Experiences of a critical reflection program for mid-career nurses

Aim: The aim of the present study was to describe the experiences of Japanese nurses who participated in a critical reflection program for mid-career nurses. Critical reflection is one method that is appropriate for the professional development of mid-career nurses. However, its implementation is difficult because of the need for educational resources. Of the numerous reports on critical reflection outcomes, few delineate the underlying process and none relates to Japanese nurses. Methods: A program was developed, based on Mezirow's transformation theory, to facilitate nurses' critical reflection. The program was implemented at three hospitals in Japan with 14 mid-career nurses. The data-collection period was from 2006 to 2007. The grounded theory approach was used to describe the results. Results: Two participants experienced a transformation in their frame of reference after undergoing critical reflection during the program. One participant's viewpoint began to change and the other's habit of mind (social norms and personality characteristics that provide one with a general orientation) changed. Both participants met the conditions that were necessary for transformation, such as having an open attitude toward change, and compared to the other participants, their critical reflection progressed markedly on the worksheets that were designed to promote critical reflection. The process of change in the frame of reference that was experienced by the two participants followed eight of the ten phases of Mezirow's transformation theory. Conclusions: The characteristics of the experiences of the two participants who underwent changes in their frame of reference were described and discussed. The conditions for such transformation and the effects of critical reflection on the participants were consistent with those reported by previous studies.