research proposal

critical analysis reflection in nursing

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Critical self-reflection for nurse educators: Now more than ever!

The dynamic healthcare world and increased demands on nurses call for a parallel shift in nursing education that is optimally geared toward effectiveness. Just as student nurses are taught to reflect on their practice to effectively meet clients’ needs, educators also need to be well versed in self-reflection to enhance their teaching methods. Self-reflection is the deliberate consideration of experiences, which when guided by the literature helps an individual gain insight and improve practice. Educators should not only opt for personal reflection but should also seek the views of their students and peers. Self-reflection becomes critical when it goes beyond mere reflection, questioning teaching assumptions, and addressing their social and political context. Given the remarked benefits of using self-reflection in education, and the current COVID-19 global repercussions which have urged faculties to try alternative methods of teaching, a concise guide to self-reflection is hereby provided for use by nurse educators.

Introduction

Over the past years, there has been an increased interest in the understanding of teaching effectiveness in higher educational institutions ( Kirpalani, 2017 ). Another notion that has received importance in the literature is self-efficacy ( Hemmings, 2015 ), a key component of Albert Bandura's social cognitive theory which is “concerned with judgement of personal capabilities” ( Bandura, 1997 , p.11), described within higher education as the educator's personal belief and confidence in his/her's ability to carry out appropriate actions to attain specific performance goals ( Artino, 2012 ). These two concepts are interrelated; teachers’ self-efficacy is interlinked with teaching effectiveness, both with respect to the teacher's performance and also as it pertains to students’ achievements ( Klassen & Tze, 2014 ). Although all educators aim to be effective, societal and healthcare changes and increasing demands on nurses ( Handwerker, 2012 ; Nielsen, Noone, Voss, & Rae, 2013 ; World Health Organisation, 2020 ) expect nurse educators to continuously monitor their teaching practice to adequately prepare future nurses. Just as student nurses and practicing nurses reflect on their practice to improve their professional and personal skills and knowledge in line with today's challenges and requirements ( Jootun & McGarry, 2014 ), nursing faculties should also follow suit to ensure successful teaching. Given the current unprecedented global situation resulting from the COVID-19 pandemic, where nursing faculties are adjusting their teaching and learning methods, ensuring success in the revised teaching methods is paramount, now more than ever.

The purpose of this paper is to highlight the importance of using personal reflection, or self-reflection to improve nursing education and to promote this practice among nurse educators working within nursing faculties worldwide, especially during these extraordinary times. An outline of the use of self-reflection amongst nurse educators is provided followed by a description of the concept of self-reflection. Reference is made to a deeper and more comprehensive concept of self-reflection, that is, critical self-reflection. Furthermore, based on the identified literature, the author provides a concise guide to self-reflection for nurse educators, referring to current times.

Use of self-reflection by nurse educators

Reflection is defined as the individual's deliberate consideration of a particular experience, guided by the literature to gain insight, ultimately developing and improving practice ( Graham & Johns, 2019 ). It can help route teaching practices towards effectiveness ( Gardner, 2014 ), resulting in the development of scholarship in the teaching of nursing ( Lubbe & Botha, 2020 ). Self-reflection, together with confidence building, is considered a distinctive requirement for the advancement of educators, particularly those who are new to the nursing faculty ( Jetha, Boschma & Clauson, 2016 ). As highlighted by Lubbe & Botha (2020 , p.9), “students can smell fear and poor knowledge.” If the educator is not knowledgeable or confident in his/her teaching practices, his/her credibility may be questioned. Self-refection can help identify gaps in knowledge and the need for professional development in a particular area ( Lubbe & Botha, 2020 ). Given the ongoing developments in healthcare, educators must remain in touch with the dynamic health care needs ( Lubbe & Botha, 2020 ), while embarking on a lifelong self-reflective journey to sustain their continuous professional development ( Graham & Johns, 2019 ; Jetha et al., 2016 ; Lubbe & Botha, 2020 ). Furthermore, if nurse educators are not trained and well versed in self-reflection, their role in promoting the use of reflective learning among their students will be limited ( Kemp & Baker, 2013 ; Naicker & van Rensburg, 2018 ).

Self-reflection is not only a means to ensure effectiveness in the teaching of nursing. According to Kirpalani (2017) , the process of self-reflecting on the educator's teaching methods may be an effective supplement to evaluative quantitative measures that are already available, such as students’ evaluations. These may not truly reflect the efficacy of the teacher's interventions ( Vanacore & Pellegrino, 2019 ), however, self-reflection activities that consider students’ informal feedback have proven to be beneficial ( Greer et al., 2010 ).

Engaging in self-reflection in the nursing faculty

Given the remarked benefits of engaging in self-reflection, the nurse educator, who is a reflective practitioner, should continuously explore the question, “Why do I teach the way I do?” Lubbe and Botha (2020 , p.7). Following the declaration of the COVID-19 pandemic where many nursing education institutions had to transition from traditional classroom-based education to online teaching and learning, keeping this question in mind helps nurse educators ensure that any revisions being made are still geared toward effectiveness.

