Reflective Learning: A Teaching Strategy for Critical Thinking

Evidence-based teaching in contact lenses education: Teaching and learning strategies

INTRODUCTION

Contact lens (CL) practice is an ever-changing field with clinical knowledge, techniques and equipment continuously evolving. These new developments are backed with clinical trials and research to ensure that practitioners feel confident that there is an evidence base to support these advances. Evidence-based practice is now a crucial part of CL practice, and its importance also filters down to CL education. For example, lectures are one of the most popular tools for an educator but, is standing at the front of a lecture theatre full of students a more effective way of teaching than providing the same material for students to read by themselves? What evidence exists specific to CL education?

METHOD

An expert panel of educators completed a comprehensive literature review of current evidence of teaching methods in CL training, or if not available then what can be learnt from other health care professional training that could be potentially applicable to CL education.

RESULTS

Due to the amount of evidence available in the overall subject area relating to healthcare education, the initial plan of compiling evidence into one narrative review paper was discarded in favour of producing two linked papers. Here, the first paper details definitions of terminology, and also teaching methods. The second paper focuses on assessment and specific clinical training required to attain CL practice competency. In this first paper, no direct evidence of the spreading and benefit of new education strategies evidence such as flipped classrooms, spaced learning, test-enhanced learning, group work, CBL, PBL, TBL, and reflective practice in CL education was found. The only technique that was widely used in the CL field was case reports and the group discussion of them. Nevertheless, the authors found a consensus of opinion from other disciplines that are transferable to CL teaching and could help students meet the intended learning outcomes.

CONCLUSION

There is a small amount of evidence supporting CL education, but most of this seems to be related to the practical element of the training. However, there is a lot of evidence in the field of healthcare education from related disciplines which provides additional but important learning tools that may be effectively implemented in CL education.

Extracurricular Activities in Higher Education and the Promotion of Reflective Learning for Sustainability

The objective of higher education institutions is to integrate reflective learning that contributes to the development of a greater awareness among individuals of the importance of facing the 21st century’s sustainability challenges. This paper analyzes the impact of an extracurricular volunteer activity in Tangier, Morocco in the development of student reflection at a Spanish university. To this end, two objectives were proposed: (1) to explore the students’ primary reflections of the experience, and (2) analyze the students’ perceptions of the importance of participating in the experience in order to develop reflective learning. In the study, in-depth interviews were conducted with 23 students who participated in the volunteer activity. Data analysis was carried out using Iramuteq software to conduct a descending hierarchical classification (DHC), and MAXQDA software to conduct a constant comparison analysis. This research highlights the value of voluntary extracurricular activities in the development of reflections that guide change in the beliefs, attitudes, and daily behaviors of students that ultimately result in sustainability. Due to this, not only is it considered essential that students participate in social projects, but also that they undertake these projects with peers and instructors who can create environments of support and trust.

Self-Evaluation and Occupational Therapy Fieldwork Educators: Do they Practise what they Preach?

In the current climate of lifelong learning and continuing professional development, the importance of self-evaluation is discussed. A cross-sectional survey was carried out to identify the strategies used by fieldwork educators to evaluate their own supervisory skills. It further examined the fieldwork educators' attitude towards, and understanding of, self-evaluation.

One hundred self-administered questionnaires were posted to a random sample of Glasgow Caledonian University fieldwork educators. A response rate of 74.5% was obtained. The respondents claimed to use a wide range of self-evaluation techniques, with the majority using between three and five strategies. While the respondents were found, overall, to view self-evaluation positively, only 55.2% of them appeared to understand this concept fully. Statistical analysis of association indicated that those respondents who understood self-evaluation were more likely to have a positive attitude towards it than those who did not fully understand this concept.

It is recommended that future fieldwork education update courses should focus on informing fieldwork educators about the concept of self-evaluation and reinforcing its benefits. Fieldwork educators should be encouraged to continue to use self-evaluation and be made aware of the advantages of using a variety of strategies.

Conclusion

The respondents in this study supported self-evaluation and used a range of strategies to evaluate their own abilities as fieldwork educators. While 44.8% of the respondents lacked a full understanding of self-evaluation, overall the respondents had a positive attitude towards it.

