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Kodama K, Kanke S, Kassai R. Palliative care practices and their relationship to training: A cross-sectional study of community-oriented physicians. Fukushima J Med Sci 2024; 70:141-151. [PMID: 39034142 PMCID: PMC11330264 DOI: 10.5387/fms.23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the training methods family physicians (FPs) use to enhance their professional development in palliative care. We also determined the relationship between these methods and palliative care practice. METHODS A questionnaire survey was administered to 557 FPs. Palliative care practices were measured using the palliative care self-reported practices scale (PCPS;range 1-5), and associations among the eight indicators of FP palliative care training were considered. Quantile regression analysis was used for the analysis. RESULTS Valid responses were received from 307 FPs:99.4% of the FPs provided palliative care and home visits, and 92.8% received palliative care training. The PCPS score was higher in participants who reported having received palliative care training (adjusted coefficient, 0.4 [95% CI, 0.12-0.68]; P=0.004). The palliative care training method was found to be significantly associated with the PCPS score "Self-study through literature" (adjusted coefficient 0.18 [95% CI, 0.01-0.34]; P=0.03) and "Reflection on the practices" (adjusted coefficient 0.24 [95% CI, 0.08-0.4]; P=0.004). CONCLUSIONS FPs actively provided palliative care in their communities and used various palliative care training methods for professional development. "Reflection on the practices" and "Self-study through literature" were important elements of community-based palliative care practice.
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Affiliation(s)
- Kuniko Kodama
- Major in Community and Family Medicine, Fukushima Medical University Graduate School of Medicine
- Department of Nursing Sciences, Tokyo Metropolitan University Graduate School of Human Health Sciences
| | - Satoshi Kanke
- Department of Community and Family Medicine, Fukushima Medical University School of Medicine
- Fukushima Centre for General Physicians, Fukushima Medical University School of Medicine
| | - Ryuki Kassai
- Department of Community and Family Medicine, Fukushima Medical University School of Medicine
- World Organization of Family Doctors
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Yoong SQ, Schmidt LT, Devi KM, Zhang H. Using palliative and end-of-life simulation to enhance pre-licensure nursing students' emotional intelligence, palliative care knowledge and reflective abilities: A single group, pretest-posttest study. NURSE EDUCATION TODAY 2023; 130:105923. [PMID: 37549556 DOI: 10.1016/j.nedt.2023.105923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Nursing students have reported that they lack skills and knowledge in palliative and end-of-life care, and as a result, they faced numerous challenges caring for patients and families receiving palliative and end-of-life care during clinical attachments. OBJECTIVES To develop a palliative and end-of-life care simulation program and evaluate its effects on nursing students' emotional intelligence, palliative care knowledge and reflective abilities. DESIGN A single group, pretest-posttest quasi-experimental study. SETTINGS A simulation center in a Singapore university. PARTICIPANTS A convenience sample of 135 third-year undergraduate nursing students. METHODS Students attended a two-day simulation program consisting of four scenarios in total. Outcomes were measured before and after the study. Palliative care knowledge was measured using the Palliative Care Knowledge Test, emotional intelligence using the Trait Meta-Mood Scale-24, and reflective abilities using the Groningen Reflective Ability Scale. Outcome and demographic data were analyzed using descriptive and inferential statistics. RESULTS Total Palliative Care Knowledge Test scores (p = 0.003) and total Trait Meta-Mood Scale-24 scores (p < 0.001) improved significantly, but there was no significant change in Groningen Reflective Ability Scale scores (p = 0.650). Demographic characteristics did not significantly influence most outcome variables. Students' highest education level and experience with caring for a person receiving palliative or end-of-life care significantly affected the posttest scores of the Palliative Care Knowledge Test. Students with prior experience in caring for a person receiving palliative or end-of-life care scored significantly better in the Palliative Care Knowledge Test post-simulation compared to those who did not (p = 0.011). CONCLUSIONS The palliative and end-of-life simulation program significantly improved nursing students' emotional intelligence and palliative care knowledge. Further research is needed on developing a reliable tool to measure nursing students' palliative care knowledge. Future simulations should include structured and deliberate reflection features aside from debriefings to enhance reflective abilities, which is an important nursing competency. More research is needed on the effect of palliative and end-of-life care simulations on emotional intelligence and reflective abilities, and the influence of demographic variables on nursing students' outcomes.
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Affiliation(s)
- Si Qi Yoong
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Laura Tham Schmidt
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Kamala M Devi
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Hui Zhang
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; St Andrew's Community Hospital, Singapore.
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Steven A, Wilson G, Turunen H, Vizcaya-Moreno MF, Azimirad M, Kakurel J, Porras J, Tella S, Pérez-Cañaveras R, Sasso L, Aleo G, Myhre K, Ringstad Ø, Sara-Aho A, Scott M, Pearson P. Critical Incident Techniques and Reflection in Nursing and Health Professions Education: Systematic Narrative Review. Nurse Educ 2021; 45:E57-E61. [PMID: 31972840 DOI: 10.1097/nne.0000000000000796] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The terms critical incident technique and reflection are widely used but often not fully explained, resulting in ambiguity. PURPOSE The aims of this review were to map and describe existing approaches to recording or using critical incidents and reflection in nursing and health professions literature over the last decade; identify challenges, facilitating factors, strengths, and weaknesses; and discuss relevance for nursing education. METHODS A systematic narrative review was undertaken. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched using MeSH terms, returning 223 articles (2006-2017). After exclusions, 41 were reviewed. RESULTS Articles were categorized into 3 areas: descriptions of the development of an original tool or model, critical incidents or reflection on events used as a learning tool, and personal reflections on critical incidents. CONCLUSIONS Benefits have been identified in all areas. More attention is needed to the pedagogy of reflection and the role of educators in reflection.
