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Collaboration and Leadership Reflection Video Assignment

Collaboration and Leadership Reflection Video Assignment

Quiz
QUESTION 1 OF 5
What does reflective practice mean to you?
Enter your response

QUESTION 2 OF 5
What is a model to help you engage in reflective practice?
Enter your response

QUESTION 3 OF 5
What are some tools to help you engage in reflective practice?
Enter your response

QUESTION 4 OF 5
Why is reflective practice important for improving one’s professional efficacy?
Enter your response

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QUESTION 5 OF 5
How do you see reflective practice being of benefit to you personally?
Enter your response

Reflective Video
The reflective video will evaluate various factors involving interdisciplinary collaboration. Interdisciplinary collaboration is essential since it promotes cohesion among healthcare providers, thus enhancing how the healthcare profession handles patient safety cases. For instance, there is an instance where I was transferred from an acute geriatric unit to a pediatric acute unit due to a nurse shortage that day since even Olley et al. (2019) note it as a common issue in acute care. In the pediatric unit, there is a need to check the patients every twenty minutes to ensure they are safe, unlike in the adult unit, where they need to utilize the bedside alarms. The successful bit of the interprofessional collaboration was that the unit head nurse helped me understand how the pediatric acute unit works, like checking up on the patients every twenty minutes. However, a particular kid was hyperactive, and when I enquired about him, all nurses within the unit assumed that he was okay and that that was his nature. Since I am cautious with my patients, I would visit these children frequently, and one time I found the child having disconnected his oxygen and struggling to breathe. However, since I was on time, I managed to save the child. Just like Carlisle et al. (2020) identify the need to evaluate quality metrics in the healthcare sector, such a situation proved the need to engage nurse collaboration to prevent such instances in the future, even in the acute geriatric unit since patient safety matters.
Leaders can use the most effective strategy to tackle health issues by engaging in transformation leadership. For instance, Lynch et al. (2018) accentuate that transformational leadership helps nurse leaders empower the nursing staff to be more productive. That is because even Udod and Racine (2017) feel that nurse empowerment help in creating a strong bond between leaders and employees, thus making the project team own the project. However, the most efficient and effective change model to incorporate into these changes is Lewin’s Change Model. According to Batras et al. (2016), the Lewin change model is essential in healthcare-related changes since it is easy to implement, its change is long-lasting, and it helps in creating great momentum due to its gradual change approach Collaboration and Leadership Reflection Video Assignment.

References
Batras, D., Duff, C., & Smith, B. J. (2016). Organizational change theory: implications for health promotion practice. Health promotion international, 31(1), 231-241. https://doi.org/10.1093/heapro/dau098
Carlisle, B., Perera, A., Stutzman, S. E., Brown-Cleere, S., Parwaiz, A., & Olson, D. M. (2020). Efficacy of using available data to examine nurse staffing ratios and quality of care metrics. Journal of Neuroscience Nursing, 52(2), 78–83.
Lynch, B. M., McCance, T., McCormack, B., & Brown, D. (2018). The development of the Person‐Centred Situational Leadership Framework: Revealing the being of person‐centredness in nursing homes. Journal of Clinical Nursing, 27(1-2), 427-440. https://doi.org/10.1111/jocn.13949
Olley, R., Edwards, I., Avery, M., & Cooper, H. (2018). A systematic review of the evidence related to mandated nurse staffing ratios in acute hospitals. Australian Health Review, 43(3), 288-293. https://doi.org/10.1071/AH16252
Udod, S. A., & Racine, L. (2017). Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses’ practice. Journal of Clinical Nursing, 26(23-24), 5224-5231. https://doi.org/10.1111/jocn.13887

