Journal of Nursing Education

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The WRAP: An Alternative to Sandwich Feedback in Clinical Nursing Education

Cheryl Besse, MN, RN; Laura Vogelsang, MN, RN

Giving timely feedback to nursing students in the clinical area is essential to maximizing learning opportunities and facilitating their development as RNs (Gaberson, Oermann, & Shellenbarger, 2015). Given the conflicting demands of the clinical setting, instructors often struggle to give valuable, formative, in-the-moment feedback before being pulled away to another student or desiring to send the student back to maximize the available learning opportunities. Another potential downside is that the student may not see the feedback as formal, thus minimizing its value and influence (Clynes & Raftery, 2008).

One popular, albeit controversial, method for providing feedback is to “sandwich” constructive criticism between two compliments. Unfortunately, this method fails to engage the learner in thoughtful reflection and collaborative development of a plan for improvement while undermining the constructive feedback by hiding it between two “slices” of praise.

The WRAP Framework

The goal of this article is to share a new type of feedback “food”: the WRAP (Wonder, Reinforce, Adjust, Plan) framework for engaged, constructive feedback paired with next steps. Inspired by a process developed by Baker, Turner, and Bush (2015) for summative feedback, WRAP is proposed as an effective way to provide quick, collaborative, and timely in-the-moment feedback that is more purposeful for the instructor and more meaningful for the student.

Wonder. During the wonder stage, the clinical instructor begins a dialogue that encourages critical analysis by the learner to thoughtfully reflect on the experience. The student is asked to identify strengths and areas for improvement in subsequent practice. Challenging a student to identify what did and did not go well encourages a balanced view of their ability and contributes to their ongoing development as a reflective practitioner.

Reinforce. Building on the reflections self-identified by the student during the wonder stage, the instructor affirms the positive behaviors and attitudes that occur and adds those the student may not have recognized. This action is an important aspect of feedback to empower the learner to recognize personal strengths and attributes and may serve to create confidence and enhances ability for independence.

Adjust. The goal of adjusting is to acknowledge the areas the student identified as needing improvement and explore reasons why. At this point, the instructor should also incorporate any weaknesses in performance not already noted by the student, including specific actions or behaviors that were not consistent with expectations. This feedback should be factual and descriptive, avoiding judgment or opinion.

Plan. After the instructor and student have reinforced what went well and discussed what behaviors require adjustment, the final step is planning for what to do next time. This is where the sandwich framework for feedback is lacking. The student should drive the planning conversation and, together with the instructor, explore specific strategies and solutions that are practical and feasible to meet the clinical learning objectives.

Application and Feedback

Clinical instructors from varied settings have supported using the WRAP method to make approaching feedback a consistent and collaborative process that is beneficial for student learning and ongoing development as a reflective practitioner. Anecdotally, nursing students have found the WRAP framework to be an effective tool, particularly given the balanced nature of the feedback, the immediacy of the delivery, and the future direction discussed in the plan. The WRAP framework is an easy to remember way to formalize the informal process of giving feedback to maximize learning and increase student potential during clinical.

Cheryl Besse, MN, RN

cheryl.besse@usask.ca

Laura Vogelsang, MN, RN

University of Saskatchewan

References

Authors

cheryl.besse@usask.ca

The authors have disclosed no potential conflicts of interest, financial or otherwise.

10.3928/01484834-20180815-12

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