Section Four

Reflective Practice Teaching activities and resources

Also in this section

Reflective practice is a dynamic process that integrates theory with application thereby bridging the gap between professional knowledge and the demands of real-world practice (Tomlinson., Thomlinson, Peden-McAlpine & Kirschbaum, et al.,2002). As such, reflective practice is considered among the most promising teaching and learning modalities for developing mental health nursing care.

Faculty act as facilitators and stimulators of student self-reflection aimed at offering care that is collaborative, strengths-based and recovery-oriented. Faculty should engage in “learning together” approach in which they actively engage with students in the process of critical reflection and thinking about diverse clinical situations. In any case, educators seeking to support and promote the practice of recovery-oriented mental health care should (Meyer, Sellers, Browning, McGuffie, Solomon, & Truog, 2009):

  1. Create a safe and trustworthy learning environment.
  2. Emphasize ethical and relational dimensions of care.
  3. Suspend hierarchy among participants.
  4. Value reflection and self-awareness.
  5. Honour multiple perspectives.

Reflective practice may occur in individual and group formats; as well as in writing, through interactive discussions or other means. There are multiple strategies for reflection that can assist nursing students to develop the requisite knowledge, skills and competence.

Tools to support reflective practice

The following approaches and tools may be used to support students to engage in ongoing critical reflection.

Journaling. Since the early-mid 1990s, nurse education has embraced the notion of journaling as a way to move the theory of knowledge acquisition of student nurses in active practice. To that end, student nurses have been asked to reflect on their practice in order to make the links between theory and practice and develop critical thinking skills (Epp, 2008), as well as to develop a professional identity (Shapiro, Kassman & Shaffer, 2006). Other writers have used journaling to enhance reflexive practice.

Such journaling, as a form of reflective exercise, creates a safe space for students to critically analyze situations, consider theoretical perspectives and experiences allowing for further insight (Boud, D., Keogh, R., & Walker, D. 1985; Caldwell, L., 2013; Glaze, J. E., 2001). With the increased acuity of health care today, nurses with high level of knowledge and critical application of this knowledge in the lives of patients is key, and journaling is thought of as one way to achieve this objective.

Some authors suggest journaling is a learned skill that begins with descriptions of events and moving to more phenomenological descriptions about their perspectives and analysis of events (Usher, Francis & Tollefson, 2001). This cascading skill is often seen as a hierarchy, though these same authors argue for the beneficial role that different levels of journaling play in nursing practice.

The engagement of teaching faculty in the review of student journals plays a key role in the advancement of student thought. Strategies such as Socratic (critical) questioning and reflections also may be offset by the power differential between the student writer and faculty evaluator. Awareness of how this plays out in student journals is key, for “we as educators need to appreciate the concept of student/teacher entry negotiation and the power implicit in the game” (Harris, 2008).

For more information, see Resources and Appendix E.

Learning circles. Learning circles promote verbal reflection in an interactive manner and involve group discussion that allows participants to critically reflect on practices, promote growth and change, provide a safe, encouraging and empowering space where students can voice concerns, reflect on their practice, and collaborate with colleagues to learn and grow (RNAO, 2016e).

Peer sharing. Peer sharing is the use of partnership dyads to allow for sharing of clinical experiences, strengthening of confidence and clinical reasoning, providing student support and socialization and increased autonomy, accountability, responsibility and self-confidence (RNAO, 2016e). 

Technology to support self-reflection. Communications via text message, online journaling, and listening to health-care stories via podcasts to generate reflections can be used as innovative strategies to promote dialogue and reflection. Nursing educational programs should ensure that adequate time, resources and opportunities (i.e., time, safe space, secure and confidential online forums) are provided to allow students to share and practice self reflection (RNAO, 2016e). For more information, see Resources in this section.

Teaching and Learning Activities

The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of theory, principles and best practices related to reflective practice.

  • Student critical reflections on practice
  • Student role play and class discussion
  • Interaction process recording and analysis (see Appendix B, C, D)
  • Simulation (standardized patients) (see Section 7.2)
  • Lived client experience/family experience (see Appendix H)
  • Reflective writing and journaling (see Appendix E). Reflective practice through written journals, discussion groups or other means may also be used to acknowledge and address the emotional work of nurses and the moral distress that nurses and nursing students encounter in their clinical practice
  • Response to video/film scenario or clinical scenarios:
    • What are you seeing and hearing? How would you describe the person/family? What are their strengths? Formulate your assessment using strengths-based, person-first language. What do you know? What don’t you know? What do you need to know in order to nurse effectively in this situation? What can you do? What can’t you do? What mental health/mental issues can you identify? What interventions might you offer? What critical questions does this scenario raise?

Learner Engagement Questions

The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding self-reflective practice. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and/or reflection exercises.