According to Kirpalani (2017) , reflections may be carried out on:

Once an issue is identified, Kirpalani (2017) suggests deciding on the appropriate time to engage in reflection. Reflection is concerned with three critical time periods of practice: before; in; and on action. In the study by Lubbe & Botha (2020) , where they elucidated on their teaching reflective journey before action, reflection was done through self-assessment by looking at their personal teaching development and experience and relating this to the context in which they had to teach, while also identifying their own learning needs. Reflection in action was done during teaching; by getting students’ feedback, and acting on it right away ( Lubbe & Botha, 2020 ). Reflection on action involved getting an informal evaluation of the course content, style, and presentation, learning from feedback, and carrying out the necessary revisions ( Lubbe & Botha, 2020 ).

In reflection, apart from contemplating on personal experiences and looking at theory and research, Brookfield (2017) suggests that educators should ask for their students’ and colleagues’ views. In Kemp and Baker (2013) ’s study, where one of the authors, a nurse educator, reflected both in action and on action in revising a continuous professional development program, the educator amplified his reflection by collecting student evaluations for feedback and discussing his views with his peers. This enabled the author to identify several positive outcomes and opportunities for improvement ( Kemp & Baker, 2013 ).

Critical self-reflection

Despite the various methods outlined to embark in this lifelong developing process, this approach can remain superficial because of its technical dimension ( Brookfield, 2017 ). Critical self-reflection goes beyond that. Legare and Armstrong (2017) refer to critical self-reflection as a deeper state of personal reflection, one which was found to support the transition from clinical practice to the nursing faculty, however, a more appropriate definition that looks beyond deep reflection to ensure comprehensiveness, was provided by Brookfield (2017) . According to Brookfield (2017) , in education, self-reflection becomes critical when the identified teaching practices are seen within their social and political context. In being critical, self-reflecting educators must understand and question the power exerted by education and the wider society on the teaching processes and interactions being carried out, consequentially challenging the hegemonistic processes ( Brookfield, 2017 ). Hence, to be a critical self-reflective educator, one should look beyond his/her reflection, exploring the impact of outside forces (including the faculty itself) on teaching practices and not holding back from questioning assumptions and beliefs commonly accepted as normal and common sense. Moreover, he/she should uncover and reframe any processes whereby teaching practices benefit mostly those in power, those in control in structuring educational experiences ( Rothman, Kelly-Woessner & Woessner, 2011 ), such as the educator him/herself, even if this is viewed by the faculty members and administrators as naturalistic and orderly ( Brookfield, 2017 ; Rothman et al., 2011 ), as this will not be effective toward student education in the long term ( Brookfield, 2017 ).

The use of critical self-reflection is illustrated in Lubbe and Botha (2020) ’s study where they share their journal of reflective practice. Although their module's learning outcomes were already set within the framework, Lubbe & Botha (2020) challenged hegemonistic processes, asking for their students’ input on their learning needs. With further planning and evaluation, they succeeded in ensuring scholarship in their teaching.

The use of critical self-reflection is particularly warranted in these extraordinary circumstances. Educators should not hold themselves back from questioning changes in module curricula and delivery, where practical placements may be on hold or inadequately being covered, or where new online methods of teaching and learning are being used. Attention must also be given to equilibrate the power dynamics in the virtual classroom, particularly if student interactions are noticed to be minimal or completely absent. “Sharing power” with students may help them achieve a sense of identity within the online learning community, and avoid disconnectedness ( Koole, 2014 ). Given that students are less likely to perceive the faculty as able to identify their educational needs ( Rothman et al., 2011 ), it is important, now, more than ever, that nurse educators reflect on their new teaching practices with a critical perspective to ensure that students’ learning needs are still being met, in line with the evolving healthcare world.

A guide to self-reflection for nurse educators

Despite the recognition of value from reflective practice, it was determined that nurse educators do not necessarily endeavor to develop their reflective practices ( Naicker & van Rensburg, 2018 ).

Self-reflection on teaching practices may not be automatic for most educators. During the COVID-19 pandemic, many nurse educators are being urged to take on new teaching methods. Rather than opting for a particular teaching method and style, or making assumptions, nurse educators should see this period as an opportunity to deeply engage in reflective practices. Various recommendations and strategies for engaging in self-reflection within the nursing faculty have been outlined in the literature and referred to in this article. A concise strategy to help educators to start is presented in Table 1 .

To increase nurse educators’ self-efficacy and effectiveness in their teaching practices, and to meet the demands of students in an ever-changing healthcare environment, the development of self-reflective skills is encouraged within the nursing faculty. Self-reflection can be carried out on an individual level; however, it is more likely that the educator progresses to a higher level if students and peer feedback are factored in. Self-reflection is a starting point, not an endpoint. Educators should embark on a lifelong self-reflective journey to sustain their continuous professional development, and learn to be critical, looking at identified issues/problems within their social and political context for obtaining meaningful outcomes. The benefits of reflection extend beyond improving effectiveness in teaching. Only when educators are well versed in using self-reflection can they ask their students to incorporate this approach, which is a means of learning and practice development. In light of the benefits associated with the engagement in self-reflective practice, and especially given the current global situation that limits teaching delivery, this article provided a concise guide to self-reflection for nurse educators.

