Clinical Judgment Development Using Structured Classroom Reflective Practice: A Qualitative Study

Abstract

This qualitative study examined the incorporation of "reflection-on-action" in a structured reflective classroom format as defined by Tanner's Clinical Judgment Model on the development of perceived clinical judgment and clinical confidence in Bachelor of Science nursing students. The qualitative results described the students' perceptions of the benefit of the intervention on their development of clinical judgment and clinical confidence. This research was an important contribution to the debate regarding the benefit of structured reflection in a classroom setting. By using reflection in the classroom, nurse educators may influence the education-practice gap and incorporate new pedagogies to strengthen the educational preparedness of nursing students to provide high-quality, competent, compassionate care to patients and their families.

Reflective Practice: A Comparative Dimensional Analysis of the Concept in Nursing and Education Studies

“…One of the most commonly used models in nursing, developed by Johns () proposed a narrative type of guided reflection that incorporates the ways of knowing noted by Carper (Horton‐Deutsch et al., ; Kofoed, ). Other models of RP include Tanner's (2006) (cited in Glynn, ; Kofoed, ; Mayville, ) and Freshwater's (2008) models of clinical judgment (cited in Horton‐Deutsch et al., ).…”

“…In terms of nursing knowledge, RP highlights the value of tacit knowledge and so is said to help generate contextualized theories that are specific to the practice (Peterson et al., ) and thus produce the added benefit of narrowing the gap between theory and practice (Evans et al., ; Glynn, ). Moreover, the RP group model is considered to affect clinical practice positively by fostering team functioning and resilience (Dawber, ).…”

“…In 1989, borrowing directly and explicitly from education theorist Donald Schön (1983), Powell (1989) was the first author in nursing studies to use the concept of RP-"on action" and "in action"-to designate the type of reflection that nurses demonstrate in a clinical setting. Nearly 25 years later, Schön indisputably remains a standard reference in the nursing literature (Brubakken, Grant, Johnson, & Kollauf, 2011;Cara & O'Reilly, 2008;Duffy, 2007;Gentile, 2012;Glynn, 2012;Gustafsson et al, 2007;Kofoed, 2011;Kumar, 2011;Nelson, 2012). Some authors (Horton-Deutsch, McNelis, & Day, 2012;Nelson, 2012) also cite Dewey (1933), one of Schön's major influences, who put forward a constructivist epistemology of teaching: learning by experience especially through reflective thinking.…”

East meets West in reflective practice

“…To avoid this, educators are encouraged to provide students with clear guidance about reflection principles and value, and the reflective practice process (Glynn, 2012). This guidance may also include providing reflective writing examples to assist students understand and develop their reflective skills and capacity.…”

Strengths-based student-led presentations in clinical reflection seminars: Narratives of learning experiences

“…Clinical reflection seminars are expected to bridge learning gaps and support students' learning experiences throughout the clinical period. [5,6] However, there is a learning curve from the class-room to clinical practicum: some students stated that clinical reflection seminars lacked content, were not efficiently run, and were disconnected from their learning needs. Some students were bored, dissatisfied, and unwilling to come to reflection seminars.…”