Evaluation of a reflective learning intervention to improve critical thinking in novice nurses

Preceptoring of Graduate Nursing Students in Iraq

Purpose

The objective of this study is to explore and examine the approaches utilized by preceptors in guiding graduate nursing students toward developing critical thinking skills within governmental nursing colleges in Iraq.

Methods

The study involved 215 preceptors employed in Al governmental nursing colleges in Iraq. Purposive sampling was used to select participants who had at least two years of nursing preceptorship experience. A survey instrument consisting of two open-ended questions was used to collect data, and descriptive and inferential statistics were used to analyze the data.

Results

Most preceptors (82.8%) agreed that critical thinking is important to graduate nursing education, and 93.5% agreed that critical thinking skills are adequately taught during preceptorship. Case studies (92.1%), simulation (87.4%), and problem-based learning (81.9%) were the most commonly used methods to enhance critical thinking skills in nursing students during preceptorship. The study identified six main challenges, including managing the diverse needs and abilities of students, integrating students into the clinical environment, educators' lack of knowledge, selection criteria, teaching strategies, and language.

Conclusion

The study concluded that most preceptors acknowledged the significance of critical thinking in nursing education and felt that these skills were effectively taught during preceptorship. Preceptors employed different techniques like case studies, simulation, and problem-based learning to enhance critical thinking abilities in nursing students.

Evidence-based teaching in contact lenses education: Teaching and learning strategies

INTRODUCTION

Contact lens (CL) practice is an ever-changing field with clinical knowledge, techniques and equipment continuously evolving. These new developments are backed with clinical trials and research to ensure that practitioners feel confident that there is an evidence base to support these advances. Evidence-based practice is now a crucial part of CL practice, and its importance also filters down to CL education. For example, lectures are one of the most popular tools for an educator but, is standing at the front of a lecture theatre full of students a more effective way of teaching than providing the same material for students to read by themselves? What evidence exists specific to CL education?

METHOD

An expert panel of educators completed a comprehensive literature review of current evidence of teaching methods in CL training, or if not available then what can be learnt from other health care professional training that could be potentially applicable to CL education.

RESULTS

Due to the amount of evidence available in the overall subject area relating to healthcare education, the initial plan of compiling evidence into one narrative review paper was discarded in favour of producing two linked papers. Here, the first paper details definitions of terminology, and also teaching methods. The second paper focuses on assessment and specific clinical training required to attain CL practice competency. In this first paper, no direct evidence of the spreading and benefit of new education strategies evidence such as flipped classrooms, spaced learning, test-enhanced learning, group work, CBL, PBL, TBL, and reflective practice in CL education was found. The only technique that was widely used in the CL field was case reports and the group discussion of them. Nevertheless, the authors found a consensus of opinion from other disciplines that are transferable to CL teaching and could help students meet the intended learning outcomes.

CONCLUSION

There is a small amount of evidence supporting CL education, but most of this seems to be related to the practical element of the training. However, there is a lot of evidence in the field of healthcare education from related disciplines which provides additional but important learning tools that may be effectively implemented in CL education.

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

OBJECTIVE

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

BACKGROUND

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

INCLUSION CRITERIA

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Power of Aha! On Stimulating and Guiding Students towards Self-Awareness and Critical Reflection while Teaching about Personality Psychology and Gender Stereotypes

This qualitative study introduces a pedagogic design which addresses the challenging task of teaching and learning self-awareness and critical reflection in the teaching of psychology. The context of the study was a course in personality psychology for first year students, and the topic of interest was how the perception of personality is affected by gender stereotypes. The pedagogic design included the recording of a mixed-sex dialogue, which was then digitally altered for pitch and timbre producing two gender-switched versions of one single recording. Students were divided into two groups who listened to one of the two different voice alterations, and were given the task to rate the personality traits of male or female sounding versions of the same character. In the subsequent debriefing seminar, students were presented with the data from their ratings. These results were then used as a reference point for inter-group discussion, and later students were also asked to reflect over the activity individually in writing. A thematic analysis of their written answers indicates that this pedagogic setup, in combination with guided reflection, can be helpful to challenge students’ own assumptions, aiding self-awareness and critical reflection related to stereotyping.

