Using video as a reflective tool in interpersonal skills training

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<ul><li><p>NurrcEdwuion Today (1991) 11, 14S14f.i 0 Longman Group UK Ltd 1991 </p><p>WORK Using video as a reflective tool in interpersonal skills training </p><p>Philip Burnard </p><p>The need for interpersonal skills training in nursing has been discussed in the nurse education literature. Reflection on practice is a key feature of interpersonal skills training. This paper offers a straightforward structure for enhancing interpersonal skills through the use of video. </p><p>There has, been considerable discussion in the literature on the development of interpersonal skills in nurse education and training (Kagan 1985; Arnold &amp; Boggs 1989; Kenworthy &amp; Nicklin 1989). Sometimes this interpersonal skills training is aimed towards counselling skills (Murgatroyd 1985; Burnard 1989; Egan 1990), at other times, towards enhanced nurse/patient communication (Macleod Clark &amp; Faulkner 1987) and sometimes towards the development of psychiatric nursing skills (Reynolds &amp; Cormack 1987). Interpersonal skills training has also been described as important in the develop- ment of mentor and preceptor relationships (Morris, John &amp; Keen 1988; Burnard &amp; Chapman 1990). </p><p>Various forms of experiential learning activi- ties have been described in the literature (Miles 1987; Marshfield 1985; Burnard 1990) and discussion has taken place on the use of video work in interpersonal skills training (Macleod Clark 8c Hunt 1985; Faulkner 1985). This paper sets out a straightforward structure for enabling </p><p>students to reflect on their interpersonal skills development through the use of video recording. </p><p>The issue of reflectivity in the learning process has been developed in the educational literature (Boud, Keogh &amp; Walker 1985; Walker 1985; Main 1985). Grundy (1982) has described how repectivity takes place in various aspects of the experiential learning cycle. Each person, inter- acting with others in a learning group brings their informed practical judgement to bear on ideas relevant to the event. This episode of researching and evaluating ideas is an example of reflection in Grundys view. A further phase of reflection may occur to re-examine more basic assumptions and deeper insights may develop. This reflective process is central to the way in which video work is used. The process described here has developed out of work carried out in the School of Nursing Studies at the University of Wales College of Nursing with Bachelor of Nursing Students. </p><p>Philip 6umard PhD, MSc RMN RGN DipN Cert Ed RNT Lecturer in Nursing Studies, University of Wales College of Medicine, Heath Park, Cardiff, Wales (Requests for offprints to PB) Manuscript accepted 29 September 1990 </p><p>PREPARING FOR VIDEO WORK </p><p>Prior to the use of video in interpersonal skills training, it is suggested that students have taken part in detailed discussions about the theory and </p><p>143 </p></li><li><p>144 NURSE EDUCATION TODAY </p><p>practice of various approaches to interpersonal skills. This can then be followed up by skills rehearsal and role play in pairs. The video work can usefully be used after all of these stages have been worked through. </p><p>It is necessary to plan video work well in advance and to ensure that the equipment is set up prior to the students working in pairs in front of the camera. It is important that the equipment intrudes as little as possible on the processes taking place. It is also helpful if the video work is of as professional a quality as possible. Poor camera work, for instance, can become as much a talking point in later discussions as the interac- tions taking place on the screen. If you have access to professional technicians, use them. </p><p>Video work is time intensive and it is recom- mended that students and facilitators work in small groups of between 6 and 8 wherever possible. Also, participation in video work should be voluntary. Seeing yourself on a video monitor can be traumatic for some people and it would be hard to defend compulsory work in front of the camera. </p><p>Students are invited to pair off and then each pair is filmed for a period of 10 minutes. Various options exist for the use of that lo-minute period: </p><p>1) One student can elect to act as counsellor to the other. Meanwhile, both students remain themselves and no attempt is made to role play. </p><p>2) The students can decide to role play. One takes on the role of nurse and the other the role of a patient with a particular set of problems. </p><p>3) The students can elect to merely sit and have a conversation with one another in front of the camera. </p><p>The degree to which the facilitator decides on one or more of these options and the degree to which she leaves the decision to the student will depend on the nature and aims of the learning session. </p><p>VIDEO PROCEDURE </p><p>Once