Assessment 1 Instructions: Collaboration and Leadership Reflection Video

For this assessment you will create a 5-10 minute video reflection on an experience in which you collaborated interprofessionally, as well as a brief discussion of an interprofessional collaboration scenario and how it could have been better approached.
Interprofessional collaboration is a critical aspect of a nurse’s work. Through interprofessional collaboration, practitioners and patients share information and consider each other’s perspectives to better understand and address the many factors that contribute to health and well-being (Sullivan et al., 2015)Collaboration and Leadership Reflection Video Assignment. Essentially, by collaborating, health care practitioners and patients can have better health outcomes. Nurses, who are often at the frontlines of interacting with various groups and records, are full partners in this approach to health care.
Reflection is a key part of building interprofessional competence, as it allows you to look critically at experiences and actions through specific lenses. From the standpoint of interprofessional collaboration, reflection can help you consider potential reasons for and causes of people’s actions and behaviors (Saunders et al., 2016). It also can provide opportunities to examine the roles team members adopted in a given situation as well as how the team could have worked more effectively.
As you begin to prepare this assessment you are encouraged to complete the What is Reflective Practice? activity. The activity consists of five questions that will allow you the opportunity to practice self-reflection. The information gained from completing this formative will help with your success on the Collaboration and Leadership Reflection Video assessment. Completing formatives is also a way to demonstrate course engagement
Note: The Example Kaltura Reflection demonstrates how to cite sources appropriately in an oral presentation/video. The Example Kaltura Reflection video is not a reflection on the Vila Health activity. Your reflection assessment will focus on both your professional experience and the Vila Health activity as described in the scenario.
References
Saunders, R., Singer, R., Dugmore, H., Seaman, K., & Lake, F. (2016). Nursing students’ reflections on an interprofessional placement in ambulatory care. Reflective Practice, 17(4), 393–402.
Sullivan, M., Kiovsky, R., Mason, D., Hill, C., Duke, C. (2015). Interprofessional collaboration and education. American Journal of Nursing, 115(3), 47–54.
Demonstration of Proficiency
• Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
o Identify how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature.
• Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
o Reflect on an interdisciplinary collaboration experience noting ways in which it was successful and unsuccessful in achieving desired outcomes.
o Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work more effectively together.
• Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
o Identify best-practice leadership strategies from the literature, which would improve an interdisciplinary team’s ability to achieve its goals.
• Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
o Communicate via video with clear sound and light.
o The full reference list is from relevant and evidence-based (published within 5 years) sources, exhibiting nearly flawless adherence to APA format.
Professional Context
This assessment will help you to become a reflective practitioner. By considering your own successes and shortcomings in interprofessional collaboration, you will increase awareness of your problem-solving abilities. You will create a video of your reflections, including a discussion of best practices of interprofessional collaboration and leadership strategies, cited in the literature.
Scenario
As part of an initiative to build effective collaboration at your Vila Health site, where you are a nurse, you have been asked to reflect on a project or experience in which you collaborated interprofessionally and examine what happened during the collaboration, identifying positive aspects and areas for improvement.
You have also been asked to review a series of events that took place at another Vila Health location and research interprofessional collaboration best practices and use the lessons learned from your experiences to make recommendations for improving interprofessional collaboration among their team. Your task is to create a 5–10 minute video reflection with suggestions for the Vila Health team that can be shared with leadership as well as Vila Health colleagues at your site. Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact [email protected] to request accommodations. If, for some reason, you are unable to record a video, please contact your faculty member as soon as possible to explore options for completing the assessment Collaboration and Leadership Reflection Video Assignment.
Instructions
Using Kaltura, record a 5–10 minute video reflection on an interprofessional collaboration experience from your personal practice, proposing suggestions on how to improve the collaboration presented in the Vila Health: Collaboration for Change activity.
Be sure that your assessment addresses the following criteria. Please study the scoring guide carefully so you will know what is needed for a distinguished score:
• Reflect on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes.
• Identify how poor collaboration can result in inefficient management of human and financial resources, citing supporting evidence from the literature.
• Identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals, citing at least one author from the literature.
• Identify best-practice interdisciplinary collaboration strategies to help a team achieve its goals and work together, citing the work of at least one author.
• Communicate in a professional manner, is easily audible, and uses proper grammar. Format reference list in current APA style.
You will need to relate an experience that you have had collaborating on a project. This could be at your current or former place of practice, or another relevant project that will enable you to address the requirements. In addition to describing your experience, you should explain aspects of the collaboration that helped the team make progress toward relevant goals or outcomes, as well as aspects of the collaboration that could have been improved.
A simplified gap-analysis approach may be useful:
• What happened?
• What went well?
• What did not go well?
o What should have happened?
After your personal reflection, examine the scenario in the Vila Health activity and discuss the ways in which the interdisciplinary team did not collaborate effectively and the negative implications for the human and financial resources of the interdisciplinary team and the organization as a whole.
Building on this investigation, identify at least one leadership best practice or strategy that you believe would improve the team’s ability to achieve their goals. Be sure to identify the strategy and its source or author and provide a brief rationale for your choice of strategy.
Additionally, identify at least one interdisciplinary collaboration best practice or strategy to help the team achieve its goals and work more effectively together. Again, identify the strategy, its source, and reasons why you think it will be effective.
You are encouraged to integrate lessons learned from your self-reflection to support and enrich your discussion of the Vila Health activity.
You are required to submit an APA-formatted reference list for any sources that you cited specifically in your video or used to inform your presentation. The Example Kaltura Reflection will show you how to cite scholarly sources in the context of an oral presentation.
Refer to the Campus tutorial Using Kaltura [PDF] as needed to record and upload your reflection.

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Additional Requirements
• References: Cite at least 3 professional or scholarly sources of evidence to support the assertions you make in your video. Include additional properly cited references as necessary to support your statements.
• APA Reference Page: Submit a correctly formatted APA reference page that shows all the sources you used to create and deliver your video.
o You may wish to refer to the Campus APA Module for more information on applying APA style.
Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course Collaboration and Leadership Reflection Video Assignment.

Collaboration and Leadership Reflection Video Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Reflect on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes. Does not describe an interdisciplinary collaboration experience. Describes an interdisciplinary collaboration experience, but the reflection on the success or failure to achieve desired outcomes is missing or unclear. Reflects on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes. Reflects on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes. Includes ways in which reflective nursing practice can help build a better understanding of past experiences to improve future practice decisions.
Identify ways poor collaboration can result in inefficient management of human and financial resources, supported by evidence from the literature. Does not Identify ways poor collaboration can result in inefficient management of human and financial resources. Identifies poor collaboration, but does not address how it can result in inefficient management of human and financial resources or does not provide supporting evidence from the literature. Identifies how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature. Identifies how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature. Multiple authors from the literature are discussed.
Identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals. Does not identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals. Identifies leadership strategies, but it is unclear how they would improve an interdisciplinary team’s ability to achieve its goals, or does not provide supporting evidence from the literature. Identifies best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals. Identifies best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals. Multiple authors from the literature are discussed.
Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively. Does not identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively. Identifies interdisciplinary collaboration strategies, but it is unclear how they would help a team to achieve its goals and work together more effectively together. Identifies best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively. Identifies best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively. Multiple authors from the literature are discussed.
Communicate via video with clear sound and light. Does not communicate professionally in a well-organized presentation. Does not communicate via video or video is difficult to hear and see. Communicates via video with clear sound and light. Communicates via video with clear sound and light. Content delivery is focused, smooth, and well-rehearsed.
The full reference list is from relevant and evidence-based (published within 5 years) sources, exhibiting nearly flawless adherence to APA format. Does not provide a reference list of relevant and/or evidence-based sources (published within 5 years). A majority of reference list sources are relevant and/or evidence-based (published within 5 years) submitted with few APA errors. The full reference list is from relevant and evidence-based (published within 5 years) sources, exhibiting nearly flawless adherence to APA format. The full reference list is from relevant and evidence-based (published within 5 years) sources, exhibiting flawless adherence to APA format.

