Effective feedback is a very important process that occurs in nursing practice.
When delivered effectively, feedback can:
Aid in learning;
Help individuals understand their strengths and deficits;
Allows learners to implement strategies to strengthen and improve their practice; and
Ultimately improve patient care and outcomes.
Given the potential positives, it is important that giving feedback becomes a priority in nursing practice and that the feedback given is effective in driving practice change and improving performance (Chang & Daly 2015; Delany & Malloy 2018).
However, effective feedback in the healthcare setting remains a challenge for many people – as educators, we can all remember a time when we have given detailed, timely feedback to a learner only to find that they never act on the feedback that you have given.
Here are some strategies and behaviours that educators should be aware of when providing feedback to their learners. These will enable educators to provide more effective feedback and increase the chance of learners implementing that feedback and improving their practice.
Learners and Their Feedback Conversation
Learners need to have an active role in their own feedback conversation.
If a learner doesn’t implement feedback provided by an educator, the educator should consider:
How was the feedback delivered?
Was the learner able to contribute their perspective?
Were they able to have a hand in devising goals that will enable them to enact the feedback and improve their performance?
Enabling the learner to have an active role in their feedback conversation, can often encourage and motivate them more to change their practice as they will be invested in the process.
When the learner is given time to contribute it is also important that the educator actively listening, for example using open ended questions, summation and clarification as well as having open body language and focused attention. This will further engage the learner in their feedback conversation (Chang & Daly 2015; Cox 2016; Delany & Malloy 2018).
The Learner-Educator Relationship
The relationship between the learner and teacher can also impact on what the learner takes on from the feedback given.
The learner must see that the individual giving feedback has their best interests at heart and often this occurs when the relationship between the two is one that is established and trusted by both parties.
In nursing however, this can be difficult due to short placement rotations and shift work. As a result the learner may not necessarily be building relationships with the same individuals and it can also mean that there are less opportunities for the direct observation of the learner by the educator who will be providing feedback (Delany & Malloy 2018; Hardavella et al 2017).
When receiving negative feedback, there can also be a tendency for some learners to become defensive.
This isn’t surprising when we think about the emotional situation that can arise when feedback challenges what the learner may believe and think. When feedback challenges the learner’s views about themselves, it can create a sense of discomfort, which can then cause them to become defensive, and not only challenge the feedback provided, but also the credibility of the individual providing the feedback.
In this situation, the relationship between the two individuals is pivotal in ensuring the feedback is understood and the emotional state of the learner is protected (Delany & Malloy 2018).
It should be noted that negative feedback can also be perceived as criticism even though the feedback may have been given with the intention of assisting the learner to improve. This can trigger feelings of shame and guilt.
It is important to remember that learners also bring their prior experiences with feedback situations to their current feedback conversation. This can impact on how they respond to the feedback depending on the circumstance, their knowledge levels and their prior experience.
For example, if the learner has had an experience receiving feedback that left them feeling demoralised, then this can have an effect on their emotional state when receiving feedback in the future.
Therefore, it is important to establish any previous negative experiences with receiving feedback as well as how the learner prefers to receive feedback (Delany & Malloy 2018).
The Feedback Environment
As an educator, it is important to build a safe feedback environment within which learners feel comfortable and supported. It needs to be an environment where feelings can be discussed, especially those feelings when mistakes are made and there are feelings of shame or guilt (Cox 2016; Van Der Leeuw 2014).
Within this environment feedback can then established as a valuable learning opportunity and a way to improve practice.
In nursing, there are many situations where feedback is seen as a requirement rather than a learning opportunity. When this happens, the feedback may carry less value because it will lack the depth needed to ensure engagement with the learner.
This can be seen in some of the feedback models used in student placement. Feedback requirements can cause disengagement with the learner and can also make the learner reluctant to discuss their own deficits in performance as they want to get good assessment feedback. When assessment is the focus of the learner, as opposed to improved practice and patient care, there is a danger that they will miss out on potential feedback conversations (Delany & Malloy 2018).
An important aspect of feedback that often gets overlooked, is the reinforcement of desirable behaviours.
As with the ‘blind spots’ mentioned earlier, some learners may not also be aware that they are displaying desirable behaviours, knowledge or attitudes, therefore by giving them feedback you are raising their awareness and reinforcing this behavior.
This feedback also helps to motivate the learner and encourage them to complete more complex tasks as well as improve morale (Delany & Malloy 2018).
Chang, E. & Daly, J. (2015). Transitions in Nursing: Preparing for professional practice, 4th Elsevier; Chatswood