Pages:
5 pages (1375 words) Double spaced
Type of paper:
Coursework Undergraduate (yrs. 1-2)
Discipline:
Nursing
Title:
See paper instructions
Sources to be cited:
3
Paper format:
APA
Paper instructions:
do this as the transcript for the video . please remember to do a reference page with 3 sources . thanks
For this assessment you will create a 5-10 minute video reflection on an experience in which you collaborated interprofessionally, as well as a brief discussion of an interprofessional collaboration scenario and how it could have been better approached.
Interprofessional collaboration is a critical aspect of a nurse’s work. Through interprofessional collaboration, practitioners and patients share information and consider each other’s perspectives to better understand and address the many factors that contribute to health and well-being (Sullivan et al., 2015). Essentially, by collaborating, health care practitioners and patients can have better health outcomes. Nurses, who are often at the frontlines of interacting with various groups and records, are full partners in this approach to health care.
Reflection is a key part of building interprofessional competence, as it allows you to look critically at experiences and actions through specific lenses. From the standpoint of interprofessional collaboration, reflection can help you consider potential reasons for and causes of people’s actions and behaviors (Saunders et al., 2016). It also can provide opportunities to examine the roles team members adopted in a given situation as well as how the team could have worked more effectively.
References
Saunders, R., Singer, R., Dugmore, H., Seaman, K., & Lake, F. (2016). Nursing students’ reflections on an interprofessional placement in ambulatory care. Reflective Practice, 17(4), 393–402.
Sullivan, M., Kiovsky, R., Mason, D., Hill, C., & Duke, C. (2015). Interprofessional collaboration and education. American Journal of Nursing, 115(3), 47–54.
Demonstration of Proficiency
Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
Identify how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature.
Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
Reflect on an interdisciplinary collaboration experience noting ways in which it was successful and unsuccessful in achieving desired outcomes.
Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work more effectively together.
Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
Identify best-practice leadership strategies from the literature, which would improve an interdisciplinary team’s ability to achieve its goals.
Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
Communicate in a professional manner that is easily audible and uses proper grammar. Format reference list in current APA style.
Professional Context
This assessment will help you to become a reflective practitioner. By considering your own successes and shortcomings in interprofessional collaboration, you will increase awareness of your problem-solving abilities. You will create a video of your reflections, including a discussion of best practices of interprofessional collaboration and leadership strategies, cited in the literature.
Scenario
As part of an initiative to build effective collaboration at your Vila Health site, where you are a nurse, you have been asked to reflect on a project or experience in which you collaborated interprofessionally and examine what happened during the collaboration, identifying positive aspects and areas for improvement.
You have also been asked to review a series of events that took place at another Vila Health location and research interprofessional collaboration best practices and use the lessons learned from your experiences to make recommendations for improving interprofessional collaboration among their team. Your task is to create a 5–10 minute video reflection with suggestions for the Vila Health team that can be shared with leadership as well as Vila Health colleagues at your site. Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact [email protected] to request accommodations. If, for some reason, you are unable to record a video, please contact your faculty member as soon as possible to explore options for completing the assessment.
Instructions
Using Kaltura, record a 5–10 minute video reflection on an interprofessional collaboration experience from your personal practice, proposing suggestions on how to improve the collaboration presented in the Vila Health: Collaboration for Change activity.
Be sure that your assessment addresses the following criteria. Please study the scoring guide carefully so you will know what is needed for a distinguished score:
Reflect on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes.
Identify how poor collaboration can result in inefficient management of human and financial resources, citing supporting evidence from the literature.
Identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals, citing at least one author from the literature.
Identify best-practice interdisciplinary collaboration strategies to help a team achieve its goals and work together, citing the work of at least one author.
Communicate in a professional manner, is easily audible, and uses proper grammar. Format reference list in current APA style.
You will need to relate an experience that you have had collaborating on a project. This could be at your current or former place of practice, or another relevant project that will enable you to address the requirements. In addition to describing your experience, you should explain aspects of the collaboration that helped the team make progress toward relevant goals or outcomes, as well as aspects of the collaboration that could have been improved.
