Exploring the professional nurse advocate role and restorative clinical supervision

The professional nurse advocate (PNA) role is the key enabler of delivery of the NHS England Advocating and Educating for Quality Improvement (A-EQUIP) model of professional nursing leadership and clinical supervision. The aim of the PNA role is to provide clinical, educational and well-being support to nurses through restorative clinical supervision. This article describes the PNA role and the A-EQUIP model and discusses some of the challenges experienced by nurses in relation to delivering care to older people and current workforce pressures. The author suggests that restorative clinical supervision may support nurses to manage these challenges and enhance their practice in the care of older people, and describes part of a workforce improvement project to illustrate this in practice. Finally, the author considers some of the barriers to implementation of restorative clinical supervision.

Thinking about default enrollment lowers vaccination intentions and public support in G7 countries

Policymakers often face a conundrum between being transparent about policies and ensuring that those policies are effective. This challenge is particularly relevant for behavioral nudges, which are not usually disclosed. Rather than avoiding transparency, we suggest that policymakers encourage citizens to reflect on nudges to help them understand their own views and align those views with their behaviors. Using data from an online survey experiment with 24,303 respondents in G7 countries, we examine the impact of reflection on a hypothetical default nudge policy for COVID-19 booster appointments. Contrary to expectations, participants say they would be less likely to get the booster when automatically enrolled compared with a control condition. Similarly, encouraging citizens to think about the status quo (baseline) policy also reduces intentions for boosters. These interventions have no effect on approval of the policy. Further, encouraging people to think about automatic enrollment decreases approval of the policy and further decreases their intentions to get vaccinated. These findings suggest that reflection on a nudge can increase backlash from a nudge and also elicit policy disapproval, thereby aligning policy support with behavioral intentions.

Evolving from Didactic to Dialogic: How to Improve Faculty Development and Support Faculty Developers by Using Action Research

Problem: Since competency-based medical education has gained widespread acceptance to guide curricular reforms, faculty development has been regarded as an indispensable element to make these programs successful. Faculty developers have striven to design and deliver myriad of programs or workshops to better prepare faculty members for fulfilling their teaching roles. However, how faculty developers can improve workshop delivery by researching their teaching practices remains underexplored. Intervention: Action research aims to understand real world practices and advocates for formulation of doable plans through cycles of investigations, and ultimately contributes to claims of knowledge and a progression toward the goal of practice improvement. This methodology aligns with the aim of this study to understand how I could improve a faculty development workshop by researching my teaching practices. Context: In 2016, we conducted four cycles of action research in the context of mini-Clinical Evaluation Exercise (mini-CEX) workshops within a faculty development program aiming for developing teaching and assessment competence in faculty members. We collected multiple sources of qualitative data for thematic analysis, including my reflective journal, field notes taken by a researcher-observer, and post-workshop written reflection and feedback in portfolio from fourteen workshop attendees aiming to develop faculty teaching and assessment competence. Impact: By doing action research, I scrutinized each step as an opportunity for change, enacted adaptive practice and reflection on my teaching practices, and formulated action plans to transform a workshop design through each cycle. In so doing, my workshop evolved from didactic to dialogic with continuous improvement on enhanced engagement, focused discussion and participant empowerment through a collaborative inquiry into feedback practice. Moreover, these processes of action research also supported my growth as a faculty developer. Lessons Learned: The systematic approach of action research serves as a vehicle to enable faculty developers to investigate individual teaching practices as a self-reflective inquiry, to examine, rectify, and transform processes of program delivery, and ultimately introduce themselves as agents for change and improvement.

"Switching Hats": Insights From Experienced Clinical Interviewers Turned Novice Research Interviewers

Health professionals/clinicians interview people regularly as part of their role. However, a qualitative research interview differs considerably to a clinical interview. If clinicians approach qualitative research interviewing based on their expertise in clinical interviewing, it could cause insufficiencies in qualitative data generation. In this reflection article, we, a team of four experienced clinical occupational therapists with no previous experience in qualitative research interviewing, share our experiences while learning to become qualitative research interviewers before undertaking our first qualitative research project. We engaged in self-directed reading, formal training on qualitative interviewing, and practice interviews and used peer feedback and reflection to prepare ourselves to conduct qualitative interviews. We drew upon the work-role transitions theory to work through our adjustment to the new role. Although we set out to "switch hats" as the research topic itself was not clinical, interviewing people on health-related topics will mean bringing our clinical instincts into our research role, while still recognizing the difference between a clinical and research interview. This article can inform experienced clinicians/novice qualitative researchers as they develop this new skillset.

Hard to let it go: repetitive negative thinking and hoarding in later life in Japan

Objectives: Hoarding in older adults can have a detrimental effect on daily life. Repetitive negative thinking (RNT) could result in a greater avoidance of discarding and increased saving behaviors; yet, the unique role of RNT on hoarding in older adults remains understudied. This study aimed to investigate whether the intensity of RNT contributes to hoarding in older adults. Methods: Two hundred and sixty-four older adults in Japan (ages 65-86 years, 132 males and 132 females) participated in an online survey. Hierarchical regression analyses were conducted to examine whether RNT could significantly explain the variance of hoarding after controlling for age, sex, years of education, self-reported cognitive impairment, and depression. Results: As we expected, RNT was significantly associated with greater hoarding behaviors, such as excessive acquisition (β = .27, p = .005) and difficulty in discarding (β = .27, p = .003). On the other hand, reflection, repetitive thinking without negative emotional valence, was significantly associated with higher scores on clutter (β = .36 p < .001). Conclusion: Our findings highlight the importance of addressing RNT in the prevention and treatment of hoarding symptoms among older adults, potentially leading to more effective interventions and improved outcomes in managing hoarding behaviors in this population.

Is lifetime abuse forgivable in old age?

Old age is characterized by reflection and a retrospective examination of the multiple meanings of various life experiences, including lifelong abuse. Forgiveness is found to have a salutary effect, especially for older adults. To understand the place and role of forgiveness in the reflective process during aging, we performed a secondary analysis of in-depth, semi-structured interviews (N = 78) with older women survivors of abuse. Inductive thematic analysis was based on concepts developed deductively from the literature review. The findings include three main themes: (1) The dimensions of forgiving: The victim as subject; (2) Being forgiven: Between lost forgiveness and hope; and (3) Self-forgiveness and the aging self. Despite the known salutary effect of forgiveness, we must consider that this is not a universally desirable process. We included the dimension of forgiveness in the study of abuse throughout the older person's life course and identified further complexities in addition to the "forgiveness"/"unforgiveness."

Exploring User Perspectives on Brief Reflective Questioning Activities for Stress Management: Mixed Methods Study

BACKGROUND

Current online interventions dedicated to assisting individuals in managing stress and negative emotions often necessitate substantial time commitments. This can be burdensome for users, leading to high dropout rates and reducing the effectiveness of these interventions. This highlights an urgent need for concise digital activities that individuals can swiftly access during instances of negative emotions or stress in their daily lives.

