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
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)
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
Project Objectives
• To foster student exchange in different health
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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.
Academic Opportunities
• Increase student mobility
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-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.
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.
Project Outcomes (con’t)
• Development of a model for the professional recognition
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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.
Opportunity for Research
• This presentation presents one example of
research conducted as a result of the
Canada-EU Mobility Project.
Critical incident technique
• Originates from the 1950’s (John
Flanagan)
• Is a learning/teaching method
• Is a research data collection method
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.
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 Describe the 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 Analyse the 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?
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)
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.
Results: The chosen incidents were
contexts, events, situations or
experiences
•
that were unfamiliar in comparing to the familiar
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that either showed examples of lack of cultural awareness in care or
demonstration of culturally sensitive care
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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”
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that were related to cultural differences that interfere with the students’
moral values, beliefs, communication abilities and the professionalism in
giving nursing care
Table 1. Learning areas the chosen incidents were related with.
EU students
Importance of cultural
awareness of health care
professionals
Impact of income, social
status, and rural issues
in inequalities in health
and well-being
Impact of lifestyle in
health and well-being
Both students
Dilemma of good/bad;
right/wrong in health care
(ethical issues)
Experiencing particular clinic,
programme, service
system or method
Witnessing
unacceptable/warm
nurse-patient interaction
Impressive personal cultural
experience
Personal confusion in a
difficult and unexpected
nursing situation
Dress code and safety nursing
practices
Canadian students
Experiencing
communication and
culture barrier in
Estonia, Finland and
Sweden
Cultural differences in
nursing role and nurses
awareness and
knowledge of health
promotion and sickness
prevention strategies
Results: In their critical incidents
the students’ showed increased
awareness
• about personal and professional self and own
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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
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
1. 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”
2. Increase dialogue about each incident either with the home or host
instructor
3. 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
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
To Conclude
• Students were able to participate, enjoy and
learn from this cultural exchange including the
critical incident writing