Hatrick (2002) – pragmatic doubt = uncertainty that exists when one accepts the indeterminancy of the human condition – must be open to possibilities within a given context Similar to Schon’s swamp and indeterminate zones of practice – making sense of experience to form one’s identity in practice Unknowing – “need to remain open to possibilities and change” (p. 390, Averill & Clements, 2007) – not All of the important questions have been asked Unknowing creates a sense of shared purpose between instructor and students
When does learning really occur in nursing practice and how can we best assess and evaluate this learning? What can we do, as educators, to foster this kind of learning? How can we best prepare nursing students to develop the critical thinking skills and clinical decision-making skills they require to practice?
Context = foundation upon which knowledge is built Reflection = evaluating perspectives and assumptions within context in order to achieve situational understanding Dialogue – knowledge through relationship Time – process of coming to know and understand - transformative
Life experiences are organized through narrative so that meaning can be interpreted. Stories are remembered because they provoke a feeling and a sensual response that are retrieved by cues in the environment – recognition of patterns NARRATIVE PEDAGOGY – sharing and interpretation of narratives Students incorporate all attributes of critical thinking into their stories to connect past experiences to their current practice. Control group using traditional care plans using nursing process – assessment, diagnosis, planning, intervention, evaluation – focus on patient outcomes with conversations with instructor focused on how to apply this knowledge in clinical situations Randomized to practice units – all students within one group will be either doing the reflective narrative journaling or the traditional care plans
Story with beginning middle and end – i.e. feeling of accomplishment, frustration, satisfaction, discouragement. Who or what was involved? Describe only Guide critical reflection –What were you thinking about when involved with the situation? Alternative perspectives – What influenced your thinking and actions? Integrate learning into future practice experiences – What did you learn? Interviews to dialogue with nursing students about the story and reflections, include examples and plan for future action. Dialogue as a critical conversation to relate their story and move from telling “what they know to why they know”. Done biweekly to have more meaningful dialogue with the interview
D = Dimension Certain behaviours factor loaded with each category and presented in certain order within questionnaire (with all of the professional development attributes at once).
Sorrel et al began to see critical thinking as not just analysis and synthesis but as a creative process as well. This instrument has been previously tested with graduate students with an interrater reliability of 95% (Kohlenberg, 1995, as cited in Sorrell et al., 1997). This tool is based on the Delphi (1990) report , exploring the meaning of critical thinking
"Good teaching cannot be reduced to technique
“Good teaching cannot be reduced
to technique; good teaching comes
from the identity and the integrity
of the teacher” (Palmer, 2007, p. 10)
Defining the experience…Defining the experience…
Meaning and possibilities
“To teach and nurse effectively,
we need to know ourselves. This
is what we bring to our teaching
and nursing partnerships, and it
can be a catalyst for provoking
caring and social change” (McEldowney,
2003, p. 220).
“Emancipatory teaching … fosters a
spirit of inquiry, an independence of
thought, an ability to question
prevailing assumptions, and a
confidence with which to meet the
complexities of a dynamic health care
system”(Myrick & Tamlyn, 2007, p. 301)
“The goal of instruction becomes
creating an opportunity for
learning that integrates content
knowledge with knowledge of
context” (Forneris & Peden-McAlpine, 2006)
Critical Thinking in PracticeCritical Thinking in Practice
(Forneris, 2004, as cited in Forneris & Peden-McAlpine, 2006, p. 2)(Forneris, 2004, as cited in Forneris & Peden-McAlpine, 2006, p. 2)
“Purposeful, self-regulatory judgment
that results in interpretation, analysis,
evaluation, and inference as well as the
explanation of evidential, conceptual,
methodical, criteriological or contextual
considerations upon which that judgment
is based”(Facione, 1990, as cited in Kuiper & Pesut,
2004, p. 383).
CriticalThinking is…CriticalThinking is…
The QuestionThe Question
What is the effect of a structured clinical
log within a reflective portfolio on the
assessment of learning (as measured by
self-efficacy and critical thinking skills)
and competence in the clinical practice of
undergraduate nursing students?
The InterventionThe Intervention
Narrative Reflective Journaling
“Narrative captures the experience by
organizing human actions and events within a
composite or real-life experience… Narrative
creates understanding by illuminating causal
thinking… temporal aspects of the human
experience as it changes over time.” (Forneris &
Peden-McAlpine, 2006, p. 3)
Guided Narrative Reflection ProcessGuided Narrative Reflection Process
(Forneris & Peden-McAlpine, 2006)(Forneris & Peden-McAlpine, 2006)
Describe a story
Guide critical reflection
Consider alternative perspectives
Integrate learning into future practice
Self EfficacySelf Efficacy
Internality, Powerful Others and Chance
(IPC) Scales (Levinson, 1981, as cited in Harvey &
Assesses three aspects of control
1. Belief in one’s own ability
2. Role of external factors in controlling life
3. Role of chance
Self-appraisal with 6-D
scale (Schwirian, 1978)
2. Critical Care
6. Professional Development
Self appraisal with comparison to
Benner’s (1984) Novice to Expert
to understand how
nursing “skills” and
behaviours are attained
through time, from
novice to expert
UNCG (University of North Carolina atUNCG (University of North Carolina at
Greensboro) Critical Thinking SkillsGreensboro) Critical Thinking Skills
Evaluation InstrumentEvaluation Instrument (Sorrell, Brown, Cipriano Silva &
Likert scale on how students perform certain
skills (5=independent to 1=unable to perform,
even with consistent guidance)
1. Ability to analyze and interpret
2. Draws logical inferences
3. Evaluates and justifies inferences
4. Deductive reasoning
5. Inductive reasoning
Data AnalysisData Analysis
Correlation of narrative reflective journaling
compared to competence, self efficacy and
critical thinking skills at students’ various stages
of education and practice
Is this relationship significant?
Is it even possible to detect a relationship, given
the number of other factors affecting students’
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