the centrality of reflexivity · the centrality of reflexivity- challenging undergraduate nursing...
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The centrality of reflexivity- challenging undergraduate nursing
students to “meet people where they are at”!
Cathy Graham, RN, MSc. Trent/Fleming School of Nursing Peterborough, ON.
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I inspiring nursing as if every
person matters
Advocacy Social Justice Relational Practice
Aging Environmental health Indigenous health Rural nursing Women’s health
Ethics Leadership Lifelong learning Professional practice Safety
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Theory, research, practice connections
Theoretical course family nursing as relational
inquiry
ask questions of ourselves, our contexts of practice as well as our patients
pragmatism, relational inquiry, socio-environmental health promotion, cultural safety, reflexivity, being in-relation, relational capacity and nursing across difference
Clinical practice course navigate the complexities of
family nursing.
relational inquiry
knowledge of family nursing, related theories and scholarly literature.
health-promoting, evidence-based practice, reflecting principles of family nursing as relational practice.
accountability and professionalism
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Underpinnings of relational inquiry
Knowledge development
Habits of practice
Relating with
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Looking in the Mirror
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Reflexivity and ways of knowing
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Reflexivity & Inquiries Observation: intrapersonal
Critical scrutiny: interpersonal
Conscious participation: contextual
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Reflexivity as integral to conscious participation and self
knowing
Not simply paying attention to your feelings, thoughts and emotions Not just thinking back on
what happened
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Self observation
Emotions and bodily knowing
Consciously asking: what am I thinking, feeling, doing in this clinical situation?
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Critical (self) scrutiny
What are my assumptions? What are my beliefs? What are my attitudes in this
clinical situation? How can I check out my
knowledge in this clinical situation?
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Conscious Participation
What I will do in this clinical situation now that I have reflected upon it? (rather than
responding habitually or unconsciously)
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Our concerns vs patient concerns
Paying attention develops our awareness of what we bring to our practice so that we do not inadvertently privilege our own concerns over families
Conscious participation ensures we consistently ask what is meaningful to this person/family
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Questions for reflexive practice
What was the goal of the interaction? Why did I respond as I did? What were the consequences for the
patient? What were the consequences for me? How was the patient feeling? How did I know
this? How did I feel? What influenced me to feel this way?
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Questions for reflexive practice
How did my actions match my beliefs?
Why did I act the way I did? What knowledge influenced me? What knowledge should have
influenced me? What did I learn from this
situation?
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Building reflexivity
Journaling (re)visiting Beliefs about mental illness Guest speakers Post conference discussion:
dedicated time for writing/discussion Scholarly reflective writing that
integrates theory, research & practice
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John’s model of Structured Reflection
reflection:
what was I trying to
achieve, why and what are
the consequences
? influencing
factors: what
internal/external factors &
knowledge affected my
decision-making?
Could I have dealt with this better:
what other choices did I
have and what would be the
consequences of those choices?
Learning: how did I feel about
this experience? what will change
because of this experience? how has this experience
changed my ways of knowing?
START HERE description of
the experience and significant
factors
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Project results to-date
Teacher perspective Role-modeling of
reflexivity is challenging: sense of vulnerability about uncertainty & ambiguity
Creating a safe place to examine clinical experiences is very individual and occurs over time
Student perspectives Confronting assumptions Identifying one’s privileges Writing gets experience out of
my head There is no one right way Nursing is much more that
DOING Learning to honour the
patients’ experiences Appreciating the complexities
of clinical practice Learning to find my voice
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References Freshwater, D. & Rolfe, G. (2001). Critical reflexivity: A politically and
ethically engaged research method for nursing. Nursing Times Research 6: 526. DOI: 10.1177/136140960100600109
Hartwick Doane, G. & Varcoe, C. (2015). How to nurse: Relational inquiry with individuals and families in changing health and health care contexts. Philadelphia, PA.: LWW.
Johns C (1995) Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing. 22, 2, 226-234.
Kaminski, J. (2013) Relational engagement as the heart of continuity of care in nursing education. Retrieved from http://nursing-informatics.com/Kaminski_RelationalEngagement.pdf
Morrow, E. (2009).Teaching critical reflection in healthcare professional education. Retrieved from http://www.kcl.ac.uk/study/learningteaching/kli/research/hern/hern-j1/elizabethmorrow-hernjvol1.pdf
Newton, JM. (2000) Uncovering Knowing in Practice amongst a Group of Undergraduate Student Nurses. Reflective Practice: International and Multidisciplinary Perspectives, 1:2, 183-197, DOI: 10.1080/713693152