Nursing narratives and reflective practice: A theoretical review

Educational programs to improve nursing competency of patient- and family-centered care in intensive care units: A systematic review

BACKGROUND

As the need for and value placed on patient- and family-centered care (PFCC) has increased worldwide, the importance of nursing competency to perform PFCC has grown, and education on this topic is also emphasized. However, little is known about the components of educational programs for intensive care unit (ICU) nurses based on the person-centered nursing theoretical framework and outcome indicators. The aim of this systematic review was to determine how the educational components of PFCC for nurses were implemented based on the person-centered nursing theoretical framework and to identify educational outcome indicators for ICU nurses.

STUDY DESIGN

We searched five electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, and RISS) from 2001 to May 4, 2024, for studies of educational programs on PFCC for nurses in ICUs. The authors independently screened and extracted the data, and three authors appraised the results. The contents of educational programs of PFCC for nurses were examined. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool.

RESULTS

Overall, 2162 records were identified, and 5 full-text articles were assessed. All studies included the professional competency of knowledge about PFCC or evidence-based practice as well as communication skill with families as an aspect of interpersonal skills. However, the domains of self-awareness and clarity of values and beliefs were not identified, and collaboration was lacking. Three studies evaluated the level of family nursing practice, and two of these reported improvements.

CONCLUSIONS

This review suggests that a PFCC educational program may be effective in improving the PFCC competencies of ICU nurses. Further research is needed to address knowledge gaps related to self-awareness, clarity of beliefs and values, and collaboration. The results from this review can be used to inform future curriculum design and the content of PFCC educational programs for nurses in the ICU.

Leveraging Narrative Reflective Writing to Teach Nursing Students About Social Determinants of Health by Harnessing "Small Moments"

BACKGROUND

There is increasing recognition that social determinants of health (SDOH) profoundly affect health outcomes. Frontline nurses must grasp how SDOH shape health disparities and inequities.

PURPOSE

This paper describes an innovative pedagogical approach that leverages didactic, experiential, and reflective methods, specifically a "small moments" writing activity, to enhance students' understanding of SDOH.

METHODS

Nursing students (n = 135) from a southeastern U.S. university participated in the activity, and 72 provided consent for inclusion in this analysis. Themes related to students' understanding of SDOH were identified, and implications for nursing practice were considered.

RESULTS

This integrative approach deepened students' understanding of SDOH. Narratives highlighted economic instability, cultural barriers, and systemic inequities as drivers of health disparities. Students described greater awareness, empathy, and culturally competent care.

CONCLUSION

Student narratives showed evidence of critical thinking, empathy, and advocacy, crucial skills for addressing health disparities.

Developing and Testing a Reflection Method for Implementation of a Professional Reporting Guideline in Community Nursing: Design-Based Research

AIM

To develop a reflection method for community nurses and certified nursing assistants to support the implementation of a professional reporting guideline for nurses and certified nursing assistants in daily care and to identify its key features.

DESIGN

Design-based research.

METHODS

This study was conducted in the Netherlands from February 2021 to April 2022. The reflection method was developed by a design group (community nurses, certified nursing assistants and a patient representative) and four test groups of nurses. Experiences of participants were explored with video recordings and observational notes from test group meetings. The data were thematically analysed to refine the reflection method and identify key features.

RESULTS

A final reflection method was developed. We identified three main themes: (1) Impact on behaviour change, (2) group learning and (3) conditional factors for critical reflection. Seven key features emerged as essential, forming the building blocks of the reflection method: focus on critical reflection, allocate time to formulate themes, include participants from various backgrounds and organisations, ensure the group is appropriately sized, allow for sufficient time, keep it simple and attractive and stimulate the group to make the transfer of learning to their clinical practice.

CONCLUSIONS

The final method included two 2 h meetings with up to six participants and a coach. Participants learned from critical reflection and feedback to improve the reporting quality and critical assessment of daily practices, especially from colleagues with varying team affiliations and educational backgrounds.

