Unravelling the unknowns of reflection in classroom teaching

Adding to the knowledge on Patient and Public Involvement: Reflections from an experience of co-research with carers of people with dementia

BACKGROUND

Patient and Public Involvement (PPI) in research ensures that publicly funded research reflects the priorities of the people who will be affected by its results. Co-research, a branch of PPI, is equal partnership between academic researchers and members of the public, who steer and conduct research together.

OBJECTIVES

To propose a model for good practice in co-researching with carers of people with dementia, by reporting and synthesizing the personal reflections of the academic and lay researchers around the methodological issues, benefits, and challenges of co-research.

DESIGN

An academic researcher and two lay researchers with lived experience of caring with someone with dementia collaborated in all stages of a qualitative research study, including development of the research protocol and topic guide, data collection, analysis and synthesis, and dissemination of findings. Throughout the study, the academic and lay researchers annotated reflections of their experience in personal diaries. Data from the diaries were synthesized and mapped out in a model for good practice in co-research.

RESULTS

Co-research yielded benefits for all those involved and on research outputs. There were practicalities and challenges that required extra resources, in order to make the involvement of lay researchers meaningful and effective.

DISCUSSION

The model for good practice illustrates overarching and stage-specific guidelines, which can inform researchers and members of the public wishing to undertake good practice in co-research.

The effects of an IPS-based IPE program on interprofessional socialization and dual identity development

The purpose of this study was to assess the effect of an interprofessional socialization (IPS) based interprofessional education (IPE) program intervention on health professions students' IPS process and dual identity development. Despite the growing acknowledgment of IPS in recent literature, there is a paucity of research investigating socialization processes learners move through in order to develop dual identity - professional and interprofessional. A concurrent embedded mixed-method design was used. One hundred and eight pre-licensure students from seven different health professions completed the IPS program intervention. Latent Growth Curve (LGC) modeling and thematic content analysis were used to analyze the quantitative and qualitative data, respectively. A significant and consistent growth rate in dual identity was found among the participants. The thematic analysis resulted in four emerging themes (uniprofessional education as a barrier, IPS program as an eye-opener, learning to collaborate, and collective unified team). The integrated findings provide support for the use of the interprofessional socialization framework.

Impact of Technology-based Reflective Practice Tools on Student Skill Development

The purpose of this study was to examine how students received the combination of technology-based tools implemented in a staged manner within a curriculum and if any specific tool was of greater benefit in developing their reflective practice skills. Participants were 45 tertiary students enrolled in a health professional course. Qualitative and quantitative analysis revealed student preference for individual tools changed over time. Students preferred supportive tools (simulated video recordings, group blogging and teaching approaches) earlier on and independent tools (e-journaling and online reflective summary writing) in their final year. The findings support the use of different reflective practice tools in course design to better support student development and improve student engagement in reflective practices.

Hard Complexities – Soft Complexities: An Exploration of Philosophical Positions Related to Evidence in Occupational Therapy

The practice of occupational therapy rests upon the ontological assumption that there is a relationship between engagement in occupation and health. Different traditions of knowing about and investigating this relationship are evident within the literature. The professional link with biomedicine has led to an adherence to positivistic methodologies but, as the profession has begun to generate discipline-specific knowledge, inquiry approaches consistent with interpretative and critical theory have become evident.

This paper explores the nature of inquiry underpinning current practice. It suggests that contemporary developments have been a reaction to a climate of uncertainty, generated by rapid political, fiscal, technological and ideological change in the delivery of health and social care in the last four decades. From these rapid changes, different views of ‘best practice’ have developed: evidence-based, reflective and reflexive practice, each with its own source of knowledge and method of inquiry. It is postulated that each of these views has implications for education, practice and research.

Using reflective writing within research

Reflective writing has become established as a key component of reflective practice, and central to the notion of learning from experience. Claims are made in the reflective practice literature of the capacity for reflective writing to develop the writer’s critical thinking and analytical abilities, contribute to their cognitive development, enable creativity and unique connections to be made between disparate sets of information, and to contribute to new perspectives being taken on issues. All of these are attributes to be expected in competent researchers. Thus, this paper considers the features of reflective writing and its use within qualitative research as a method in its own right, as a data source and within the analytical processes. It is argued that, although reflective writing is increasingly becoming visible within qualitative research reports, it needs to be further acknowledged as central to the methodological processes within research studies and recognised as an essential part of their methodology.

