Is Reflection an Important Educational Strategy for Nurses?
Introduction
Reflection has increasingly been recognized as a crucial element of nursing practice as well as an instructional approach through which student nurses can acquire knowledge using their clinical experiences (Fragkos, 2016; Miraglia & Asselin, 2015). While no universal definition of the term reflection exists, Asselin and Fain (2013) describe reflection as a deliberate process through which individuals engage in critical thought about clinical experiences to generate newer insights that could potentially transform their professional practice. Nicol and Dosser (2016) observe that reflection uses experiential knowledge to facilitate personal and professional development while reinforcing continuous learning. The significance of reflection has been established extensively, with scholars contending that reflection gives nurses an opportunity to use clinical experiences to add on existing knowledge (Miraglia & Asselin, 2015), cultivate clinical judgment (Nielsen, Stragnell, & Jester, 2007), build collaborative practice, develop robust communication skills, and advance the quality of care given to patients (Horton-Deutsch, 2012). Horton-Deutsch and Sherwood (2008) also observed that reflection allowed nurses to develop their emotional intelligence.
While most people assume that reflective practice or ability is an inborn trait for nurses, recent empirical evidence suggest that nurses can prolong reflective capabilities through pauses and professional assistance to systematically apply newly-acquired outlooks in transforming their professional practice (Asselin, SchwartzBarcott, & Osterman, 2013; Asselin & Fain, 2013). As such, reflection as a training strategy is conceptualized as an avenue for promoting evidence-based practice, enhancing professional practice, and possibly advancing patient outcomes. As an instructive tactic, reflection enables student nurses to evaluate clinical experiences alongside the emotions and thoughts concomitant with those experiences, enabling the student to alter their assumption and beliefs, acquire new knowledge, and transform their clinical practice (Dube & Ducharme, 2014; Norrie, et al., 2012).
Even though various studies have been executed to investigate the notion of reflection and its application as an instructional strategy, no or few systematic reviews have actually synthesized literature on the significance of reflection as an instructional tactic in the professional training and development of nurses. The current systematic review aims to address this paucity of empirical evidence by synthesizing empirical literature on the application of reflection in nurse training programs. The review will focus on the manner in which reflection has been used in nurse training and the benefits acquired from its use among nurse students.
Potential Impact of the Review If u can add references in this part please
Whereas reflection as an instructional strategy in nursing professional development is mandatory in countries like the UK, USA and Australia, (Asselin & Fain, 2013; Kemp, 2009; McDonald, Jackson, Wilkes, &Vickers, 2012) reflection remains unexplored in the Saudi Arabia nurse training context. Exploring degree of success of the use of reflection as a training strategy for nurses in the former countries will validate its introduction and application in Saudi Arabia. Specifically, studies conducted in these countries have demonstrated the usefulness of reflection in the professional development of nurses, prompting the integration of this strategy in nurse training curricula (Bulman, Lathlean, & Gobbi, 2012; Forneris & Peden-McAlpine, 2007; Tsingos-Lucas, Bosnic-Anticevich, & Smith, 2016; Walker, Cooke, Henderson, & Creedy, 2013). For example, in the UK, reflection is a mandatory requirement in the registration process for all nurses (Nursing and Midwifery Council, 2016). The integration of reflective practice into nursing education programs and professional practice can significantly transform nursing in the country, while simultaneously addressing the challenges encountered by nurses in Saudi Arabia. The current review on reflection as an instructional strategy will contribute to nursing education, and enhance nursing practice in Saudi Arabia. A database search reveals that no empirical data has been published in the Saudi Arabia context and, therefore, this systematic review will the first to document this subject in this country; specifically, to enhance emotionally competent nursing practice. Moreover, Saudi Arabia is experiencing revolutionary changes in its healthcare sector and is under pressure to satisfy the international nursing standards. Therefore, there is need to incorporate reflective practice into educational outcomes of Saudi nursing programs in order to acquire and maintain international recognition and accreditation. This review acts as a precursor, exploring the manner in which reflective practice can be integrated into the Saudi Arabian nurse training programs and the possible outcomes that can be achieved through such action.
Existing Literature
Reflection as an educational strategy has been extensively studied, especially in recent years. Various scholars agree that, even though, reflection is not a new concept in education, it is only recently that it has been recognized as the cornerstone of professional nursing practice. Different studies have been conducted to demonstrate the benefit of reflective practice in nursing. These studies show that nurses who reflectively analyze their daily experiences exhibit a superior understanding of their professional mandate or actions and give superior nursing care (Hatleik, 2012; Hicks-Russell, Geist & House Maffet, 2013; McDonald, et al., 2012). Further, an analysis of the available literature reveals four main themes associated with the application of reflection as an instructional strategy in nursing education. These themes include emotional impact, practice development, mentorship and barriers to reflective practice (Caldwell & Grobbel, 2013). In a quantitative study, Chong (2009) investigated the perceptions of 98 student nurses on reflective practice to determine its usefulness. Chong (2009) reported that students expressed the significance of reflection in the translation of theory into nursing practice. According to the students, reflection enabled them to develop new study perspectives for analyzing clinical situations, isolating their learning style, and enhancing their decision making abilities. Chong (2009) also noted that reflective practice helped the students to develop a superior sense of accountability and responsibility in their practice. Similar findings were reported by Bulman, Lathlean, and Gobbi (2012) who found that reflection changed and improved the practice of nurses by transforming their thought process. Bulman and colleagues also observed that reflection allows nurses to appreciate their achievements which, in turn, increases their confidence in their nursing role.