OBJECTIVE

The primary aim of this study was to investigate the viability of using a brief digital exercise, specifically a reflective questioning activity (RQA), to help people reflect on their thoughts and emotions about a troubling situation. The RQA is designed to be quick, applicable to the general public, and scalable without requiring a significant support structure.

METHODS

We conducted 3 simultaneous studies. In the first study, we recruited 48 participants who completed the RQA and provided qualitative feedback on its design through surveys and semistructured interviews. In the second study, which involved 215 participants from Amazon Mechanical Turk, we used a between-participants design to compare the RQA with a single-question activity. Our hypotheses posited that the RQA would yield greater immediate stress relief and higher perceived utility, while not significantly altering the perception of time commitment. To assess these, we measured survey completion times and gathered multiple self-reported scores. In the third study, we assessed the RQA's real-world impact as a periodic intervention, exploring engagement via platforms such as email and SMS text messaging, complemented by follow-up interviews with participants.

RESULTS

In our first study, participants appreciated the RQA for facilitating structured reflection, enabling expression through writing, and promoting problem-solving. However, some of the participants experienced confusion and frustration, particularly when they were unable to find solutions or alternative perspectives on their thoughts. In the second study, the RQA condition resulted in significantly higher ratings (P=.003) for the utility of the activity and a statistically significant decrease (P<.001) in perceived stress rating compared with the single-question activity. Although the RQA required significantly more time to be completed (P<.001), there was no statistically significant difference in participants' subjective perceived time commitment (P=.37). Deploying the RQA over 2 weeks in the third study identified some potential challenges to consider for such activities, such as the monotony of doing the same activity several times, the limited affordances of mobile phones, and the importance of having the prompts align with the occurrence of new troubling situations.

CONCLUSIONS

This paper describes the design and evaluation of a brief online self-reflection activity based on cognitive behavioral therapy principles. Our findings can inform practitioners and researchers in the design and exploration of formats for brief interventions to help people with everyday struggles.

Azimuth Angle Dependence of Polarized Infrared Spectra of Injection-Molded Polyoxymethylene

Injection-molded polyoxymethylene (POM) has molecular chains mainly oriented in the injection direction. We investigated the directional dependence of the polarized infrared reflection and attenuated total reflection spectra by rotating the anisotropic POM sample. Because of the strong absorption and large frequency dispersion of the C-O vibration in the main-chain direction, we found phenomena such as shoulder wing generation that resulted from the mixing of optical responses attributed to the vibration in the main chain and that in the direction perpendicular to the main chain. The spectra of the directional dependence can be explained qualitatively because of the anisotropy of the mode with large frequency dispersion.

Implementation of the REFLECT Communication Curriculum for Clinical Oncology Graduate Medical Education

Background: Communication and interpersonal skills are essential medical components of oncology patient care. Patients and families rely on physicians for treatment, expertise, guidance, hope, meaning, and compassion throughout a life-threatening illness. A provider's inability to empathize with patients is linked to physician-related fatigue and burnout. Because oncology training programs focus on teaching evidence-based medicine and clinical acumen, little time may be dedicated to professional development and acquisition of interactive skills. Traditional communication courses typically include two components: formal, knowledge-based learning skills, which are gained from didactic lectures, and role-playing, which usually occurs in small groups. We report the implementation of a novel longitudinal communication curriculum for trainees in Oncology. Materials and Methods: At a single-center institution, an innovative communication curriculum titled "REFLECT" (Respect, Empathy, Facilitate Effective Communication, Listen, Elicit Information, Compassion, and Teach Others) was implemented for radiation oncology residents and medical oncology fellows to improve and refine physician/patient interactions. All oncology specialty residents and fellows were eligible to participate in this communication curriculum. The curriculum emphasized a reflective process to guide trainees through challenging scenarios. Results: Since October 2018, this comprehensive course consisted of quarterly (four hour) workshops comprising assigned reading, knowledge assessments, didactic lectures, expert guest lecturers, standardized patient simulations, role-playing, patient/expert panels, coaching, reflective writing, and debriefing/feedback sessions. The curriculum provided longitudinal communication training integrated with the learners' daily physician/patient encounters rather than occasional isolated experiences. Fifteen workshops have been completed. Each focused on navigating challenging situations with patients, loved ones, or colleagues. Conclusions: Future directions of the curriculum will entail improving the communication skills of oncology trainees and gathering communication improvement data to assess the program's success formally.

Challenges Faced by Medical Trainees in Outpatient Management Education in Acute Care Hospitals: A Thematic Analysis

Introduction As societies age globally, medical education faces the challenge of adapting to the evolving healthcare needs of an aging population. This study focuses on the education of medical residents in outpatient departments in Japan, a country with a rapidly aging society. The research aims to understand the perceptions and challenges medical residents face in outpatient management, highlighting the areas for potential improvement in their educational framework. Method This study involved first-year medical residents at Fuchu Hospital in Osaka, using thematic analysis based on relativist ontology and constructivist epistemology. Data were collected through field notes and reflection sheets, documenting residents' interactions with patients, learning difficulties, and personal reflections. Semi-structured interviews were conducted to gain profound insights into their experiences and views on outpatient management education. Results Three main themes emerged from the analysis: The experience of continuity of care, the view regarding comprehensive management, and the gap between purposes and learning content. Residents expressed concerns about the limited opportunities for continuous patient care, leading to challenges in managing chronic diseases effectively. The focus on organ-specific specialties in acute care hospitals resulted in a fragmented understanding of patient care, particularly for elderly patients with multimorbidity. Furthermore, the study identified a discrepancy between the educational goals of outpatient management and the actual content delivered, highlighting the need for more observational experiences and practical guidance in outpatient settings. Conclusion The findings suggest a pressing need for a more structured, comprehensive, and personalized approach to outpatient management education for medical residents. As aging populations continue to grow, it is vital to equip medical professionals with the skills and knowledge to manage a wide range of patient conditions effectively. Improving the educational framework in outpatient departments can enhance patient care quality and prepare medical residents to meet the challenges of an aging society. This study contributes valuable insights into improving medical education in outpatient settings, particularly in aging societies like Japan.

Multimodal optical mesoscopy reveals the quantity and spatial distribution of Gram-positive biofilms in ex vivo tonsils

Biofilms are known to be present in tonsils, but little is known about their spatial location and size distribution throughout the tonsil. Studies of the location and distribution of biofilms in tonsil specimens have thus far been limited to either high-magnification methods such as electron microscopy, which enables high-resolution imaging but only from a tiny tissue volume, or lower magnification techniques such as light microscopy, which allow imaging of larger specimens but with poor spatial resolution. To overcome these limitations, we report the use of multimodal optical mesoscopy to visualise and quantify the number and spatial distribution of Gram-positive biofilms in fresh, excised paediatric tonsils. This methodology supports simultaneous imaging of both the tonsil host and biofilms in whole mounts of tissue up to 5 mm × 5 mm × 3 mm with subcellular resolution throughout. A quantitative assessment of 36 tonsil specimens revealed no statistically significant difference between biofilm presence on the tonsil surface and the interior of the tonsil. This new quantitative mesoscale imaging approach may prove useful in understanding the role of biofilms in tonsillar diseases and other infections.