all pairs of students are clear about how </p><p>they are going to spend their 10 minutes in front of the camera, all of the pairs are filmed, one after the other. If time permits, the pairs then work in reverse, with the counsellor taking the role of the one who is counselled or the patient taking the role of the nurse. In this way, all students get to see themselves in a facilitative or therapeutic role. All of the filming is recorded onto VHS video tape for analysis by the group. </p><p>After each pair has been filmed, they are encouraged to share immediate feelings and thoughts about the process with the rest of the group. Given the fact that video work takes time, it is recommended that this first reflective period be a short one of no more than 5 minutes per pair. </p><p>ASSESSMENT </p><p>Following the filming, at leas two options exist. First, the students can have a break between the filming and the reflection and assessment phase. This break may be of a day or a week, during which time, they are encouraged to think about their performances on tape. Alternatively, the reflection and assessment phase can follow on directly from the filming. </p><p>The first stage of the assessment phase is for the students as a group to view each of the 10 minute clips of film. During this viewing, they use a reflection and assessment form to consider various aspects of the performances that they see and to make notes of those reflections. An example reflection and assessment form is illustrated in Figure 1. It draws on the work of Herons Six Category Intervention Analysis (Heron 1989) and Egans suggestions about the effective therapeutic behaviours (Egan 1990). It also encourages students to reflect on the process of therapeutic interaction. </p><p>It is to be noted that students are not required to g-rude themselves or each other in terms of each of the items on the form. Students that I have used this sort of form with are adamant that they find it much more useful to have the form as a guide to thinking about what they are watching than as a quantitative measure of their own or anothers effectiveness. This stage completes the second reflective period. </p></li><li><p>NURSE EDUCATION TODAY 145 </p><p>Make Notes 6n the Following Aspects of the Video Performance: </p><p>1. Behavioural aspects of the interpersonal encounter: * Did the person sit scjuarely in relation to </p><p>her/his partner? l Did she/he maintain and open position? * Did she occasionally lean towards the other </p><p>person? * Did she maintain effective and appropriate </p><p>eye contact? l Did she appear to be relaxed? </p><p>2. Interpersonal Interventions * What were the predominating interventions </p><p>used? </p><p>Prescriptive? Informative? Confronting? Cathartic? Catalytic? Supportive? </p><p>3. Stages in the encounter * How did the person handle the following: - the introduction, - the development, - the closing? </p><p>4. Personal Qualities * How did the person demonstrate the </p><p>following: - empathy, - concern, - openness? </p><p>Fig 1 A reflection/assessment form for use with video work </p><p>FEEDBACK </p><p>Following each viewing of each clip of film and following the reflective phase using the form and notes, a process of sharing reaction is developed. First, the person who was the main player in the video session offers her reflections on her per- formance to the group. She may use the form as structure or may choose to feedback in an informal way. The group facilitators task is to help her to explore as many aspects of the performance as possible. During this time, the other group members only observe what is going on and do not comment. </p><p>Following the main players feedback, that person may invite feedback on her performance from other members of the group, including the facilitator. Her choices here are to invite: </p><p>* only positive feedback, * only negative feedback, * both positive and negative feedback. </p><p>It seems unlikely that anyone would choose o?zly negative feedback but all the choices should be made clear. Some students prefer only posi- tive comments to be made by other group members. This stage allows the student to compare her own reflection and assessment with those of others and follows the format of self and peer assessment (Kilty 1982; Burnard &amp; Chapman 1990). </p><p>After one player has completed her feedback and has received the sort of feedback she wants from the group, the process moves on to the next person. This cycle continues until all of those videoed have had a turn at sharing their own reflections and listening to the evaluative com- ments of others. The facilitator in this process should play an equal role in the group and not seek to have the first or last word, nor to summarise at the end of each element of the cycle. </p><p>The point of this further reflection on per- formance is to become both critical of ones own performance and to be able to incorporate both the theory and