nursing reflective journal example

Reflective Journaling for Nursing Students: A Guide

Did you know that for every experience you encounter, you could reflect on it and learn? As a nurse, you will navigate complex and challenging clinical experiences filled with varied emotions, interventions, decisions, etc, influencing your actions. A nursing reflective journal offers a way to pause, think, and analyze how these feelings and experiences influence and shape your behavior and practice. It is a personal record; call it a diary, where nurses document their thoughts, experiences, emotions, and encounters related to clinical practice.

Knowing how to write a reflective journal assignment is one of the best ways of understanding the past to predict the future. While these papers are personal, they should have an academic tone, which is why most students struggle to write one. However, fear not!

In this guide, our nursing writers have done the heavy lifting, and in this article, they take you through what a reflective journal entails and its importance and provide step-by-step instructions on how to write a reflective journal.

Reflective Journal Meaning?

Reflective journaling in nursing refers to writing about your feelings, thoughts, fears, opinions, and interactions about a specific event. It is a way to explore the “so what" question rather than "what."

Reflective thinking entails the following elements: 1) description, where you talk about the experience; 2) interpretation, which is how your experience challenged your existing knowledge and opinions; and 3) outcome, which is how the experience contributed to your understanding and professional development.

As a nursing student, your instructor will ask you to write your reflections about an experience during clinical rotations. You will need to be introspective and deeply examine your thoughts, feelings, and opinions about the event before writing them.

Reflective thinking is used in nursing to help students and nurses develop critical thinking skills and the art of reflection to understand better and clarify stubborn concepts.

History of Reflective Practice

Reflective writing has its roots in education. John Dewey , a philosopher and educator, addressed reflection in 1910 as "Active, persistent, and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it, and the further conclusions to which it tends." This is considered the first description of reflective writing.

Over the years, this description has had many interpretations, but the message is still the same.

Dewey believed that every experience is a source of learning. Reflective thinking is activated the moment you sense a problem or any situation. By going deeper and understanding those experiences and trying to solve the problem through available data, you create a connection between beliefs, thoughts, opinions, and real actions.

Another prominent contributor to reflective practices was Donal Schön, an American theorist and educator. In his book, “ The Reflective Practitioner ," Schön describes reflection as an important practice that helps professionals, including nurses, to critically examine all their experiences in a real-world context.

Schön’s ideas were not specifically related to nursing. However, they had a profound effect on nursing education, shaping the way nursing students engage in reflective journaling to enhance their future clinical skills.

Why is Reflecting Important in Nursing?

The following are the reasons why reflection in nursing is important:

Close the Gap between Theory and Practice

Nursing instructors believe that writing a reflective journal in nursing can help close the gap between theory and practice by facilitating the inclusion of a theoretical framework into clinical experience. Reflective journaling allows you to apply theories learned in the classroom to real-world hospital situations. When you can document your experience and reflect on how nursing theories and principles apply in practice, you can deepen your knowledge of a theory and how it is helpful in nursing interventions.

Improve Your Critical Thinking Skills

By engaging in reflective thinking practices, you can critically analyze a clinical situation and identify areas of improvement. Remember, reflective thinking is about deliberate stranger contemplation of your experiences and actions. Applying this in real-life situations will force you to critically assess the situation and relate the new knowledge acquired to prior knowledge.

In other words, you will be forced to cultivate in-depth critical thinking, which entails asking questions, analyzing, and integrating your answers.

Teaching Strategy for Educators

Reflective journals in nursing are important for students, but educators can also use them as a teaching strategy. When students engage in reflective writing, educators can identify areas they are struggling with or gaps in knowledge and competence. Then, they can develop additional education and training opportunities to address these gaps.

By taking a proactive approach to learning, educators can ensure their students continuously enhance their knowledge and competence while also staying updated on nursing research and evidence-based practices.

Enhance Self-Awareness

Self-awareness refers to the ability to focus on yourself and how your thoughts, feelings, and opinions align or do not align with your values and standards. Research shows that self-awareness is essential in nursing and profoundly affects nurse-patient relationships and patient care. When you engage in reflective thinking practices, you take a close look at yourself. Still, more importantly, you develop a deeper understanding of your beliefs, values, and biases that influence your decisions and interactions in a clinical experience.

Step-by-step Guide for Writing a Nursing Reflective Journal

Reflective journaling in nursing takes a structured process that involves documenting and reflecting on your thoughts, emotions, and actions about a clinical experience. Use the following steps to write your reflections:

Choose What to Reflect On

First, take time to think about what you want to reflect on before writing the paper. As a nurse or a nursing student, you can reflect on anything you experience during your shift, ranging from a missed diagnosis, stubborn or dissatisfied patients, a nursing ethical dilemma , a failed surgery or procedure, etc.

You can also reflect on things that went right in your shift, such as:

• A cancer diagnosis that was caught early
• A teaching experience with patients
• A difficult procedure that you managed to do successfully.

If you are not sure which experience to focus on, use the following tips to help you:

• Think of a recent clinical experience you went through. Think back to what stood out most and left a lasting impression in your life.
• Consider things that evoked strong emotions during your clinical rotations and enhanced your understanding of nursing education and practice.
• Additionally, consider people (either colleagues or patients) who had a profound impact on you during the clinical experience.

No matter which event happened during your clinical, you can reflect on it and use it for self-development.

Ensure you choose a topic that resonates with you lea, leads to deep introspection, and facilitates personal growth.

Choose a Topic

Just like other types of academic writing, your reflective journal in nursing must have a topic. A topic will provide focus and direction and guide you when writing. The topic you select will guide the writing process, so it is important that you take time to choose the right topic.

So, what is the best topic for a reflection paper? Well, the best topic must have the following characteristics:

• Relevant to the experience and nursing practice that you encountered and reflect your learning.
• It has personal significance and has an impact on your learning.
• Evoke strong emotions, whether positive or negative.
• Complex enough to let you have a deep introspection and provide a critical analysis of the experience.
• The topic must align with your academic and professional goals.

Ensure you consider all the characteristics when selecting a topic to provide a meaningful reflection and learning.

Choose a Proper Format

The first step to writing your nursing reflective journal is choosing the right to follow. Unless your instructor tells you otherwise, your reflection paper must contain the following elements:

• Introductions

The introduction is where you introduce the essence of your paper. Start your reflection paper by briefly introducing what you are reflecting upon so that readers know what to expect. Additionally, provide a thesis statement that provides a general opinion of the subject you are analyzing. This could be a lecture, a nursing article, a clinical experience, etc.

The body of your reflection paper should explore the main idea of your paper. In other words, the thesis statement. Go into detail about what you went through and how it influenced you. This is where you also talk about what you learned from the experience.

Conclusion. As the last part of your reflection paper, the conclusion should briefly state the thoughts, opinions, and experiences discussed in the paper. It should also state what you learn based on your analysis of the experiences.

That said, most reflective journal assignments in nursing are written in APA, Harvard, Vancouver, or AMA format. Ensure that your in-text citations and references align with the formatting styles.

Select a Reflective Framework for Your Nursing Reflective Journal

A reflective framework is a model that guides the thought process and reasoning about a particular event. Whenever you engage in reflective practices, you must use a reflective framework to write down your thoughts, feelings, and opinions about the events.

There are various models of reflection you can use. The main framework is Gibbs's reflective model, a powerful tool that fosters deep learning and critical thinking. Developed by Grahams Gibbs, this reflective model provides a structured framework for writing your reflective journal in nursing.

Some of the reflective models you can use when engaging in reflective practices include:

• Kolb’s Learning Cycle
• Schön’s framework
• ERA framework
• CARL framework
• Brookfield framework
• Roper Logan and Tiernerys reflections
• Atkins and Murphy's model

Ensure you select a reflective model that resonates with you and provides guides that help you write your reflection in a structured format.

Related Articles:

• How to write a nursing reflective essay.
• Nursing theories and theorists.
• Non-nursing theories used in nursing practice.

Describe the Experience

Go into detail about what you went through. Be objective about this and ensure you recount in detail the experience. To help you with this, use the following questions:

What happened?

• Where did the experience take place?
• When did it take place?
• Who was involved
• What did you do? Talk about everyone who participates, even if you feel their role was insignificant.
• Why did the event happen? What was the intention of the event when it occurred?
• What was the outcome?
• What did you want to happen instead?

The main things to include at this point involve what happened. Whenever you talk about the experience, detail it in the order in which it happened. Paint a clear and accurate picture of what occurred. Think of this stage as narrating the story only when you are providing facts. Do not talk about feelings or opinions.

Identify your Feelings about the Experience

This stage calls for self-reflection in your nursing reflective journal. Discuss your feelings during the experience and acknowledge any frustration, joy, anger, empathy, or other emotions you felt during the event.

Take a moment to think back to the event. What emotions were you experiencing? What was your gut reaction? Were you disgusted? Frightened? Angry?

After the event occurred, how did your feelings change? Detail how your feelings change with each passing moment.

Next, think of how those involved in the event might have felt. Did you observe any reactions? For instance, did someone throw up? Cry? Storm out of the room? Ensure you talk about all this, as they will help you make sense of the events.

Use these questions to describe your emotions in detail. Remember, by being detailed in your descriptions, the reader will feel what you felt.

Analyze the Experience

At this stage of your nursing reflection journal, evaluate the experience by considering both your actions and outcomes. Assess the situation by considering both the good and bad. Ask yourself, the following questions to properly make your evaluations:

• What was so good about the experience? Highlight the positive outcomes of the experience.
• What went wrong or what didn't work well?
• Did you contribute anything? If yes, what was it? Highlight all your contributions through the experience. Were they positive or negative?
• What were the contributions of others? Were they positive or negative?
• If the experience was difficult, state whether it was resolved in the end.
• Was there something that the people involved did that made you think twice about the situation or taught you something?

Provide an Analysis 

Up until now, you aimed to describe the events and feelings. Now you have the opportunity to say what it all means. In other words, this is the point where you make sense of what happened during the experience.

Ask yourself the following questions to analyze the situation properly:

• Why did this go well or bad? Reconsider the things that went badly and ask why
• What do you think could have caused the problem?
• Think about your contributions and state whether they made any meaningful impact on the experience.

Basically, ask questions like, so what? And why?

Ensure you connect the experience to a nursing theory. To ensure this is successful, choose a theory that aligns with the topic of your reflection. For example, if your reflection is about the challenges you encountered when communicating with patients, choose a theory like Trans-cultural Nursing Theory.

Once you have chosen the theory, identify its concepts, which will help you as you write. Talk about how your actions, decisions, and emotions align with or diverge from the principles of the chosen theory.

