Incorporating the service accomplishments into pre-registration curriculum to enhance reflective practice

Much emphasis is being placed on the importance of reflective practice as a means to ensure that practitioners are competent in their practice. It is therefore important to ensure that student nurses acquire these reflective skills as part of their development throughout pre-registration curricula. Although reflective practice is seen as a major part of curricula activity, the style in which reflection is advocated takes many different formats. Strategies for developing reflection which focus on outcomes for students can become subjective and fail to place healthcare practice within the context of social structures and values. This paper offers a framework for reflection that promotes an outlook which is both objective and subjective, based on Mezirow's six levels of reflection (as adapted by Powell 1989) and O'Brien's (1987) five service accomplishments. Focus of reflection within the wider context of society and healthcare policy should enable development of a practitioner who is both competent in practice and can analyse and evaluate their practice.     

Reflection: does it enhance professional nursing practice?

It is generally accepted that nurses who engage in reflective activity do so to develop their practice. However, there is little empirical evidence to suggest that practice development or improved patient care occurs as a direct result of reflection. The UKCC, as part of its framework for postregistration education, expects all nurses to engage in some form of reflective activity and to provide written accounts within a personal professional profile. This article examines some of the assumptions surrounding the practice of reflection and asserts that, in the main, nurses do not readily engage in reflection in a purposeful way.     

Reflection and patterns of knowing in nursing

Over the last decade nursing has progressed from a reliance on empirical theory applied to practice to a recognition that experience develops knowledge that can guide the actions of practitioners. Reflection is a means of surfacing experiential knowledge, and students may begin to use reflection as their experience of nursing accumulates. As Carper was a key figure in widening that knowledge accepted as knowing in nursing beyond the empirical, it is both justified and recommended that her work should be incorporated into reflective practice. Johns has integrated Carper's work in his model of guided reflection and this paper briefly examines this combination. The main focus is on two further patterns of knowing: unknowing and sociopolitical knowing. These patterns are examined and the contribution they could make to reflective practice is discussed.     

Review of Supervising the reflective practitioner: An essential guide to theory and practice.

Reviews the book, Supervising the reflective practitioner: An essential guide to theory and practice by Joyce Scaife (see record 2010-09732-000). This review begins with an elaboration on the two key terms in the title. First, the book is about supervising rather than being or becoming a reflective practitioner. As Scaife notes, much of supervision involves modeling, and therefore, a supervisor must be reflective in order to encourage the student to become more reflective. However, a psychodynamic practitioner would think of this as parallel process, so that the reflection in supervision might ultimately be translated into reflection in psychotherapy. The more important term in the title is reflective practitioner. This immediately draws to mind the concept of reflective practitioner introduced by Donald Sch?n (1983), and there are some very important parallels that the reviewer points out. In conclusion, the reader will be rewarded by multiple exercises that will be useful in supervising and in classroom teaching. Scaife very helpfully points out that assessment often is contrary to the spirit of reflection, because the student attempting to satisfy the instructor is not attending to his or her own needs, as is necessary for successful reflection. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Thoracic aneurysm repair using circulatory arrest or retrograde cerebral perfusion]

The meaning and process of reflection and reflective practice appear to be currently accepted and institutionalized within the nursing profession. This paper, through use of a literature review, attempts to question the value that is consequently placed on this strategy and argues that on closer examination, reflection has no clear or universal definition, an uncertain framework for implementation, and is of unproven benefit to the professional practice of nurses. Given this evidence, the author concludes that reflection is a fundamentally flawed strategy that must be of limited benefit to the nursing profession.     

The fibrous proteins of stratum corneum

The proteins of cow snout stratum corneum can be extracted in part with Tris buffer, pH 9.0, containing 6 M urea. Sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis shows that about half the extracted material migrates as prekeratin when the extract is treated with both SDS and mercaptoethanol; only trace amounts of the proteins migrating as prekeratin are seen when SDS alone is used. The urea extract gives precipitin lines to an antibody against prekeratin. After exhaustive extraction with the Tris-urea buffer an additional amount of protein is solubilized by extraction with buffer containing mercaptoethanol. This extract shows an electrophoretic pattern similar but not identical to prekeratin. These results suggest that the stratum corneum contains fibrous proteins with different degrees of cross-linking. An analogous system has also been observed in human stratum corneum.     