More research is needed to confirm and expand on the results of this study. It is recommended that this study be replicated with a larger sample from a cross-section of universities. The chi-square tests of association carried out found the expected frequencies to be quite low in some cases. Had the sample been larger, these tests could, perhaps, have been put to more use. Further studies should also concentrate on fieldwork educators' understanding of other concepts taught to and used by students on placement, and on the relationship between the visiting lecturer and the fieldwork educators.

Self-assessment, reflection on practice and critical thinking in nursing students

In accordance with the principles of the European Higher Education Area, the aim of this study was to contribute to the implementation of self-assessment through the application of reflection on learning and critical thinking. The theoretical framework employed was Habermas's critical theory and emancipatory interest as a preliminary step to generate educational transformations. The methodological contribution is the design a student self-assessment document that promotes reflection on action and critical thinking.

RESULTS AND DISCUSSION

The development of assessment through peer evaluation and other intermediate solutions until achieving self-assessment entails a shift in the educational and scientific paradigm, but also involves the implementation in practice of democratic and ethical principles, values and premises in society. Self-assessment is a novel concept for students, and obliges them to reinterpret their role. Due to the diversity of students' principles, values, motivations, interests and aspirations, this reinterpretation of their role can have a positive outcome, stimulating an active and critical attitude towards group work and self-assessment; or, on the contrary, can generate a stance characterised by disinterest, passivity and lack of critical thinking.

CONCLUSIONS

The forms of assessment adopted in a given educational system reflect ways of thinking related to ideologies, values, ethical principles and educational paradigms: in order to render implementation of effective self-assessment feasible, it is necessary to undertake structural and regulatory reforms. Students have little experience of reflection on practice or critical thinking. Massification and cultural and structural factors determine the form of assessment. In this context, it would seem advisable to move towards self-assessment gradually and cautiously.

A comparison of critical thinking skills in standard and non-standard entry diploma students

Critical thinking is often seen as the hallmark of the educated professional.The conceptualization and measurement of critical thinking have been topics of much debate for over 70 years. This study reports a small scale comparative study of critical thi nking skills in standard and non-standard entry diploma students. A significantdifference in critical thinking skills between these groups at the point of entry was observed. There were no significant differences in critical thinking skills between the start of the course and the end of the common foundation course for both groups. This finding is consistent with many other studies investigating critical thinking in nurse education. The implications of these findings and the wider issue of the measur ement of critical thinking are discussed.

Developing reflective writing as effective pedagogy

While reflective writing about practice experiences is frequently used in nursing curricula to foster critical thinking, faculty members may be unaware of how to help students reflect, what kinds of feedback are helpful, and how to deal with students' concerns. This article describes faculty best practices in mentoring the student to effectively think critically through structured reflective writing. Models of structured reflection, Baker's four-step model and John's revision of Carper's patterns of knowing, are discussed as effective guides at graduate and undergraduate levels. The article addresses potentially problematic issues with the implementation and evaluation of reflective writing assignments in clinical courses. With foresight and planning, reflective writing may be an empowering strategy for facilitating students' thinking skills.

Evidence-based practice: SLTs under siege or opportunity for growth? The use and nature of research evidence in the profession

BACKGROUND

Speech and language therapists are encouraged to be evidence-based practitioners in contemporary clinical practice. This apparently signifies their commitment to 'good' practice. An examination of evidence-based practice (EBP) and its adoption in clinical practice is therefore warranted.

AIMS

This paper aims to explore EBP, specifically research evidence, as related to the field of speech and language therapy (SLT), using profession specific and cross-disciplinary examples. It asks the reader to consider whether research evidence contributes positively to SLT practice, or adds to the demands placed on clinicians?

METHODS & PROCEDURES

A review of the literature on the nature and use of research evidence in the field of speech and language therapy and related health professions was undertaken using multiple databases (Cochrane, Medline, Cinahal, BioMed, Trip, Dare) and the following up of references provided within texts and articles. This paper asks the reader to consider the topic from the perspective of the nature of research produced, the barriers perceived, and the use of research evidence by SLTs and the allied health professions.

OUTCOMES & RESULTS

The uptake of research evidence in the profession is similar to other health professions and continues to be problematic. There are multiple reasons why this is so, originating from both the nature and use of research.

CONCLUSIONS & IMPLICATIONS

Research evidence is one of the pillars of EBP. Despite problems with the nature and use of such evidence, it has a positive contribution to make to clinical practice as it provides for a scientific touchstone. However, it may be that the speech and language therapist and not the research evidence is the primary pivot upon which scientific practice is based.