IMPACT

This reflection method enables community nurses and certified nursing assistants to learn collaboratively, aligning with the 'Nursing and Caring Reporting' guideline and bridging the gap between research and clinical practice.

REPORT METHOD

The COREQ guideline was used.

PATIENT OR PUBLIC CONTRIBUTION

The study design facilitated close collaboration among researchers, community nurses, certified nursing assistants and clients.

Relationship Between Perceived Organizational Support, Work Well-Being, and Medical Narrative Ability Among Nurses: A Cross-Sectional Multicenter Study

Aims: The purpose of this study was to investigate the relationship between nurses' perceived organizational support, work well-being, and medical narrative ability. Background: With the proposed bio-psycho-social medical model, nurses' medical narrative ability is closely related to patients' health problems and quality of life. Nurses' perceived organizational support and work well-being can improve nurses' empathy and reflection ability to a certain extent and promote patients' rehabilitation. However, the relationship between nurses' perceived organizational support, work well-being, and medical narrative ability is unclear. Methods: A total of 1831 nurses from 8 hospitals in China were surveyed using an online questionnaire that included nurses' sociodemographic, perceived organizational support, work well-being, and medical narrative ability. IBM SPSS 27.0 was used for Pearson's correlation analysis, one-way ANOVA, t-test, and mediation effect analysis using Model 4 in PROCESS (5000 resamples). Results: The total mean score of perceived organizational support (46.68 ± 11.00), work well-being (53.09 ± 10.81), and medical narrative ability (154.48 ± 22.93) among nurses was found to be moderate. The relationship between perceived organizational support, work well-being, and medical narrative ability was significant, with correlation coefficients ranging from 0.348 to 0.685 (p < 0.01). The relationship between perceived organizational support and medical narrative ability is partially mediated by work well-being. The intermediate effect accounted for 52.36% of the total effect. Conclusion: This study found that nurses' work well-being mediated the relationship between perceived organizational support and medical narrative ability. Implications for Nursing Management: This study evaluated nurses' medical narrative ability and explored the relationship between nurses' perceived organizational support, work well-being, and medical narrative ability. The results of this study can help nursing managers and educators to take appropriate measures to intervene nurses' perceived organizational support and work well-being, so as to improve nurses' medical narrative ability and optimize nursing quality.

Story-Sharing Facilitation Guide: An Educational Strategy to Develop Strengths-Based Nursing and Healthcare Leaders

BACKGROUND

A reflective praxis process has been developed to facilitate story-sharing, an educational strategy grounded in narrative pedagogy.

METHOD

This article describes this strategy, the Story-Sharing Facilitation Guide (SSFG). The guide allows educators to facilitate the telling of a story that often triggers a memory of similar or contrasting experiences. Sharing stories helps learners find personal and professional meaning, develop new insights, and revise actions. The SSFG is underpinned by Dreyfus and Taylor's Contact Theory of how human beings learn and come to know and understand their different life-worlds.

RESULTS

The SSFG was developed and used by faculty in a leadership training program. Evaluation results of the program found this to be an effective educational method.

CONCLUSION

The guide provides educators with an intentional process of reflection that deepens learning and allows for labeling the experience and linking it with the concepts being taught. [J Nurs Educ. 2024;63(10):703-708.].

Nurses under fire: Insights from testimonies of community nurses and midwives in nonhospital settings in the southern Israel conflict zone

Nurses-with or without prehospital care training-may find themselves delivering immediate care to injured individuals outside a healthcare facility, sometimes even in situations where their own life is at risk. This study explores the experiences of community nurses and midwives who provided immediate care during the Hamas militant movement's attack in southern Israel. The researchers collected and analyzed eight nurse and midwife survivors' testimonies published in digital media to gain a deeper understanding of their perspectives. Through qualitative content analysis, common themes, patterns, and insights were identified. The study aimed to contribute valuable knowledge in this field and followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for methodological rigor. Two themes emerged from the testimonies, focusing on the nurses' swift realization of necessary action under fire and resilience and ingenuity in practice. Despite lacking training and resources, the nurses professionally assessed the situation and improvised creative solutions to care for the wounded. Although they had no prehospital emergency care background, community nurses and midwives were able to respond effectively, providing lifesaving care. The findings highlight the nurses' resilience, adaptability, and dedication in unprecedented situations. However, the study also emphasizes the importance of providing all nurses with baseline prehospital care training and structured planning of this care to empower them to deliver optimal patient care in uncertain and dangerous conditions, especially in and around conflict and disaster zones.