Experiential Learning Program to Strengthen Self-Reflection and Critical Thinking in Freshmen Nursing Students during COVID-19: A Quasi-Experimental Study

This article focuses on the unique needs and concerns of nursing educators and nursing students in the face of the COVID-19 pandemic. During social distancing, interacting with other human beings has been restricted. This would undermine the experiential learning of nursing students. Hence, it is important to develop and evaluate an experiential learning program (ELP) for nursing education. A pre-test and post-test design were used. The study was conducted in a university in Central Taiwan. A total of 103 nursing students participated in the study from February to June 2019. The study intervention was the experiential learning program (ELP), including bodily experiences and nursing activities with babies, pregnant women, and the elderly. After the intervention, the students completed the self-reflection and insight scale (SRIS) and Taiwan Critical Thinking Disposition Inventory (TCTDI) as outcome measures. An independent t-test showed that there was a significant difference between pre-test and post-test in both SRIS and TCTDI (p < 0.01). The Pearson product-moment correlation analysis showed that SRIS and TCTDI were significantly positively correlated (p < 0.01). ELP has a significant impact on the self-reflection and critical thinking of first-year nursing students, which can be used as a reference for the education of nursing students. During these turbulent times, it is especially vital for faculties to provide experiential learning instead of the traditional teaching concept.

Critical thinking skills in intensive care and medical-surgical nurses and their explaining factors

Critical thinking affects patient safety in critical situations. Nurses, in particular, intensive care unit (ICU) nurses, need to develop their critical thinking skills. The present article seeks to compare the level of critical thinking in medical-surgical and ICU nurses and investigate the factors explaining it. A cross-sectional study was conducted on 120 medical-surgical and ICU nurses (60 per group). Data were collected using the California Critical Thinking Skills Test and analyzed in SPSS-16 using independent samples t-test, ANOVA, and the regression analysis. The mean critical thinking score was 8.68 ± 2.84 in the ICU nurses and 9.12 ± 2.99 in the medical-surgical nurses. No significant differences were found between the two groups in terms of the critical thinking score and the scores of its domains. The results of the regression analysis showed that demographic variables explain only 8% of the variations in critical thinking score, as only gender explains nurses' critical thinking score. The results revealed poor critical thinking scores in the nurses working in medical-surgical wards. Investigating the reasons for the poor scores obtained and using educational strategies such as PBL, conceptual map, participation in interdisciplinary rounds, the development of clinical guidelines and participation in continuing education conferences are recommended for developing critical thinking skills in nurses.

Storytelling in Medical Education: Narrative Medicine as a Resource for Interdisciplinary Collaboration

Objective: The study intended to use narrative medicine study for interdisciplinary collaboration to let medical and healthcare students have a chance to interact with one another and listen to patients’ stories to enhance students’ reflective thinking, communication, empathy, and narrative medicine writing skills. Methods: A fifteen-week quasi-experimental design was used to examine the learning outcomes of the intervention. Two groups of students were randomly assigned as the experimental group (33 students) and the control group (32 students). Before and after the intervention, both groups had to fill in a Reflective Thinking Scale for Healthcare Students and Providers (RTS-HSP), Patient–Healthcare Provider Communication Scale (P-HCS), Empathy Scale in Patient Care (ES-PC), and Analytic Narrative Medicine Writing Scoring Rubric (ANMWSR). Results: The findings showed that on the reflective thinking scale, experimental group students had significantly higher reflective thinking posttest scores in “reflective skepticism,” “empathetic reflection,” and “critical open-mindedness,” but not in “self-examination.” As for patient–healthcare provider communication, they had significantly higher posttest scores in all “perception of trust and receptivity,” “patient-centered information giving,” “rapport building,” and “facilitation of patient involvement” factors. As for empathy, they had significant higher posttest scores in “behavioral empathy” and “affective empathy,” but not in “intelligent empathy.” In narrative medical writing skills, they had significant higher posttest scores in the “attention → representation → affiliation,” “depth of reflection,” “focus and context structure,” and “ideas and elaboration” sections, but not in the “language and conventions” section. Conclusion: The findings suggest that narrative medicine is worth recommending for interdisciplinary collaboration for healthcare education.

Clinical Reasoning in Physical Therapy: A Concept Analysis

BACKGROUND

Physical therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research.

OBJECTIVE

The objective was to conceptualize a broad description of physical therapists' clinical reasoning grounded in the published literature and to unify understanding for future work related to teaching, assessment, and research.

DESIGN/METHODS

The design included a systematic concept analysis using Rodgers' evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relation between features of the concept are clarified.

RESULTS

Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management.

LIMITATIONS

Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature were incomplete or key sources were mistakenly excluded.

