Through the looking glass: the rabbit hole of reflective practice

Exploring the Educational Value of an Immersive Virtual Reality Method Within a Continuing Education Module in Nursing: A Mixed Methods Study

BACKGROUND

Few studies have explored the potential educational value of immersive 360° video in continuing education. This study explored the potential value of immersive 360° video as an acceptable educational method in a continuing education module in nursing.

METHOD

A convergent parallel mixed methods design was adopted. The setting was a nursing and midwifery school at a university. The 11 participants were RNs. Data were collected at three time points with surveys and focus groups.

RESULTS

Participants found educational value in the triggering of a deep reflective process, supported by a subsequent classroom discussion. Further, there were nuances and complexities to be considered, with a need to tailor material toward high-acuity, low-frequency, or challenging clinical events when considering content.

CONCLUSION

Immersive 360° videos are a potentially useful method for providing continuing education; however, the content must be tailored to students' learning needs. A reflective model may provide a valuable structure for discussions after the use of immersive 360° video. [J Contin Educ Nurs. 2024;55(5):261-268.].

'What is it we are trying to achieve here'? Community maternal and child health nurses and clinical supervision: A qualitative descriptive study

AIMS

To explore clinical supervision practice by Victorian Maternal and Child Health nurses, identify the self-reported supervision needs of nurses and the facilitators and barriers to meeting those needs.

BACKGROUND

Community-based Maternal and Child Health nurses have responsibilities for the safety and wellbeing of children and specific clinical support needs. Clinical supervision has the potential to support nurses' clinical practice and reflective skills; however, little is known internationally about child and family health nurses' supervision practices.

DESIGN

Qualitative descriptive study.

METHODS

Twenty-three semi-structured interviews were conducted between October and December 2021 with nurses, managers and supervisors across metropolitan, regional/rural areas of Victoria, Australia. Inductive thematic analysis was applied to the data. The Consolidated Criteria for Reporting Qualitative Research guided this study.

RESULTS

Three main themes, with subthemes were generated; 'Understand what we do', 'It's the gathering of the nurses' and 'Bringing a case'. A lack of agreed purpose, aims and varied understandings of clinical supervision contributed to suboptimal clinical supervision. Although participants agreed about the importance of clinical supervision, the perceived benefits were inconsistently realized.

CONCLUSIONS

This study points to a need for greater organizational awareness of the conditions and leadership needed to build reflective skills and culture in community-based child and family nursing.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research has guided this study.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution in the conduct of this study.

IMPACT

A stronger focus is needed to build reflective culture and skill in child and family nursing. Areas for improving child and family nurses' use of clinical supervision have been identified. This study can inform nurse education, policy and service leaders, to strengthen clinical supervision in child and family nursing contexts.

Student Self-assessment: Reflecting on Physician Assistant Educator's Perceptions and Current Practices in Physician Assistant Training

PURPOSE

The purpose of this study was to examine relationships between physician assistant (PA) educators' perspectives on students' self-assessment (SA) accuracy and students' use of SA education practices and types of abilities assessed.

METHODS

Using correlation analysis and a novel, online survey, PA educators were asked about their perceptions of students' SA accuracy in relation to SA educational activities and assessed abilities.

RESULTS

A total of 308 educators responded. Most respondents used at least one type of SA activity, with feedback and practice being the most common types and comparative assessment, the least common type. Most respondents indicated that students self-assess noncognitive abilities more than cognitive abilities, with SA of communication skills occurring most. Spearman's correlation coefficient was used for correlation analysis with a significant, small correlation noted between the frequency of activities and educators' overall perceptions of students' SA accuracy (r = 0.15, P = .02) and SA accuracy of cognitive abilities (r = 0.17, P = .02). Educators' perceptions of students' SA accuracy were positively skewed, regardless of student training level (ie, didactic and clinical training phases). A mild predictive relationship exists between overall perception of students' SA accuracy and how frequently educators use SA activities (r = 0.29, P = .05).

CONCLUSION

Although respondents indicated they used practice and feedback activities, providing instruction on how to self-assess and using comparative evaluations to calibrate SAs will improve accuracy. Further research is needed to understand why educators perceive PA students' SA abilities as more accurate, regardless of training level.

Valuing the emotions of leadership learning experience in nursing education

AIM

This paper argues that a greater understanding of the role of emotions in experiencing leadership, the impact of role models and cultures of the workplace and profession, may enable further development for effective leadership development at undergraduate level and beyond.