A simplified gap-analysis approach may be useful:
What happened?
What went well?
What did not go well?
What should have happened?
After your personal reflection, examine the scenario in the Vila Health activity and discuss the ways in which the interdisciplinary team did not collaborate effectively and the negative implications for the human and financial resources of the interdisciplinary team and the organization as a whole.
Building on this investigation, identify at least one leadership best practice or strategy that you believe would improve the team’s ability to achieve their goals. Be sure to identify the strategy and its source or author and provide a brief rationale for your choice of strategy.
Additionally, identify at least one interdisciplinary collaboration best practice or strategy to help the team achieve its goals and work more effectively together. Again, identify the strategy, its source, and reasons why you think it will be effective.
You are encouraged to integrate lessons learned from your self-reflection to support and enrich your discussion of the Vila Health activity.
You are required to submit an APA-formatted reference list for any sources that you cited specifically in your video or used to inform your presentation. The Example Kaltura Reflection will show you how to cite scholarly sources in the context of an oral presentation.
Refer to the Campus tutorial Using Kaltura [PDF] as needed to record and upload your reflection.
Additional Requirements
References: Cite at least 3 professional or scholarly sources of evidence to support the assertions you make in your video. Include additional properly cited references as necessary to support your statements.
APA Reference Page: Submit a correctly formatted APA reference page that shows all the sources you used to create and deliver your video.
You may wish to refer to the Campus APA Module for more information on applying APA style.
Vila Health ® Activity
Collaboration for Change
Introduction
Management
Care Staff
Conclusion
Introduction
The only constant in the world of health care is change. When changes happen at health care facilities, the process can go roughly or smoothly, depending on how well the collaboration among staff is with the process.
Last year at Clarion Court Skilled Nursing Facility, which is in Shakopee, MN, and part of the Vila Health network, the implementation of Healthix, a new electronic health record (EHR) system, was very bumpy for all involved, leading to serious risks to patient safety.
Vila Health’s central QA office has asked you to travel to Clarion Court and talk to several staffers on both the management and patient care sides to get some perspectives on what went wrong (or right!) and what lessons can be learned for the future.
First, talk to management.
Management
Stephen Silva
Administrator, Clarion Court
OK. I understand why you’re here, and I don’t want to be uncooperative. But I want you to keep something in mind as you talk to everyone here: this situation happened because of problems upstream in the Vila Health network. If we were allowed more autonomy at the facility level, this wouldn’t have gone so roughly.
What do I mean? Well, the pressure from Vila Health Corporate to keep costs low and run a steady profit is intense. And I mean, I understand that this is a business. Of course! But we need to balance short-term thinking with long-term perspective. Anyway. Just day to day, it was getting clear that our old record system was being held together with duct tape and bailing wire, and we needed to upgrade. But rather than let us run our own search for the right system for our situation, we get a mandate from Corporate that if we were going to upgrade, we would need to buy Healthix, because Vila Health has an ongoing relationship with them and we’d get a deal.
And: I mean, I like a deal! I need to keep costs down, so that’s great. But it’s not great to wind up with the wrong tool just because we got a deal. Healthix’s designed for hospitals and we’re a skilled nursing facility. And those are related things, but they’re not exactly the same thing. If you need to screw something together, you don’t go and buy a hammer just because they’re cheaper. But nobody at corporate would listen to me when I tried to make that point.
After running roughshod on us there, corporate stomped down on us again by insisting we use an “implementation coach” that they had an existing relationship with. So we get some guy flying in from Baltimore who doesn’t know us, our staff, our needs, or anything other than how to make Healthix work in the big hospitals he usually works at. I think that was 90% of our trouble right there, this guy from the outside coming in and just refusing to listen to everybody here when we told him over and over that this or that detail just wasn’t quite right for us. People talk about staff buy-in as an important thing, and ours pretty much evaporated after the second day of that clown stomping around in here ignoring everyone’s suggestions.