CONCLUSIONS

A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice.

Self-reflection and critical thinking: the influence of professional qualifications on registered nurses

Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (β = 0.24, t = 4.141, p < .001). Qualifications also affected self-reflection with insight (β = 0.11, t = 1.808, p > .05) and critical thinking (β = 0.18, t = 3.143, p < .001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight.

Clinical narratives in residency education: Exploration of the learning process

Background: Post-professional residency educational programs aim to advance the knowledge and skills of therapists in a clinical specialty area, however, little is known about the process, outcomes, or effectiveness of residency education. Purpose: The purpose of this study was to use narrative as a teaching and learning tool to gain insight into the progressive development of the residents' learning process. Design: Qualitative methods including a retrospective analysis of residents' narratives were used to explore the professional development and thought process of residents. Methods: Six physical therapy residents wrote reflective narratives across 4 time placements during their one-year residency. Qualitative content analysis was used to analyze the data for types of reflection across time frames and to construct themes based on meaning statements. Results: Four main themes evolved from the residents' clinical narratives: 1) developing clinical reasoning skills; 2) developing professional formation and identity; 3) moral agency; and 4) emerging characteristics of expertise Conclusions: In this study, clinical narratives served as a pedagogical tool to enhance aspects of clinical expertise. The utilization of clinical narrative may be used as one tool to help to create reflective practitioners with improved skills foundational to clinical practice.

Reflection in the training of nurses in clinical practice settings: a scoping review protocol

This scoping review will seek to find answers for the following questions which will focus on the use of reflection in the education of nurses in clinical settings:The review will also extract and map data regarding: i) what outcomes have been found in relation to the use of different tools and approaches (e.g. dialogues, diaries, case studies); ii) how approaches and tools have been implemented as interventions; iii) details of the topic or focus of reflection (e.g. ethical issues, care of older adults etc.); iv) details about the participants involved in reflection activities (e.g. first or second year undergraduate nursing students etc.); and v) barriers/challenges to the use of reflection approaches/tools. Additional details may also be extracted and mapped during the process of the scoping review and this will be explained in the final scoping review report.

Enhancing Critical Thinking in Graduate Nursing Online Asynchronous Discussions

BACKGROUND

Graduate nursing students in online courses often have limited success in developing the critical thinking (CT) skills essential for advanced roles. This study describes the use of complementary strategies in a graduate-level nursing course to enhance CT in online discussions.

METHOD

Using Paul and Elder's framework for understanding the components of CT, the authors designed an asynchronous online course using multiple strategies to promote CT. We used mixed methods to collect descriptive and numerical data and content and repeated measures analyses to identify changes in CT skills and student perceptions across the semester.

RESULTS

CT scores increased significantly and aligned with students' perceived improvements in CT.

CONCLUSION

Evidence of CT in online discussions increased significantly across the semester with the use of multiple instructional strategies and substantial student and faculty efforts. The findings are a useful benchmark for future studies comparing combinations of strategies to identify those most effective and least arduous. [J Nurs Educ. 2016;55(9):514-521.].

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.

The evaluation of reflective learning from the nursing student's point of view: A mixed method approach

BACKGROUND

Adapting university programmes to European Higher Education Area criteria has required substantial changes in curricula and teaching methodologies. Reflective learning (RL) has attracted growing interest and occupies an important place in the scientific literature on theoretical and methodological aspects of university instruction. However, fewer studies have focused on evaluating the RL methodology from the point of view of nursing students.

OBJECTIVES

To assess nursing students' perceptions of the usefulness and challenges of RL methodology.

DESIGN

Mixed method design, using a cross-sectional questionnaire and focus group discussion.

METHODS

The research was conducted via self-reported reflective learning questionnaire complemented by focus group discussion.

RESULTS

Students provided a positive overall evaluation of RL, highlighting the method's capacity to help them better understand themselves, engage in self-reflection about the learning process, optimize their strengths and discover additional training needs, along with searching for continuous improvement. Nonetheless, RL does not help them as much to plan their learning or identify areas of weakness or needed improvement in knowledge, skills and attitudes. Among the difficulties or challenges, students reported low motivation and lack of familiarity with this type of learning, along with concerns about the privacy of their reflective journals and about the grading criteria.

CONCLUSIONS

In general, students evaluated RL positively. The results suggest areas of needed improvement related to unfamiliarity with the methodology, ethical aspects of developing a reflective journal and the need for clear evaluation criteria.

