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.     

Exploring the oxygen supply and demand framework as a learning tool in undergraduate nursing education

In nursing education, physiological concepts are typically presented within a body 'systems' framework yet learners are often challenged to apply this knowledge in the holistic and functional manner needed for effective clinical decision-making and safe patient care. A nursing faculty addressed this learning challenge by developing an advanced organizer as a conceptual and integrative learning tool to support learners in diverse learning environments and practice settings. A mixed methods research study was conducted that explored the effectiveness of the Oxygen Supply and Demand Framework as a learning tool in undergraduate nursing education. A pretest/post-test assessment and reflective journal were used to gather data. Findings indicated the Oxygen Supply and Demand Framework guided the development of pattern recognition and thinking processes and supported knowledge development, knowledge application and clinical decision-making. The Oxygen Supply and Demand Framework supports undergraduate students learning to provide safe and effective nursing care.     

A new way of reflecting in nursing: the Peshkin Approach

Title.  A new way of reflecting in nursing: the Peshkin Approach.
Aim.  This paper is a report of a new approach to reflection in nursing and demonstrates its positive outcomes for student learning in clinical practice.
Background.  Reflection is a popular educational tool in nursing and most traditional reflective models take an incident as the starting point. We have developed a new approach that focuses on subjective thoughts and feelings. We were inspired by the work of Peshkin and his focus on the 'subjective I'. For this reason, we have termed this new way of reflecting 'The Peshkin Approach'.
Data sources.  Eight nursing students kept a reflective diary during a 6-week clinical placement in 2008. The focus was on recording their thoughts and feelings. They analysed the diary entries using a systematic approach. The aim was to identify aspects of their subjectivity influencing them in clinical practice.
Discussion.  Through analysis of journal entries, the students became aware of the subjective I's that were influencing their experiences. They found the advantages of the approach to be twofold: increased self-awareness and enhanced learning.
Conclusion.  Maintaining a reflective journal that focuses on subjectivity can enhance the clinical experiences of nursing students. We advocate this new approach as complementary to more traditional forms of reflection and argue for its incorporation into nurse education programmes. In comparison to traditional reflective models that we have used, the Peshkin Approach to Reflection has significant advantages in terms of promoting student learning in clinical practice. We hope the approach can be critiqued and developed further by those interested in enhancing nurse education.     

The role of analogy-guided learning experiences in enhancing students' clinical decision-making skills

The purpose of this study was to address the need for effective educational interventions to promote students' clinical decision making (CDM) within clinical practice environments. Researchers used a quasi-experimental, non-equivalent groups, posttest-only design to assess differences in CDM ability between intervention group students who participated in analogy-guided learning activities and control group students who participated in traditional activities. For the intervention, analogy-guided learning activities were incorporated into weekly group discussions, reflective journal writing, and questioning with clinical faculty. The researcher-designed Assessment of Clinical Decision Making Rubric was used to assess indicators of CDM ability in all students' reflective journal entries. Results indicated that the intervention group demonstrated significantly higher levels of CDM ability in their journals compared with the control group (ES(sm) = 0.52). Recommendations provide nurse educators with strategies to maximize students' development of CDM ability, better preparing students for the demands they face when they enter the profession.     

The successful use of problem-based learning in an online nurse practitioner course

The development of technology and online education has opened the door to creative use of new and existing teaching methodologies. The authors describe how they used problem-based learning in an online course as a method for teaching clinical decision making to nurse practitioner students. The close match between problem-based learning and the characteristics of adult learners and successful distance learners is outlined as support for use of this methodology. In addition, the authors describe the challenges, rewards, and lessons learned in this innovative approach to online education.     

Promoting self-reflection in clinical practice among Chinese nursing undergraduates in Hong Kong

This study evaluated the effect of a structured education programme on improving the self-reflection skills of Chinese nursing undergraduates in managing clinical situations. Johns' Structured Reflection Model was used as a framework for the development of the education programme. Thirty-eight nursing undergraduates attended a 3-hour interactive workshop on reflective skills and were encouraged to practise the skills learned under the guidance of a nurse instructor during their 4-week clinical practicum. The findings indicated that the programme was helpful in improving the undergraduates' reflective skills though only a few of them reached the highest level as critical reflectors. Some undergraduates identified time constraints and the lack of a trusting relationship with their nurse instructor as barriers to their reflective learning. The findings may help nurse educators develop education programmes with structured learning strategies to promote nursing undergraduates' self-refection in clinical practice.     

Journal writing: a teaching strategy for gerontology nursing courses

Journal writing, recognized as a valuable method to augment and enrich learning, has been used in adult education, higher education, and in the health care professions. Journal writing promotes reflective thought and increases awareness. This article describes how journal writing was used in the gerontology rotation of an associate degree nursing program to engage students in the content, encourage examination of personal beliefs, recognize biases, and reflect on perceptions about older adults.     

