[Skip!] [Why?]

Case 14
Reflection as a Method of Assessment in Paediatric Palliative Care Education


Jayne Price and Patricia McNeilly






Queen’s University of Belfast, 97 Lisburn Road, Belfast BT97BL, Northern Ireland.

14.1 Context

Northern Ireland, like many countries, is facing a time of change and reform in relation to patterns of healthcare delivery, technological advancement, changes in public health and demographics coupled with the rising expectation of patients and their families (NIPEC2004). Such radical change has a major impact not only on those delivering the care, but also on educational providers who offer continuing educational opportunities for practitioners. Paediatric Palliative Care has evolved as a small, but distinct specialty locally, nationally, and internationally in recent years (Price et al.2005). Cooley et al. (2000) highlighted that the key to future developments within the specialty, would be the importance of expatiating on the training and educational needs of professionals caring for these children and their families.

Last year, Queen’s University of Belfast (QUB) responded to the needs of practitioners working within the field of children’s palliative care in the province, by introducing the first multi-professional palliative care programme in Ireland. The programme was evaluated extremely positively and has developed and expanded in terms of numbers of students this year

This submission presents the first model of reflection for paediatric palliative care, which has been constructed and introduced by the course coordinators as a learning and teaching strategy and also as a framework for the assessment process inherent in the first module of this 2-modular programme. Its conception came about due to a lack of certain key areas relevant to the unique specialty of Paediatric Palliative Care in the numerous useful models of reflection that abound within the literature. Input into the design of the model also involved a clinician who was working within this specialty ensuring that theory and practice were integrated in a collaborative approach.

Given the evolving nature of palliative care services for children and the need for an increased evidence base to underpin this practice, the demonstration of the students’ (and, indeed, the practitioners’) ability to reflect on their practice and to think critically has never been more important. There is also pressure within nursing education to employ assessment strategies, which the students can use in their practice (Knight2002). It is vital that assessments within educational programmes foster such critical thinking and drive student learning in a positive, comprehensive manner, if outcomes for children and their families are to continue to be improved. One way of achieving this is to utilize the process of reflection within the assessment strategy of educational programmes, which we illustrate here highlighting the success of linking theory and practice effectively.

14.2 Learning Outcomes being Assessed

The assessment process has been designed to address the overall aim of the module, i.e., to develop the student’s knowledge to improve quality care. The following sections present the aims and objectives of the module.

14.2.1 Aim

To develop the student’s existing knowledge of child and family centred palliative care in order that quality of care is improved for the children/young people and their families wherever they are cared for.

14.2.2 Module Objectives

At the end of this module the student will be able to:

14.3 Assessment Procedures/Details

The students in the QUB Paediatric Palliative Care Programme are required to submit a written reflection of an incident or issue arising when delivering care to a child and his/her family requiring a palliative approach to care. The written assignment for level-2 is 2,000 words and 3,000 words at level-3. The Model of Reflection for Paediatric Palliative Care is a narrative tool that provides a framework for the students’ thought process, exploring specific issues whilst encouraging professional and personal development (see Appendix A: Model of Reflection for Children’s Palliative Care).

The aim of the model is to guide paediatric palliative care professionals across the multi-professional interface to reflect on their experiences of caring for life-limited children and their families, in order to advance the provision of quality care. The model centres on the uniqueness of each individual child and his/her family and comprises of a series of phases, including a preliminary and post-reflection phase and also requires the practitioner to examine additional elements, specifically, socio-economic influences and cultural/spiritual/ethical issues (McNeilly et al.2006).

Students present their reflection in a seminar, thus, sharing their experiences with their student cohort. Much rich discussion follows, which enhances and widens the students’ learning. Feedback from the course team is given following the seminar presentation and also with the written submission.

14.4 Strengths and Limitations

14.4.1 Strengths

14.4.2 Limitations

14.5 Contributor’s Reflections on the Assessment

As the field of children’s palliative care continues to advance and develop, educationalists and practitioners are required to collaborate in order that dynamic innovative educational programmes challenge the health care professionals to develop their knowledge and skills, thus aiding them to develop their knowledge and ability to critically appraise and to enhance the care they deliver. The assessment process in this programme aims to achieve this and we believe that the newly devised model of reflection guides the student to examine and analyse areas of practice pertinent to the field in which they work, promoting problem solving, as well as personal and professional development.

While other models of reflection in the literature are useful, they are very generalist and non-specific, whereas, this model is specific to the holistic and varying needs of the child and family requiring a palliative approach to care. This model is unique and guides the student’s thought processes on the very specific issues inherent in children’s palliative care; it gives the students focus and challenges their practice, fostering deep learning. The external examiner commended the assignments as showing sensitivity, maturity and clear development, which was aided by the use of this comprehensive and all embracing model of reflection. This model adds to the limited evidence-base underpinning practice in this arena, links theory to practice, demonstrates collaborative working, using an assessment strategy that can be used by professionals, promotes an ethos of lifelong learning and ultimately, improves quality care packages for the child and family.

14.6 Bibliography

Appendix A: Model of Reflection for Children’s Palliative Care

(Reproduced with the kind permission of the European Journal of Palliative Care.)

Diagram: see text immediately below for detailed description.

Textual Description of Diagram

There follows a detailed textual description of the diagram above. This is intended to facilitate readers who, through visual disability or otherwise, are unable to satisfactorily perceive the diagram itself. Note that this description is provided only with the web (HTML) version of the case study, as this is the only version which is properly accessible via relevant assistive technologies.

The model is presented as a network of boxes, generally containing text, with linkages between them.

First there is a row of two horizontal boxes joined together:

In the centre of the diagram there is a more complex structure of ten boxes in total. This is arranged as an upper row of three horizontal boxes joined in a line, a lower row of five horizontal boxes joined in a line, and two outer, vertically oriented boxes, left and right, “capping” the two rows, with arrows pointing inward from left and right into each of the two rows (four arrows in total).

The two outer, capping boxes, pointing inward:

The upper horizontal row of three connected boxes:

The lower horizontal row of five connected boxes:

Below this is a another row of two horizontal boxes joined together:

Finally, on the bottom of the diagram, there is a single horizontal box with the text: “Overall conclusion—what have I learnt? Have my values changed? Is there anything I need to do now?”