Resources: Financial and Human Resources

Finances
• Johnson, J. E. (2017). Financial terms 101. American Nurse Today, 12(4), 16–18. https://www.americannursetoday.com/financial-terms-101/
o This resource provides definitions and brief explanations about key financial terms that you will need to know.
Human Resources
• Carlisle, B., Perera, A., Stutzman, S. E., Brown-Cleere, S., Parwaiz, A., & Olson, D. M. (2020). Efficacy of using available data to examine nurse staffing ratios and quality of care metrics. Journal of Neuroscience Nursing, 52(2), 78–83.
o This article looks at measurable outcomes in relation to the nurse-to-patient ratio.
• Olley, R., Edwards, I., Avery, M., & Cooper, H. (2019). Systematic review of the evidence Related to mandated nurse staffing ratios in acute care hospitals. Australian Health Review, 43, 288‒293.
o This article evaluates and summarizes current research on nurse staffing methods and relates those to outcomes.

Efficacy of Using Available Data to Examine Nurse Staffing Ratios and Quality of Care Metrics Collaboration and Leadership Reflection Video Assignment

ABSTRACT
BACKGROUND: Nurse staffing ratios impact both the quality and safety of care on a particular unit. Most hospitals have access to a large volume of nurse-sensitive outcomes. We hypothesized that these data could be used to explore the impact of changing the nurse-to-patient ratio on patient-reported outcomes, nurse satisfaction scores, and quality of care metrics. METHODS: Retrospective data from hospital resources (eg, Press Ganey reports) were linked to daily staffing records (eg, assignment sheets) in a pre-post study. Before September 2017, the nurse-to-patient ratio was 1:1.75 (pre); afterward, the ratio was reduced to 1:1.5 (post). RESULTS: Press Ganey National Database of Nursing Quality Indicators scores were improved, staffing turnover rates were reduced, and falls were linked to periods of high nurse-to-patient ratios. CONCLUSION: This study shows the efficacy of using readily available metrics to explore for associations between nurse staffing and nurse-sensitive outcomes at the nursing care unit level. This provides a unique perspective to optimize staffing ratios based on personalized (unit-level) metrics.
Nurse managers are exposed to a diverse, and often overwhelming, amount of data from which they are expected to derive, track, and store information. Quality of care metrics, financial balance, nurse satisfaction, and patient satisfaction are a few of the more common constructs that nurse managers encounter as nurse-sensitive outcomes. Staffing levels are hypothesized as one of many predictor variables that may impact the aforementioned nurse-sensitive outcomes.1 Because the nurse-to-patient (RN:PT) ratio must be individualized, staffing ratios vary significantly by unit type (eg, ambulatory clinic vs intensive care).2 Given that each nursing unit has unique properties, there is an unmet need in the methods by which nurse managers can evaluate the impact of individualizing staffing ratios to meet their unit needs. In addition, many times, staffing changes are made without tracking data and outcomes for both patients and staff. This study examined the efficacy of using discrete, readily available data to explore the impact of changing the RN:PT ratio on patient-reported outcomes, nurse satisfaction scores, and quality of care metrics. Collaboration and Leadership Reflection Video Assignment

