Significance: The significance of this project was to provide a safe environment for nurses to reflect how their work is an embodiment of the essence of caring and the profession of nursing as they strive to achieve their goal of professional promotion. The work of this project illustrates the integration of all 10 Caritas Processes as the foundation of our Professional Practice Model with the foundation of the PNPD process as defined by Benner’s (1984) seven domains of practice and levels of skill acquisition-novice to expert. The model of diagnostic reasoning and scientific problem solving, that has been traditionally used to teach the nursing process, does not encourage humanistic inquiry (Watson, 1988), holistic judgments (Wagner, 1998). Knowing nurse-self is a process that occurs within the context of multiple ways of knowing relational self. How one comes to know self in this context is not clear; reflection on clinical practice is one valuable way to integrate the cognitive, affective and cultural components of caring (Adamson and Dewar, 2015; Wagner, 1998).
Purpose: The purpose of this project is to share our experience of creating a biogenic (life sustaining) environment where the practitioner-to-practitioner relationship can flourish, allowing the expression of feelings through authentic listening, open communication, and practices of self-reflection the true work of nursing will be reflected by transpersonal experiences.
Setting and Participants: In a classroom setting, fifteen registered nurses (RNs), and two Assistant Nurse Managers participated in the initial eight-hour class for the Professional Nursing Practice Program. Subsequent six PNDP lounge sessions were held for additional support during the portfolio development writing process for submission.
Project Description/Process: The following activities were included during the initial class: centering table, flipped classroom, introduction of reflective practice with use of art supplies, sharing/reflecting on myths and anxieties related to PNDP process, reflective journaling describing levels of reflection and multiple ways of knowing, exemplar review consisting of review and analysis of sample exemplars, mock panel interview with personal testimony from recently promoted nurse, and ending the day sharing reflections demonstrated through words, art, and poetry. During PNDP drop-in lounges, the following changes were implemented: creation of zen space consisting of centering table, lighting, music, aroma therapy, and open discussion among peers, sharing exemplars and providing peer feedback to each related to reflective practice based on the narrative presented.
Project Outcome(s): Class evaluation; qualitative and quantitative, successful promotion during the October submission period for PNDP by number of initial class participants who applied were used to determine project outcomes. Survey were sent to candidates related to preparation process; evaluation of results. During drop-in lounges: personal, verbal feedback as people come into the space.
Project Evaluation or Partial/Projected Evaluation if not completed: Class evaluation, personal testimony, and post panel interview survey were used for project evaluation. Initial class overall evaluation was 4.93 out of 5 on a Likert scale and participant comments alluded to a decrease in anxiety writing exemplars, better understanding of how the exemplar should be written taking into consideration the various clinical level domains, and value of creating community. Feedback from drop in lounges included comments related to the relaxed atmosphere and calm demeanor of the facilitator that contributed to feeling free to share fears and concerns in a safe and supporting environment.
Future Directions: Future direction includes introducing reflective journaling to the Nurse Residency Program Cohorts; utilization of exemplar writing for competency validation at the competent level. On-going evaluation of response and outcomes to interventions during class and drop-in lounges. Expanding support and availability to Shared Leadership members interested in pursuing PNDP promotion.