MET:Educational Blogging to Promote Reflective Clinical Practice

This page was originally authored by Catherine Ranson (ETEC 510 June 2011)

Reflective Practice

As a reflective practitioner I nurture my “knowing self”, a self that is sensitive yet critical of self within the caring moment. Through reflection I learn through the experience and transcend previous ways of knowing. (Johns 2000, p.68)

There are many definitions for reflective practice, [1], reflection means to think about, review or ponder over previous activities because they were effective or there is a need to make sense of them, or the need to evaluate because they may have been ineffective or troublesome. An analogous definition is to take the information in relation to your experience, knowledge and skill level shaped through self assessment, or judgment by others, examine it and resolve how to change it for the future. Reflection provides the integration of theory into practice, closes the gap for the practitioner. [2]

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What are Blogs?

Blogs[3] also known as “webblogs,” is a type of webpage[4] consisting of short, frequent posts usually arranged in reverse chronological order. Blogging sites contain many different types of content, such as news, project updates, media, ideas, photos and many additional topics of interest. Blogs are considered a creative outlet for bloggers (those who post) to share information with others that typically are reflective descriptions of their life experiences and the world around them (Luehmann and MacBride, 2009).

The weblog or blogger genre surfaced in the early 1990s yet it was not until the late 1990s that blogs became popular. Blogging rules have been evolving through debate and consensus with very little pressure or opinion from experts. Blog construction is considered to be more user friendly than many other forms of online written expression due to its text-based format and straightforward organization. “Personal reflections are a vital part of weblogs, providing a human scale perspective on the problem of information acquisition and analysis,” and “providing individuals with distinct platform for self-expression and discussion of ideas” (Oravec 2003, p.227).

Blogging as an Educational Tool to Promote Reflective Clinical Practice

Today’s health care professionals are required to function in complex and changing systems, continuously updating their knowledge and skills, while dealing with complex patient and healthcare problems. Preparing professionals who possess these capabilities has become challenging and complex. Reflective practice is frequently noted in educational literature as essential attributes of creating competent health care professionals who are prepared to address current and future healthcare challenges.(Argyris and Scho¨n 1974; Epstein and Hundert 2002; Moon 1999; Scho¨n 1983, 1987).

Technology has introduced many options for collaborative and student-centered learning that engages students in constructing their own knowledge constructivism and understanding through active involvement in online learning communities[5]. Weblogs (blogging), wikis and i-chat are common technologies implemented into course design to promote reflective thinking, peer-evaluation and self-directed learning [6]. Numerous authors have written about the educational value of “blogging” and how it supports critical thinking, student-centered and self-directed learning, and reflective practice (Gwozdek et al. 2009, Kaufmann et al. 1997, Ladyshewsky & Gardner 2008, Rabikowska 2008).

Blogging, an online technology, can be effectively implemented into clinical practice curriculum to create a platform for students to apply reflective thinking, engage in self-evaluation, and share learning experiences with one another,that would ultimately lead to peer-evaluation. Both primary and secondary school curriculum have implemented online learning communities such as “blogging” into course delivery and use evaluative components where students are assessed on their participation and the richness of the content expressed with peers and teachers online. University and college students arrive as “digitally literate” [7] expecting accessibility to resources that will keep them connected to the web and will welcome virtual learning environments (VLEs) as an element of learning strategies (Ladyshewshy & Gardner, 2008). Blogging (weblogs) are emerging in educational context that encourages the development of reflective thinking, socialization [8] and self-directed learning within the broader context of face-to-face learning(Oravec 2003; Leslie & Murphy 2008; Gwozdek, Klausner & Kerschbaum, 2009).

Pedalogical Reasons for Blogging to Promote Reflective Clinical Practice

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Educational reform emphasizes the significance of student-centered pedagogy that will engage students in constructing their own learning through active participation in online learning communities, creating a community of practice [9] Luehmann & McBride (2009) studied the affordances of classroom blogging practices by investigating two different classroom blogs to assess student participation. The study concluded that student–centered learning can occur if the blog is properly structured and employed to facilitate self-directed learning; the ownership of learning space must be assigned to the students to encourage student support of one another and opportunities to learn from each other.

