Keeping a reflective practice diary: a practical guide

The development of undergraduate pharmacy students as reflective thinkers for the evolving field of pharmacy

OBJECTIVES

Iterative reflective practice is recognised to support learners' formation of humanism and resilience, facilitating the healthy development of professional identity. In one undergraduate pharmacy programme, students experience a series of seminars to develop their understanding and skills in the practice of reflection and its articulation. In Stage (year) 4, students engage in a reflection conference where they present a reflective account of a 'Significant Learning Event' or their journey 'From Student to Professional'. Student abstracts from this conference were investigated to explore the nature of the reflective practice.

METHODS

The student abstracts submitted for the reflection conference in the academic years 2017-2018 and 2018-2019 were subjected to manifest and latent content analysis to investigate what and how students chose to reflect. This was supplemented by the ethnographic approach of the researchers, who attended, observed and engaged with students at the event.

KEY FINDINGS

107 abstracts were submitted across the cohorts. Students reflected mainly upon experiences across a range of extra- and co-curricular activities, and reported significant learning, according to Fink's taxonomy, mainly in the human dimension, caring and learning to learn.

CONCLUSIONS

At the culmination of the reflection educational strand within this programme, students demonstrated purposeful, deliberate introspection and metacognition in their abstracts for the reflection conference. These skills are fundamental to support transformative learning, whereby students have the ability to self-regulate and critique their frames of reference with autonomy and flexibility that will enable them to most effectively engage and benefit from lifelong learning within the profession.

An evaluation of the appropriateness and effectiveness of structured reflection for midwifery students in Ireland

Midwifery students undertaking the undergraduate midwifery education programme in Ireland participate in facilitated reflective sessions that aim to develop their skills of reflecting on and in clinical practice. This paper presents a qualitative evaluation of the appropriateness and effectiveness of the facilitated reflection sessions for pre and post-registration midwifery students in two large Dublin maternity teaching hospitals. The aim was to evaluate structured reflective practice sessions which sought to assist midwifery students to become competent reflective practitioners. Group reflection sessions were conducted weekly in a clinical practice area at the same time each week over one academic year. After the series of structured reflective sessions, midwifery students and facilitating staff were invited to evaluate the reflective process. This evaluation consisted of a self-completion survey to identify the factors that facilitated and impeded student participation in the sessions. Respondents answered a series of questions about the reflective practice sessions and were also invited to enter qualitative data regarding their subjective experiences of the process in free text boxes. The data were then collated into themes by an independent reviewer. The results of the evaluation clearly indicate that midwifery students and facilitators welcomed the opportunity to engage in group reflection sessions as a form of peer support and as a catalyst for learning from clinical practice. Findings suggest that reflective practice can contribute to the development of skilled, self-aware and engaged practitioners.

Addressing ethical concerns arising in nursing and midwifery students' reflective assignments

BACKGROUND

Written reflections on practice are frequently requirements of nursing curricula. They are widely accepted as necessary for improving critical thinking and problem-solving skills. Faculty, are expected to review reflections and provide feedback that helps professional development and facilitates good practice. It is less clear what the actions of nurse educators should be when ethical infractions are revealed in the narratives.

OBJECTIVES

We had two aims: 1) To combine insights from a literature review of empirical and theoretical research related to responding to ethical issues revealed in student reflections with our experiences reviewing the reflections of undergraduate nursing and midwifery students, and 2) to construct and analyze a hybrid case from these insights in order to develop guidelines for nurse educators.

RESEARCH DESIGN

A literature review was conducted using CINAHL, MEDLINE, PsycINFO, SocINDEX and ERIC databases and pertinent key words. A hybrid case was constructed of commonly encountered ethical issues using insights from the literature review and the authors' experiences. The case was analyzed by combining Beauchamp and Childress' principlist approach with Campbell and McCarthy's ethical decision-making tool (Table 1). Participants and Research Context: No human participants Findings: A gap in the literature exists related to addressing ethical issues revealed in student practice reflections. However, a combination of insights from the literature and the authors' experiences facilitated the development of a hybrid case. Subsequent case analysis facilitated the development of a series of guidelines that can be utilized to address a range of issues commonly emerging in the reflections of nursing students during practice experiences.

DISCUSSION

A number of recommendations and guidelines are provided to enable the safeguarding of students and staff and support them in practicing ethically.

CONCLUSION

Structured ethical analysis of a constructed hybrid reflection of commonly revealed ethical issues was useful in developing guidelines for educators.