Questioning skills demonstrated by approved clinical instructors during clinical field experiences

CONTEXT

The current trend in athletic training clinical education places greater emphasis on the quality of interactions occurring between Approved Clinical Instructors (ACIs) and athletic training students (ATSs). Among other attributes, the ability of ACIs to facilitate and direct quality clinical learning experiences may be influenced by the skill with which the ACI is able to use selected teaching strategies.

OBJECTIVE

To gain insight into ACIs' use of questioning as a specific teaching strategy during the clinical education experiences of undergraduate ATSs.

DESIGN

Qualitative case study design involving initial and stimulated-recall interviews, prolonged field observations, and audio recording of ACI-ATS interactions.

SETTING

The primary athletic training facility at one athletic training education program accredited by the Commission on Accreditation of Athletic Training Education.

PATIENTS OR OTHER PARTICIPANTS

The 8 ACI participants included 3 full-time athletic training education program faculty members and 5 graduate-level assistants. The 24 ATS participants included 1 senior, 17 juniors, and 6 sophomores.

DATA COLLECTION AND ANALYSIS

Transcribed data collected from 8 initial interviews, 23 field observations, 23 audio-recorded ACI-ATS interactions and 54 stimulated-recall interviews were analyzed through microscopic, open, and axial coding, as well as coding for process. The cognition level of questions posed by ACIs was analyzed according to Sellappah and colleagues' Question Classification Framework.

RESULTS

The ACI participants posed 712 questions during the 23 observation periods. Of the total questions, 70.37% were classified as low-level cognitive questions and 17.00% as high-level cognitive questions. The remaining 12.64% were classified as other.

CONCLUSIONS

Although all ACIs used questioning during clinical instruction, 2 distinct questioning patterns were identified: strategic questioning and nonstrategic questioning. The way ACIs sequenced questions (their questioning pattern) appeared to be more important than the number of specific cognitive-level questions posed. Nonstrategic questioning appears to support knowledge and comprehension, whereas strategic questioning appears to support critical thinking.

A framework guiding critical thinking through reflective journal documentation: a Middle Eastern experience

The purpose of this paper is to present a framework to guide critical thinking through reflective journaling, and describe how a group of 20 Middle Eastern nurses used reflective journaling to enhance their practice. Journal documentation was used during clinical practicum to foster the development of critical thinking in order to assist nurses when analysing and evaluating their clinical experiences. The findings from this study demonstrated that nurses accepted the framework for journal documentation because it provided structure for reflection, speculation, synthesis and metacognition of events experienced during clinical practice. Journaling gave nurses the opportunity to transfer thoughts onto paper and write down subjective and objective data, and created dialogue between the nurse educators and nurses. They were engaged in productive and positive activity to enhance their nursing practice. Nurses also commented that writing helped to develop their confidence in writing English.

Critical thinking: A two-phase framework

This article provides a comprehensive review of how a two-phase framework can promote and engage nurses in the concepts of critical thinking. Nurse education is required to integrate critical thinking in their teaching strategies, as it is widely recognised as an important part of student nurses becoming analytical qualified practitioners. The two-phase framework can be incorporated in the classroom using enquiry-based scenarios or used to investigate situations that arise from practice, for reflection, analysis, theorising or to explore issues. This paper proposes a two-phase framework for incorporation in the classroom and practice to promote critical thinking. Phase 1 attempts to make it easier for nurses to organise and expound often complex and abstract ideas that arise when using critical thinking, identify more than one solution to the problem by using a variety of cues to facilitate action. Phase 2 encourages nurses to be accountable and responsible, to justify a decision, be creative and innovative in implementing change.

Evaluation of a reflective learning intervention to improve critical thinking in novice nurses

AIM

This paper reports a study to determine if a reflective contextual learning intervention would improve novice nurses' critical thinking skills during the first 6 months of their practice.

BACKGROUND

Nursing research evaluating the development of critical thinking in novice nursing practice is limited. The continual struggle by nurse educators to improve critical thinking demonstrates the need for innovative educational interventions that assist in the development of critical thinking as novice nurses enter into practice.