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Affiliation(s)
- Alison Steven
- Author Affiliations: Professor of Research in Nursing and Health Professions Education (Dr Steven) and Vice Chancellors Fellow (Dr Wilson), Department of Nursing, Midwifery and Health, Northumbria University, United Kingdom; Professor of Nursing (Dr Turunen) and PhD Student (Ms Azimirad), Department of Nursing Science, University of Eastern Finland, Finland; Associate Professors (Drs Vizcaya-Moreno and Pérez-Cañaveras), Nursing Department, University of Alicante, Spain; Postdoctoral Researcher (Dr Kakurel), Copenhagen Centre for Health Technology, Denmark; Professor of Innovation & Software (Dr Porras), Department of Innovation & Software, Lappeenranta University of Technology, Finland; Senior Lecturer (Dr Tella) and Lecturer (Ms Sara-Aho), Faculty of Health Care and Social Services, Saimaa University of Applied Sciences, Finland; Professor of Nursing (Ms Sasso) and Lecturer, (Dr Aleo), Department of Health Sciences, University of Genoa, Italy; Associate Professors (Drs Myhre and Ringstad), Østfold University College, Norway; and Senior Lecturer (Ms Scott) and Professor of Nursing (Dr Pearson), Department of Nursing, Midwifery and Health, Northumbria University, United Kingdom
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Schwoegl EN, Rodgers ME, Kumar SS. Reflective Journaling by Second-Year Dental Students During a Clinical Rotation. J Dent Educ 2020; 84:157-165. [PMID: 32043590 DOI: 10.21815/jde.019.170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 09/01/2023]
Abstract
Reflection involves taking the time to deeply consider a past situation and examine areas of weakness or confusion. It allows identification of learning needs and the development of an action plan to improve future experiences. The aim of this study was to assess second-year dental students' ability to reflect in writing on a clinical rotation when prompted with a guided reflection template. The 76 second-year dental students enrolled in a periodontics clinical rotation course at one U.S. dental school in 2016-17 completed two reflective writing exercises during the semester. A total of 144 journals (after excluding incomplete journals) were analyzed individually by two evaluators following a rubric developed by Kember. This rubric combined Mezirow's seven levels of reflection into four categories: Habitual Action (HA), Understanding (U), Reflection (R), and Critical Reflection (CR). The first two categories are examples of non-reflective thoughts, and the latter two are reflective. The two sets of journals were also compared. On average, the journals contained 0.2% HA, 15.9% U, 73.8% R, and 10.1% CR, averaging 16.1% non-reflective thoughts and 83.9% reflective thoughts. Comparison of the students' first journal submissions to their second showed that the first journals averaged a higher percentage of reflective thought than the second journals: 85.2% vs. 82.7%, respectively. However, the first journals showed a lower average percentage of critical reflection than the second journals: 9.3% vs. 11.3%, respectively. Overall, a high degree of reflection was found in these students' journals after rotation in periodontics clinic, suggesting that reflective journaling can serve as a useful learning exercise to promote continual improvement during clinical training.
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Williams JC, Ireland T, Warman S, Cake MA, Dymock D, Fowler E, Baillie S. Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:389-404. [PMID: 31108006 DOI: 10.1111/eje.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/16/2019] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Self-reflection has become recognised as a core skill in dental education, although the ability to self-reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self-reflective ability of adults studying or working within any setting, not just health care. MATERIALS AND METHODS A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost. RESULTS A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self-reported scales and observed behaviour. CONCLUSIONS Three types of instrument were identified to assess the ability to self-reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self-reflect, and how this should be managed.
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Affiliation(s)
- Julie C Williams
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Tony Ireland
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Sheena Warman
- Bristol Veterinary School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Martin A Cake
- School of Veterinary and Biomedical Sciences, Murdoch University, Perth, Western Australia, Australia
| | - David Dymock
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Ellayne Fowler
- Centre for Medical Education, University of Bristol, Bristol, UK
| | - Sarah Baillie
- Bristol Veterinary School, Faculty of Health Sciences, University of Bristol, Bristol, UK
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Donohoe A. The Blended Reflective Inquiry Educators Framework; origins, development and utilisation. Nurse Educ Pract 2019; 38:96-104. [PMID: 31234120 DOI: 10.1016/j.nepr.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 06/02/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Abstract
Reflective practice is widely considered to be an integral part of contemporary pedagogical practice in higher education. The integration of reflection and reflective practice into professional education curricula in areas such as nursing, education and the social sciences, has coincided with an expansion of the reflective practice literature which continues to proliferate within a range of disciplinary fields. However, an interesting paradox is beginning to emerge whereby educators who are charged with developing students reflective ability are often required to do so in the absence of practical educator-focused frameworks and/or guidelines. The purpose of this paper is to contribute to the debate by presenting the 'Blended Reflective Inquiry Educators Framework' which is designed for educators who wish to support students to develop their reflective abilities and reflective capacity. This innovative framework was developed following a two stage action research study which was designed to investigate how registered nurses can be facilitated to develop reflective practice skills and abilities. The study resulted in the development of this innovative educator's framework which uses an inquiry based, blended learning approach, to facilitate reflective practice.
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Affiliation(s)
- Ann Donohoe
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland.
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7
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Fook J, Kellehear A. Using Critical Reflection to Support Health Promotion Goals in Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971002600406] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jan Fook
- J Fook (corresponding author): Interprofessional Institute, South West London Academic Network, Royal Holloway, University of London, Egham, TW20 0EX UK
| | - Allan Kellehear
- A Kellehear: Department of Social and Policy Sciences, University of Bath, Bath, UK
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Tsingos-Lucas C, Bosnic-Anticevich S, Smith L. A Retrospective Study on Students' and Teachers' Perceptions of the Reflective Ability Clinical Assessment. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2016; 80:101. [PMID: 27667838 PMCID: PMC5023972 DOI: 10.5688/ajpe806101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/27/2015] [Indexed: 05/10/2023]
Abstract
Objective. To evaluate student and teacher perceptions of the utility of the Reflective Ability Clinical Assessment (RACA) in an undergraduate pharmacy curriculum at an Australian university. Methods. A mixed-method study comprising the administration of a 7-item student survey on a 6-point Likert-type scale and a 45-minute focus group/phone interview with teachers. Results. Student (n=199) and teaching staff respondents (n=3) provided their perceptions of the implementation of the new educational tool. Student responses showed significant positive correlations between self-directed learning, counseling skills, relevance to future practice, and performance in an oral examination. Seven key themes emerged from the teacher interviews. Conclusion. The study revealed both students and teachers perceive the RACA as an effective educational tool that may enhance skill development for future clinical practice.
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Affiliation(s)
| | | | - Lorraine Smith
- The University of Sydney, Sydney, New South Wales, Australia
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9
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Johnston B, Pringle J, Buchanan D. Operationalizing reflexivity to improve the rigor of palliative care research. Appl Nurs Res 2015; 31:e1-5. [PMID: 26620579 DOI: 10.1016/j.apnr.2015.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Abstract
Reflective practice involves deliberate consideration of actions, attitudes and behaviors. Reflexivity in research is considered important for ensuring that research is ethically and rigorously conducted. This paper details the challenges of conducting research involving patients with palliative care needs within the acute hospital environment. It discusses the contribution of reflexivity to a pilot study using the Patient Dignity Question (PDQ) "What do I need to know about you as a person to take the best care of you that I can?" as a brief intervention to foster a more person-centered climate. Challenges that emerged are discussed from the perspectives of the researchers, the participants, and the setting; they relate to: timing and recruitment, the nature of palliative care illness, attitudes to research, and the research environment. Awareness of such issues can prompt researchers to devise appropriate strategies and approaches that may inform and assist the rigor and conduct of future research.