Declarations of interest: The author has nothing to report.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Effects of a work-based critical reflection program for novice nurses

BMC Medical Education volume 18 , Article number: 30 ( 2018 ) Cite this article

Metrics details

Critical reflection is effective in improving students’ communication abilities and confidence. The aim of this study was to evaluate the effectiveness of a work-based critical reflection program to enhance novice nurses’ clinical critical-thinking abilities, communication competency, and job performance.

The present study used a quasi-experimental design. From October 2014 to August 2015, we collected data from 44 novice nurses working in an advanced general hospital in S city in Korea. Nurses in the experimental group participated in a critical reflection program for six months. Outcome variables were clinical critical-thinking skills, communication abilities, and job performance. A non-parametric Mann-Whitney U-test and a Wilcoxon rank sum test were selected to evaluate differences in mean ranks and to assess the null hypothesis that the medians were equal across the groups.

The results showed that the clinical critical-thinking skills of those in the experimental group improved significantly ( p = 0.003). The differences in mean ranks of communication ability between two groups was significantly statistically different ( p = 0.028). Job performance improved significantly in both the experimental group and the control group, so there was no statistical difference ( p = 0.294).

Conclusions

We therefore suggest that a critical reflection program be considered an essential tool for improving critical thinking and communication abilities among novice nurses who need to adapt to the clinical environment as quickly as possible. Further, we suggest conducting research into critical reflection programs among larger and more diverse samples.

Peer Review reports

As nurses are significant decision-makers within healthcare systems, their clinical judgments and decisions are required to contribute to the quality of such systems [ 1 ]. Nursing education essentially aims to advance the practical application of theoretical knowledge [ 2 ], so it is important to provide learners with opportunities for experiential learning. In this respect, critical reflection enables learners to develop self-awareness and doubt, allowing them to gain a comprehensive perspective regarding particular issues [ 3 ]. In other words, critical reflection is a fundamental component of clinical nursing practice, potentially impacting personal and professional development.

Nursing students and nurses are required to solve problems in complex clinical situations [ 4 ]. In this context, continual critical reflection can bridge the gap between theory and practice and stimulate personal and professional development [ 5 ]. Therefore, training in critical thinking and clinical decision-making ought to form a vital part of not only university education but also professional development in clinical fields.

Critical reflection is a meta-cognitive skill and a key mechanism in the process of critical thinking [ 6 ]. Furthermore, critical reflection is part of both experiential learning and transformative learning, and critical reflection acquired from practice enhances learning [ 7 ]. According to the model proposed by Cox [ 8 ], clinical education consists of two main cycles, namely the experience cycle and the explanation cycle. Critical reflection forms the core of Cox’s model.

In light of the above, it appears imperative for educators to develop learners’ critical reflection ability. Critical reflection is a valuable learning process for enhancing nurse-patient communication [ 9 ]. Critical reflection in analyzing the outcomes of nursing practice has been found to be effective in improving learners’ communication competencies [ 10 ], and it has been reported that such improvement in communication abilities has a positive effect on nursing job performance [ 11 ]. With the increased emphasis on nurses’ judgment skills, nursing students ought to receive work-related education by which to develop their clinical critical-thinking skills on the basis of actual nursing contexts. Additionally, one qualitative study reported that reflective practice in professional development reduced stress and improved patient care capabilities [ 12 ].

However, there has been little research on the efficacy of work-based educational intervention concerning critical reflection training and there has been little empirical evidence of the effectiveness of critical reflection.

Against this background, the present research aimed to quantify the effects of critical reflection training among novice nurses and offer strategic guidelines on how best to advance the effects of critical reflection training. Specifically, the purpose of this study was to evaluate the effectiveness of a particular work-based critical reflection program in enhancing novice nurses’ clinical critical-thinking abilities, communication competency, and job performance.

Research design

This study employed a quasi-experimental research design carried out to identify the effect of a work-based critical reflection program. We received ethical approval for the study from the Institute of Review Board of Asan Medical Center (2014–1021). Following IRB approval, we implemented a three phase program: 1) development of the work-based Critical Reflection Program, 2) training of eight nurses to facilitate the program as Reflective Practitioners (RPs), and 3) implementation of the Critical Reflection Training Program and measurement of the effects on critical thinking, communication, and performance.

Samples and participants

The participants of this study were novice nurses stationed at an advanced general hospital. Novice nurses were eligible to participate if they met the following criteria: they were a (1) new graduate nurse (2) who had completed their orientation of approximately two months, and who (3) had not experienced any other critical reflection program. The exclusion criterion was unwillingness to participate.

The required sample size of at least 44 participants was determined using the G*power 3.1 program for the matched paired t-test with a significance level of 0.05, power of 0.9, and effect size of 0.5. The effect size was based on findings that analyzed the effects of critical reflection research training on the clinical decision making of new graduate nurses [ 13 ], because no research has verified this using the same variables as in this study. To allow for dropout, 50 potential participants were initially selected and randomly assigned to either the experimental or control group. Of the 25 participants recruited for the experimental group, one dropped out, leaving 24 experimental participants. Of the 24 participants recruited for the control group, four dropped out, leaving 20 control participants.

