Développement, mise à l'essai et évaluation d'une intervention de pratique réflexive avec des infirmières oeuvrant auprès de personnes âgées hospitalisées

The purpose of this research was to develop, field-test and evaluate the effects of a reflective practice intervention (RPI) with nurses who care for hospitalized elders. Based on the theory of Human Caring put forth by Watson (1979) and on the Model for Structured Reflection developed by Johns (2006), the study used a mixed design. A qualitative action-research approach was used for the development and testing of the RPI. The evaluation of the intervention used a qualitative approach and a quantitative quasi-experimental approach with a comparison group (CG). Upon completion of the RPI, the nurses were invited to identify the benefits of the intervention on their skills and nursing knowledge and on their perception of the RP as a way of improving their professional practice. Three hypotheses were advanced: following this RPI and compared with the CG, nurses in the experimental group (EG) would improve their attitudes and knowledge regarding elders, identify a larger number of nursing interventions adapted to the hospitalized elder clientele, and achieve a higher level of reflection.  The study was carried out with 43 university-hospital nurses (EG = 22; CG = 21). The RPI spanned a 22-week period. It included eight thematic workshops each 75 minutes long, delivered at three-week intervals, combined with reading assignments and individual exercises. The RPI focused on three themes central to elder hospitalization: medication, mobilization, and discharge planning.  Qualitative and quantitative data were collected through questionnaires, both open-ended (vignettes, reflective essays) and standardized (Kogan’s Attitudes Toward Old People Scale, Palmore’s Facts on Aging Quiz), completed pre- and post intervention by both groups. Nurses form the EG also completed a questionnaire on the RP experience and some took part in focus groups. A thematic content analysis was carried out on the qualitative data using the approach proposed by Miles and Huberman (2003), and Wilcoxon rank tests were run on the quantitative data.  Results show that the nurses developed different skills and abilities required for a RP, including introspection, openness to others, and critical analysis. The participants recognized that the RPI allowed them, among other things, to develop empiric, ethical, esthetic, personal and emancipatory knowledge. Moreover, they saw the RPI as a means of improving professional practice, particularly thanks to its potential for countering the routinization of care. Furthermore, compared with their CG counterparts, the EG nurses significantly improved their attitudes and knowledge regarding elders. However, no significant inter-group differences emerged following the RPI in terms of either the number of interventions adapted to situations experienced by hospitalized elders or the level of reflection achieved. Research hypotheses were partly supported.  This study demonstrates the potential of a RPI as an innovative professional development approach that valorizes the experience of nurses while allowing them to change their attitudes towards elders in a positive fashion and to adjust their knowledge according to the needs of this frail and vulnerable clientele. Possible avenues of pursuit are proposed for clinical practice, training, management and research.

Keyphrases: Reflective practice, Professional development, Gerontologic nursing, Hospitalized elderly, Educative intervention, Mixed design, Action research, Quasi-experimental design