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Affiliation(s)
- Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, The University of Nottingham, Queen's Medical Centre, Nottingham NG7 2HA.
| | - Jan Pringle
- University of Dundee and University of Nottingham, School of Nursing and Midwifery, Airlie Place, Dundee
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10
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Tsingos C, Bosnic-Anticevich S, Lonie JM, Smith L. A Model for Assessing Reflective Practices in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2015; 79:124. [PMID: 26690718 PMCID: PMC4678749 DOI: 10.5688/ajpe798124] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 07/01/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVE. To research the literature and examine assessment strategies used in health education that measure reflection levels and to identify assessment strategies for use in pharmacy education. METHODS. A simple systematic review using a 5-step approach was employed to locate peer-reviewed articles addressing assessment strategies in health education from the last 20 years. RESULTS. The literature search identified assessment strategies and rubrics used in health education for assessing levels of reflection. There is a significant gap in the literature regarding reflective rubric use in pharmacy education. CONCLUSION. Two assessment strategies to assess levels of reflection, including a reflective rubric tailored for pharmacy education, are proposed.
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Affiliation(s)
- Cherie Tsingos
- The University of Sydney Faculty of Pharmacy, Sydney, Australia
| | - Sinthia Bosnic-Anticevich
- The University of Sydney Woolcock Institute of Medical Research, The University of Sydney Sydney Medical School, Australia
- The University of Sydney Sydney Medical School, Australia
| | - John M. Lonie
- Long Island University College of Pharmacy, New York, New York
| | - Lorraine Smith
- The University of Sydney Faculty of Pharmacy, Sydney, Australia
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Westerbotn M, Kneck Å, Hovland OJ, Elrond M, Pedersen I, Lejonqvist GB, Dulavik J, Ecklon T, Nilsson IL, Sigurdardottir ÁK. Taking part in Nordic collaboration; nursing students' experiences and perceptions from a learning perspective: A qualitative study. NURSE EDUCATION TODAY 2015; 35:712-717. [PMID: 25758015 DOI: 10.1016/j.nedt.2015.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 11/12/2014] [Accepted: 01/15/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Nordic networking of different kinds has a long tradition aiming to increase collaboration and understanding between citizens in different countries. Cultural competence in relation to health care and nursing is important for clinical nurses and is a central issue in nurse education. OBJECTIVE To gain an understanding of what nurse students experienced and learned during an intensive course in diabetes together with students and nurse educators from Denmark, Finland, Iceland, Norway, Sweden and the Faroe Islands. METHODS In 2012, an intensive course within the Nordic network, Nordkvist, was conducted in Faroe Islands with the theme "Nursing - to live a good life with diabetes". To answer the objective of the study, 26 students conducted written reflections based on two questions. The data was analyzed using qualitative content analysis. RESULTS Through meetings with nurse students and educators from the Nordic countries the intensive course strengthened the students' identification with the nursing profession. The students gained new perspectives on diabetes, such as how complex it can be to live with a chronic illness. Because of the difficulties in understanding one another and because of different mother tongues, the students gained a better understanding of patients' vulnerability in relation to hospital jargon and how it felt to be in an unfamiliar place. CONCLUSIONS The intensive course increased the students' personal and professional growth, cross-cultural competence, and their identification with nursing. Students' understanding of health care in the Nordic countries improved as similarities and differences were recognized.
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Affiliation(s)
- Margareta Westerbotn
- Sophiahemmet University, Box 5605, 114 86 Stockholm, Sweden; Sciences Karolinska Institutet, Division of Nursing, Department of Neurolobiology, Care Sciences and Society, Sweden.
| | - Åsa Kneck
- Sciences Karolinska Institutet, Division of Nursing, Department of Neurolobiology, Care Sciences and Society, Sweden; Ersta Sköndal University College, Department of Health Care, P.O. Box 11189, 10061 Stockholm, Sweden.
| | - Olav Johannes Hovland
- University of Agder, Faculty of Health and Sport Sciences, Institute of Health and Nursing Science, Postbox 422, 4604 Kristiansand, Norway.
| | - Malene Elrond
- University College Sjælland (UCSJ), Sygeplejerskeuddannelsen, Ingemannsvej 17, 4200 Slagelse, Denmark.
| | | | - Gun-Britt Lejonqvist
- Arcada University of Applied Sciences, Jan-Magnus Janssons plats 1, 00550 Helsingfors, Finland.
| | - Johild Dulavik
- Faculty of Natural and Health Sciences, Department of Nursing, University of the Faroe Islands, Jónas Broncksgøta 25, Fo 100 Tórshavn, Faroe Islands.
| | - Tove Ecklon
- University College Lillebaelt, Department of Nursing, Svendborg, Baagoesalle 8 b, 5700 Svendborg, Denmark.
| | - Inga-Lill Nilsson
- University of Borås, School of Health Sciences, Allégatan 1, 501 90 Borås, Sweden.
| | - Árún K Sigurdardottir
- School of Health Sciences, University of Akureyri, Nordurslod, 600 Akureyri, Iceland.
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Hovland OJ, Johannessen B. What characterizes Norwegian nursing students’ reflective journals during clinical placement in an African country? INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2015. [DOI: 10.1016/j.ijans.2015.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Patients with cancer can easily become overloaded with information about diagnosis, prognosis, treatments and side effects. One of a nurse's most important roles is to help patients and their families make sense of this, providing support and information through their cancer journey. However, many barriers exist, including the nurse's own knowledge limitations, time constraints and the patient's engagement with the nurse. This paper uses critical reflection to evaluate an incident from clinical practice involving a patient with prostate cancer suffering from a distressing side effect of treatment: urinary incontinence following a transurethral resection of the prostate (TURP). The paper examines nurse-patient communication, and evaluates how nurses can use communication strategies to minimise patient distress. Practical approaches to managing urinary incontinence are also discussed. This paper demonstrates that critical reflection is a valuable learning process that can alter clinical nursing practice to provide the best care for people with cancer.
