Interventions to support reflection and learning: a qualitative study

Abstract

The aim of this research was to explore the role of a professional development supervisor in helping health professionals to reflect on their role in patient consultations. This article is written from the viewpoint of patient‐centred care and seeks to examine how the mentor/supervisor can facilitate reflection and learning by discussing, with professionals, videotapes of their regular meetings with patients. The specific context of the article is an educational intervention in Sweden, based on modern theories of competence development for professionals in diabetes care. A purposeful sample of 18 patients with type 2 diabetes agreed to have their regular meeting with a general practitioner (GP) or diabetes nurse videotaped. The GPs or diabetes nurses of these patients then participated in an intervention, comprising sessions when they reviewed with a supervisor their consultations with the patients. These supervising sessions were videotaped and are investigated in this article. The supervisor's role was to make observations that could alter the professional's understanding of the diabetes consultation through video‐cued narrative reflection. Five overarching themes were identified from the content (the what‐aspect) of the intervention: medical problems; patient characteristics and reactions; patient education; the consultation as such; and the healthcare organization. The activities used in carrying out the intervention (the how‐aspect) were: confirmation and feedback; interpretation; reflective questioning; suggestions and corrections; and closed‐end questions or brief answers. It was hypothesized that this way of conducting reflective educational interventions would be beneficial for healthcare professionals when working with patients with various longstanding medical conditions, recognizing that a patient‐centred approach which included the patient's learning and possibilities for self‐management are more suitable for the chronic illness encounter.

A Categorization Scheme for Assessing Pharmacy Students' Levels of Reflection During Internships

“…Systematic reflection on experiences in practice has, during the past 10 years, come more and more into focus in many curricula in higher education, 7,9,10,14 including nursing education, [15][16][17][18] medical education, 19,20 and lately, pharmacy education as well. 1,9,10,[21][22][23][24] Being able to assess reflective practice/learning is thus essential in order to provide feedback to students and to certify that students have reached learning goals with regard to reflective learning.…”

Counseling chronically ill adults in the healthcare setting: An integrative literature review

“…However, staff often paid attention to the language and style of counseling [44,67,69] . Interaction in counseling rarely involved a two-way discussion with the chronically ill adult [43,57,65,67] , even when staff were interested in the chronically ill adults' accounts of their experience [44,52,56,70] or staff believed that direct discussion of positive and negative aspects of their care would be beneficial for chronically ill adults [70] . However, sometimes the staff used two-way methods such as hypothetical questions and peer talk [70] .…”

“…The chronic diseases researched included Chronic pulmonary disease (COPD) [46,47] , asthma [48,49] , hypertension [50,51] , rheumatoid arthritis [42,43,52,53] , diabetes [40,54,[55][56][57][58] , heart failure [59][60][61] and chronic back pain [44,62] . One study encompassed several chronic diseases: diabetes, congestive heart failure and hypertension [41] .…”

“…Counseling was implemented using different counseling methods and materials such as group or individual sessions [43,53,55,56,60,66] . Counseling was typically conducted orally, although written material was usually provided as part of the counseling session [43,55,66] as an aid for patients' memories [43,48,63] .…”

“…Counseling was based on chronically ill adults' individual needs [40,43,56,[65][66][67] and goals [43,68,69) . However, there were also examples of counseling in which the needs of chronically ill adults were not taken into account [66] , or in which the nursing staff identified needs but did not discuss them with the chronically ill adults [56] . In goal-oriented counseling goals were discussed with chronically ill adults [43] , who then implemented them in their daily disease treatment [51,62] .…”