  • What is your understanding of recovery oriented mental health care? Strengths-based care? Person/family-centred care? What are your beliefs, ideas and experiences regarding mental health? Mental illness?
  • What aspect of mental health/mental illness are you most interested in and why?
  • What are your concerns/preoccupations?
  • What specific challenges are you facing in your nursing studies and practice?
  • What are your strengths?
  • What areas of practice do you feel most confident in? Least confident?
  • What are your learning needs and goals?
  • What would be most helpful to you at this time/in this situation?

Evaluation and Self-reflection

The following tools can be used to evaluate students in their understanding and application of selfreflective practice.

  • Promote self regulation and critical reflection by including a student self-evaluationcomponent.
  • Ensure a reflective practice component in summative coursework and evaluations; i.e., address application to practice versus testing rote (memorization based on repetition) knowledge/content with process recording assignment, responses to clinical scenarios and essay questions.

SELF-REFLECTION

Reflection question: Are you critically examining your actions and experiences inorder to acquire a new understanding of the situation, and developing one’s practice and clinical knowledge?

Resources

RNAO BPGS

WEB LINKS


REFERENCE MATERIALS

  • Allen, F. M., & Warner, M. (2002). A developmental model of health and nursing. Journal of Family Nursing, 8(2), 96-135
  • Allott, P., & Loganathan, L. (2002). Discovering hope for recovery from a British perspective: A review of literature. Canadian Journal of Community Mental Health, 21(3), 13-33.
  • Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation journal, 16(4), 11.
  • Boud, D., Keogh, R., & Walker, D. (1985). Reflection: Turning experience into learning. London: Kogan Page.
  • Caldwell, L. (2013). The importance of reflective practice in nursing. International Journal of Caring Sciences, 6(3), 319.
  • Carnevale, F. A. (2013). Confronting moral distress in nursing: recognizing nurses as moral agents. Revista Brasileira de Enfermagem. 66 (Spec):33-8.
  • Doane, Gweneth Hartrick & Varcoe, C. (2007). Relational practice and nursing obligations Advances in Nursing Science, 30(3), 192–205.
  • Fageberg, I., & Gustaffson, C. (2004). Reflection, the way to professional development? Journal of Clinical Nursing, 13, 217-280.
  • Fryer-Edwards, K., Arnold, R. M., Baile, W., Tulsky, J. A., Petracca, F., & Back, A. (2006). Reflective teaching practices: an approach to teaching communication skills in a small-group setting. Academic Medicine, 81(7), 638-644.
  • Gordon, J., Macleod, A., & Mann, K. (2009). Reflection and reflective practice in health professions education: a systematic review, 14(4), 595-621.
  • Gottlieb, N.L., Feeley, N.& Dalton, C. (2005). The collaborative partnership approach to care: A delicate balance. Toronto, ON: Elsevier Health Sciences.
  • Gottlieb, L. (2013). Strengths-based nursing care: Health and healing for person and family. New York, NY: Springer Publishing Company.
  • Hyrkäs, K., Paunonen Ilmonen, M., & TerttuTarkka, M.(2008).Teacher candidates’ reflective teaching and learning in a hospital setting–changing the pattern of practical training: a challenge to Growing into teacherhood. Journal of Advanced Nursing, 33(4), 503-511.
  • Foundation of Nursing Studies. (2013). Guidance for critical reflection on practice development. London: FoNS.
  • Johns, C. & Freshwater, D. (2009). Transforming nursing through reflective practice. Oxfard, UK:Blackwell Publishing Ltd.
  • Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. The British Journal of Psychiatry, 199(6), 445-452.
  • Meyer, E. C., Sellers, D. E., Browning, D. M., McGuffie, K., Solomon, M. Z., & Truog, R. D. (2009). Difficult conversations: Improving communication skills and relational abilities in health care. Pediatric Critical Care Medicine, 10(3), 352-359.
  • Moon, J. (1999). A handbook of reflective and experiential learning. London: Routledge.
  • Mental Health Commission of Canada. (2015). Guidelines for recovery-oriented practice: Hope. Dignity. Inclusion. ON: Author.
  • Paget, T. (2001). Reflective practice and clinical outcomes: practitioners’ views on how reflective practice has influenced their clinical practice. Journal of Clinical Nursing. 10(2), pp 204-214.
  • Pugnaire-Gros, C., & Young, L. (2007). Teaching the McGill model of nursing and client-centred care: Collaborative strategies for staff education and development. Teaching nursing: Developing a student centred learning environment, 189–220.
  • Schön, U.-K., Denhov, A., & Topor, A. (2009). Social relationships as a decisive factor in recovering from severe mental illness. The International Journal of Social Psychiatry, 55(4) 336-347.
  • Tomlinson, P. S., Thomlinson, E., Peden McAlpine, C., & Kirschbaum, M. (2002). Clinical innovation for promoting family care in paediatric intensive care: demonstration, role modelling and reflective practice. Journal of Advanced Nursing, 38(2), 161-170.