METHOD

This small case study was conducted in the United States of America in 2004 with six student/preceptor dyads. The contextual learning intervention was the case through which the novice nurses' critical thinking were analysed using Stake's phases of data analysis. Specific questions (i.e. novice nurses' use of reflection, context, dialogue, time) guided the analysis. Repeating patterns were coded and isolated and later collapsed/enhanced as the analysis moved forward.

FINDINGS

Three main themes describe the novice nurses' development of critical thinking: (1) influence of anxiety and power on critical thinking; putting pieces together; (2) questioning as critical thinking: sequential thinking to contextual thinking; and (3) emergence of the intentional critical thinker.

CONCLUSION

Used as a reflective practicum, contextual learning can be a model of clinical learning in nursing education that develops the contextual, reflective nature of critical thinking.

Teaching the Abyss: Living the Art-Science of Nursing

This column addresses how nurse educators can provide the teaching-learning experiences for novice nurses to develop the leadership competence to effectively practice nursing in an extremely demanding healthcare environment. The authors delve into Mitchell and Bunkers’ use of the metaphor of an abyss to explore the lived experience of risking being with others in extremely intense interpersonal situations. Using reflection, students’ journal narratives affirm connections made among past experiences and the new knowledge gleaned from exploring and naming the phenomenon of the abyss. Several teaching-learning strategies are offered as ways for addressing the leadership issues related to dealing with intense relational experiences in nursing practice, including exploring nurse theorist Rosemarie Rizzo Parse’s essentials of leadership.

Critical Thinking and Evidence-Based Practice

Critical thinking (CT) is vital to evidence-based nursing practice. Evidence-based practice (EBP) supports nursing care and can contribute positively to patient outcomes across a variety of settings and geographic locations. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of baccalaureate education and must be introduced early in students' development as independent, self-directed learners and as professional nurses. Among the knowledge, skills, and processes needed to support EBP, CT is paramount. The development of CT can prepare nurses with the necessary skills and dispositions (habits of mind, attitudes, and traits) to support EBP. The intents of this study were to explore the importance of CT as an essential skill to support EBP and to describe some of the strategies and processes considered key to the ongoing development of CT.

Evaluation of a reflective practice intervention to enhance family care

AIM

This paper discusses the design, evaluation and outcomes of a reflective practice intervention (RPI) that taught paediatric critical care nurses how to incorporate a family intervention into their practice.

BACKGROUND

The literature on reflective practice contains numerous descriptions of reflective practice and various frameworks on how to engage in reflective practice. Additionally, there has been wide debate about the benefits of and problems with the use of reflective practice. However, few empirical studies have been done to evaluate its effectiveness in changing nursing practice.

METHOD

Van Manen's phenomenological research approach was adapted for use in this study. This approach was consistent with the experiential nature of reflective practice. Interviews were conducted with eight staff nurse participants after the RPI to determine changes in family practice. Analysis of the interview text produced three essential themes.

FINDINGS

Three interrelated themes describe change in the nurses' experiences as a result of participating in the RPI: (1) acknowledging and re-framing preconceived ideas about families, (2) recognizing the meaning of family stress and (3) beginning to incorporate the family into nursing care.

CONCLUSIONS

The RPI stimulated double loop learning that changed paediatric critical care nurses' attitudes about family, enhanced their communication and ability to build trusting relationships with families and brought about a new appreciation of the uniqueness of family stress. There was a new integration of family care into the nurses' practice as a result of the intervention.

Reflective practice and daily ward reality: a covert power game

BACKGROUND

The concept of reflection is propounded in the literature as an epistemology for practice that enables practitioners to solve their daily problematic situations through conscious thought processes which eventually leads to practice-based knowledge. Hence, reflection became a central tenet of both theory development and educational provision in nursing. Furthermore, this centrality of reflection was reinforced by statutory nursing bodies and service providers by adopting it as the means for carrying out adequate professional practice. Although this may be the case, issues of implementation of reflection within the daily reality of practitioners are frequently overlooked within the literature. Moreover, little consideration appears to be given on the impact that the organizational culture and the politics of power may exert on the implementation of reflective practices within daily ward reality.

AIMS

This paper explores how reflection is viewed by nurses within their daily reality in the medical wards, examines the relationships between the organizational culture of these wards and the practitioners and investigates whether reflective methods of practice were being implemented when the study was conducted.

