Mind shift: creating change through narrative learning cycles

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Mind shift: creating change through narrative learning cycles

Undertaken as part of a Master of Health Science the research explores an annual appraisal process strategy “,clinical conversation”, from the perspective of seven nurses assessed using this technique. The findings show that clinical conversation facilitates reflection, both as a solitary exercise and with others, to ensure that learning from experience is optimised.The outcome of the clinical conversation was primarily one of learning, the acquisition of new insights into self as practitioner. The learning was facilitated through the process of narration: telling the story of clinical practice. Three distinct narrative cycles were identified, each an experiential learning episode. The experience of undertaking a variety of assessment activities created a narrative with self and triggered an internal reflective process, the experience of working with a peer created an additional narrative, a mutual dialogue reflecting back on practice, the experience of sharing practice with an assessor created a further and final narrative, a learning conversation. The study shows that each nurse responded differently to each narrative learning cycle: for some the conversation with the assessor was more of a catalyst for change, whilst for others it was working with a peer, still others it was solitary self reflection. Clinical conversation, by offering a range of reflective opportunities, appears to be able to respond to a variety of differing learning styles.Each narrative can be seen as a catalyst for change. Primarily, nurses felt differently about themselves in practice, the way they saw themselves had shifted. These alterations in perspective led all nurses to identify ways in which they would change their actual clinical practice. In this way the nurses attempted to align their espoused beliefs about practice with their own actual practice.The implication of the research is that whilst clinical conversation was designed as an assessment tool to appraise clinical competence, its intrinsic value lies in supporting the professional development of nurses.

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