The Goldilocks Dilemma on Balancing User Response and Reflection in mHealth Interventions: Observational Study

Background

Mobile health (mHealth) has the potential to radically improve health behaviors and quality of life; however, there are still key gaps in understanding how to optimize mHealth engagement. Most engagement research reports only on system use without consideration of whether the user is reflecting on the content cognitively. Although interactions with mHealth are critical, cognitive investment may also be important for meaningful behavior change. Notably, content that is designed to request too much reflection could result in users' disengagement. Understanding how to strike the balance between response burden and reflection burden has critical implications for achieving effective engagement to impact intended outcomes.

Objective

In this observational study, we sought to understand the interplay between response burden and reflection burden and how they impact mHealth engagement. Specifically, we explored how varying the response and reflection burdens of mHealth content would impact users' text message response rates in an mHealth intervention.

Methods

We recruited support persons of people with diabetes for a randomized controlled trial that evaluated an mHealth intervention for diabetes management. Support person participants assigned to the intervention (n=148) completed a survey and received text messages for 9 months. During the 2-year randomized controlled trial, we sent 4 versions of a weekly, two-way text message that varied in both reflection burden (level of cognitive reflection requested relative to that of other messages) and response burden (level of information requested for the response relative to that of other messages). We quantified engagement by using participant-level response rates. We compared the odds of responding to each text and used Poisson regression to estimate associations between participant characteristics and response rates.

Results

The texts requesting the most reflection had the lowest response rates regardless of response burden (high reflection and low response burdens: median 10%, IQR 0%-40%; high reflection and high response burdens: median 23%, IQR 0%-51%). The response rate was highest for the text requesting the least reflection (low reflection and low response burdens: median 90%, IQR 61%-100%) yet still relatively high for the text requesting medium reflection (medium reflection and low response burdens: median 75%, IQR 38%-96%). Lower odds of responding were associated with higher reflection burden (P<.001). Younger participants and participants who had a lower socioeconomic status had lower response rates to texts with more reflection burden, relative to those of their counterparts (all P values were <.05).

Conclusions

As reflection burden increased, engagement decreased, and we found more disparities in engagement across participants' characteristics. Content encouraging moderate levels of reflection may be ideal for achieving both cognitive investment and system use. Our findings provide insights into mHealth design and the optimization of both engagement and effectiveness.

Evaluating a Pediatric Palliative Care Elective Rotation Through Prompted Reflective Writing and Aligning With Competencies

Background: Hospice and palliative medicine is important in the education of pediatric residents. Little is known about if and how residents' learnings during a pediatric palliative care elective fulfill core competencies and Pediatrics subcompetencies as set forth by the Accreditation Council for Graduate Medical Education (ACGME) and published subspecialty competencies for residents in pediatric hospice and palliative medicine (pHPM). Objectives: To evaluate what residents are learning on a four-week pediatric palliative care elective rotation at a single institution and how these learnings fulfill ACGME and pHPM competencies. Setting/Subjects: Prompted, written reflections were collected from residents completing a pediatric palliative care rotation at a large, urban academic center in the United States between academic years 2016-2017 and 2020-2021. Measurements: A qualitative, inductive reasoning approach was used to analyze reflections for emergent themes and codes. A deductive approach was used to map resulting codes to ACGME core competencies, Pediatric subcompetencies, and pHPM competencies. Results: Twenty-five resident reflections were collected. Inductive analysis revealed three primary themes and 102 codes. These codes were mapped to all six ACGME core competencies and mapped to most Pediatric subcompetencies with the exception of performing a physical examination, organizing and prioritizing patients, diagnostic evaluation, and community and population health. Codes mapped to most pHPM competencies with the exception of two symptom-based competencies, malignant bowel obstruction and severe fatigue. Conclusions: Residents' written reflections following a pediatric palliative care elective rotation demonstrated robust learnings that fulfill many core, specialty, and subspecialty competencies, particularly those that relate to patient- and family-centered care, communication, professionalism, and systems-based practice.

An Easily Implemented, Inexpensive, Useful Novel Surgical Intern Wellness Initiative

OBJECTIVE

Determine whether use of reflective questions asked on a twice monthly basis is a useful addition to our intern wellness curriculum, with a goal of longitudinal development. Prior studies have demonstrated the use of reflection in processing educational experiences toward professional growth at both the medical student and resident level.

DESIGN

During the first year, every 2 weeks, the 13 interns were asked and answered 2 reflective prompts by email. Their responses went to a single faculty member and were then blinded for analysis. The second year of the program, prompts were discussed by participants in a closed group setting. Participation was voluntary. The questions fell into 6 major categories: role expectations, role assessment, role affirmation, role reflection, emotional self-assessment, work-life integration, and boundaries. Thematic analysis of the responses was performed using an inductive approach by 2 independent expert reviewers.

SETTING

Brown General Surgery Residency Program, academic years 2021 to 2022 and 2022 to 2023.

CONCLUSIONS

Use of reflective questions is a valuable tool as part of an intern wellness curriculum and can be easily implemented. It is inexpensive, does not require a huge time commitment, and is easily adaptable to a program's specific needs. It encourages developing surgeons to recognize and share in their emotions as they encounter the new and stressful experiences inherent in residency and may help to prevent burnout. Sustained participation through the year and robust responses suggest good resident engagement and acceptance of the program.

Beyond conventional healthcare for mental health problems: Experiences of existential group conversations

BACKGROUND

Mental health problems (MHP) are a major public health challenge. Conventional healthcare has shown limitation on reducing MHP and there is a call for offering methods beyond healthcare as well as improve access to healthcare.

AIMS

To explore experiences among people having MHP of (i) taking part in existential conversations in groups beyond conventional healthcare and (ii) seeking and receiving conventional healthcare.

MATERIALS AND METHODS

Four focus group interviews were conducted after finishing existential conversations in groups. Data was analyzed following thematic analysis.

RESULTS

The theme Access to a community for exploration and acceptance describes communication through impressions and expressions together with others. A reflective perspective on everyday life, describes re-evaluation through reflection. Within the theme Experiences of healthcare related encounters, referring to the second aim, participants recollected feelings of disconnectedness, difficulties verbalizing MHP and dealing with rigid, standardized measures.