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Bernabeo EC, Holmboe ES, Ross K, Chesluk B, Ginsburg S. The utility of vignettes to stimulate reflection on professionalism: theory and practice. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2013; 18:463-84. [PMID: 22717991 DOI: 10.1007/s10459-012-9384-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 05/30/2012] [Indexed: 05/17/2023]
Abstract
Professionalism remains a substantive theme in medical literature. There is an emerging emphasis on sociological and complex adaptive systems perspectives that refocuses attention from just the individual role to working within one's system to enact professionalism in practice. Reflecting on responses to professional dilemmas may be one method to help practicing physicians identify both internal and external factors contributing to (un) professional behavior. We present a rationale and theoretical framework that supports and guides a reflective approach to the self assessment of professionalism. Guided by principles grounded in this theoretical framework, we developed and piloted a set of vignettes on professionally challenging situations, designed to stimulate reflection in practicing physicians. Findings show that participants found the vignettes to be authentic and typical, and reported the group experience as facilitative around discussions of professional ambiguity. Providing an opportunity for physicians to reflect on professional behavior in an open and safe forum may be a practical way to guide physicians to assess themselves on professional behavior and engage with the complexities of their work. The finding that the focus groups led to reflection at a group level suggests that effective reflection on professional behavior may require a socially interactive process. Emphasizing both the behaviors and the internal and external context in which they occur can thus be viewed as critically important for understanding professionalism in practicing physicians.
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Affiliation(s)
- E C Bernabeo
- American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106, USA.
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15
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Koole S, Vanobbergen J, De Visschere L, Aper L, Dornan T, Derese A. The influence of reflection on portfolio learning in undergraduate dental education. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2013; 17:e93-e99. [PMID: 23279421 DOI: 10.1111/j.1600-0579.2012.00766.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Disparity exists between the growing consensus about the positive effects of reflection on performance and the scarcity of empirical evidence demonstrating this effect. Portfolios are considered a useful instrument to assess and supervise competence-based education and to stimulate reflection. The present study describes the introduction of a portfolio in a social dentistry and oral health promotion course and investigates student reflection as a predictor for the acquisition of the other competences in the course. METHODS Fourth year undergraduate dental students (n = 110) in the course 'Society and Health' between 2008 and 2011 collected evidence in their portfolios, demonstrating the acquisition of five competences: the ability to (1) assess the oral health profile of a target group; (2) integrate theoretical models in health promotion; (3) search for and apply scientific evidence; (4) work trans-, multi- and/or trans-disciplinarily; (5) reflect on personal development. Linear regression analysis was used to investigate the predictive value of reflection on the other course related competences. RESULTS Reflection scores proved to significantly predict other course-related competences, when analysing all students between 2008 and 2011 and for each year separately, explaining between 10.7% and 25.5% of the variance in the other competences. CONCLUSION Undergraduate dental students' competences related to social dentistry and oral health promotion were significantly predicted by the reflection scores obtained in a portfolio-based context. In line with the growing consensus about the benefits of reflection for dental students and professionals, results suggest the value to further develop the integration of reflection in dental education and practice.
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Affiliation(s)
- S Koole
- Centre for Educational Development, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Mc Carthy J, Cassidy I, Tuohy D. Lecturers' experiences of facilitating guided group reflection with pre-registration BSc Nursing students. NURSE EDUCATION TODAY 2013; 33:36-40. [PMID: 22093881 DOI: 10.1016/j.nedt.2011.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 09/26/2011] [Accepted: 10/24/2011] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Jane Mc Carthy
- Department Nursing and Midwifery, Health Sciences Building, Northbank Campus, University of Limerick, Limerick, Ireland.
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Koole S, Dornan T, Aper L, De Wever B, Scherpbier A, Valcke M, Cohen-Schotanus J, Derese A. Using video-cases to assess student reflection: development and validation of an instrument. BMC MEDICAL EDUCATION 2012; 12:22. [PMID: 22520632 PMCID: PMC3426495 DOI: 10.1186/1472-6920-12-22] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 04/20/2012] [Indexed: 05/14/2023]
Abstract
BACKGROUND Reflection is a meta-cognitive process, characterized by: 1. Awareness of self and the situation; 2. Critical analysis and understanding of both self and the situation; 3. Development of new perspectives to inform future actions. Assessors can only access reflections indirectly through learners' verbal and/or written expressions. Being privy to the situation that triggered reflection could place reflective materials into context. Video-cases make that possible and, coupled with a scoring rubric, offer a reliable way of assessing reflection. METHODS Fourth and fifth year undergraduate medical students were shown two interactive video-cases and asked to reflect on this experience, guided by six standard questions. The quality of students' reflections were scored using a specially developed Student Assessment of Reflection Scoring rubric (StARS®). Reflection scores were analyzed concerning interrater reliability and ability to discriminate between students. Further, the intra-rater reliability and case specificity were estimated by means of a generalizability study with rating and case scenario as facets. RESULTS Reflection scores of 270 students ranged widely and interrater reliability was acceptable (Krippendorff's alpha = 0.88). The generalizability study suggested 3 or 4 cases were needed to obtain reliable ratings from 4th year students and ≥ 6 cases from 5th year students. CONCLUSION Use of StARS® to assess student reflections triggered by standardized video-cases had acceptable discriminative ability and reliability. We offer this practical method for assessing reflection summatively, and providing formative feedback in training situations.
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Affiliation(s)
- Sebastiaan Koole
- Centre for Educational Development, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tim Dornan
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Leen Aper
- Centre for Educational Development, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Bram De Wever
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Albert Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Martin Valcke
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Janke Cohen-Schotanus
- Centre for Research and Innovation in Medical Education, Faculty of Medical Sciences, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands
| | - Anselme Derese
- Centre for Educational Development, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Lawrence LA. Work engagement, moral distress, education level, and critical reflective practice in intensive care nurses. Nurs Forum 2012; 46:256-68. [PMID: 22029769 DOI: 10.1111/j.1744-6198.2011.00237.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this study was to examine how nurses' moral distress, education level, and critical reflective practice (CRP) related to their work engagement. The study is relevant to nursing, given registered nurse (RN) documented experiences of job-related distress and work dissatisfaction, and the nursing shortage crisis. A better understanding of factors that may enhance RN work engagement is needed. METHODS A non-experimental, descriptive, correlational design was used to examine the relationships among four variables: moral distress, education level, CRP, and work engagement. The sample included 28 intensive care unit RNs from three separate ICUs in a 355-bed Southwest magnet-designated hospital. RESULTS There was a positive direct relationship between CRP and work engagement, a negative direct relationship between moral distress and work engagement, and CRP and moral distress, together, explained 47% of the variance in work engagement. Additionally, in the neonatal intensive care unit, a positive direct relationship between increased educational level and CRP was identified, with a suggested negative relationship between increased education level and moral distress. IMPLICATIONS Strategies to promote CRP and reduce moral distress are recommended, to promote RN work engagement. Additionally, further study on the role of education in nurses' work engagement is recommended.
