Using critical incident technique to promote students reflections skills in a transatlantic nurse education project

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Using critical incident technique to promote
students reflections skills in a transatlantic
nurse education project

• Dr. Kim A. Critchley, University of Prince Edward
  Island
• Canada
• Dr. Liisa Koskinen, Savonia University of Applied
  Sciences
• Finland

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International Project

• Inequalities in Access to Health Care for Rural
  Communities Funded through Canada EU Program
  for Cooperation in Higher Education and Training
• (October 2004 September 2007)

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International Partners

• Canada
• Mount Royal College Calgary Pam Nordstrom and
  Maureen Mitchell
• Universite de Moncton France Chasse and France
  Marquis
• University of Prince Edward Island Kimberley
  Critchley and Barbara Campbell
• EU
• England, Bournemouth University Ann Hemingway
  and Eileen Richardson
• Sweden, Uppsala University Clara Aarts and Eva
  Bergknut
• Finland, Savonia University of Applied Sciences
  Liisa Koskinnen
• Estonia, Tallinn Health College Tiina Johansoo

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Project Objectives

• To foster student exchange in different health
  care disciplines.
• To establish a network of scholars and practicing
  health care professionals working toward the
  enhancement of joint curricula.
• To promote increased cooperation and exchange of
  ideas among the partner communities.

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Academic Opportunities

• Increase student mobility
• -from October 2004 to September 2007, 24 EU
  and 40 Canadian students would undertake an
  exchange visit for 12 weeks.
• Enhancement of joint modules of training in
  association with the partner institutions and
  communities.
• Observation of all involvement in International
  work methods and culture.

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Project Outcomes

• Seamless credit transfer for students among
  consortium partner institutions.
• Faculties working together in the enhancement of
  new joint curricula.
• Opportunities for students to work toward
  achieving proficiency in a second language.
• Web-based joint training.

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Project Outcomes (cont)

• Development of a model for the professional
  recognition and certification of programs.
• Increased cross-cultural understanding through
  student mobility and on-line communication.
• Stimulated interest among health care students in
  foreign language and cross-cultural study.
• Greater understanding of the strengths of each
  consortium partner and opportunities to share
  resources.
• Opportunities for students and faculty to work
  and conduct research.

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Opportunity for Research

• This presentation presents one example of
  research conducted as a result of the Canada-EU
  Mobility Project.

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Critical incident technique

• Originates from the 1950s (John Flanagan)
• Is a learning/teaching method
• Is a research data collection method

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CRITICAL INCIDENT ANALYSIS RECORD SHEET (for
EU/Canada exchange students) Sit down at least
three times during your exchange trip and choose
one critical incident that has taken place
recently and explore it in detail. Critical
incidents are brief descriptions written by
learners about meaningful events in their lives
(Brookfeld 1990). Any experience you encounter
during your exchange trip may be a critical
incident and therefore a situation you can
reflect upon. In the other words incidents
happen but a critical incident is produced by the
way you look at a situation a critical incident
is your interpretation of the significance of the
event. Here are some key steps for organising
youre reflecting and writing.
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• 1 Identify the event or occurrence with as much
  specificity as possible - the problem to be
  solved, issues involved, etc. You may not have
  precise ideas on this when you start writing.
  Just start writing.
• 2 Describe the relevant details and circumstances
  surrounding the event so that you and the tutor
  who reads your entry will understand what
  happened. What? When? How? Why? Where?
• 3 List the people involved, describe them and
  their relationship to you and to each other.
• 4 Describe your role in the situation - what you
  did, how you acted.
• 5 Analyse the incident. How well or badly did you
  understand the situation? How did you handle it?
  What would you do differently the next time? Why?
• 6 Analyse this incident in terms of its impact on
  you and explain why you view it as critical in
  relation to rural inequalities in health or a
  specific area of the Ottawa Charter. How does it
  relate to your particular objective(s)? What have
  you learned from the experience? How has your
  perspective on your own role and that of others
  been changed and/or reinforced?

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Can critical incidents method be used in
educating reflective practitioners in nursing?

• The method
• Supports learners critical thinking and
  experiential learning (Niemi 2003, Mikkonen 2005)
• Helps learners personal (Silkelä 2001 Merikivi
  2003) and professional development (Turunen 2002)
• Assists learners integration of nursing theory
  into practice (Koskinen, Jokinen Mikkonen 2007)
  
• Improves learners reflection skills (Koskinen et
  al 2007)

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The study

• Aim
• To describe students learning from the incidents
• To stimulate discussion on the usefulness of the
  method in intercultural nursing education
• Data collection
• Critical incidents (n92) written by 18 Canadian
  and 13 British, Estonian, Finnish and Swedish
  students (n31)
• Data analysis
• Stage 1 data reduction in seven research
  centres. The data were in English, Estonian and
  Swedish.
• Stage 2 data reduction, data display, conclusion
  and verification (Miles Huberman 1994). The
  data were in English.

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Results The chosen incidents were contexts,
events, situations or experiences

• that were unfamiliar in comparing to the familiar
• that either showed examples of lack of cultural
  awareness in care or demonstration of culturally
  sensitive care
• that either showed examples of good nursing care
  or lack of good nursing care
• that were pivotal both personally and
  professionally the extreme as life altering
  occurrences
• that were related to cultural differences that
  interfere with the students moral values,
  beliefs, communication abilities and the
  professionalism in giving nursing care

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Table 1. Learning areas the chosen incidents were
related with.
EU students Both students Canadian students
Importance of cultural awareness of health care professionals Impact of income, social status, and rural issues in inequalities in health and well-being Impact of lifestyle in health and well-being Dilemma of good/bad right/wrong in health care (ethical issues) Experiencing particular clinic, programme, service system or method Witnessing unacceptable/warm nurse-patient interaction Impressive personal cultural experience Personal confusion in a difficult and unexpected nursing situation Dress code and safety nursing practices Experiencing communication and culture barrier in Estonia, Finland and Sweden Cultural differences in nursing role and nurses awareness and knowledge of health promotion and sickness prevention strategies
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Results In their critical incidents the
students showed increased awareness

• about personal and professional self and own
  emotions
• about the importance of non-verbal communication
  in nursing care
• about cultural differences in nursing role and
  nursing care
• about cultural differences in health programmes,
  services and methods
• about societal inequalities

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Implications for intercultural nursing education

• Critical incident method can be used in fostering
  nursing student learning and reflection skills
  in the context of intercultural education
• Make sure that the learning objectives are shared
  between the project partners and students before
  they leave and throughout the exchange more
  discussion and support on what to expect
• Increase dialogue about each incident either with
  the home or host instructor
• Extend the time spent in each clinical and
  community setting more time to bridge the
  cultural and language barrier and move from
  observer to the actual patient contacts

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Implications

• 4. Possibly owing to the shortness of the
  intercultural visits, the students viewed host
  culture s health service either through
  rose-tinted spectacles or negative eyes.
  These can be seen as consistent with the
  phenomenon of superiority or reversal in
  Bennetts (1993) study of intercultural
  sensitivity instructors might be valuable for
  recognizing this phenomenon, in order to be able
  to encourage further cultural self-examination
  among the students

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• To Conclude
• Students were able to participate, enjoy and
  learn from this cultural exchange including the
  critical incident writing

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