Training procedure for the reflective practitioners

For the purposes of this study, authors developed a Critical Reflection (CR) Training Program on the basis of Kolb’s [ 14 ] learning cycle model and Cox’s [ 8 ] model for clinical teaching. The developed program was reviewed by two educational experts. We explained the purpose of the program to potential reflective practitioners (RPs), and then we recruited eight nurses who voluntarily agreed to be trained as RPs. The RPs were trained by means of a four-week/two hours per week program. We provided RPs with the manual for the critical reflection program. One of the researchers conducted the RP training which consisted of: 1) experiential learning and critical reflection, 2) reinforcement of clinical competence through critical reflection, 3) application of critical reflection in nursing fields, and 4) strategies for guiding critical reflection. To maintain fidelity of the intervention and maintain reliability among RPs, time was alloted for RPs to share their experiences and discuss specific difficulties.

Work-based critical reflection program for novice nurses

We explained the purpose of the program, and novice nurses voluntarily agreed to participate. Each novice nurse in the experimental group was partnered with a trained RP who had worked in similar area. After setting a mutual goal, each experimental participant underwent six months of critical introspection training.

The training program for critical reflection consisted of a number of phases. The opening phase offered an overview, identified needs, introduced the detailed procedure of critical reflection, and established a learning agreement. Following this, in the beginning stage, the participants wrote critical reflection journals on the basis of a case study developed for learning, upon which the RPs provided feedback. In the practice phase, the participants selected actual clinical cases, wrote critical reflection journals, and shared their experience and RP’s feedback. The form of the critical reflection journal, and the basic questions with which the participants were presented were based on the essential elements of debriefing proposed by Zigmont, Kappus, and Sudikoff [ 15 ], including relaxation, discovery, and deepening. The questions included the following: “What were the circumstances of the case? Was there prioritization of patient data? What did you do well as the nurse in charge? What did you consider important in this situation? What do you think needs to be improved, and what was done incorrectly? How might you apply what you learned in further similar contexts?” These questions helped the participants to make connections between the experience and explanation cycles.

Measurement

Data on participants’ general characteristics, clinical critical-thinking skills, communication competency, and job performance were collected in both the experimental and control groups. All participants were asked to complete (a) a questionnaire covering demographic information; (b) the Clinical Critical Thinking Skill test (CCTS) [ 16 ]; (c) the Global Interpersonal Communication Competency Scale (GICCS) [ 17 ]; and (d) the performance measurement scale [ 18 ].

The CCTS proved the reliability and validity of Shin et al. [ 16 ], which contained 19 questions; a correct answer scores one point and an incorrect answer zero, yielding a total score out of 19, with a higher score implying better clinical critical-thinking skills. The reliability of the instrument was measured by means of Cronbach’s α, which was 0.69 at pre-testing and 0.56 at post-testing.

The GICCS was developed and validated by Hur [ 17 ], and consists of 15 five-point Likert scale items. A higher score indicates better communicative competence. At the time when the tool was developed, Cronbach’s α was 0.72, and 0.76 at pre-testing and 0.70 at post-testing.

The job performance scale was developed by Ko et al. [ 18 ]. It consists of 17 five-point Likert scale items, and a higher score indicates better job performance. At the time of development, Cronbach’s α was 0.92, and 0.92 at pre-testing and 0.94 at post-testing.

Statistical analysis

Data were analyzed using descriptive and analytic statistics using IBM SPSS 22.0. Chi-squared test was used to compare the results of proportions. The Kolmogorov-Smirnov test result was less than 0.05 with a probability of 0.039. The null hypothesis was rejected and the nonparametric test was used. Based on the normality test results, the non-parametric Mann-Whitney U-test and Wilcoxon rank sum test was selected to evaluate differences in mean ranks and to assess the null hypothesis that the medians were equal across groups. The statistical significance level was set at p < 0.05.

The data from the demographic questionnaire were used to ensure homogeneity between the experimental and control groups in terms of their general characteristics. No statistically significant differences were found, indicating that the two groups were largely homogeneous (Table 1 ). The mean age of the control group was 23.2 (± 1.16) years, and the mean age of the experimental group was 23.3 (± 1.45) years. In terms of gender, 90.0% and 91.7% of participants in the control group and the experimental group were women, respectively. A total of 75.0% of the control group and 79.2% of the experimental group answered that they had completed the critical thinking course. A total of 65.0% of the control group and 66.7% of the experimental group had experience in problem-based learning.

In terms of the efficacy of the work-based critical reflection program, the clinical critical-thinking skills improved significantly in the experimental group ( p = 0.003). The differences in mean rank of communication ability between the two groups were significantly different ( p = 0.028). Job performance improved significantly in both the experimental group and the control group, so there were no statistical differences ( p = 0.294) (Table 2 ).

The main findings of this study show that the work-based critical reflection program had a positive effect on participants’ clinical critical-thinking abilities (Table 2 ), in line with previous research findings that critical thinking skills improved through critical thinking training in a fellowship program for nurses [ 19 ]. The CCTS scores before intervention are similar to those of studies using the same scales for nursing students [ 16 ], but in the score after intervention is higher. In this study, Cronbach’s α for CCTS was 0.56~ 0.69. This value indicates a relatively low internal reliability value. This is because the CCTS elicited a response of 0 or 1, similar to dichotomous variables. However, each item on the CCTS had the correct answer, and it was suggested that the difficulty and discrimination at the time of development was good.