Temporal Exploration of New Nurses' Field Adaptation Using Text Network Analysis

PURPOSE

This study aimed to analyze the experiences of new nurses during their first year of hospital employment to gather data for the development of an evidence-based new nurse residency program focused on adaptability.

METHODS

This study was conducted at a tertiary hospital in Korea between March and August 2021 with 80 new nurses who wrote in critical reflective journals during their first year of work. NetMiner 4.5.0 was used to conduct a text network analysis of the critical reflective journals to uncover core keywords and topics across three periods.

RESULTS

In the journals, over time, degree centrality emerged as "study" and "patient understanding" for 1 to 3 months, "insufficient" and "stress" for 4 to 6 months, and "handover" and "preparation" for 7 to 12 months. Major sub-themes at 1 to 3 months were: "rounds," "intravenous-cannulation," "medical device," and "patient understanding"; at 4 to 6 months they were "admission," "discharge," "oxygen therapy," and "disease"; and at 7 to 12 months they were "burden," "independence," and "solution."

CONCLUSION

These results provide valuable insights into the challenges and experiences encountered by new nurses during different stages of their field adaptation process. This information may highlight the best nurse leadership methods for improving institutional education and supporting new nurses' transitions to the hospital work environment.

Evaluating the use of reflective cafés in Specialist Community Practitioner and Specialist Community Public Health Nurse programmes

Background: Specialist Community Practitioner (SCP) and Specialist Community Public Health Nurse (SCPHN) students are required to evidence their competency by the use of reflective practice as part of the NMC proficiencies. A reflective café trilogy comprising of three reflective teaching sessions was developed and introduced into a university programme to support and encourage alternative methods for deeper reflection within this student group. Aim: It was important for educators to evaluate if a reflective café met the student's needs and understand the usefulness of a 'reflective café' as a technique to support the process of reflecting on practice. Methods: Evaluation was undertaken using an online questionnaire. Findings: Students evaluated if the reflective café was useful for their own development and identified that the number of sessions met their developmental needs. Conclusion: The potential to develop alternative methods to reflect was recognised and the team plan to develop other reflective processes to support students in the future.

Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study

AIMS AND OBJECTIVES

To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units.

BACKGROUND

In mental health units, the therapeutic relationship is especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care.

DESIGN

Action and observation stages of a participatory action research project.

METHODS

Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used.

RESULTS

The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice.

CONCLUSIONS

This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse-patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice.

RELEVANCE TO CLINICAL PRACTICE

These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day-to-day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.

Mind The Gap: A Philosophical Analysis of Reflection's Many Benefits

Issue: Expectations of reflection run high in medical practice and medical education; it is claimed as a means to many ends. In this article, the authors do not reject the value of reflection for medical education and medical practitioners, but they still ask why reflection can (potentially) yield so many different benefits, and what that implies for the status of reflection in medical education practice. Evidence: Based on a conceptual analysis of debates about reflection in the philosophical tradition, the authors argue that there are two quintessential gaps that play a role in the proliferation of (potential) benefits. First, reflection deals with bridging the gap between theory and practice; second, it deals with bridging the gap between the individual sense and communal sense. These gaps prevent the systematization of reflection, and they are fundamental to human thinking and experience in any situated environment, which led contemporary research on reflection to list a wide variety of benefits. Implications: The authors argue that if reflection resists systematization, it cannot be learned by following rules or protocols, but only practiced. Then, reflection should no longer be taught and researched as an individual skill one learns, nor as a means to some particular, beneficial end. Rather, one should practice reflection, and experience what it means to be part of a community wherein professionals jump the theory-practice gap constantly in a myriad of situations. Based on their analysis, the authors provide three concrete recommendations for reflection in medical education. First, to give precedence to reflective activities that encompass both gaps wherein situated examples can flourish; second, to use reflective guidelines as sources of inspiration; third, to show reserve about assessing reflection.