CONCLUSION

Existential conversations in group may contribute to a more reflected doing in accordance with one's own values as well as improved mental health literacy. Design and measures within healthcare need to explicitly address MHP and consider individual's own preferences.

SIGNIFICANCE

This study contributes to understanding of coping with MHP in everyday life from an existential perspective.

[Psy le comité was told to us]

Speaking on behalf of others is no easy task. When 30 members of a psychiatric hospital's ethics committee rely on three of them to explain its functions and roles to neophytes, and to put into words what the committee represents in their eyes, the mission is a delicate one. We have to remain as faithful to our own thinking as we are to the spirit of the group. We will try to answer these questions as best we can, to shed light on the origins, missions and specific features of an ethics committee in a psychiatric hospital, without betraying our own thinking or that of our colleagues.

Factors Affecting the Level of Reflective Thinking and Clinical Decision-Making Skills in Medical Faculty Students

Objectives

The aim of this study is to evaluate the reflection skills of students at the Faculty of Medicine and the factors influencing these skills, as well as to measure the impact of students' reflection skills on their clinical decision-making.

Methods

This study is an educational research project conducted on fifth-year Ear Nose Throat (ENT) interns at Vakif University's Faculty of Medicine. The "Reflective Thinking Level Determination Scale" and the "Clinical Decision-Making Scale," which are valid and reliable, were used to assess the reflection skills and clinical decision-making abilities of the 125 students participating in the study.

Results

In our study, the mean score of the sub-dimensions of the Groningen Reflection Skills Scale was 77.04±5.14 for the fifth-year student population surveyed. Scores from the "Self-Reflection" and "Reflective Communication" sub-dimensions of the Groningen Reflection Skills Scale were compared based on gender, participation in summer internships, receipt of scholarships, membership in social sciences clubs, place of residence, school attended, diary-keeping habits, study styles, and cities of residence. Although there were some differences between the groups, these differences were not statistically significant. The total scores of the students on the Clinical Decision-Making Scale sub-dimensions ranged from 98 to 169, with a mean score of 146.18±10.97. A statistically positive and moderate correlation was found between the total scores of the participants on the Groningen Reflection Skills Scale and the total scores they obtained on the Clinical Decision-Making Scale (r=0.403; p=0.001).

Conclusion

Consequently, an increase in the reflection skills of participants is associated with higher clinical decision-making scores. Reflection is the primary means of transitioning students from novices to experts, enhancing both comprehensive learning and learning experiences. Therefore, every medical school should develop a training program for student reflection, along with a feedback and assessment system integrated into the curriculum.

From reflection to phronesis in 'good' physiotherapy practice

BACKGROUND

Reflection is promoted in health professional education as a way to learn in and on practice. 'Being reflective' is considered important to 'good' and 'expert' physiotherapy practice, yet there is limited research on reflective practices of experienced physiotherapists. For Aristotle, a good person reasons and acts in ways to promote human flourishing. Physiotherapists' perspectives on the place of reflection in good practice has the potential to advance professional understandings of how it may be enacted. Such knowledge may inform health professions education, regulatory guidelines, professional practices, and patient interactions.

PURPOSE

The purpose of this research was to examine experienced musculoskeletal (MSK) practitioners' perceptions of reflection in the practice of a 'good' physiotherapist.

METHODS

A secondary analysis of data arising from a hermeneutic phenomenological study into physiotherapists' perceptions of the qualities and practices that constitutes a 'good' physiotherapist was undertaken. The secondary analysis focused on ways of 'being reflective', which emerged as a major theme in the original study.

FINDINGS

Six themes were identified related to 'being reflective' in a 'good' physiotherapist: 1) learning from experience; 2) integrating multiple perspectives; 3) navigating indeterminate zones; 4) developing embodied knowledge; 5) questioning assumptions; and 6) cultivating wisdom.

CONCLUSIONS

Findings support the notion that 'good' physiotherapy involves a disposition toward making wise judgments through reflection. This practice-based knowledge can inform educational initiatives that nurture practices that foster attention to reflective processes that inform phronesis in professional life. Through reflexivity on what the profession takes for granted, physiotherapists may be better prepared when navigating the indeterminate zones of practice.

How to organise and run Schwartz rounds

RATIONALE AND KEY POINTS

Schwartz rounds are a group-based model of reflective practice originally designed to assist medical staff to develop more compassion in their care. The aim of Schwartz rounds is to help healthcare professionals such as nurses 'reconnect' with why they first entered the caring profession. • Schwartz rounds are designed to assist multidisciplinary healthcare professionals with the emotional, social and ethical aspects of caregiving. • Schwartz rounds can also be used to support resilience training and boost workforce morale. • The use of Schwartz rounds can assist nurses to understand the moral challenges they may encounter while caring for patients. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might help you organise Schwartz rounds in your clinical area. • How you could use this information to educate your colleagues about Schwartz rounds.

When caring becomes an art - how clinical gaze are perceived to be developed

PURPOSE

This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze.

METHODS

This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ).

RESULTS

Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context.

CONCLUSIONS

Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.

Reflection on medical errors: A thematic analysis

BACKGROUND

As there is a need to prepare doctors to minimize errors, we wanted to determine how doctors go about reflecting upon their medical errors.

METHODS

We conducted a thematic analysis of the published reflection reports of 12 Dutch doctors about the errors they had made. Three questions guided our analysis: What triggers doctors to become aware of their errors? What topics do they reflect upon to explain what happened? What lessons do doctors learn after reflecting on their error?

RESULTS

We found that the triggers which made doctors aware of their errors were mostly death and/or a complication. This suggests that the trigger to recognize that something might be wrong came too late. The 12 doctors cited 20 topics' themes that explained the error and 16 lessons-learnt themes. The majority of the topics and lessons learnt were related more to the doctors' inner worlds (personal features) than to the outer world (environment).

CONCLUSION

To minimize errors, doctors should be trained to become earlier and in time aware of distracting and misleading features that might interfere with their clinical reasoning. This training should focus on reflection in action and on discovering more about doctors' personal inner world to identify vulnerabilities.

A model to facilitate critical thinking of radiography students

INTRODUCTION

Critical thinking is a much-needed skill required by radiography students, across disciplines, when they graduate. The facilitation of critical thinking is a task that radiography educators are faced with in order to produce graduates who can apply these skills in the clinical setting, for the best care of the patient. The development of critical thinking skills is challenging, and currently there is no radiography-specific model which has been implemented and evaluated as a framework of reference for radiography educators. The aim of this article is to present a critical thinking model as a framework of reference that was implemented and evaluated by diagnostic radiography educators.

METHODS

A theory-generating qualitative, exploratory, descriptive and contextual design was used for the development of a model to facilitate critical thinking skills of diagnostic radiography students in a South African setting.

RESULTS

A theory-generation model to facilitate critical thinking skills for radiography students was developed. The model was implemented and evaluated by radiography educators. Three themes emerged from the evaluation of the model after implementation. The results indicated the implementation of the model provided a platform for radiography educators to collaborate and purposefully tailor activities to incorporate critical thinking into their teaching.