Reflection and critical incident analysis: ethical and moral implications of their use within nursing and midwifery education

Despite the dearth of rigorous empirical investigation, reflection and reflective practice have become buzz words in nursing and midwifery education. Reflection and critical incident analysis may be tools which can facilitate the integration of theory and practice. It is proposed that in the absence of explicit and thorough preparation of lecturers and students, together with very careful curriculum planning, these activities may be counter-productive or even harmful. In the absence of structure, reflection and associated critical incident analysis may lead to student disaffection or, worse, the potential for actual psychological disturbance. Empirical studies on the use of identified models of reflection and critical incident analysis are urgently needed to assist nursing and midwifery lecturers and students to achieve predictable learning outcomes for this potentially valuable activity.     

A nursing journey through discursive praxis

This paper argues that conceiving nursing as a form of praxis, encompasses amongst other things, the critical reflection upon one's nursing practice in order to work out and understand internal and external constructions of personal theories. This reflective examination will demonstrate the implicit knowing that nurses develop as a result of their personal, day to day practice. Highlighting this knowing and incorporating the richness of their practice experience becomes the basis for their own personal nursing praxis.     

Defects generated in human stratum corneum specimens by ultrasound

Over the last two decades, ultrasound (US) has been applied to enhance transdermal drug delivery. This method is called sonophoresis. The physical mechanism of the enhancement is far from being fully understood. It has been shown in our study that 168-kHz continuous US of spatially averaged pressure amplitude of 1.9 x 10(5) Pa induced a new structural state and generated defects (entrapped air pockets) in human stratum corneum specimens. The dimensions of the defects were found to be about 20 microns, large enough to allow the transdermal passage of high-molecular-weight drug molecules that normally elude the unenhanced transdermal drug delivery.     

Effectiveness of public health interventions in food safety: a systematic review

Reflective practice is now widely debated as a means of improving nursing practice. However, assumptions about reflective practice are rarely clarified and seldom subjected to critique. Therefore, the purpose of this paper is to take up Clarke, James & Kelly's suggestion that limits to the scope and depth of reflection be considered. This is achieved by reflecting on what these authors claim it means to reflect in action. Four arguments are presented: (i) that nurses cannot be conscious of all aspects of nursing practice because there are aspects of practice that cannot be represented in consiousness, (ii) that those aspects of practice that can be represented in consciousness can be so only imperfectly, (iii) that all such representations are not reflexive, and (iv) that any representation in the form of an internal dialogue that could be regarded as reflection is overdetermined. Implications for reflexivity are then considered.     

Influence of vitamin E acetate on stratum corneum hydration

The influence of vitamin E (tocopherol, CAS 10191-41-0) on stratum corneum hydration was tested in O/W and W/O emulsions. Additionally, the O/W emulsion was used in an in vivo/in vitro method to gravimetrically obtain evidence concerning the water-binding capacity of the stratum corneum. In the W/O emulsion, 2.5%, 5%, and 7.5% vitamin E were compared. With both types of emulsions, vitamin E increased the stratum corneum hydration statistically significantly (p = 0.0002). In addition, we could provide evidence of an enhanced water-binding capacity after treatment with vitamin E (p = 0.05). For the hydrating effect of vitamin E. its concentration is of importance. The optimum concentration turned out to be 5%.     

