Reflective Practice: A Comparative Dimensional Analysis of the Concept in Nursing and Education Studies

Psychiatric nurse and educator perspectives on professional boundaries in nursing education: An interpretive description study

BACKGROUND

Psychiatric nurses are responsible for maintaining professional boundaries. However, professional boundaries are as described as unclear and psychiatric nursing students are at risk of crossing these boundaries. Educational instruction regarding professional boundaries within psychiatric nursing often lacks foundational structure placing students at risk of transgressions.

PURPOSE

The purpose of the study was to describe boundaries in psychiatric nursing practice, identify strategies effective in teaching professional boundaries, and inform curriculum development in psychiatric nursing education.

METHOD

Interpretive description was utilized to answer: How do psychiatric nurse educators interpret and explain professional boundaries in psychiatric nursing undergraduate education? Psychiatric nurse educators and psychiatric nurses were recruited from an academic institution in western Canada. Twenty participants engaged in semi-structured interviews. Eight of those participants also attended a focus group.

RESULT

Participants reported that 'textbook' definitions of boundaries were insufficient in illustrating the complexities of the construct. Rather, relational forms of learning such as educators sharing clinical stories, role play activities, clinical supervision, and clinical debriefing were described as helpful strategies.

CONCLUSION

Foundational knowledge regarding professional boundaries in psychiatric nursing practice appears to be incorporated in the formal curriculum. However, learning is enhanced through the informal and hidden curriculum.

Developing and testing a reflection method for implementation of the informal care 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 the Dutch Informal Care guideline in daily care.

DESIGN

Design-based research.

METHODS

A design group and four test groups of community nurses and nursing assistants were formed to develop a reflection method that aligns with the needs and preferences of its end-users. The design and test group meetings were video recorded. The video data were iteratively discussed and analysed thematically to adapt and refine the method and to identify its key features.

RESULTS

A final reflection method was developed. Five main themes were identified from the analysis: the group, reflective triggers, knowledge about the guidelines, the coach and preconditions. The themes are linked to nine key features representing the building blocks of the reflection method. The key features are group size, participants with different (educational) backgrounds, pairs of participants, expressing thoughts, video feedback, reflection game, making the connection with the guideline, coaching as a process facilitator and meeting organizational and contextual conditions for implementation.

CONCLUSION

An evidence- and practice-based reflection method for community nurses and certified nursing assistants is developed to support the implementation. By involving community nurses and certified nursing assistants, the method closely matches their needs and preferences. Critical elements of the reflection method are a game element, video feedback and working in pairs in a group of participants from different (educational) backgrounds. Guidance is needed to make the transfer from theory to practice.

IMPACT

A reflection method for community nurses and certified nursing assistants was developed to enhance care work according to guideline recommendations, aiming to improve the care provided by informal caregivers.

REPORT METHOD

The COREQ guideline was used.

PATIENT OR PUBLIC CONTRIBUTION

This reflection method was developed in close collaboration with all stakeholders during the entire study.

Medical students' reflective capacity and its role in their critical thinking disposition

BACKGROUND

Developing reflective capacity and critical thinking is one of the prerequisites of education in health professions, especially medicine. This study aimed to determine the reflective capacity of medical students and its role in their critical thinking disposition.

METHODS

In this cross-sectional descriptive research, conducted in 2022, a total of 240 medical intern students were selected using the convenient sampling method. Data were collected using a reflective capacity questionnaire and critical thinking disposition questionnaire and analyzed with descriptive and inferential statistics using SPSS20.

RESULTS

The mean reflective capacity was 4.53 ± 0.50, and mean critical thinking disposition was 127.52 ± 10.85. Among the dimensions of reflection, "active self-appraisal (SA)" and "reflective with others (RO)" had the highest and lowest means, respectively. The dimensions of critical thinking disposition with the highest and lowest means were related to innovation and intellectual maturity, respectively. Reflective capacity and its dimensions were found to have a direct and statistically significant relationship with critical thinking disposition and its dimensions. Regression analysis results showed that reflective capacity accounts for 28% of students' critical thinking disposition.

CONCLUSION

The relationship between students' reflective capacity and their critical thinking disposition has rendered reflection as one of the necessary components of medical education. Thus, determining the learning activities by considering the reflection process and models will be very effective in creating and strengthening critical thinking disposition.

Master of nursing specialist experiences of an internship through the use of written reflections: A qualitative research study

Background

Reflective practice is an educational strategy and an essential part of the professional development of nurses. However, there are few reflective journals in the master of nursing specialist program or clinical nursing education.