Cox [ 8 ] proposes that learning may be improved when the experience cycle moves on to the explanation cycle, and the learning cycle may lead to working knowledge when students go through reflection and explanation stages, respectively. Adequate preparation for a following patient is only possible when students have gone through this explanation cycle. At this point, teachers should avoid providing students with a detailed explanation about whether or not their decisions are correct, and rather offer an atmosphere in which they can develop their own hypothesis and go through the process of verifying it. This approach may help enhance clinical reasoning and critical reflection [ 20 ]. The RPs who participated in this study learned to train novice nurses to ask relevant questions and arrive at reasonable answers. Rather than offering direct solutions, they provided participants with direction in finding appropriate answers to their questions. Such questions allowed novice nurse learners to move from the experience cycle to the explanation cycle on their own.

However, the training program did not improve communication ability. This finding was not consistent with those of Farrington and Townsend [ 9 ]. In the experimental groups, that the results of post-scoring were lower than the pre-scored results is very interesting, and it is difficult to compare it because there is little research that measures, using the same tool, change in the communication ability score of new nurses. The preliminary survey responses are the results of pre-exposure to the critical reflection program, showing that new nurses expected to enter the clinic after graduation and that they had positive expectations of their communication ability. However, the intervention test was conducted after newly graduated nurses had provided nursing care to patients at the end of the training period, during which time they encountered complex and difficult communication situations in the clinical field.

Finally, with regard to job performance, both experimental and control groups improved significantly from before to after the intervention. This suggests that job performance is likely to improve over time, irrespective of whether or not critical thinking training is offered. Such improvement may indeed have been expected in the present context, as the hospital in which the study was performed had adopted a two-month preceptorship program for novice nurses. Thus, the improvement of job performance in the control group implies the effectiveness of hands-on training through such preceptorship.

Nevertheless, in contrast to the control group, which only received the preceptorship, the experimental group improved in terms of not only job performance but also clinical critical-thinking skills and communication competency.

Recently, in Korea, it has been noted that the turnover rate for nurses with less than one year of practical experience is twice as high as that for other nurses, at 33.6% [ 21 ]. According to previous qualitative studies, novice nurses suffer a range of negative experiences: “being emotionally hurt by senior nurses … fear of being scorned at … being scared of senior nurses … having low confidence” [ 22 ], and “experiencing a gap between school education and practice” [ 23 ]. Because of the special nature of hospital work, hospitals have a complex organizational structure with varying types of relationships among professionals. The role of the nurse unit, or ward manager, is pivotal in influencing the learning environment for new nurses, and there is a clear association between positive nursing role-models and a supportive learning environment [ 24 ].

Also, the results of this study support the claim that work-based educational interventions are effective for strengthening nurses’ resilience through critical reflection [ 25 ]. Critical reflection provided a positive way to approach practice, so inclusion of education on reflection should be considered an essential component of novice orientation and preceptor training programs [ 26 ]. Therefore, it is important for health professionals to possess clinical decision-making and communication abilities. Novice nurses are not exempt from this requirement, so to prevent them from leaving their current posts, it is critical to help them improve their communication abilities and confidence, and to provide them with not only elementary training for nursing but also experiential learning that can close the gap between theoretical knowledge and practice.

However, the present study had certain limitations. Firstly, as the participants were drawn from a single hospital in South Korea, the extent to which the findings may be generalized is limited. Secondly, the sample size was limited to that required for statistical power. Thirdly, in terms of fidelity of intervention, although we developed and provided the manual to RPs and monitored them twice during the intervention, we could not control the fidelity depending on the characteristics of each RPs. Further research with critical thinking training programs among more diverse and larger samples may lend further support to the present findings.

The work-based critical reflection program not only had a positive effect on clinical decisions through communication and clinical critical-thinking ability but also helped novice nurses to adapt to their working environment with ease. For these reasons, a critical reflection program could be considered an essential tool for improving critical thinking among novice nurses who need to adapt to the clinical environment as promptly as possible. However, our study had some limitations, as mentioned above; therefore we recommend that further studies include larger and more diverse samples.

Abbreviations

Clinical Critical Thinking Skill

Critical reflection

Critical thinking

Problem-based learning

Reflective practitioner

Thompson C, Aitken L, Doran D, Dowding D. An agenda for clinical decision making and judgement in nursing research and education. Int J Nurs Stud. 2013;50:1720–6. https://doi.org/10.1016/j.ijnurstu.2013.05.003 .

Article Google Scholar

Oermann MH, Gaberson KB. Evaluation and testing in nursing education. 4th ed. New York: Springer; 2014.

Stocker M, Burmester M, Allen M. Optimisation of simulated team training through the application of learning theories: a debate for a conceptual framework. BMC Med Educ. 2014;14:69. https://doi.org/10.1186/1472-6920-14-69 .

Sangestani G, Khatiban M. Comparison of problem-based learning and lecture-based learning in midwifery. Nurse Educ Today. 2013;33:791–5. doi: j.nedt.2012.03.010

Kaasalainen S, Brazil K, Kelley ML. Building capacity in palliative care for personal support workers in long-term care through experiential learning. Int J Older People Nursing. 2014;9:151–8. https://doi.org/10.1111/opn.12008 .

Dreifuerst KT. Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. J Nurs Educ. 2012;51:326–33. https://doi.org/10.3928/01484834-20120409-02 .

