Promoting reflective practice for nursing students through an arts based workshop.

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When did you first introduce the innovation?

Less than 12 months ago

Please describe the innovation you have developed

We developed an innovative arts based workshop for student nurses to¬†encourage them to reflect on an event or experience they have encountered in a clinical context that has impacted on them emotionally. During the workshop we assisted them to transform a piece of their own reflective writing about this event/experience into a Haiku. Having created their own Haikus, the students were then provided with a selection of art materials needed to create their own ‘Poem House’ in which to house their Haiku. A ‘Poem House’ is a three dimensional artefact that combines visual interpretation with poetic text and which holds special significance for the maker (Grisoni and Collins, 2012).

What prompted you to develop this innovation?

As part of their undergraduate degree student nurses are required to reflect on their academic and clinical experiences and to evidence what they have learned. Reflection on their clinical placements takes the form of written records which contributes to their clinical portfolio. This is a compulsory element of their degree programme. However, students often perceive this requirement as a chore and can fail to see its value. In addition, these written reflections tend to be very factual in nature. Even when encouraged to use a model for reflection e.g. Gibb’s (1988) in which feelings play an integral part, students appear to be uncomfortable documenting and sharing their emotions in this way. I picked up a sense of this from one to one meetings I have had with my personal tutees. They express concern that if they were to acknowledge and record their emotions they may be ‘judged’ and’ found wanting’. They tell me it is therefore easier just to ‘leave them out’. I also had first hand experience of reading and verifying hundreds of these reflective pieces so I knew this to be true.

In your view, what is it about this innovation that makes it different/important?

Several studies have demonstrated the value that arts-enriched reflection can bring to professional development activities within health care (Seymour 1995, Rutland and Ahern 2007) and it is recognised that artistic expression encourages self-reflection (Rabow, 2003). However, opportunities to be creative within the curriculum can be limited. So I embraced the opportunity afforded to me as part of Innovative Learning Week (an Edinburgh University initiative) to successfully apply for funding to put on this workshop.

The aims and objectives of this innovative workshop were to:

1. provide students with the opportunity to engage with a variety of arts enriched reflective activities
2. support students to process and deal with the emotional aspects of caring
3. encourage self-reflection thereby promoting self-awareness and resilience
4. encourage students to think more broadly about how they choose to undertake personal reflection in the future.

Through the use of several reflective techniques the students were encouraged and supported to revisit a significant emotional event in order to help them make sense of and learn from it. An awareness of self is very important to both personal and professional development. These students are the qualified nurses of tomorrow. By encouraging them to value and appreciate the benefits of reflection we were seeking to ensure that they learn how to be reflective practitioners who can remain so throughout their professional nursing careers.

To what extent does your innovation make use of existing approaches, resources or technologies?

Our innovation takes as its focus the need to encourage reflective practice in our nursing students. However, rather than following the routine practice of asking students to evidence this by capturing their reflection in a text-based format we developed an art based workshop to explore with them other ways to come at this reflection.

To what degree has this innovation led to changes in education or clinical practice?

Students report that they have changed the way they view reflection (please see comments in the next section) and have felt more comfortable introducing pictures and other art work into their clinical portfolios in which they must provide evidence of their reflection. They have also indicated that they are more prepared to acknowledge and write about their emotions than they were before they participated in this workshop. I have certainly noticed a difference when reading through their clinical portfolios.

What evidence do you have of the impact of the innovation?

The student evaluation of the workshop was extremely positive.

In addition, focus groups were held, as part of an ongoing research project, after the workshop with the students who had attended. One student commented that ‘I couldn’t understand how I could reflect in my EU Directives. I just couldn’t do it. So I would just list things I had done and it was never good enough. After this workshop for my last placement I had about 5-6 pages of EU Directives and paragraphs of stuff. The workshop has absolutely changed my perspective on reflection. It unlocked my ability to be able to reflect on my experiences’.

Another student said ‘ I feel like I view reflection differently now. I’ve noticed things you could reflect on even when I am out on placement where before I wouldn’t have a clue what to reflect on’.

To what degree has the innovation been disseminated in your organisation or elsewhere?

Following the workshop I organised a ‘pop up’ exhibition within the School so that the students had an opportunity to showcase and discuss their work. I invited colleagues from within our subject area and beyond as well as other key people such as the university’s Vice Principal for Curriculum Innovation and the Director of the Institute for Academic Development to join us. Their engagement on the night and their feedback following the exhibition was extremely positive.

Please provide details of any plans you have to disseminate the innovation in the future.

I am intending to submit an abstract to the RCN International Research Conference 2016.

I also have plans to write this up as a paper with a view to submitting it to ‘Nurse Education Today’ or similar.

I am also exploring the possibility of holding another exhibition within hospitals in NHS Lothian.