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J Adv Nurs. 2007 Feb;57(4):410-21.

Evaluation of a reflective learning intervention to improve critical

thinking in novice nurses.
Forneris SG1, Peden-McAlpine C.

Department of Nursing, College of St Catherine, St Paul, Minnesota, USA.


This paper reports a study to determine if a reflective contextual learning intervention would
improve novice nurses' critical thinking skills during the first 6 months of their practice.
Nursing research evaluating the development of critical thinking in novice nursing practice is
limited. The continual struggle by nurse educators to improve critical thinking demonstrates the
need for innovative educational interventions that assist in the development of critical thinking
as novice nurses enter into practice.
This small case study was conducted in the United States of America in 2004 with six
student/preceptor dyads. The contextual learning intervention was the case through which the
novice nurses' critical thinking were analysed using Stake's phases of data analysis. Specific
questions (i.e. novice nurses' use of reflection, context, dialogue, time) guided the analysis.
Repeating patterns were coded and isolated and later collapsed/enhanced as the analysis
moved forward.
Three main themes describe the novice nurses' development of critical thinking: (1) influence of
anxiety and power on critical thinking; putting pieces together; (2) questioning as critical
thinking: sequential thinking to contextual thinking; and (3) emergence of the intentional critical
Used as a reflective practicum, contextual learning can be a model of clinical learning in nursing
education that develops the contextual, reflective nature of critical thinking

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Nurse Educ Today. 2013 May;33(5):504-11. doi: 10.1016/j.nedt.2012.03.001. Epub 2012 Mar 28.

Using a critical reflection process to create an effective learning

community in the workplace.
Walker R1, Cooke M, Henderson A, Creedy DK.

Author information

School of Nursing and Midwifery, Research Centre for Clinical & Community Practice
Innovation, Griffith Institute of Health and Medical Research, Griffith University, Nathan, 4111,
Queensland Australia.

Learning circles are an enabling process to critically examine and reflect on practices with the
purpose of promoting individual and organizational growth and change. The authors adapted
and developed a learning circle strategy to facilitate open discourse between registered nurses,
clinical leaders, clinical facilitators and students, to critically reflect on practice experiences to
promote a positive learning environment. This paper reports on an analysis of field notes taken
during a critical reflection process used to create an effective learning community in the
workplace. A total of 19 learning circles were conducted during in-service periods (that is, the
time allocated for professional education between morning and afternoon shifts) over a 3 month
period with 56 nurses, 33 students and 1 university-employed clinical supervisor. Participation
rates ranged from 3 to 12 individuals per discussion. Ten themes emerged from content analysis
of the clinical learning issues identified through the four-step model of critical reflection used in
learning circle discussions. The four-step model of critical reflection allowed participants to
reflect on clinical learning issues, and raise them in a safe environment that enabled topics to be
challenged and explored in a shared and cooperative manner.
Copyright 2012 Elsevier Ltd. All rights reserved.