Background
The RN:PT ratio is an expression of the number of nurses available to provide direct care to a number of patients. The RN:PT ratio (ie, staffing ratio) impacts patient quality, nurse satisfaction, and patient satisfaction.3,4 Although this ratio is a common topic of discussion for nurse managers,4 nursing administration, and news media,5 there is a relatively small amount of data-driven evidence linking nurse-sensitive outcomes to various RN:PT ratios within a defined nursing unit. This is especially true of specialty care units.Analyses performed at the hospital level (eg, the hospital is the unit of analysis) demonstrate that the RN:PT ratio impacts the quality of care provided to patients and directly influences the safety of care provided, with higher RN:PT ratios being preferred.6 The ratio of nurses to patients depends on the acuity of the patients (eg, there is a different RN:PT ratio need in the intensive care unit [ICU] as compared with the rehabilitation unit). Kane et al7 completed a systematic review in 2007 that showed that increasing registered nurse (RN) staffing by 1 additional full-time nurse was associated with a 9% decrease in hospital-related ICU mortality. Increasing the RN ratio by 1 RN per patient day was associated with a decrease in hospital-acquired pneumonia, unplanned self-device removal, respiratory failure, and cardiac arrest in ICUs. In this same review, length of stay was shortened by 24% in ICUs and by 31% in surgical patients by increasing the RN ratio by 1 RN per patient day.7Nursing units are becoming increasingly specialized. Staffing needs must be individualized to patient acuity, staff experience, staff workload, ancillary services and testing, and hourly changes in patient census.8,9 A mismatch in the ratio could result in financial burden or burnout of the nursing staff, resulting in mistakes.10 It is important to include different variables such as patient needs, intensity of patient care needs, and time spent undertaking operational requirements (ie, distance to and accessibility of medications or equipment required for patient care) because these impact the nurse’s time at the bedside. In short, the time required by the nurse to take care of 1 patient should not adversely affect the care of other patients or force a nurse to cut corners while caring for a patient to care for others.10The RN:PT ratio affects staff engagement and the quality of care they are able to provide, as well as having a direct influence on patient satisfaction. Improved nurse staffing has been linked to lower rates of nosocomial complications such as infection, pneumonia, and pressure ulcers.1,11,12 Patients with more staff reported higher levels of confidence in the nurses caring for them and satisfaction with care.13 In addition, increasing the RN:PT ratio decreases nurse workload. The decrease in workload allows the nurse additional time with the patient and care partners, which has been shown to increase patient satisfaction.6Staffing is a common topic for nurse managers and administrators, yet there is little literature to support the impact of changing staff ratios in the neurocritical care unit (NCU) on staff and patient outcomes. Most of the available resources are focused on patient satisfaction scores.14–18 Similar to previous studies examining staffing impact, the population and unit of analysis being used in this study is the NCU. The intervention in this study is a change in the RN:PT staffing ratio.19–21Like many NCUs, ours provides postanesthesia care to neurological surgery patients rather than the postanesthesia care unit. To meet professional guidelines for postanesthesia care, our NCU adheres to the American Society of PeriAnesthesia Nurses (ASPAN) guidelines.22 We reviewed the ASPAN guidelines and compared their recommendations with our practice workflow. With 75% of our average daily census being postoperative, we wanted to provide additional support for the RNs to allow them more time with the patient during the immediate postoperative phase of care. Following ASPAN recommendations gave our NCU an additional 4.3 full-time employees and allowed our nurses more time to recover their patients.

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Methods
This analysis includes both retrospective and prospective data representing staffing ratios and nurse-sensitive outcomes from August 2016 to June 2018. The RN:PT ratio before September 1, 2017, was 1:1.75, at which time the NCU was approved to adjust the RN:PT ratio to 1:1.5. The decision to change the planned staffing ratio was made by the nurse manager based on the evidence summarized previously. The plan was approved by administration (Director of Neuroscience Services) after being presented to the hospital chief nurse executive and chief financial officer (see Supplemental Digital Content 1, available at http://links.lww.com/JNN/A214, and Supplemental Digital Content 2, available at http://links.lww.com/JNN/A215). This staffing change led to a budget alteration for additional full-time RNs to be hired. Data were collected from various sources to determine the impact of the ratio change on staff and patients. The university institutional review board determined the study was exempt from institutional review board review. All data are from a single university teaching hospital NCU and were deidentified. Data analyses were performed using SAS v9.4 (SAS Institute).Staff satisfaction data were abstracted from annual Press Ganey National Database of Nursing Quality Indicators (NDNQI)23 reports. Staffing data were abstracted from daily assignment sheets. Patient satisfaction was abstracted from monthly Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems scores. Quality indicators and infection rates were tracked by the hospital infectious disease department and reviewed monthly; these data were abstracted to provide quality of care metrics. Collaboration and Leadership Reflection Video Assignment
Results
From August 2016 through August 2017 (preintervention), the mean RN:PT ratio was 1:1.80 on day shift and 1:1.73 on night shift. From September 2017 to June 2018 (postintervention), the mean RN:PT was 1:1.73 on day shift and 1:1.63 on night shift. There was a decrease in the frequency of 1:3 assignments; preintervention, there were 107 times when an NCU nurse was assigned to care for 3 patients (58 on day shift, 49 on night shift) compared with 40 times (18 on day shift, 22 on night shift) during the postintervention period.Nurse satisfaction was examined using NDNQI results. The NDNQI survey response rate was 60% preintervention and 95% postintervention. There was improvement in 5 major NDNQI survey categories, where nurses’ preintervention and postintervention scores increased from the 75th to 90th percentile (Table 1). These categories included the ranking for nurses who felt that they have what they need and they can make a contribution that gives meaning to their life, that staffing and resources were adequate, job enjoyment, nursing foundations for quality of care, and mean practice environment scale score. Staffing turnover (RNs who leave divided by the total number of RNs) was 19.8% for the year 2016–2017, 16.7% for the year 2017–2018, and 5.7% for the year 2018–2019.