CONCLUSIONS

Through the implementation of the model, radiography educators felt empowered by using a framework of reference to facilitate critical thinking skills of radiography students.

Ethical questioning in arts and health-based research: propositions and reflections

Ethical questioning is a framework for considering the ethical implications and practices in research and is used as a tool for thinking about the connections between art and health. It enables researchers and practitioners to gain a deeper understanding of the emotional dimensions in the field of art and health. In this paper, we propose that ethical questioning, grounded in the principles of ethics of care, can foster a more reflexive and holistic approach to understanding the concept of well-being. We also propose that adopting ethical questioning as a methodology, which requires intentional self-reflection and recognition of positionality, can expose and challenge conventional knowledge hierarchies, resulting in more ethical research outcomes and relationships between researchers and participants. Ultimately, our hypothesis proposes that ethical questioning holds the potential to offer an actionable practice that demonstrates ethics of care.

Expertise in Coach Development: The Need for Clarity

In this position paper, we start by identifying the issues inherent to coach development; we then consider the current status of coach development and present our position before concluding with key points and suggesting resolutions for the issues. Our intention is to propose the progression of appropriate practices and approaches for the professional development and preparation of coaches. In coach development, a lack of clarity exists at both organisational and individual levels, particularly around the role of and aims for coach developers. Organisationally, we consider a radical reframing required to progress the profession of coach development. We also suggest that many individuals currently involved in coach development do not possess the requisite knowledge to move the field forward. Our aspirations for coach development include recognising the need for expertise and what it looks like in practice. Coaching and coach development interactions should examine particular coaching challenges, concentrating on the thought processes and decision-making strategies necessary to solve them. This necessitates a bespoke, problem-based approach to learning.

Recent Progress in Resonant Acoustic Metasurfaces

Acoustic metasurfaces, as two-dimensional acoustic metamaterials, are a current research topic for their sub-wavelength thickness and excellent acoustic wave manipulation. They hold significant promise in noise reduction and isolation, cloaking, camouflage, acoustic imaging, and focusing. Resonant structural units are utilized to construct acoustic metasurfaces with the unique advantage of controlling large wavelengths within a small size. In this paper, the recent research progresses of the resonant metasurfaces are reviewed, covering the design mechanisms and advances of structural units, the classification and application of the resonant metasurfaces, and the tunable metasurfaces. Finally, research interest in this field is predicted in future.

Reflecting on insight and insights into reflection: a systematic review of insight and reflection in post graduate medical education

BACKGROUND

Clinicians recognize insight as important for safe independent medical practice. Clinical education literature focuses on self-reflection. The aim of this review is to describe how clinical educators conceptualize reflection and ask is it analogous to how clinicians conceptualize insight?

METHODS

Using PRISMA guidelines, a systematic review of the literature around insight and reflection in postgraduate medical education was undertaken. A thematic analysis of the concepts of insight and reflection was performed.

RESULTS

A total of 75 reports were included in the analysis. The literature focussed predominantly on reflection with little discussion of insight. Three main themes were generated: episodic reflection; cyclic reflection; reflection as a state. Reflection as a state seemed to be the professional quality most often aspired to but was less well defined in terms of educational interventions. When more than one model was described, it was often with a reflective state being the ideal that episodic or cyclic reflection may approximate. It is not clear that it is possible to progress up the hierarchy.

CONCLUSION

We present a novel description of a hierarchy from discrete episodes of reflection, to cyclic processes that involve reflection, through to a state in which the practitioner is reflective. There is no unified understanding of how an individual ascends this hierarchy, or a cohesive description of what insight is for an independent medical practitioner. This review highlights the need for research into how practicing clinicians conceptualize and characterize insight in their training and practice.

Reflecting on ICU patient's dignity using Taylor's Emancipatory Reflection Model

Intensive Care Unit (ICU) patients not only require life-sustaining treatments but also the preservation of their psychological well-being and dignity, and ICU nurses face heavy work pressure, focusing more on life-sustaining treatments for patients, while the patient's psychological experiences are often overlooked. This article aims to explore the issue of nurse-led patient dignity preservation in the ICU from China. Reflection is a process of deep thinking and examining one's actions, experiences, perspectives, or emotions. It involves retrospectively reviewing, analyzing, and evaluating past events to gain insights, understanding, and personal growth. Through reflection, individuals can consider whether their actions align with their values and goals and whether they can learn valuable lessons from them. This article discusses the preservation of patient dignity in the ICU from China based on Taylor's Emancipatory Reflection Model, which involves four steps: constructing, deconstructing, confronting, and reconstructing. The process of reflection incorporates theories such as Maslow's Hierarchy of Needs, Comfort Theory, and the style of Paternalistic Decision-making. This study is of great significance in enhancing Chinese nurse's attention to patient dignity, improving the inpatient experience of ICU patients, and enhancing the quality of nursing practice by critically examining current nursing practices in China and providing improvement recommendations.

Reflections of nurses in the fight against COVID-19 in Hubei: a qualitative study

OBJECTIVES

To explore the reflections and experiences of nurses who were deployed to the frontline to combat COVID-19 in Wuhan, China. In order to gain insights that can be useful in developing cultivating positive professional values and attitudes towards future public health emergencies.

DESIGN

Qualitative study using semistructured interviews. Data were transcribed and analysed using the Colaizzi's 7-step method. The study is reported in accordance with the consolidated Standards for Reporting Qualitative Research.

SETTING

Telephonic interviews with nine participants who were deployed from Nanjing to Hubei Province for the fight against COVID-19.

PARTICIPANTS

Of 11 volunteer nurses deployed to Hubei Province for the fight against COVID-19, two nurses did not finish the interview because of their working hours. The remaining nine were recruited through purposive sampling using the following criteria: nurses who were deployed at the first stage and those who verbally agreed and signed an informed consent form to participate in the study.

RESULTS

Three thematic categories and subthemes that were identified from the analysis were as follows: (1) 'Assertive attitude to fight against the pandemic', included three subthemes: 'Inner calling towards professional accountability for saving lives', 'Extrinsic support that facilitates the commitment to the nursing profession' and 'Holistic value ascribed to the nursing profession'. (2) 'Challenges associated with the anti-pandemic mission', included 'overcoming challenges around the strict requirements for personal protection' and 'Fear and uncertainty over the rapid progression of the disease'. (3) 'Unbearable heaviness and lightness of being a nurse', with two subthemes: 'the heavy crown of the anti-pandemic hero' and 'eternal reverence without regrets'.

CONCLUSIONS

As reflected by the nurses on frontline combating COVID-19, it was necessary to inculcate professional nursing values in them, as only their dedication and selflessness could improve humanity's chances against the disease.