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Affiliation(s)
- Lisa A Lawrence
- Nursing Department, Pima Community College, Tucson, AZ, USA.
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Koole S, Dornan T, Aper L, Scherpbier A, Valcke M, Cohen-Schotanus J, Derese A. Factors confounding the assessment of reflection: a critical review. BMC MEDICAL EDUCATION 2011; 11:104. [PMID: 22204704 PMCID: PMC3268719 DOI: 10.1186/1472-6920-11-104] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 12/28/2011] [Indexed: 05/14/2023]
Abstract
BACKGROUND Reflection on experience is an increasingly critical part of professional development and lifelong learning. There is, however, continuing uncertainty about how best to put principle into practice, particularly as regards assessment. This article explores those uncertainties in order to find practical ways of assessing reflection. DISCUSSION We critically review four problems: 1. Inconsistent definitions of reflection; 2. Lack of standards to determine (in)adequate reflection; 3. Factors that complicate assessment; 4. Internal and external contextual factors affecting the assessment of reflection. SUMMARY To address the problem of inconsistency, we identified processes that were common to a number of widely quoted theories and synthesised a model, which yielded six indicators that could be used in assessment instruments. We arrived at the conclusion that, until further progress has been made in defining standards, assessment must depend on developing and communicating local consensus between stakeholders (students, practitioners, teachers, supervisors, curriculum developers) about what is expected in exercises and formal tests. Major factors that complicate assessment are the subjective nature of reflection's content and the dependency on descriptions by persons being assessed about their reflection process, without any objective means of verification. To counter these validity threats, we suggest that assessment should focus on generic process skills rather than the subjective content of reflection and where possible to consider objective information about the triggering situation to verify described reflections. Finally, internal and external contextual factors such as motivation, instruction, character of assessment (formative or summative) and the ability of individual learning environments to stimulate reflection should be considered.
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Affiliation(s)
- Sebastiaan Koole
- Centre for Educational Development, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tim Dornan
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Leen Aper
- Centre for Educational Development, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Albert Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
| | - Martin Valcke
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Belgium
| | - Janke Cohen-Schotanus
- Centre for Research and Innovation in Medical Education, Faculty of Medical Sciences, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands
| | - Anselme Derese
- Centre for Educational Development, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Mezei L, Murinson BB. Pain education in North American medical schools. THE JOURNAL OF PAIN 2011; 12:1199-208. [PMID: 21945594 DOI: 10.1016/j.jpain.2011.06.006] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 05/30/2011] [Accepted: 06/14/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED Knowledgeable and compassionate care regarding pain is a core responsibility of health professionals associated with better medical outcomes, improved quality of life, and lower healthcare costs. Education is an essential part of training healthcare providers to deliver conscientious pain care but little is known about whether medical school curricula meet educational needs. Using a novel systematic approach to assess educational content, we examined the curricula of Liaison Committee on Medical Education-accredited medical schools between August 2009 and February 2010. Our intent was to establish important benchmark values regarding pain education of future physicians during primary professional training. External validation was performed. Inclusion criteria required evidence of substantive participation in the curriculum management database of the Association of American Medical Colleges. A total of 117 U.S. and Canadian medical schools were included in the study. Approximately 80% of U.S. medical schools require 1 or more pain sessions. Among Canadian medical schools, 92% require pain sessions. Pain sessions are typically presented as part of general required courses. Median hours of instruction on pain topics for Canadian schools was twice the U.S. median. Many topics included in the International Association for the Study of Pain core curriculum received little or no coverage. There were no correlations between the types of pain education offered and school characteristics (eg, private versus public). We conclude that pain education for North American medical students is limited, variable, and often fragmentary. There is a need for innovative approaches and better integration of pain topics into medical school curricula. PERSPECTIVE This study assessed the scope and scale of pain education programs in U.S. and Canadian medical schools. Significant gaps between recommended pain curricula and documented educational content were identified. In short, pain education was limited and fragmentary. Innovative and integrated pain education in primary medical education is needed.
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Affiliation(s)
- Lina Mezei
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Book Review: Being Present: A Nurse’s Resource for End-Of-Life Communication. Nurs Sci Q 2011. [DOI: 10.1177/0894318410389072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Humphreys A, Richardson J, Stenhouse E, Watkins M. Assessing the impact of nurse and allied health professional consultants: developing an activity diary. J Clin Nurs 2010; 19:2565-73. [PMID: 20546385 DOI: 10.1111/j.1365-2702.2009.03022.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To construct and test an activity diary designed to measure the impact and explore the activities of nurse and allied health professional consultants in relation to each speciality and function of the role. BACKGROUND This was part of a funded feasibility study to assess the contribution of nurse and allied health professional consultants. DESIGN This was an exploratory study. METHOD Thematic analysis of guided discussions with five nurse consultants and one physiotherapy consultant identified activities which were used to construct an activity diary. The activities were grouped under the four pillars or functions of the consultant role; expert practice, leadership, research and education. Participants recorded their activities in a diary over a one-week period. CONCLUSION Results suggest that with some modification, this activity diary could be used to capture the impact, complexity and diversity of activities of the consultant role. RELEVANCE TO PRACTICE Advanced practice roles are essential to the healthcare workforce of the future. This tool provides a method for measuring the contribution and complexity of the consultant role.
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Affiliation(s)
- Ann Humphreys
- Faculty of Health and Social Work, School of Nursing and Community Studies, University of Plymouth, Drake Circus, Plymouth, Devon, UK.
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LEUNG D, ESPLEN M. Alleviating existential distress of cancer patients: can relational ethics guide clinicians? Eur J Cancer Care (Engl) 2010; 19:30-8. [DOI: 10.1111/j.1365-2354.2008.00969.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bradbury-Jones C, Hughes SM, Murphy W, Parry L, Sutton J. A new way of reflecting in nursing: the Peshkin Approach. J Adv Nurs 2009; 65:2485-93. [DOI: 10.1111/j.1365-2648.2009.05144.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2009; 14:595-621. [PMID: 18034364 DOI: 10.1007/s10459-007-9090-2] [Citation(s) in RCA: 866] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 11/05/2007] [Indexed: 05/20/2023]
Abstract
The importance of reflection and reflective practice are frequently noted in the literature; indeed, reflective capacity is regarded by many as an essential characteristic for professional competence. Educators assert that the emergence of reflective practice is part of a change that acknowledges the need for students to act and to think professionally as an integral part of learning throughout their courses of study, integrating theory and practice from the outset. Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education, and across a variety of health professions. The evidence to support and inform these curricular interventions and innovations remains largely theoretical. Further, the literature is dispersed across several fields, and it is unclear which approaches may have efficacy or impact. We, therefore, designed a literature review to evaluate the existing evidence about reflection and reflective practice and their utility in health professional education. Our aim was to understand the key variables influencing this educational process, identify gaps in the evidence, and to explore any implications for educational practice and research.
