Reflection : Storytelling

Challenge

Want students to use these aspects of storytelling to better understand their experiences and  actions therefore through the use of story, students engage in an active learning process  whereby they actively read and reflect on their stories. At the same time the professor is  offered a window into the student’s understanding of the clinical incident. Through reflection,  we focus on the context of the story and, through the use of guiding questions, students begin  to understand any implicit meanings. This helps then to intentionally connect their classroom  learning with real-life practice. Stories are shared between students in a small seminar class.  Our role as faculty is to guide a critically reflective dialogue within the small student discussion  group. Stories provide the mechanism for understanding as they can be reflected on,  reanalyzed and understood.

In addition to guiding students to use their critical thinking skills in a clinical story context, we  also want them to begin to understand something about their thinking process. So we talk  with them a bit about critical thinking and problemsolving, and help them make connections  between these terms. In this way they begin to more closely focus on their own thinking  processes. Our learning objective reflects both of these considerations

Selection

Following presentation, discussion and assigned learning activities, the students will be able  to:

1. Use elements of storytelling to help them analyze and learn from their clinical practice  experiences.

2. Improve critical thinking skills (analysis, inference, explanation and evaluate) through  stories that they tell about their clinical practice experiences.

3. Analyze and discuss the knowledge that they have gained from actual clinical experiences

4. Discuss the characteristics, skills, and attitudes of the critical thinker, and relationship  between the concepts: nursing process, critical thinking, problem-solving and decision- making.

Application

In the early weeks of the course, students have had very few clinical experiences prior to and  in the first two months of the course. Through student participation in the critical reflection  seminar at the end of the semester, we help students to make connections between what  they learned early in the course through the use of case studies in the classroom and lab, to  what they experienced during their clinical experiences.

We review the stories that the students have submitted for the reflective seminar, and  prepare for the guided reflective dialogue that will occur in the seminar by analyzing the  stories for their possible meanings. Each instructor works individually with approximately 24  students divided into 3 small groups. It has been our experience that faculty can become  overwhelmed with the amount of time guided reflective dialogue takes in order to make

learning meaningful. Preparing for the seminar in advance by reviewing the stories helps us  to keep the reflective dialogue from moving into a “feedback” session.

Critical conversations help students to move from telling what they know to why they know.  Engaging learners in a critical dialogue also emphasizes the use of questions that fairly and  respectfully challenge information. This type of question helps students to ignore  unnecessary and irrelevant information and determine the aspects of the care situation that  are significant. They assist students to reconstruct a situation, defend an action, hypothesize  an expected consequence, identify values, and judge the appropriateness of an action.

Insight

The reflective seminar is conducted at the end of the semester after the students’ first clinical  experience. Students’ examine their experiences in the clinical setting using their critical  thinking skills, connecting the theory they learned in the classroom to actual clinical practice.  They meet in small seminar groups, each group taking place over a 3-hour period of time. As  the students begin to engage in their own clinical experiences, guided reflection becomes a  more personal learning activity. Student’s prepare for this activity by reflecting on their own  clinical experiences and turn them into stories. Stories of their clinical experiences are then  shared and discussed during the post clinical seminar. Using guided questions, like those  outlined in Figure 2, faculty guide the students in a reflective dialogue to reinforce the  learning connections the students are making and reinforce their use of critical thinking skills.  Students document their learning insights into their story by creating a post-seminar  reflection using the guided questions outlined in Figure 1. This seminar exercise provides us  insight into how best to train each individual student’s clinical judgment skills. We can assess  both how they applied clinical knowledge to the case at hand and their strength in using  critical thinking skills. Their responses to our seminar questions and their written reflections  allowed us to examine what guided their thinking about the clinical case, and to see how they  measured their personal learning accomplishments. Figure 3 is a short segment from one  students’ reflective journal.

Application

In the early weeks of the course, students have had very few clinical experiences prior to and  in the first two months of the course. Through student participation in the critical reflection  seminar at the end of the semester, we help students to make connections between what  they learned early in the course through the use of case studies in the classroom and lab, to  what they experienced during their clinical experiences.

We review the stories that the students have submitted for the reflective seminar, and  prepare for the guided reflective dialogue that will occur in the seminar by analyzing the  stories for their possible meanings. Each instructor works individually with approximately 24  students divided into 3 small groups. It has been our experience that faculty can become  overwhelmed with the amount of time guided reflective dialogue takes in order to make  learning meaningful. Preparing for the seminar in advance by reviewing the stories helps us  to keep the reflective dialogue from moving into a “feedback” session.

Critical conversations help students to move from telling what they know to why they know.  Engaging learners in a critical dialogue also emphasizes the use of questions that fairly and

respectfully challenge information. This type of question helps students to ignore  unnecessary and irrelevant information and determine the aspects of the care situation that  are significant. They assist students to reconstruct a situation, defend an action, hypothesize  an expected consequence, identify values, and judge the appropriateness of an action.

Approach

Part of an introductory baccalaureate nursing assessment course where students are  beginning to learn how to assess a clinical case. In this course, stories are integrated into the  teaching approach in an effort to begin developing a foundation for students to think within  the context of nursing practice. Because we believe that this pedagogical approach is very  effective for building critical thinking skills, we introduce this story approach early in the  course. The class session we outline here would fit well in any clinical course with health  science students involved in beginning clinical experiences.

Creating context assists students’ abilities to share their thoughts and feelings about clinical  practice experiences and to reflect and make meaningful learning connections. We want  them to practice using critical thinking in the context of these stories and make meaningful  learning connections. We believe that their successful learning will motivate them to transfer  these cognitive behaviors to actual practice. These exercises will facilitate their development  to critically think in practice.