The who, what, where, when and why of engaging with policymakers: A critical reflection

Improving relationships between researchers and policymakers is one element of knowledge mobilisation that has proven to increase the translation of research into policy. However, researchers report they find it difficult to engage policymakers with research. In this article, a personal narrative approach was used to analyse my experience, as a PhD candidate, when engaging policymakers to participate in a qualitative research study. A total of 93 contacts were made in an attempt to recruit policymakers; these contacts consisted of both policymakers and knowledge brokers. The experience of contacting and engaging with policymakers identified barriers other researchers may experience and offers enablers to assist when engaging policymakers. This reflective approach resulted in the development of the five following themes: who you know, what ifs, when is it enough, where is the research going and why value is important. These five themes can act as a guide for researchers when preparing to engage policymakers into research.

Pilot study of a group clinical supervision model for medical students

OBJECTIVE

To trial a clinical supervision model with medical students, co-designed by students and clinicians, and evaluate its feasibility, acceptability, and perceived benefits.

METHOD

Two clinical supervision groups, one online and one face-to-face, were conducted for six one-hour sessions, over 12 weeks. Clinical supervision was evaluated through mixed methods including attendance levels, focus groups, and quantitative surveys.

RESULTS

Thirteen students participated, including one rural and one regional group, each with a clinical supervisor. Attendance was 100%. Students viewed clinical supervision as a safe time for reflection on clinical experiences, validation from senior clinicians and peers, and connection to the medical community. Themes that emerged included strategies to prevent moral injury, self-care, and the need for a trusted clinical supervisor.

CONCLUSION

The clinical supervision model received positive medical student evaluations and 100% attendance. This shows promise as an avenue to professionally support medical students as they navigate complex clinical training.

Career stage-specific predictors of reflective ability among clinical nurses

AIMS

To identify career stage-specific factors that influence reflective ability in clinical nurses and the relative strength of these effects.

DESIGN

Exploratory cross-sectional study.

METHODS

Between August and September 2019, nursing professionals working at general hospitals (n = 1169) completed a questionnaire on reflective ability and its suspected influencing factors. Participants were grouped by career stage as defined by years of nursing experience. Each factor's predictive strength regarding different dimensions of reflective ability was analysed separately in each group via stepwise multiple regression.

RESULTS

Reflective ability was significantly influenced by support for personal growth from superiors and seniors among first-year participants and professional identity formation among those in their second or later years. Furthermore, it was significantly influenced by self-confidence in nursing practice in years 4-5, effort to improve knowledge and skills in years 6-9 and role model presence in years 10-19.

CONCLUSION

Career stage-specific predictors of reflective ability were related to nurses' environment and changes in the roles expected of them. Support measures aimed at improving this capacity should emphasize factors characteristic of the career stage(s) of nursing professionals.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Identifying the influencing factors of nurses' reflective ability can improve the same, deepen nurses' views on nursing, help them develop an intentional nursing practice and contribute to the improvement of the quality of nursing practice.

IMPACT

This study is the first to identify career stage-specific predictors of reflective ability in clinical nurses and the relative strength of their effects. Reflective ability was affected by growth support from superiors and seniors in first-year nurses and formation of nursing identity in second-year nurses. Additionally, nurses' environment and various roles affected their reflective ability. Hospitals should build an appropriate environment for nurses and develop the concept of 'oneself as a nurse' among nurses.

PATIENT OR PUBLIC CONTRIBUTION

This study was conducted with the approval of an ethical review committee that included general citizens. Furthermore, the research results were reviewed by general citizens prior to dissemination, and we received their opinions as to whether the writing was sufficiently clear and whether the information required by the audience was included. We improved the content to be disseminated based on relevant opinions provided.

Characteristics of positive and negative autobiographical memories central to identity: emotionality, vividness, rehearsal, rumination, and reflection

Introduction

Some events are remembered as more central to a person's identity than others. However, it is not entirely clear what characterizes these autobiographical memories central to one's identity. In this study, we examined the effects of various characteristics on centrality to identity of positive and negative memories. Characteristics such as emotionality, vividness, and how frequently a memory is retrieved and shared with others as well as ruminative and reflective self-foci were studied.

Methods

The sample included 356 participants (18-92 years of age). First, participants responded to demographic questions and individual difference questionnaires. Next, they recalled memories in response to 12 emotional cue words. The cue words were balanced for emotional valence (i.e., six positive and six negative) and presented in a random order. After retrieving all memories, participants rated them regarding centrality, using the short seven-item Centrality of Event Scale and other memory characteristics, on a seven-point Likert scale. Multivariate multilevel regression was used for data analyzes, to consider multiple characteristics at the same time and account for data dependency within individual.

Results

The results showed that emotionality, vividness, and frequency of memory retrieval contributed to higher centrality of memories, and employing a reflective self-focus resulted in rating memories as more central. In specific cases, these characteristics were associated differently with centrality of positive and negative memories.

Discussion

Central memories can be perceived as markers in a person's life story. The findings of this study suggest that these marker events are also highly available in a person's memory system, by being actively emotional, visually rich, and frequently retrieved. Moreover, not only memory characteristics but also individual's features are important to fully understand the autobiographical memory centrality.

Recycling of Nanocellulose from Polyester-Cotton Textile Waste for Modification of Film Composites

Textile waste has emerged as a critical global challenge, with improper disposal practices leading to adverse environmental consequences. In response to this pressing issue, there is growing interest in recycling textile waste containing cellulose as an alternative approach to reducing the impact of industrial waste on the environment. The objective of this research is to investigate the extraction and characterization of nanocellulose from polyester-cotton textile waste as a potential solution to address the growing concerns of waste management in the textile industry. To obtain nanocellulose, a comprehensive process involving alkaline sodium hydroxide (NaOH) treatment of the polyester-cotton textile (35% PET and 65% cotton) was employed, resulting in average yield percentages ranging from 62.14% to 71.21%. To achieve the complete hydrolysis of PET polyester in the blends, second hydrolysis was employed, and the optimized condition yield cotton fiber was 65.06 wt%, relatively close to the theoretical yield. Subsequently, the obtained cellulosic material underwent an acid hydrolysis process using 70 percent (v/v) sulfuric acid (H2SO4) solution at 45 °C for 90 min, resulting in nanocellulose. Centrifugation at 15,000 rpm for 15 min facilitated the separation of nanocellulose from the acid solution and yielded 56.26 wt% at optimized conditions. The characterization of the nanocellulose was carried out utilizing a comprehensive array of techniques, including absorption, transmission, and reflection spectra, and Fourier transform infrared. The characterization results provide valuable insights into the unique properties of nanocellulose extracted from textile waste. In this research, the obtained nanocellulose was mixed with PVA and silver nanoparticle to form biodegradable film composites as the reinforcement. In comparison, biodegradable film of PVA:nanocellulose 9.5:0.5 with silver nanoparticle 0.3 wt% and glycerol as a plasticizer exhibits better tensile strength (2.37 MPa) and elongation (214.26%) than the PVA film with normal cellulose. The prepared biodegradable film was homogeneous and had a smooth surface without the internal defect confirmed by the CT scan. This result opens avenues for enhancing the quantities of eco-friendly film composites, potentially replacing conventional plastic films in the future.