Patient satisfaction was examined by exploring patient responses from Press Ganey surveys. Of 108 completed surveys, 55 were preintervention and 53 were postintervention. This study reviewed 5 Press Ganey quality variables (percentage of response rated the hospital 9–10, response of hospital staff, communication with nurses, hospital environment, and discharge information presented). Of the 5 patient satisfaction variables on the Press Ganey survey, only 1 quality indicator, communication with nurses, increased (Table 2). Statistical analysis was performed on different quality aspects; none of the findings was statistically significant. Collaboration and Leadership Reflection Video Assignment

Quality of care was examined by calculating the number of falls, catheter-associated urinary tract infection, and central line–associated blood stream infection in the preintervention and postintervention periods. The number of catheter-associated urinary tract infections decreased from 12 to 3. The number of central line–associated blood stream infections also decreased from 1 to 0. Although all 6 falls documented occurred after the ratio change was implemented, these falls occurred on days when the RN:PT ratio was higher than 1:1.5. The hospital-acquired pressure ulcers decreased from 26 before the staffing change to 22 after the staffing change.
Discussion
The data provide compelling evidence to support the efficacy of using discrete and readily available data to examine the impact of nurse staffing on nurse satisfaction, patient satisfaction, and patient outcomes. Whereas general care units flourished, nursing care units are becoming increasingly specialized.24 It seems intuitive that a generalized approach to staffing is unlikely to be successful in the face of the trend toward specialization.
Nurse Satisfaction
In 2016, the NCU adjusted staffing to help adhere to ASPAN guidelines.22 Review of our nurse engagement and nurse satisfaction data, similar to Nadolski et al,4 demonstrated increased engagement and satisfaction. Mean scores increased for multiple items including RNs reporting that they have what they need, can make a contribution that gives meaning, have adequate staffing, and enjoy their job; all increased after the ratio change. It is well known that, when nursing staff are more satisfied with their job, they stay longer.25 This decreases turnover, staff stress, and cost of hiring new employees. Before the change in September 2017, our suggested nurse ratio was not aligned with the ASPAN standard, which gave room for improvement by increasing the number of nurses to patients. Before implementation of the new scheduling ratio, more nurses reported not being able to sit down during their entire shift, which can result in exhaustion and impair their ability to perform.26 According to Stalpers et al,27 nursing staff perception about the quality of care provided in the ICU has been identified to be independent of the way the same nursing staff feels about their personal job satisfaction.
Patient Satisfaction
Intensive care nurses play a vital role in building rapport with patients and their families. Nurses are not only care providers, but through maintaining close communication and spending more time at the patient’s bedside, they can better identify treatment-related concerns.28 Nurses with busier schedules and higher patient loads may be rushed to fulfill their responsibilities and hence have no time to review patient symptoms or respond to their concerns.29 It has been identified that heavy workloads hinder the capacity of nurses to thoroughly care for the patients and may impact patient satisfaction, nurse burnout, and even patient mortality.11,26 It seems likely that the lack of statistically significant differences in prescores and postscores in Table 2 reflects that Press Ganey may not be an appropriate metric for evaluating nurse-sensitive outcomes.30 Collaboration and Leadership Reflection Video Assignment
Quality of Care
The greatest impact identified was decreased incidence of urinary tract infections (12 cases before the change vs 3 cases after the change). There was a decrease in ventilator-related infections (4:1) and pneumonia (1:0). Also identified were decreased cases of pressure ulcers (26:22) and complications of central line–related infections (1:0). Since the change, 6 falls were reported in contrast to 5 reported the previous year. Circumstances surrounding falls were investigated in detail, and it was identified that falls occurred on the shifts when staffing ratios were around 1 nurse for 2 patients (even higher than the RN:PT of 1:1.80 in 2016), which shows that there is improvement in many healthcare quality aspects among the ICU implementation contrary to the new adopted ratio of 1:1.73 to 1:1.63.
Limitations
Change is not always easy to initiate, especially when there is a monetary impact on a unit or hospital. Nurses are constantly advocating for higher RN:PT ratios, but there are multiple barriers to creating this change. Overall, it was a lengthy process; the unit manager initiated conversations with upper level nursing and hospital administration in April 2017, and the staffing change occurred in September 2017. In addition, upper level management pushed to collect pre– and post–staffing change data for both the patients and the staff. This process involved a nurse scientist, a statistician, and a research coordinator. By integrating all of this infrastructure into the culture of change, the staff were able to visualize the impact of the staffing ratio change, which further motivated engagement, additional understanding of the metrics, and the outcomes of the metrics on the unit culture.This was a retrospective analysis that includes survey data and therefore is limited to the available data. Nurse census data were collected at 7 AM and 7 PM; if a nurse came in at 11 AM, they were not counted in the 7-AM census. Changes to staffing ratios at various times throughout the day could be accounted for in future studies. In addition, the use of Press Ganey as a measure of patient satisfaction has limitations in that the responses are sometimes from patients who had to stay in our NCU overflow unit, which separated patient rooms by curtains and may impact patient satisfaction scores.30 Collaboration and Leadership Reflection Video Assignment
Conclusion
The RN:PT ratio is an important metric that has implications for frontline management and upper administration. This study demonstrates the efficacy of using readily available data to examine nurse-sensitive outcomes and their association with staffing patterns. In this study, reducing the staffing ratio was associated with improved nurse satisfaction, decreased adverse events, and increased patient satisfaction. This study adds to the nursing literature that lower staffing ratios provide a cost benefit as well as demonstrate improved nursing-sensitive outcomes.

Reflective Practice and the Quiz
• Jacobs, S. (2016). Reflective learning, reflective practice. Nursing, 46(5), 62–64.
o This article provides a review of what self-reflection entails, why it is important for nurses, and some tools to help you reflect.
• Wilkinson, T. J. (2017). Kolb, integration and the messiness of workplace learning. Perspectives on Medical Education, 6(3), 144–145.
o This article examines how reflection and the use of a cyclical improvement model can help connect theory and learning to real-world application.
• Vila Health: Collaboration for Change.
o This activity will provide you with the context for the second part of this assessment Collaboration and Leadership Reflection Video Assignment.