El diario del estudiante de enfermería en la práctica clínica frente a los diarios realizados en otras disciplinas. Una revisión integradora

El presente artículo es una revisión integradora de la literatura cuyo objetivo fue identificar, en revistas nacionales e internacionales indexadas en las bases de datos Isi Web of Knowledge, Eric, PubMed, EbscoHost, Scopus, SciELO, Cuiden, Cuidatge y Scirus, en el periodo comprendido entre 1995 y 2011, datos que contribuyeran a determinar cómo la escritura del diario reflexivo ayuda al estudiante de enfermería durante sus prácticas clínicas, así como a establecer diferencias y similitudes con los diarios realizados por estudiantes de otras disciplinas. Se llevó a cabo una revisión amplia de la cual se seleccionaron 54 artículos científicos con base en criterios de inclusión y exclusión, sin descartar ninguna metodología de investigación e incluyendo aquellos que analizaran el diario del estudiante, fueran o no del ámbito de la enfermería. Se concluye que la escritura del diario reflexivo que realiza el estudiante de enfermería durante sus prácticas clínicas tiene beneficios tales como la mejora de la comunicación con el paciente, fundamental para el cuidado. La escritura del diario debería ser incluida en todos los planes de estudio de grado en el ámbito de las prácticas clínicas.

Raised emotions: A critique of the Peshkin Approach to Reflection

AIMS AND OBJECTIVES

We critique a new approach to reflection in nursing that uses thoughts and feelings as the focus of the reflective process.

BACKGROUND

We have developed the 'Peshkin Approach to Reflection'; so-called because it is influenced by the work of Peshkin and his focus on the 'subjective I'. Whereas most reflective models used in nursing take an incident as the starting point, this new approach focuses on subjective feelings and thoughts.

DISCUSSION

We offer an overview of the stages of the process: preparation; writing, analysis, and application to practice. Central to the paper is a critique of the approach with particular emphasis on the issues raised by focusing on emotions as part of the reflective process. We show that within the emotional labour of nursing, feelings may become repressed. Thus, we suggest that bringing emotions to the forefront of reflective practice in an appropriately supportive environment has significant benefits.

CONCLUSIONS

Emotions are inextricably bound with nursing practice. For that reason, we argue that much can be gained from raising emotions in a manner that helps nursing students - or indeed nurses and other practitioners - gain a deeper self-understanding. In turn, this can enhance therapeutic use of self.

A cooperative inquiry into action learning and praxis development in a community nursing module

As nurse lecturers we investigated practice development and action learning approaches aimed at enabling postregistration bachelor's- and master's-level nursing students (Community Health Studies, Nursing in the Home) to advance practice in the context of policy and professional developments. A patchwork text was used to assess summatively what students achieved (practice change/development) and how this was informed critically, via an extended epistemology. First-person inquiry supplemented by cooperative inquiry postcourse completion (including reflective discussions with 16 students and 16 practice mentors) were used to assist coresearcher constructions of meaning. A relational, tripartite approach to learning and assessment (students', teachers', and practice mentors' collective contributions) depends on continuing reflective attention. Action learning enhances interrelation of experience with dialectic thinking. The patchwork text functions to promote creative writing, evaluative thinking, and praxis development. Role modeling by all, being genuine and not just "talking" genuine, is challenging yet crucial if people are to function as mutual resources for learning.

Patchwork text: a praxis oriented means of assessment in district nurse education

A patchwork text was used to assess summatively B.Sc. and M.Sc. district nurse students' learning and how this was informed critically, during a module on a one year fulltime community programme. Assessment was embedded within an action learning process that adopted an extended epistemology so students demonstrated connections between practice, theory and their reflections. Five lecturers undertook first-person and co-operative inquiry into their experiences, including post-course reflexive discussions with 16 students and their practice mentors. Maintaining reflective diaries functioned to enhance writing as learning, with students presenting in non-linear terms, their regress, progress and self-evaluative skills. Marking was challenging for lecturers. Elements of criteria based upon portfolio assessment and qualitative research were supplemented by action research quality indicators, in terms of students explicating their choices and rationale. Summative judgements were enhanced and validated by markers engaging in critical dialogue with second markers and moderators and not through exclusive use of ever-increasingly sophisticated criteria. Crucially, assessment requires mentor verification of students' accounts. In summary, a relational, tripartite approach to learning and assessment (students, teachers and practice mentors collective contributions) enhances quality of both learning and its assessment, including competency assessment. Errors and weaknesses are also identified, no panaceas are claimed.

