Reflective practice and clinical outcomes: practitioners' views on how reflective practice has influenced their clinical practice

Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes

Background

Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-based assessment.

Methods

Seven high-fidelity scenarios reflecting core anesthesiology skills were administered to 51 first-year residents (CA-1s) and 16 third-year residents (CA-3s) from three residency programs. Twenty trained attending anesthesiologists rated resident performances using a seven-point behaviorally anchored rating scale for five domains: (1) formulate a clear plan, (2) modify the plan under changing conditions, (3) communicate effectively, (4) identify performance improvement opportunities, and (5) recognize limits. A second rater assessed 10% of encounters. Scores and variances for each domain, each scenario, and the total were compared. Low domain ratings (1, 2) were examined in detail.

Results

Interrater agreement was 0.76; reliability of the seven-scenario assessment was r = 0.70. CA-3s had a significantly higher average total score (4.9 ± 1.1 vs. 4.6 ± 1.1, P = 0.01, effect size = 0.33). CA-3s significantly outscored CA-1s for five of seven scenarios and domains 1, 2, and 3. CA-1s had a significantly higher proportion of worrisome ratings than CA-3s (chi-square = 24.1, P < 0.01, effect size = 1.50). Ninety-eight percent of residents rated the simulations more educational than an average day in the operating room.

Conclusions

Sensitivity of the assessment to CA-1 versus CA-3 performance differences for most scenarios and domains supports validity. No differences, by experience level, were detected for two domains associated with reflective practice. Smaller score variances for CA-3s likely reflect a training effect; however, worrisome performance scores for both CA-1s and CA-3s suggest room for improvement.

Exploring narratives of psychological input in the acute inpatient setting

OBJECTIVES

This research explored what happens when psychological input is offered in the inpatient setting and examined service users' and staff members' understanding and portrayal of these experiences.

DESIGN

Narrative analysis, an interview design, was used to examine experiences of inpatient psychological interventions in National Health Service inpatient mental health settings.

METHODS

Ten participants (four service users and six staff members; five males and five females; seven White British, one White Irish, one Black African, and one Black Caribbean) were recruited via clinical psychologists from an inpatient psychology department and participated in 18- to 90-min interviews.

RESULTS

Evidence suggested that direct, indirect, and strategic psychological interventions were used in the inpatient setting, with formulation and the therapeutic relationship conceptualized as common features. Connections between inpatient psychology and change, evidenced in the stories, suggested that interventions can help people make sense of a crisis, improve relationships, and contribute to meaningful recovery. Evidence of barriers suggests that psychological input in this setting might not always be compatible with everyone's needs.

CONCLUSIONS

This paper explored service users' and staff members' experiences of psychological input in the inpatient setting. The analysis revealed that psychological provision in the inpatient mental health setting is varied and encompasses direct and indirect input, valued by service users and clinicians. It also identified that psychological input in the acute inpatient mental health setting is perceived as meaningful and can lead to changes at an interpersonal and intrapersonal level. There is a sense that providing psychological thinking in the inpatient setting can be challenging due to environmental constraints and individual factors. This highlights the need for further research focused on the costs and clinical effectiveness of providing psychological thinking within the acute inpatient mental health setting.

PRACTITIONER POINTS

Staff members and service users made connections between psychological input and change, suggesting that interventions can improve relationships, help people make sense of a crisis, and contribute to meaningful recovery. There are significant barriers to and challenges of providing psychological input in this setting: Some participants suggested that this approach might not suit everyone.

Content Validation and Utility of a Critical Reflective Inquiry Assessment Tool

A Critical Reflective Inquiry (CRI) Assessment Tool was developed based on the CRI Model to assess reflection in nursing practice. Experienced clinicians evaluated the CRI Assessment for clarity and relevance to the CRI Model and nursing practice utility. Content validity index was calculated for each item in the scale and then averaged across all items. The tool has potential in education and orientation for assessing the depth and focus of reflection and what is learned.