Ladyshewsky and Gardner (2008)suggest that reflective practice is an important element of clinical practice in health care professions and that “blogging” is an improved vehicle to promote reflective practice skills, offering health science students an “interactive space” to reflect and discuss their clinical learning experiences with one another. Peers are influential, yet require a safe starting place for discussing clinical practice as they use similar language and biomedical information familiar to those participating. In addition, the interaction amongst peers is less threatening than those that involve teachers or evaluators, therefore, enhanced disclosure of experiences will occur resulting in deeper discussion and learning outcomes.

The implementation of student participation through a reflective process that includes peer dialogue will result in both the application of didactic knowledge to clinical proficiency and the sharing of strategies that could be useful in future patient care situations (Davies, 1995). The weblog format has the ability to facilitate social construction, inspire new ideas, and foster openness to various interpretations and appreciation of the efforts of others.There is a commom theme suggests “blogging” promotes socialization, self-directed learning, self-reflection and critical thinking skills in almost any educational setting, all of which would enhance clinical practice and promote reflective practice decisions.

The importance of pedagogical decision-making with respect to blogging and the implementation of “teacher presence” impacts the success of the learning objectives; which are significant considerations when integrating technology to promote learning(Luehmann & McBride, 2009).

Recommendations for the implementation of blogging highlight the need for content structure, teacher presence as the facilitator, student ownership of the space, and introduction of the student to the regulations and rules up front so participation and learning is successful (Oravec, 2003). The “interactive space” that Ladyshewsky and Gardner (2008) present creates an excellent learning community for clinical students to discuss patient cases and evidenced-based practice strategies.

Blogs offer teacher and student online discussion (time-stamped comments), video posting(vlog), podcasting [10] platform,posting via email & cell phone, free web space for class materials, minimal web skills required,a way to address topics in writing through authentic writing in a digital medium.

The virtual learning environment created through a “blog” will provide students with a required personal “space” where both individual expression and freedom of choice on how they decide self-reflection should take place. Blogging was chosen as the most favorable instrument for self-reflection outside the classroom setting. Studies have concluded that the learning activities are in alignment with constructivist learning theory, the e-tools used during blogging tasks encouraged knowledge construction through interactions with others, stimulated the learners to reflect, organize,analyze and problem solve as expressed in their posts(Rabikowska,2009.

Weblogs can be used as a “middle space” between face-to-face and online instructional pedagogy, a blended learning approach. They can provide educators with creative new learning strategies to promote students’ diverse areas of intellectual integrity and learn to respect and process the work of others(Oravec, 2003).

Are there negative effects of reflection? There is little research reporting negative effects of reflection. Challenges of teaching reflection in the health care context has been identified, however with any intervention it is important to note the intended and unintended outcomes (Mann et al. 2009).

The Purpose of Reflective Practice Video

http://www.slideshare.net/ronko4/using-student-blogs-as-reflective-practice

Examples of Blogging that Promotes Reflective Clinical Practice

It is generally agreed that there are three types of reflection: (RNAO, 2011)

Content reflection, where the practitioner recounts what happened.

An example might be a straight description of the situation or problem. "Mrs. Brown did not share any issues of concern with me despite my clarification to her that I was there for her, yet she mentioned to her family that no one had time for her."

Process reflection, where the practitioner recounts how it happened, or what the process was. Carrying on with the example.

"I mentioned in the beginning of the encounter with Mrs. Brown what my purpose was, then I began to carry out an intense physical assessment. I asked again about any concerns once in the middle of taking the blood pressure, and did not mention it again. Mrs. Brown did not make eye contact when she said everything was ok."

Premise reflection where the problem itself is examined or why it happened is examined.