Teaching health assessment in the virtual classroom

Health assessment skills are vital to professional nursing practice. Health assessment has traditionally been taught using lecture, teacher-developed tests, practice and live demonstration, and interactive and computer-based learning materials. Rapid advances in information technology during the past decade have greatly expanded distance learning options in higher education. Although much nursing education now uses the Internet, there has been limited use of the Web to teach psychomotor and clinical skills. This article describes how online instruction can be integrated into a health assessment course to teach physical examination skills. The development of instructional videos that can be digitally streamed onto the Web for ready and repeated access can also enhance online learning of technical and clinical skills. Student evaluation of this Web-enhanced course revealed that online assignments enabled them to pace their learning, thereby promoting greater flexibility and independence. Students were able to master the technical skills of working online with minimal difficulty and reported that working online was no more stressful than attending class. The most helpful aspect of the online course was the instructor-developed video that was digitally streamed online.     

Enhancing medical-surgical nursing practice: using practice tests and clinical examples to promote active learning and program evaluation

In a 14-week medical-surgical nursing review course, two teaching strategies are used to promote active learning and assess the transfer of knowledge to nursing practice. Practice tests and clinical examples provide opportunities for participants to engage in self-assessment and reflective learning and enhance their nursing knowledge, skills, and practice. These strategies also contribute to program evaluation and are adaptable to a variety of course formats, including traditional classroom, web conference, and online self-study.     

Meeting our students’ educational needs during a global pandemic: Creating online clinical learning experiences

The purpose of this paper is to describe the conversion of in-person simulations into online evolving case study activities in an undergraduate nursing curriculum as a result of COVID-19 precautions. The School of Nursing at Eastern Kentucky University utilized technological resources to provide meaningful online learning activities to meet student learning outcomes. The key teaching strategies to maintain were application and synthesis of knowledge through guided reflective activities and discussion. Interactive evolving case studies were selected with critical thinking questions and video clips to promote student engagement. The curricular concepts were medication administration, prioritization of patient care, communication, patient safety, and clinical judgment. Student and faculty evaluations were overwhelmingly positive, resulting in sustained use of these teaching strategies within the curriculum.     

The portfolioworkbook as a strategy for student-centred learning

This paper describes the portfolioworkbook as a strategy to support student-centred learning in nurse education. The portfolio workbook combines the use of reflection on prior experiences, forward planning to meet identified course outcomes, critical incident analysis and a reflective journal to ensure the integration of theory with practice. This enables the student, rather than the teacher, to control the educative process, and thus develops the skills of autonomy and decision-making envisaged in the development of Project 2000 courses.In using a weekly add-on format, the workbook provides a comprehensive record of the student's learning, whilst at the same time monitoring progress and facilitating the acquisition of knowledge and skills. The use of reflective practice from the beginning of the course, and reinforced throughout, enables the student to internalize the process as a way of identifying and managing their own learning needs.The author concludes that this strategywould be appropriate for all types of nurse learners; however, a precondition for this is an espousal and commitment by teachers to student-centred philosophies and methods of learning.     

Community of Inquiry Framework for Advanced Practice Nursing Students

Distance education programs are increasingly common in nursing education, and educators are challenged with creating online courses that provide students with quality learning experiences. For advanced practice nursing (APN) students, online courses need to engage students in learning while meeting their unique needs. The Community of Inquiry (COI) framework is grounded in theories of learning and teaching and is relevant for use in developing online courses for APN students. The purpose of this article is to describe the development of an online clinical practice management course for APN students using the COI framework.     

Guided reflective journals depict a correlation to the academic success of nursing students

Reflective guided journal assignments can be correlated to the academic success of nursing students in the clinical area through the evaluation of the student's level of reflective writing. The student's journal recordings can be compared with their course grades and course completion rates. Students are encouraged to better prepare themselves for the clinical area and to self-direct their learning experiences, and the nursing instructor identifies students who require additional guidance in applying theoretical concepts.     

