Issues in reflection and debriefing: how nurse educators structure experiential activities

Abstract

Experiential learning is particularly useful in vocational education programs where theory needs to be linked to practice. Although experiential learning is often advocated in nursing education and the importance of debriefing and reflection is almost always espoused, the focus in the literature has tended to be on detailed descriptions of the action phase with little close analysis of how the reflective phase is facilitated. The Lewinian model described by Kolb [Experiential Learning. Experience as Source of Learning and Development, Prentice-Hall, New Jersey, 1984] and the structuring approach suggested by Thiagarajan [Experiential Learning Packages, Prentice-Hall, Englewood Cliffs, NJ, 1980] have been used as the theoretical context for an exploration of how nurse teachers describe their facilitation of the debriefing and reflective phases of experiential learning activities. Explication of the entire planned experiential learning experience is important for increasing the chances of the student being able to close the experiential learning loop. The more covert reflective phases for facilitating experiential learning are crucial and if neglected, or inexpertly and insensitively handled, may at best lead to poor learning outcomes or at worst lead to emotional damage and `unfinished business' for the student. Interviews with eight experienced university educators elicited descriptions of how they constructed experiential activities with special reference to their descriptions of how the debriefing or reflective phases were structured.

Introduction

Through the use of three compelling `stories' Northcott (2002) highlights key ethical issues relating to the use of experiential learning strategies and the danger of an inexpertly facilitated activity causing “more damage than good”. Experiential learning is commonly recommended in the literature as being a preferred method for teaching communications, interpersonal relationships and management skills (Merchant, 1989, p. 310) whilst experiential learning methods have been “hailed as the way to train psychiatric nurses” (Burnard, 1985, p. 12). Stanton and Grant (1999, p. 3), assert that experiential learning principles underpin a diversity of recently developed innovative teaching strategies in medical education because they are “particularly useful” in vocational training where “integration of theory and practice is paramount”. This is equally true for nursing and probably for all health disciplines. Although experiential methods are presumably common in nursing education and are frequently espoused, there is limited research in the nursing literature which explores the nature and extent of its use.

A lack of a supportive caring environment underpins the negative experiences which Northcott (2002) describes. He asserts that the participants he describes have “unfinished business” and even “permanent damage” (p. 91). In each case it can be argued that the “unfinished business” was largely unresolved because of poor handling of the reflection or debriefing phase of the experiential learning cycle and a concomitant limited understanding by the facilitator of the stages of the experiential process. The importance of debriefing and facilitation of reflection is frequently advocated in the literature about experiential learning (Osborne, 1990; Dewar and Walker, 1999; Maudsley and Strivens, 2000; Sofaer, 1995; Norman, 2001) but the dynamics and structure are rarely explicated in any detail. Shin (2000, p. 2) has also identified that “nonsupportive faculty” is one of the most anxiety producing factors for students in experiential clinical settings. Failure to debrief effectively or “getting the balance wrong between active experience and reflection” and “neglecting to provide a structure for learning”(Gibbs, 1988 quoted in Stanton and Grant, 1999, p. 5) can be seen as a critical failure on the part of the teacher which may leave the student feeling angry and unsupported.

Further, Burnard (1985, p. 33), although he is convinced of the value of experiential learning states that “it is too easy to jump onto a new education bandwagon” and that educators need to fulfill their obligations by addressing thoroughly the theoretical bases (including ethical and moral issues) along with the need for adequate teacher training to implement it at the `grass-roots' level. In this context, there is a need to learn more about specific strategies for facilitating experiential learning and as a starting point, to explore the perception that experienced nurse educators have on the whole process, and in particular, of how reflection is mediated. To this end a small number of interviews were undertaken with experienced nurse educators about how they typically structured experiential activities. Whether they reported both action and debriefing phases as part of their design for the process and the type of sub-structure for each phase was explored.