METHODS

An interpretative ethnographical methodology was implemented and the data collecting methods used were observation, interviews and qualitative content analysis with a group of 16 practising nurses from four medical wards of one NHS Trust in England. Two interviews were conducted with each nurse within 3-week intervals. The content of these interviews evolved from the analysis of episodes of practice observed when the nurses were giving nursing care. These data were supplemented by narratives from the nurses' in the form of written reflective accounts that were analysed via qualitative content analysis techniques.

FINDINGS

Four themes were generated: (i) relationships between nurses and doctors; (ii) relationships between nurses and managers; (iii) nursing practice; and (iv) nurses' input in the outcome of a clinical situation.

CONCLUSIONS

The concept of reflection appears to be invalidated by the organizational hierarchy of the wards on the basis of a power struggle game. The ward structure portrays reflection as an abnormal method of practice and knowledge development. This belittlement of reflection does not mirror the practitioners' reality. Instead, it is an intelligent and intentional act on behalf of the dominant professional groups in the wards to create an illusionary picture of ward reality to allow them to survey and define nursing practice and thus maintain and remain in power. This is explicated by using Foucault's analysis and critical social theory framework. Hence, reflective processes are constrained by this covert power game; reflection, where used, is confined to nurses' personal time and space.

RELEVANCE TO CLINICAL PRACTICE

The realization of this covert power game by individual clinical nurses can become the incipient point for formally using reflective methods in the practice setting.

Critical-thinking types among nursing and management undergraduates

Watson and Glaser (1994) developed a short version, Form S, of their long-established Watson-Glaser Critical Thinking Appraisal (WGCTA), as a quickly administered measure of critical thinking. This exploratory study used scores from the five sub-tests in Form S, with samples from two professional schools, nursing (n=233) and management (n=131) undergraduates, to identify the typology of critical-thinking types. Four clusters were identified, using a two-stage clustering procedure, in both samples. Discriminant analyses showed that 96% of participants were correctly classified using cluster membership and scores from the five sub-tests as discriminating variables. Implications and recommendations for education and training in critical thinking are presented as well as recommendations for future research on critical-thinking types.

Teaching and Measuring Critical Thinking

Nurse educators are under pressure to show critical thinking as a program outcome. Many different strategies have been suggested for developing critical thinking among nursing students. It is easy to believe these strategies increase critical thinking, but not all have actually been measured for reliability or validity. Based on an exhaustive literature search, the author attempted to identify teaching strategies that are being used to increase critical thinking and how effective those strategies have been.

Using electronic portfolios to measure student achievement and assess curricular integrity

Successful achievement of program outcomes is the primary goal of nursing education programs. Electronic portfolios are a contemporary method by which to measure student achievement, assess curricular efficacy, and evaluate program integrity in nursing education. The authors outline the sequential process of understanding, introducing, and integrating electronic portfolios into a curriculum.

Reflective practise in clinical teaching

The present paper describes the process of reflective practise in clinical teaching through a workshop entitled 'Effective Clinical Teaching'. The clinical teachers were invited to analyze the content of a videotape in which various clinical teaching scenarios were presented. Following this, they discussed a series of questions designed to promote reflective activities and evaluated the interaction among the student, the client and the clinical teachers in each scenario. The teachers also identified the positive and negative aspects of the teaching approaches portrayed on the tape. Finally, the participants made recommendations that would improve the interaction and suggested alternate teaching strategies to enhance the learning outcome. In addition, there was sharing of clinical teaching experiences among the clinical teachers. Through this process of reflection on action, the clinical teachers were able to understand various teaching approaches as perceived by students, and to address the issues that might hinder student learning in clinical settings. Different reflective activities have also been proposed to enhance student's reflective learning skills.

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.

Unravelling the unknowns of reflection in classroom teaching

BACKGROUND

The use of reflection in education has emerged as an effective means of connecting theory with practice. However, the literature reveals limited empirical work on the conceptualization of reflection.

AIM OF THE STUDY

The purpose of this qualitative research study was to understand more fully the meaning and use of reflection in teaching, and how reflection contributes to the development of teaching expertise in the classroom. Ethical approval. The study received ethical approval from the Faculty of Nursing Ethical Review Committee, University of Manitoba. Issues related to confidentiality of information, and power relationships between the investigators were addressed. Students were reassured that no data were collected about them during participant observations in the classrooms.