Objectives

Based on Gibbs' reflective cycle theory, masters of nursing specialists (MNS) will use a diary to record their reflections on a particular clinical event. The purpose of this study was to identify reflective practice as tool to help MNS improve their professional and personal development.

Design

A descriptive qualitative study.

Methods

The purposive sampling method was used in the qualitative study. The data were derived from the master of nursing specialist who interned at the hospital from June to December 2021. After completing the job rotation and relevant course training within 6 months, a clinical experience was selected as a reflection. The traditional qualitative content analysis method was applied to analyze the collected data in the research.

Results

A total of 10 reflective diaries completed by ten students were analyzed. This qualitative study demonstrated that the Gibbs' reflective cycle is valuable and helpful in the clinical practice of master of nursing specialists. This program helps master of nursing specialists reflect on their clinical practice and translate real-life experiences into valuable learning experiences for developing their professional development and personal skills.

Conclusions

By writing reflection diaries, master of nursing specialists can reflect on the problems encountered during clinical rotations and take action following that reflection, which can assist them in improving their professional development and personal skills to handle clinical nursing aspects in the future, as well as improve their full participation in clinical practice.

The meaning of reflection for understanding caring and becoming a caring nurse

BACKGROUND

Reflection is essential for students to learn and understand caring, their formation as human and caring beings, and their ability to meet patients in a caring way. Consequently, to facilitate nurse students' development into professionals, learning support is needed where the focus is on understanding caring and becoming caring nurses.

AIM AND RESEARCH QUESTIONS

The exploratory study aim is to gain knowledge of the meaning of reflection in first-term nursing education, and how reflection grounded in caring theory can deepen the students' understanding of caring and their professional formation of becoming a caring nurse.

METHOD

Data consisted of individual written reflections and were collected from 64 nursing students from Norway, who had completed their instruction in caring theories and participated in four reflection groups where they reflected on caring and becoming a caring nurse. A thematic analysis was used.

FINDINGS

The results are based on the three main themes, Reflection provides an understanding of caring by developing a language for caring; Reflection provides an understanding of seeing the person behind the illness; and Reflection contributes to increased self-understanding and awareness of oneself as a caring nurse.

CONCLUSIONS

Instruction in caring theories and participation in reflection groups, with reflection grounded in caring theory, has a key function in facilitating students' development of a language for caring in nursing and appropriation of caring theory. The appropriation of caring theory provides a foundation for the nurse students to see themselves within a broader perspective and is important for mutual support in the professional formation of becoming a caring nurse. The expected outcome of such integration is a nursing curriculum that progressively supports the development of nursing students professionally and personally in the formation of becoming a caring nurses.

Effects of Dimensional Analysis on Infusible Medication Calculation Skills Among Nursing Students in an Intensive Care Unit

Medication errors are among the most common life-threatening mistakes made in health care. The ability to accurately calculate drug doses, especially in intensive care units (ICUs), where the majority of medications are infused, reduces medication errors. Researchers have proposed dimensional analysis to improve mathematical calculations of drugs. This study was conducted to determine the effects of dimensional analysis on the infusible medication calculation skills among nursing students in ICUs. In this quasi-experimental study, the research samples consisted of sixth-semester nursing students who were assigned to an intervention group (n = 34) and a control group (n = 32). For the intervention group, the calculations of common infusible drugs in the ICU were taught using the dimensional analysis method, whereas the control group received training without the dimensional analysis method. Data collection instruments included a demographic characteristics questionnaire and a 10-item questionnaire of drug calculations that were measured before and after the intervention in both groups. Data analysis was performed using SPSS 22. The mean pretest scores for infusible drug calculations of nursing students in the ICU were 5.15 ± 2.35 for the intervention group and 5.25 ± 2.56 for the control group (P = .86). The mean posttest scores of the intervention group and control group were 9.22 ± 0.79 and 6.27 ± 1.87, respectively (P = .0001). Dimensional analysis training significantly improved the infusible medication calculation skills of nursing students in the ICU. It is recommended to include this method in undergraduate, graduate, and continuing education nursing courses to increase skills in calculating infusible drugs and to reduce medication errors.

Clinical judgement in nursing - An evolutionary concept analysis

AIMS

The aim of this concept analysis was to develop a contemporary operational definition of Clinical Judgement in nursing.

DESIGN

Concept analysis.

METHODS

Rodgers' evolutionary method of concept analysis. Throughout the study, the authors followed the SRQR checklist.

RESULTS

This concept analysis guided the development of an operational definition of clinical judgement, within the context of nursing, articulated as Clinical judgement is a reflective and reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in the formation of a clinical conclusion.

