Critical Reflection as Strategy for Outcomes Evaluation, Its advantages Disadvantages and Issues In Nursing Education

Nursing Education and Critical Reflection as Strategy for Outcomes Evaluation, Its advantages Disadvantages & Issues

 

What is Critical Reflection?  In Nursing Education as Outcome Evaluation Tool, Advantages of Critical Reflection In Nursing Education for Outcome Evaluation, Disadvantages of Critical Reflection In Nursing Education for Outcome Evaluation, Issues of Critical Reflection In Nursing Education for Outcome Evaluation.

What is Critical Reflection?  In Nursing Education as Outcome Evaluation Tool 

    The development of self-assessment skills is key to student success and is an essential component of professional development (Benner et al., 2010; Bercher, 2012). The use of reflection is also a technique that can be used in inter professional education to improve awareness of the mental model individuals apply to a practical experience. 

    Shared mental models are defined as “individually held knowledge structures that help team members function collaboratively in their environments” (McComb & Simpson, 2014, p. 1479). Building shared mental models among team members is considered to enhance the effectiveness of the team. 

    Self-monitoring of clinical practice (paying attention to clinical actions while in the moment, purposely examining the effect of one' s actions, and using these insights to improve future thinking and practice) should be cultivated by health care professionals (Larkin & Klonoff , 2014) . 

    The concept of reflective practice developed from the work of Schoen (1984) in the early 1980s. Schoen determined two kinds of reflective thinking: The first occurs in the moment and can be characterized by the phrases “thinking on one's feet” or “mindfulness.” The second is reflection after the fact. Both of these reflective activities are important for practicing health professionals (Larkin & Klonoff , 2014, p. 56). 

    The purpose of self reflection is to create a more thoughtful, self aware, and reflective practitioner who will ultimately contribute to improved quality of care. Reflection generates attribution and judgment about performance that evokes an emotional response. These attributions and emotions can either enhance or decrease students' level of self-efficacy (Bercher, 2012). 

    The use of reflection on experiences as a learning tool promotes self-awareness and supports self directed learning when nursing students engaged in critical analysis (Tashiro, Shimpuku , Naruse, Matsutani , & Matsutani , 2013). The use of reflection as a learning activity encourages students to fully consider a question, an experience, or a thesis, and to process their thoughts. 

    For example, a reflection may focus on preclinical experience exploration of values, post clinical reactions to an experience, or a self-assessment of a component of professional development. The reflection itself may be implemented through a variety of techniques such as short (one- to two-page) papers, progressive journaling, or through oral questioning and discussion with individuals or in groups. 

    Reflections allow faculty to assess level of understanding and guide students in the awareness of their mental models, and help students expand critical thinking skills, which leads to professional development (Tashiro et al., 2013).

   Journaling can be a strategy for reflection and can be organized as a pre class (preparing for the class), intra class (as a result of activities conducted during the class or clinical experience), and post class (such as a homework reflection where examples may be used to demonstrate understanding of key concepts). 

    Evaluation of reflection is based on an educational connoisseurship model in which students become connoisseur critics. According to Eisner (1985), a connoisseur is able to appreciate and distinguish the important from the trivial. Although students may not have enough experience to be true connoisseurs, the faculty member can role model and coach students to develop these skills. 

    Bevis and Watson (1989), in a modification of Eisner's work, identified six levels of critiquing: looking, seeing, perceiving and intuiting, rendering, interpreting meaning, and judging. These steps include identifying an event, viewing it with a focus, interpreting the event on a personal level (complete with value clarification), and discerning the significance of the event. 

    Evaluation criteria can be built around these steps. Providing feedback to student reflections requires thoughtful responses by faculty. Effective assessment includes feedback about the student's efforts; individualized and clearly expressed comments that focus on the work not the student as an individual; and concern for the student's learning. 

    Faculty comments should focus on the learning to be obtained from the assignment. Seven components for responding to writing identified by Beach and Marshall (1991) are useful for response .

Advantages of Critical Reflection In Nursing Education for Outcome Evaluation

    As a strategy, reflection provides an opportunity to examine critical thinking and values awareness. The process of contemplative learning practices, including completing reflection on experiential learning, serves to reinforce the expected standards (O'Sullivan et al., 2012) and can contribute to deep learning (Kuroda, 2014). Sequential reflections provide evidence of learning over time.

Disadvantages of Critical Reflection In Nursing Education for Outcome Evaluation

    The use of critical self-reflection for evaluation requires time for both students and faculty. Students may experience initial frustration if the scope of the assignment is not well defined and the skills required for critiquing are not practiced. The process used to grade the critique must be clearly defined. For this type of assignment, the grading may be less focused on form, and more focused on the insights (Pohlman, 2013). 

    Defining the criteria for evaluation and clearly communicating them is essential. For example, Wyss, Freedman, and Siebert (2014) developed a grading rubric for online graduate student discussions, beginning with general directions and criteria. 

    The final rubric was centered on three key attributes and provided clear descriptions of what constituted minimal, basic, and proficient performance. These authors note that student performance improved with the implementation of the rubric.

Issues of Critical Reflection In Nursing Education for Outcome Evaluation

    Students must be oriented to the elements that are essential to a high quality reflection. The authors' initial experience with reflection found that students spent the majority of a written reflection assignment describing the event or incident, providing minimal analysis. If the purpose of the reflection activity is to provide evidence of analysis and application, then the assignment needs to be structured for this. 

    A three-part journal framework can accomplish this goal. The first section is for description of the event, the second section requests the student to demonstrate an understanding of the concepts by applying the content from the course to the experience, and the third section asks the student to apply the understanding gained from the analysis to a future professional experience. 

    Time involved for both students and faculty is an issue. Writing thoughtful reflections requires a time commitment on the part of students. Those who procrastinate may not obtain the benefits of the exercise. For faculty, reading and responding can be a lengthy process. 

    For example, if reflections are assigned in the framework of a sequential journal, faculty must decide whether they are going to read each entry for evaluation purposes or take a sample. The purpose of the assignment must be clearly established for its full benefits to be realized. Establishing grading criteria before students complete the assignment will convey outcome expectations. 

    Faculty feedback should also be of a critically reflective nature and may be most effective as a formative evaluation. The use of anonymity could be appropriate for grading this kind of assignment, because it can enhance objectivity on the part of the evaluator and minimize student fears that can inhibit honesty and creativity. 

    In critical reflection, the relationship of the student and faculty changes to shared power in the learning environment. The faculty student relationship becomes more collegial, and a high level of mutual trust and desire to grow is essential. It is also imperative that the philosophy of the school and faculty support the practice of critical reflection. 

    Students should also know who will view their reflections. If peers will view the reflections (eg, via threaded discussions, etc.) the amount of self disclosure students choose to provide may be affected. Confidentiality for the student reflection is an important consideration. If the reflection assignments are kept in an electronic format, password protection adds security.