Experiences and Perceptions of Nursing Staff Working With Long-Stay Patients in a High Secure Psychiatric Hospital Setting

BACKGROUND AND OBJECTIVE

Forensic psychiatric nursing is a demanding nursing specialty that deals with a highly complex group of patients who are detained in restrictive environments, often for lengthy periods. There is little information about the daily experiences of these nurses. This study sought to explore the roles and relationships of forensic psychiatric nurses with long-stay patients in a high secure hospital in England.

METHOD AND ANALYSIS

The study obtained data via three focus groups, and thematic analysis was carried out using NVIVO 10 software.

RESULTS

Five prominent themes emerged: First, nurses elaborated on their roles with patients and the kinds of interactions they had with them. The next two themes explored the reasons why some patients are long-stay patients and the challenges nurses face while working with this group. The fourth theme was the impact of external support, such as the patient's families, on length of stay. The final theme covered the changes that the nurses observed in these patients and in themselves over time.

CONCLUSION

It was noticeable that those interviewed were committed professionals, eager to provide an optimistic and hopeful environment for the patients to help them progress through "the system". The study presents a number of pertinent issues regarding long-stay patients that provide a basis for further research and to inform policy, educational reforms, and clinical practice.

A pilot study to determine the validity and reliability of the Level of Reflection-on-Action Assessment

The purpose of this study was to determine the reliability of the Level of Reflection-on-Action Assessment (LORAA). The LORAA is an instrument developed to identify the level of reflection achieved by students on their reflective journal entries and includes prompts for the educator to guide students to higher levels of reflection. The LORAA was developed based on a literature review and was content validated by a panel of three experts in reflective learning. Interrater reliability was achieved when pilot tested using five sample student journal entries rated at 0.67 by three independent raters on four entries and at 0.80 with two raters on all five entries. On further testing using a larger sample of 18 student journal entries, interrater reliability was achieved at 0.94 with two raters. The results suggest that the LORAA can be used to determine the level of reflection achieved by students on reflective journal entries.

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

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

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

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

Reflecting on holistic nursing: the contribution of an academic with lived experience of mental health service use

The educational preparation of registered nurses is presumed to reflect a holistic approach with emphasis on the bio-psycho-social model of care. The broader literature suggests this goal is not always realised. The aim of this study is to present the views, experiences, and perceptions of undergraduate nursing students who were taught by an academic with a lived experience of mental health service use. In particular, we wanted to look at the expected impact of this approach to learning on their nursing practice. A qualitative, exploratory approach was used, involving in-depth individual interviews with 12 undergraduate nursing students completing the course, "recovery for mental health nursing practice," as part of a major in mental health nursing in a university in Queensland, Australia. Students were asked to reflect upon and discuss their experiences of being taught by a person with lived experience of mental health service use. Data were analysed following Colaizzi's steps to identify the main themes. The three main themes were (1) recovery--bringing holistic nursing to life; (2) influencing practice; and (3) gaining self-awareness through course assessment: challenge and opportunity. These themes suggest an appreciation for holistic nursing and an increased capacity for reflective understanding. The responses from participants suggest the Recovery course had a significant impact on their attitudes to nursing and that their nursing practice would be positively enhanced as a consequence.

Developing reflective writing as effective pedagogy

While reflective writing about practice experiences is frequently used in nursing curricula to foster critical thinking, faculty members may be unaware of how to help students reflect, what kinds of feedback are helpful, and how to deal with students' concerns. This article describes faculty best practices in mentoring the student to effectively think critically through structured reflective writing. Models of structured reflection, Baker's four-step model and John's revision of Carper's patterns of knowing, are discussed as effective guides at graduate and undergraduate levels. The article addresses potentially problematic issues with the implementation and evaluation of reflective writing assignments in clinical courses. With foresight and planning, reflective writing may be an empowering strategy for facilitating students' thinking skills.

Work engagement, moral distress, education level, and critical reflective practice in intensive care nurses

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.

Encouraging reflection: Do professional development workshops increase the skill level and use of reflection in practice?