the practice of interpersonal skills training into ones own repertoire of actions and skills through personal assessment. </p><p>Once the whole process of reflection and assessment has been worked through, various possibilities present themselves. A shortlist of these includes: </p><p>1) </p><p>2) </p><p>3) </p><p>4) </p><p>undertaking a refilming process to incor- porate changes to interpersonal per- formance, pairs activities, without video, to practice new behaviours, further discussion and a linking of practice to theory and practice of the revised skills in the real situation: the clinical and community setting. </p><p>CONCLUSION </p><p>Thus the whole cycle is either completed or continued. Figure 2 offers a summary of the stages involved in using the video approach to reflecting on and enhancing interpersonal skills. </p><p>The processes described here represent an </p></li><li><p>146 NURSE EDUCATION TODAY </p><p>1, Theory input, dicussion and practice of </p><p>1 3. Video work in pairs. I </p><p>4. Short reflective period between each filming session. </p><p>5. Review of film clips with accompanying reflection, using reflection/assessment form. </p><p>6. Feedback session </p><p>7. Further practice of interpersonal skills with or without video. </p><p>Fig 2 Stages in the use of video work in interpersonal skills training. </p><p>endorsement of the student centred, facilitative </p><p>approach to teaching and learning. They involve a degree of negotiation between facilitator and </p><p>students but also involve a considerable degree of structure. It is asserted that this structure </p><p>allows for a greater depth of reflection and discussion than is possible if a free for all </p><p>approach is taken to the setting up and running of a video session. It is the structure that allows </p><p>the freedom to reflect and to analyse. </p><p>The use of video in this way does not suit everyone. It probably suits best the sorts of </p><p>students who are more extrovert and more open </p><p>to receiving feedback from others. To expose yourself to the scrutiny of others, in this way, is </p><p>not particularly easy. It if can be achieved, however, the benefits of having such direct and accessible feedback on your own interpersonal </p><p>behaviour are considerable. </p><p>References </p><p>Arnold E, Boggs E 1989 Interpersonal relationships: professional communication skills for nurses. Saunders, Philadelphia </p><p>Boud D, Keogh R, Walker D 1985 Reflection: turning experience into learning. Kogau Page, London </p><p>Burnard P 1990 Learning human skills: an experiential guide for nurses, 2nd Edition. Heinemann, Oxford </p><p>Burnard P, Chapman C M 1990 Nurse education: the way forward. Scutari Press, London </p><p>Burnard P 1989 Counselling skills for health professionals. Chapman and Hall, London </p><p>Egan G 1990 The skilled helper: a systematic approach to effective helping. 4th Edition. Brooks/Cole, Pacific Grove, California </p><p>Faulkner A 1985 The evaluation of teaching interpersonal skills to nurses. In Kagan C (ed) Interpersonal skills in nursing: research and appltcations. Croom Helm, London </p><p>Grundy S 1982 Three modes of action research: Curriculum Perspectives, 2:3. </p><p>Heron J 1989 Six category intervention analysis, 3rd Edition. Human Potential Resource Group, University of Surrey, Guildford, Surrey </p><p>Kagan C (ed) 1985 Interpersonal skills in nursing: research and applications. Croom Helm, London </p><p>Kenworthy N, Nicklin P 1989 Teaching and assessing in nursing practice: an experiential approach. Scutari Press, London </p><p>Kilty J 1982 Self and peer assessment. Human Potential Research Project, University of Surrey, Guildford </p><p>Macleod Clark J, Faulkner A 1987 Communication skills teaching in nurse education. In Davis B D (ed) Nursing education: research and developments. Croom Helm, London </p><p>Macleod Clark J, Hunt J (eds) 1985 Communication in patient care: video teaching programmes. Macmillan, London </p><p>Main A 1985 Reflection and the development of learning skills. In Boud D, Keogh R, Walker D (eds) Reflection: turning experience into learning. Kogau Page, London </p><p>Marshfield G 1985 Issues arising from teaching interpersonal skills in general nurse training. In Kagan C (ed) Interpersonal skills in nursing: research and applications. Croom Helm, London </p><p>Miles R 1987 Experiential learning in the curriculum. In Allan P, Jolley M (eds) The curriculum in nursing education. Croom Helm, London </p><p>Morris N, John G, Keen T 1988 Learning the ropes. Nursing Times 84; 16: 24-27 </p><p>Murgatroyd S 1985 Counselling and helping. Methuen, London </p><p>Reynolds W, Cormack D 1987 Teaching psychiatric nursing: Interpersonal skills. In Davis B D (ed) Nursing education: research and developments. Croom Helm, London </p><p>Walker D 1985 Writing and reflection. In Boud D, Keogh R, Walker D (eds) Reflection: turning experience into learning. Kogau Page, London </p></li></ul>