I’m sure you’ll hear more about this, but that’s the main thing. Excuse me, I’ve got to go on to a meeting. But remember: sometimes things go smoother if you let the people on the ground make their own decisions.
Elise Wang
Director of Operations
I guess I’m glad someone’s asking about the EHR implementation. God, that was a nightmare. I think that ended up chewing up an entire year of my life, with different phases of rampup, and then implementation, and then, I don’t know, fallout. There were long stretches where I’d just wake up in the morning and have to force myself to get out of bed because I didn’t want to go in and deal with the day’s mess.
I know Stephen’s upset with a bunch of the process stuff, how we ended up using Healthix instead of a system more suited for our facility, and so on. And he’s got a big point! But to be honest, I think the trouble was a lot more localized. We were always going to pick *some* system, and every system has its quirks.
I think the whole thing was a massive, massive failure of change management. A place like this only works when there’s teamwork and collaboration. And that stuff doesn’t just happen, you have to make it work. And I was trying to lay the groundwork- I know the staff here, I know who responds to what, and I was trying to get things rolling with the kind of slow, collaborative process that we value here. But we had this abrupt, crash timeline with the corporate implementation coach coming, I think his name was Josh, and he just keeps bulldozing ahead and ignoring what people said to him, and that’s just a recipe for disaster. He irritated our IT guys when they had some concerns, and then they stopped cooperating. You know, absolute do-the-bare-minimum-required-and-nothing-further type thing, just short of a strike. And if I could kind of understand that on the human level, WOW was that unhelpful and disruptive. And pretty childish. It took Stephen calling them into his office and chewing them out for them to participate even grudgingly.
But I don’t know. I could have told him that if our IT people felt shut out of a thing they’d eventually be responsible for, they’d react badly. I *did* tell him that. But he didn’t listen.
We had kind of the same sort of situation with the nurses, too. But less childish in their case. They felt like the training process was leaving them unprepared and left behind, and they had to start making choices about using Healthix the right way or just taking care of patients. And they chose patients, of course, but that wasn’t good in the long run. I’m sure you’ll hear more about that from them when you start talking to them.
Chad Cook
IT Manager
Hey, there. I’m happy to talk to anybody and everybody about that stinking EHR. I came so close to quitting so many times with that that thing.
I gotta tell you, running IT in this place isn’t a picnic in the best of times. I like my coworkers and respect the other managers, but since this is a skilled nursing facility everyone acts like IT is an afterthought. And I kind of get that- for a long time, it was! But c’mon, we’re a couple of decades into the 21st century now, and technology is core to everything! It’s like trying to have a car without brakes or something.
So we’re underfunded and understaffed and overstretched to begin with. That means it takes most of our capacity to keep things running, not leaving us a ton of bandwidth for planning and for special projects. Which sucks, and is no way to run a railroad, but when I try to tell Stephen that he just sighs and says the budget is what it is. So you shrug and move on and wait for the whole thing to blow up.
My gut tightened up when Stephen decreed that we were doing a new EHR, then. I could see the need, for sure. But I could also see that we didn’t have the staff to really do it right, and probably weren’t going to take the time to even try. It was just rush rush rush, boom, here’s this new system that’s getting rammed down our throats by corporate, sprinting the whole way. And then this joker from corporate swoops in to tell us what to do and how to do it, never taking a moment to listen to me or my guys if we had something to say. By the sixth round of that, yeah, we got pretty irritated, and yeah, I might have taken my guys aside and told them it’d be fine by me if they did what was specifically asked of them and not a thing more. I mean, Corporate Josh is going to ignore our knowledge from making this place work? Fine, we’ll keep that knowledge to ourselves.
