Critical reflection in team-based practice: A narrative review.

INTRODUCTION: Research on critical reflection (a process of recognising and challenging assumptions that frame health care practice) has demonstrated strong potential for making health care more collaborative and equitable, yet its enactment within team-based health care remains underexplored. We conducted a narrative review to advance understanding of how critical reflection develops, occurs in and impacts team-based practice and care. METHODS: We searched three databases (Medline, CINAHL and Scopus) for articles related to the concepts of critical reflection and/or critically reflective practice in the context of team-based health care and examined how teams engage with those theoretical concepts, to inform ideas for a new approach to support critically reflective practice. FINDINGS: The search identified 974 citations of which nine articles showed elements of critical reflection in team-based practice. However, since only one of the nine included articles explicitly used the term 'critical reflection' in their research, critical reflection as a theoretical concept was found to be largely missing from the current team-based health care literature. Instead, aspects of critical reflection were evident in terms of challenging power hierarchies and questioning practice assumptions through dialogue, with a goal of collaborative practice. This sharing of knowledge and skills allowed teams to push boundaries and innovate together in practice. The included articles also emphasised the importance of creating a purposeful environment for open dialogue and practice change to occur. CONCLUSION: To support equitable care through collaborative practices, we suggest dialogue as and for critical reflection should be explicitly developed and researched within team-based health care.

Transformation and Articulation of Clinical Data to Understand Students' and Health Professionals' Clinical Reasoning: Protocol for a Scoping Review.

BACKGROUND: There are still unanswered questions regarding effective educational strategies to promote the transformation and articulation of clinical data while teaching and learning clinical reasoning. Additionally, understanding how this process can be analyzed and assessed is crucial, particularly considering the rapid growth of natural language processing in artificial intelligence. OBJECTIVE: The aim of this study is to map educational strategies to promote the transformation and articulation of clinical data among students and health care professionals and to explore the methods used to assess these individuals' transformation and articulation of clinical data. METHODS: This scoping review follows the Joanna Briggs Institute framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for the analysis. A literature search was performed in November 2022 using 5 databases: CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science (Clarivate). The protocol was registered on the Open Science Framework in November 2023. The scoping review will follow the 9-step framework proposed by Peters and colleagues of the Joanna Briggs Institute. A data extraction form has been developed using key themes from the research questions. RESULTS: After removing duplicates, the initial search yielded 6656 results, and study selection is underway. The extracted data will be qualitatively analyzed and presented in a diagrammatic or tabular form alongside a narrative summary. The review will be completed by February 2024. CONCLUSIONS: By synthesizing the evidence on semantic transformation and articulation of clinical data during clinical reasoning education, this review aims to contribute to the refinement of educational strategies and assessment methods used in academic and continuing education programs. The insights gained from this review will help educators develop more effective semantic approaches for teaching or learning clinical reasoning, as opposed to fragmented, purely symptom-based or probabilistic approaches. Besides, the results may suggest some ways to address challenges related to the assessment of clinical reasoning and ensure that the assessment tasks accurately reflect learners' developing competencies and educational progress. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50797.

A conceptual framework of student professionalization for health professional education and research.

OBJECTIVES: To present a conceptual framework of student professionalization for health professional education and research. METHODS: Synthesis and discussion of a program of research on competency-based education. RESULTS: Competency-based education relies on active, situation-based group learning strategies to prepare students to become health professionals who are connected to patient and population needs. Professionalization is understood as a dynamic process of imagining, becoming, and being a member of a health profession. It rests on the evolution of three interrelated dimensions: professional competencies, professional culture, and professional identity. Professionalization occurs throughout students' encounters with meaningful learning experiences that involve three core components: the roles students experience in situations bounded within specific contexts. Educational practices conducive to professionalization include active learning, reflection, and feedback. CONCLUSIONS: This conceptual framework drives a research agenda aimed at understanding how students become health professional and how learning experiences involving action, reflection, and feedback foster that process and the advancement of professional practices.

e-Health interventions for healthy aging: a systematic review.

BACKGROUND: Healthy aging (HA) is a contemporary challenge for population health worldwide. Electronic health (e-Health) interventions have the potential to support empowerment and education of adults aged 50 and over. OBJECTIVES: To summarize evidence on the effectiveness of e-Health interventions on HA and explore how specific e-Health interventions and their characteristics effectively impact HA. METHODS: A systematic review was conducted based on the Cochrane Collaboration methods including any experimental study design published in French, Dutch, Spanish, and English from 2000 to 2018. RESULTS: Fourteen studies comparing various e-Health interventions to multiple components controls were included. The target population, type of interventions, and outcomes measured were very heterogeneous across studies; thus, a meta-analysis was not possible. However, effect estimates indicate that e-Health interventions could improve physical activity. Positive effects were also found for other healthy behaviors (e.g., healthy eating), psychological outcomes (e.g., memory), and clinical parameters (e.g., blood pressure). Given the low certainty of the evidence related to most outcomes, these results should be interpreted cautiously. CONCLUSIONS: This systematic review found limited evidence supporting the effectiveness of e-Health interventions, although the majority of studies show positive effects of these interventions for improving physical activity in older adults. Thus, better quality evidence is needed regarding the effects of e-Health on the physiological, psychological, and social dimensions of HA. SYSTEMATIC REVIEW REGISTRATION: The review protocol was registered in PROSPERO (registration number: CRD42016033163).

[Clinical surveillance process by expert critical care nurses: Illustration of the results of a study in nursing from a clinical vignette]. / Processus de surveillance clinique par des infirmières expertes de soins critiques : illustration des résultats d'une étude en sciences infirmières à partir d'une vignette clinique.

