Dr. Kim A. Critchley, University of Prince Edward Island Canada

1. Using critical incident technique to promote students reflections skills in a transatlantic nurse education project Dr. Kim A. Critchley, University of Prince Edward Island Canada Dr. Liisa Koskinen, Savonia University of Applied Sciences Finland

2. International Project Inequalities in Access to Health Care for Rural Communities – Funded through Canada – EU Program for Cooperation in Higher Education and Training (October 2004 – September 2007)

3. International Partners • Canada • Mount Royal College Calgary – Pam Nordstrom and Maureen Mitchell • Universite de Moncton – France Chasse and France Marquis • University of Prince Edward Island – Kimberley Critchley and Barbara Campbell • EU • England, Bournemouth University – Ann Hemingway and Eileen Richardson • Sweden, Uppsala University – Clara Aarts and Eva Bergknut • Finland, Savonia University of Applied Sciences – Liisa Koskinnen • Estonia, Tallinn Health College – Tiina Johansoo

5. Project Objectives • To foster student exchange in different health care disciplines. • To establish a network of scholars and practicing health care professionals working toward the enhancement of joint curricula. • To promote increased cooperation and exchange of ideas among the partner communities.

6. Academic Opportunities • Increase student mobility -from October 2004 to September 2007, 24 EU and 40 Canadian students would undertake an exchange visit for 12 weeks. • Enhancement of joint modules of training in association with the partner institutions and communities. • Observation of all involvement in International work methods and culture.

7. Project Outcomes • Seamless credit transfer for students among consortium partner institutions. • Faculties working together in the enhancement of new joint curricula. • Opportunities for students to work toward achieving proficiency in a second language. • Web-based joint training.

8. Project Outcomes (con’t) • Development of a model for the professional recognition and certification of programs. • Increased cross-cultural understanding through student mobility and on-line communication. • Stimulated interest among health care students in foreign language and cross-cultural study. • Greater understanding of the strengths of each consortium partner and opportunities to share resources. • Opportunities for students and faculty to work and conduct research.

9. Opportunity for Research • This presentation presents one example of research conducted as a result of the Canada-EU Mobility Project.

10. Critical incident technique • Originates from the 1950’s (John Flanagan) • Is a learning/teaching method • Is a research data collection method

11. CRITICAL INCIDENT ANALYSIS RECORD SHEET (for EU/Canada exchange students) Sit down at least three times during your exchange trip and choose one critical incident that has taken place recently and explore it in detail. Critical incidents are brief descriptions written by learners about meaningful events in their lives (Brookfeld 1990). Any experience you encounter during your exchange trip may be a critical incident and therefore a situation you can reflect upon. In the other words: incidents happen but a critical incident is produced by the way you look at a situation; a critical incident is your interpretation of the significance of the event. Here are some key steps for organising you’re reflecting and writing.

12. 1 Identify the event or occurrence with as much specificity as possible - the problem to be solved, issues involved, etc. You may not have precise ideas on this when you start writing. Just start writing. 2 Describethe relevant details and circumstances surrounding the event so that you and the tutor who reads your entry will understand what happened. What? When? How? Why? Where? 3 List the people involved, describe them and their relationship to you and to each other. 4 Describe your role in the situation - what you did, how you acted. 5 Analysethe incident. How well or badly did you understand the situation? How did you handle it? What would you do differently the next time? Why? 6 Analyse this incident in terms of its impact on you and explain why you view it as critical in relation to rural inequalities in health or a specific area of the Ottawa Charter. How does it relate to your particular objective(s)? What have you learned from the experience? How has your perspective on your own role and that of others been changed and/or reinforced?

13. Can critical incidents method be used in educating reflective practitioners in nursing? • The method • Supports learners’ critical thinking and experiential learning (Niemi 2003, Mikkonen 2005) • Helps learners’ personal (Silkelä 2001; Merikivi 2003) and professional development (Turunen 2002) • Assists learners integration of nursing theory into practice (Koskinen, Jokinen & Mikkonen 2007) • Improves learners’ reflection skills (Koskinen et al 2007)

14. The study • Aim: • To describe students learning from the incidents • To stimulate discussion on the usefulness of the method in intercultural nursing education • Data collection • Critical incidents (n=92) written by 18 Canadian and 13 British, Estonian, Finnish and Swedish students (n=31) • Data analysis • Stage 1: data reduction in seven ”research centres”. The data were in English, Estonian and Swedish. • Stage 2: data reduction, data display, conclusion and verification (Miles & Huberman 1994). The data were in English.

15. Results: The chosen incidents were contexts, events, situations or experiences • that were unfamiliar in comparing to the familiar • that either showed examples of lack of cultural awareness in care or demonstration of culturally sensitive care • that either showed examples of good nursing care or lack of good nursing care • that were pivotal both personally and professionally “the extreme as life altering occurrences” • that were related to cultural differences that interfere with the students’ moral values, beliefs, communication abilities and the professionalism in giving nursing care

16. Table 1. Learning areas the chosen incidents were related with.

17. Results: In their critical incidents the students’ showed increased awareness • about personal and professional self and own emotions • about the importance of non-verbal communication in nursing care • about cultural differences in nursing role and nursing care • about cultural differences in health programmes, services and methods • about societal inequalities

18. Implications for intercultural nursing education • Critical incident method can be used in fostering nursing student’ learning and reflection skills in the context of intercultural education • Make sure that the learning objectives are shared between the project partners and students before they leave and throughout the exchange – more discussion and support on ”what to expect” • Increase dialogue about each incident either with the home or host instructor • Extend the time spent in each clinical and community setting – more time to bridge the cultural and language barrier and move from observer to the actual patient contacts

19. Implications… 4. Possibly owing to the shortness of the intercultural visits, the students viewed host culture’ s health service either through ‘rose-tinted spectacles’ or ‘negative eyes’. These can be seen as consistent with the phenomenon of superiority or reversal in Bennett’s (1993) study of intercultural sensitivity – instructors might be valuable for recognizing this phenomenon, in order to be able to encourage further cultural self-examination among the students

20. To Conclude • Students were able to participate, enjoy and learn from this cultural exchange including the critical incident writing