Using Critical Reflective Inquiry to Enhance Reflection Among Acute Care Nurses

Monday, 18 November 2013: 10:00 AM

Marilyn E Asselin, PhD, RN-BC
Adult/Child Nursing, College of Nursing, University of Massachusetts Dartmouth, North Dartmouth, MA
Donna Schwartz-Barcott, PhD, RN
College of Nursing, University of Rhode Island, Kingston, RI

Learning Objective 1: Describe the kind of situations identified and problems encountered by acute care nurses reflecting on practice.

Learning Objective 2: Explore the extent to which group discussion using Critical Reflective Inquiry may facilitate or inhibit reflection on practice.

Reflection, a learned skill involving complex critical thinking, is viewed as an essential component of professional practice. Several reflection models exist however, there is limited research on the use of any one model in practice.  Kim’s Critical Reflective Inquiry (CRI) Model offers a structured approach to reflection using question cues plus reflective narratives to guide the practitioner. Recently, the authors used Kim’s model in a study involving individual and group facilitated, structured reflection, to explore its use with staff nurses.  Nurses wrote a series of CRI narratives which illuminated problems they encountered when reflecting on clinical situations. Three research questions guided this descriptive study using qualitative content analysis to examine 21 CRI narratives from 6 experienced and practicing acute care nurses. How was each situation framed by the nurse? What major problems did the nurses encounter? In what ways did the CRI group discussion inhibit or facilitate reflection? Narratives were framed as problematic clinical situations but initially were not fully described and analyzed in great depth.  A major problem was that the nurses tended to become stalled in the process of reflecting.  For some, this was a holding onto the situation without further reflection for a considerable period of time (up to 2 years). For others, it was being stuck in their thinking and continually replaying the situation without being able to move beyond their current thinking towards a resolution. Additionally, for some the reflection evolved over time culminating in an intention to change practice. Group cohesiveness fostered in-depth, structured discussion leading to more comprehensive descriptions, critical analyzes and resolutions of the reflections. Implications include the recognition that reflection on one’s own may result in prolonged, stalled reflective thinking and may not be as productive as group discussion using CRI. CRI has the potential to enhance critical reflection in practice.