But you know what? Corporate Josh got to fly back to Baltimore and I had to sit here with my team and help the medical staff fight their way through the worst user interface I’ve ever seen. Had to be calm and patient when they got mad at the clunkiness and took it out on us because we were the only ones handy, even though we didn’t have any say in picking the stupid thing. Or then be the guy having Stephen yell at me that patient care is sliding because the care staff are having so much trouble with Healthix that they’re falling behind and crucial stuff isn’t getting entered and people’s medication schedules got blown. That was fun! I still get to be the guy who has to sweat through patch installations every two weeks and then go around apologizing for the bugs that pop up every. Single. Time.
I guess we’ve gotten through the worst of it, and nobody died because of it, but wow was that bad. And it would have been a whole lot easier if I could have at least felt like I was defending my own decision instead of something forced on me.
Care Staff
Shonda McCrae
RN
Ohhhhhhh, Healthix. I hate Healthix.
I got into this line of work because I wanted to help people, not because I wanted to fight with computers. I can barely work my phone! I mean, I don’t think I’m a dumb person by any means, but we’ve all got our strengths and being good with computers isn’t one of mine.
But OK, I know it’s a tool of the trade these days. I understand that. I liked the paper chart system, but I knew that we were way, way behind the times with it, and I was excited when Administrator Silva said we were getting with the times.
But it just hit us like a tidal wave! No time to talk about what we needed, no time to figure out what was best for us! Just this burst of workers showing up to install computers in all the rooms—and boy did that cause a mess, playing some kind of shell game with our patients from room to room—and then a couple hours of really half-assed training and then here we go, on our own. That “coach” they brought in, Josh Whatshisname, I tried to tell him that it takes me a while to learn how to do things on computers. He just kept pushing me away and telling me that the IT folks here would always be able to help me. As if. Those guys sit around and watch YouTube videos all day and won’t get off their butts unless Administrator Silva is on the phone personally telling them to go help out.
I remember the first week we were using Healthix, I kept having all kinds of trouble just logging in to the system to enter vital signs. You know, something that just takes a second with a paper chart. And should just take a second with a computerized system! But you try to log in and just get this error message saying “invalid security domain” or something like that. You re-enter your stuff, over and over, just getting more and more panicked and falling behind on your rounds! Then you get one of the IT guys to leave their YouTube to come and help you and they just shrug and have you try again for the tenth time, and then they tell you that it’s a known problem that Healthix has “trouble with authentication” sometimes. A known problem! Well that’s sure helpful!
I ended up just writing vitals down on paper again and then trying to catch up and reenter it all later in the shift when there was quiet time and I could try logging in again. But that didn’t work so well, because sometimes there’s not a quiet time, and sometimes you lose the sheets of paper, and it’s just a mess. And that’s not counting the times you couldn’t see some important note about a patient that’d been left in Healthix because you couldn’t log in! We’re lucky we got through that.
Lisa Cotrone
RN
I am so tired of talking about Healthix. I go home and complain about it to my husband every night. He’s sick of hearing about it. I’m sick of talking about it. But I hate it so much I can’t stop.
I’m a real practical person. If there’s something I need to get done, I want to get it done by the straightest route possible. I don’t want to have to monkey around with logins and go to this screen and then that screen and go through this pull-down list and try to remember what all the new abbreivations mean that are just a little bit different from the old abbreviations.
I’m not dumb. I can see why people want to use a system like Healthix. But holy cats did we do a bad job of setting it up here. After you log in, you have to click through three pages to get to the page we nurses need the most often to enter vitals and check for status notes. Why can’t we just make it so that that page is the first thing that comes up? I don’t know if that’s possible or not, because every time I suggest it, the IT guys just get huffy.
I just don’t like being told that all of this is the way it is, this or the highway. Take the time to explain it to me and I’ll be a lot more on board. Especially if you sit and listen to what I have to say. You might not even agree, just make me feel like I’m part of the process, not some little kid just being told what’s what.