METHODS

The investigators were the sources of data. Data were collected using five different methods over the course of two academic years, including written autobiographies, critical incident journals, classroom observations, debriefing following classroom observations and research team meetings.

FINDINGS

The data were analysed using content analysis, and four themes were identified (i) making connections, (ii) developmental aspects, (iii) influence of context on reflection, and (iv) influence of emotions on reflection. Study limitations. The interpretation of the findings of this study should be used with caution given the qualitative design and small number of participants.

CONCLUSION

Participation in the study increased the awareness of the investigators' personal use of reflection. The process of studying our own use of reflection allowed us to step outside the performance treadmill to better understand, accept and reshape what we do over and over in the classroom. This study supports an examination of one's experiences as a means of understanding reflection and its use in the classroom.

"Enter to learn, go forth to serve": service learning in nursing education

The Pew Health Professions Commission (1998) has recommended community-based service learning as an integral part of nursing education. Service learning activities in a baccalaureate nursing program with an integrated curricular model are described with a women's health elective used as one example of the integration of service learning with clinical experiences. Based on clinical journal entries, students identified benefits of service learning including (1) a sense of personal satisfaction, (2) professional growth, (3) a higher level of critical thinking skills, (4) preparation for nursing practice in a dynamic and diverse health care delivery system, and (5) an increased awareness of unmet needs in clients, families, communities, and populations. Students are truly engaged because they have the opportunity to apply theoretical concepts in giving service, creating a "capacity for connectedness," and learning social responsibility as professionals.

A creative writing program to enhance self-esteem and self-efficacy in adolescents

PURPOSE

To describe the rationale, content, and results of a group creative writing program to increase adolescent self-esteem and self-efficacy.

METHODS

Subjects were low-income, at-risk minority youth (N = 11). Free writing in response to specific exercises, sharing their own stories in their own language, and responding to their peers were used daily for 2 weeks as part of the high school English class. The program was oriented toward health rather than problems, with the content created by the adolescents.

FINDINGS

The opportunity to tell their own story, in their own language in a safe, structured setting with positive feedback led to higher self-efficacy and self-esteem.

CONCLUSIONS

This study suggests that a writing intervention focused on building self-in-relation self-esteem and the four aspects of self-efficacy resulted in increased sense of well-being.

Strengthening clinical reasoning in graduate nursing students

Clinical reasoning skills are the cornerstone of successful nursing practice. To strengthen the clinical reasoning skills of graduate nursing students, faculty at one university developed an innovative course focusing on theoretical knowledge about clinical decision making and reflective exercises to foster student thinking.

Reflective education for professional practice: discovering knowledge from experience

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

The Preceptoring Map for RN-to-BSN Students

RN-to-BSN students reflect an array of experiences often so diverse the traditional student placement challenges neither students nor preceptors. In response to this need for an alternate to the standard clinical placement for RN students, a collaborative model was developed. Because of dramatic changes in the health care environment, the "traditional" placement for students is no longer readily available nor necessarily appropriate. These circumstances, combined with the uniqueness of RN-to-BSN students prompted the authors to develop the Preceptoring Map. The model was developed in collaboration with the research department of Massachusetts General Hospital. The Preceptoring Map designates two tracks, the N track and the P track. Using Benner's novice to expert theories, the tracks were operationalized to the student population. Determining which track will be most appropriate is multifaceted. Included in the evaluation process are the students' work experiences and expertise, critical-thinking skills assessment, and self-assessment. Faculty review these outcomes, combined with an indepth interview with the placement coordinator, to match students and preceptors for the most successful clinical placements.

Critical thinking. Strategies for clinical practice

Critical thinking is an elusive concept. As a profession, nursing has yet to accept a universal definition of critical thinking. Despite the lack of consensus, nurse leaders in academia and practice settings overwhelmingly agree that critical thinking is essential. It is clear, considering the healthcare environment, nurses need to use critical thinking as a process for decision making in the clinical arena. This article clarifies critical thinking in practice by illuminating the imperative role it plays. Suggestions for fostering critical thinking, including specific strategies, provide a framework for practice.

Critical thinking as an outcome of nursing education. What is it? Why is it important to nursing practice?