In nursing, surveillance is generally presented as an essential element to ensure patient safety. In order to better understand how clinical surveillance is put into practice by expert nurses, a study in nursing was conducted in 2016. This article aims to present the results of this research with a clinical vignette to make concrete the links that exist between theory and practice. This will result in a better understanding of the surveillance process by expert nurses in critical care settings.

The clinical surveillance process as carried out by expert nurses in a critical care context: A theoretical explanation.

BACKGROUND: Nursing Science presents surveillance as an indispensable component of patient safety. Although the literature defines surveillance fully, its implementation is not well understood. AIM: This research aims to formulate a theoretical explanation of the surveillance process that expert nurses employ in critical care. METHOD: To develop the theoretical explanation for the surveillance process of critical care nurses, Strauss and Corbin's (1998) grounded theory approach and Think Aloud Method (Fonteyn et al., 1993) were used with fifteen expert critical care nurses (n=15). FINDINGS: Surveillance in critical care is a continual process of collaborative vigilance that starts with the thought process and behaviour related to data collection, analysis and interpretation. The surveillance process comprises five key elements: 1) Managing the risk of complications; 2) Collecting data; 3) Detecting a problem; 4) Making a decision and 5) Working in synergy. CONCLUSION: In developing a theoretical explanation, this research leads to an understanding of the surveillance process performed by expert nurses in a critical care context.

Ethical competence: An integrative review.

BACKGROUND: Ethics, being a fundamental component of nursing practice, must be integrated in the nursing education curriculum. Even though different bodies are promoting ethics and nursing researchers have already carried out work as regards this concept, it still remains difficult to clearly identify the components of this competence. OBJECTIVE: This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice. METHOD: An integrative review was carried out, for the 2009-2014 period, in the CINAHL, MEDLINE, and EMBASE databases and in the journal Nursing Ethics. The keywords nursing ethics or ethical competence were used in order to make sure to widely encompass the concept of "ethical competence" in the case of a university curriculum in nursing. In the end, 89 articles were selected. Ethical consideration: We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review. RESULTS: Ethical sensitivity, Ethical knowledge, Ethical reflection, Ethical decision-making, Ethical action, and Ethical behavior are the most frequently used terms with regard to ethical competence in nursing. They were then defined so as to better ascertain the possible components of ethical competence in nursing. CONCLUSION: Even though ethical competence represents a sine qua non competence in nursing practice, no consensus can be found in literature with respect to its definition. The identification of its components and their relationships resulting from this integrative review adds to the clarification of its definition. It paves the way for other studies that will contribute to a better understanding of its development, especially among nursing students and practicing nurses, as well as the factors that may exert an influence. More adapted education strategies can thus be put forward to support its development.

[Knowledge transfer and appropriation processes of nursing students and African settings of care: a multiple case study]. / Processus de transfert et d'appropriation des savoirs d'étudiantes en sciences infirmières et de milieux de soins Africains: une étude de cas multiples.

BACKGROUND: in this era of globalisation and international academic training, many nursing programs offer the possibility of intercultural placement to their students in their initial training. The rise of this phenomena is ubiquitous throughout all Canadian universities, leading to increased student mobility at the international level with increased placements being organised at the international level, on several continents. PURPOSE: this exploratory study aims at better understanding the processes of knowledge transfer and appropriation during international and intercultural placements in nursing in African countries. FRAMEWORK: the models of empowerment and the Cycle of knowledge to practice have guided this study. METHOD: a multiple case study has been conducted with six settings of care from two countries of Africa. Individual interviews were conducted with the nursing students (n = 11) and with the African nurses supervisors (n = 9), and group interviews with the local partners (n = 2). Direct and participant observations were also done by the nursing students while they were in Africa in the summer and by the two principal investigators when they spent a week in the settings of care, the following fall. RESULTS : advantages of this learning activity were noted, especially in regards to personal and professional growth of the nursing students and in regards to knowledge transfer to the host settings. DISCUSSION : four themes emerged and led to recommendations as to the importance of: 1) bidirectional communication, continuity of projects between cohorts of nurses, and support at distance and on site, 2) reinforcement of the emancipatory sociopolitical knowing 3) diversity of care and community sites and expositions, and 4) different phases of the Cycle of knowledge to practice.

Knowledge mobilized by a critical thinking process deployed by nursing students in practical care situations: a qualitative study.

AIM: This paper is a report of a qualitative study of mobilization of knowledge within the critical thinking process deployed by female undergraduate nursing students in practical care situations. BACKGROUND: Holistic practice is based on variety of knowledge mobilized by a critical thinking process. Novices and, more specifically, students experience many difficulties in this regard. Therefore, a better understanding of the knowledge they mobilize in their practice is important for nurse educators. DESIGN: A qualitative study, guided by grounded theory, was carried out. Sixteen nursing students, registered in an undergraduate programme in an Eastern Canadian university, were recruited. Descriptions of practical care situations were obtained through explicitation interviews in 2007. A sociodemographic questionnaire, semi-structured interviews and field notes were also used. Data were analysed using an approach based on grounded theory. An additional stage of analysis involved data condensation. FINDINGS: Various types of knowledge guide nursing students' practice. These include intrapersonal, interpersonal, perceptual, moral/ethical, experiential, practical, scientific and contextual knowledge. The mobilization of these types of knowledge is only possible when the process of critical thinking has attained a higher level, giving rise to a new knowledge that we have termed combinational constructive knowledge rather than aesthetic knowledge. CONCLUSION: Clarification of the types of knowledge guiding the practice of student nurses and of the role of critical thinking in their mobilization could lead to innovative educational strategies. The findings provide guidance for the revision and development of both academic and clinical training programmes.