Clinical Growth: An Evolutionary Concept Analysis

Clinical growth is an essential component of nursing education, although challenging to evaluate. Considering the paradigm shift toward constructivism and student-centered learning, clinical growth requires an examination within contemporary practices. A concept analysis of clinical growth in nursing education produced defining attributes, antecedents, and consequences. Attributes included higher-level thinking, socialization, skill development, self-reflection, self-investment, interpersonal communication, and linking theory to practice. Identification of critical attributes allows educators to adapt to student-centered learning in the clinical environment. These findings allow educators to determine significant research questions, develop situation-specific theories, and identify strategies to enhance student learning in the clinical environment.

Nursing students' perceptions of learning after high fidelity simulation: Effects of a Three-step Post-simulation Reflection Model

BACKGROUND

High-fidelity simulation (HFS) has become a bridge between theoretical knowledge and practical skills. A safe and realistic environment is commonly used in nursing education to improve cognitive, affective and psychomotor abilities. Debriefing following a simulation experience provides opportunities for students to analyze and begin to reflect upon their decisions, actions and results. The nursing literature highlights the need to promote the concept of reflective practice and to assist students in reflection, and research indicates the need to refine and develop debriefing strategies, which is the focus of the current paper.

PURPOSE

To explore the value of reflections after HFS by investigating nursing students' perceptions of their learning when a Three-step Post-simulation Reflection Model is used.

DESIGN

A qualitative descriptive research approach was applied.

METHOD

A Three-step Post-simulation Reflection Model that combined written and verbal reflections was used after an HFS experience in a second-year course in the Bachelor Program in Nursing at Luleå University of Technology, Sweden. Reflective texts written before and after a verbal group reflection were subjected to qualitative content analysis.

FINDINGS

The main theme in the first written reflections was identified as "Starting to act as a nurse", with the following categories: feeling stressed, inadequate and inexperienced; developing an awareness of the importance of never compromising patient safety; planning the work and prioritizing; and beginning to understand and implement nursing knowledge. The main theme in the second written reflections was identified to be "Maturing in the profession", with the following categories: appreciating colleagues, good communication and thoughtfulness; gaining increased self-awareness and confidence; and beginning to understand the profession.

CONCLUSION

The Three-step Post-simulation Reflection Model fostered an appreciation of clear and effective communication. Having time for thoughtfulness and reflection promotes self-awareness and a better understanding of both the nursing profession and patient safety. The progress demonstrated in the depth of the themes in the written reflections indicates that repeated reflections stimulate and enhance student learning. The findings point towards the potential effectiveness of alternate methods of reflections.

Measuring third year undergraduate nursing students' reflective thinking skills and critical reflection self-efficacy following high fidelity simulation: A pilot study

Critical reflection underpins critical thinking, a highly desirable generic nursing graduate capability. To improve the likelihood of critical thinking transferring to clinical practice, reflective thinking needs to be measured within the learning space of simulation. This study was divided into two phases to address the reliability and validity measures of previously untested surveys. Phase One data was collected from individuals (n = 6) using a 'think aloud' approach and an expert panel to review content validity, and verbatim comment analysis was undertaken. The Reflective Thinking Instrument and Critical Reflection Self-Efficacy Visual Analogue Scale items were contextualised to simulation. The expert review confirmed these instruments exhibited content validity. Phase Two data was collected through an online survey (n = 58). Cronbach's alpha measured internal consistency and was demonstrated by all subscales and the Instrument as a whole (.849). There was a small to medium positive correlation between critical reflection self-efficacy and general self-efficacy (r = .324, n = 56, p = .048). Participant responses were positive regarding the simulation experience. The research findings demonstrated that the Reflective Thinking and Simulation Satisfaction survey is reliable. Further development of this survey to establish validity is recommended to make it viable.

Enhancing Clinical Reasoning Through Simulation Debriefing: A Multisite Study

AIM

The aim of this research was to replicate Dreifuerst's 2012 findings of enhanced clinical reasoning scores using a structured debriefing: Debriefing for Meaningful Learning (DML).

BACKGROUND

The direct effect of debriefing on clinical reasoning is not well studied. The nursing education literature supports debriefing as a reflective dialogue necessary to enhance clinical reasoning.

METHOD

A quasi-experimental, pretest-posttest, repeated measure research design was used to evaluate nursing students' clinical reasoning using the Health Sciences Reasoning Test (HSRT).

