Thames College kindly invited me to give a seminar presentation to 60 nurses working in Sri Lanka. I felt very honoured to be asked to speak to a group of Sri Lankan nurses and wondered what I could teach them that would be relevant to their nursing practice.
In the UK we teach nurses about reflective practice. I thought this would be a valuable topic for Sri Lankan nurses and worthy of the seminar. The aim of the seminar was to introduce the nurses to a variety of strategies for using reflective practice. I started by introducing the concept of reflective practice then introduced different types of reflection - thinking things over and writing reflectively. Whilst both of these approaches share common elements, they each have individual features that contribute separately to the techniques of reflection which is to learn and understand more about practice. I introduced models of reflection and other more creative ways to provide a range of approaches for the different situations in which nurses may find themselves reflecting. It is important for nurses to build up a 'kit-bag' of reflective strategies, some formal, others less so, as ways of learning from practice and experiences throughout a nursing career.
I then introduced the concept of story boarding. This involved using the reflections the nurses had written to tell their story. Story telling has been used through the centuries and by many cultures to pass on stories and experiences to each generation. The concept of story boarding is used very simply, yet effectively, to create a series of pictures which tell a story.
The process of story boarding helps us to find both a structure to its content, and an order for the points we want to make, therefore, it also helps us to prioritise and identify what is important and what is not. How does this work? One reason is because pictorially demonstrating a story is a much slower process than the speed at which we write, think or talk therefore we are slowed down in our thinking as we mentally sift and segregate the most important things to represent. We cannot create a story board as quickly as we write, think or talk thus story boarding will be very different in content and structure to the way we reflect when writing, talking to others or by ourselves contemplatively. It has three distinct features that can be seen as advantages:
1. We are forced to acknowledge issues that may be ignored if we are carrying on a conversation or reflecting inside our heads.
2. We can put a hierarchical order to issues that are significant to us.
3. This enables us to work through these issues as we have identified them, rather than being side-tracked away to other things.
These make story boarding an extremely effective process, and one which helps us to work systematically through the process of reflection and storytelling.
The next stage of the seminar was to take the nurses reflection and story boarding a stage further and discuss critical analysis and critical thinking. The story boarding technique had broken the whole reflection down into parts which enabled analysis of each part to understand them better, this is critical analysis. Critical thinking brings in an emotional dimension and analyses not just knowledge but beliefs and values. This is essential if reflective practice is going to be effective and have a positive impact on the quality of patient care.
The nurses were asked to engage in a process called the 'why, if, then, because, however' activity. This activity was designed to enable the nurses to ask critical questions within their reflections to prompt critical analysis. For every key sentence in their reflection they had to ask 'why?' Each 'why?' then had to be broken down into 'if', 'then' and 'because'. They were then asked to consider if there was a 'however' to show they recognised and accepted that there may be a different view point which is at the heart of critical analysis and critical thinking.
The nurses who attended the seminar where wonderful and fully engaged in the activities they were asked to perform. I was very impressed with: their interesting and varied reflections; the amazing art work they produced in their story boarding; their eagerness to learn and their ability to adapt to new methods of teaching.
I would like to thank Thames College for inviting me to participate in a very professionally organised and enjoyable seminar.