Reflection is a way of evaluating best practice and challenging existing norms, while at the same time, considering one’s personal values and assumptions in our personal and professional lives. However, many health practitioners may lack the skills to do this effectively. Through participation in a series of three workshops, practitioners in the Radiation Medicine Program at Princess Margaret Hospital have learned and acquired new skills to encourage reflection and reflective practice in themselves, their colleagues as well as with their students. A pre- and post-course survey was used to ascertain their level of knowledge of reflection and reflective practice. An additional survey at 3 months assessed the frequency of use and ongoing comfort level with reflective practice. Results of the evaluation indicate that the participants’ knowledge of reflective practice has improved their understanding of reflection in clincal practice. They recognize the importance of reflection and anticipate increasing their use of reflection in/on practice. As well, participants have been able to sustain the positive momentum 3 months after the course was delivered.

Evaluation of an occupational therapy mentorship program: effects on therapists' skills and family-centered behavior

There is growing interest in understanding the usefulness of mentorship programs for children's rehabilitation service providers. This evaluation study examined the effects of an occupational therapy mentorship program on the skills and behaviors of 8 new and 17 experienced occupational therapists practicing at a regional children's rehabilitation center. Self- and peer-report measures of family-centered behavior, critical thinking ability, listening/interactive communication skill, and clinical behavior were collected before and after an 11-month facilitated, collaborative group mentorship intervention. Significant pre-post changes associated with intervention were found on 9 of 12 outcome measures, including information provision, respectful treatment, self-confidence, and listening and clinical skill. Changes were not found on the more trait-like variables of open-mindedness, interpersonal sensitivity, and interpersonal skill. Experienced therapists had higher scores than new therapists on most variables, including family-centered behavior, listening skill, and clinical skill. Implications regarding the utility of mentorship programs in children's rehabilitation centers are discussed.

Radiation therapists’ perspectives of the role of reflection in clinical practice

A recurring theme from the literature is that the definition of reflection is nebulous and/or complex. Many authors have suggested that more research needs to be conducted to better understand an individual’s perception of reflection and reflective practice, and how these concepts affect their clinical practice as well as their personal growth and development. This paper offers the findings of a qualitative study of radiation therapists in Canada. The aim of the study was to explore radiation therapist’s understanding of the concept of reflection, and to understand how they incorporated it into their daily practice. Secondary objectives were to examine some of the perceived barriers to its use, and the possible challenges of implementing reflective writing. Two focus groups were initially conducted, and a follow-up questionnaire was developed using the themes generated from the focus groups. The questionnaire was distributed to radiation therapists at two large cancer centres in Toronto, Canada. Most participants indicated that it is an integral part of their practice and professional lives, and that they use a variety of different methods for engaging in reflection. It is not without its barriers, but many of these can be overcome by providing time, coaching and a supportive work environment. Respondents were divided as to whether they would benefit from being taught reflection; however, small group teaching would be the favoured method. Further study is suggested to determine whether there are any improvements to patient care and in particular patient outcomes.

Using reflective learning to improve the impact of continuing education in the context of work rehabilitation

Reflective learning has been described as a promising approach for ameliorating the impact of continuing education (CE) programs. However, there are still very few studies that have investigated how occupational therapists use reflection to improve the integration of CE program content in their decision-making processes. The study objectives were to describe how these professionals, working in the sector of work rehabilitation, used reflective learning to integrate research evidence into their clinical decision-making process and to identify the factors that influenced the reflective learning process. A collaborative research study was conducted. Eight occupational therapists were recruited to participate to the group that was convened for 12 meetings and held during a 15-month period. The strategies used were critical analysis of ill-structured and authentic clinical situations, peer support, reflective journal writing and complementary reading. The group facilitator acted as a research evidence mentor and guided the group process. The data collected was analyzed using the grounded theory method. The reflective learning process, used by the participants, enabled them to change their perspective at six different stages in their decision-making process. The participants developed their ability to use different types of reflective thinking: introspection, concept attainment, self-attribution, problem solving, action planning and reorganization. The factors that most influenced learning were: ease in sharing experience, normative beliefs, coping with negative emotions, perceived self-efficacy, social support and risk taking. Results led to the development of the Model of Research Utilization Grounded in Critical Reflection.