Please note that this part is analytical. So, do not describe it; analyze it by analyzing the experience, emotions, and feelings to make sense of everything.

Pay attention as you write this section, as it will determine whether you indeed learned something from the events that happened. Many students lose marks at this point because they fail to capture the essence of

Write Your Conclusion

Think about what can be concluded from the event that happened and the analyses you have done.

Ask yourself the following:

• Did you learn anything?
• Was there anything you missed that you think could have made an impact on the whole experience?
• Could you have discussed what happened with your instructor? If yes, would it have influenced you or the actions in any way?
• Is there any nursing literature you think you should read to make sense of the

Consider providing examples of how you intend to apply all the lessons learned. This way, you will show your instructors that you have truly reflected on the experiences.

Develop an Action Plan

At this stage, you should wrap up anything else you need to understand about the experience and what you should improve in the future. So, how do you write an action plan for a reflection?

Use the following questions to help you develop a great action plan:

• How will you use what you have learned in a similar situation? Have you become more confident in handling such a situation?
• How has the experience helped you improve in your studies and clinicals?
• Will you be able to communicate with patients and colleagues during your practice?
• What advice will you give others going through a similar situation?
• What actions are you committed to taking?
• What are the benchmarks for these actions?
• When do you think you will be able to complete these actions?

Remember, the action plan is about the future of you and your actions. So, capture this action well in your reflective journal nursing.

Proofread and Revise Your Paper

Once you are done writing, take some time off, preferably a day or two, depending on the deadlines given, before reviewing your paper. This will allow you to review your paper with a fresh pair of eyes and ensure you identify any errors in your work.

Check for spelling, grammar, and punctuation errors and correct them. Additionally, ensure that your nursing reflective journal has properly described your experience and feelings and provided an evaluation analysis before finally writing your action plan.

Example of a Reflective Journal

Below is an example of a reflective journal written by a student who did a clinical rotation with a patient named Mrs. Smith. If you need to hire a nursing writer to write your reflective journal, don't hesitate to place an order on our website. 

Experience Today, I cared for Mrs. Smith, a 78-year-old patient admitted with pneumonia. Mrs. Smith presented with difficulty breathing, a persistent cough, and decreased oxygen saturation levels. Description Mrs. Smith was visibly distressed upon arrival, her labored breathing evident even from a distance. As I approached her bedside, I noticed her apprehension, which mirrored my own. Despite my attempts to maintain a calm demeanor, I could feel my heart racing as I assessed her condition.   Thoughts and Feelings Initially, I felt overwhelmed by the severity of Mrs. Smith's symptoms and the urgency of her situation. Doubts crept into my mind about whether I possessed the skills and knowledge necessary to provide effective care. However, as I focused on attending to her immediate needs, my anxiety began to subside, replaced by a sense of determination and purpose. Analysis Reflecting on the experience, I recognize that my initial reaction was driven by fear of the unknown and a lack of confidence in my abilities. However, as I engaged with Mrs. Smith and collaborated with my colleagues, I drew upon my training and expertise to deliver competent and compassionate care. This experience reaffirmed the importance of remaining calm under pressure and trusting in my capabilities as a nurse. Strengths and Weaknesses One strength I demonstrated during this encounter was my ability to prioritize Mrs. Smith's needs and mobilize resources efficiently. However, I acknowledge that there were moments when I struggled to maintain composure, particularly when her condition deteriorated. Moving forward, I aim to cultivate resilience and emotional regulation to better cope with challenging situations. Alternative Actions In hindsight, I recognize that I could have benefited from seeking assistance earlier when Mrs. Smith's condition worsened. By involving other members of the healthcare team sooner, we could have implemented interventions more promptly and potentially mitigated the escalation of her symptoms. Theory and Practice This experience underscored the significance of effective communication and interdisciplinary collaboration in nursing practice. By leveraging the expertise of my colleagues and adhering to evidence-based protocols, we were able to optimize Mrs. Smith's care and achieve positive outcomes. Goals for Improvement Going forward, I aspire to enhance my crisis management skills and develop strategies for maintaining composure in high-stress situations. Additionally, I intend to pursue further education and training in respiratory care to broaden my knowledge base and enhance my ability to care for patients with pulmonary conditions. Action Plan To achieve these goals, I will seek out opportunities for professional development, such as attending workshops or enrolling in relevant courses. I will also engage in regular reflection and seek feedback from my peers and mentors to continually refine my practice. This journal entry serves as a testament to my growth as a nurse and a commitment to ongoing learning and improvement. Through reflection and self-awareness, I strive to cultivate the skills and attributes necessary to deliver exemplary care and make a meaningful difference in the lives of my patients.

Final Thoughts

Writing a nursing reflective journal is never a walk in the pack. However, by following the above guide, you can write a reflective journal in nursing that captures the vents, critically analyzes them, and improves your future experiences as a nurse.

If you need help with writing these or any other types of nursing papers , we can help. Our writers have the skills and expertise to help guide you when writing a reflection paper. Reach out to us today for high-quality papers.

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Student Nurse Reflection Guide and Examples

A student nurse reflection is a thoughtful process where nursing students analyze their clinical experiences, personal growth, and professional development throughout their nursing education. This practice involves critically examining one’s actions, thoughts, and emotions during patient care encounters, clinical placements, and other nursing-related activities. By engaging in reflection, nursing students can gain valuable insights into their strengths, areas for improvement, and overall progress in becoming competent registered nurses.

Reflections typically take the form of written essays, journal entries, or structured discussions with peers and instructors. These exercises encourage nursing students to connect theoretical knowledge with practical experiences, fostering a deeper understanding of the nursing profession and their role within it.

Table of Contents

Understanding Nurse Reflection in Nursing School

In nursing school, reflection is an integral part of the learning process. It serves as a bridge between classroom theory and clinical practice, allowing students to make sense of their experiences and apply their knowledge in real-world situations. Nursing students are often required to engage in reflective activities throughout their education, which may include:

• Writing reflective essays after clinical rotations
• Maintaining a reflection journal throughout the nursing program
• Participating in group reflections with peers and instructors
• Completing self-assessment exercises to track personal and professional growth

These reflective practices help nursing students develop critical thinking skills, enhance their clinical judgment, and cultivate a patient-centered approach to care. By regularly reflecting on their experiences, students can identify patterns in their behavior, recognize areas where they excel, and pinpoint aspects of their practice that need improvement.

The Importance of Reflection on Clinical Experience

Reflection on clinical experience is crucial for nursing students as it allows them to:

• Process complex emotions: Clinical settings can be emotionally challenging, and reflection provides a safe space for students to explore and understand their feelings.
• Identify knowledge gaps: By analyzing their actions during patient care, students can recognize areas where they need to expand their knowledge or skills.
• Develop cultural competence: Reflecting on interactions with diverse patient populations helps students become more culturally sensitive and aware.
• Enhance critical thinking: Analyzing clinical situations from multiple perspectives sharpens students’ ability to make sound decisions in future encounters.
• Improve patient care: By reflecting on past experiences, students can develop strategies to provide better care in similar situations.

Example: A nursing student reflects on a challenging patient interaction during their mental health nursing rotation:

“During my clinical placement in the psychiatric unit, I encountered a patient experiencing acute psychosis. Initially, I felt overwhelmed and unsure of how to approach the situation. Reflecting on this experience, I realize that my discomfort stemmed from a lack of confidence in my communication skills with patients in crisis. Moving forward, I plan to seek additional training in therapeutic communication techniques and practice role-playing scenarios with my peers to better prepare for similar situations in the future.”

How to Approach Your Reflection Journal as a Nursing Student

Approaching your reflection journal as a nursing student requires consistency, honesty, and a willingness to explore your thoughts and feelings deeply. Here are some tips to help you make the most of your reflection journal:

• Set a regular schedule: Dedicate time each day or week to write in your journal, ensuring that reflection becomes a habit.
• Use a structured format: Consider using a reflection model like Gibbs’ Reflective Cycle to guide your entries and ensure comprehensive analysis.
• Be specific: Focus on particular events or experiences rather than general observations.
• Include both positive and negative experiences: Reflect on successes as well as challenges to gain a balanced perspective.
• Connect theory to practice: Relate your experiences to nursing concepts and theories learned in class.
• Ask yourself probing questions: Use prompts like “What could I have done differently?” or “How did this experience change my perspective on nursing?”
• Document your growth: Periodically review past entries to track your progress and identify recurring themes.
• Be honest and vulnerable: Don’t shy away from acknowledging mistakes or areas where you struggle.
• Maintain patient confidentiality: Use pseudonyms or general descriptions when discussing patient care experiences.
• Seek feedback: Share selected entries with instructors or peers to gain additional insights and perspectives.

Why is Reflective Practice Important for Student Nurses?

Reflective practice is essential for student nurses as it contributes significantly to their personal and professional development. Here are several key reasons why reflective practice is crucial:

Enhancing Clinical Skills Through Self-Reflection

Self-reflection allows nursing students to critically analyze their clinical skills and identify areas for improvement. By examining their performance in various clinical situations, students can:

• Recognize patterns in their decision-making processes
• Identify strengths and weaknesses in their technical skills
• Develop strategies to enhance their clinical competence
• Learn from both successes and mistakes

Example: A nursing student reflects on their experience taking vital signs:

“During today’s clinical rotation, I realized that I was consistently recording blood pressure readings higher than those obtained by my clinical instructor. Through reflection, I identified that my technique for positioning the patient’s arm was incorrect. I plan to practice proper positioning and technique to improve the accuracy of my vital sign measurements.”

Developing Communication Skills in Clinical Settings

Effective communication is paramount in nursing, and reflective practice provides an opportunity for students to hone these skills. By reflecting on their interactions with patients, families, and healthcare team members, nursing students can:

• Analyze the effectiveness of their communication strategies
• Identify barriers to clear and compassionate communication
• Develop empathy and cultural sensitivity
• Improve their ability to convey complex medical information to patients

Reflection as a Tool for Personal and Professional Growth

Reflective practice serves as a catalyst for ongoing personal and professional development. It encourages nursing students to:

• Cultivate self-awareness and emotional intelligence
• Align their actions with professional values and ethics
• Develop resilience and coping strategies for challenging situations
• Set meaningful goals for their nursing career

By engaging in regular reflection, nursing students can cultivate a growth mindset and become lifelong learners in their profession.

How to Write a Reflective Essay as a Nursing Student?