Reflection in preregistration nursing curricula

BACKGROUND

The concepts of reflection and reflective practice are increasingly popular themes in the nursing literature. Reflective practice has been advocated as a method for overcoming the divergence between nursing theory and practice, and as a means of articulating and developing knowledge embedded in practice. However, these claims are based more on theoretical debate than research evidence. In common with other regulatory bodies, the Irish regulatory nursing body advocates the need for reflective nurses, and curricula are being adapted to reflect this. These changes are taking place when there is still little guidance on the teaching or assessment of reflective practice. Given the lack of research on the topic and the need for evidence on which to base the teaching of reflective practice, a descriptive exploratory study was undertaken.

AIM

The aim of this paper is to report how a group of nurse teachers perceived and interpreted reflective practice in preregistration nursing curricula in schools of nursing in The Republic of Ireland.

METHODS

Data were collected using a postal questionnaire distributed to all schools of nursing involved in the preregistration diploma in nursing (n = 40).

RESULTS

The results indicate variation between institutions in the number of hours allocated to the subject and where reflective practice was included in the curriculum. Emphasis was placed on theoretical models of reflection as opposed to the process or the skills required to become a reflective practitioner. Lecture and group discussion were the dominant teaching methods. Additionally, a number of teachers expressed dissatisfaction with the preparation they had received to teach the subject, and identified some of the challenges they experience when teaching reflective practice.

CONCLUSIONS

The results provide a focus for further debate amongst nurse educators involved in implementing reflective practice in the curriculum. The results are limited by a response rate of 50% and by the geographic setting. Further research is needed to substantiate the findings of the study. However, there results do suggest that there is a need to clarify curricular content in relation to reflective practice and prepare nurse tutors for their role in teaching this subject more effectively.

Applying Personal Reflective Critical Incident Reviews in Critical Care

Critical care nurses can use the personal reflective critical incident review to subjectively relate common experiences relating to crisis and then devise nursing strategies to help alleviate it. This review article, related to a current situation on an intensive care unit, helps the nurse cope with the stress of the unit. Critical care nurses must react to situations that affect everyone, including themselves. Analyzing their own reactions during a crisis situation helps nurses to accomplish this goal.

Reflection: a casualty of modularisation?

INTRODUCTION

The use of reflection in nursing and midwifery is well-established and reflective skills are taught on both pre- and post-registration courses as a way of integrating theory and practice, and of developing students' critical and analytical skills. Reflection is generally regarded positively with an assumption that reflective skills benefit both practitioners and patients. The aim of this study was to identify the educational strategies used to develop reflective skills in one pre-registration diploma in nursing curriculum.

METHODS

The survey was cross-sectional in design. A questionnaire was designed for the study to explore perceptions of both students and lecturers in one educational establishment. Curriculum documentation was analysed to examine where in the curriculum the development of reflective skills was prominent. The sample consisted of two student cohorts from the adult branch and all senior lecturers within the Institute who taught on the pre-registration programme.

RESULTS

The findings revealed a complex picture of students' and lecturers' views of the teaching and learning strategies used to develop reflective skills. Lectures and group work were the strategies cited most commonly by the students, whereas the lecturers felt the strategies used most often were personal tutorials, group work and case scenarios. The documentary analysis revealed that out of the 13 modules, there was explicit reference in only three modules to reflective practice. Furthermore, it was evident that the majority of lecturers were not clear where in the curriculum reflective skills were taught which suggested that an overview of the whole curriculum is not always evident.

CONCLUSIONS

Modularisation may have contributed to a fragmentation in the way in which some key health practitioner skills are developed and built upon throughout a curriculum. There needs to be agreement on the nature of the skills which are central to the development of reflective practitioners and clear thinking on how these are developed and assessed within a curriculum.

Using journals for community health students engaged in group work

Teaching students concepts integral to community health nursing, such as collaboration and partnership, while providing clinical practica in community agencies, mandates that students address group process and evaluate self-growth. To facilitate reflection on self-learning in the context of collaborative group work, faculty and students use a structured, graded, weekly journal. This teaching and learning tool serves as a mechanism for assisting students with understanding group process.

A discussion of the strengths and weaknesses of 'reflection' in nursing practice and education

This paper begins by exploring the principles underpinning 'reflective practice'. The impact of reflection on the nursing profession is discussed, with particular attention being paid to nursing education. The value of reflective practice in nursing has been subject to considerable debate. This paper reviews both the claimed strengths and shortcomings of 'reflection', particularly in relation to the use of reflective material in the assessment of students.