Development and Preliminary Evaluation of the Effects of a Preceptor Reflective Practice Program: A Mixed-Method Research

Studies on methods to share nursing and learning experiences with preceptors are lacking. This study was conducted to determine the preliminary effects of developing and applying a reflective practice program for preceptor nurses who experience stressful situations to convert negative emotions into positive ones. This study was conducted over 12 weeks from March to May 2022 on 47 participant nurses in South Korea. Preceptor Reflective Practice Program (PRPP) was conducted in parallel with writing a reflective journal and a reflective practice workshop. Data collection was integrated through quantitative and qualitative approaches. Quantitative data were collected through questionnaires on stress coping, the burden of preceptors, social support, and emotional intelligence, and analyzed by SPSS WIN 26.0 program. The questionnaire data were analyzed after the preceptor nurses had written a reflective journal. Stress coping, social support, and emotional intelligence significantly increased in preceptor nurses after participating in the PRPP. This study found that the PRPP helped nurses improve their emotional intelligence through reflective practice and convert stress into a more positive direction. Therefore, at the organizational and national levels, a reasonable compensation system to provide support workforce and to the work of preceptor nurses should be established.

Perspectives of Nursing Students on Promoting Reflection in the Clinical Setting: A Qualitative Study

Background: Reflection increases meta-cognitive capacities, promotes student-instructor relationships, overcomes the theory-practice gap, and enriches learning. This study aims at exploring nursing students’ perspectives on the facilitators of reflective practices in the clinical setting. Methods: Semi-structured interviews were conducted among 21 Saudi nursing students at one major university in Saudi Arabia. Results: Two major themes were prevalent upon thematic analysis, namely, “Personal Drivers of Reflection” which consisted of “Motivation to Learn”, “Desire to develop”, “Ethical Regard”, and “Responsibility towards patients” and “External Drivers of Reflection” which consisted of “Patient characteristics”, “Case complexity”, and “Competent Instructors”. Conclusion: As per the results of the study, nursing students perceived that they underwent reflection as a response to personal motivational and external educational aspects. According to the findings, instructors should assist students through clinical reflection, with a special focus on their interactions and motivation.

Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research

Reflection is a complex concept in medical education research. No consensus exists on what reflection exactly entails; thus far, cross-comparing empirical findings has not resulted in definite evidence on how to foster reflection. The concept is as slippery as soap. This leaves the research field with the question, 'how can research approach the conceptual indeterminacy of reflection to produce knowledge?'. The authors conducted a critical narrative umbrella review of research on reflection in medical education. Forty-seven review studies on reflection research from 2000 onwards were reviewed. The authors used the foundational literature on reflection from Dewey and Schön as an analytical lens to identify and critically juxtapose common approaches in reflection research that tackle the conceptual complexity. Research on reflection must deal with the paradox that every conceptualization of reflection is either too sharp or too broad because it is entrenched in practice. The key to conceptualizing reflection lies in its use and purpose, which can be provided by in situ research of reflective practices.

A novel reflective practice intervention improves quality of care in the emergency department

INTRODUCTION

Most interventions to improve clinical outcomes in the emergency department (ED) are based on structural changes. This study embraced a different strategy and examined the impact of a reflective practice intervention (RPI) on ED quality of care.

METHODS

A pre-post-intervention quasi-experimental nested design was conducted between January 2017 and June 2018 in an Israeli public tertiary academic ED. Nighty-six ED teams (triage and staff nurses and a physician) were included pre and post RPI. Data were collected pre and post RPI at patient-triage nurse encounters using triage-accuracy questionnaires. Time to decision, length-of-stay, and hospitalization and mortality rates were retrieved from the medical charts of 1920 patients (20 per team).