The development and implementation of a hospital based paediatric orthopaedic nursing transition program

Within Australia and the rest of the world paediatric orthopaedic nursing as a subspeciality nursing workforce faces challenges due to a lack of formal education programs that support the development of knowledge. Despite these challenges the need to ensure the availability of competent and knowledgeable nursing staff to positively contribute to health care outcomes remains unchanged. Thus a need has arisen to develop locally implemented education programs. A multi-tiered paediatric orthopaedic nursing transition program which incorporates work based learning processes combined, with formal assessment components, has been designed utilising Benner's "theory of novice to expert" to facilitate the growth of experts in the clinical setting driven by the requirements of individual clinical settings. The implementation of this program has led to increased confidence in the clinical setting for nursing staff which has positively influenced the care of children and their families in the orthopaedic service.

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

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

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

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

Teaching on the spiritual dimension in care to undergraduate nursing students: the content and teaching methods

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.

Achieving meaningful learning in health information management students: the importance of professional experience

Learning is a complex process, not merely a transfer of information from teacher to student. for learning to be meaningful, students need to adopt a deep approach, and in the case of vocational students, to be given the opportunity to learn experientially. Health information management is a practice profession for which students are educated through theory at university and professional experience in the workplace. This article discusses how, through the process of experiential learning, professional experience can promote reflective thinking and thus deep learning, that is, the ability to integrate theory and practice, as well as professional and personal development in health information management students.

Learning from practice--reflections on a critical incident

Reflective practice is considered not only as a valuable tool for providing appropriate levels of care but also as an important prerequisite for the provision of professional nursing. Indeed, there appears to be consensus in the literature that reflections have the potential to assist practitioners to tap into knowledge gained from experience and connect theory to practice. However, evidence suggests that nurses, including emergency nurses, neglect reflective techniques. This paper outlines how the processes of reflection led to one emergency nurse developing new insights and understandings on nursing practice.

The use of reflective journals in the promotion of reflection and learning in post-registration nursing students

The aim of this qualitative case study was to examine the use of reflective journals in promoting reflection and learning in post-registration nursing students. A purposive homogenous sample of 42 part-time post-registration students who had undertaken a module either as part of the Diploma in Professional Studies in Palliative Care or Breast Care Nursing within a UK University took part in the study. Data were collected from reflective journals and interviews. The students' journals were analysed to determine the extent and level of reflection using a model devised by Boud [Boud, D., Keogh, R., Walker, D. (Eds.), 1985. Reflection: Turning Experience into Learning. Kogan Page, London] and adapted by Wong [Wong, F.K.Y., Kember, D., Chung, L.Y.F., Yan, L., 1995. Assessing the levels of student reflection from reflective journals. Journal of Advanced Nursing 22, 48-57]. A model devised by Mezirow [Mezirow, J., 1990. How critical reflection triggers transformative learning. In: Mezirow, J. et al. (Eds.), Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. Jossey-Bass, San Francisco, pp. 1-20; Mezirow, J., 1991. Transformative Dimensions of Adult Learning. Jossey-Bass, San Franscisco] was used to identify non-reflectors, reflectors and critical reflectors. The findings suggest that student writing can be used as evidence for the presence or absence of reflective thinking. Evidence also suggests that journals are a useful tool for promoting reflection and learning. However, some students appear to benefit more from their use than others.

Transforming Student Perspectives Through Reflective Writing

One of the primary goals of registered nurse-to-bachelor of science in nursing education is to help registered nurses see things in a new way or to transform their perspective. A package of 4 commonly used reflective writing activities used before, during, and after class is described as it is used for perspective transformation. This learning package goal is to push registered nurse-to-bachelor of science in nursing students in their first course to consider new ways of thinking about their practice and their education.

Sense or no-sense: The nurse as embodied ethnographer

Researching in familiar environments brings about challenges as nurses are learned to tune out their senses to give expert nursing care, and contemporary nursing research using observations has been criticized for being disembodied--not often using senses other than sight. This article draws on experiences from a fieldwork study of palliative and aged care environments to show how a deliberate use of the senses can enhance the richness of nursing research and open up new avenues for investigation. Examples from a reflexive fieldwork journal are presented to demonstrate how sensate experiences was used in a reflexive process that led into areas that otherwise might have remained unexplored. The authors argue that the interplay between sensate experiences and analytical logic can bring the background to the foreground and provide new ways of making the familiar unfamiliar. In making sense of what residing in health care environments might mean, an embodied research activity is fruitful.

La enseñanza de la enfermería como una práctica reflexiva

El saber enfermero se caracteriza epistemológicamente como un conocimiento práctico, el que por su propia naturaleza personal y tácita no puede ser formalizado ni transmitido, sólo puede ser demostrado. Este saber práctico reflexivo existe en la acción profesional de manera implícita y personal, y se desarrolla en una realidad compleja, incierta y saturada de valores. En la formación profesional, este conocimiento práctico debería orientar el planeamiento y la acción curricular. Más allá de preguntar cómo mejorar la "aplicación" en la práctica del conocimiento académico, deberíamos buscar maneras para que los estudiantes comprendan cómo las enfermeras especialistas son capaces de manejar las zonas indeterminadas de su práctica. En este trabajo se presentan los fundamentos epistemológicos de las concepciones alternativas según la visión técnica dominante de la relación jerárquica entre conocimiento técnico y la práctica educativa o cuidativa. Como una estrategia que puede contribuir para este intento y como eje del currículum presentamos el desarrollo del practicum en la formación inicial de las enfermeras.