'Hands on, Hands off': a model of clinical supervision that recognises trainees' need for support and independence

Rationale.This article presents a study of junior doctor supervision at a rural hospital. The objective of the present study was to gain insight into the types of supervision events experienced, the quality of supervisory relationships, the frequencies of supervision contact in a rural hospital setting, and the implications of these factors for supervision practice. Methods.A cohort of junior doctors was asked to provide in-depth information about their interactions with their supervisors and other relevant clinical colleagues. The information was filled in on diary sheets to capture the nature, focus and quality of the cohort’s supervision experiences over 2 weeks. The information also covered frequency and types of supervisory contacts. Results.The quantitative data reveals that supervisory events occur predominantly as part of ongoing patient care and rarely off-line as part of targeted supervisory practice. The qualitative data analysis reveals that junior doctors value supervisory support of two kinds: assistance from more senior clinicians who are expert in areas where trainees need help, and trust to act independently, without being abandoned. Conclusion.Supervision must be both structured and dynamic. Besides providing a regular forum for discussion and reflection, supervision must accommodate the variable needs of individual junior doctors and navigate between being hands-on and hands-off. Such dynamic approach is necessary to reassure junior doctors they are in a ‘zone of safe learning’ where they can act with adequate and flexible support and negotiate changes in supervisory attention. What is known about the topic?Research is recognising the challenges of treatment complexity and unexpected outcomes faced by junior doctors. These factors mean that supervision needs to include dealing with the experiential and interpersonal aspects of junior doctors’ clinical work. It is also recognised that the supervisory relationship remains to be investigated in depth. Further, because supervision guidelines in Australia are still under development, they do not as yet specify senior doctors’ or registrar’s supervisory accountabilities. Relying on conventional approaches to managing medical supervision, hospitals and associated medical schools are struggling to ensure that supervising doctors’ perceptions of and approaches to supervision are aligned with emerging definitions of effective supervision. What does this paper add?The ‘hands on, hands off’ model developed here enriches post-graduate medical curricula on two fronts. First, it advises supervisors that they need to be hands-on, practising ‘active supervision’. This involves regular and structured contact with junior doctors to enhance the safety and quality of the care provided by them. Second, it advises supervisors to be hands-off, practising ‘passive supervision’. This involves ‘trustful’ monitoring junior doctors’ everyday work and negotiating with them their unique and changing learning trajectories. What are the implications for practitioners?The model proposed here has three implications for practitioners. First, the model posits that medical supervision is about ‘being there’. Junior doctors set great store by being granted ready access to advice and help if and when that is needed. Second, the model emphasises that junior doctors expect to gain supervisors’ trust to act independently albeit with supervisory access and guidance being readily available. Third, junior doctors’ needs change, not necessarily in a linear, uni-directional way. For supervisors, this means that they need to devise regular feedback opportunities for their trainees to articulate their developments, concerns and changing needs.

Exploring the hand hygiene competence of student nurses: a case of flawed self assessment

Hand hygiene remains the single most effective measure to prevent hospital acquired infection and yet poor compliance is reported repeatedly. Nurses represent the largest labour group and perform the greatest amount of direct patient care in the contemporary National Health Service. They receive their initial hand hygiene training in the pre-registration curriculum within a competence framework based on knowledge, skills and attitudes. The pre-eminent training method is one that delivers behavioural competence, making the tacit assumption that compliance will follow. In this study a mixed methods approach demonstrated that students overestimated their knowledge and skills, found it difficult to give an objective account of their performance, and reported an improbable level of compliance. The reasons why people can be self serving in their judgements may be due to information processing errors, exacerbated by the model of education and training. Flawed self assessments may present major barriers to improved performance if students view their compliance as better than it actually is. Conceptualising hand hygiene as a taxonomy of learning and introducing the cognitive strategies of reflection and self assessment would better enable students to problem solve, seek out new information, draw on past experience and gain greater and deeper understanding of the complex topic of hand hygiene behaviour.