Modulation of human stratum corneum properties by salicylic acid and all-trans-retinoic acid

Topical all-trans-retinoic acid (RA) has been reported to decrease the in vivo skin response to sodium lauryl sulfate (SLS). The converse was also shown with a synergistic effect of RA following prior applications of SLS. The reason for such effects is not clear. We employed measures of transepidermal water loss (TEWL), squamometry and sequential corneosurfametry to explore the protective activity of a 0.05% RA cream at the level of the stratum corneum. Nonionic oil-in-water emulsions with or without 5% salicylic acid (SA) served as test product references. Data indicated that the RA formulation was responsible for a stochastic impairment in the TEWL and for an increased intercorneocyte cohesion. SA and the unmedicated emulsion did not lead to similar TEWL changes. The squamometry test proved to be very sensitive to disclose the effects of SA and RA without, however, allowing to distinguish the difference in the physiological processes involved. The corneosurfametry bioassay did not show any protection or synergistic effect between RA or SA and SLS challenge on the stratum corneum. This is in contrast to a previous work showing a positive protective effect afforded by retinol against SLS. The combined effects of irritant compounds affecting the stratum corneum are complex. The precise reason for some of their biological consequences remains a conundrum. On balance, products such as SA and RA do not appear to afford protection or impairment to a surfactant challenge at the level of the stratum corneum.     

Toward reflective practice: A multicultural competence training model from a community mental health center.

Despite the importance of multicultural competence in clinical practice and training, there is a surprising dearth of innovative training models from fieldwork sites that would be replicable in other practicum settings. The authors illustrate a multicultural competence training model from a community mental health center that highlights the Guidelines on Multicultural Education, Training, Research, Practice, and Organization Change for Psychologists (American Psychological Association, 2003). The model focuses on providing multicultural training through two separate but linked training teams for the dual purposes of internal reflection and reflective practice. The authors conclude with a discussion of the implications of this training model for practice, research, and organizational change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing the reflective teacher

The conceptual issues and research findings surrounding the meaning and use of reflection are examined in this paper and serve as a foundation for discussing significant assumptions and beliefs regarding the use of reflection in nursing education. The strengths and limitations of reflection are discussed. The paper links current knowledge about reflection to the development of reflective thinking and its use by nurse educators and suggests strategies to enhance this development.     

A proton magnetic resonance study of water in human stratum corneum

Proton magnetic resonance spectroscopy has been used to study the nature of water in human stratum corneum. For a single planar sheet of stratum corneum mounted at a specific orientation to the applied magnetic fild, three distinct absorptions may be seen having different chemical shifts and spin-lattice relaxation times (T1). All T1 values for these resonances are smaller than that for normal liquid water. One absorption is unusual in that the resonance position is dependent upon the orientation of the sample within the field.     

Imaging regions of transport across human stratum corneum during high-voltage and low-voltage exposures

Scanning confocal fluorescence microscopy was used to image localized regions of calcein transport across human stratum corneum during constant low-voltage (iontophoresis) and pulsed high-voltage exposures. Following an electrical protocol, imaging revealed regions of fluorescence which were interpreted as sites where transport of a fluorescent probe (calcein) into the stratum corneum had taken place. Electrically-assisted transport of calcein, whether enhanced by iontophoresis or high-voltage pulsing, appears to occur through intercellular and, to some extent, transcellular pathways into localized regions of stratum corneum that are not associated with appendages. Uniquely associated with the highest voltage pulses used (300 V across the skin) was the appearance of small, brightly fluorescent areas containing nonfluorescent interiors, i.e., fluorescent "rings". We present evidence which suggests that the dark interiors represent sites through which transport occurred during pulsing, but where calcein was no longer present at the time of imaging. Transport of charged microspheres into the stratum corneum was also observed.     

Expression of corneodesmosin in the granular layer and stratum corneum of normal and diseased epidermis

The stratum corneum (SC) has long been considered as a sort of inert membrane destined to be shed at the surface of the epidermis. During the last two decades, however, several lines of evidence have been reported, suggesting that active physical and chemical changes take place in the horny layer despite the absence of intracytoplasmic organelles. In particular, processing of filaggrin, replacement of the plasma membrane by a ceramide envelope and constant, progressive modification of extracellular lipid multilayers have been put forward. Recently, attention has focused on the intercellular junctions, which may be involved in the regulation of SC desquamation. Corneodesmosin, a newly discovered protein of s.c. desmosomes (corneodesmosomes), is synthesized at the latest stages of keratinocyte differentiation and persists between the horny cells until desquamation occurs. In the present study, we performed immunohistochemical and immuno-ultrastructural investigations on corneodesmosin expression in various skin lesions characterized by abnormal production and/or retention of the horny layer. Our results suggest that corneodesmosin expression is independent from profilaggrin synthesis. We found corneodesmosin in almost all morphologically recognizable corneodesmosomal structures and specifically those which persisted up to the SC surface. Hyperkeratotic lesions which are characterized by an increased number of junctions showed intense immunoreactivity with anticorneodesmosin antibody. A complete absence of corneodesmosin was not observed in any disease. This finding, together with our previous biochemical studies, suggests that corneodesmosin may exert a protective function against proteolytic degradation of corneodesmosomes both in normal skin and in the pathological horny layer.     