Prospective Relation between Ruminative Subtypes and Suicide Ideation: Moderating Role of Problem Solving

Background

Although reflection has been characterized as a more adaptive subtype of rumination than brooding, evidence suggests that reflection is associated with suicide ideation. The present longitudinal study investigated the mediating role of hopelessness and depressive symptoms and the moderating role of problem solving in explaining why reflection may lead to suicide ideation.

Methods

Two hundred ninety-four undergraduates participated in the study and were followed up every 6 months over 18 months. Participants completed measures of brooding and reflection, hopelessness, depressive symptoms, problem solving, and suicide ideation.

Results

Results revealed that after adjusting for baseline suicide ideation, the serial mediation path from brooding (but not reflection) to suicide ideation via hopelessness and depressive symptoms was significant. Baseline reflection predicted suicide ideation 18 months later through depressive symptoms at 12 months for people average in passive problem solving, and for those low or average in active problem solving. Brooding predicted suicide ideation through depressive symptoms, regardless of problem-solving.

Conclusions

Reflection may result in suicide ideation via depressive symptoms among people with poor problem-solving skills. Clinical and theoretical implications are discussed.

A thematic analysis of bereaved adults' meaning-making experience of loss through playing video games

Introduction

Recalling personal memories on the loss and deriving new meanings from them is deemed necessary for adapting to bereavement. Recent studies suggest that games can afford players meaningful experiences that can support players through stressful life events, but its potential on the meaning-making of loss has not been much explored. To address this gap, we investigated the bereaved players' experiences of playing commercial video games that elicited their personal memories of loss and what meanings they derived from those experiences.

Method

Twelve adult players with bereavement experiences (six male, six female, age range: 20-31) played two video games (Bear's Restaurant and Spiritfarer). Their experiences during and after gameplay were tracked via play diaries and in-depth interviews. Data was analyzed using thematic analysis method.

Results

We discovered seven themes on the meanings that players made from their gameplay experience: "Recalling memories", "Avoiding engagement with the pain", "Recognizing positive emotions", "Acknowledging the deceased's perspective", "Reviewing the meaning of loss", "Planning a better future", and "Fulfilling a wish". Our findings indicate that bereaved players recalled and related their autobiographical memories to their in-game experiences. Furthermore, they derived new meanings on both the loss and their post-loss life after playing video games.

Discussion

We discuss how video games can provide a unique meaning-making experience to bereaved players by affording them an agency to actively reconstruct their narrative of loss and facilitating the sharing of grief.

The person-centred care game: a reflective tool for learning person-centred care in higher education

Person-centred care (PCC) is being implemented within many health care systems and educational institutions are important enablers of learning PCC. Teachers in higher education are responsible for helping students develop the ability to reflect. One approach is with serious games, which allow students to reflect on realistic situations and shape their skills with virtual patients. This paper describes the development of a serious game, the person-centred care game - (PCC game), which was designed to promote learning of PCC by reflection. We demonstrated how this PCC game could be used to induce PCC knowledge and skills by student reflection in an academic course on PCC.

Exploring the outcomes of a reflective teaching strategy with students: A feasibility study

Purpose: Reflection can be a valuable learning strategy for connecting theory with practice and illuminating insights and understandings from complex or messy experiences. This learning is critical for educators and health professionals who work or teach students in complex contexts. In anticipation of their future needs, speech-language pathology students, like many health profession students in Australia, are expected to demonstrate the ability to reflect on their practice as part of their professional practice or clinical education. It is challenging to support educators to facilitate reflection and students to learn when, why, and how to reflect for personally and professionally meaningful outcomes given the diversity in understandings and capabilities present in the literature. The purpose of this study was to investigate the feasibility of an evidence-based reflection intervention to clarify and support student reflective practice.Method: A convergent mixed methods design captured quantitative and qualitative results from 16 participants for a better understanding of the feasibility of a reflection intervention.Result: The diversity in the reflection literature also appears to be present in students' reflection approaches. This diversity can encourage student engagement and ownership of reflecting when considered within a rich learning environment.Conclusion: Findings are discussed for timely, intellectually and emotionally safe reflection interventions that develop students' reflective inquiry in the real-world.

Students' and Instructors' Perspectives on Learning and Professional Development in the Context of Interprofessional Simulation

Phenomenon: Simulation-enhanced interprofessional education is a potentially valuable pedagogical approach in health professional education. Simulation-enhanced interprofessional education merits more empirical exploration particularly in terms of experiences from different perspectives. Approach: The study aims to provide a multi-perspective in-depth understanding of students' engagement in a simulation-based interprofessional learning environment. Ninety students and thirteen facilitators participated. We analyzed data from examination sheets of medical and nursing students in a simulation-enhanced interprofessional education course and from a facilitator survey, using manifest inductive content analysis. The analysis was informed by actor network theory and Schön's reflection on action model. Findings: Students reflected on their performance in relation to (1) personal attributes, such as systemization skills; (2) other team members, such as communication skills; and (3) the surrounding environment, such as efficient employment of resources. They also reflected on the consequences of their actions and future professional growth. We observed group differences in conceptualizations of performance and knowledge enactment. Facilitators' and students' perceptions of performance were mostly aligned. Leadership enactment in the learning environment was problematic for students as well as facilitators. Insights: Students' engagement in the learning environment helped them develop a prototype of their professional identity and explore potential domains or tools for further learning and professional growth. Features of the learning environment fostered teamwork skills and allowed students to learn from each other, thus improving performance. Our findings have several implications for education, and professional practice, including the need for meticulous planning of learning environments and the importance of more intensive pedagogical efforts for soon-to-be health professionals regarding workplace dynamics and potential conflicts. It is also important to consider that an interactive learning environment can invoke reflection on action not only among students but also among facilitators and that this can contribute to the development of clinical praxis.

Reflective Transition Practice Model: The New Graduate Registered Nurse

Reflection is a strategy that may enhance transition into practice for the new graduate registered nurse (NGRN). If introduced in the early stages of practice, reflection can be used as a tool to continuously evaluate and improve practice. A theory synthesis of Meleis' transition theory and Schon's reflective practice model was developed to support reflection as a tool for new nurses transitioning into the role of professional nurses. Reflection has the potential to improve the NGRNs' perception of their role, decrease feelings of disconnectedness, and improve patterns of response.