Writing a reflective essay as a nursing student requires a structured approach that combines personal experience with academic analysis. Follow these steps to create a compelling reflective essay:

Key Components of a Nursing Student Reflection Essay

• Introduction: Briefly describe the experience or event you’re reflecting on and its significance to your nursing education.
• Description: Provide a detailed account of the situation, including relevant context and your role in the event.
• Feelings and Thoughts: Explore your emotional and cognitive responses to the experience.
• Evaluation: Analyze what went well and what could have been improved in the situation.
• Analysis: Connect your experience to nursing theories, concepts, or best practices learned in your coursework.
• Conclusion: Summarize the key insights gained from the reflection and how they will inform your future nursing practice.
• Action Plan: Outline specific steps you’ll take to apply what you’ve learned in future clinical situations.

Examples of Reflection on Clinical Experiences

Here’s a brief example of a reflection on a clinical experience:

“During my second clinical placement in the pediatric ward, I encountered a challenging situation while administering medication to a 5-year-old patient. The child was visibly anxious and refused to take the oral medication. Initially, I felt frustrated and unsure of how to proceed. Reflecting on this experience, I realize that I could have better prepared for potential resistance by discussing age-appropriate strategies with my clinical instructor beforehand.

In analyzing the situation, I recognize that my approach lacked creativity and sensitivity to the child’s fears. Moving forward, I plan to expand my knowledge of pediatric care techniques and practice using distraction methods to make medication administration less stressful for young patients. This experience has highlighted the importance of adaptability and patient-centered care in nursing practice.”

Tips for Effective Writing in Nursing Education

• Use clear, concise language
• Incorporate relevant nursing terminology
• Support your reflections with specific examples
• Maintain a professional tone while expressing personal insights
• Use proper citation methods when referencing nursing literature or theories
• Proofread carefully to ensure accuracy and clarity

What Are the Best Practices for Reflection During Clinical Placements?

Reflection during clinical placements is a valuable tool for nursing students to maximize their learning experiences. Here are some best practices to consider:

Integrating Patient Care Experiences into Reflection

• Focus on significant events: Choose experiences that had a strong impact on your learning or emotions.
• Consider the patient’s perspective: Reflect on how your actions affected the patient’s care and well-being.
• Analyze your decision-making process: Examine the rationale behind your choices in patient care situations.
• Explore ethical considerations: Reflect on any ethical dilemmas or challenges you encountered during patient care.

Using Clinical Observation for Deeper Insights

• Observe experienced nurses: Reflect on the techniques and approaches used by registered nurses and clinical instructors.
• Analyze team dynamics: Consider how different healthcare team members collaborate to provide patient care.
• Reflect on the healthcare environment: Consider how the clinical setting influences patient care and nursing practice.
• Observe patient-nurse interactions: Analyze communication styles and their impact on patient outcomes.

Creating a Reflection Journal for Nursing Practice

• Use a consistent format: Develop a template or structure for your journal entries to ensure comprehensive reflection.
• Set reflection goals: Identify specific aspects of your nursing practice you want to focus on during each clinical placement.
• Include both objective and subjective information : Record factual details as well as your personal thoughts and feelings.
• Maintain confidentiality: Use pseudonyms or general descriptions to protect patient privacy.
• Review and analyze: Regularly review your journal entries to identify patterns and track your progress over time.

How to Use Reflections to Improve Nursing Skills?

Reflections can be a powerful tool for enhancing nursing skills when used strategically. Here are some ways to leverage your reflections for skill improvement:

Identifying Areas for Improvement in Nursing Practice

• Conduct a self-assessment: Use your reflections to honestly evaluate your strengths and weaknesses in various nursing competencies.
• Seek feedback: Compare your self-assessment with feedback from clinical instructors and peers to gain a well-rounded perspective.
• Set SMART goals: Based on your reflections, establish Specific, Measurable, Achievable, Relevant, and Time-bound goals for skill improvement.
• Create a skill development plan: Outline specific actions you’ll take to address identified areas for improvement.

Applying Reflective Insights to Future Clinical Rotations

• Review past reflections: Before each new clinical rotation, review relevant reflections from previous experiences to inform your approach.
• Implement learned strategies: Apply insights and techniques developed through reflection to similar situations in new clinical settings.
• Monitor progress: Continuously reflect on your performance to track improvements and identify ongoing challenges.
• Adjust your approach: Use reflective insights to adapt your nursing practice as you gain more experience and encounter diverse patient populations.

Building a Strong Nursing Career Through Reflection

• Develop a reflective mindset: Cultivate the habit of regularly reflecting on your nursing practice throughout your career.
• Engage in peer reflection: Participate in reflective discussions with colleagues to gain new perspectives and share insights.
• Use reflection for professional development: Identify areas for further education or specialization based on your reflective insights.
• Contribute to nursing knowledge: Consider sharing your reflective experiences through nursing publications or presentations to benefit the wider nursing community.

What Challenges Do Nursing Students Face in Reflection?

While reflection is a valuable tool for nursing students, it can also present several challenges:

Overcoming Barriers to Effective Self-Reflection

• Time constraints: Balancing reflection with academic and clinical responsibilities can be challenging. Set aside dedicated time for reflection and integrate it into your daily routine.
• Discomfort with self-criticism: Some students may find it difficult to critically analyze their own performance. Focus on the learning opportunity rather than dwelling on perceived failures.
• Lack of structure: Without guidance, reflections may lack depth or focus. Use reflective models or prompts to guide your thinking and ensure comprehensive analysis.
• Fear of judgment: Students may worry about sharing personal thoughts or mistakes. Remember that reflection is a tool for growth, not evaluation.
• Difficulty connecting theory to practice: Bridging the gap between classroom learning and clinical experiences can be challenging. Actively seek connections and ask for guidance from instructors when needed.

How to Stay Motivated in Your Reflection Journey

• Set reflection goals: Establish clear objectives for your reflective practice to maintain focus and purpose.
• Celebrate progress: Acknowledge improvements and insights gained through reflection to stay motivated.
• Join a reflection group: Engage with peers in reflective discussions to share experiences and gain new perspectives.
• Vary your reflection methods: Experiment with different reflection techniques (e.g., journaling, mind mapping, audio recordings) to keep the process engaging.
• Connect reflection to career aspirations: Understand how reflective practice contributes to your long-term goals as a nurse.

Seeking Support from Peers and Instructors

• Participate in group reflections: Engage in structured reflection sessions with classmates to gain diverse perspectives.
• Schedule meetings with clinical instructors: Discuss your reflections and seek guidance on areas for improvement.
• Utilize academic support services: Take advantage of writing centers or tutoring services to enhance your reflective writing skills.
• Join nursing student associations: Connect with peers who can offer support and share their own reflective experiences.
• Seek mentorship: Develop relationships with experienced nurses who can provide insights and guidance based on their own reflective practices.

Related article; Reflections on my Nursing Journey

FAQs on Student Nurse Reflection

How to write a reflection for a nursing student.

To write a reflection as a nursing student, start by describing a specific clinical experience or event. Analyze your thoughts, feelings, and actions during the situation. Evaluate what went well and what could be improved. Connect your experience to nursing theories or concepts learned in class. Conclude by outlining how this reflection will inform your future nursing practice.

What is an example of reflection in nursing?

An example of reflection in nursing could be: “During my clinical rotation in the emergency department, I observed a nurse skillfully de-escalate a situation with an agitated patient. Reflecting on this experience, I realized the importance of maintaining a calm demeanor and using therapeutic communication techniques in high-stress situations. I plan to practice these skills to improve my ability to handle similar scenarios in the future.”

What I learned as a student nurse?

As a student nurse, you might learn various skills and insights, such as:

• The importance of effective communication with patients and healthcare team members
• How to perform basic nursing procedures and assessments
• The value of evidence-based practice in providing quality patient care
• The significance of cultural competence in healthcare
• Time management and prioritization skills in a clinical setting
• The emotional aspects of nursing and the importance of self-care

What are some examples of student feedback for nursing students?

Examples of student feedback for nursing students might include:

• “Your patient assessment skills have improved significantly since your last clinical rotation.”
• “Consider practicing your IV insertion technique to increase your confidence and accuracy.”
• “Your communication with patients is excellent, but try to be more assertive when collaborating with other healthcare team members.”
• “Your documentation is thorough, but work on being more concise while maintaining important details.”
• “You showed great empathy when dealing with the distressed family member. Keep developing this important skill.”

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Journaling: A valuable tool for registered nurses

Write about your life and experiences to better understand them and yourself..

• Journaling is a valuable resource that nurses can use to support their health and wellness .
• Journaling allows you to script feelings and thoughts to better understand yourself and events, as well as cultivate self-compassion and self-awareness.
• Writing strengthens cognition, fosters insight, and improves emotional regulation.

NURSES’ FOCUS on compassion can be both rewarding and depleting. To offset the fatigue that can come with nursing care, nurses must find ways to express their feelings and tend to their own well-being. Journaling is a valuable resource that nurses can use to support their health and wellness. Using journaling to script feelings and thoughts promotes understanding, self-compassion, and self-awareness. In addition, writing strengthens cognition, fosters insight, and improves emotional regulation.

Although the benefits of journaling are well established, it’s underused as a method for self-care and reflection. Philosopher and educational reformer John Dewey wrote that “reflective thinking alone is educative.” Journaling provides a foundation for reflective thinking and can help anyone, including nurses, express their emotions and improve their health and well-being.

Journaling defined

At its most basic, journaling is a record of personal thoughts, daily events, and evolving insights. It also provides a foundation for creativity, guidance, selfawareness, understanding, and spiritual development. While journaling, authors can express themselves without censorship, disapproval, or judgment. Screaming, expressing anger, whimpering, feeling sad, wailing, and raging may occur while journaling.

Journaling benefits

Research also shows that journaling is an important tool for developing critical-thinking skills. Nurses use journaling to explore “general observations, questions, speculative statements, expressions of self-awareness, statements of synthesis, revisions of previously held ideas, and the accumulation of new information to develop critical thinking…” as noted in a 2017 article by Dimitroff and colleagues. Scheffer and Rubenfeld defined reflection as “contemplation upon a subject, especially one’s assumptions and thinking, for the purposes of deeper understanding and self-evaluation.” And Raterink found that journaling was valuable in the clinical setting when used by graduate nursing students. As the students became more comfortable with journaling and self-reflection, they felt more competent about their critical-thinking skills and habits.

Journaling tips

Use these suggestions to get started with your journaling.

A proven tool

Journaling provides an opportunity to express emotions and gain self-awareness. It also is a proven way to gain perspective and achieve a higher level of health and wellness, which benefits nurses directly and, in turn, all of the people whose lives we touch.

