Reflective Practice Journaling and Clinical Reasoning: A Qualitative Inquiry Study

Transcription

1 Reflective Practice Journaling and Clinical Reasoning: A Qualitative Inquiry Study

2 Authors Debra Scardaville, PhD, RN, CPNP-PC Associate Professor, New Jersey City University Dr. Joyce Wright, RN, PhD, CNE Associate Professor, New Jersey City University New Jersey City University 2

3 Objectives Explore the use of a guided reflection model educational pedagogy in the validation of critical thinking and clinical reasoning in RN-BSN students. Interpret the use of reflective journaling in contemporary nurse education curriculum. 3

4 Abstract Summation Results of a qualitative descriptive study exploring the use of reflective journaling as a pedagogical strategy in the attainment of clinical reasoning and clinical judgement among RN-BSN students in a residency program at a public university in the US is presented. Insights into nursing education are given. Keywords Reflective journaling; clinical reasoning; ways of knowing 4

5 Research Question What is the RN-BSN residency students experience and perception of evolvement of clinical reasoning and clinical judgment through the process of reflection and reflective journal writing? 5

6 Research Study IRB approved Design: Qualitative descriptive research study Use of reflective journaling as a pedagogical strategy to evaluate the attainment of clinical reasoning Purposive sampling of seven RN residency program students were obtained through informed consent. 6

7 HRSA Grant This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) Grant Number: D 19 HP Grant Title: An Academic-Practice Partnership to Transition Ethnically Diverse Graduates into Community Health Settings ($293, a year for 3 years. Total is $897,000) This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 7

8 Residency Programs: Overview Residency programs, described by the American Association of Colleges of Nursing [AACN] as a model intended to provide supplemental education within the context of the workplace through the provision of mentored, individualized clinical experiences Benefits: have demonstrated to provide benefits through a variety of ways including overall improvement (Rush, Adamack, Gordon, Lilly, & Janke, 2013); additional attainment of knowledge through skills training, debriefing, and hands on self-care knowledge (Pine & Tart, 2007); and culturally congruent care based upon evidence (Letourneau & Fater, 2015). 8

9 Residency Program: New Jersey City University An exceptional academic-practice partnership, funded by the Health Resources and Service Administration (HRSA), has been developed by New Jersey City University (NJCU)(public university), two Associate Degree Nursing Programs, a Magnet Designated Medical Center and an urban Public Health Department to implement an innovative one-year RN-BSN program with a concurrent nursing residency. 9

10 Residency Program (cont.) This enhanced one-year program provided diverse Associate Degree Nurse Graduates (ADGN) to put theory into practice by teaming up with preceptors at the Medical Center and Public Health Department for an intensive, hands-on clinical experience. The success of the ADGN students was accomplished through financial assistance, mentoring, and a comprehensive network of student support services. 10

11 Participant Population: HRSA Students Accepted from (2) Associate Degree Partner Colleges with Articulation Agreements Diverse Students :[12] Hispanic, [11] African American All Students had Grade Point Average above 3.0 on a 4.0 Scale Scholarship provided for 60% of the college tuition or $6,250. Stipends of $5,000 for Fall and $5,000 Spring 11

12 Conceptual Definitions Reflective Practice a means of self-examination that involves looking back over what has happened in practice to improve or encourage professional growth (Ruth- Sahd, 2003, p. 488) conscious, dynamic process of thinking about, analyzing, and learning from an experience that gives one insights into Self and practice (Freshwater, 2008; Kim, Lauzon, Burbank & Martins, 2010; Asselin, 2011) an essential element of evidence-based practice through questioning (Thompson & Burns, 2008). Critical Thinking Clinical reasoning as a complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information and weigh alternative actions (Simmons, 2010, p. 1155) Clinical judgment an interpretation about a patient s needs and/or the judgment to take action (or not), the use of standard approaches or modification of standard approaches or improvising of a new one as deemed appropriate to the patient s response (Tanner, 2006, p. 204). 12

13 Key Concepts Critical Thinking Clinical Reasoning Clinical Judgement 13

14 Theoretical Foundations Ways of Knowing in Nursing (Carper, 1978) Ethical Knowing Personal Knowing Aesthetic Knowing Empirical Knowing Ways of Knowing (Chinn & Kramer, 2014) Emancipatory Knowing 14

15 Methodology Reflective Journaling Secured electronic format Anonymity Reviewed by both researchers Dialogue with students Thematic analysis independently John s Model of Reflection (1994) Cue Questions 15

16 Thematic Analysis Findings Clinical Reasoning and Ways of Knowing continuum Empirical Knowing Emancipatory Knowing 16

17 Voice Community of Caring Emancipatory Knowing Vulnerability Disparity 17

18 Reflection Journal Quotes "this year has been full of priceless discoveries and knowledge "I think and see things differently" "this program literally changed my life and my view of nursing as a profession" "I'm not so task oriented as I was before, now I'm able to look at a patient and see the big picture "I am pleased to see how I have evolved into this successful bi-cultural nurse leader "Living in my community, but not assessing the community itself" Living in but not seeing. 18

19 Curricular and Educational Implications Reflective journaling as a warranted pedagogical strategy Active constructivist learning theories Models of clinical learning 19

20 Positive Outcomes All 23 Graduates are employed!! Specialties (Labor & Delivery, Medical Surgical Nursing, Emergency Department) One Graduate chosen for marketing material for the National Hispanic Nurses Association One Graduate is a traveling nurse, California, Hawaii All graduates have gone back to their neighborhoods to present to their neighborhood schools 20

21 Graduates, Cohort I 21

22 Through the implementation of this HRSA funded 3 year program, New Jersey City University will graduate a total of 23 diverse BSN degree-holding nurses which will have completed the residency and be highly marketable and employable post-graduation. 22

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24 Selected References Asselin ME. (2011). Reflective narrative: A method for learning through practice. J Nurses Staff Development, 27(1):2-5. Benner, P. (1984). From novice to expert, excellence and power in clinical nursing practice. Menlo Pak, CA: Addision-Wesley Publishing Company. Brussard, M. (2015a). Clinical judgment in reflective journals of pre-licensure nursing students. Journal of Nursing Education, 54(1), Brussard, M. (2015b). The nature of clinical judgment development in reflective journals. Journal of Nursing Education, 54(8), Carper, B. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), Chinn, P. & Kramer, M. (2014). Knowledge development in nursing: Theories and processes (9 th ed.). Philadelphia: Mosby. Epp, S. (2008). The value of reflective journaling in undergraduate nursing education: A literature review. International Journal of Nursing Studies, 45, Freshwater D. (2008). Reflective practice: The state of the art. In: D. Freshwater, B. J. Taylor, & G. Sherwood (Eds.), International textbook of reflective practice in -Nursing. Oxford, UK: Blackwell Publishing. Johns, C. (1995). Framing learning through reflection using Carper s fundamental ways of knowing in nursing. Journal of Advanced Nursing, 22, Kennison, M. (2012). Developing reflective writing as effective pedagogy. Nursing Education Perspectives, 33(5), Letourneau, R.M. & Fater, K.H. (2015). Nurse residency programs: An integrative review of the literature. Nursing Education Perspectives, 36, Simmons, B. (2010). Clinical reasoning: Concept analysis. Journal of Advanced Nursing, 66(5), Zori, S. (2016). Teaching critical thinking using reflective journaling in a nursing fellowship program. The Journal of Continuing Education in Nursing, 47(7),

25 Thank you! For Further Information/Questions: Dr. Debra Scardaville Dr. Joyce Wright 25