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Affiliation(s)
- Karen Mann
- Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada B3H4H7.
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Duffy A. Guiding students through reflective practice – The preceptors experiences. A qualitative descriptive study. Nurse Educ Pract 2009; 9:166-75. [DOI: 10.1016/j.nepr.2008.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 06/03/2008] [Accepted: 07/06/2008] [Indexed: 11/28/2022]
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HORTON-DEUTSCH SARA, SHERWOOD GWEN. Reflection: an educational strategy to develop emotionally-competent nurse leaders. J Nurs Manag 2008; 16:946-54. [DOI: 10.1111/j.1365-2834.2008.00957.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Epp S. The value of reflective journaling in undergraduate nursing education: A literature review. Int J Nurs Stud 2008; 45:1379-88. [PMID: 18325522 DOI: 10.1016/j.ijnurstu.2008.01.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 01/13/2008] [Accepted: 01/18/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Sheila Epp
- Faculty of Health and Social Development, School of Nursing, University of BC Okanagan, 3333 University Way, Kelowna BC, V1V 1V7, Canada.
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Baldacchino DR. Teaching on the spiritual dimension in care to undergraduate nursing students: the content and teaching methods. NURSE EDUCATION TODAY 2008; 28:550-562. [PMID: 17950959 DOI: 10.1016/j.nedt.2007.09.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 08/22/2007] [Indexed: 05/25/2023]
Abstract
The study unit on 'The spiritual dimension in care'had a Judeo-Christian orientation. It was introduced to the Diploma nursing curriculum at the University of Malta in the academic year 2002-2003. The aim was to increase students' awareness about the essence of spirituality in care so as to enable them to implement holistic care. Spirituality may or may not incorporate religiosity. Thus, believers may have spiritual needs which may include religious needs whilst the atheists and agnostics may still have spiritual needs. While considering secularisation, the Christian culture of Malta was addressed in this study unit. This article describes the content structure of the study unit based on the ASSET model (Narayanasamy, A., 1999. ASSET: a model for actioning spirituality and spiritual care education and training in nursing. Nurse Education Today 19, 274-285) and outlines the various teaching methods used. Following feedback from the first and second cohort groups in 2003 and 2004, respectively, the reviewed study unit was delivered to the third cohort group of students (n=65) in Semester 2 in the academic year 2004-2005. Apart from the use of traditional teaching methods, such as lessons and a seminar, other methods were used constantly throughout the study unit, for example, self-reflection exercises, case-studies and small group discussions to enhance learning. Recommendations are proposed to review the content of this study unit and to introduce other teaching methods for effective learning.
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Affiliation(s)
- Donia R Baldacchino
- Nursing Research Institute of Health Care, University of Malta, 16, St. John's Street, Siggiewi, QRM 13, Malta.
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Bailey ME, Graham MM. Introducing guided group reflective practice in an Irish palliative care unit. Int J Palliat Nurs 2008; 13:555-60. [PMID: 18073703 DOI: 10.12968/ijpn.2007.13.11.27591] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper describes the processes involved over one year in introducing, facilitating and evaluating a project of guided reflective practice for a group of eight palliative care nurses in Milford Care Centre, Republic of Ireland. While literature has tended to concentrate on critical discussion relating to reflection, less attention has been directed towards the organisation and facilitation of reflective processes in practice. In addressing this deficit, a detailed account of the collaborative processes and challenges involved in this project are presented. Group evaluation of the project is discussed under the following themes: understanding the process of reflective practice; the value of keeping a reflective diary; guided group reflection and moving forward. The introduction of guided reflection for palliative care nurses has afforded both the facilitators and the participants an opportunity to meet away from the clinical environment, and to work together, finding fresh insights to inform practice. The valuing and promotion of reflective processes by an organisation arguably provides a fundamental strategy to support nurses in a quality palliative care setting.
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Affiliation(s)
- Maria E Bailey
- Department of Nursing and Midwifery, University of Limerick (and formerly Milford Care Centre Castletroy, Limerick, Republic of Ireland).
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Abstract
Anonymized reflection was employed as an innovative way of teaching ethics in order to enhance students' ability in ethical decision making during a `Care of the Dying Patient and Family' module. Both qualitative and quantitative data were collected from the first two student cohorts who experienced anonymized reflection ( n = 24). The themes identified were the richness and relevance of scenarios, small-group work and a team approach to teaching. Students indicated that they preferred this style of teaching. This finding was verified by a postal questionnaire conducted four months later. The conclusions drawn from this study suggest that using anonymized reflection is an effective method for teaching ethics to nurses and indicates that learning about ethical issues in this way reduces uncertainties.
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Affiliation(s)
- Gaye Kyle
- Thames Valley University, Slough, Berks, UKBablake House, Letcombe Regis, Wantage, Oxon,
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Humphreys A, Johnson S, Richardson J, Stenhouse E, Watkins M. A systematic review and meta-synthesis: evaluating the effectiveness of nurse, midwife/allied health professional consultants. J Clin Nurs 2007; 16:1792-808. [PMID: 17880468 DOI: 10.1111/j.1365-2702.2007.01757.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper presents the findings of a systematic review and meta-synthesis, which was undertaken to identify and assess studies that evaluated the nurse/midwife/allied health professional consultant role. BACKGROUND As part of the modernization agenda in the National Health Service the United Kingdom government proposed 'Consultant' posts for nurses/midwives and allied health professionals as an opportunity for experienced practitioners to extend their roles. Four key functions were identified as being significant to this role development: expert practice, leadership, education and research. Explicit within the proposal was a requirement of these new roles to be evaluated. METHOD Inclusion criteria focussed on studies where an aspect of the role had been evaluated or where the consultant carried out the research. A total of 1931 citations was filtered to reveal 107 studies that possibly met the inclusion criteria. Of these 107, 14 studies were critically appraised and subjected to thematic analysis. Study methodology varied but of the 14 studies, 10 involved some form of measurement. The others adopted a literature review or descriptive approach. CONCLUSIONS The extent to which consultants were involved in all aspects of the 'four pillars' was assessed in only a small number of studies. However, a number of studies implicitly implied active engagement in expert practice and leadership by focussing on specific service developments. RELEVANCE TO CLINICAL PRACTICE To date, a number of studies evaluating service developments, education, expert practice and leadership have been carried out. However although a number of studies have assessed perceived impact of the consultant role, no measure of actual benefit has been published to date. Studies that evaluate the cost benefit/outcomes of these roles in relation to both activity and quality of service are required.
