Guided reflection as a tool to deal with the theory– practice gap in critical care nursing students

Abstract

<jats:p>Critical care nursing students experience inconsistencies between the theoretical content they have learnt and what is expected from them in practice, which retards the learning process. This has been described as the theory–practice gap. There seems to be no single solution to address the integration of theory and practice. In an attempt to bridge this gap, a study was done to establish the influence of guided reflection on critical care nursing students in dealing with their theoretical and practical experiences. A qualitative, explorative, descriptive and contextual design was followed. An instrument for guided reflection was designed which was used during semi-structured interviews during the data collection process. Field notes and narrative descriptions were also used as means to collect data. Themes that emerged from the data included a description of incidents experienced, critical analysis of knowledge, critical analysis of feelings and changed perspective experienced. Theory–practice integration occurred to an extent in some of the categories; conversely, the inability to apply theory to practice evoked responses such as feelings of guilt and incompetence. Guided reflection appeared to have assisted the participants in clarifying theoretical and practical experiences, and in reaching a changed perspective by understanding the link between theory and practice. Guided reflection ought to be incorporated in the education of nurses from their basic training in theory and practice so that student nurses will be aware of their own competencies in order to provide optimal patient care.OpsommingKritiekesorgverpleegstudente ervaar teenstrydighede ten opsigte van dit wat hul geleer word en wat van hul in die praktyk verwag word wat weer die leerproses vertraag. Dit word as die teorie–praktykgaping beskryf. Daar blyk geen enkelvoudige oplossing te wees vir die integrasie van teorie en praktyk nie. In ’n poging om die gaping te oorbrug, is ’n studie oor die invloed van begeleide refleksie op kritiekesorgverpleegkundige studente se teoretiese en praktiese ervaringe gedoen. ’n Kwalitatiewe, verkennende, beskrywende en kontekstuele navorsingsontwerp is gevolg. ‘n Instrument vir begeleide refleksie is ontwerp wat gebruik is tydens semi-gestruktureerde onderhoude in die data-insamelingsproses. Veldnotas en narratiewe beskrywings was ook middele ten einde data in te samel. Tema’s wat uit die data na vore gekom het was ‘n beskrywing van ervaringe, kritiese analise van data, kritiese analise van gevoelens en ‘n veranderde perspektief met betrekking tot ervaringe. Teorie–praktyk integrasie het tot ‘n mate in sommige kategorieë plaasgevind het. Daarinteen het die onvermoë om die teorie in die praktyk toe te pas response tot gevolg gehad, soos skuldgevoelens en gevoelens van onbevoegdheid. Dit wil voorkom asof begeleide refleksie die deelnemers gehelp het om duidelikheid en ’n veranderde perspektief ten opsigte van hul teoretiese en praktiese ervaringe te verkry. Begeleide refleksie behoort reeds vanaf basiese opleiding in verpleegkundiges se teoretiese en praktiese opleiding geïnkorporeer te word sodat verpleegkundiges bewus sal wees van hulle eie vaardighede om sodoende optimale pasiëntsorg te kan lewer.</jats:p>

Exploring the perception of nursing students about consequences of reflection in clinical settings

“…For many years, there has been a gap between theory and practice in nursing students’ clinical education ( 11 – 13 ). Researchers believe that reflection strives to close the gap between knowledge and practice, and converts each experience to a potential experiential learning, for the ultimate purpose of increasing quality of care for the served population ( 14 – 16 ). According to the findings of some studies, reflection leads to outcomes such as improving relationships between students and instructors, bridging the theory-practice gap, deep learning and strengthening the meta-cognitive skills ( 17 , 18 ).…”

Critical Incident Techniques and Reflection in Nursing and Health Professions Education

“…Thirty-two papers used CIT or reflection as learning tools in nursing and health professional education. [37][38][39][40][41][42]51 Tools included written critical incident reports, 13,16,17,21,22,28,31,33,40,51 semi-structured interviews, 5,18,19,[23][24][25][26]30,34 survey responses, 27 and reflective essays. 45 Some papers used multiple methods in collecting critical incidents: a reflective journal and focus group, 15 a critical incident questionnaire and group interview, 29 a combination of reflective journals, case studies, critical incident analyses, document analyses, and semi-structured interviews.…”

“…Studies were viewed as a process for generating and enhancing learning 19 by optimising learning from real experiences, 15,25 specifically, understanding the meaning of learning, 9 development of critical thinking and reflection skills, 5,13,21 and creativity 5 .…”

“…One variation in nursing is the notion of a 'significant event' rather than critical incident, suggested as leading to better descriptions of the event. 5 Such variations indicate the continued evolution and flexibility of CIT as a research technique, potentially both a strength and weakness. 6 A growing movement toward reflection on incidents 4 saw participants asked to consider the meaning, personal importance and motivation.…”

Ensino clínico sob o paradígma da prática embasada em evidências: integração da teoria e prática para a prevenção da úlcera por pressão

“…Preocupados com a lacuna existente entre a teoria e a prática, Swardt;Toi;Botha (2012) integração da teoria com a prática e que resultou em perspectiva transformadora no aprendizado e na prática clínica. Na segunda subcategoria "o despertar para as competências da enfermagem na avaliação do paciente com risco para UP", ficou evidente que os estudantes identificaram como sendo competência do enfermeiro a avaliação dos pacientes com desenvolvimento para UP.…”