CONCLUSION

The purpose of this concept analysis was to propose a detailed definition of clinical judgement in nursing, that reflected its theoretical base within today's contemporary healthcare system. Using Rodgers' evolutionary method of concept analysis, surrogate terms, attributes, antecedents and consequences were identified, and a contemporary definition was developed. No patient or public contribution was required to design or undertake this research.

Reflective practice in nursing: A concept analysis

PURPOSE

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

DATA SOURCES

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

DATA SYNTHESIS

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING PRACTICE

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

Dispatched nurses' experience of wearing full gear personal protective equipment to care for COVID-19 patients in China-A descriptive qualitative study

Aims and objectives

We explored dispatched nurses’ experiences of wearing full gear personal protective equipment to care for patients with coronavirus disease‐2019 (COVID‐19) in Wuhan, China.

Background

Full gear personal protective equipment is the primary and foremost measure to prevent the contact and transmission of severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV2); however, working in full gear personal protective equipment may hinder nursing care activities and thus negatively affect patients’ and nurses’ health.

Design

This descriptive qualitative inquiry followed the COREQ guidelines.

Methods

Individual semi‐structured telephone interviews were conducted in a purposive sample of 15 frontline nurses who were dispatched to the outbreak epicentre from March to April 2020. Verbatim transcripts were content analysed.

Results

Four themes emerged from the data: inadequate preparedness for working with full gear personal protective equipment, full gear personal protective equipment stimulated stress responses, coping strategies and professional growth. Participants learned a great deal from problem‐focussed and emotion‐focussed strategies to tackle challenges related to the prolonged wearing of full gear personal protective equipment for quality nursing care and reduced risk of exposure. They became more vigilant to the adherence to evolving protocols and appropriate training concerning full gear personal protective equipment use.

Conclusions

Frontline nurses confronted various but diminishing challenges related to the use of full gear personal protective equipment when caring for patients with COVID‐19 across the approximate 40‐day period. Consistent use of coverall personal protective equipment to protect from SARS‐CoV‐2 in high exposure settings would be feasible if nurses were better prepared; therefore, scenario‐based skill training concerning the prolonged use of full gear personal protective equipment should be offered regularly and intensively.

Relevance to clinical practice

This study informs future decisions concerning improved full gear personal protective equipment‐related psychomotor training and promoting ways for nurses to cope with the stress that comes from working in highly contiguous environments.

Reflective capacity in nurses in specialist education: Swedish translation and psychometric evaluation of the Reflective Capacity Scale of the Reflective Practice Questionnaire

AIM

This study aimed to test the validity and reliability of the Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire in a nursing context.

DESIGN

Non-experimental and cross-sectional.

METHODS

The instrument was translated from English to Swedish using a translation and back-translation procedure. Data for the validity and reliability analysis were collected from Registered Nurses in specialist education (n = 156) at two Swedish universities.

RESULTS

The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire is a valid and reliable instrument that assesses the reflective capacity of healthcare practitioners. Our findings suggest a unidimensional structure of the instrument, excellent internal consistency and good reliability.

CONCLUSION

The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire has a degree of reliability and validity that is satisfactory, indicating that the instrument can be used as an assessment of reflective capacity in nurses.

'Don't abandon me': Young people's experiences of child and adolescent psychiatric inpatient care supporting recovery described in blogs

Child and adolescent psychiatric (CAP) inpatient care has the potential to support or hinder young people's mental-health recovery. Research describing inpatient care from the perspective of young people is rare. Personal blogs provide an opportunity to further understand how inpatient care relates to young people's recovery processes. This study aimed to explore young people's experiences of CAP inpatient care supporting mental-health recovery. The study is reported in accordance with the COREQ guidelines. Data were created during 2018 from twenty-seven personal blogs describing first-hand experiences of being a patient in a CAP inpatient care facility in Sweden and analysed using a method for interpretive description. Information in blogs suggests they were written by women, a majority of which had experienced eating disorders. Findings describe young people's experiences of CAP inpatient care supporting mental-health recovery in an interpretive explanation with one theme, 'Don't abandon me', and three sub-themes: 'Listen to me', 'Believe in me', and 'Allow me to feel safe'. This study adds to the growing body of empirical work suggesting the importance of the concept of recovery in young people's mental health. To support recovery, CAP inpatient care needs to focus on developing the content of care rather than minimizing the length of the stay. User experience should be at the heart of efforts aimed at improving services.

Positioning Psychiatric and Mental Health Nursing as a Transformative Force in Health Care

From the perspective of psychiatric and mental health nurses in Sweden, this discussion paper aims to position psychiatric and mental health nursing as a transformative force contributing to enforcing person-centered values and practices in health care. We argue the potential impact of psychiatric and mental health nursing on service user health and recovery, nursing student education and values, and the organization and management of health care. Psychiatric and mental health nursing is discussed as a caring, reflective, and therapeutic practice that promotes recovery and health. Implications for nursing education, research, management, and practice are outlined.

