Critical Reflective Inquiry Research Articles

Agile Backward Design: A Framework for planning higher education curriculum

AbstractIn the last two decades there has been an increase in research and discussion regarding curriculum in Higher Education (HE). The literature in this field tends to focus on curriculum change at either the whole institution or individual program or unit level. Formal writing on HE curriculum also does not offer a framework that openly draws upon context, learner needs, pedagogical approaches, and industry requirements to formulate a collaborative model of curricular development. To fill these gaps in HE curriculum discussion and literature the aim of this study was to develop a cross-disciplinary model applicable to both unit (academic module that makes up a program) and program (degree) levels of curriculum development by enabling academics to generate and structure engaging learning opportunities for students. The research team developed this model by drawing on elements of Agile mindset and Backward Design. We call it Agile Backward Design (ABD). This paper reports on this new approach to curricular design. A critical reflective inquiry approach was used to discuss the development of the model. To report the transformation that was made at the program and unit level a case study was employed. In ABD, the researchers have constructed a dynamic and responsive framework that has been foundational in the design and development of innovative curriculum and pedagogy at the unit and program level of undergraduate degrees in the IT discipline area.

Improving Critical Thinking in New Graduate Nurses Through the Use of Reflective Journaling: A Quality Improvement Project

BackgroundCritical thinking is an important skill for newly graduated nurses to develop to learn how to best recognize and manage deterioration in their patients. New nurses may be too focused on nursing tasks and may not have adequate time to pause and reflect on their patient experiences that foster critical thinking. An exercise like reflective journaling may help new graduate nurses engage in active reflection with the goal of learning from their experiences, which may enhance the development of critical thinking. PurposeThe purpose of this paper is to explore whether the use of a once weekly reflective journaling exercise influences the development of critical thinking in new graduate nurses during their 6-week nursing orientation. MethodsA quality improvement (QI), pre- and post-test design was used to improve the current process of nursing orientation for newly graduated nurses in a single hospital setting. Six participants participated in a once weekly reflective journaling intervention, utilizing Kim's Critical Reflective Inquiry, over a 6-week orientation period. Participants completed the Health Sciences Reasoning Test (HSRT) before reflective journaling was implemented and at the end of their 6-week hospital orientation. Preliminary ResultsPreliminary results found that there were no significant mean differences in the total HSRT scores after the reflective journaling was implemented (t = 1.085, p = .328). However, there was a strong, positive, and significant correlation between participants’ baseline and post reflective journaling critical thinking scores in the deduction domain (r =.810, p = 0.051). Clinically significant differences in the pre- and post-test domain scores of the HSRT were evident in the interpretation, inference, explanation, induction, and numeracy domains. ConclusionNew graduated nurses may benefit from using reflective journaling into their hospital orientation, but more research is needed to determine efficacy.

“People are People”: Exploring Student-centred Design Thinking in the Co-creation of University Learning Experiences

This article explores the relationship between a co-created student project and people-centred design thinking. Through a critical reflective inquiry approach, we explore the broader challenges and implications of implementing people-centred design principles, as opposed to approach, in the context of Higher Education today. The article is guided by the experiences of two academic members of university staff and their engagement with an innovative student-centred project and pedagogical framework titled Thinking Inside the Box. The purpose of this intentionally critical self-reflection is to mobilise these experiences of student-centred design thinking to identify learner and professional opportunities, challenges to innovation and other touchpoints at the individual, tactical, operational and strategic levels.

Actors of Community Development: Insider and Outsider Perspectives

The diverse socio-economic and geographical situation of Nepal contributes to the complexity of community development. In such varied contexts, holistic community development faces many challenges, addressing cross-cutting issues like health and education, which may be viewed differently by men and women, as well as different castes, ethnicities, economic status, political associations and religions. The community's well-being must be the central focus of every development intervention, yet there is no one opinion that reflects the diversity of opinions within every community. How can community development practitioners listen to all viewpoints and find an accepted method to achieve grassroots development in such a complex environment, when they themselves come from diverse backgrounds and education, and bring their own attitudes and opinions? The central focus of this study was to investigate the reflective practices of community development at the grassroots level of rural Nepal. The study investigates the practices and perceptions of community development practitioners and their reflexivity regarding their life experiences and efforts to adequately relate to diverse communities. For this, critical reflective inquiry has been used. Practitioners with extensive experiences were chosen as research participants for that purpose. The life experience of both authors and the practitioners is interpreted through the lens of actor perspective on community development. Additionally, we consider how the insider and outsider perspectives of development practitioners may influence their work. Three key elements with the potential to directly interference the process of community development in rural Nepal were explored: local people as subjective forms of beneficiary; community development practitioners as mediators of interventions; and development policies as a roadmap of community inclusion. The dynamic involvement of these three elements is crucial to reach goals envisioned by community development interventions, yet often the practitioners are ignored. The paper concludes that the success of such interventions rests upon the active and reflective intercourse of this triangulation.