Also: you better not tell her I said this, but I got really sick of Shonda’s cutesy oh-I-can’t-help-myself routine as we were trying to make it work. Sure, we were all frustrated, and sure that system was a stubborn mess. But suck it up and figure it out! Don’t just get all woe-is-me. I got so tired of getting yanked off of my own rounds so that I could come to her rescue. Especially when she knew that I wouldn’t be able to help her! It was tough not to feel like she just needed an audience for her little show.
I guess it’s better now, but there are still a lot of little pockets of hurt feelings here and there. Of course, there always are.
Nora Church
RN
Wow do I hate Healthix, and I especially hate the way we brought it in here. I was really excited when it was announced that we were installing it. It sounded great, and the list of stuff it was supposed to help us with sounded so awesome. But then once it got installed, the reality didn’t match the sales job at all! We got told this story about how our lives were going to be so easy, just entering information and having easy access to whatever we needed to see.
But then we just get thrown to the wolves, barely any training. A lot of our patients have been in the system for a while, and their info is all garbled and messed up in there. And that’s if you can get to it! Once it lets you log in—which might take a while, depending on what kind of mood the system’s in—you open the system and see 20 tabs you have to pick through, and maybe three of them are actually useful to you. And then as you’re poking through, every now and then the whole thing freezes up and just gives you a spinning circle for half a minute. When you’re in with a patient, you always want to be paying attention to them! But since we’ve installed Healthix, you’re always distracted by fighting with the computer.
Am I mad that management and IT here just left us hanging to figure it out on our own? You bet I am, but I’m not surprised. I’m used to that. Here’s the thing that really burns my butt: some of the nurses on staff who won’t help anyone else out. I hate to name names, but take Lisa Cotrone. She got her head above water faster than anyone else with this thing. It was still clunky for her, but she could get by. But you ask her for help and she gets all snippy at you really fast. “I figured it out, why can’t you?” is her whole approach to the world. That’s not helpful, and it doesn’t really leave me full of warm feelings for the long term.
I bet you heard this a lot, but I’m one more person who spent a couple of weeks carrying a little notebook with me on rounds, writing stuff down to enter later. I know a couple of patients missed meds because of that. It was a disgrace, and we’re lucky it wasn’t a full-on disaster to get us in the newspapers.
Conclusion
What are some of the ways in which staff collaboration failed in the implementation of the EHR?
Your response:
This question has not been answered yet.
What could have been done differently on the management side to facilitate better collaboration?
Your response:
This question has not been answered yet.
How about on the care staff side?
Your response:
This question has not been answered yet.
Kolb, integration and the messiness of workplace learning
Tim J. Wilkinsoncorresponding author
Author information Copyright and License information Disclaimer
‘I don’t know what’s wrong with our students. We’ve taught them all they need to know but they just can’t seem to remember any of it when they’re at work’. This paraphrase may be a familiar call of some teachers bemoaning how students have difficulty in applying their learning.
Linking classroom theory to workplace practice is the focus of a systematic review in this issue of Perspectives on Medical Education [1], but let’s start with a brief, and idiosyncratic, history of learning.
People have been learning from work and from experience since the earliest days of our evolution. Some time ago we must have decided it was a good idea to separate theory from practice so that we would teach the theory and that presumably would make the practice more robust. The dark days of the 19th century, factory style schooling attests to this philosophy: students in darkened classrooms being taught but not necessarily learning. Flexner had the best of intentions to link medical practice to theory but even here this was translated into doing the theory first and the practice later [2]. Then we must have realized that we needed to put the theory closer to practice and integrate.
Within medical education, integration became the next buzzword but there was potential for confusion. We realized that learning anatomy separately from physiology made it difficult for students to make the links between structure and function – so we invented horizontal integration where we combined previously separated disciplines in our teaching. Next came early clinical contact so that practice can be brought earlier into our curriculum – so called vertical integration. The next challenge is ‘upward’ vertical integration of theory into the later stages of our curricula so that theory becomes better linked to practice.
The irony here is we had integration of theory with practice before schools were created, and then we separated them and now we’re putting it all back together again. At least we’re trying to.