Critical thinking is currently a highly valued educational outcome throughout the educational spectrum, but particularly so in relation to higher and professional education. International concerns have focused upon citizen's thinking abilities and thus the nations' abilities to function and compete in complex societies and economies. Educationalists are questioning the wisdom of teaching content as opposed to teaching how to think as a means of dealing with relentless information development and change. Nursing education is also embracing the construct critical thinking as a desirable educational outcome. Some commentators refer to the importance of critical thinking in nursing practice as a central component or in some cases a given. This paper intends to examine the background to the construct and address in detail some of the important questions surrounding critical thinking, and its association with competent nursing practice.

Critical thinking and analysis: a model for written assignments

The purpose of this article is to propose a model for critical analysis which can be incorporated into nurse education to enhance nurses' understanding of the concepts and to assist students in undertaking academic assignments. It provides a definition and conceptualization of critical thinking and critical analysis, and highlights the differences, similarities and interrelationships between them. The model suggests that there are 10 components of critical analysis. This provides the first step for developing further research on the content of the model, i.e. certain components are accepted and those which are unsuitable are rejected. The model assists the development of educational strategies to promote critical analysis skills, which are an essential element of the autonomous, critical thinking nurse practitioner.

Discovering Confidence in Clinical Reasoning and Critical Thinking Development in Baccalaureate Nursing Students

The purpose of this preliminary investigation was to discover students' experiences of clinical reasoning and critical thinking development. Findings are reported from one group of baccalaureate nursing students participating in a clinical reasoning course. Narrative approaches were used to reveal how students experience their developing reasoning skills. Class videotapes and reflective logs in which students described their reasoning and responses to others' reasoning provided data. An interpretive phenomenological approach was used to derive a beginning understanding of the experiences of students' developing clinical reasoning and critical thinking. Confidence emerged as a significant aspect of students' experiences. This report of the investigation focuses on only one aspect of clinical reasoning and critical thinking, namely, students' perceptions of threats to confidence and ways of building confidence.

Reflection and nursing education

The notion of reflection has become a significant concept within nursing education. What is it? How is it learned/taught? How is it implemented in practice? This paper explores reflection as both a technique and a purposeful inter-subjective process. Some of the current theoretical underpinnings of reflection, with particular attention to a Heideggerian perspective, are examined. It is suggested that the Heideggerian notion of reflection as the integration of calculative and contemplative thinking is an effective way to consider the concept of reflection.

Expanding self-awareness through exploration of meaningful experience

In a phenomenological investigation of nurses' meaningful experiences with patients, the author continued investigation of caregiver/patient interaction reported in two previous studies of confirmation and exclusion. Exploration of meaningful experience is presented as an avenue for greater self-awareness for the caregiver. Findings include description of study participants' lived meaningful experiences and the essential structures of experiencing meaningfulness. The lived meaningful experiences were characterized by intense emotion, implicit experiencing, and relating. The essential structures of experiencing meaningfulness were found to be a temporal process of reflecting and articulating the discovery of self and the function of meaningful experience as a template for both future and past experiences. Expanded self-understanding through exploration of meaningful experience is discussed for its significance in nursing practice and education.

Use of writing portfolios for interdisciplinary assessment of critical thinking outcomes of nursing students

This article discusses an interdisciplinary research project in which faculty from nursing and english collaborated in the assessment of students' critical thinking skills as reflected in writing portfolios. Faculty reviewed students' writing portfolios and then corresponded on email from two different universities about evidence of critical thinking in the portfolios. Findings suggest that writing portfolios can provide important evidence of critical thinking outcomes. To do this, however, faculty need to design writing assignments to foster critical thinking skills, helping students to think not only about learning to write, but also about using writing to learn.

It is time to move from the nursing process to critical thinking

As we reflect on the concept of critical thinking in perioperative nursing practice, we should ask ourselves whether we think critically. If not, we must learn the principles of critical thinking and apply them in our clinical practice settings. Our perioperative nurse managers and directors must demonstrate critical thinking in leading other nurses in the delivery of quality, cost-effective, service-oriented patient care. They also must identify peers who use critical thinking skills to support and sustain them in their quest.

Community-based pediatric experiences: education for the future

In the world of managed care, nontraditional learning experiences outside the hospital setting are imperative for nursing students. This article describes pediatric clinical learning experiences designed to prepare baccalaureate nursing students for practice. Home visits to families caring for children with illnesses, clinical experiences in an elementary school setting, special olympics physical examinations and a drug store assignment illustrate pediatric faculty's efforts to achieve this goal.