Leadership, Teamwork, and Collaboration: The Lived Experience of Conducting Multisite Research Focused on Quality and Safety Education for Nurses Competencies in Academia

The aim of this study was to explore facilitators and barriers to conducting a multisite national study in nursing academia unsupported by grant funding. Scholarship focused on the Quality and Safety Education for Nurses (QSEN) competencies stimulates opportunities for research and collaboration among nurse educators and clinicians. Twelve members of the QSEN Academic Task Force collaborated on a multisite study of the effectiveness of a QSEN teaching strategy and published the findings. A descriptive phenomenological reflective approach using Kim's critical reflective inquiry model was used to explore the lived experiences of the original study investigators. Data were analyzed using Colaizzi's phenomenological reduction. Findings revealed seven facilitators and one overarching barrier to conducting academic research projects of this scope. Participants found that strong leadership, a commitment to teamwork and collaboration, and a shared interest were critical to conducting a successful national study across academic settings.

Fostering Interdisciplinary Boundary Spanning in Health Communication: A Call for a Paradigm Shift

ABSTRACT Scholarship in the field of health communication is broad, with interdisciplinary contributions from researchers trained in a variety of fields including communication, nursing, medicine, pharmacy, public health, and social work. In this paper, we explore the role of “health communication boundary spanners” (HCBS), individuals whose scholarly work and academic appointment reflect dual citizenship in both the communication discipline and the health professions or public health. Using a process of critical reflective inquiry, we elucidate opportunities and challenges associated with HCBS across the spectrum of health communication in order to provide guidance for individuals pursuing boundary spanning roles and those who supervise and mentor them. This dual citizen role suggests that HCBS have unique skills, identities, perspectives, and practices that contribute new ways of being and knowing that transcend traditional disciplinary boundaries. The health communication field is evolving in response to the need to address significant healthcare and policy problems. No one discipline has the ability to single-handedly fix our current healthcare systems. Narrative data from this study illustrate the importance of seeing HCBS work beyond simply being informed by disciplinary knowledge. Rather, we suggest that adapting ways of knowing and definitions of expertise is an integral part of the solution to solving persistent health problems.

Implementation and evaluation of a training programme to promote the development of professional competences in nursing: A pilot study

BackgroundClinical narratives may be used as a means to improve the acquisition of clinical competences. Even though there are studies that recognize the potential value of clinical narratives to promote nursing professional development, there is no evidence that shows their value as a tool to improve nurses' competences to provide person-centred nursing care. PurposeTo evaluate the preliminary efficacy of narratives for the development of three nursing professional competences —respect, intentional presence and knowing the person— for providing person-centred care. MethodUsing a pre-post quasi-experimental design, a pilot study with a total of 34 nurses enrolled in a training course of nursing specialization was conducted between September 2016 and June 2017. All the nurses received a multi-component intervention based on the Critical Reflective Inquiry model. The strategies of this programme consisted of writing three narratives, attending two masterclasses, participating in a discussion group, and participating in a face-to-face interview. The NarratUN Evaluation tool was used to assess the outcomes. Changes among nurses were analysed using the Wilcoxon signed Rank test. ResultsThe difference in the means between the pre- and post-intervention scores were statistically significant for respect [0.59 (95% CI 0.23–0.95; p = 0.001)], intentional presence [0.75 (95% CI 0.32–1.17; p < 0.0001)] and knowing the person [0.62 (95% CI 0.25–0.99; p = 0.001)]. The difference in the mean score for use of the narrative and reflection also increased significantly [0.65 (95% CI 0.32–0.98, p < 0.001)]. ConclusionsThe use of narratives combined with other reflective strategies (masterclass sessions and discussion groups) proved to be effective for the development of professional competences of nurses.