Kolb had useful views on learning from experience or linking theory to practice and his learning cycle has become part of most education courses [3]. It’s simple but also effective. In short, he describes a cycle whereby learners make links between theory and practice (or experience) in a number of ways. They can start with the theory and then apply this into practice. Or they can start with practice and reflect on how it might link to theory. Either way there is a cycle of initial theory preparation/briefing, experience, reflection/debriefing, modification of theory. With each cycle, and with ongoing experience and reflection, learners modify their views of the world. In short, they learn.
In our attempt to make learning more efficient and to provide more guidance and control, we’ve also invented learning outcomes – these are what we would like our learners to learn. They provide guidance to students and are generally seen as a very good thing.
Apprenticeship went through some phases too. Initially seen as a good thing where the protégé learns from the master, it then fell into disfavour, as it all seemed to be about practice without relevant theory. Within the health professions, working without theory is seen as a bad thing. The emergence of evidence-based medicine was one response to this. Another response was to suggest that apprenticeships are too uncontrolled.
We’ve now entered the next age of learning where we think workplace learning is good but we need to understand it better. We also need to link workplace-based learning more explicitly to theory. A laudable goal, and the focus of the systematic review in this issue [1].
There are many reasons why workplace learning is to be encouraged. We know that seeing the whole task helps a learner know where the component parts might fit [4]. We know that seeing role models and the actual doing of work helps frame learning, helps show what is relevant and helps in professional identity formation. We also know that learning in context makes it easier to apply that learning back into that context. Workplace learning is back and it’s here to stay.
However, workplace learning is also very messy. What is learnt is unpredictable and learning is not the prime activity as it takes second place to doing the work – in clinical settings, the patient is the focus not the student. The curriculum is not as well defined; it is more serendipitous. Learning outcomes are harder to control and predict. Sometimes learners do not feel welcomed in workplaces and this sense of alienation can inhibit learning.
What helps learning in workplaces and the linking of theory with practice? The first component of dealing with the messiness and unpredictability is to recognize it. Focusing on the process of learning, not just the outcomes, is an important first step [5]. To do this, we should explain the opportunities available but acknowledge that different learners will all have different experiences and take up different opportunities. We can’t control that, and shouldn’t try. We also need to acknowledge the social process of learning. The work of Lave and Wenger has been very influential here highlighting how a sense of belonging emerges from concepts of communities of practice and legitimate peripheral participation [6].
Linking theory to practice in the workplace is the focus of the systematic review in this issue [1] and it’s here where Kolb re-emerges because the components of effective activities seem to mirror his learning cycle [3]. The systematic review showed that effective interventions offered ‘just in time’ information prior to an experience or task, included effective briefing, provided well supervised and observed practice with immediate feedback, and followed it with time for reflection and good debriefing. This means the learner can consider how the experience links to existing learning and how that learning might then be modified so that the outcome is even better the next time it is put into practice. Deliberate supervised practice, with effective briefing and debriefing, seem core elements of the effective learning strategies that were identified.
We also see that people learn in workplaces despite us. The systematic review found no intervention was worse than control, and there were some where people learned just as well from the control group as the intervention.
Linking theory (or the classroom) to practice requires conscious application of a cycle of learning, while attending to the important social and professional identity components offered by workplace learning – the need for the learners to feel welcome, for them to have opportunities to observe the whole task, to observe role models and to have supervised opportunities for practice preceded by briefing and followed by debriefing. This structure does not imply formality. Such structure can be used in informal supporting ways. Workplaces do not respond well to imposed formality – we cannot easily control what people learn at work but we can help them recognize and use the learning opportunities, we can help them make sense of their experiences and most of all we can help them feel they are allowed to be there.
Reflective learning, reflective practice
Jacobs, Steven MN, MA Ed, RN Author Information
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Complete Reference
IT’S IMPORTANT that nurses practice self-reflection. But what exactly does self-reflection mean and why is it important? Further, how is it enacted and conveyed to others? As an educator, I had a classroom experience that led me to examine these questions in depth. In this article, I discuss what I learned.