A Labor of Love: From Cranberry Biologist to Nurse Scholar and Educator

There are many nursing scholars who have contributed to nursing knowledge. Dr. Monika Schuler started her career as a cranberry biologist and is now a nurse scholar and educator. Her contributions to nursing knowledge include two new models that contribute to our understanding of nursing professional growth: (1) the reflection, feedback, and restructuring model for role development in nursing and (2) the substance use disorder nursing attitude model. Dr. Schuler is working with colleagues toward developing an understanding of how nursing experiences inform their role development. In this scholarly dialogue, Dr. Schuler shares her path to nursing scholarship and her recent contributions to nursing knowledge development.

Thinking About Reasons for One's Choices Increases Sensitivity to Moral Norms in Moral-Dilemma Judgments

Whereas norm-conforming (deontological) judgments have been claimed to be rooted in automatic emotional responses, outcome-maximizing (utilitarian) judgments are assumed to require reflective reasoning. Using the CNI model to disentangle factors underlying moral-dilemma judgments, the current research investigated effects of thinking about reasons on sensitivity to consequences, sensitivity to moral norms, and general action preferences. Three experiments (two preregistered) found that thinking about reasons (vs. responding intuitively or thinking about intuitions) reliably increased sensitivity to moral norms independent of processing time. Thinking about reasons had no reproducible effects on sensitivity to consequences and general action preferences. The results suggest that norm-conforming responses in moral dilemmas can arise from reflective thoughts about reasons, challenging the modal view on the role of cognitive reflection in moral-dilemma judgment. The findings highlight the importance of distinguishing between degree (high vs. low elaboration) and content (intuitions vs. reasons) as distinct aspects of cognitive reflection.

Nurse researcher identity and reflexivity in interpretive phenomenological analysis: a personal narrative

BACKGROUND

Nurses have a significant part to play in research. However, novice nurse researchers face difficulties in transitioning into research roles. These difficulties can affect their sense of identity, their clarity of role and the research process.

AIM

To highlight how reflexive processes enable novice nurse researchers to develop self-awareness, overcome tensions and navigate their dual identities as they transition into researchers.

DISCUSSION

Participating in reflexive activities when conducting research provides the researcher with a biography of the experience. It also encourages the examination of thoughts and feelings that can inform and enhance the quality of the research, as well as the confidence of the researcher. Transitioning from nurse to researcher can be complex and present professional and ethical dilemmas, creating conflict when nurses adopt and adjust to the new role. Reflexivity offers opportunities to identify and examine these dilemmas and tensions, as well as support for nurses as they move into research roles.

CONCLUSION

Nurses hold onto their professional identities as they transition into research, viewing the researcher identity as complementary to their initial clinical professional identity. This dual-professional identity connects healthcare and research, but also creates challenges for nurses, so should be given more attention.

IMPLICATIONS FOR PRACTICE

More research is needed to examine the path from nurse to researcher and why nurses remain committed to their professional nurse identity. As nurse researchers are becoming commonplace in healthcare, research education programmes need to include strategies to help novice nurse researchers navigate the tensions between their nurse and researcher identities.

Using reflection in nursing practice to enhance patient care

The ability to reflect on, and learn from, practice experiences is essential for nurses when seeking to provide effective person-centred care. This article outlines the various types of reflection that nurses can use, such as reflection-in-action and reflection-on-action. It also details some of the main models of reflection and explains how nurses might develop their skills in reflection to enhance the quality of patient care. The article provides examples of cases and reflective activities to demonstrate how nurses can use reflection in their practice.

Why Should We Study the Foreign Language Effect: Debiasing through Affecting Metacognition?

Debiasing is a method of improving people's decisions by reducing their reliance on salient intuitions causing them to behave suboptimally or biasedly. However, many of the known debiasing techniques have limited effectiveness or can only remedy a one-shot decision, rather than having a lasting impact. In this work, I focus on the role of metacognition in debiasing decision-making and discuss how it can be better understood through the lens of the foreign language effect. The foreign language effect suggests that using a foreign language can sometimes benefit people's decision-making without providing them with additional information or instructions regarding the task. However, we do not fully understand how the foreign language effect works and its limitations. I conclude by urging scientists to research this effect with the hope of having a lasting positive impact on society.

Acoustic Wave Reflection in Water Affects Underwater Wireless Sensor Networks

The phenomenon of acoustic wave reflection off fluid-solid surfaces is the focus of this research. This research aims to measure the effect of material physical qualities on oblique incidence acoustic attenuation across a large frequency range. To construct the extensive comparison shown in the supporting documentation, reflection coefficient curves were generated by carefully adjusting the porousness and permeability of the poroelastic solid. The next stage in determining its acoustic response is to determine the pseudo-Brewster angle shift and the reflection coefficient minimum dip for the previously indicated attenuation permutations. This circumstance is made possible by modeling and studying the reflection and absorption of acoustic plane waves encountering half-space and two-layer surfaces. For this purpose, both viscous and thermal losses are taken into account. According to the research findings, the propagation medium has a significant impact on the form of the curve that represents the reflection coefficient, whereas the effects of permeability, porosity, and driving frequency are relatively less significant to the pseudo-Brewster angle and curve minima, respectively. This research additionally found that as permeability and porosity increase, the pseudo-Brewster angle shifts to the left (proportionally to porosity increase) until it reaches a limiting value of 73.4 degrees, and that the reflection coefficient curves for each level of porosity exhibit a greater angular dependence, with an overall decrease in magnitude at all incident angles. These findings are given within the framework of the investigation (in proportion to the increase in porosity). The study concluded that when permeability declined, the angular dependence of frequency-dependent attenuation reduced, resulting in iso-porous curves. The study also discovered that the matrix porosity largely affected the angular dependency of the viscous losses in the range of 1.4 × 10^-14 m² permeability.

Self-efficacy, reflection, and resilience as predictors of work engagement among English teachers

Introduction

Given the significant role of work engagement of teachers in educational contexts, some scholarly attention has been directed to exploring the predictors of this construct. Against this backdrop, this study aimed to investigate the predictors of teacher work engagement among Chinese English as a foreign language (EFL) teachers by testing a model that includes teacher self-efficacy, teacher reflection, and teacher resilience.

Methods

To achieve this goal, 512 EFL teachers were invited to participate in an online survey, which consisted of four questionnaires. The construct validity of the measures was confirmed through confirmatory factor analysis. Then, structural equation modeling was utilized to examine the relationships between the variables.

Results

The findings indicated that teacher self-efficacy, teacher reflection, and teacher resilience were direct predictors of work engagement, and teacher self-efficacy had an indirect effect on work engagement via teacher reflection and resilience. Similarly, teacher reflection also had an indirect impact on work engagement through teacher resilience.

Discussion

These results have important implications for teacher education programs. The significance of these predictors of work engagement among EFL teachers highlights the importance of fostering self-efficacy, reflection, and resilience among teachers in order to promote their work engagement. Further research can explore ways to enhance these predictors through training and support programs for teachers.