RESULTS

Accurate triage was significantly higher post than pre intervention (4.84 ± 1.45 vs. 3.87 ± 1.48; range 1-7; p < .001), whereas time to decision (253.30 ± 246.75 vs. 304.64 ± 249.14 min), hospitalization rates (n = 291, 30.3% vs. n = 374, 39.0%; p < .001), and hospital length-of-stay (5.73 ± 6.72 vs. 6.69 ± 6.20; p = .04) significantly decreased.

CONCLUSIONS

By adapting organizational reflective practice principles to the ED dynamic environment, the RPI was associated with a significant improvement in ED quality-of-care measures.

Reflecting on nursing practice during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant challenges for nurses, both professionally and personally. In these unprecedented times, new opportunities to reflect on practice have emerged. Through reflection, whether individually or with others, nurses can explore areas of their practice that could be developed and improved. This article outlines the types of reflection and discusses its benefits and challenges, explaining how it is linked to nurses' regulatory revalidation processes. It also details various models and activities that nurses can use to reflect on their practice during the COVID-19 pandemic and beyond.

The experience of patients with cancer on narrative practice: A systematic review and meta-synthesis

BACKGROUND

In recent years, narrative practice has been applied in clinical settings to address the relational and psychological concerns that occur in tandem with physical illness. It is an emerging strategy to treat patients as individuals with their own stories, rather than purely based on symptoms.

OBJECTIVE

To synthesize the experience of patients with cancer using narrative practice.

METHODS

Following a systematic search strategy, a literature search was conducted to identify qualitative studies on the experience of patients with cancer using narrative practice. Nine databases were searched up to April 2018, which included six English databases and three Chinese databases. A meta-synthesis was conducted to synthesize the findings of the included studies.

MAIN RESULTS

Seven studies out of 2894 studies were included in this review. Patients with cancer had different preferences on narrative practices. In terms of the impacts of narrative practice on patients with cancer, six themes were identified, which included '(a) reducing the gap between patients and clinicians; (b) healing effect; (c) social connection; (d) facilitating self-reflection, self-recognition and self-realization; (e) risk of negative impacts; and (f) Patients' preference on different approaches of narrative practice'.

CONCLUSIONS

Patients with cancer experienced positive effects regarding narrative practice. Although some patients may experience negative effects, narrative practice is a humanized way to provide care for patients with cancer in the clinical settings.

Implementation and evaluation of a training programme to promote the development of professional competences in nursing: A pilot study

BACKGROUND

Clinical narratives may be used as a means to improve the acquisition of clinical competences. Even though there are studies that recognize the potential value of clinical narratives to promote nursing professional development, there is no evidence that shows their value as a tool to improve nurses' competences to provide person-centred nursing care.

PURPOSE

To evaluate the preliminary efficacy of narratives for the development of three nursing professional competences -respect, intentional presence and knowing the person- for providing person-centred care.

METHOD

Using a pre-post quasi-experimental design, a pilot study with a total of 34 nurses enrolled in a training course of nursing specialization was conducted between September 2016 and June 2017. All the nurses received a multi-component intervention based on the Critical Reflective Inquiry model. The strategies of this programme consisted of writing three narratives, attending two masterclasses, participating in a discussion group, and participating in a face-to-face interview. The NarratUN Evaluation tool was used to assess the outcomes. Changes among nurses were analysed using the Wilcoxon signed Rank test.

RESULTS

The difference in the means between the pre- and post-intervention scores were statistically significant for respect [0.59 (95% CI 0.23-0.95; p = 0.001)], intentional presence [0.75 (95% CI 0.32-1.17; p < 0.0001)] and knowing the person [0.62 (95% CI 0.25-0.99; p = 0.001)]. The difference in the mean score for use of the narrative and reflection also increased significantly [0.65 (95% CI 0.32-0.98, p < 0.001)].

CONCLUSIONS

The use of narratives combined with other reflective strategies (masterclass sessions and discussion groups) proved to be effective for the development of professional competences of nurses.