Mandate for reflective practice
I was teaching an introductory nursing course and, like all good nurse educators, I spoke of the need for students to begin the process of self-reflection within their practice. I said we all need to engage in this process because as nurses, we must constantly evaluate our actions, behaviors, responses, and the decisions we make while practicing nursing. I discussed how reflective practice is a professional obligation; the College of Nurses of Ontario mandates that practicing nurses engage in reflective practice.1 During my discussion, I also showed some lecture slides that described reflective practice. One slide showed a robot with the notation that, as nurses, we can’t act blindly, without reflection or critical thinking.
A few weeks later, when I asked why nurses need to engage in self-reflection, one student wrote only, “Because nurses aren’t robots.” At first, I was dismayed and disappointed by this simple answer—but really, what kind of answer was I expecting? As I reflected, I realized that we do a disservice to this concept in nursing curricula. We say nurses need to engage in self-reflection, but we don’t explain or model what reflection really is. For much of our curriculum, we teach content, but do we as educators consistently reflect if learning has actually occurred?
Reflection is much more than revisiting how we administered a particular medication. Authentic reflection requires not only providing rationales for our actions, but also constantly exploring and examining ourselves and our own growth. This includes every aspect of our nursing practice, from skills to communication to interactions with others. Reflection not only ensures that we followed all the rights of medication administration, but also that we relate to our patient and colleagues in a humane, holistic manner.
Freire stated that those who wish to commit themselves to others need to constantly reexamine themselves. True reflective practice provides a way for nurses to escape impulsive, routine, and judgmental assumptions about situations, practice, colleagues, and patients.2
Reflective learning or practice?
Henderson, Napan, and Monterio use the term reflective learning to describe consciously thinking about and analyzing actions.3Reflective practice is the process of obtaining new insights through self-awareness and critically reflecting upon present and prior experiences.4
More recently, reflective learning has been defined as a process of holding experiences up to a mirror in order to examine them from different perspectives, whereas reflective practice assists one to explore what exists “just beyond the line of vision.”5 Similarly, the College of Nurses of Ontario states reflective practice is a process of nurses’ reviewing aspects of their practice to decide what’s working and what could be done differently.1
But reflective practice in nursing and/or nursing education is more complex than a single definition. As Bagay reminds us, reflection is a multifaceted process of action that each professional nurse considers throughout his or her entire career.6
Bulman, Lathlean, and Gobbi wished to uncover a greater understanding of how reflection is perceived and used by nursing students and instructors in an educational context. They found that reflection is associated with one’s professional motivation to “move on” and “do better” in practice in order to learn from the experience, and critically examine one’s “self.”7 This isn’t new. Over 80 years ago, Dewey articulated this type of reflection as important to an active search for solutions to difficulties from past experiences in order to learn.8 Bulman et al. also found that reflection was associated with humanistic nursing, emphasizing the importance of active expression of oneself to holistically care for others.7
Within education, much discussion has centered on the importance of teaching students to develop critical thinking skills through the use of reflection, both within and outside the profession of nursing.9-12 Fulton expands on this and argues that nursing educators also need to encourage students to be curious thinkers.13 Curious thinking uncovers problems. Because curious thinkers are more interested in the questions than the answers, they question everything in their practice, beginning the process of authentic and complete reflection.13 Authentic reflection is action-oriented. It’s an active process of discovering oneself.