QUESTION 1 OF 5
What does reflective practice mean to you?
Enter your response

QUESTION 2 OF 5
What is a model to help you engage in reflective practice?
Enter your response

QUESTION 3 OF 5
What are some tools to help you engage in reflective practice?
Enter your response

QUESTION 4 OF 5
Why is reflective practice important for improving one’s professional efficacy?
Enter your response

QUESTION 5 OF 5
How do you see reflective practice being of benefit to you personally?
Enter your response

PRACTICE:
IT’S IMPORTANT that nurses practice self-reflection. But what exactly does self-reflection mean and why is it important? Further, how is it enacted and conveyed to others? As an educator, I had a classroom experience that led me to examine these questions in depth. In this article, I discuss what I learned. Collaboration and Leadership Reflection Video Assignment
Mandate for reflective practice
I was teaching an introductory nursing course and, like all good nurse educators, I spoke of the need for students to begin the process of self-reflection within their practice. I said we all need to engage in this process because as nurses, we must constantly evaluate our actions, behaviors, responses, and the decisions we make while practicing nursing. I discussed how reflective practice is a professional obligation; the College of Nurses of Ontario mandates that practicing nurses engage in reflective practice.1 During my discussion, I also showed some lecture slides that described reflective practice. One slide showed a robot with the notation that, as nurses, we can’t act blindly, without reflection or critical thinking.A few weeks later, when I asked why nurses need to engage in self-reflection, one student wrote only, “Because nurses aren’t robots.” At first, I was dismayed and disappointed by this simple answer—but really, what kind of answer was I expecting? As I reflected, I realized that we do a disservice to this concept in nursing curricula. We say nurses need to engage in self-reflection, but we don’t explain or model what reflection really is. For much of our curriculum, we teach content, but do we as educators consistently reflect if learning has actually occurred?Reflection is much more than revisiting how we administered a particular medication. Authentic reflection requires not only providing rationales for our actions, but also constantly exploring and examining ourselves and our own growth. This includes every aspect of our nursing practice, from skills to communication to interactions with others. Reflection not only ensures that we followed all the rights of medication administration, but also that we relate to our patient and colleagues in a humane, holistic manner.Freire stated that those who wish to commit themselves to others need to constantly reexamine themselves. True reflective practice provides a way for nurses to escape impulsive, routine, and judgmental assumptions about situations, practice, colleagues, and patients.2
Reflective learning or practice?
Henderson, Napan, and Monterio use the term reflective learning to describe consciously thinking about and analyzing actions.3Reflective practice is the process of obtaining new insights through self-awareness and critically reflecting upon present and prior experiences.4More recently, reflective learning has been defined as a process of holding experiences up to a mirror in order to examine them from different perspectives, whereas reflective practice assists one to explore what exists “just beyond the line of vision.”5 Similarly, the College of Nurses of Ontario states reflective practice is a process of nurses’ reviewing aspects of their practice to decide what’s working and what could be done differently.1But reflective practice in nursing and/or nursing education is more complex than a single definition. As Bagay reminds us, reflection is a multifaceted process of action that each professional nurse considers throughout his or her entire career.6Bulman, Lathlean, and Gobbi wished to uncover a greater understanding of how reflection is perceived and used by nursing students and instructors in an educational context. They found that reflection is associated with one’s professional motivation to “move on” and “do better” in practice in order to learn from the experience, and critically examine one’s “self.”7 This isn’t new. Over 80 years ago, Dewey articulated this type of reflection as important to an active search for solutions to difficulties from past experiences in order to learn.8 Bulman et al. also found that reflection was associated with humanistic nursing, emphasizing the importance of active expression of oneself to holistically care for others.7Within education, much discussion has centered on the importance of teaching students to develop critical thinking skills through the use of reflection, both within and outside the profession of nursing.9-12 Fulton expands on this and argues that nursing educators also need to encourage students to be curious thinkers.13 Curious thinking uncovers problems. Because curious thinkers are more interested in the questions than the answers, they question everything in their practice, beginning the process of authentic and complete reflection.13 Authentic reflection is action-oriented. It’s an active process of discovering oneself.
Necessary practice
Johnson states that reflection is necessary to determine how one learns and one thinks, make sense of information, think critically, view problems from varying perspectives, develop new insights, bridge theory and practice, and understand one’s strengths and weaknesses.11 Reflective practice in nursing correlates to the development of critical, autonomous, and advanced practitioners.14 In short, reflective practice is necessary to:
