Experiential learning and critical thinking in nursing

Critical thinking and clinical competence: results of the implementation of student-centered teaching strategies in an advanced practice nurse curriculum

The nursing profession has advanced dramatically over the past 50 years. People are living longer, technology is advancing at a rapid rate, and patients are presenting more critically ill. The recent move in the US and other countries away from secondary and tertiary care towards primary care will have a dramatic impact on the practice of nursing as the focus of treatment is aimed at prevention and maintenance of health. Budgetary constraints and a shrinking nursing workforce have added additional strain on the ability of nurses to remain clinically competent in this fast-paced healthcare environment. In addition, the demographics of students have shifted, with more adult and ethnically diverse students entering various nursing programs. These changes have compelled schools of nursing worldwide to revise their approach to student education to keep up with the challenge associated with these influences. Terms such as problem-based learning, critical thinking, evidence-based practice, and student-centered teaching strategies have replaced traditional terminology typically linked with education and practice. However, it appears that not all centers of nursing education have embraced the need to change to new methods of teaching and continue to teach as they were taught. This article will detail the approach used to develop and implement problem-based learning in an advanced practice nurse curriculum in the US. The results and recommendations for implementation are discussed based upon student and nurse educator feedback.

Critical Thinking: Perceptions of Newly Graduated Female Baccalaureate Nurses

Nursing education strives to develop critical thinking through emphasis on process, inquiry, and reasoning. Although North American nursing education programs have recommended integrating the critical thinking construct into the conceptual framework that supports undergraduate nursing programs, critical thinking is still ambiguously and inconsistently applied within the profession. The research described in this article explored the development of thinking in five newly graduated baccalaureate RNs by accompanying them on the conceptual, theoretical, and practical evolutionary journey of their first 6 months in nursing practice and explicating their knowledge development over time, offering insights into the role of undergraduate education in teaching, and fostering critical thinking as an approach to nursing practice.

The holism in critical thinking. A concept analysis

In nursing, critical thinking is particularly important because of its potential impact on patient care. With the rapid changes in health care and the influx of new technology, nurses must be able to use critical thinking to make decisions that provide optimal patient care. The rapid, dynamic changes occurring in the health care setting have dictated a stronger, more comprehensive, holistic way of arriving at decisions than the traditional nursing process. This more comprehensive, holistic approach is called critical thinking. Nurses must be able to engage in critical thinking to handle the onslaught of continuous procedural and technological changes. Critical thinking has become such a key component in learning that the National League for Nursing requires that graduates be able to demonstrate critical thinking. This article is a concept analysis of critical thinking using the Walker and Avant model.

Clinical nurses as teachers: insights from students of nursing in their first semester of study

This paper reports the findings of a study which sought to gain insights about the role of clinical nursing staff in the planned clinical experience of undergraduate nursing students. This study differs from others in that the perspectives of students of nursing in their first year of the undergraduate programme are sought, and the role of clinical nurses rather than clinical teachers is of particular interest. Using a story-telling approach, an exploration of students' perspectives on the role of clinical nursing staff in their clinical learning was undertaken. Analysis allowed findings to be grouped into helpful and unhelpful behaviours, Helpful behaviours included understanding and being friendly, showing interest and explaining. Behaviours that students found unhelpful to their learning were often passive rather than active, but they made students feel acutely aware of being unwelcome in the clinical area. Several students described feeling intrusive, uncomfortable and even unwelcome in clinical areas because o the attitudes and behaviour of clinicians. Findings of this study highlight the importance of clinicians and academic nurses working together to ensure that students of nursing, who represent the future of the profession, are provided with the best possible opportunities for clinical learning.

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

There has been a recent increasing interest in reflective practice in nursing. There is a wealth of literature about its apparent advantages and benefits, but very little empirical research into clinical outcomes consequent to reflective practice. This study attempts an initial exploration into this area. A retrospective, three-phase, multi-method study in a single department of nursing was conducted. The research sample comprised students and former students of the department who had previously participated in an assessed reflective practice course or module. Years of experience, speciality or academic level did not have a significant influence, but the effectiveness of the facilitator was an important factor. The results suggest that reflective practice is regarded highly and that most respondents could identify significant, long-term changes to clinical practice resulting from it.

