A Qualitative Inquiry into Nursing Students' Experience of Facilitating Reflection in Clinical Setting

Development and psychometric evaluation of a reflection on clinical practice questionnaire for nursing students

BACKGROUND

Reflection on clinical practice is the core of education for nursing students. Evaluating reflection on clinical experiences requires a tool which accurately measures reflection skills. The present study aims to develop and test the psychometric properties of a tool for measuring nursing students' reflection on clinical practice.

METHODS

Based on a mix-method exploratory approach, the study was carried out in two stages: in the first stage (the qualitative phase), the concept of reflection on clinical practice was established. In the second stage (the quantitative phase), the psychometric properties of the developed scale were evaluated.

RESULTS

Based on the results of the exploratory factor analysis and the verification process, the final version of the scale came to consist of 36 items and 6 dimensions. The dimensions were: professional competence, internal sources of motivation, challenging situational clinical setting, dynamic organizational atmosphere, reflection-based self-management, and dynamic professional growth. Overall, 6 factors accounted for 62.79% of the variances. The factor loadings of the items ranged between 0.62 and 0.94, all of which were significant. The total intraclass correlation (ICC) of the scale was found to be 0.94. Also, evaluation of the reliability of the scale as measured through internal homogeneity yielded a total Cronbach's alpha of 0.90.

CONCLUSION

The findings show that the developed scale for evaluation of nursing students' reflection on clinical practice possesses satisfactory validity and reliability, and nursing professors can use this instrument to assess students' reflection skills.

Developing reflective competence between simulation and clinical practice through a learning transference model: A qualitative study

OBJECTIVE

This study sought to understand the effects of a pedagogical resource combining a multi-moment debriefing model with reflective journaling that is designed to develop reflective competence.

DESIGN

A qualitative educational study was used with an instrumental case study design. Participating in the study were 32 nursing students who wrote 96 individual reflective journals in accordance with each moment (M1, M2, M3) of the proposed reflective practice resource. The journaling was conducted during both the clinical simulation activity and the period of clinical practice.

METHODS

The reflective journals resulting from the high-fidelity clinical simulation process were used to explore three moments of learning: debriefing immediately after simulation, post-scenario debriefing, and clinical practice. The typology of content analysis used was classical content analysis, which followed a deductive logic, since to assess reflection levels the 5Rs Reflective Writing Scale was used.

RESULTS

In the post simulation moment (M1), students produced a greater number of meaningful units associated with a level of strategic narrative reflection. During clinical practice however reflection was more analytical, with the highest level of reflection.

CONCLUSION

Nursing students developed reflective competence through an iterative process of reflective practice establishing a continuum between simulation experience and clinical.

Attitude of Nursing and Midwifery students towards clinical practice and its associated factors in Northwest Ethiopia: a cross-sectional study

OBJECTIVE

The aim of this study was to assess the attitude of Nursing and Midwifery students towards clinical practice and its associated factors at University of Gondar, Northwest Ethiopia. 2018.

RESULT

The prevalence of a favorable attitude towards clinical practice was found to be 42.9% in this study. The odds of having favorable attitude were found to be 2 times higher among students who prepared well for clinical practice [AOR = 2.07, 95%, CI (1.25, 3.44)] compared with counterparts. Similarly students who communicate well with clinical staffs [AOR = 1.89, 95%, CI (1.05, 3.41)], practiced in well-equipped hospital [AOR = 1.76, 95%, CI (1.01, 3.06)], and accompanying frequently by a clinical supervisor [AOR = 1.69, 95%, CI (1.02, 2.81)] were more likely to have favorable attitude compared with counterparts.

Triggers for reflection in undergraduate clinical nursing education: A qualitative descriptive study

BACKGROUND

Reflection is a key component of effective teaching in baccalaureate nursing education. However, there are limited empirical studies into the factors which trigger reflection in undergraduate clinical nursing education.

OBJECTIVES

This study aimed to explore reflection triggers in undergraduate clinical nursing education with a specific focus on verbalized reflection in spoken dialogues.

METHODS

This qualitative descriptive study was conducted in 2017-2018. Participants were seventeen clinical nursing instructors, 32 nursing students, and nine newly graduated nurses who were purposively recruited from four universities and two hospitals in Iran. Data were collected via 26 in-depth semi-structured face-to-face interviews with clinical nursing instructors and newly graduated nurses and four focus group discussions with students. Conventional content analysis was used for data analysis.

RESULTS

Reflection triggers fell into the following four main categories: conscious comparison of actions, confrontation with influential realities, emotional and moral involvement in patient care, and demanding accountability.

CONCLUSION

This study suggests triggers for reflection in clinical nursing education. Instructors' use of reflection triggers can help students reflect on their actions and practice.

The clinical environment: A facilitator of professional socialisation

BACKGROUND

Competencies of health care workers, including nurses, often do not meet the health needs of populations. The clinical learning environment (CLE) is vital in socialising neophyte student nurses to display the desired competencies. Student nurses are however confronted with challenges, especially in the CLE, during this process.

AIM

This article shares three validated guidelines to support professional nurses and nurse educators in facilitating appropriate professional socialisation of student nurses in the CLE.

SETTING

The study was conducted in an 832-bed academic hospital and nine nursing education institutions (NEIs) that offered the nursing programme concerned in a province in South Africa.

METHOD

A sequential, exploratory, mixed-methods study was conducted and qualitative data were collected from two purposive samples, consisting of seven focus group interviews and field notes. Five themes that emerged from the integrated data guided the instrument design to collect data quantitatively from 277 educators. Experts validated 10 guidelines to a set of criteria, which was developed combining all data.

RESULTS

Qualitative and quantitative research evidenced that the CLE mostly did not support student nurses during professional socialisation. A few role models' behaviour was noteworthy, while student supervision was inadequate. The CLE was stressful, lacked in resources, marked by uncoordinated student placement, insufficient communication and inadequate preparation of student nurses. This evidence informed the development of the guidelines.

CONCLUSIONS

The guidelines were (1) the empowerment of role models through reflective practice, (2) capacity building of professional nurses and nurse educators as clinical supervisors by means of intervention strategies and (3) adopting a multifaceted approach in the creation of a positive CLE. These guidelines could facilitate appropriate professional socialisation of student nurses.

Exploring the perception of nursing students about consequences of reflection in clinical settings

BACKGROUND

Reflection on practical experiences is a key element that enables students to recognize their own strengths and weaknesses and develop nursing skills. Whilst reflection may enhance students' learning in practice, there is little evidence about nursing students' perception of the consequences of reflection in clinical settings.

OBJECTIVE

This study aimed to explore Iranian nursing students' perception regarding the consequences of reflection during clinical practices.

METHODS

This qualitative study was conducted by a conventional content analysis approach in two nursing schools at Shiraz and Fasa Universities of Medical Sciences in Iran. Data were collected through in-depth semi-structured interviews during 2015-2016, from 20 students selected by purposive sampling. All the interviews were tape-recorded, transcribed verbatim, and analyzed by content analysis method. Rigor of this study was approved by member check and external audit.

RESULTS

Two categories emerged from the data analysis, including movement toward professionalism and self-actualization of emotions. The former consisted of three subcategories of function modification, sharing experiences and generalizing experiences. The latter consisted of two subcategories of inner satisfaction and peace of mind.

CONCLUSION

The results indicated that nursing students' reflection in clinical settings is effective in personal and professional levels. Reflection in a personal level led to positive emotions that increased the quality of care in patients. Accordingly, nursing educators need to create a nurturing climate as well as supporting reflective behaviors of nursing students.