Rees (2013) examined the emotional effect of reflection among nurses. The study found that reflection allowed student nurses to identify distress causing experiences, giving them a clear understanding of their reactions to such situations and an opportunity to think deeply about the lessons drawn from the experience. Barry, Blum, and Purnell (2007) also reported similar findings noting that reflection gives nurses a safe emotional outlet to deliberate and superiorly understand their emotions and practice. In a systematic review, Miraglia and Asselin (2015) analyzed twenty five studies that investigated the application of reflective educational strategies in clinical practice. The review found that reflection as an instructional approach promotes learning, augments the readiness to use new knowledge, and facilitates practice change.
Review Questions
The overall aim of the current review is to examine the importance of reflection as an educational strategy in nurse training programs. The review will be guided by the following questions:
- In what ways has reflection or reflective practice been applied as an instructional tactic in nursing training and professional development?
- What results have been documented for reflective instructional strategy?
- Is there a link between reflective practice and emotional intelligence abilities of nurses?
References
Asselin, M. E., & Fain, J. A. (2013). Effect of reflective practice education on self-reflection, insight, and reflective thinking among experienced nurses. Journal for Nurses in Professional Development, 29(3), 111-119. doi:10.1097/nnd.0b013e318291c0cc
Asselin, M. E., Schwartz-Barcott, D., & Osterman, P. (2013). Exploring reflection embedded in practice: A qualitative study. Journal of Advanced Nursing, 69(4), 905-914. doi:10.1111/j.1365-2648.2012 .06082.x
Barry, C.D., Blum, C.A., & Purnell, M.J. (2007). Caring for individuals displaced by Hurricanes Katrina and Wilma: The lived experiences of student nurses. International Journal for Human Caring, 11(2), 67-73.
Bulman, C., Lathlean, J., & Gobbi, M. (2012). The concept of reflection in nursing. Qualitative findings on student and teacher perspectives. Nurse Education Today, 32, e18-e13.
Chong, M.C. (2009). Is reflective practice a useful task for student nurses? Asian Nursing Research, 3(2), 111-119.
Dube, V., & Ducharme, F. (2014). Evaluation of a reflective practice intervention to enhance hospitalized elderly care. Journal for Nurses in Professional Development, 30(1), 34-41. doi: 10.1097/ nnd.0000000000000028
Forneris, S. G., & Peden-McAlpine, C. (2007). Evaluation of a reflective learning intervention to improve critical thinking in novice nurses. Journal of Advanced Nursing, 57(4), 410-421.doi:10.1111/j.1365-2648.2006.04120.x
Fragkos, K. C. (2016). Reflective Practice in Healthcare Education: An Umbrella Review. Education Sciences, 6 (27), 1-16. doi:10.3390/educsci6030027
Hatlevik, I. K. R. (2012). The theory-practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap between theory and practice in initial nursing education. Journal of Advanced Nursing, 68(4), 868-877.
Hicks Russell, B., Geist, M., & House Maffett, J. (2013). An integrated clinical reasoning and reflection framework for undergraduate nursing students. Journal of Nursing Education, 52(1), 59-62.
Horton-Deutsch, S. (2012). Learning through reflection and reflection on learning: Pedagogies in action. In G. D. Sherwood, & S. Horton-Deutsch (Eds.), Reflective practice: Transforming education and improving outcomes (pp. 104-134). Indianapolis, IN: Sigma Theta Tau International.
Horton-Deutsch, S. & Sherwood, G. (2008). Reflection: an educational strategy to develop emotionally competent nurse leaders. Journal of Nursing Management, 16. 946-954.
Kemp, P. (2009). Work-based learning with staff in an acute care settings. Mental Health Practice, 12(10), 31-35.
McDonald, G., Jackson, D., Wilkes, L., & Vickers, M. H. (2012). A work-based educational intervention to support the development of personal resilience in nurses and midwives. Nurse Education Today, 32, 378Y384.
Miraglia, R. & Asselin, M.E. (2015). Reflection as an Educational Strategy in Nursing Professional Development. Journal for Nurses in Professional Development, 31(2), 67-72. doi: 10.1097/NND.0000000000000151 10% from this reference the plagiarism
Nicol, J.S., & Dosser, I. (2016). Understanding reflective practice. Nursing Standard, 30(36), 34-40.
Norrie, C., Hammond, J., D’Avray, L., Collington, V., & Fook, J. (2012). Doing it differently? A review of literature on teaching reflective practice across health and social care professions. Reflect. Pract., 13, 565–578.doi: 10.1080/14623943.2012.670628
Nursing and Midwifery Council. (2016). Standards for pre-registration nursing education. Nmc.org.uk. Retrieved 23 June 2017, from https://www.nmc.org.uk/standards/additional-standards/standards-for-pre-registration-nursing-education/
Rees, K. L. (2013). The role of reflective practices in enabling final year nursing students to respond to the distressing emotional challenges of nursing work. Nurse Education in Practice, 13(1), 48-52.
Tsingos-Lucas, C., Bosnic-Anticevich, S., & Smith, L. (2016). A Retrospective Study on Students’ and Teachers’ Perceptions of the Reflective Ability Clinical Assessment. American Journal of Pharmaceutical Education, 80(6), 101. http://doi.org/10.5688/ajpe806101
Walker, R., Cooke, M., Henderson, A., & Creedy, D. K. (2013). Using a critical reflection process to create an effective learning community in the workplace. Nurse Education Today, 33, 504-511. doi:10.1016/j.nedt.2012.03.001
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