• develop coping strategies
• enhance interprofessional communication
• increase students’ understanding of nursing practice
• promote the expression of feelings
• make sense of personal emotional practice challenges
• help nursing students to know themselves.
It’s obvious that reflective practice is much more than simply wondering how one’s shift went, and it’s more than simply discouraging nurses and nursing students from applying their knowledge and skills robotically. Reflection for nursing students also helps them bridge the gap between new information they’re learning and their prior knowledge.18 These connections help to deepen their understanding of the content and material. They not only learn to solve problems, but also to help others and use their learning in “new and imaginative ways.”18Collaboration and Leadership Reflection Video Assignment
Tools for reflection
But how does one actually engage in reflective practice within nursing? Henderson, Napan, and Monterio offer a five-point reflection scale (reporting, responding, relating, reasoning, reconstructing) that can be viewed as a continuous circle.3,11 Gibbs offers another reflection model with six components (description, feelings, evaluation, analysis, conclusion, action plan).19Of course, these are only two models of reflective practice; there certainly are others. What’s most important to consider is the fact that with these and other models, reflection is an active, deliberate, and cognitive process in which one examines a situation from varying perspectives, is open to new knowledge and information, and looks for numerous explanations and outcomes.11But how often do we describe these models of reflection to nursing students? We ask them to write reflections on how their day went, but we don’t often ask them to authentically reflect on how they interact with others. Sure, we talk to them about being professional with all colleagues and peers. We say it’s necessary to exude professionalism, but we rarely explain to students that this requires them to constantly reflect upon how they act with others, what they actually say, and how they say it.20 Only then will reflective practice serve the larger purpose of holistically enlightening nurses.
How educators can model reflective practice
Nurse educators must model reflective practice. One of the ways I do this is by asking my students to complete an anonymous evaluation of our class. I explain to students that I want their input about how I can best teach (and reach) them, and how we can all work together to enhance the learning environment. I do this early in the semester; the following week, I discuss their comments, ideas, and opinions. I incorporate as many of their thoughts as I can during the balance of the semester. Brookfield promotes this type of reflective practice in education because it allows instructors to see themselves through their students’ eyes.21Although educators often engage in reflection about our own actions and communication, we need to remember that sound education is always more about the process than the product.22 Our job is to constantly view the world from different perspectives. And this can be achieved only by modelling and engaging in true reflection of all our actions and communications as educators.
REFERENCES
• 1. College of Nurses of Ontario. [Context Link]
• 2. Freire P. [Context Link]
• 3. Henderson K, Napan K, Monterio S. Encouraging reflective learning: an online challenge. In: R. Atkinson, C. McBeath, D. Jonas-Dwyer, R. Philips, eds. [Context Link]
• 4. Freshwater D, Taylor B, Sherwood G. [Context Link]
• 5. Freshwater D. The scholarship of reflective practice [position paper]. Indianapolis, IN: Sigma Theta Tau International; 2012.[Context Link]
• 6. Bagay JM. Self-reflection in nursing. J Prof Nurs. 2012;28(2):130–131.[Context Link]
• 7. Bulman C, Lathlean J, Gobbi M. The concept of reflection in nursing: qualitative findings on student and teacher perspectives. Nurse Educ Today. 2012;32(5):e8–e13.[Context Link]
• 8. Dewey J. [Context Link]
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• 10. Bourdieu P. [Context Link]
• 11. Johnson JA. Reflective learning, reflective practice, and metacognition: the importance in nursing education. J Nurses Prof Dev. 2013;29(1):46–48.[Context Link]
• 12. Swanwick R, Kitchen R, Jarvis J, McCracken W, O’Neil R, Powers S. Following Alice: theories of critical thinking and reflective practice in action at postgraduate level. Teaching in Higher Education. 2014;19(2):156–169.[Context Link]
• 13. Fulton JS. Reflections on teaching nursing. J Infus Nurs. 2014;37(4):229–230.[Context Link]
• 14. Mantzoukas S, Jasper MA. Reflective practice and daily ward reality: a covert power game. J Clin Nurs. 2004;13(8):925–933.[Context Link]
• 15. Elmqvist C, Fridlund B, Ekebergh M. Trapped between doing and being: first providers’ experience of “front line” work. Int Emerg Nurs. 2012;20(3):113–119.[Context Link]
• 16. Ip WY, Lui MH, Chien WT, Lee IF, Lam LW, Lee DT. Promoting self-reflection in clinical practice among Chinese nursing undergraduates in Hong Kong. Contemp Nurse. 2012;41(2):253–262.[Context Link]
• 17. Rees KL. The role of reflective practices in enabling final year nursing students to respond to the distressing emotional challenges of nursing work. Nurse Educ Pract. 2013;13(1):48–52.[Context Link]
• 18. Doyle T. [Context Link]
• 19. Gibbs G. [Context Link]
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• 21. Brookfield SD. [Context Link]
• 22. Palmer PJ. [Context Link] Collaboration and Leadership Reflection Video Assignment

