Upward feedback in nursing: A matter of giving, taking and asking

Geijn, B.F.H. van de Walle – van de; Brinke, Desirée Joosten-ten; Klaassen, Tim; Tuijl, Anne van; Fluit, Cornelia

doi:10.1016/j.nepr.2020.102792

Cited by 4 publications

(6 citation statements)

References 23 publications

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“…This would imply a shift in power dynamics not only in the doctor patient relationship but also in health care teams in which medical specialists are typically at the higher end of the hierarchy. The importance of a safe environment, trust and dialogue are equally depicted in previous research on upward feedback in nursing 35 . Revealing one's shortcomings and showing vulnerability by inviting feedback is, however, not yet fully engrained in medical culture 36 .…”

Section: Discussionmentioning

confidence: 99%

“…The importance of a safe environment, trust and dialogue are equally depicted in previous research on upward feedback in nursing. 35 Revealing one's shortcomings and showing vulnerability by inviting feedback is, however, not yet fully engrained in medical culture. 36 Similarly, our findings show that patient feedback that contrasts or questions professionals' identity may be difficult to incorporate in health care professionals' learning.…”

Section: Role Conflictsmentioning

confidence: 99%

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Challenges in engaging patients in feedback conversations for health care professionals' workplace learning

Sehlbach,

Bosveld,

Romme

et al. 2024

Medical Education

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IntroductionPatient feedback is relevant information for improvement of health care professionals' performance. Engaging patients in feedback conversations can help to harness patient feedback as a powerful tool for learning. However, health care settings may prevent patients and health care professionals to effectively engage in a feedback dialogue. To advance our understanding of how feedback conversations may support learning in and from practice, we sought to explore patients' and health care providers' perspectives on engaging patients in feedback conversations as informal learning opportunities.MethodsFor this qualitative study, we used a pragmatic approach and conducted semi‐structured interviews with 12 health care providers and 10 patient consultants. We applied an inductive approach to thematic analysis to understand interviewees' perceptions regarding patient feedback for workplace learning.ResultsParticipants attributed importance to patient feedback and described how the feedback may improve treatment relationships, professionals' performance and care processes on the team level and the organisational level. Participants experienced conflicting roles as patient and educator or expert and learner, respectively. Changing relationships, feelings of vulnerability and perceived power dynamics in treatment relationships would affect participants' engagement in feedback conversations. Patients and professionals alike saw a role for themselves in giving or inviting feedback but often missed the tools for engaging in feedback conversations.DiscussionPatient feedback can contribute to professionals' practice‐based learning but requires navigating tensions around conflicting roles and power dynamics in the treatment relationship. Both patients and health care professionals need to embrace vulnerability and may need facilitation and guidance to use patient feedback effectively. Attention to power dynamics, if not a shift towards collaborative relationships, is however crucial to engage patients in feedback conversations, thereby capitalising the power patients posses.

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Section: Discussionmentioning

confidence: 99%

Section: Role Conflictsmentioning

confidence: 99%

Challenges in engaging patients in feedback conversations for health care professionals' workplace learning

Sehlbach,

Bosveld,

Romme

et al. 2024

Medical Education

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“…That said, research within medical education and the broader field of education have highlighted common challenges learners face when assessing or giving feedback to their teachers: 1) having to complete too many forms that are time consuming [5]; 2) feeling ill-equipped to provide feedback to teachers [3,6,11]; 3) feeling uncertain about teachers' receptivity and the impact of their feedback on teaching practices [6,[11][12][13]; and, 4) experiencing power imbalances and fearing consequence [3,11,12]. These issues have contributed to a situation in which concerns regarding the validity and utility of SETs are widespread [14][15][16], making it likely that the value of narratives from learners [17] is all too easily overlooked.…”

Section: Introductionmentioning

confidence: 99%

Upward Feedback: Exploring Learner Perspectives on Giving Feedback to their Teachers