Critical thinking: toward a nursing science perspective

Critical thinking is an important phenomenon in nursing science because of its implications for education, practice, and the advancement of nursing knowledge. As a context-dependent, evolving life process, critical thinking appears to be congruent with assumptions and principles of SUHB. Thus, it may be asserted that critical thinking arises within the mutual process of human and environment and thus is a pattern manifestation of the human-environment field process. Before this assertion can be fully accepted, however, much investigation is needed. Nurse scholars are called upon to re-examine critical thinking and to consider possibilities that, until now, have been neglected or unimagined. To date, the positivistic view of critical thinking has yielded limited information. Nurse scientists, therefore, have an opportunity to extend and refine knowledge of critical thinking by embarking upon new and exciting avenues of discovery.

The use of reflection in a palliative care programme: a quantitative study of the development of reflective skills over an academic year

The use of reflection in a palliative care programme: a quantitative study of the development of reflective skills over an academic year Reflection has gained a reputation for encouraging the integration between theory and practice within professional education. However, this reputation is based on an evidence base that mostly consists of theoretical debate. The aim of this study was to test our experience that the ability to reflect is developmental and that some reflective skills are harder to achieve than others. The research was undertaken by assessing the degree to which registered nurses achieved reflective criteria within assignments submitted for a variety of palliative care undergraduate modules. A total of 160 assignments were analysed using a marking grid constructed from a literature review and the results were compared between students and across academic terms. The results suggest that students are able to describe their practice but find it harder to analyse knowledge, the context of care and to action plan. Nevertheless, reflective abilities developed over time with significant developments made between each term. However, the development of skills indicative of critical reflection was less evident and confined to the ability to raise implications for future learning. The lack of multivariate analysis limits the study. However, the findings build on previous research and prompt questions for future work, particularly with respect to the process of reflection and how this can be supported in order to encourage the development of critical reflective skills.

Reflective education for professional practice: discovering knowledge from experience

To continually develop as a discipline, a profession needs to generate a knowledge base that can evolve from education and practice. Midwifery reflective practitioners have the potential to develop clinical expertise directed towards achieving desirable, safe and effective practice. Midwives are 'with woman', providing the family with supportive and helpful relationships as they share the deep and profound experiences of childbirth. To become skilled helpers students need to develop reflective skills and valid midwifery knowledge grounded in their personal experiences and practice. Midwife educators and practitioners can assist students and enhance their learning by expanding the scope of practice, encouraging self-assessment and the development of reflective and professional skills. This paper explores journal writing as a learning strategy for the development of reflective skills within midwifery and explores its value for midwifery education. It also examines, through the use of critical social theory and adult learning principles, how midwives can assist and thus enhance students learning through the development of professional and reflective skills for midwifery practice.

Mediating conflict and control: practice challenges for nurses working in palliative care

A work-based professional development program was offered to a group of registered nurses working in palliative care. The goal of the program was to improve skills in psychosocial care (Yates et al., 1996). Participants were encouraged to reflect critically on their practice experience within a group setting. The focus of the group discussion and reflection were shared practice incidents. Each participant was given the opportunity to identify and describe an incident from their professional practice that presented a challenging issue within palliative nursing. This paper explores the themes of conflict and control, evident within the collection of fifteen practice incidents and discusses the nurses' role as mediator. The concepts of patient advocacy and professional autonomy are challenged through the nurses' experience of providing care within a hierarchical and bureaucratic health service. The outcome of reflection for the organization is most effective when shared experience and collective action (rather than individual practice) are the focus.

ROPES: an experiential learning activity for leadership skills

The cluster of activities called ROPES is borrowed and modified for teaching from OUTWARD Bound, the renowned outdoor management training program. ROPES uses experiential learning situations in which characteristic problem-solving tasks encourage the participants to stretch their personal limits and to learn teamwork. In doing so, trust, self-confidence, and communication and leadership skills develop through accomplishment of specific challenging activities. ROPES activities were found to be an effective method of instruction for teaching leadership in a senior nursing leadership course.