‘I don’t know what’s wrong with our students. We’ve taught them all they need to know but they just can’t seem to remember any of it when they’re at work’. This paraphrase may be a familiar call of some teachers bemoaning how students have difficulty in applying their learning.
Linking classroom theory to workplace practice is the focus of a systematic review in this issue of Perspectives on Medical Education [1], but let’s start with a brief, and idiosyncratic, history of learning.
People have been learning from work and from experience since the earliest days of our evolution. Some time ago we must have decided it was a good idea to separate theory from practice so that we would teach the theory and that presumably would make the practice more robust. The dark days of the 19th century, factory style schooling attests to this philosophy: students in darkened classrooms being taught but not necessarily learning. Flexner had the best of intentions to link medical practice to theory but even here this was translated into doing the theory first and the practice later [2]. Then we must have realized that we needed to put the theory closer to practice and integrate.
Within medical education, integration became the next buzzword but there was potential for confusion. We realized that learning anatomy separately from physiology made it difficult for students to make the links between structure and function – so we invented horizontal integration where we combined previously separated disciplines in our teaching. Next came early clinical contact so that practice can be brought earlier into our curriculum – so called vertical integration. The next challenge is ‘upward’ vertical integration of theory into the later stages of our curricula so that theory becomes better linked to practice.
The irony here is we had integration of theory with practice before schools were created, and then we separated them and now we’re putting it all back together again. At least we’re trying to.
Kolb had useful views on learning from experience or linking theory to practice and his learning cycle has become part of most education courses [3]. It’s simple but also effective. In short, he describes a cycle whereby learners make links between theory and practice (or experience) in a number of ways. They can start with the theory and then apply this into practice. Or they can start with practice and reflect on how it might link to theory. Either way there is a cycle of initial theory preparation/briefing, experience, reflection/debriefing, modification of theory. With each cycle, and with ongoing experience and reflection, learners modify their views of the world. In short, they learn.
In our attempt to make learning more efficient and to provide more guidance and control, we’ve also invented learning outcomes – these are what we would like our learners to learn. They provide guidance to students and are generally seen as a very good thing.
Apprenticeship went through some phases too. Initially seen as a good thing where the protégé learns from the master, it then fell into disfavour, as it all seemed to be about practice without relevant theory. Within the health professions, working without theory is seen as a bad thing. The emergence of evidence-based medicine was one response to this. Another response was to suggest that apprenticeships are too uncontrolled. Collaboration and Leadership Reflection Video Assignment
We’ve now entered the next age of learning where we think workplace learning is good but we need to understand it better. We also need to link workplace-based learning more explicitly to theory. A laudable goal, and the focus of the systematic review in this issue [1].
There are many reasons why workplace learning is to be encouraged. We know that seeing the whole task helps a learner know where the component parts might fit [4]. We know that seeing role models and the actual doing of work helps frame learning, helps show what is relevant and helps in professional identity formation. We also know that learning in context makes it easier to apply that learning back into that context. Workplace learning is back and it’s here to stay.
However, workplace learning is also very messy. What is learnt is unpredictable and learning is not the prime activity as it takes second place to doing the work – in clinical settings, the patient is the focus not the student. The curriculum is not as well defined; it is more serendipitous. Learning outcomes are harder to control and predict. Sometimes learners do not feel welcomed in workplaces and this sense of alienation can inhibit learning.
What helps learning in workplaces and the linking of theory with practice? The first component of dealing with the messiness and unpredictability is to recognize it. Focusing on the process of learning, not just the outcomes, is an important first step [5]. To do this, we should explain the opportunities available but acknowledge that different learners will all have different experiences and take up different opportunities. We can’t control that, and shouldn’t try. We also need to acknowledge the social process of learning. The work of Lave and Wenger has been very influential here highlighting how a sense of belonging emerges from concepts of communities of practice and legitimate peripheral participation [6].
Linking theory to practice in the workplace is the focus of the systematic review in this issue [1] and it’s here where Kolb re-emerges because the components of effective activities seem to mirror his learning cycle [3]. The systematic review showed that effective interventions offered ‘just in time’ information prior to an experience or task, included effective briefing, provided well supervised and observed practice with immediate feedback, and followed it with time for reflection and good debriefing. This means the learner can consider how the experience links to existing learning and how that learning might then be modified so that the outcome is even better the next time it is put into practice. Deliberate supervised practice, with effective briefing and debriefing, seem core elements of the effective learning strategies that were identified. Collaboration and Leadership Reflection Video Assignment
We also see that people learn in workplaces despite us. The systematic review found no intervention was worse than control, and there were some where people learned just as well from the control group as the intervention.
Linking theory (or the classroom) to practice requires conscious application of a cycle of learning, while attending to the important social and professional identity components offered by workplace learning – the need for the learners to feel welcome, for them to have opportunities to observe the whole task, to observe role models and to have supervised opportunities for practice preceded by briefing and followed by debriefing. This structure does not imply formality. Such structure can be used in informal supporting ways. Workplaces do not respond well to imposed formality – we cannot easily control what people learn at work but we can help them recognize and use the learning opportunities, we can help them make sense of their experiences and most of all we can help them feel they are allowed to be there.
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Biography
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Tim J. Wilkinson
MBChB, MClinEd, PhD, MD, FRACP, FRCP, is director of the MBChB programme, professor in Medicine and associate dean (Medical Education) at the University of Otago, New Zealand
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References
1. Peters S, Clarebout G, Diemers A, et al. Enhancing the connection between the classroom and the clinical workplace: a systematic review. Perspect Med Educ. 2017. doi:10.1007/s40037-017-0338-0 [PMC free article] [PubMed]
2. Bonner TN. Iconoclast: Abraham Flexner and a life in learning. Baltimore: The Johns Hopkins University press; 2002. [Google Scholar]
3. Kolb D. Experiential learning: experience as the course of learning and development. Englewood Cliffs, New Jersey: Prentice Hall; 1984. [Google Scholar]

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4. Billett S. Learning through health care work: premises, contributions and practices. Med Educ. 2016;50:124–131. doi: 10.1111/medu.12848. [PubMed] [CrossRef] [Google Scholar]
5. Sheehan D, Wilkinson TJ, Billett S. Interns’ participation and learning in clinical environments in a New Zealand hospital. Acad Med. 2005;80:302–308. doi: 10.1097/00001888-200503000-00022. [PubMed] [CrossRef] [Google Scholar]
6. Lave J, Wenger E. Situated learning: Legitimate peripheral participation. New York: Cambridge University Press; 1991. [Google Scholar] Collaboration and Leadership Reflection Video Assignment