With a view towards understanding how students develop new knowledge and practices that facilitate role development in the clinical and simulation settings, the purpose of this project was to examine the process by which new knowledge is absorbed and processed leading to perspective transformations and ultimately role development.
In considering how students learn, constructivist pedagogy involves active learning where students have an opportunity to challenge previous thoughts on content and try out different aspects of their future role with guidance (Handwerker, 2012). This active learning helps a student develop metacognition and an ability to transfer knowledge and skills to new situations ultimately resulting in the development of clinical reasoning and a sense of relevance. The clinical and simulation environment is an ideal place for active learning. Recent work by Arreciado Maranon and Ilsa Pera (2015) reinforce the value of clinical education in forming student identities particularly as they are given an opportunity to examine this education in light of what was learned in the classroom. Students often come into clinical experiences with preconceived notions of what they will see and do, though there are numerous occasions when something unexpected occurs (Palese, Petean, & Cerne, 2013). Furthermore, many nursing students experience an incongruity between what they are taught in the classroom and what they experience in the practice settings (Chappy, Jambunathan, & Marnocha, 2010). Understanding how students process, reconcile, and learn from what is studied in the classroom compared to what is experienced in the clinical setting and how this facilitates learning and role development was examined.
Methods:
Influenced by Mezirow’s (1978) Transformative Learning Theory, Tanner’s (2006) Clinical Judgement Model , and Benner, Sutphen, Leonard, and Day’s (2010) landmark work on Educating Nursesa constructivist approach was adapted in the development of a new model for describing the process of learning and role development in the clinical and simulation setting. This approach involved reviewing the literature, re-analyzing themes, development of multiple schematics, continual review, personal observations of students in the clinical and simulation settings, and feedback from peer educators. The resulting Reflection, Feedback, and Restructuring Model was developed.
Results:
The Reflection, Feedback, and Restructuring Model describes an inductive, iterative process strongly influenced by feedback. The first component of the model depicts a new experience encountered by the student. The second component focuses on the student’s reflection of the event where an attempt is made to interpret the event in the context of what is known or has been learned in the classroom. Within this reflection component is an inductive response in terms of identification of gaps in knowledge (if any) and formulating a plan for responding should this event occur again. The next step in the process draws on the literature related to the value of formative feedback which has been described as an essential component of student learning and improves performance and skills, motivation, personal development, and confidence (Koharchik, 2016; Motley & Dolansky, 2015; Plakht, Shiyovich, Nusbaum, & Raizer, 2013). The final step in the process of student learning and role development involves restructuring. In this phase, the student responds to the feedback and adopts a new perspective of what is appropriate given what was experienced. The student may recognize he or she may need to restructure preconceived notions or ways of doing things. Finally the student emerges with a new sense of what is normal and expected nursing actions. This new normal serves as foundation for future nursing action and role development.
Conclusion:
A key component of nursing education is the integration of knowledge and practice for the development of critical thinking skills that inform subsequent action in the practice setting when providing patient care. For many students, a component of the learning involves reformulating and re-conceptualizing what is learned in the classroom with what is seen and experienced in the clinical setting. The model was used as a conceptual framework to guide the development of reflective questions used by Schuler (2016) examining professional role conceptions following a shadowing experience. The Reflection, Feedback, and Restructuring conceptual model may be a useful tool to guide nurse educators facilitating the transition from the classroom to the clinical setting and facilitating knowledge and role development for the nursing student.
(Please note - an attempt was made to attach a figure to this abstract that depicts the model was unsuccessful).