Again carrying on with the example. "I wonder why she did not respond to my questions? Why did I not notice and respond to her body language at the time? Why did I not feel comfortable probing a bit more?" Why did I ask about her concerns early in the interview and again when in the middle of a task. How comfortable was I? What would I do differently in a future situation? Do I feel comfortable acting differently in the future? What would assist me in future." http://www.rnao.org/Self_Directed_Learning/sect3Lesson5Part1.htm

Gwozdek et al. (2009) conducted a study with 28 first year dental hygiene students who participated in online journaling as a reflective component to their clinical practice with clients and concluded that students perceived online journaling to be valuable and assisted students to integrate didactic theory with clinical practice. The student interaction through “blogging” encouraged students to use critical thinking skills and reflect on what they learned in clinical practice.

http://mywebspace.quinnipiac.edu/PHastings/bac.html Blogging across the curriculum, a study at the University level.

Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. http://www.biomedcentral.com/1472-6920/6/41/?ref=n

References

Argyris, C., & Schon, D. (1974). Theory into practice: Increasing professional effectiveness. San Francisco: Jossey Bass.

Davis, E. (1995) Reflective Practice: A focus for caring. Journal of Nursing Education, (34) 167-174.

Downes, S. (2004). Educational blogging. Educause Review, 39(5), 14-26. http://www.educause.edu/ir/library/pdf/erm0450.pdf

Epstein, R., & Hundert, E. (2002). Defining and assessing professional competence. JAMA, 287, 226–235.

Gwozdek, A., Klausner, C., & Kerschbaum , W. (2009). Online directed journaling in dental hygiene clinical education. Journal of Dental Hygiene. (83) 1, 1-8. ISSN. 1043254X

Harper, V. B. Jr., & Harper, E. J. (2006). Understanding student self-disclosure typology through blogging. The Qualitative Report, 11(2), 251-261. http://www.nova.edu/ssss/QR/QR11-2/harper.pdf

Henzi, D.,Davis, E., Jasinevicius, R., Hendricson, W.,(2007) In the students’ Own Words: What Are the Strengths and Weaknesses of the Dental School Curriculum? Journal of Dental Education, 71, (5), 632-645.

Kaufman, R., Portney, L. & Jette, D. (1997). Clinical performance of physical therapy students in traditional and problem based curricula. Journal of Physical Therapy Education, 11(1), 26-31.

Ladyshewsky, R., & Gardner, P. (2008) Peer assisted learning and blogging: A strategy to promote reflective practice during clinical fieldwork. Canada Australasian Journal of Educational Technology, (3), 241-257. ISSN. 14493098. Retrieved from EBSCOhost database.

Leslie, P., Murhphy, E., (2008) Post-Secondary Students ‘Purposes for Blogging. International Review of Research in Open and Distance Learning. (9) 1-17. ISSN: 1492-3831. Retrieved from EBSCOhost database.

Luehmann, A., MacBride, R. (2009) Classroom blogging in the service of student-centered pedagogy: Two high school teachers’ use of blogs. Technology, Humanities, Education & Narrative, (6) 5-36. Retrieved from EBSCOhost database

Mann, K.,Gordon, J.,& MacLeod, A., (2009) Reflection and reflective practice in health professions education: a systematic review. Advances in Health Sciences Education Volume 14, Number 4, 595-621, http://www.springerlink.com/content/a226806k3n5115n5/fulltext.pdf

Moon, J. (1999). A handbook of reflective and experiential learning. London: Routledge.

Oravec, Jo Ann. (2003). Blending by Blogging: weblogs in blended learning initiatives. Journal of Educational Media. (2-3), 225-233. doi: 10.1080/1358165032000165671 ISSN # 1358-1651. Retrieved from EBSCOhost database.

Palloff, R. and Pratt, K. (1999b) Defining and redefining community. Building Learning Communities in Cyberspace: Effective Strategies for the Online Classroom. (pp. 21-32). San Francisco: Jossey-Bass Publishers.

Rabikowska, M. (2008) “The Paradoxical Position of Self-reflection in Teaching and Assessment in Higher Education: How the Application of Blogging Challenges Learning Habits”. The International Journal of Learning,(15), 1-10.Retrieved from http://www.Learning-Journal .com, ISSN 1447-9494. Scho¨n, D. (1983). The reflective practitioner. San Francisco: Jossey-Bass. Scho¨n, D. (1987). Educating the reflective practitioner. San Francisco: Jossey-Bass.