"Good teaching cannot be reduced to technique

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  • 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

    1. 1. “Good teaching cannot be reduced to technique; good teaching comes from the identity and the integrity of the teacher” (Palmer, 2007, p. 10)
    2. 2. Defining the experience…Defining the experience… UncertaintyUncertainty – “Unknowing”  Opportunity  Meaning and possibilities  Questioning approach  Critical inquiry
    3. 3. “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).
    4. 4. “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)
    5. 5. “The goal of instruction becomes creating an opportunity for learning that integrates content knowledge with knowledge of context” (Forneris & Peden-McAlpine, 2006)
    6. 6. 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) Time Context Reflection Dialogue
    7. 7. SelfSelf--Regulated Learning TheoryRegulated Learning Theory (Kuiper & Pesut, 2004)(Kuiper & Pesut, 2004)
    8. 8. “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…
    9. 9. 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?
    10. 10. 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)
    11. 11. 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 experiences
    12. 12. Self EfficacySelf Efficacy  Internality, Powerful Others and Chance (IPC) Scales (Levinson, 1981, as cited in Harvey & McMurray, 1994)  Assesses three aspects of control 1. Belief in one’s own ability 2. Role of external factors in controlling life events 3. Role of chance
    13. 13. CompetenceCompetence Self-appraisal with 6-D scale (Schwirian, 1978) 1. Leadership 2. Critical Care 3. Teaching/Collaboration 4. Planning/Evaluation 5. Interpersonal Relations/Communications 6. Professional Development Self appraisal with comparison to Benner’s (1984) Novice to Expert behaviours Phenomenological approach to understand how nursing “skills” and behaviours are attained through time, from novice to expert
    14. 14. 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 & Kohlenberg, 1997)  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
    15. 15. 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’ learning?
    16. 16. ReferencesReferences Bainbridge Frymier, A., Shulman, G., and Houser, M. (1996). The development of a learner empowerment measure. Communication Education, 45, 181-199. Bandura, A. (1997). Insights: self-efficacy. Harvard Mental Health Letter, 13(9), 4-6. Banning, M. (2006). Nursing research: perspectives on critical thinking. British Journal of Nursing, 15(8), 458-461. Boughn, S. (1995). An instrument for measuring autonomy-related attitudes and behaviors in women nursing students. Journal of Nursing Education, 34(3), 106- 113. Conger, M. and Mezza, I. (1996). Fostering critical thinking in nursing students in the clinical setting. Nurse Educator, 21(3), 11-15. Craft, M. (2005). Reflective writing and nursing education. Journal of Nursing Education, 44(2), 53-57. Fonteyn, M. and Cahill, M. (1998). The use of clinical logs to improve nursing students’ metacognition: a pilot study. Journal of Advanced Nursing, 28(1), 149-154. Forneris, S. and Peden-McAlpine, C. (2006). Contextual learning: a reflective learning intervention for nursing education. International Journal of Nursing Education Scholarship, 3(1), 1-18.
    17. 17. Harvey, V. and McMurray, N. (1994). Self-efficacy: a means of identifying problems in nursing education and career progress. International Journal of Nursing Studies, 31(5), 471-485. Maynard, C. (1996). Relationship of critical thinking ability to professional nursing competence. Journal of Nursing Education, 35, 12-18. McMullan, M. (2006). Students’ perceptions on the use of portfolios in pre-registration nursing education: a questionnaire survey. International Journal of Nursing Studies, 43, 333-343. Nelson, S. and Purkis, M. (2004). Mandatory reflection: the Canadian reconstitution of the competent nurse. Nursing Inquiry, 11(4), 247-257. Polit, D. and Beck, C. (2008). Nursing research: generating and assessing evidence for nursing practice. Philadelphia: Lippincott-Williams & Wilkins. Ruland, J. and Ahern, N. (2007). Transforming student perspectives through reflective writing. Nurse Educator, 32(2), 81-88. Sedlak, C. (1992). Use of clinical logs by beginning nursing students and faculty to identify learning needs. Journal of Nursing Education, 31(1), 24-28. Sorrell, J., Brown, H., Cipriano Silva, M. and Kohlenberg, E. (1997). Use of writing portfolios for interdisciplinary assessment of critical thinking outcomes of nursing students. Nursing Forum, 32(4), 12-24.
    18. 18. Steen Lauterbach, S. and Becker Hentz, P. (2005). Journaling to learn: a strategy in nursing education for developing the nurse as person and person as nurse. International Journal for Human Caring, 9(1), 29-35. Usher, K, Francis, D., and Owens, J. (1999). Reflective writing: a strategy to foster critical inquiry in undergraduate nursing students. Australian Journal of Advanced Nursing, 17(1), 7-12.

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