Lynda J. Dimitroff is an educational and leadership consultant in Rochester, New York.

Selected references

Adams K. Expressive Writing: Foundations of Practice . Lanham, MD: Rowman & Littlefield Education; 2013.

Brady EM, Sky HZ. Journal writing among older learners. Educ Gerontol . 2003;29(2):151-63.

Burtson PL, Stichler JF. Nursing work environment and nurse caring: Relationship among motivational factors. J Adv Nurs . 2010;66(8):1819-31.

Dewey J. How We Think . Mineola, NY: Dover Publications, Inc.; 1997.

Dimitroff LJ, Sliwoski L, O’Brien S, Nichols LW. Change your life through journaling—The benefits of journaling for registered nurses. J Nurs Educ Pract . 2017;7(2): 90-8.

Field V, Bolton G, Thompson K. Writing Works: A Resource Handbook for Therapeutic Writing Workshops and Activities . London: Jessica Kingsley Publishers; 2006.

Francis ME, Pennebaker JW. Putting stress into words: The impact of writing on physiological, absentee, and self-reported emotional wellbeing measures. Am J Health Promot . 1992;6(4):280-7.

Hiemstra R. Uses and benefits of journal writing. New Directions for Adult and Continuing Education . 2001;90:19-26.

Hinderer KA, VonRueden KT, Friedmann E, et al. Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. J Trauma Nurs . 2014;21(4):160-9.

Keidel GC. Burnout and compassion fatigue among hospice caregivers. Am J Hosp Palliat Care . 2002;19(3):200-5.

Kuo CL, Turton M, Cheng SF, Lee-Hsieh J. Using clinical caring journaling: Nursing student and instructor experiences. J Nurs Res . 2011; 19(2):141-9.

Lepianka JE. Using reflective journaling to improve the orientation of graduate nurses. J Contin Educ Nurs . 2014;45(8):342-3.

Parr G, Haberstroh S, Kottler J. Interactive journal writing as adjunct in group work. The Journal for Specialists in Group Work . 2000; 25(3):229-42.

Pennebaker JW. Opening Up. The Healing Power of Expressing Emotions . New York: The Guildford Press; 1990.

Pennebaker JW, Colder M, Sharp LK. Accelerating the coping process. J Pers Soc Psychol . 1990;58(3):528-37.

Raterink G. Reflective journaling for critical thinking development in advanced practice registered nurse students. J Nurs Educ . 2016;55(2):101-4.

Sacco TL, Ciurzynski SM, Harvey ME, Ingersoll GL. Compassion satisfaction and compassion fatigue among critical care nurses. Crit Care Nurse . 2015;35(4):32-43.

Scheffer BK, Rubenfeld MG. A consensus statement on critical thinking in nursing. J Nurs Educ . 2000;39(8):352-9.

Smart D, English A, James J, et al. Compassion fatigue and satisfaction: A cross-sectional survey among US healthcare workers. Nurs Health Sci . 2014;16(1):3-10.

Stamm BH. The ProQOL Manual . Idaho State University: Sidran Press; 2005.

Waldo N, Hermanns M. Journaling unlocks fears in clinical practice. RN . 2009;72(5):26-31.

Zori S. Teaching critical thinking using reflective journaling in a nursing fellowship program. J Contin Educ Nurs . 2016;47(7):321-9.

3 Comments .

Do you help in writting nursing reflective journal for others. if, what is the cost?

American Nurse Today reached out to a nurse attorney who has contributed to the journal. Here are her comments:

I think journaling is a very useful tool—as long as it does not include actual descriptions of actual events with actual patients. Keep in mind that journaling about adverse events poses a potential risk to nurses. In a deposition nurses will be asked if they have any logs, journals, or diaries and if so, they can be discoverable and will need to be produced. There will always be something in that journal that can be a statement against that nurse’s interest. Additionally, nurses will be asked if they keep this kind of detailed log on every patient they take care of. The answer is no, so the next obvious question is why they did so in this case. It is difficult to overcome presumption that the reason the nurse made a detailed log in this case is because something happened that should not have. It also makes the nurse less credible when under oath he or she testifies to not remembering some details about the case when being asked about it in what can be years after the event. There are also potential problems with HIPAA, state privacy laws, violation of organizational policies, and professional misconduct charges. I always advise nurses to NOT keep journals, logs, or diaries about patient events, much less copies of documents like incident reports or medical records for just these reasons. Journaling about feelings and one’s personal journeys can be helpful. Just remember that journaling about feelings is one thing—memorializing adverse events is another.

Edie Brous, Esq. PC Nurse Attorney Note: This information is not intended to provide legal counsel.

In reading my November issue of American Nurse Today I found an article on journaling. While attending a workshop given by a nurse/attorney we were told never to journal anything about your job as this can be “discoverable” in any future litigation. The article in this issue promotes journaling about work experiences. I wonder what would be the response from a nurse/attorney on this practice. Is there one on staff of this publication who could comment?

Paula Milner MS, RN Phoenix, AZ

Comments are closed.

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How to Write a Nursing Reflection Paper: A Complete 2024 Guide with an Example

Introduction

A nursing reflection paper is a type of academic writing where nurses analyze their experiences, behaviors, and outcomes in clinical practice . It involves a critical examination of events, decisions, and actions taken during nursing practice, with a focus on understanding and learning from these experiences to improve future professional performance. The paper typically includes personal insights, emotions, and the application of theoretical concepts to practical situations. This article aims to provide a comprehensive guide on how to write a nursing reflection paper. It will cover the importance of reflection, the types of reflection, how to prepare for writing, the structure of a reflection paper, writing tips and techniques, and common challenges and solutions.

Importance of Reflection in Nursing Practice

Reflection in nursing practice is essential for several reasons:

• Professional Development: Reflection helps nurses to identify areas for improvement and develop their skills and knowledge.
• Patient Care: By reflecting on their interactions and interventions, nurses can enhance their patient care strategies and outcomes.
• Self-awareness: Reflection fosters self-awareness, enabling nurses to understand their biases, emotions and reactions to various situations. This self-awareness is crucial for developing empathy and providing patient-centered care .

Understanding Reflection in Nursing

What is reflection, different types of reflection.

• Reflective Practice: Involves routinely thinking about one’s work experiences to understand and improve upon them. It is an ongoing process of self-assessment.
• Critical Reflection: Entails a deeper level of analysis , where the nurse questions and examines the underlying assumptions and values that influence their actions and decisions. This type often involves questioning the status quo and considering alternative perspectives and actions.

Theoretical Frameworks

• Gibbs’ Reflective Cycle: This model consists of six stages: Description, Feelings, Evaluation, Analysis, Conclusion, and Action Plan. It provides a structured approach for reflection, encouraging comprehensive analysis from different angles.
• Kolb’s Experiential Learning Theory: This theory emphasizes the process of learning through experience. It involves a four-stage cycle: Concrete Experience, Reflective Observation, Abstract Conceptualization, and Active Experimentation. This framework helps nurses understand how their experiences lead to learning and change in practice .

Benefits of Reflection for Nurses

Enhancing professional growth.

Reflection allows nurses to critically evaluate their practice, leading to personal and professional growth. It helps in identifying strengths and areas for improvement, fostering a commitment to lifelong learning.

Improving Patient Care

Through reflection, nurses can analyze their patient care practices, identify successful strategies, and recognize areas needing improvement. This continuous evaluation leads to better patient outcomes and enhanced quality of care.

Increasing Self-awareness

Reflection promotes self-awareness by encouraging nurses to examine their thoughts, feelings, and actions. This increased self-awareness helps in managing stress , building resilience, and developing better interpersonal skills.

Preparing to Write a Nursing Reflection Paper

Identifying the purpose of the reflection, personal growth.

Reflecting on personal experiences helps nurses understand their emotions, reactions, and behaviors. This self-awareness is essential for personal growth and emotional intelligence .

Professional Development

Reflection aids in identifying learning needs and setting goals for professional development. It encourages nurses to seek further education and training to enhance their skills and knowledge.

Educational Requirements

Reflection papers are often required in nursing education to assess students’ understanding of clinical experiences and theoretical knowledge. Writing reflection papers helps students integrate theory with practice and develop critical thinking skills.

Selecting an Experience to Reflect On

Significant events.

Choose experiences that had a profound impact on your practice or learning. These could be situations where you faced ethical dilemmas , complex clinical cases, or successful patient outcomes.

Challenging Situations

Reflecting on challenging situations helps in understanding how you handled stress, conflict, or uncertainty. It also provides insights into areas for improvement.

Learning Experiences

Select experiences that contributed to your learning and professional growth. This could include new skills acquired, knowledge gained, or changes in your clinical practice .

Gathering Information

Keeping a reflective journal.

Maintaining a reflective journal allows you to document your experiences, thoughts, and feelings regularly. This practice helps in capturing details that might be forgotten later and provides a rich source of material for your reflection paper.

Collecting Evidence and Data

Gather relevant evidence and data related to your reflective experience. This could include patient records , feedback from colleagues, or personal notes. This information will support your analysis and add depth to your reflection.

Seeking Feedback from Colleagues

Discuss your experiences with colleagues and seek their feedback. Their perspectives can provide valuable insights and help you see the situation from different angles.

Structuring Your Nursing Reflection Paper

Brief overview of the reflective experience.

Provide a brief introduction to the experience you are reflecting on. Include the context, setting, and key participants involved.

Purpose of the Reflection

Explain why you chose this particular experience for reflection. What are the main objectives of your reflection? Are you focusing on personal growth, professional development , or meeting educational requirements?

Thesis Statement

Present a clear thesis statement that outlines the main points you will discuss in your reflection paper. This statement will guide the structure and focus of your paper.

Description of the Experience

Context and background.

Provide a detailed description of the context and background of the experience. Include relevant information such as the clinical setting, patient demographics , and any specific circumstances that influenced the situation.

Key Events and Actions

Describe the key events and actions that took place during the experience. Be specific and provide enough detail to give the reader a clear understanding of what happened.

Personal Role and Involvement

Explain your role and involvement in the experience. What were your responsibilities and actions? How did you interact with patients, colleagues, and other healthcare professionals ?

Analysis and Reflection

Emotional responses.

Reflect on your emotional responses to the experience. How did you feel during and after the event? What emotions were triggered, and how did you manage them?

Cognitive Responses

Analyze your cognitive responses, including your thoughts, perceptions, and decision-making processes. How did you assess the situation? What were your critical thinking and problem-solving strategies?

Linking Theory to Practice

Connect your experience to relevant theoretical frameworks and concepts. How did your knowledge of nursing theories and principles influence your actions and decisions? How can you apply these theories to improve your practice?