Differences in stratum corneum pH gradient when comparing white Caucasian and black African-American skin

This study assessed pH gradient changes in relation to stratum corneum (SC) depth and possible differences between white caucasian and black African-American skin. Ten white and eight black people entered the study. SC was progressively removed by cellophane tape stripping on the volar forearm and weighed with a microbalance. Transepidermal water loss (TEWL) and SC pH were measured every three tape strippings. Significantly increased TEWL and decreased pH values were found with increasing SC depth in both races. Significantly increased TEWL in black people was found after three and six tape strippings (P < 0.05 and 0.03, respectively); pH was significantly decreased in black people after three tape strippings (P < 0.005). No differences were found between the races after nine, 12 and 15 strippings, i.e. in the deeper SC layers. The data confirm that pH in the superficial SC layers decreases with SC depth; only total SC removal results in increased pH values. In the superficial layers, there are significant differences in both water evaporation and skin pH, possibly explaining the contradictory literature.     

Attitudes and behavior in counseling skill development.

To examine the association between attitudes and skill performance under laboratory conditions, 37 undergraduates received brief training in 2 counseling skills (reflection of feeling and interpretation) and then conducted interviews with coached clients. Ss with positive attitudes toward using reflection of feeling produced significantly higher quality reflective responses than did those with negative attitudes toward the use of this skill. By contrast, no significant association between attitudes toward interpretive responses and interpretation quality was found. In addition, Ss were able to use reflective responses when instructed, whereas they were less able to respond to instructions about the timing of interpretive responses. Results suggest that when trainees are relatively facile in the use of a skill, quality is associated with attitudes, whereas when facility is less, the association is attenuated. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new model system for lipid interactions in stratum corneum vesicles: effects of lipid composition, calcium, and pH

We prepared large unilamellar vesicles (LUVs) with three different stratum corneum lipid compositions: constant amounts of ceramides (55 wt %) and fatty acids (15%) with varying amounts of cholesterol sulfate (0-15%) and cholesterol (15-30%). One of the compositions served as a model for normal stratum corneum, while the second one served as a model for recessive X-linked ichthyosis stratum corneum. The third composition consisted of no cholesterol sulfate. Intervesicle lipid interactions in these LUVs were monitored by fluorescence methods for content leakage, and contents mixing at pH 9, in the absence and presence of Ca2+, and at pH 6. Since the content leakage and contents mixing assays were originally developed for phospholipid vesicles, we characterized the probe binding and the probe quenching properties for stratum corneum LUV systems, and modified the assays slightly accordingly. The time-dependent fluorescence intensity changes in the probe-containing LUVs at pH 9 and 6 and in response to the addition of calcium were monitored. Our results demonstrated that all three types of LUVs were relatively stable at pH 9. Addition of Ca2+ or decreasing the pH to 6 activated intervesicle lipid mixing followed by vesicle fusion and lysis. We found that the LUVs with no cholesterol sulfate and 30% cholesterol exhibited a more extensive Ca2+- or low-pH-activated intervesicle lipid interaction than LUVs with either 5% cholesterol sulfate and 25% cholesterol or 15% cholesterol sulfate and 15% cholesterol. These results suggest that fusogenic agents such as Ca2+ and H+ act to neutralize the fatty acids in the lipid bilayer of stratum corneum vesicles. The inclusion of 5-15% cholesterol sulfate helps to prevent the collapse of fused vesicles into other structures.