Focus group study of student physiotherapists' perceptions of reflection

CONTEXT

The reflective practice module in the physiotherapy programme at the University of Limerick, Ireland represents the first incidence of the inclusion of such a module within physiotherapy curricula in Ireland. However, research examining the contribution of reflection as a means of learning is limited, particularly from the student perspective.

OBJECTIVES

This study sought to explore students' perceptions of reflection and its potential contribution to their development before and after the module.

METHODS

A qualitative research methodology using focus groups was employed to evaluate physiotherapy undergraduate students' perceptions of the module. Three focus groups were held in total. Two were held with Year 3 students, before and after their reflective practice module, respectively, to examine any changes in their perceptions of reflection. A third was held with Year 4 students to determine their perceptions after both the module and subsequent clinical placements. Sessions were audiotaped, transcribed and subjected to in-depth thematic analysis to resolve the significant themes that emerged from the data.

RESULTS

Students reported a more advanced level of reflective ability post-module completion. They perceived personal and professional benefits to practising reflection and recognised these skills as strategies with which they could continue to facilitate their professional development. For students, time constraints in the clinical setting represented a barrier to reflection.

CONCLUSIONS

Students support inclusion of the module in their training, acknowledging its role in improving their confidence and clinical reasoning, and facilitating continuing professional development. Further studies are required to generalise these findings to a wider population.

A categorization scheme for assessing pharmacy students' levels of reflection during internships

OBJECTIVE

To test the reliability, feasibility, and responsiveness of a categorization scheme for assessing pharmacy students' levels of reflection during internships.

METHODS

Pharmacy interns at Uppsala University were asked to write a reflective essay about patient counseling at the start and end of their internships. A modified version of Kember's categorization scheme for assessing the level of reflection was used to evaluate these essays.

RESULTS

Based on their essay scores, the students' levels of reflection increased during the internship course (p < 0.001) The mean time for categorization was 3 minutes per essay. The interrater reliability of the 182 essays was kappa = 0.63.

CONCLUSIONS

The evaluation of the categorization scheme showed that it has good interrater reliability, feasibility, and responsiveness. This scheme might be useful in pharmacy practice educational settings, but needs further validation.

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.

Burnout in the caring nurse: learning resilient behaviours

This paper reviews current literature to offer a discussion related to burnout, an issue that affects the entire healthcare sector, including nurses and patients. Literature suggests a correlation between moral distress and burnout in nurses. These issues are considered to be current and affect recruitment and retention of nurses. The authors propose supporting nurses by using knowledge of resilient behaviours as a means of transcending burnout and workplace stress. The authors believe that this process can be achieved through existing hospital professional development processes, for example supervision, reflective practice, in-service education and other forms of professional development.

Supporting practice teachers to identify failing students

The subject of identifying and supporting failing students in community nursing education programmes has been largely overlooked in the literature, yet is of great concern to practice teachers. This article discusses the views on the topic of a group of practice teachers in the light of existing, related research and proposes a number of indicators for good practice. It is suggested that of central importance is the need for higher education institutions and practice teachers to work together in identifying students causing concern at an early stage in their studies, based on both objective and subjective observations, and to have in place documented procedures to be followed when such situations arise.

A Theoretical Discussion About the Clinical Value of Phenomenology for Nurses

This article develops a theoretical discussion related to the value of a phenomenological framework in contributing to contemporary nursing knowledge. Nursing is based on the understanding of patients' personal experiences and their responses to their illness. Phenomenological methodology utilizes the patient's own language to reflect meanings embedded in their health experience.

