A model to facilitate reflective thinking in clinical nursing education

D.Cur.The overall aim of the study is to describe a model to facilitate reflective thinking of learners in clinical nursing education. This aim is realised through exploration and description of the meaning of reflective thinking in phase one of the study using Wilson (1963). Theoretical validity was ensured. The results of phase one provided a conceptual framework to direct data collection in phase two by exploring and describing the perceptions of nurse educators with regard to how reflective thinking of learners can be facilitated in clinical nursing education. An etic approach to qualitative data analysis as described by Morse (1994) was used, with matrices (Miles & Huberman, 1994) to provide meaningful categories, subcategories and themes. Both the results of phase one and two provided the main concepts, which were classified and defined within Dickoff, James and Wiedenbach (1968:435)'s six components of the survey list. Conceptualisation of the six components constitutes phase three of the study. Lastly phase four deals with the description and evaluation of the model with guidelines to operationalise the model. Nurse educators, who are facilitators, are challenged with the responsibility to establish quality clinical nursing education in line with the international norms, ethics, legal and professional standards. They are challenged with the creation of the environment conducive to facilitate reflective thinking through interaction. The facilitative interactive methods of teaching and assessment based on the constructivistic approach to learning demands dialogue, discourse and narratives, and therefore problem-based learning, outcomes-based education and community-based education using the PHC principles forms an integral aspect in creating the environment conducive to the facilitation of reflective thinking in clinical nursing education. These teaching and learning approaches needs active involvement of the learner in constructing his/her own clinical knowledge, skills, attitudes and values through collaborative, co-operative shared activities in partnership with all other stakeholders responsible to provide clinical learning opportunities for learners to integrate theory to practice. The affective component of both the facilitator and the learner actually drives the process of reflective thinking in a specific cultural context. The traditional methods of teaching and evaluation hinder the facilitation of reflective thinking. Models and conceptual frameworks that address reflective thinking in nursing does not address how reflective thinking can be facilitated, hence the research question is "how can reflective thinking of learners be facilitated in clinical nursing education"? The explorative, descriptive, qualitative, theory generative and contextual design is used to describe a model to facilitate reflective thinking of learners in clinical nursing education, with guidelines to operationalise the model. Paradigmatic perspective with regard to man (facilitator and the learner), environment (clinical nursing education), reflective thinking (purpose) and the interactive facilitation as the dynamic of the study are described within Theory for Health Promotion in Nursing (1991). The constructivistic perspective provides the theoretical framework. The qualitative approach that is exploratory and descriptive for theory generation provides the methodological assumption. The results of concept analysis and the results of the perceptions of nurse educators with regard to how reflective thinking of learners can be facilitated in clinical nursing education provide conceptual meaning and identification. The identified major and minor concepts are classified and defined using Dickoff, James and Wiedenbach (1968:435)'s six components of the survey list. Through synthesis, at the end of each conceptualisation, concluding relational statements are described from which the model is inferred. The model is described using Chinn and Kramer (1991:107-125)'s method of theory generation and evaluation. Experts in qualitative research and model development do refinement of the model. The facilitator is responsible to create the environment that is stimulating and conducive for learning. The learner on the other hand is responsible for selfdirected, self-regulatory learning where active participation in the construction of own learning through interaction is the hallmark, in order to facilitate reflective thinking in clinical nursing education. Interactive facilitation is the dynamic through which reflective thinking has to be facilitated. Clinical nursing education provides the context. The procedure to facilitate reflective thinking of learners in clinical nursing education is through the three phases of reflective thinking guided by the adapted educational process in the format of the nursing process. Once the purpose of the model is achieved (reflective thinking), the learners will be expected to improve practice through rational decision making and solving of problems. They will be expected to practice independently and autonomously, and to view clinical situations holistically with changed perspective based on the existing conception. Learners will have acquired skills for lifelong learning. The described guidelines will assist nurse educators with the operationalization of the model in order to provide quality assurance in clinical nursing education, with subsequent provision of quality nursing care and the improvement of the credibility of the profession