Recovery-Oriented Reflective Practice Groups: Conceptual Framework and Group Structure

The recovery-oriented reflective practice group (RORPG) is a staff-directed intervention aimed at achieving the recovery-focused transformation of mental health settings. This discussion paper aims to outline and reflect on the conceptual framework and group structure of recovery-oriented reflective practice groups. RORPGs build on conceptualizations of reflective practice, personal recovery, mental health nursing as a relational and reflective practice, and abductive reasoning. Dewey's phases of reflection, together with an understanding of nursing practice as a dynamic process of care, provide a structure for group sessions in which abductive reasoning can be considered a core activity. This paper outlines a sound theoretical foundation and suggests that RORPGs might prove useful for providing a space for learning in practice, informed by both theoretical and practical knowledge.

Shared learning from national to international contexts: a research and innovation collaboration to enhance education for patient safety

BACKGROUND

Patient safety is key for healthcare across the world and education is critical in improving practice. We drew on existing links to develop the Shared LearnIng from Practice to improve Patient Safety (SLIPPS) group. The group incorporates expertise in education, research, healthcare, healthcare organisation and computing from Norway, Spain, Italy, the UK and Finland. In 2016 we received co-funding from the Erasmus + programme of the European Union for a 3-year project.

AIM

SLIPPS aims to develop a tool to gather learning events related to patient safety from students in each country, and to use these both for further research to understand practice, and to develop educational activities (virtual seminars, simulation scenarios and a game premise).

STUDY OUTLINE

The SLIPPS project is well underway. It is underpinned by three main theoretical bodies of work: the notion of diverse knowledge contexts existing in academia, practice and at an organisational level; the theory of reflective practice; and experiential learning theory. The project is based on recognition of the unique position of students as they navigate between contexts, experience and reflect on important learning events related to patient safety. To date, we have undertaken the development of the SLIPPS Learning Event Recording Tool (SLERT) and have begun to gather event descriptions and reflections.

CONCLUSIONS

Key to the ongoing success of SLIPPS are relationships and reciprocal openness to view things from diverse perspectives and cultures.

Evaluating reflective practice groups in a mental health context: Swedish translation and psychometric evaluation of the clinical supervision evaluation questionnaire

BACKGROUND

Implementation of reflective practice groups in psychiatric and mental health contexts might improve the quality of care through promoting self-awareness, clinical insight, and facilitating stress management and team building. There is a need for valid and reliable instruments to test the outcomes of reflective practice groups in the mental health context. This study aimed to test the validity and reliability of the Swedish version of the Clinical Supervision Evaluation Questionnaire.

METHODS

The instrument was translated from English to Swedish using a translation and back-translation procedure. Data for the calculation of content validity was collected from an expert group. Data for the reliability analysis was collected from rehabilitation assistants and ward managers participating in reflective practice groups (n = 20). Content validity was measured by computing a content validity index. Construct validity was assessed by calculating the corrected item-total correlation statistics. Reliability was evaluated by analysing the Cronbach's alpha coefficient, the intraclass correlation coefficient and inter-item correlations.

RESULTS

The content validity index for the scale as a whole was 0.94. Item-total correlations ranged between 0.23 and 0.81, and deletion of an item did not notably improve Cronbach's alpha. Cronbach's alpha for the scale was 0.89. The intraclass correlation coefficient for single measures was 0.35. The mean inter-item correlation was .37.

CONCLUSION

The Swedish version of the Supervision Evaluation Questionnaire has a degree of reliability and validity that is comparable to the original version in English, indicating that it can be used as an assessment of reflective practice groups in the mental health context.

Critical Reflection in Cultural Competence Development: A Framework for Undergraduate Nursing Education

BACKGROUND

Nursing faculties are urged to adopt a curriculum that supports culturally competent care and to mentor students to provide care that promotes social justice, particularly for the marginalized members of society. This article describes the development of a framework for critical reflection in cultural competence development among undergraduate nursing students.

METHOD

Following the Medical Research Council guidelines for developing complex interventions, empirical and theoretical literature was reviewed to define the framework rationale and its components.

RESULTS

The resulting framework is grounded in Blanchet Garneau's constructivist model of cultural competence development and Mezirow's transformative learning theory. It clarifies the desired outcomes, the main steps to foster critical reflection among students, and the contextual conditions and prerequisites for teachers and learners.

CONCLUSION

Education oriented toward critical reflective practice promotes a full reflection about Western social and clinical practices and points out the role of nurses in reducing health inequities.