RESULTS

The change in HSRT mean scores was determined to be significant for the intervention group at the .05 level and insignificant for the control group. The change in HSRT mean scores between the intervention and control groups was determined to be significant at the .10 level.

CONCLUSION

Nursing students who had the DML debriefing scored significantly higher in their clinical reasoning than nursing students who had usual and customary debriefing.

Learning to think like a nurse: the development of clinical judgment in nursing students

The purpose of this project was to examine the clinical judgment and reasoning skills of nursing students in high-fidelity simulation. Two levels of students (N = 104), novices and those who are slightly more advanced, participated in individual videotaped simulations. Afterward, interviews were conducted to explore what the student was thinking and feeling during simulation. Five themes emerged from the interviews: thinking like a nurse, assessment, looking for answers, communication, and magical or reflective thinking. There was a clear distinction in the reasoning skills of the novice students compared with students with more clinical experience. Tanner's model of clinical judgment in nursing is used to understand the findings of the study.

Critical thinking in nursing: Scoping review of the literature

This article seeks to analyse the current state of scientific knowledge concerning critical thinking in nursing. The methodology used consisted of a scoping review of the main scientific databases using an applied search strategy. A total of 1518 studies published from January 1999 to June 2013 were identified, of which 90 met the inclusion criteria. The main conclusion drawn is that critical thinking in nursing is experiencing a growing interest in the study of both its concepts and its dimensions, as well as in the development of training strategies to further its development among both students and professionals. Furthermore, the analysis reveals that critical thinking has been investigated principally in the university setting, independent of conceptual models, with a variety of instruments used for its measurement. We recommend (i) the investigation of critical thinking among working professionals, (ii) the designing of evaluative instruments linked to conceptual models and (iii) the identification of strategies to promote critical thinking in the context of providing nursing care.

Learning styles and critical thinking relationship in baccalaureate nursing education: a systematic review

BACKGROUND

Critical thinking is a desirable competency for contemporary nurses although there are growing concerns supporting a disturbing paucity in its achievement. Learning styles reflect habitual behaviors which determine distinct preferences within learning situations. Evidence suggests that critical thinking could evolve through learning processes. Variances in critical thinking achievement by nursing students might therefore be influenced by individual learning preferences. The concepts "learning styles" and "critical thinking" have been independently examined in the nursing literature. No reviews were found however exploring their association in nursing education.

OBJECTIVES

To identify the potential relationships between learning styles and critical thinking in baccalaureate nursing students.

DESIGN

Systematic review.

DATA SOURCES

Eleven electronic databases were utilized without geographical and time publishing filters. Hand-searching journals and scanning references from retrieved studies were also performed.

METHODS

Databases were searched for descriptive correlational studies which considered the relationship between learning styles and critical thinking in baccalaureate nursing students. The authors independently progressed three stage screening. Retrieved articles were reviewed at title, abstract and full text levels according to predetermined criteria. All included studies were quality appraised using a rating tool for descriptive studies.

RESULTS

Six studies were finally included. Findings were grouped under four key themes: predominant learning styles, critical thinking scoring, critical thinking evolution across academic progress and learning styles-critical thinking correlations. Learning styles' diversities, weak critical thinking and inconsistent evolution through academic progress were revealed across studies. Critical thinking differed significantly between learning styles.

CONCLUSIONS

Commonly accepted models in nursing education were lacking in both learning styles and critical thinking. Within studies identical learning styles were found to be positively or negatively related to critical thinking. However comparative findings across studies revealed that all learning styles might be positive determinants toward critical thinking evolution, suggesting that there is a relationship between learning styles and critical thinking. Certain links between learning styles and critical thinking were supported in given settings and given nursing student populations. Further field exploration is required.

An integrated educational model for continuing nurse education

AIM

This paper reports on the development and evaluation of an integrated clinical learning model to inform ongoing education for surgical nurses. The research aim was to evaluate the effectiveness of implementing a Respiratory Skills Update (ReSKU) education program, in the context of organisational utility, on improving surgical nurses' practice in the area of respiratory assessment.

BACKGROUND

Continuous development and integration of technological innovations and research in the healthcare environment mandate the need for continuing education for nurses. Despite an increased worldwide emphasis on this, there is scant empirical evidence of program effectiveness.

METHODS

A quasi experimental pre test, post test non-equivalent control group design evaluated the impact of the ReSKU program on surgical nurses' clinical practice. The 2008 study was conducted in a 400 bed regional referral public hospital and was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies.