The Impact of Critical Reflective Inquiry Education on Experienced Nurses' Insights Into Practice.

Successful succession planning necessitates use of innovative strategies to encourage and support knowledge recovery and transfer. This quality improvement project evaluated the impact of a critical reflective inquiry workshop on experienced nurses' insights into practice. Nurses assessed written clinical narratives using the Critical Reflective Inquiry Assessment Tool before and after the workshop. Guided reflection led by nursing professional development practitioners fostered insight into practice, which is an essential step in supporting knowledge transfer to novice nurses.

Content Validation and Utility of a Critical Reflective Inquiry Assessment Tool.

A Critical Reflective Inquiry (CRI) Assessment Tool was developed based on the CRI Model to assess reflection in nursing practice. Experienced clinicians evaluated the CRI Assessment for clarity and relevance to the CRI Model and nursing practice utility. Content validity index was calculated for each item in the scale and then averaged across all items. The tool has potential in education and orientation for assessing the depth and focus of reflection and what is learned.

The use of critical reflective inquiry among American Baccalaureate Nursing Students in a global service learning experience in Haiti: A qualitative study

Background: Global service-learning (GSL) experiences are gaining increased recognition as essential nursing education components. Nursing students immersed in global communities contribute to society, through reciprocal partnerships, by improving health. GSL students should engage in reflection as a form of assessment, although there is limited empirical data onlearning outcomes, and no universal model of reflection exists. The purpose of this study was to better understand the nature ofpractice events students chose to describe during a week-long GSL experience in Haiti, their reflective analysis, and ability tocritique their experiences as a catalyst to change future practice. Methods: In this qualitative descriptive study, critical reflective inquiry (CRI) through guided journaling was utilized for ten nursing students who traveled to Haiti for clinical immersion. Data was analyzed using a template approach in relation to study aims and phases of the model. Results: CRI was a useful framework as students illuminated the progression of reflective thinking. Five categories in practice situations were delineated: a) ethical dilemmas, b) health promotion, c) professional role modeling and power of team, d)challenges in communicating and making a connection, and e) respect of the Haitian perspective. Students also articulated moralreckoning and ethical sensitivity skills not previously reported in relation to GSL experiences. Conclusions: CRI could be considered a universal model of reflection for GSL experiences among nursing students. Use of focus groups in future studies may improve recall of student experiences as they often described same practice situations. It is difficult to determine if reflection can be maintained to transform practice, but long term impacts of GSL could be studied longitudinally. In contrast to current literature, students’ description of moral reckoning and ethical sensitivity skills pose a challenge to nurseeducators about how to further develop these essential skills post GSL immersion.

What do nurses think they are doing in pre-school autism assessment?

This study reports on the perspective of all the specialist nurses in community paediatric teams in one NHS trust on their role in pre-school autism assessment. Kim's critical reflective inquiry research method ( Kim, 1999 ) was adapted through the inclusion of the researcher as a participant. Participants reflected on the nursing beliefs and values they hold in common, and on their actions in practice. The study found that the beliefs and values held by these nurses, and their intention to offer holistic nursing delivered through a professional relationship of care, correlated with the kind of care that parents have said families need, and make a unique contribution to team assessment.

Exploring the Use of Critical Reflective Inquiry With Nursing Students Participating in an International Service-Learning Experience.

Increasing interest in providing international educational experiences for nursing students has led to a variety of short-term international service-learning experiences. However, the impact of these experiences has not been clearly articulated. In this qualitative descriptive research study, Kim's critical reflective inquiry model was used to help guide students in reflecting on and identifying the impact of an international service-learning program in the Dominican Republic. The model was helpful in promoting in-depth description and reflection on the students' underlying assumptions and values, as well as identifying beginning strategies for emancipation in specific patient care situations. Providing a group process for critical reflection may optimize the perspective transformations in meeting the goals and objectives of the experience.

Australian Nurse Practitioner Practice: Value Adding through Clinical Reflexivity.