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Affiliation(s)
- Ann Humphreys
- School of Nursing and Community Studies, Faculty of Health and Social Work, University of Plymouth, Devon, England, UK.
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McGrath D, Higgins A. Implementing and evaluating reflective practice group sessions. Nurse Educ Pract 2006; 6:175-81. [DOI: 10.1016/j.nepr.2005.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Revised: 08/15/2005] [Accepted: 10/26/2005] [Indexed: 11/29/2022]
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Ward A, Gracey J. Reflective practice in physiotherapy curricula: a survey of UK university based professional practice coordinators. MEDICAL TEACHER 2006; 28:e32-9. [PMID: 16627320 DOI: 10.1080/01421590600568512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
There has been recent increasing interest in reflective practice within physiotherapy education as a method for reducing the 'theory-practice gap' and as a means of articulating, exposing and developing knowledge embedded in practice. Several contrasting theories have been developed to explain the role, place, purpose and definition of reflection in learning and teaching; however, much of the research to date has relied on theoretical debate rather than high quality empirical evidence. The aim of this paper was therefore, to report how a group of United Kingdom (UK) based physiotherapy Professional Practice Coordinators (n = 33) with their unique insight into the concept from both the academic and clinical perspective viewed and interpreted the use of reflective practice within their physiotherapy curriculum. Consent for the study was obtained via the professional body (The Chartered Society of Physiotherapists) (CSP) and data was collected via postal questionnaire. Results indicated a diversity of experience in respondents both in terms of their role as Coordinator and their training in reflective practice. There was also no clear consensus regarding facilitative models or assessment methods even though the majority of coordinators believed that reflective practice should be considered to be a central component of physiotherapy teaching strategies. The results of this survey provide a focus for further empirical research into reflective practice as part of the physiotherapy curricula, while advancing the understanding of reflective practice from a broader perspective and clarifying the benefits to students, teachers, patients and practitioners.
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Affiliation(s)
- Alan Ward
- School of Health Sciences, University of Ulster, Co Antrim, Northern Ireland
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Jasper MA, Fulton J. Marking criteria for assessing practice-based portfolios at masters' level. NURSE EDUCATION TODAY 2005; 25:377-89. [PMID: 15904997 DOI: 10.1016/j.nedt.2005.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 03/15/2005] [Indexed: 05/02/2023]
Abstract
Whilst portfolios have increasingly been used to assess attainment and competence in nursing and other health care professions for over a decade, the assessment processes and criteria for assessing them have remained largely rudimentary and undeveloped. In fact, assessment often remains localised, impressionistic and dependent upon the interpretation and adaptation of criteria developed generically for work at this level within individual Higher Education Institutes (HEIs). This paper presents Masters' level marking criteria for portfolios from practice-based healthcare disciplines developed from the Quality Assurance Agency (QAA) descriptors of Masters level achievement and graduateness [Quality Assurance Agency for Higher Education, 2001. The Framework for Higher Education Qualifications in England, Scotland, Northern Ireland] in combination with practice-based outcomes. A six-stage methodology was devised to analyse these descriptors, develop, re-order, test and refine them in order to enhance their applicability to portfolios from practice-based disciplines. As part of this process the emerging criteria were tested against existing portfolios. Extracts from these are presented to illustrate the criteria. Two case study sites from diverse areas of England are used where Masters' courses in nursing and healthcare disciplines are offered. For portfolios to be effective in demonstrating Masters' level academic criteria, learning outcomes and advanced professional practice they need to demonstrate coherent structure, conclusions drawn from reflection on practice and a body of evidence that is coherent with, and linked to their reflective commentaries. The marking criteria presented to assess these attributes incorporate features of the structures, processes and outcomes of both practice and learning. The strategy can be used by both assessors and students, in formative and summative assessment, to identify student attainments, strengths and weaknesses.
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Affiliation(s)
- Melanie A Jasper
- Head of Health and Social Welfare Studies, Canterbury Christ Church University College, North Holmes Road, Canterbury, Kent, CT1 1QU, United Kingdom.
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Abstract
BACKGROUND The concept of reflection is propounded in the literature as an epistemology for practice that enables practitioners to solve their daily problematic situations through conscious thought processes which eventually leads to practice-based knowledge. Hence, reflection became a central tenet of both theory development and educational provision in nursing. Furthermore, this centrality of reflection was reinforced by statutory nursing bodies and service providers by adopting it as the means for carrying out adequate professional practice. Although this may be the case, issues of implementation of reflection within the daily reality of practitioners are frequently overlooked within the literature. Moreover, little consideration appears to be given on the impact that the organizational culture and the politics of power may exert on the implementation of reflective practices within daily ward reality. AIMS This paper explores how reflection is viewed by nurses within their daily reality in the medical wards, examines the relationships between the organizational culture of these wards and the practitioners and investigates whether reflective methods of practice were being implemented when the study was conducted. METHODS An interpretative ethnographical methodology was implemented and the data collecting methods used were observation, interviews and qualitative content analysis with a group of 16 practising nurses from four medical wards of one NHS Trust in England. Two interviews were conducted with each nurse within 3-week intervals. The content of these interviews evolved from the analysis of episodes of practice observed when the nurses were giving nursing care. These data were supplemented by narratives from the nurses' in the form of written reflective accounts that were analysed via qualitative content analysis techniques. FINDINGS Four themes were generated: (i) relationships between nurses and doctors; (ii) relationships between nurses and managers; (iii) nursing practice; and (iv) nurses' input in the outcome of a clinical situation. CONCLUSIONS The concept of reflection appears to be invalidated by the organizational hierarchy of the wards on the basis of a power struggle game. The ward structure portrays reflection as an abnormal method of practice and knowledge development. This belittlement of reflection does not mirror the practitioners' reality. Instead, it is an intelligent and intentional act on behalf of the dominant professional groups in the wards to create an illusionary picture of ward reality to allow them to survey and define nursing practice and thus maintain and remain in power. This is explicated by using Foucault's analysis and critical social theory framework. Hence, reflective processes are constrained by this covert power game; reflection, where used, is confined to nurses' personal time and space. RELEVANCE TO CLINICAL PRACTICE The realization of this covert power game by individual clinical nurses can become the incipient point for formally using reflective methods in the practice setting.
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Affiliation(s)
- Stefanos Mantzoukas
- Faculty of Health and Human Sciences, Wolfson Institute of Health Sciences, Thames Valley University, London, UK.