Critical Analysis of the Situation

Critically analyze the situation, considering different perspectives and alternative actions. What went well, and what could have been done differently? What lessons did you learn from this experience?

Summary of Key Insights

Summarize the key insights and learning points from your reflection. Highlight the main takeaways and how they will influence your future practice.

Implications for Future Practice

Discuss the implications of your reflection for your future practice. How will you apply the lessons learned to improve your clinical skills and patient care ?

Personal and Professional Growth

Reflect on how the experience and your reflection on it have contributed to your personal and professional growth. What new skills, knowledge, or attitudes have you developed?

Nursing Reflection Paper Writing Tips and Techniques

Maintaining confidentiality and professionalism, anonymizing patient information.

Ensure that patient confidentiality is maintained by anonymizing patient information. Use pseudonyms or general descriptions to protect patient identities.

Ethical Considerations

Adhere to ethical guidelines and professional standards when writing your reflection paper. Be honest and respectful in your reflections, avoiding any biased or judgmental language.

Writing in the First Person

Emphasizing personal experience.

Use the first person to emphasize your personal experiences and reflections. This makes your paper more engaging and authentic.

Using Clear and Concise Language

Write in clear, concise language, avoiding jargon and complex terms. Aim for clarity and simplicity to ensure your reflections are easily understood.

Incorporating Evidence and Examples

Using real-life scenarios.

Use real-life scenarios to illustrate your reflections. Provide specific examples from your practice to support your analysis and insights.

Integrating Academic References

Support your reflections with academic references and evidence from nursing literature. This adds credibility to your paper and demonstrates your engagement with current research and theories.

Common Challenges and How to Overcome Them

Overcoming writer’s block.

To overcome writer’s block, start by free-writing your thoughts and feelings about the experience. Don’t worry about structure or grammar initially; just get your ideas down on paper. You can refine and organize them later.

Balancing Emotional and Objective Analysis

Strive to balance your emotional responses with objective analysis. While it’s important to acknowledge your emotions, also critically evaluate the situation using evidence and theoretical frameworks .

Ensuring Depth of Reflection

Avoid superficial reflections by delving deeper into your experiences. Ask yourself probing questions and consider different perspectives to enhance the depth of your reflection.

Managing Time Effectively

Set aside dedicated time for reflection and writing. Break the task into manageable sections and set deadlines for each part to ensure timely completion.

Example of a Nursing Reflection Paper on a Critical Incident in Nursing Practice

Reflecting on my experiences in nursing practice is essential for my professional development and personal growth. This reflection focuses on a critical incident that occurred during my clinical rotation in the emergency department. I will use Gibbs’ Reflective Cycle to structure this reflection, providing a comprehensive analysis of the incident, my responses, and the lessons learned.

Description

During a busy shift in the emergency department, a middle-aged man was admitted with severe chest pain. He was diaphoretic and experiencing shortness of breath. As part of the triage team, I was responsible for taking his vital signs, obtaining a medical history, and starting the initial assessment. While performing these tasks, I noticed that his condition was deteriorating rapidly. His blood pressure was dropping, and he became increasingly unresponsive.

At the time, I felt a mixture of anxiety and urgency. The patient’s critical condition was overwhelming, and I was worried about making mistakes that could affect his care. I also felt a strong sense of responsibility and the pressure to act quickly. Despite my nervousness, I tried to stay focused and calm to provide the best care possible.

The initial assessment and rapid response were successful in stabilizing the patient temporarily. However, I realized that I could have been more efficient in communicating the patient’s condition to the attending physician. Although I followed the protocol, I hesitated briefly when reporting the patient’s symptoms, which could have delayed the intervention. On the positive side, my ability to perform under pressure and my knowledge of emergency procedures were strengths that contributed to the patient’s stabilization.

This incident highlighted the importance of effective communication and swift action in emergency situations. My brief hesitation underscored the need for confidence and clarity when conveying critical information. The experience also emphasized the value of teamwork and the role of each team member in ensuring patient safety . I recognized that my initial anxiety could have been mitigated with better preparation and experience.

Reflecting on this incident, I have learned that preparation, confidence, and effective communication are vital in emergency nursing . I realized the importance of continuous learning and simulation training to improve my skills and response times. Moreover, I understood the need to trust my instincts and training when faced with critical situations.

Action Plan

To improve my future practice, I plan to engage in regular simulation training to enhance my response to emergency scenarios. I will also focus on developing my communication skills, particularly in high-pressure situations. Additionally, I will seek feedback from colleagues and mentors to identify areas for improvement and gain insights into effective emergency care strategies.

Writing a nursing reflection paper involves critically analyzing your experiences to gain insights and improve your practice. It requires a structured approach, using reflective frameworks and supporting your reflections with evidence.Engage regularly in reflective practice to continuously learn and grow as a nurse. Reflection not only enhances your professional skills but also contributes to better patient care and personal fulfillment.

If you need assistance with writing your nursing reflection paper, consider seeking help from our academic writing services . Our team of professional writers will craft a reflection that meets academic standards and effectively communicates your experience.

• What is the purpose of a nursing reflection paper? The purpose of a nursing reflection paper is to analyze and reflect on personal clinical experiences, evaluate one’s actions and decisions, and identify areas for improvement to enhance both personal and professional growth.
• How do I choose the right experience to reflect on? Select an experience that was significant, challenging, or particularly educational, as these will provide the most insight into your clinical practice and personal development.
• How can I ensure my reflection paper is comprehensive? Use a structured reflective framework, such as Gibbs’ Reflective Cycle or Kolb’s Experiential Learning Theory, and provide detailed descriptions, emotional responses, critical analysis , and action plans for improvement.
• What are some common challenges in writing a reflection paper and how can I overcome them? Common challenges include writer’s block, balancing emotional and objective analysis, and ensuring depth. Overcome these by starting with free writing, focusing on both emotional insights and objective facts, and setting aside specific times for writing and reflection.

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Superficial

Superficial (= descriptive reflection)   non-reflectors

Reflection at this level is very basic – some would say it is not reflection at all, as it is largely descriptive! However the description should not just be of what happened but should include a description of why those things happened. Reflection at a superficial level makes reference to an existing knowledge base, including differing theories but does not make any comment or critique of them.

Example - Superficial reflection

Today I spent time with James (client) and his family on the ward. The family had a lot of questions about the rehabilitation process and wanted to know what was going to happen for James.

I wanted to reassure them that things were OK because I knew this was what they needed to know. I said that while it was difficult for anyone to know the rate of James’ improvement I could be sure that he would improve and that it was important for the family to keep hopeful about his future.

James’ father became angry and after raising his voice at me, telling me I was a “patronising little fool”, he stormed out of the room. James mother sat weeping beside his bed and I felt I had really stuffed things up for this family. I need to get some advice about how to handle angry families.

Medium (= dialogic reflection) reflectors At this level of reflection, the person takes a step back from what has happened and starts to explore thoughts, feelings, assumptions and gaps in knowledge as part of the problem solving process. The reflector makes sense of what has been learnt from the experience and what future action might need to take place.

Example - Medium reflection

Today I spent time with James (client) and his family on the ward. The family had a lot of questions about the rehabilitation process and wanted to know what was going to happen for James. I wanted to reassure them that things were OK because I remembered from a uni lecture by a carer that carers needed reassurance, information and hope for the future of the person they cared for. I said that while it was difficult for anyone to know the rate of James’ improvement I could be sure that he would improve and that it was important for the family to keep hopeful about his future.

James’ father became angry and after raising his voice at me, telling me I was a “patronising little fool”, he stormed out of the room. James mother sat weeping beside his bed. I felt confused and like I had done the wrong thing. I remembered from the same lecture about the emotional rollercoaster of caring for someone after a brain injury and how families could experience a range of emotional responses as they adjusted to their new reality.

I started thinking about what was happening in this family and how James’ parents were both clearly distressed and may have been having difficulty supporting each other due to their own distress. James’ father’s abuse of me was possibly not a fair reflection on me but said a lot about how he was feeling.

I decided to ask James’ mother how things were going for the family and she started to open up about how she felt. She revealed that James’ accident had opened up longstanding conflict between her and her husband, and that she didn’t feel hopeful about anything. It seemed like a useful conversation.

Deep (= critical reflection) critical reflectors

This level of reflection has the most depth. This level of reflection shows that the experience has created a change in the person – his/her views of self, relationships, community of practice, society and so on. To do so, the writer needs to be aware of the relevance of multiple perspectives from contexts beyond the chosen incident – and how the learning from the chosen incident will impact on other situations.

For some critical reflective writing tasks it is expected that your writing will incorporate references to the literature - see  Example - Deep reflection incorporating the literature below. Note that these are short excerpts from longer documents previously submitted for assessments (Permission granted by author).

Example - Deep reflection

I started thinking about what was happening in this family and how James’ parents were both clearly distressed and may have been having difficulty supporting each other due to their own distress. James’ father’s abuse of me was possibly not a fair reflection on me but said a lot about how he was feeling. I wondered about his parent’s differing emotional responses and tried to put myself “in their shoes” to consider what it must be like for them. I could see that their questions and behaviours were driven by their extreme emotional states. They both needed an outlet for their emotions.

I also thought about what James needed from his parents to optimise his participation in the rehabilitation program and how I could support them to provide that. I knew I didn’t have the skills or confidence to provide the grief counselling they probably needed but I thought I could provide them with some space to share and acknowledge their grief and to suggest options for them to get further assistance in this area. I sat by his mother and said “This is really hard for you all isn’t it”. She responded with “so hard” and cried some more. We sat without talking for a while and when she was calmer I said “a lot of families find it helpful to talk with our social workers about how they are feeling when things like this have happened”. She agreed it would be good to talk and I helped her organise an appointment for the next day.

From the experience today I have learned that families don’t need superficial reassurance and that this can be perceived as patronising. It will be more helpful if I can acknowledge their emotional distress and fears and reassure them that their response – whatever it is – is normal and expected. If I show that I can cope with their distress I can assist them to get the support they need and this will be critical in getting the best outcome for clients like James.

Example - Deep reflection incorporating the literature

NOTE: These short excerpts are from longer documents previously submitted for assessments (Permission granted by authors). Also note the format of the in-text citations reflect this.

I needed to understand more about what resilience actually is, and whether it is learnable or inherent in a person’s personality.  McDonald, Jackson, Wilkes, & Vickers, (2013) define resilience as the capacity to deal with “significant disruption, change or adversity” (p.134) and that in the workplace, adversity relates to the difficult or challenging aspects of the role. The authors identify traits associated with resilience such as “hardiness, hope, self-confidence, resourcefulness, optimism flexibility and emotional intelligence” (McDonald et al., p.134) and discuss how training programs have been established within the workplace to teach people these skills.

