The development of a clinical reflective practice model for paediatric nursing specialist students in Indonesia using an action research approach

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Reflective practice (RP) is extensively used to facilitate students’ learning from their experiences and to improve practice. Despite substantial literature regarding RP effectiveness, Indonesian nursing education had not systematically applied RP within education programs. Most RP models have been developed and applied in Western countries with a number of studies indicating that culture may influence implementation in Eastern countries. This current study aimed to develop and implement a RP model that integrates Indonesian cultural characteristics to improve students’ clinical learning. An action research (AR) approach was used with reflection as a core step in each cycle. In AR cycle one, the researcher and six clinical educators developed a clinical reflective practice (CRP) model that considered Indonesian culture. The educators and 23 students implemented the model over a six months period. Data were collected through reflection sessions with educators and students conducted at the end of cycle one. Data were analysed separately for both groups with four themes from clinical educators (varied strategies used; towards self-development; avoiding behaviour; and areas for improvement) and five from students (making sense of RP; positive impacts; struggling with the writing process; uncertainty in supervision process; and supervision needs to be improved). These findings demonstrated that the CRP model was in the beginning stage of acceptance and needed some improvements. In AR cycle two, the CRP model was revised in line with the findings from cycle one and was implemented over a three month period, followed by further data collection. Three themes emerged from the clinical educators’ experiences (struggling with the implementation; challenging the culture; and students changing) and four from the students’ experiences (developing expertise; feeling competent in practice; creating a safe space; and courage to speak up). An evaluation session held with students six weeks after completing their placement resulted in further themes (expanding their views, safe place, a light in the dark, self-awareness booster, and learning through experience). Findings indicate that clinical educators were still in a process of accepting the CRP model, whilst the students gained more positive benefits, resulting in an enhanced learning experience. The CRP model implementation highlights the cultural challenge for clinical educators in using a reflection process that resulted in students driving their own learning; thereby enhancing their overall learning experience. The resulting changes from the CRP model within the leading nursing education institution in Indonesia may influence other institutions to implement RP to improve students’ clinical learning.
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