The role of the Australian Nurse Practitioner (NP) is in its infancy and at a crossroads where extensive research demonstrates effective quality care and yet the role remains underrecognised and underutilised. The translation of practice into “value” is critical for the sustainability of NP roles and requires the practitioner to adopt a systematic method of inquiry. Kim's (1999) “Critical Reflective Inquiry” (CRI) method was adapted by two Australian NPs who specialise in diabetes and chronic disease management. Kim highlights the intent of CRI as understanding the meaning of practice, delivering improvements to practice through self-reflection, and the critique of practice that can lead to practice changes and development of new models of care translated to “products” of value. Based on the thematically analysis of 3 years of CRI application, the authors formed 5 headings that represented the NP's practice as Specialised Care Access, Complications and Diagnostics Interventions, Pharmaceutical Treatment, Vulnerable Populations, and Leadership. The utility of CRI demonstrates how NP practice is integral to a continuous cycle of addressing health care services gaps, and the conversion of “products” into “value” and positions the NP to assimilate the role of the practitioner-researcher.

Exploring problems encountered among experienced nurses using critical reflective inquiry: implications for nursing professional development.

This study explored problems encountered by nurses using critical reflective inquiry to examine clinical situations and the impact of group discussion on the reflective process. Secondary qualitative analysis of 19 reflective situations, rom a reflection continuing education program, revealed that nurses had problematic pauses in reflection and were stuck in cyclical self-questioning. Peer group discussion prompted deeper reflection. Experienced nurses may need assistance to enhance the comprehensiveness, depth, and scope of reflection on practice situations.

A Mixed Methods Evaluation of an International Service Learning Program in the Dominican Republic

To examine the impact of an international service learning experience (ISL) using a quantitative and qualitative approach. A descriptive study was used to explore the impact of an ISL experience on global awareness, professional and personal growth with 11 baccalaureate nursing students in the Dominican Republic. Students participated in a three credit ISL program in the Dominican Republic which included pre- and postexperience seminars and a 2-week, on-site immersion experience. The International Education Survey (IES) was used as the quantitative measure. Content analysis of Critical Reflective Inquiry (CRI) narratives was used as the qualitative method. Students reported a high overall impact (M = 5.9) using the IES with high means for the Professional Student Nurse Role (M = 6.10, SD: 0.74), Personal Development (M = 6.08, SD: 0.76), International Perspectives (M = 6.03, SD: 0.71), and a lower mean for Intellectual Development (M = 5.40, SD: 0.69). CRI narratives revealed specific areas of impact, for example, increased empathy and ability to communicate effectively with patients from life situations very different from their own. Further exploration of the usefulness of various evaluation tools and methodological designs is warranted to understand this type of pedagogy and its' impact on student learning outcomes short- and long-term.

Learning Outcomes And Self-Assessments Of Baccalaureate Students In An Introduction To Nursing Course

This study investigated how students (N=64) assessed the process and meaning of their learning of course competencies, using critical reflective inquiry. At the conclusion of an introduction to nursing course, beginning students were asked to reflect upon what and how they had learned, to consider what course competencies they had met, and to identify the learning experiences that facilitated them. Written responses were categorized and coded by course competencies using the selective coding method, and then ranked for degree of self-assessment (SACD). A significant relationship was found between final grade in the course and SACD (r=.676, p <.000.), as well as GPA at beginning of junior year (r=.420, p< .037). This study of student reflexive practice contributes to an understanding of the process of competency development in nursing students as they progress from novices to competent generalists

Critical reflective inquiry for knowledge development in nursing practice.

This paper presents a method of inquiry which uses nurses' situated, individual instances of nursing practice as the basis for developing knowledge for nursing and improving practice. This method of inquiry is founded upon the ideas in action science and reflective practice, and critical philosophy. Nursing practice is viewed as a rich source of new knowledge as practitioners are engaged in creating as well as modifying knowledge to respond to specific clinical situations. At the same time, practitioners may be in practice without recognizing deficiencies or ineffectiveness. As a method to tap these two aspects of practice, the inquiry is designed to encompass three phases, i.e. descriptive, reflective and critical/emancipatory, and is oriented to provide understanding to practitioners of the nature and meaning of their own practice, to correct and improve practice through self-reflection and critique, and to generate models of 'good' practice and theories of application as well as to discover processes of practice as played out in clinical situations. This method of inquiry can be used by nurses and nursing students in collaboration with researches or mentors to develop nursing knowledge about practice, improve individual practice, and engage in shared learning.