A plan for building resilience for my future role as a midwife would need to start now in order that positive patterns are embedded in my practice and everyday life. This would include activities discussed above as well as attempting to engage in habits of mindfulness on a day to day basis (Foureur, Besley, Burton, Yu, & Crisp, 2013).

Foureur, M., Besley, K., Burton, G., Yu, N., & Crisp, J. (2013). Enhancing the resilience of nurses and midwives: Pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemporary Nurse: A Journal for the Australian Nursing Profession , 45 (1), 114-125.

McDonald, G., Jackson, D., Wilkes, L., & Vickers, M. (2013). Personal resilience in nurses and midwives: Effects of a work-based educational intervention. Contemporary Nurse: A Journal for the Australian Nursing Profession , 45 (1), 134-143.

It is vital to ensure a healthy work-life balance (Pelvin, 2010). Imbalances in professional and personal life can cause burnout (Fereday & Oster, 2010). Burnout increases with the incidence of family-work conflict (Jordan et al., 2013). Non work-related interests help reduce the risk of burnout; exercising, resting, leisure-time and self-pacing all assist in managing stress (Jordan et al., 2013; Mollart et al., 2013). Self-awareness and mindfulness positively affect our personal relationships and make valuable contributions to the professional workplace (van der Riet et al., 2015). Mindfulness also enables midwives to be totally present with women and their families (White, 2013). Keeping an up-to-date family diary has assisted in planning and pacing my study, work, personal and social activities.

Fereday, J., & Oster, C. (2010). Managing a work–life balance: The experiences of midwives working in a group practice setting.  Midwifery, 26 (3), 311-318.

Jordan, K., Fenwick, J., Slavin, V., Sidebotham, M., & Gamble, J. (2013). Level of burnout in a small population of Australian midwives.  Women and Birth , 26 (2), 125-132.

Mollart, L., Skinner, V. M., Newing, C., & Foureur, M. (2013). Factors that may influence midwives work-related stress and burnout.  Women and  Birth , 26 , 26-32.

Pelvin, B. (2010). Life skills for midwifery practice. In S. Pairman, S. Tracy, C. Thorogood & J. Pincombe (Eds), Midwifery: Preparation for practice (2 nd ed.). (pp. 298-312). Chatswood, NSW: Elselvier Australia.

van der Riet, P., Rossiter, R., Kirby, D., Dluzewska, T., & Harmon, C. (2015). Piloting a stress management and mindfulness program for undergraduate nursing students: Student feedback and lessons learned.  Nurse Education Today , 35 , 44-49.

White, L. (2013). Mindfulness in nursing: An evolutionary concept analysis. J ournal of Advanced Nursing , 70 (2), 282-294.

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Reflective journal writing: how can it help?

Discover the benefits of writing down your thoughts and how to get started

Reflective journal writing is a way of documenting what you’re thinking and feeling in the moment, and can be a useful tool to help manage stress and anxiety.

Dr Christopher Westoby, author of The Fear Talking: The True Story of a Young Man and Anxiety, is a strong believer in the power of stories to educate, improve understanding and benefit the wellbeing of the storyteller.

We spoke to Chris about the benefits of writing for your mental wellbeing.

Can reflective writing help nursing staff?

Absolutely. Regardless of your background, and wherever you work, everyone has this universal need to reflect upon their own experiences and one of the best tools we have for that is writing. It is similar to the process of opening the windows to a room and letting some air in.

Everyone has this universal need to reflect upon their own experiences 

We all have so many thoughts and memories whirling round our head at any given time – especially in the current climate. Sometimes the cloud of everything happening at once can be more overwhelming than any one event itself. Reflective journal writing can help with that.

How does it help?

We often struggle to come to terms with whatever it is we’ve been through unless we take a second and address these things head on. And while it may not always be an easy thing to do – or a quick fix – by writing what’s going on internally, what you’re doing is externalising something that has been haunting you or playing on your mind. Once it’s out there on the page, it’s like you can lay it to rest. 

You also now have a choice on what you want to do with it. Are you going to delete it or keep it for yourself? Are you going to let someone else read it? As you make those decisions, you’re taking control of your emotions and the clouds may start to clear.

So, what are the benefits?

The sense of control over your own experiences can be empowering and help relieve any stress or anxiety you’re experiencing. You’ve let it be acknowledged that what you’re feeling is something, it’s being validated and now it’s written down, it may no longer feel quite so insurmountable.

Any tips to get started?

My first tip is to use whatever format works best for you – whatever it is that will help get you in the habit of doing it. Don’t use handwriting if you’d rather type, and vice versa. 

I’ve worked with students before who have talked about using voice memos. They’ve just hit record and then they either deleted it or transcribed it depending on what they’ve found most beneficial. 

My second tip is to think of prompts. Maybe ask yourself questions to help get you started – what am I grateful for? What have I found difficult? Perhaps focus on one part of the day – how did I feel after my shift? On the way to work? Going to bed?

Finally, think about setting yourself some restrictions. Try setting a timer on your phone and then keep writing until it goes off. The more restrictions you set, the less daunting writing can be. You might actually find yourself more inspired.

How often should I write?

It’s a good thing to try and do every day – even if it’s only a few sentences – for as long as you find it useful. I’d suggest giving it a go for two weeks and see how you’re finding it.

What if I find it hard writing about myself?

If it seems too difficult writing about yourself, try writing about someone else or something you observed today – perhaps something you noticed on your journey home or through your window. If you write about something else, you will inevitably find yourself beginning to include elements of yourself. 

If you’re finding it too emotionally draining to revisit certain memories, remember this writing is your property – you can change what you need to, you can change the details and you can just talk about a small part of it. The key is to remember that you’re in control and it’s up to you how you document it.

The key is to remember you're in control

There are fewer ways to offload to one another at the moment, to distract ourselves and to blow off steam, so even if journal writing doesn’t work for you, it’s worth a try.

The benefits might surprise you.

About Chris

Chris is Programme Director of the Hull Creative Writing MA (Online). His book The Fear Talking: The True Story of a Young Man and Anxiety was published in December 2020. He led the RCN’s workshop “Time to Write for Yourself” last year.

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Reflective Practice in Nursing: A Guide to Improving Patient Care

Reflective Practice in Nursing: A Guide to Improving Patient Care -Reflective practice is an important aspect of nursing that involves the critical analysis of one’s own experiences and actions to improve nursing practice. It is a process of self-reflection and self-evaluation that can lead to personal and professional growth. This article will explore the concept of reflective practice in nursing, its importance in nursing practice, and the strategies and tools that can be used to facilitate reflective practice.

Table of Contents

Understanding Reflective Practice

The definition and concept.

Reflective practice refers to the intentional process of evaluating one’s experiences, thoughts, and actions to gain a deeper understanding of their impact. In nursing, it’s about analyzing the why and how behind every action taken, allowing for a comprehensive assessment of one’s performance.

Historical Context

The roots of reflective practice in nursing can be traced back to the work of influential theorists like Donald Schön, who emphasized the significance of “reflection-in-action” and “reflection-on-action.” These concepts laid the foundation for integrating self-reflection into nursing practice.

Concept of Reflective Practice in Nursing

Reflective practice in nursing is a process of self-reflection and self-evaluation that involves analyzing one’s own experiences and actions to improve nursing practice. It is a way of learning from experiences, both positive and negative, to improve future practice. Reflective practice is based on the assumption that nurses can improve their practice by reflecting on their experiences and critically analyzing their own actions.

Importance of Reflective Practice in Nursing

Reflective practice is important in nursing practice for several reasons. Firstly, it helps nurses to improve their practice by identifying areas for improvement and developing strategies to address them. Secondly, it can enhance nurses’ critical thinking skills by encouraging them to analyze their own experiences and consider different perspectives. Thirdly, it can promote self-awareness and personal growth by encouraging nurses to reflect on their own values and beliefs and how they influence their practice .

There are many benefits to reflective practice in nursing. It can help nurses to:

• Improve patient care outcomes
• Develop critical thinking skills
• Enhance communication skills
• Increase self-awareness
• Promote professional growth and development
• Cope with stress and burnout

Strategies and Tools for Facilitating Reflective Practice

There are several strategies and tools that can be used to facilitate reflective practice in nursing. Some of these include:

• Journaling: Journaling is a common tool used in reflective practice. Nurses can use a journal to record their thoughts and experiences, and then reflect on them to identify areas for improvement.
• Critical Incident Analysis: Critical incident analysis involves reflecting on a specific event or experience in practice and analyzing it to identify strengths and areas for improvement.
• Reflection on Action and Reflection in Action: Reflection on action involves reflecting on past experiences and analyzing them to identify areas for improvement. Reflection in action involves reflecting on experiences as they are happening and making adjustments to practice in real time.
• Peer Reflection: Peer reflection involves discussing experiences and actions with colleagues to gain different perspectives and insights.
• Feedback: Feedback from colleagues, supervisors, and patients can be a valuable tool for reflective practice, providing insight into areas for improvement.
• Professional Development: Professional development activities, such as attending conferences and workshops, can provide opportunities for nurses to learn and reflect on their practice.

Implementing Reflective Practice

Models of reflective practice.

Several models guide nurses through the reflective process. The Gibbs’ Reflective Cycle, for instance, involves stages like description, feelings, evaluation, analysis, conclusion, and action plan. These models provide a structured framework for introspection.

Steps in the Reflective Process

• Description: Recount the situation or experience in detail.
• Feelings: Examine your emotions during the event.
• Evaluation: Assess the positives and negatives of the situation.
• Analysis: Dig deeper into the factors influencing your actions.
• Conclusion: Sum up the insights gained from reflection.
• Action Plan: Define steps for future improvements.

Example of Reflective Practice in Nursing

As a registered nurse working in a busy hospital, I recently had an experience that highlighted the importance of reflective practice in improving patient communication and overall care. This incident prompted me to consider my approach to patient interactions and how it could be refined for better outcomes.

In this particular situation, I was assigned to care for a patient who was admitted for a complex surgical procedure. The patient, Mrs. Johnson, appeared anxious and had numerous questions about the upcoming surgery. Due to the high patient load, I felt a sense of time pressure and inadvertently rushed through her questions, providing concise answers without fully addressing her concerns.