Necessary practice
Johnson states that reflection is necessary to determine how one learns and one thinks, make sense of information, think critically, view problems from varying perspectives, develop new insights, bridge theory and practice, and understand one’s strengths and weaknesses.11 Reflective practice in nursing correlates to the development of critical, autonomous, and advanced practitioners.14 In short, reflective practice is necessary to:
develop coping strategies
enhance interprofessional communication
increase students’ understanding of nursing practice
promote the expression of feelings
make sense of personal emotional practice challenges
help nursing students to know themselves.15-17
It’s obvious that reflective practice is much more than simply wondering how one’s shift went, and it’s more than simply discouraging nurses and nursing students from applying their knowledge and skills robotically. Reflection for nursing students also helps them bridge the gap between new information they’re learning and their prior knowledge.18 These connections help to deepen their understanding of the content and material. They not only learn to solve problems, but also to help others and use their learning in “new and imaginative ways.”18
Tools for reflection
But how does one actually engage in reflective practice within nursing? Henderson, Napan, and Monterio offer a five-point reflection scale (reporting, responding, relating, reasoning, reconstructing) that can be viewed as a continuous circle.3,11 Gibbs offers another reflection model with six components (description, feelings, evaluation, analysis, conclusion, action plan).19
Of course, these are only two models of reflective practice; there certainly are others. What’s most important to consider is the fact that with these and other models, reflection is an active, deliberate, and cognitive process in which one examines a situation from varying perspectives, is open to new knowledge and information, and looks for numerous explanations and outcomes.11
But how often do we describe these models of reflection to nursing students? We ask them to write reflections on how their day went, but we don’t often ask them to authentically reflect on how they interact with others. Sure, we talk to them about being professional with all colleagues and peers. We say it’s necessary to exude professionalism, but we rarely explain to students that this requires them to constantly reflect upon how they act with others, what they actually say, and how they say it.20 Only then will reflective practice serve the larger purpose of holistically enlightening nurses.
How educators can model reflective practice
Nurse educators must model reflective practice. One of the ways I do this is by asking my students to complete an anonymous evaluation of our class. I explain to students that I want their input about how I can best teach (and reach) them, and how we can all work together to enhance the learning environment. I do this early in the semester; the following week, I discuss their comments, ideas, and opinions. I incorporate as many of their thoughts as I can during the balance of the semester. Brookfield promotes this type of reflective practice in education because it allows instructors to see themselves through their students’ eyes.21
Although educators often engage in reflection about our own actions and communication, we need to remember that sound education is always more about the process than the product.22 Our job is to constantly view the world from different perspectives. And this can be achieved only by modelling and engaging in true reflection of all our actions and communications as educators
Collaboration and Leadership Reflection Video Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Reflect on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes. Does not describe an interdisciplinary collaboration experience. Describes an interdisciplinary collaboration experience, but the reflection on the success or failure to achieve desired outcomes is missing or unclear. Reflects on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes. Reflects on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes. Includes ways in which reflective nursing practice can help build a better understanding of past experiences to improve future practice decisions.
Identify ways poor collaboration can result in inefficient management of human and financial resources, supported by evidence from the literature. Does not Identify ways poor collaboration can result in inefficient management of human and financial resources. Identifies poor collaboration, but does not address how it can result in inefficient management of human and financial resources or does not provide supporting evidence from the literature. Identifies how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature. Identifies how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature. Multiple authors from the literature are discussed.
Identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals. Does not identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals. Identifies leadership strategies, but it is unclear how they would improve an interdisciplinary team’s ability to achieve its goals, or does not provide supporting evidence from the literature. Identifies best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals. Identifies best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals. Multiple authors from the literature are discussed.
Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively. Does not identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively. Identifies interdisciplinary collaboration strategies, but it is unclear how they would help a team to achieve its goals and work together more effectively together. Identifies best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively. Identifies best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively. Multiple authors from the literature are discussed.
Communicate in a professional manner that is easily audible and uses proper grammar, including a reference list formatted in current APA style. Does not communicate in a professional manner that is easily audible and uses proper grammar, including a reference list formatted in current APA style. Communicates in a way that is difficult to hear and understand. There are many grammatical errors or the reference list has many errors in APA style. Communicates in a professional manner that is easily audible and uses proper grammar, including a reference list formatted in current APA style. Communicates in a professional manner that is easily audible and uses proper grammar, including an error-free reference list formatted in current APA style.
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