Wisener¹,

Hart²,

Driessen³

et al. 2023

Perspect Med Educ

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Introduction: Feedback from learners is known to be an important motivator for medical teachers, but it can be de-motivating if delivered poorly, leaving teachers frustrated and uncertain. Research has identified challenges learners face in providing upward feedback, but has not explored how challenges influence learners’ goals and approaches to giving feedback. This study explored learner perspectives on providing feedback to teachers to advance understanding of how to optimize upward feedback quality. Methods: We conducted semi-structured interviews with 16 learners from the MD program at the University of British Columbia. Applying an interpretive description methodology, interviews continued until data sufficiency was achieved. Iterative analysis accounted for general trends across seniority, site of training, age and gender as well as individual variations. Findings: Learners articulated well-intentioned goals in relation to upward feedback (e.g., to encourage effective teaching practices). However, conflicting priorities such as protecting one’s image created tensions leading to feedback that was discordant with teaching quality. Several factors, including the number of feedback requests learners face and whether learners think their feedback is meaningful mediated the extent to which upward feedback goals or competing goals were enacted. Discussion: Our findings offer a nuanced understanding of the complexities that influence learners’ approaches to upward feedback when challenges arise. In particular, goal conflicts make it difficult for learners to contribute to teacher support through upward feedback. Efforts to encourage the quality of upward feedback should begin with reducing competition between goals by addressing factors that mediate goal prioritization.

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“…3,13 In clinical workplaces, the term upward feedback indicates verbal feedback from a trainee (eg, resident/postgraduate trainee) to their clinical supervisor, and we use this term to indicate feedback conversations, not evaluations. 14 Although research indicates that specific comments with suggestions for improvement from learners are more effective than numerical ratings in improving clinical teachers' performance, 15,16 faculty perceptions of the credibility of anonymous written feedback are variable. 17,18 Some argue that open feedback conversations are more likely to enhance teachers' receptivity to upward feedback than anonymous feedback data.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Only When They Seek: Exploring Supervisor and Resident Perspectives and Positions on Upward Feedback

Ramani

Lee-Krueger

Ordons

et al. 2022

J Contin Educ Health Prof

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Introduction:Verbal feedback from trainees to supervisors is rare in medical education, although valuable for improvement in teaching skills. Research has mostly examined narrative comments on resident evaluations of their supervisors. This study aimed to explore supervisors' and residents' beliefs and experiences with upward feedback, along with recommendations to initiate and facilitate effective conversations.Methods:Using 60-minute focus group discussions, a previous study explored opinions of internal medicine residents and clinical supervisors at the Brigham and Women's Hospital regarding the impact of institutional culture on feedback conversations. For this study, we conducted a thematic analysis of the transcribed, anonymous data to identify key concepts pertaining only to verbal upward feedback, through the theoretical lens of Positioning theory.Results:Twenty-two supervisors and 29 residents participated in three and five focus groups, respectively. Identified themes were mapped to three research questions regarding (1) existing beliefs (lack of impact, risks to giving supervisors feedback, need for preparation and reflection), (2) experiences (nonspecific language, avoidance of upward feedback, bypassing the supervisor), and (3) recommended approaches (setting clear expectations, seeking specific feedback, emphasizing interest in growth).Discussion:Study participants appeared to assume learner–teacher positions during feedback conversations, resulting in residents' concerns of adverse consequences, beliefs that supervisors will neither accept feedback nor change their behaviors, and avoidance of constructive upward feedback. Residents suggested that emphasis on mutual professional growth and regular feedback seeking by supervisors could encourage them to take on the role of feedback providers. Their recommendations could be a valuable starting point for faculty development initiatives on upward feedback.

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Upward feedback in nursing: A matter of giving, taking and asking

Cited by 4 publications

References 23 publications

Challenges in engaging patients in feedback conversations for health care professionals' workplace learning

Challenges in engaging patients in feedback conversations for health care professionals' workplace learning

Upward Feedback: Exploring Learner Perspectives on Giving Feedback to their Teachers

Only When They Seek: Exploring Supervisor and Resident Perspectives and Positions on Upward Feedback

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