Participant diaries as a source of data in research with older adults

Solicited participant diaries are an excellent source of data that has not been given sufficient attention as a data collection strategy for qualitative research. In a recent grounded theory study designed to explore strategies used by older adults to manage their chronic health problems, solicited diaries, when combined with an initial and follow-up interview, provided a rich source of data about day-to-day activities of participants. There were three options for maintaining the diary: written, audiotaped, or telephone conversation. The solicited diaries were guided by a set of open-ended questions designed to encourage participants to focus on daily activities and reflect on their values. The authors provide examples of data from participant diaries and suggestions for incorporating solicited participant diaries into data collection strategies for qualitative research.

Participatory inquiry with a colleague: an innovative faculty development process

Clinical evaluation is central to the aims of nursing education; however, little has been written about the actual evaluative practices of nurse educators and the sources of influence on those practices. In this article, we describe our experience as co-investigators into the evaluation practices of one of us (J.A.J.) and overview some of the challenges and opportunities of participatory inquiry. We describe how J.A.J.'s involvement in this research project encouraged her to explore her evaluative practices in a meaningful way, which moved her to a place of deeper understanding about her work and transformed her as a nurse educator. As a result of this study, we are convinced of the necessity for a faculty development process whereby colleagues commit to a critical inquiry process focused on identifying each other's evaluative practices and sources of influence on those practices. In addition, schools of nursing can encourage faculty participation in peer development by adopting an expanded view of scholarship in which the disciplined examination of one's evaluative practices is accepted as evidence of the scholarship of teaching.

Reflection in preregistration nursing curricula

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.

Reflective Practice: A Critical Analysis of Data-Based Studies and Implications for Nursing Education

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.

Evaluation of students' satisfaction with nursing education in Norway

BACKGROUND

The use of standardized questionnaires for measuring student satisfaction in higher education is motivated by theories predicting a close relationship between students' satisfaction and learning outcomes. The reliability and validity of the Course Experience Questionnaire as an indicator of teaching performance have been established by factor analysis in earlier studies from several countries. The Nursing Clinical Facilitators Questionnaire has been used for measuring satisfaction with clinical practice.

AIMS

The aims of this study were (1) to find out how satisfied nursing students in their last semester were with their clinical practice and the nursing programme as a whole, and (2) to measure the reliability and validity of the two standardized questionnaires.

METHODS

The data were collected using the two standard questionnaires, combined with some background items, in a survey design. Exploratory factor analysis was performed.

FINDINGS

A total of 276 nursing students from three university colleges in Western Norway answered the questionnaire in 1999/2000. The scores indicated slight overall dissatisfaction with the nursing programme, but general satisfaction with clinical practice. Furthermore, 70% of the students who expressed dissatisfaction with the quality of the nursing programme were nevertheless satisfied with clinical practice. The broad constituent structure of the Course Experience Questionnaire was replicated, with some deviation for the appropriate assessment scale. The Nursing Clinical Facilitators Questionnaire turned out to have two subscales, representing supportive and challenging behaviour, with satisfactory internal reliability.

CONCLUSION

Annual evaluations using the two standardized questionnaires may result in greater focus being given to students' satisfaction with the nursing programmes and clinical practice in Norwegian nursing education departments. Comparative studies with the same instruments in other countries would also be of interest.

Contributions of qualitative research to evidence-based practice in nursing

AIM

This article aims to identify the contributions of qualitative research to evidence-based practice in nursing.

BACKGROUND

Qualitative research dates back to the 1920s and 1930s, when anthropologists and sociologists used qualitative research methods to study human phenomena in naturalistic settings and from a holistic viewpoint. Afterwards, other subject matters, including nursing, adopted qualitative methods to answer their research questions. The restructuring of health care over the past decade has brought about increased accountability in nursing research. One method for increasing this accountability is evidence-based practice.

METHOD

The method used was a search in the Cumulative Index to Nursing and Allied Health Literature database from 1999-present. The search resulted in 61 citations for evidence-based practice in nursing research; however, only 5 citations focused on evidence-based practice and qualitative research.

FINDINGS

The authors' findings revealed six contributions of qualitative research to evidence-based practice: generation of hypotheses; development and validation of instruments; provision of context for evaluation; development of nursing interventions; development of new research questions; and application of Qualitative Outcome Analysis.

CONCLUSION

Qualitative research makes important contributions to the quality of evidence-based practice.