Clinical postconference is an ideal time for students to learn how to engage in productive reflection. Postconference allows students to reflect on and review their clinical judgment and look at each experience again to determine their effectiveness, thus increasing their competence. This article describes an innovative clinical postconference strategy to facilitate discussion and reflection among students.

Background

The health care system changes rapidly, and to prepare for independent practice, nursing students need self-knowledge and the ability to learn from reflecting on their decision making. Studies have shown that one-third of graduate nurses who passed the NCLEX-and are in practice-lack entry-level critical thinking skills.1 Their own clinical experiences examined through reflection could be highly beneficial for students, but postconference is not always a productive learning experience.

Reflection has been shown to be a strategy to build clinical judgment and enhance the recognition of quality and safety issues.2-7 Findings show that reflection supports students in analyzing their thoughts and feelings, involving a change in perspective and transforming their thinking.2 Reflection allows students to assess their clinical experience and build on their emerging knowledge. Students become more self-aware and realistic about their performance. They feel empowered to meet the needs of their patients, address quality and safety issues, and identify their own strengths and areas for improvement.2 Reflection also helps students recognize experiences that cause them distress and enables them to deal with emotional challenges and fears.2 The outcome of reflection is for students to think deeply about the meaning of their nursing practice.2 Although reflection heightens students' awareness of actions, thoughts, attitudes, and feelings, the opportunity to reflect on their clinical experiences usually occurs at the end of a semester, rather than the beginning.

Problem

Students are fatigued at end of clinical practice; are easily distracted by phones, computers, and other devices; and often inadequately reflect on what they experienced that day. Without a structured environment that is intentionally designed to engage students in processing clinical experiences, reflection by students may be inadequate. Further, novice educators may not know specific strategies to conduct an engaging postclinical conference and may struggle to optimize these discussions. The Circle Way8 is an innovative strategy to foster reflective thinking in postconference.

Approach

The Circle Way8 provides a safe gathering place with an intentional purpose and defines the boundaries and social structure to create an opportunity for meaningful conversation. Characteristics of The Circle Way include acknowledgement that the physical environment of a gathering influences communication dynamics and that a social structure of equality encourages deeper reflection among participants.8 When The Circle Way is used in postconference, students face each other around a table or in a circle of chairs representing a campfire context. The instructor explains the rules about how the discussion will unfold and students agree to them. It is understood that everyone participates in the discussion, contributing experiences, opinions, feelings, analysis, and connections without interruption. A stone is passed among students to signify who has the floor, sharing their summary of the day. Each student is given 2 minutes to discuss their patient in SBAR (Situation, Background, Assessment, Recommendation) format, without interruption. A 2-minute sand timer is used to keep track of time. Questions from students and faculty are held until a final round of discussion occurs. All contributions are respected. The discussion takes place within a framework that delineates a clear beginning, middle, and end.8 By following these procedures, the stage is set for a professional discussion among peers.

Outcomes

A small group of faculty who used The Circle Way8 reported about its impact on the quality of their postconferences. They believed it improved students' ability to process clinical experiences, promoted respectful communication, increased student engagement with the group reflection process, and supported students to process their clinical experiences and develop their clinical judgment. Faculty further indicated that the method increased student motivation and enthusiasm by preventing one student from dominating the discussion, allowing all to participate. Overall, faculty found postconference created a positive learning environment and was an effective method to teach communication skills.

Conclusions

Faculty and students can benefit from a structured approach for clinical postconference. To help students achieve optimal learning outcomes from clinical experiences and prepare them for upcoming changes in the NCLEX-RN, clinical educators should support students in developing reflective practice. Postconference is an ideal opportunity to help students develop reflection skills. The Circle Way8 is a supportive and effective tool for enhancing the postconference experience for faculty and students. The structure and function of this method to promote processing of clinical information provide opportunities to make clinical postconference a meaningful learning experience for students. Actively involving students in reflective practice during clinical experiences may be an important step toward achieving the goal of producing nurses who can think critically and are aware of safety implications and improvement opportunities.

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