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Abstract
BACKGROUND The concepts of reflection and reflective practice are increasingly popular themes in the nursing literature. Reflective practice has been advocated as a method for overcoming the divergence between nursing theory and practice, and as a means of articulating and developing knowledge embedded in practice. However, these claims are based more on theoretical debate than research evidence. In common with other regulatory bodies, the Irish regulatory nursing body advocates the need for reflective nurses, and curricula are being adapted to reflect this. These changes are taking place when there is still little guidance on the teaching or assessment of reflective practice. Given the lack of research on the topic and the need for evidence on which to base the teaching of reflective practice, a descriptive exploratory study was undertaken. AIM The aim of this paper is to report how a group of nurse teachers perceived and interpreted reflective practice in preregistration nursing curricula in schools of nursing in The Republic of Ireland. METHODS Data were collected using a postal questionnaire distributed to all schools of nursing involved in the preregistration diploma in nursing (n = 40). RESULTS The results indicate variation between institutions in the number of hours allocated to the subject and where reflective practice was included in the curriculum. Emphasis was placed on theoretical models of reflection as opposed to the process or the skills required to become a reflective practitioner. Lecture and group discussion were the dominant teaching methods. Additionally, a number of teachers expressed dissatisfaction with the preparation they had received to teach the subject, and identified some of the challenges they experience when teaching reflective practice. CONCLUSIONS The results provide a focus for further debate amongst nurse educators involved in implementing reflective practice in the curriculum. The results are limited by a response rate of 50% and by the geographic setting. Further research is needed to substantiate the findings of the study. However, there results do suggest that there is a need to clarify curricular content in relation to reflective practice and prepare nurse tutors for their role in teaching this subject more effectively.
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Affiliation(s)
- Honor Nicholl
- School of Nursing and Midwifery Studies, Trinity College, Dublin, Ireland.
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Ruth-Sahd LA. Reflective Practice: A Critical Analysis of Data-Based Studies and Implications for Nursing Education. J Nurs Educ 2003; 42:488-97. [PMID: 14626387 DOI: 10.3928/0148-4834-20031101-07] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Reflective practice has become part of the discourse of nursing education classrooms, conferences, and journals, and are popular features of nursing continuing education programs. Yet, the idea of reflective practice has become increasingly more disparate. This critical analysis examines data-based studies and provides an overview of reflective practice, discusses common themes that emerged from the studies, and identifies implications for reflective practice in the field of nursing education.
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Affiliation(s)
- Lisa A Ruth-Sahd
- Lancaster Institute for Health Education, School of Nursing, Lancaster, Pennsylvania, USA.
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Williamson GR. Misrepresenting random sampling? A systematic review of research papers in the Journal of Advanced Nursing. J Adv Nurs 2003; 44:278-88. [PMID: 14641398 DOI: 10.1046/j.1365-2648.2003.02803.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM This paper discusses the theoretical limitations of the use of random sampling and probability theory in the production of a significance level (or P-value) in nursing research. Potential alternatives, in the form of randomization tests, are proposed. BACKGROUND Research papers in nursing, medicine and psychology frequently misrepresent their statistical findings, as the P-values reported assume random sampling. In this systematic review of studies published between January 1995 and June 2002 in the Journal of Advanced Nursing, 89 (68%) studies broke this assumption because they used convenience samples or entire populations. As a result, some of the findings may be questionable. DISCUSSION The key ideas of random sampling and probability theory for statistical testing (for generating a P-value) are outlined. The result of a systematic review of research papers published in the Journal of Advanced Nursing is then presented, showing how frequently random sampling appears to have been misrepresented. Useful alternative techniques that might overcome these limitations are then discussed. REVIEW LIMITATIONS: This review is limited in scope because it is applied to one journal, and so the findings cannot be generalized to other nursing journals or to nursing research in general. However, it is possible that other nursing journals are also publishing research articles based on the misrepresentation of random sampling. The review is also limited because in several of the articles the sampling method was not completely clearly stated, and in this circumstance a judgment has been made as to the sampling method employed, based on the indications given by author(s). CONCLUSION Quantitative researchers in nursing should be very careful that the statistical techniques they use are appropriate for the design and sampling methods of their studies. If the techniques they employ are not appropriate, they run the risk of misinterpreting findings by using inappropriate, unrepresentative and biased samples.
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Pritchard M, Davies B. End of life in pediatric oncology: how clinical practice leads to research. J Pediatr Oncol Nurs 2002; 19:191-7. [PMID: 12444571 DOI: 10.1177/104345420201900603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In pediatric oncology nursing, and across practice disciplines in general, clinical research serves as the cornerstone for improving patient care. Historically, advances made in the care and cure of childhood cancer have stemmed directly from clinical research. The developments of new research questions are varied in their origin--some questions are based on previous work that leads logically to the next question, some are based on a clinical problem that requires more immediate attention, and then there are those that arise from an individual clinical experience. This last category provides clinicians with a poignant reason to search for answers on how to provide the most optimal care for all future patients. As the number of advanced practice nurses in pediatric oncology increases, there is the likelihood of an increased pursuit of clinical research. This article describes how one clinician's experience with dying children resulted in the pursuit of answers to clinical research questions. By reflecting on clinical practice and incorporating our practice in the development of research questions, we can improve the quality of care provided to all children with cancer.
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Affiliation(s)
- Michele Pritchard
- Department of Hematology/Oncology, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105, USA
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Abstract
BACKGROUND The use of reflection in education has emerged as an effective means of connecting theory with practice. However, the literature reveals limited empirical work on the conceptualization of reflection. AIM OF THE STUDY The purpose of this qualitative research study was to understand more fully the meaning and use of reflection in teaching, and how reflection contributes to the development of teaching expertise in the classroom. Ethical approval. The study received ethical approval from the Faculty of Nursing Ethical Review Committee, University of Manitoba. Issues related to confidentiality of information, and power relationships between the investigators were addressed. Students were reassured that no data were collected about them during participant observations in the classrooms. METHODS The investigators were the sources of data. Data were collected using five different methods over the course of two academic years, including written autobiographies, critical incident journals, classroom observations, debriefing following classroom observations and research team meetings. FINDINGS The data were analysed using content analysis, and four themes were identified (i) making connections, (ii) developmental aspects, (iii) influence of context on reflection, and (iv) influence of emotions on reflection. Study limitations. The interpretation of the findings of this study should be used with caution given the qualitative design and small number of participants. CONCLUSION Participation in the study increased the awareness of the investigators' personal use of reflection. The process of studying our own use of reflection allowed us to step outside the performance treadmill to better understand, accept and reshape what we do over and over in the classroom. This study supports an examination of one's experiences as a means of understanding reflection and its use in the classroom.
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Affiliation(s)
- Judith M Scanlan
- Faculty of Nursing, Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
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