The value of reflective journaling in undergraduate nursing education: a literature review

OBJECTIVES: The purpose of this literature review was to ascertain the evidence for the use of reflective journaling as a tool to promote the pedagogical strategy of reflection for the purpose of learning from practice for practice in undergraduate nursing education. DESIGN: Concept-centric. DATA SOURCES: The literature review involved structured searches of all OVID gateway databases, EBSCO host databases, and Blackwell Synergy. Qualitative and Quantitative Studies from 1992 to 2006 were included if they focused on reflective journaling in undergraduate clinical education. REVIEW METHODS: Due to the vast plethora of literature on reflection, keywords were utilized to focus the search. Approximately 150 abstracts were reviewed for primary sources of research. A total of nine studies met the inclusion criteria. The review subsequently divided the literature into four content themes allowing for appraisal and analysis of the findings, followed by summary and key recommendations for nursing education and research. RESULTS: There was evidence that educators struggle to incorporate reflective processes into education; however, the research provided rationale and support for engaging undergraduate students in the reflective process. Researchers found reasonable levels of reflection in undergraduate students' journaling and educators reported students' learning as a result of reflective journaling. Further to this, there was evidence that writing reflectively improved over time; a learned skill also dependent on a good facilitator and trust. Unfortunately, there was a paucity of research that explored the undergraduate nurses' experiences with the process of having to create written communication, with a critical reflective focus on practice. CONCLUSION: Nursing educators are correct in pursuing the teaching and learning of the reflective process in undergraduate nursing education. Nurse educators need to utilize various tools and strategies for facilitating the growth of undergraduate students into reflective practitioners. Indeed there was only limited evidence to support reflective journaling as an appropriate tool to promote reflection for the purpose of learning from practice for practice in undergraduate nursing education. Research that provides insight into the undergraduate student experience and perceptions of reflective journaling is needed to facilitate the structuring and use of reflective journaling as a tool in undergraduate nursing education.     

A three-step method of self-reflection using reflective journal writing

Fiscal and financial constraints present a challenge for nurse educators to broaden the diversity and scope of teaching/learning methodologies. One method designed to promote autonomy and self-direction of nursing students is self-reflection combined with reflective journal writing. This paper describes a three-step process of self-reflection encompassing critical appraisal, peer group discussion and self-awareness. This process of self-reflection was initiated with one group of clinical nursing students. Using student and teacher feedback, implications for employing this teaching/learning strategy in clinical practice are suggested.     

Using a constructivist approach with online concept maps: relationship between theory and nursing education

Concept maps have been used in nursing education as a method for students to organize and analyze data. This article describes an online course that used concept maps and self-reflective journals to assess students' thinking processes. The self-reflective journals of 21 students collected over two semesters were qualitatively examined. Three major themes emerged from students' use of concept maps: 1) factors influencing the map creation, 2) developmental learning process over time, and 3) validation of existing knowledge and construction of new knowledge. The use of concept maps with reflective journaling provided a learning experience that allowed students to integrate content consistent with a constructivist paradigm. This integration is a developmental process influenced by the personal preferences of students, concept map design, and content complexity. This developmental process provides early evidence that the application of concept mapping in the online environment, along with reflective journaling, allows students to make new connections, integrate previous knowledge, and validate existing knowledge.     

Educational technology integration and distance learning in respiratory care: practices and attitudes

INTRODUCTION: Educational technologies have had an important role in respiratory care. Distance learning via postal correspondence has been used extensively in respiratory care, and Internet-based distance learning is now used in the training of respiratory therapists (RTs), clinical continuing education, and in baccalaureate degree and higher programs for RTs and educators. OBJECTIVES: To describe the current scope of respiratory care educational technology integration, including distance learning. To investigate online research potential in respiratory care. METHODS: A probabilistic online survey of United States respiratory care program directors was conducted on educational technology practices and attitudes, including distance learning. A parallel exploratory study of United States respiratory care managers was conducted. RESULTS: One-hundred seventy-seven (53%) program directors participated. One-hundred twenty-eight respiratory care managers participated. For instructional purposes, the respiratory care programs heavily use office-productivity software, the Internet, e-mail, and commercial respiratory care content-based computer-based instruction. The programs use, or would use, online resources provided by text publishers, but there is a paucity. Many program directors reported that their faculty use personal digital assistants (PDAs), often in instructional roles. 74.6% of the programs offer no fully online courses, but 61.0% reported at least one course delivered partially online. The managers considered continuing education via online technologies appropriate, but one third reported that they have not/will not hire RTs trained via distance learning. Neither group considered fully online courses a good match for RT training, nor did they consider training via distance learning of comparable quality to on-campus programs. Both groups rated baccalaureate and higher degrees via distance learning higher if the program included face-to-face instruction. Online distance-learning participatory experience generally improved attitudes toward distance learning. There was a good match between manager RT expectations in office-productivity software and program instructional practices. CONCLUSIONS: Educational technologies have an important role in respiratory care. Online distance learning for baccalaureate and higher degrees in respiratory care is promising. Online distance learning in respiratory care must include face-to-face instruction. Distance-learning deployment in respiratory care will require resources. A follow-up probabilistic survey of United States respiratory care managers is needed. Online surveys conducted for respiratory care are promising, but neither less expensive nor easier than conventional means.