Kuennen JK. Critical reflection: a transformative learning process integrating theory and evidence-based practice. Worldviews Evid-Based Nurs. 2015;12:306–8. https://doi.org/10.1111/wvn.12095 .

Cox K. Planning bedside teaching. Med J Aust. 1993;158:280–2.

Farrington N, Townsend K. Enhancing nurse-patient communication: a critical reflection. British J Nurs. 2014;24:771–5.

Weaver A. High-fidelity patient simulation in nursing education: an integrative review. Nurs Educ Perspect. 2011;32:37–40. https://doi.org/10.5480/1536-5026-32.1.37 .

Son Y, Lee YA, Sim KN, Kong SS, Park Y. Influence of communication competency and burnout on nursing performance of intensive care unit nurse. J Korean Acad Fundam Nurs. 2013;20:278–88. doi:10.7739

Lutz G, Scheffer C, Edelhaeuser F, Tauschel D, Neumann M. A reflective practice intervention for professional development, reduced stress and improves patient care – a qualitative development evaluation. Patient Educ Couns. 2013;92:337–45. https://doi.org/10.1016/j.pec.2013.03.020 .

Kwon IG, Park SM. Effects of critical reflective inquiry on new graduate nurses’ clinical decision-making. Clin Nurs Res. 2007;12:39–50.

Kolb DA. Experiential learning: experience as the source of learning and development. New Jersey: Prentice-Hall; 1984.

Zigmont JJ, Kappus LJ, Sudikoff SN. The 3D model of debriefing: defusing, discovering, and deepening. Semin Perinatol. 2011;35:52–8. https://doi.org/10.1053/j.semperi.2011.01.003 .

Shin S, Jung D, Kim S. Validation of a clinical critical thinking skill test in nursing. J Educ Eval Health Prof. 2015;12:1. https://doi.org/10.3352/jeehp.2015.12.1 .

Hur GH. Construction and validation of global interpersonal communication competence scale. Korean J Commun Stud. 2003;47:380–426.

Ko YK, Lee TW, Lim JY. Development of a performance measurement scale for hospital nurses. J Korean Acad Nurs. 2007;37:286–94.

Zori S, Kohn N, Gallo K, Friedman MI. Critical thinking of registered nurses in a fellowship program. J Contin Educ Nurs. 2013;44:374–80. https://doi.org/10.3928/00220124-20130603-03 .

Yang E, Lee S, Hwang E. Teaching medical students in primary and secondary care: a resource book. Seoul: Koonja Publishing Inc.; 2008.

Korean Hospital Nurses Association. Hospital nurses association work report: hospital nurses staffing state survey. Seoul: Hospital Nurses Association; 2012.

Kim SA, Jeon HW. Experience of turnover in new nurses. J Korean Public Health Nurs. 2014;28:644–57. https://doi.org/10.5932/JKPHN.2014.28.3.644 .

Park JH, Chun IS. The lived experience of newly employed nurses: phenomenological study. Qual Res. 2008;9:99–110.

Walker R, Cooke M, Henderson A, Creedy D. Characteristics of leadership that influence clinical learning: a narrative review. Nurs Educ Today. 2011;31:743–56.

McDonald G, Jackson D, Wilkes L, Vickers MH. A work-based educational intervention to support the development of personal resilience in nurses and midwives. Nurs Educ Today. 2012;32:378–84. https://doi.org/10.1016/j.nedt.2011.04.012 .

Asselin ME, Fain JA. Effect of reflective practice education on self-reflection, insight, and reflective thinking among experienced nurses. J Nurses Prof Dev. 2013;29:111–9. https://doi.org/10.1097/NND.0b013e318291c0cc .

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Acknowledgements

We appreciate the eight reflective practitioners and the novice nurses who participated in the critical reflection program.

This work was supported by the Ewha Womans University Research Grant of 2016. The funding body did not influence the design of this study, data collection, analysis, and interpretation.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available due to confidential participants’ data but are available from the corresponding author on reasonable request.

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Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea

Yeon Hee Kim, Ja Min & Soon Hee Kim

College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea

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Contributions

All authors contributed to the design of the study. SS performed the statistical analysis and wrote the first manuscript. JM and SK carried out data collection and data coding. YK, JM, and SS participated in its design and coordination, helped to draft the manuscript, and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sujin Shin .

Ethics declarations

Ethics approval and consent to participate.

We received ethical approval for the study from the Institute of Review Board of Asan Medical Center (2014–1021); all participants were informed of the objectives, methods, and procedures of data collection. Their rights to confidentiality, anonymity, and voluntary withdrawal from study participation were explained and assured, as was the disposal of material containing personal information after the completion of the study. Written informed consent to participate was obtained from all participants.

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Kim, Y.H., Min, J., Kim, S.H. et al. Effects of a work-based critical reflection program for novice nurses. BMC Med Educ 18 , 30 (2018). https://doi.org/10.1186/s12909-018-1135-0

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Received : 13 January 2017

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Published : 27 February 2018

DOI : https://doi.org/10.1186/s12909-018-1135-0

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The use of Critical Reflection in Nursing Practice

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Critical Reflection In Nursing

The advantages and disadvantages of reflection in nursing.

