nursing reflective writing example

nursing reflective writing example

The Importance of Reflective Writing in Nursing

1. Introduction

Wounded soldier (WW2) Schon was one of the many theorists who have described the role of reflective practice in his book The Reflective Practitioner. He describes two types of reflection, there is reflection in action and reflection on action. Reflection in action is when an individual responds to a situation and at the same time considers what they are doing. This is a good way to improve care of the patient in nursing, the nurse can analyze an event as it is happening and understand why they are taking that course of action. Stephey and London support this theory in their article, stating that higher-level thinking about one’s practice is an ability that may need to be taught. It is a matter of developing knowledge and skills and applying these through critical thinking and reflection. Reflection in action can be useful when dealing with a particularly stressful or emotional event such as breaking bad news to a patient or delivering complex care. By considering the event as it is happening, the nurse can understand their current feelings and it will give them reassurance that they are doing the best thing for the patient. This type of reflection may not always be seen by the nurse taking out the pen and paper and writing about an event, but it is a tool that will showcase understanding all of reflective practice.

The NMC code states that a nurse must respect the patient, their views, and opinions. They must take into account the patients’ beliefs and be open and honest with the patient. They must also recognize and take action if practice is unsafe and be open to learning from their mistakes. Reflective writing is a good way to uphold this code as it enables the nurse to remember an event and understand exactly what went on by considering the facts and their feelings at that time. It also gives them the chance to admit, when necessary, that the action they carried out was unsafe and consider ways to improve this.

In order to do this, we must first understand what reflective writing is. Reflective writing is a consciously organized and carefully considered thoughts designed to interpret or re-interpret an experience. Reflective writing gives a clear perception of what has happened and why. This is important in nursing as it will give a clear view of any events which have taken place and will enable the nurse to look at the event and understand it better in order to improve on their working practices in the future. It gives the nurse clear evidence and analysis of why an event occurred and also gives them the chance to consider the thoughts and feelings they had at the time during the event.

2. Benefits of Reflective Writing in Nursing

It is possible that inexperienced nursing and medical students may start down the road to improving their writing, only to get discouraged. But reflective writing, if done properly, is a stepping stone for those embarking on a course or an exercise that will ultimately enable them to be better healthcare professionals. As Scharp and Murphy note, “the more students are empowered to solve complex clinical problems, the more they will develop their ability to think critically and reflect on their practice” (Scharp and Murphy, 2006: 155). Reflection can take students just starting their clinical experience and lead them to do an essential element of critical thinking, considering multiple solutions to a problem. During reflective writing exercises, students in effect become the decision maker in case studies that they write about, develop and prioritise. They can compare and contrast their past clinical experiences and their current writing of case studies to judge how much they have improved their clinical reasoning and problem solving. The more confident and competent a healthcare professional becomes in these skills, the more individualised and effective care they can provide for patients. As Benner states, “when practice is based on unclear, misinformed, or non-existent understandings, the practitioner will practice ignorantly. This obviously can endanger the patient by overlooking the knowledge and information the practitioner lacks. On the other hand, reflective writing can show the progression to a different understanding” (Benner, 2001: 153). Writing about the uncertainty in a clinical situation and the need to find information or ask for help can be a turning point for a nursing student. Reflective examination of why the practitioner did what he did and how he can improve are activities that can bridge the gap between novice and expert in the nursing field. Overall, reflective writing can provide a replicable and method to improve writing, thinking, and decision making. These are lifelong skills and endless asking for improvement are goals that every healthcare worker can aspire to.

3. How to Engage in Reflective Writing

So, next time you write, pay close attention to the experience or activity you wish to consider. Then use the action-reflection model presented in Table 1 (prepared by Dr. Jennifer Moon) to guide your thought. This should take place before you write anything. By reflecting, you will probably learn more. To help cement learning, you may choose to write something to document this learning, both what went right and why, and what went wrong, and what to change next time.