Later that day, I engaged in reflective practice, realizing that my approach might not have been the most effective way to support Mrs. Johnson during such a critical time. I used the Gibbs’ Reflective Cycle to guide my self-examination:

• Description: I recalled the interaction with Mrs. Johnson and the rushed manner in which I answered her questions.
• Feelings: I acknowledged that my actions might have contributed to her anxiety and dissatisfaction.
• Evaluation: I assessed the negative impact of my approach on patient communication and the potential consequences for her overall well-being.
• Analysis: I delved into the factors that influenced my behavior, such as time constraints and a high workload.
• Conclusion: I concluded that while these factors were present, they should not have compromised the quality of patient care and communication.
• Action Plan: I determined that in future interactions, I would allocate dedicated time to address patient concerns, ensuring they feel heard and valued.

This reflective process led me to take actionable steps to improve my patient communication skills. In subsequent interactions with Mrs. Johnson, I intentionally created a calm and attentive environment. I provided her with detailed explanations about the surgery, and potential outcomes, and addressed her concerns with empathy. I also encouraged her to ask questions and clarified any doubts she had.

The impact of this reflective practice was profound. Mrs. Johnson’s anxiety visibly decreased, and she expressed gratitude for the time I spent addressing her concerns. Her positive feedback not only boosted her confidence but also reminded me of the significant role effective communication plays in fostering trust between nurses and patients.

This experience taught me that reflective practice isn’t just a theoretical concept but a practical tool that can transform patient care. By taking the time to analyze our interactions, understand our emotions, and make conscious efforts to improve, nurses can create meaningful connections with patients and enhance their overall well-being.

Barriers to Reflective Practice

Despite the importance of reflective practice in nursing, there are several barriers that can make it difficult to implement. Some of these include:

• Time constraints: Nurses may feel that they do not have enough time to engage in reflective practice due to heavy workloads.
• Lack of support: Nurses may not receive support from colleagues or supervisors for engaging in reflective practice.
• Fear of judgment: Nurses may feel uncomfortable reflecting on their experiences and actions for fear of being judged.
• Lack of training: Nurses may not have received adequate training in reflective practice, making it difficult to engage in the process.

Reflective practice is an important aspect of nursing that can lead to personal and professional growth. It involves the critical analysis of one’s own experiences and actions to improve nursing practice. Strategies and tools for facilitating reflective practice include journaling, critical incident analysis, peer reflection, and professional development. However, there are several barriers that can make it difficult to implement reflective practice, including time constraints, lack of support, fear of judgment, and lack of training. Despite these barriers, it is important for nurses to engage in reflective practice to improve their practice and promote positive patient outcomes.

Please note that this article is for informational purposes only and should not substitute professional medical advice.

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Reflective practice in nursing: A concept analysis

Affiliation.

• 1 Western University, London, Ontario, Canada.
• PMID: 34626459
• DOI: 10.1111/2047-3095.12350

Purpose: This paper aims to clarify the concept of reflective practice in nursing by using Rodgers' evolutionary method of concept analysis.

Data sources: Literature and references on the concept of reflective practice were obtained from two databases: Scopus and Nursing and Allied health database. Peer-reviewed articles published in English language between 2011-2021 that included the terms 'reflection' and/or 'reflective practice' in the title were selected. Seminal pieces of work were also considered in this analysis. A total of 23 works were included. Most of the selected works addressed the concept of reflective practice in nursing education or nursing practice.

Data synthesis: The data analysis integrated the stages identified in Rodgers' method of concept analysis to analyze the concept of reflective practice. Analysis of selected works provided an understanding of common surrogates, antecedents, attributes, and consequences of the concept of reflective practice.

Conclusions: Reflective practice is a cognitive skill that demands conscious effort to look at a situation with an awareness of own beliefs, values, and practice enabling nurses to learn from experiences, incorporate that learning in improving patient care outcomes. It also leads to knowledge development in nursing. Considering the current circumstances of the COVID-19 pandemic, this paper identifies the need for nurses to go beyond reflection-on-action and also include reflection-in-action and reflection-for-action as part of their practice.

Implications for nursing practice: This analysis identifies the need for future nursing researchers to develop reflective models or strategies that promote reflection among nurses and nursing students before, during, and after the clinical experiences.

Keywords: Rodgers’ evolutionary concept analysis method; nursing; reflective practice.

© 2021 NANDA International, Inc.

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Through the looking glass: the rabbit hole of reflective practice

Senior Education Coordinator, Beaumont Hospital, Dublin, Ireland

View articles · Email Paul

Mary O'Neill

Honorary Research Associate, Faculty of Nursing and Midwifery, RCSI, Dublin; MSc Supervisor/Facilitator, Institute of Leadership, RCSI, Dublin

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Reflective practice is a common feature of nurse education. Indeed, the development of nursing practice is associated with being a ‘reflective practitioner’. However, how we see ourselves or interpret past events is often influenced by our own unconscious biases. While it is reasonable to hold favourable views of one's ability, biased or lack of self-insight might mean that one is actually unskilled and unaware of it. In the ambiguous clinical context where an act or omission can have potentially devastating consequences, the implications of this are significant. The questions of whether and how reflection addresses unconscious biases are relatively unexplored in the nursing literature. Given that accurate self-assessment is integral to reflective practice, this article attempts to explore the potential impact of unconscious bias on reflection. The authors conclude that while biases may limit our ability to learn from reflection, this is not a reason to dispense with reflective practice, but rather, is even more reason to critically engage with the process. Nurses of all levels must be encouraged to reflect on both their practice, and their reflection.

Reflection on, and in, practice is an integral part of nursing, with professional organisations and accrediting bodies calling for the inclusion of reflection at all levels of undergraduate, postgraduate and continuing nurse education ( Aronson, 2011 ; Coward, 2011 ; Nursing and Midwifery Board of Ireland, 2015 ; Nursing and Midwifery Council (NMC), 2018 ; Donohoe, 2019 ). Proponents of reflective practice advocate strongly for its inclusion in curricula, arguing that reflection is intrinsically aligned to intended modular and programmatic outcomes with the potential to enhance learning by enabling students to reflect on, reconcile and reconceptualise their practical experiences with theoretical instruction ( Price, 2005 ; Grealish et al, 2018 ). In addition to the coalescence of theory and practice, it is claimed that structured reflection enables the exploration of one's beliefs, emotions, and theories; thus, informing plans for future learning ( Aronson, 2011 ) and moving practitioners from a position of unconscious incompetence (novice) towards a position of unconscious competence (expert) ( Benner, 1984 ).

Indeed, it is generally accepted that the unconsciously incompetent do not know what they do not know, and that through reflection they can gain valuable insights and learning from which to improve their practice. However, research conducted by social psychologists David Dunning and Justin Kruger challenges this commonly held belief. Kruger and Dunning (1999) propose that the unconsciously incompetent are dually burdened in that, not only do they not know what they do not know, their incompetence robs them of the self-insight to realise it. Consequently, the unconsciously incompetent tend to overestimate their ability while conversely those who perform well presume that others do so too, and thus, tend to underestimate their performance ( Kruger and Dunning, 1999 ). In relation to reflective practice, this may create an ironic situation where those most likely to benefit from reflecting on their practice are also those who are least likely to be able to do so effectively ( Pennycook et al, 2017 ). As one of the prerequisites of voluntary self-improvement is actually to recognise the need for improvement in the first place ( Pennycook et al, 2017 ), this may have far-reaching implications for nursing.

In the ambiguous clinical context where act or omission can have potentially devastating consequences, there is a heavy price to pay for being unskilled and unaware of it ( Kim et al, 2015 ). Inspired by the seminal work and subsequent discussion of the Kruger and Dunning (1999) theory, this article aims to examine reflective practice in the context of cognitive bias and limited self-insight. The authors propose that a variety of cognitive biases, self-serving illusions and heuristic decision-making processes may, unbeknown to the nurse, limit their ability to reflect on, and learn from, practice. As an underexplored area in the nursing literature, this article broadly frames the issue, which it is hoped will prompt further discussion, research, analysis and, indeed, insightful reflection.

How do we ‘know’?

In the swampy lowlands of the clinical setting ( Schön, 1983 ; Rycroft-Malone et al, 2004 ), empirical (‘hard science’) ways of knowing do little to fully explain the complexity of nursing practice. Indeed, while few would argue against the delivery of patient-centred care based on the scientific method, the knowledge that informs our practice is also based on subjective previous experience, our sense impressions and our thought processes ( Kant 1781 ; Carper 1978 ). As such, our epistemology (theory of knowledge) is a product of both what, and how, we know. We attain knowledge and truth by comparing and contrasting one idea with the next, and we only come to this through exposure to different stimuli. Distinct from the empirical approach, the strength of this interpretive approach thus comes from subjective, personal ways of knowing, such as reflective practice. This reflection allows us to think about our practice, to grow, to learn and to gain an understanding of our lived experiences ( Schön, 1983 ; Benner, 1984 ; Saylor, 1990 ; Street, 1991 ).

However, the human mind is not without its weaknesses. Our memory may fail us, our interpretation of past events may be clouded, or we may be biased in how we think. Cognitive bias is a disposition to think, feel or act in a particular way based on our prior knowledge, experience and personal attributes ( Kapur, 2015 ). When these cognitive biases occur without our awareness, they become unconscious biases ( Cuellar, 2017 ). This happens for many reasons, such as in situations when there is either too much information, not enough meaning, a need to act fast or where there is uncertainty about what to remember (see http://bit.ly/31rS0fr for an interactive map). It is important to note that these mental blind spots can lead to erroneous decision-making ( Kapur, 2015 ), which ultimately limits our ability to objectively think, and reflect on, our practice.

Nonetheless, elucidating the existence and impact of cognitive bias through reflective practice may result in learner defensiveness and scepticism ( Schultz and Baker, 2017 ) as our need to maintain harmony between our attitudes and behaviour (cognitive consistency), and our need to avoid disharmony (cognitive dissonance) ( Festinger, 1957 ) drives us to view ourselves positively. Additionally, as the human mind can only process a certain amount of information at any one time (known as cognitive load), when these situations occur, we tend to revert to a ‘rule of thumb’, mental short-cut decision-making process, called heuristics. Heuristics simplify decisions and reflections by filtering information based on our prior experience and preferences. For example, when a patient receives frusemide, a heuristic decision would be to check the patient's potassium level. While it might not be possible to reduce cognitive load, or eliminate our predisposition towards mental shortcuts and cognitive biases, understanding that these exist can be useful when making decisions and reflecting on practice.