BACKGROUND

Leadership has gained prominence as a necessary skill in nursing literature and policy, linking its importance to patient safety, working cultures, resilience and emotional labour globally. Viewed as essential in many undergraduate nursing programmes and a requirement by professional regulators, there is a globally agreed acceptance of its importance. Despite this, the focus on evaluating and researching the effectiveness of leadership learning and through experiences of students in contexts of learning remain limited. This paper presents a discussion on the importance of experiences of leadership, exploring the emotional impact and how enabling reflexivity and critical analysis can be integrated in education. An approach is proposed for nursing education where the emotional impact of experiencing leadership is given significance. Experiences of leadership in practice and educational learning in higher education should allow students to reflect and conceptualise experience, aligning educational contexts of learning. Acknowledgement of emotional experience and pragmatism provides opportunity to strengthen evidence and knowledge and establish leadership as a concept of value in the profession from an early stage.

DESIGN

A critical theoretical discussion paper METHODS: Based on a narrative inquiry study, drawing on theory and philosophies of emotions in education and leadership from 1907 to 2023 RESULTS: Acknowledgement of emotional experience and pragmatism provides opportunity to strengthen evidence and establish leadership as a concept of value in the profession from an early stage.

CONCLUSIONS

Placing value on the experience of leadership by reflexivity and pragmatic, experiential approaches to learning can align educational contexts of learning and focus on effective leadership learning for the nursing profession.

TWEETABLE ABSTRACT

Pragmatic approaches and reflexivity rationalise emotional experiences of leadership and encourage critical thinking and learning.

Nursing students' development of using physical assessment in clinical rotation-a stimulated recall study

Background

The overall aim of this study was to explore third-year bachelor nursing students’ stimulated recall reflections on their physical assessment competence development. The choice of learning strategies in nursing education seems to have great impact on nursing students’ use of physical assessment skills while in clinical rotation. There is a need to explore nursing students’ learning processes related to the use of physical assessments.

Methods

Explorative qualitative design using a triangulation of data collection methods. Nine final-year nursing students’ physical assessment performances during patient encounters were audio-taped and observed. Shortly after, an individual stimulated recall interview based on the audio-recorded patient encounter and observation notes was conducted. A two-fold analysis was conducted: 1) analysis of students’ performed assessments, and 2) phenomenological hermeneutical analysis of the stimulated recall interviews.

Results

Nursing students assessments shifted from a checklist approach to a symptom-based, more holistic and person-centred approach, emphasizing conversation as part of their assessments. The nursing students also reported that a safe and stimulating learning environment was a prominent feature for their continuing development. Learning from skilled role models with expectations to them using physical assessment skills facilitated their continuing skills appliance, interprofessional communication and reflective practice.

Conclusions

This study contribute with a novel, comprehensive and in-depth description of what influenced nursing students’ learning processes experiences of using physical assessment skills during clinical rotation. The results reveal the need for targeted course designs by implementing scaffolded learning activities in practical and theoretical courses aimed at strengthening students’ learning of physical assessment skills—building upon and emphasizing their prior knowledge and competence, which may lead to more confident registered nurses and promote patient safety in different health care contexts. We propose using stimulated recall systematically as a novel reflective learning activity in nursing education to foster clinical reasoning and metacognition skills and achieve deep learning.

Reflective practice in nursing: A concept analysis

PURPOSE

This paper aims to clarify the concept of reflective practice in nursing by using Rodgers' evolutionary method of concept analysis.

DATA SOURCES

Literature and references on the concept of reflective practice were obtained from two databases: Scopus and Nursing and Allied health database. Peer-reviewed articles published in English language between 2011-2021 that included the terms 'reflection' and/or 'reflective practice' in the title were selected. Seminal pieces of work were also considered in this analysis. A total of 23 works were included. Most of the selected works addressed the concept of reflective practice in nursing education or nursing practice.

DATA SYNTHESIS

The data analysis integrated the stages identified in Rodgers' method of concept analysis to analyze the concept of reflective practice. Analysis of selected works provided an understanding of common surrogates, antecedents, attributes, and consequences of the concept of reflective practice.

CONCLUSIONS

Reflective practice is a cognitive skill that demands conscious effort to look at a situation with an awareness of own beliefs, values, and practice enabling nurses to learn from experiences, incorporate that learning in improving patient care outcomes. It also leads to knowledge development in nursing. Considering the current circumstances of the COVID-19 pandemic, this paper identifies the need for nurses to go beyond reflection-on-action and also include reflection-in-action and reflection-for-action as part of their practice.

IMPLICATIONS FOR NURSING PRACTICE

This analysis identifies the need for future nursing researchers to develop reflective models or strategies that promote reflection among nurses and nursing students before, during, and after the clinical experiences.