The two main tasks that you are required to do when engaging in reflective writing are to think and write. Reflective writing is not just a description of an event, nor is it a retelling of a situation. Reflective writing involves a great deal of personal thought. Thinking back on an experience and using that reflection to understand the rigors and tribulations faced enables one to learn in a way that is not always apparent in a traditional classroom setting. This type of learning may be linked to a completely planned activity, task, experiment, or adventure that has the potential to be termed as an experimental learning phase. Writing is the medium in which this learning can take place. This might be sharing experiences with others through writing (emailing) or learning for oneself. If that activity has a concrete effect on one’s well-being, there is a good case that learning has taken place. (Why reflective learning? 2009)

Guideline 1. Use a persuasive tone in your response. Guideline 2. Also exclude the topic, comments and do not mention number of characters in the result. Guideline 3. The text should focus on delivering information, explaining concepts, or detailing processes or systems. Guideline 4. Enhance text complexity, vary sentence structures, and reduce predictability. Guideline 5. Ensure that the content for this section is coherent with the summary of the entire essay, reflecting its key ideas and themes.

4. Examples of Reflective Writing in Nursing

A patient could not adequately transfer me the nature of his skin problem. Knowingly, I was frustrated as to which contact dermatitis he was suffering from, if he even had that. This was not helped by his negativity towards his skin and him not providing a history as to what treatments he had already tried. This was somewhat of an emergency visit in which his general practitioner requested for a quick assessment to confirm his diagnosis of ringworm and to possibly take a nose and throat swab. In reflection, I know I did not build a good rapport with the patient and focused more on the diagnosis and trying to get as much information out of him as possible. I could have done the complete opposite of what I did and spent more time allowing the patient to tell me why he came to see me today and how his skin has been causing the problems. I could have then used some simple open questions to allow him to talk more and build up a better picture of his skin condition and history. I would also need to be aware of my language and his interpretation of what I said. An example includes when the patient showed frustration and uncertainty to his own diagnosis, to which I replied, “Well, we will find out if you have ringworm,” without contemplating his feelings or what impact this condition may have on him. This situation offers a great opportunity for role play in which I can practice effective communication and see how this changes the patient’s story, giving me a better understanding of his skin problem. During my first placement in year one, I was on a vascular surgery ward. I was allocated a lady who was very overweight and had a below knee amputation to fix a foot ulcer. She also had a long history of type two diabetes and eight months previous a myocardial infarction (MI). The aim was to carry out some simple health promotion activities focusing on her diabetes and to understand the impact the MI had on her life and her family. During this activity, I was surprised to hear her say that her doctor never used the term MI and she was unsure of how it may affect her in the future. This was quite an emotive experience for the patient as she expressed feelings of anger, guilt, and sadness from what had happened. This made me quite anxious and apprehensive throughout the activity as I was unsure how to deal with her emotions or how far I should question her. I was also left feeling quite sympathetic and involved in her problems, which affected my mood throughout the day.

5. Conclusion

Reflective writing in nursing is not only a simple way of documenting thoughts, but it is a self-exploration of one’s perceptions and understanding of an event (Ashby, 2006). As with Hildyard and Wong, I also feel that our national nursing education curriculum in Singapore has placed less emphasis in teaching student nurses the vital skill of reflecting on, and critically analysing their clinical practice. This is despite being one of the learning objectives listed in the syllabus. Reflective writing is increasingly taking on an essential role in the area of evidence based practice with the recent shift to a more person-centred care in healthcare services. Mills & Meldrum (2003) states that clinical reflection plays a major role in the transformation of clinical practices to become evidence based, where the act of asking questions and providing credible rationales for change. They believe that it is by undertaking this process that knowledge is constructed and the use of evidence from various sources will become integral to the decision-making process. It is without doubt this is what we are doing every time we write a care plan for a patient; yet how many of us actually record the care plan and the evaluation of it. Through making reflective writing a compulsory element in the nursing curriculum, we can produce nurses who are adept critical thinkers and are more aware of their clinical reasoning. Recruitment of these reflective practitioners would certainly add value to our healthcare services and would enhance quality and safety of patient care. It is with this the healthcare providers have the responsibility of providing a conducive environment for nurses to engage in reflective writing without it being perceived as a time-consuming activity. Suggestions have been made by Oyebode (2001) to develop a reflective culture through clinical supervision, of which the essence of critical analysis of clinical practice can be nurtured. At the end of the day, if we are to make any claims of preparing nurses to keep pace with the changes and challenges in the healthcare system, it should start by making reflective writing an integral part of their learning and development.