In this assignment the discussion on the advantages and disadvantages of using reflection in nursing practice is undertaken. Boyd and Fales, 1983 states reflection is "the process of internally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in

Reflective Reflection In Nursing

According to CNO (2015), reflection is a process of gradual self-awareness, commitment to action, and is an intentional process of thinking, analyzing and learning. As I reflect on my experience in the long-term care facility, I realize the importance of building a therapeutic nurse-client relationship with our residents. Through the ability to prioritize the resident needs, effectively communicating and capability to relate by assessing resident’s values, and evaluating your own self-awareness can one truly build a therapeutic relationship that promotes optimal well-being. An experience in particular from my clinical placement with a resident that has unspecified dementia has thought me so much about self-awareness and how critical it is in enhancing a therapeutic relationship with my resident. My reflection will be structured based on Gibbs (1988) reflective model framework, starting with a description of my experience, exploring my feelings, evaluation, analysis of my experience, conclusion, and action plan.

Nursing Reflection

Throughout my time on the Mother Baby Care Unit, I have faced many instances in which I have been able to reflect on both my patients and the care that I was providing them. One situation in particular that I found myself critically reflecting upon involved a new mother who was feeling slightly stressed about being discharged as her newborn son would not be going home with her. For confidentiality reasons, this patient will be given the pseudonym of Kayla for the remainder of this reflection.

Reflection Journal On Critical Thinking For Nurses

Critical thinking is defined as a disciplined, self directed thinking that meets appropriate intellectual standards within a particular mode or domain of thinking (Paul and Elder, 2014). In Nursing, the possession of this important skill helps a nurse to assess a given situation, identify the main problem, determine a perfect solution and implement an effective method of dealing with the problem.

Reflection On Nursing Practice

The nursing practise has continually evolved and can be described as autonomous due to the significant involvement of nurses in patient care. This then necessitates critical reflection as a way to continually develop and improve the nursing practise. The Gibbs' model, one of the reflection models, assists nurses in complying to the codes and guidelines of nursing practice. For example, developing action plans, evaluating patient outcomes, and thinking critically. This essay will describe an event involving nurses and explain the feelings it evoked. It will also provide an evaluation of the positives and negatives, analysis and enhancement of learning, and an action plan.

In the context of professional practices reflection is defined as the examination of personal thoughts and actions (David, 2004). In this essay I am reflecting on an incident that happened in my earlier years of working as a professional nurse. The incident I am sharing and the subsequent learning I have gained by reflecting it helped me in the later years of my nursing career.

Essay on Reflective Nursing Case Study

In this case study I will use Gibbs (1988) model of reflection to write a personal account of an abdominal examination carried out in general practice under the supervision of my mentor, utilising the skills taught during the module thus far.

Nursing Reflection as a Student Nurse

The following essay is a reflective account on an event that I, a student nurse encountered whilst on my second clinical placement in my first year of study. The event took place in a Fountain Nursing Home in Granite City. I have chosen to give thought to the event described in this essay as I feel that it highlights the need for nurses to have effective communication skills especially when treating patients that are suffering with a mental illness. Upon arriving to the Nursing home for the second time on Thursday November 14,2013; assigned the same patient as before. On meeting my patient the first thing I noticed myself doing without even thinking about it was giving her a visual inspection. Before nursing school I never really looked at

The objective of this reflection is to explore and reflect upon a situation from a clinical placement on an orthopedic unit. The incident showed that I did not provide safe, timely and competent care for my patient when the oxygen saturation was low. Furthermore, this reflection will include a description of the incident, and I will conclude with explaining what I have learned from the experience and how it will change my future actions.

The Royal College of Nursing (2015) (RCN), believe professional values are to be followed to create the evolving nurse, with Advocacy highlighted as a fundamental feature. The central thesis of this paper is to reflect my understanding of advocacy against my own clinical practice as a first-year student nurse. The analysis to reflect on this clinical practice will use Driscolls (2007) ‘The What?’ Model, which questions the stages of the learning cycles to reflect on, the incident, what has been learned and the outcome on both current and future practice. Patient Confidentiality will be protected and respected throughout this reflection as described in The Nursing and Midwifery code (2015) (NMC), and The Data Protection Act (1988), all personal information including the patient’s name is considered privileged information and be dealt in a way which does not comprise the patient’s dignity or infringe upon their right to privacy.

This semester, I hope to gain the confidence in my nursing skills necessary to help me work more independently with my patient care. Expanding on my assessment skills, communication skills, clinical judgment skills, and safety skills are important in gaining more independence in my care for my patients. I hope that this semester I can learn how to work with chest tubes, be more direct with what I need from my patient, be more confident with my knowledge in medications, improve my skills in delivering an SBAR, and learning the terminology used at Mayo Clinic and in nursing.

It was found that the nurses had insufficient recording of wound care and the staff were not monitoring the wounds consistently or keeping Mr Selir’s GP up to date on his condition. After this incident, the nursing home introduced new staff, systems and processes to improve the quality of care to residents. I felt frustrated and disturbed as coming from overseas, my family background has always taught us to respect and look after our elderly therefore back in our country we don’t believe in nursing homes. According to Nursing and Midwifery Board of Australia [NMBA] 2016, health professionals ought to provide safe, appropriate and responsive quality nursing practice.

