Using Guided Reflection to Integrate Self-Care Practices in a New Graduate Nurse Program

Introduction: Jean Watson’s Caring Science theory and importance of self care foundational aspects of our Professional Practice Model (PPM); and although it is important for nurses to understand the framework for professional nursing, the process of enculturating new nurses to the organization includes only a brief introduction to PPM and Caring Science®. Prior to launching a new orientation program, called Foundations of Acute and Critical Care (FACC) for new graduate and experienced nurses, our organization used a traditional approach to orientation that focused on developing skills and knowledge with limited exposure to the ontological aspect of caring. This caring science integration project exposes the new nurse to the concept and importance of self-care practices using a guided reflection methodology.

Significance: The new graduate nurse is confronted by a health care environment riddled with a system-focus on outcomes and quality care. This environment places undue stress and strain on the new graduate at a time when they are in the process of skill acquisition to perform at the competent level of Benner’s domains (Benner, 1984). The expectations to meet the requisite competencies in addition to adjusting to a work schedule that consists of rotating 12-hour shifts leads to neglecting effective self-care practices. Nurse turnover in the first year of nursing is 25% (NSI Nursing Solutions, 2017). This rate outpaces all other nursing tenure categories (NSI Nursing Solutions, 2017). During the first year when graduates are transitioning from a theory-based approach to a practice approach, called the theory-practice gap, they often experience feelings of guilt and incompetence (De Swardt, Du Toit, & Botha, 2012).

Purpose: The purpose of this presentation is to share our project to incorporate guided reflection into the cadence of education as an instructional component of the twelve-week FACC training program to engage the learners to integrate self-care into their daily nursing practice.

Setting and Participants: The setting is a Magnet designated, academic medical center in California, USA.The participants are newly hired graduate nurses enrolled in the FACC training program. The FACC training program was developed in March 2017, and to date 50 new graduate nurses have completed the FACC program.

Project Description/Process: This project consisted in integrating one experiential learning modality of the FACC program. The FACC program is a sequential learning program with a cadence that consists of lecture, on-line learning modules, unit precepted days and case study days. The last day of the program is a case study day that begins with faculty reminding the new graduate nurses the importance of self-care and presenting the activity for the day. Each group of learners has supplies at their table, rocks, crayons, markers, and paper. They are encouraged to participate in creating an artful piece that reflects their experience in the program over the past 12-weeks. At the end of the day, participants are invited to present their artwork and reflections regarding what the program has meant to them. Guided reflection is one method of building self-care practices designed to ‘challenge students to synthesize information and generate alternative solutions, opening the process to aesthetic and personal knowing’ (Wagner, 2002).

Project Outcome(s): The overarching anticipated outcomes will be a greater fulfillment as a nurse both professionally and personally as well as a positive impact for patients/families and collegial relationships. The primary outcome achieved was the participation in the guided reflection activity. The long term expectation is that each new graduate nurse will incorporate self-care and reflective practices for their personal and professional growth and development. In doing so, the nurse will integrate focused deliberation by increasing cognitive, self-awareness, affective, and cultural components of caring as well as insight dissemination to recognize and apply newly acquired knowledge to future patient interactions (Wagner, 2002; Watson, 2008).

Project Evaluation: All the new graduates in the program actively participated in the activity. They shared their artwork and expressed their thoughts and experiences including their plan to incorporate reflection into their nursing practice and lives.

Future Directions: Based on participant feedback, the guided reflection activity will remain as an integral part of the FACC program. Further discussion to determine the best evaluation method for this activity as part of the overall evaluation of the FACC program and self-care practice integration is ongoing.