Reflective practice as a way of knowing

Reflection on, and in, action is a long-standing teaching and learning strategy in many professions ( Van Doran, 2017 ); the underlying premise being that by reflecting on what we do, we gain new insights, foster self-regulation and further develop as accountable, professional practitioners. While various professional groups tend to approach reflection from different perspectives and use different models, many of these frameworks share similar properties ( Table 1 ). Common to all models is the requirement for practitioners to think about their part in, interpretation of, and meaning attributed to experience, by situating it in the context of internal and external sources of knowledge. Indeed, Schön ( 1983 ; 1987 ) offered his model of reflection as a critique of technical rationality, arguing that the learning gained from practical experience makes a significant contribution to knowledge development. Similarly, Boud (2009) argued that, when used properly and responsibly, reflection acts as a valuable force for good in nursing practice, enabling nurses to challenge any inconsistencies between what they practise and the values and belief systems they espouse. Reflection is considered such an important learning tool that, in addition to its integration into many undergraduate and postgraduate nurse education programmes, it also forms the basis of portfolio development and is a professional requirement for qualified nurses in some jurisdictions ( NMC, 2018 ).

While accepting that reflection is an important learning tool, we must acknowledge that it has also been described as misunderstood, misinterpreted, lacking in conceptual clarity ( Kinsella, 2010 ), failing to offer a critique of technical rationality, and falling short of providing a new philosophy of nursing practice and education ( Rolfe, 2014 ). Indeed, Coward (2011) argued that reflective models are now viewed by nursing students and some nurse educators as a compulsory chore, often administered as overly structured academic assignments that restrict, rather than enrich, thinking. Such critique is far removed from the original objective of Schön and one must wonder why, and where, the practice of reflection lost its way. One potential answer to this question is that, consciously or unconsciously, we are not truly reflecting on our practice.

Biases and their potential impact on reflection

True reflection requires ‘time, effort and a willingness to question our actions, underlying beliefs and values’ ( Aronson, 2011:201 ), which may be challenging to our internal consistency. True reflection on practice also requires accurate and insightful self-assessment ( Price, 2005 ) and for those who are overconfident, unaware, or indifferent to their biases, blind spots or fallacies ( Pennycook et al. 2017 ), reflection may pose a threat. Indeed, while some people are willing to engage in deliberative thought ( Pennycook et al, 2017 ), it is more normal for humans to be biased ( Cuellar, 2017 ). These biases may result in errors in clinical judgement or errors in reflection ( Kapur, 2015 ). The psychology literature describes a wide variety of cognitive biases, all of which may impact on insightful self-reflection. It is not possible to discuss each in detail here, but as a starting point for discussion, we have selected some common biases and propose their potential impact ( Table 2 ).

Lewis Carroll's books, Through the Looking-Glass ( Carroll, 1871 ) and Alice's Adventures in Wonderland ( Carroll, 1865 ) offer a useful analogy that can be applied to the concept of reflective practice. In these books, the character Alice finds fascinating worlds both beyond the looking-glass and down the rabbit hole. These capricious worlds of curiosity and contradiction challenge Alice to question not just her surroundings, but her self. Asking: ‘Who in the world am I? Ah, that's the great puzzle!’, Alice resolves: ‘Tell me that first, and then, if I like being that person, I'll come up: if not, I'll stay down here [in the rabbit hole] till I'm somebody else’ ( Carroll, 1865 ).

Maintaining a positive self-image, an internal consistency, is a fundamental human need ( Zhang et al, 2018 ) and far from being irrational, self-serving biases are often perfectly rational ( Hedden, 2019 ). They get us out of bed in the morning, keep us motivated and make us happy ( Karpen, 2018 ). However, while there may be many psychological benefits to positively biased, but somewhat erroneous self-assessment, there are also many negatives. Although completely unbiased self-knowledge may neither be attainable nor desirable ( Karpen, 2018 ), biases become particularly problematic when they impact on our learning, because, if we cannot rely on experience to teach us about our deficits, how are we ever to gain self-insight ( Ehrlinger et al, 2008 ) or grow as truly reflective practitioners? In answer to this, the psychology literature offers helpful insights that may mitigate or eliminate biases, which will ultimately improve our judgement, self-perception and ability to accurately reflect on our practice. Important areas for consideration on how we might engage in better reflection include encouraging lifelong learning, contextualising reflection, and promoting a focus on what bias awareness and critical reflection actually means.

Encouraging lifelong learning

Continuing education and professional development in the form of both structured and informal learning can help mitigate biased self-assessment, because through learning, we begin to recognise what we do not know ( Kruger and Dunning, 1999 ). Thus, we might encourage better reflection and greater self-insight simply by encouraging lifelong learning ( Karpen, 2018 ) and critical thinking skills.

Contextualising reflection

McKinnon (2016) suggested that reflective practice is more than an inherently internal process and that it ‘extends to the environment in which reflection takes place including the learning values at work’ ( McKinnon, 2016:3 ). Therefore, how we reflect and use reflective models must be set in the context of the objective and subjective realities of the practice setting. Situating reflection as a ‘triple loop’ approach ( Argyris and Schön, 1978 ) to learning prevents an uncritical and descriptive cause-and-effect analysis of the situation and instead allows the practitioner to examine the underlying context, their assumptions and conceptual frameworks ( Aronson, 2011 ). This more sophisticated form of reflection has the potential to draw on the metaparadigms in nursing ( Fawcett, 1984 ) of person, environment, health and nursing. Indeed, the absence of such engagement with the external when reflecting could be classified as thinking without thinking, as the essence of reflection is embedded, and aims to further develop competence in, practice.

Bias awareness and a focus on critical reflection

Reflection, undertaken on its own and on our own, will not fully illuminate the extent or effect of limited self-insight, as essentially, this is a conscious and rational solution to an unconscious and intuitive problem ( Bleakley, 2000 ; Karpen, 2018 ). Indeed, as noted previously, even highlighting the existence and impact of cognitive bias may result in learner defensiveness and scepticism ( Ehrlinger et al, 2008 ; Schultz and Baker, 2017 ). Educators are challenged by this dilemma and need to operate within a pedagogical, or teaching and learning, framework that enables them to use a repertoire of skills to facilitate reflective learning. Here, Karpen (2018) offers some useful psychologically safe bias mitigation and debiasing techniques, including keeping students within the limits of self-enhancement and ensuring that reflection is undertaken both with guidance and concrete assessment criteria. Perhaps the biggest challenge, however, is in encouraging critical reflection, a concept that is not easily understood and not easily taught. The establishment of guiding questions that help directly address, or at least bring to light, our unconscious biases, may be of benefit, especially when paired with follow-up questions based on standards of critical thinking ( Table 3 ).

Final thoughts

Being aware of ones' strengths, weaknesses and areas for improvement is essential for both our professional and personal lives, and one way of gaining greater self-insight is through reflective practice. However, while reflective practice has a clear contribution to make, it is also subject to much criticism. A growing body of literature speaks of, for example, overly structured approaches that restrict thinking ( Coward, 2011 ), reflective fatigue and apathy ( Timmins and Neill, 2013 ; McKinnon, 2016 ) and a lack of tools available to educators to actually enable them to facilitate reflective learning ( Donohoe, 2019 ). Indeed, as evidenced in the literature, when incorporating reflection in their teaching, many educators have implemented exercises that produce anecdotal and descriptive narratives instead of engaging with reflection in a truly critical, radical and meaningful manner ( Aronson, 2011 ; Rolfe, 2014 ). However, perhaps this suggests that the problem is not necessarily with reflective practice itself, but rather the problem is our practice of reflection. If we do want to really rediscover the radial origins of reflection ( Rolfe, 2014 ), then we need to go beyond the two-dimensional mirror image of surface self-reflection, and enter a cognitive rabbit hole where we are challenged to critically examine who it is that we really are. One way of doing this is through the elucidation of unconscious biases where, between the two positions of the ‘comforting lies we tell ourselves', and the ‘unpleasant truths we may prefer to ignore’, we will find the liminal space of accurate, but balanced, self-assessment. This is a space where we are neither overconfident nor driven to despair, and it is one that offers self-insight and growth potential. It is a safe space where we can begin to balance our biases, rather than berating ourselves for having them ( Karpen, 2018 ), and one where we can foster fresh approaches to learning in, and from, practice.

A good way to learn more about some of the concepts discussed here is to search for online videos. These concepts might seem complex and difficult, but there are many high-quality videos freely available where you can see and hear experts explain them in an understandable way. Start by using some of the search terms listed in Box 1 .

If we, the authors of this article, were to be biased in our thinking, we might suggest that this is probably one of the most important articles written relating to reflective practice since the seminal work of Schön (IKEA effect, egocentric bias). Our inflated self-assessment would lead us to propose that the eminence of this article is testament to our experience and expertise as nurse educators (self-serving bias, above average effect); that this is an article we always knew we would write (hindsight bias); and that a wealth of evidence supports our conclusions (cherry-picking fallacy). We are sure that you would agree (illusion of transparency), but would conclude that if you do not, it is probably because you are just jealous (social comparison bias). However, regardless of what you may think, or what evidence you may have to the contrary (belief perseverance), as we have invested a lot of time into writing this, we will continue to trust that we have made a novel contribution to nursing knowledge (sunk cost effect)!

If we were to be less biased and more critically reflective, we might conclude that while this article may provoke some thought, it has not been empirically researched in a traditional sense, did not involve a systematic review of the literature, and is written by those without a background in psychology. We might determine that we only highlight concepts and information that support our premise (choice supportive bias, confirmation bias), that we focus solely on some stereotypical traits of reflective practice (representative bias), or that our past experience of reflection has affected our judgement (confabulation bias). We might realise that we have not attempted to discuss underlying motivation for biases, or that, perhaps no relationship exists between bias and reflection whatsoever (illusory correlation). Indeed, it is probable, or at least possible, that unbeknown to us, other more knowledgeable persons have already examined this link (Kruger-Dunning effect), and have already drawn similar conclusions (misattribution effect). Either way, we will reflect on both our biases and our reflection, and hope that you, the reader, do so too.

• Reflective practice is seen as an important tool for learning in nursing
• A prerequisite of voluntary self-improvement is actually recognising the need for improvement in the first place
• The Kruger-Dunning effect, and other unconscious biases, may limit our self-insight and our ability to reflect
• It may be the case that those most likely to gain from reflecting on their practice are those least likely to be able to do so
• Raising awareness of unconscious bias and overconfidence in self-assessment is important in order to optimise learning from reflective practice

CPD reflective questions

• Why is the synergy between cognitive biases and reflection on practice important?
• If reflection were to be more sophisticated, then what would it look like?
• Can you identify and reflect on a bias from Table 2 that resonates with you?
• Is there a difference between reflection on practice and our practice of reflection?