Thinking like a nurse: a research-based model of clinical judgment in nursing

This article reviews the growing body of research on clinical judgment in nursing and presents an alternative model of clinical judgment based on these studies. Based on a review of nearly 200 studies, five conclusions can be drawn: (1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand; (2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns; (3) Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit; (4) Nurses use a variety of reasoning patterns alone or in combination; and (5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning. A model based on these general conclusions emphasizes the role of nurses' background, the context of the situation, and nurses' relationship with their patients as central to what nurses notice and how they interpret findings, respond, and reflect on their response.

Clinical teaching and support for learners in the practice environment

The purpose of planned clinical experience for students of nursing is primarily to provide students with the opportunity to develop their clinical skills, integrate theory and practice, and assist with their socialization into nursing. Nursing, in the main, is a practice-based profession. To this extent, it is essential that nurse education continues to have a strong practical element despite its full integration into higher education institutions (Department of Health, 1999). However, providing adequate support and supervision for learners is challenging. Undoubtedly, exacerbated by increasing numbers of learners, staff shortages and mentors training deficits. This article aims to critically analyse several strategies, which can be used to promote clinical learning.

Reflective practice in physiotherapy curricula: a survey of UK university based professional practice coordinators

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.

A framework for portfolio development in postgraduate nursing practice

AIMS AND OBJECTIVES

The aim of this study is to explore the introduction of portfolios into the first year of an MSc in Nursing Programme.

BACKGROUND

This paper outlines a framework for portfolio development in postgraduate nursing practice. The framework is being piloted, within the Irish context, with students in the first year of a Masters in Nursing programme and has the potential to be developed for other nursing programmes at postgraduate level.

DESIGN AND METHOD

An action research approach has been chosen to study the implementation of the portfolio and the development of a framework to guide this initiative. To date the development of the framework is being piloted as part of the 'taking action' phase of a first action research cycle.

RESULTS

In its current stage of development the framework is constructed to embrace the core concepts of specialist nursing practice and the nursing management competencies, from current Irish health care documents. In addition the portfolio is anchored around personal development planning and is supported by the use of action learning tutorials and academic and practice facilitators. The first evaluating phase will take place later this year and will involve the collection of data from students, facilitators and lecturers.

CONCLUSION

The introduction of the portfolio at postgraduate level has highlighted, to date, issues of confidentiality in committing experiences to paper, issues around its assessment, and issues around sharing this document with other students.

RELEVANCE TO CLINICAL PRACTICE

Portfolio development at postgraduate level emphasizes linking theory and practice and stresses the importance of reflection on practice. The portfolio can also be used by nurses to develop their clinical career pathways and encourage personal development planning.

Nurse Competence Scale: development and psychometric testing

BACKGROUND

Self-assessment assists nurses to maintain and improve their practice by identifying their strengths and areas that may need to be further developed. Professional competence profiles encourage them to take an active part in the learning process of continuing education. Although competence recognition offers a way to motivate practising nurses to produce quality care, few measuring tools are available for this purpose.

AIM

This paper describes the development and testing of the Nurse Competence Scale, an instrument with which the level of nurse competence can be assessed in different hospital work environments.

METHODS

The categories of the Nurse Competence Scale were derived from Benner's From Novice to Expert competency framework. A seven-step approach, including literature review and six expert groups, was used to identify and validate the indicators of nurse competence. After a pilot test, psychometric testing of the Nurse Competence Scale (content, construct and concurrent validity, and internal consistency) was undertaken with 498 nurses. The 73-item scale consists of seven categories, with responses on a visual analogy scale format. The frequency of using competencies was additionally tested with a four-point scale.

RESULTS

Self-assessed overall scores indicated a high level of competence across categories. The Nurse Competence Scale data were normally distributed. The higher the frequency of using competencies, the higher was the self-assessed level of competence. Age and length of work experience had a positive but not very strong correlation with level of competence. According to the item analysis, the categories of the Nurse Competence Scale showed good internal consistency.

CONCLUSION

The results provide strong evidence of the reliability and validity of the Nurse Competence Scale.