder the process of learning from and through experience. More rigorous attempts by those conducting such groups may be required, to maintain the boundary and thus the safety of the group, and to obtain supervision, in order to deal more effectively with problems arising.