FINDINGS

The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group's reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales.

CONCLUSION

The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

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.

A theoretically informed education program designed specifically for acute surgical nurses

AIM

The aim of the research was to evaluate the effectiveness of implementing the Respiratory Skills Update (ReSKU) education program using integrated teaching and learning strategies, in the context of organisational utility, on improving surgical nurses' practice in the area of respiratory assessment.

BACKGROUND

Technological advances and changes in healthcare delivery have necessitated that nurse educators adopt innovative teaching and learning strategies to better prepare acute care nurses for their increasingly complex roles. This 2007 study used a robust overarching theoretical framework to develop and evaluate an educational model using the ReSKU program as a basis for the content.

METHODS

The study was conducted in a 400 bed regional referral public hospital, in Australia. The research was guided by the work of Forneris (2004) to operationalise a critical thinking process incorporating the complexities of the clinical context. The theoretical framework used multi-modal, interactive educational strategies that were learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators.

CONCLUSION

The construct of critical thinking in practice combined with clinical reasoning and purposeful and collective reflection is a powerful educational strategy to enhance competency and capability in clinicians.

The socialization process of newly graduated nurses into a clinical setting: role of the clinical nurse educator

This article is a review and synthesis of the literature related to the socialization of newly graduated nurses. Personal experience and standards frame the clinical nurse educator role in facilitating learner development and socialization. Successful strategies to improve the socialization process of newly graduated nurses from the literature and recommendations for the future are presented.

The use of reflective practice in new graduate registered nurses residency program

New graduate nurses encounter emotional distress related to complex patient care situations and overwhelming workloads. Unequipped with coping mechanisms, new nurses verbalize difficulty feeling accepted in their assigned units. Self-perceptions of inadequacy and lack of independence contribute to anxiety. Consequently, hospitals are at risk for losing newly graduated nurses within the first year. The cost of losing new nurses is overwhelming to hospital institutions and further contributes to the looming nursing shortage. This article describes the use of a reflective practice exercise in a new registered nurse residency program in a magnet hospital to facilitate reflection and problem solving in the patient care unit. More research is needed to investigate the effectiveness of reflective practice in developing coping skills and retention rate in new graduate nurses.

Evaluation of a PBL strategy in clinical supervision of nursing students: patient-centred training in student-dedicated treatment rooms

AIM

The present study aimed at investigating staff members' and nursing students' perception of and satisfaction with an intervention involving patient-centred training in student-dedicated treatment rooms during clinical supervision.

BACKGROUND

It is well known that clinical education is important and that the clinical learning environment influences the development of nursing students' ability to solve clinical problems. In the present study, an intervention using a problem-based learning (PBL) strategy was introduced and evaluated in clinical education. The PBL strategy is called 'Patient-centred training in student-dedicated treatment rooms'.

DESIGN AND METHODS

Descriptive; both quantitative and qualitative methods were used. A questionnaire and focus group interviews were used.

RESULT

Most participants found the PBL strategy to be highly satisfactory, both for staff and for students. The students seemed to feel that their time in clinical education had been used efficiently.

CONCLUSION

Integration of theory and practice during clinical training has been emphasized as a necessary component, and the new strategy, which involves a method of promoting students' reflection, represents one way of facilitating such integration, in that it may bridge the gap between theory and practice. More extensive and more specific research is need in the future.

Nurse lecturers' perceptions of what baccalaureate nursing students could gain from clinical group supervision

The extensive amount of studies on clinical supervision during the nursing students' clinical programmes has shown that supervision most often is given on a one-to-one basis, and that many challenges are embedded in this kind of supervision. In some studies group supervision has been used, with mostly successful effects according to the nursing students. At a university in Sweden, a model of group supervision was included in the baccalaureate nursing programme, conducted by nurse lecturers. The purpose of this study was to describe the value of clinical group supervision to nursing students, as perceived by the nurse lecturers. Data consisted of field notes written by the nurse lecturers after 60 supervision sessions, and qualitative content analysis was performed. The findings showed how reflection in a group of equals was considered to give the nursing students opportunities to increase their understanding of themselves and others, prepare them for coming events, increase their personal and professional strengths, and inspire them for further development. On the basis of the findings and previous studies the value of using nurse lecturers as group supervisors was discussed. The impact of a contract to achieve a good learning environment in group supervision was also stressed.