Reflection In Nursing

Skin integrity is an important concept that’s nurses assess on their patients. A key skill in nursing practice is to frequently assess the skin for possible breakdown or decreased skin integrity. Skin assessments should be conducted thoroughly once a shift and frequently reassessed for any signs of change. Skin discrepancies may be the first sign of an underlying issue. Early detection of any breakdown can help to implement interventions sooner. Unfortunately, unless there is a major skin discrepancy, skin issues can easily get overlooked, specifically in documentation and report. The focus of this paper is to research new skin integrity assessments to improve documentation effect and accuracy, resulting in decreased prevalence of skin breakdown in hospitalized patients. Topics discussed include reviewing current practices and new skin assessment techniques that decrease the prevalence of skin breakdown and pressure ulcers.

Reflection is a process of exploring and examining ourselves, our perspectives, attributes, experiences and actions / interactions. It helps us gain insight and see how to move forward (Nursing Times 2018). I believe reflection is particularly important when it comes to Nursing, as medicine is constantly changing/ improving and us ourselves medical professionals must adapt with the changes in medicine. I find that reflection is extremely useful in doing this as we can look over procedures or experiences that we have had, how that made us feel, whether we would change anything, then in the future we can see the changes that may have been made, whether this has changed our feelings and opinions on medical practice.

Essay On Nursing Reflection

The following reflection demonstrates my awareness for my own cultural influences. Through the cultural lenses of a student nurse and a tennis member. They have impacted the way I view others and is a guidance to my bicultural professional health care relationship.

Critical Reflection

A Critical Reflection (also called a reflective essay) is a process of identifying, questioning, and assessing our deeply-held assumptions – about our knowledge, the way we perceive events and issues, our beliefs, feelings, and actions. When you reflect critically, you use course material (lectures, readings, discussions, etc.) to examine our biases, compare theories with current actions, search for causes and triggers, and identify problems at their core. Critical reflection is not a reading assignment, a summary of an activity, or an emotional outlet. Rather, the goal is to change your thinking about a subject, and thus change your behaviour.

How to Critically Reflect

Writing a critical reflection happens in two phases.

First phase: Analyze

A popular method for analyzing is the three stage model,

What? So What? Now what?

In the What? stage, describe the issue, including your role, observations, and reactions. The what? stage helps you make initial observations about what you feel and think. At this point, there’s no need to look at your course notes or readings.

Use the questions below to guide your writing during this stage.

In the second So What? stage, try to understand on a deeper level why the issue is significant or relevant. Use information from your first stage, your course materials (readings, lectures, discussions) -- as well as previous experience and knowledge to help you think through the issue from a variety of perspectives.

Tip: Since you’ll be using more course resources in this step, review your readings and course notes before you begin writing.

Below are three perspectives you can consider:

In the third Now what? stage, explore how the experience will shape your future thinking and behaviour.

Use the following questions to guide your thinking and writing:

Second phase: Articulate

After completing the analysis stage, you probably have a lot of writing, but it is not yet organized into a coherent story. You need to build an organized and clear argument about what you learned and how you changed. To do so, develop a thesis statement , make an outline , write , and revise.

Develop a thesis statement

Develop a clear argument to help your reader understand what you learned. This argument should pull together different themes from your analysis into a main idea. You can see an example of a thesis statement in the sample reflection essay at the end of this resource.

Make an outline

Once you have a clear thesis statement for your essay, build an outline. Below is a straightforward method to organize your essay.

Write and revise

Time to get writing! Work from your outline and give yourself enough time for a first draft and revisions.

Sample Critical Reflection

Below are sample annotated paragraphs from one student’s critical reflection for a course on society and privilege.

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Development of Critical Reflection Competency Scale for Clinical
Through critical reflection, nurses reflect on their experiences and ask the “why” question about the nursing situation, expanding their
Critical self-reflection for nurse educators: Now more than ever!
Reflection is concerned with three critical time periods of practice: before; in; and on action. ... Reflection in action was done during teaching
Effects of a work-based critical reflection program for novice nurses
Critical reflection in analyzing the outcomes of nursing practice has been found to be effective in improving learners' communication
The use of Critical Reflection in Nursing Practice
Nurses can develop better understanding of the ways in which they practice, the influences on their practice, and of their responses to
Critical Reflection In Nursing
Critical reflection is vital to develop evidence based practice for safe and quality approaches to professional nursing practice.
Critical Reflection In Nursing
Free Essay: Critical reflection is an indispensable tool used in evidence based nursing practice. Critical reflection is often a difficult concept to define
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Foundation of Nursing Studies 2015 ... Critical reflection is more than just 'thinking about' or 'thoughtful' ... Analyses the experience – make sense.
Critical Reflection
How to Critically Reflect · Analyze: In the first phase, analyze the issue and your role by asking critical questions. Use free writing as a way to develop good
Reflective Practice in Nursing
Ruth-Sahd, L.A. (2003) Reflective practice: a critical analysis of data-based studies and implications for nurse education. Journal of Nursing Education
Reflective Practice: A Critical Analysis of Data-Based Studies and
What are the conditions necessary to foster reflec- tion in the nursing education classroom? • What are the nurse educators' responsibilities and risks? • How