reflective writing for nursing portfolio

reflective writing for nursing portfolio

Reflective Writing in Nursing

1. Introduction

In keeping with the constructivist paradigm, learning is often viewed in terms of students constructing their own knowledge and its meaning relative to their current and past knowledge, learning experiences, and beliefs. Reflection is an important part of this construction process. Reflective practice has been identified as one of the key ways in which we can learn from our experiences. Regardless of our educational or professional level, often it is the result of experience that is our most powerful teacher; however, simply having an experience does not ensure that learning will follow. Reflection, in its simplest form, is a way of learning from our experiences: it is an assessment of where we have been and where we want to go. Articulating and sharing one’s goals and aspirations are key elements of the reflective process. By looking into a mirror and seeing the reflection, the mirror is showing us something that we already have, and the reflection is a duplication of the real image. In the same way, reflective practice is a duplication and representation of an event in its original form.

Reflective writing in nursing is an innovative learning strategy that can be used to enhance students’ critical thinking ability. It has been used effectively in teaching undergraduate nursing students and has been shown to improve critical thinking. Reflective writing is not a new idea; traditionally, it has been the foundation of learning. In the original Renaissance model of apprenticeship, master craftsmen did not teach their apprentices the skills and knowledge needed to perform their craft. Instead, they led them through a process of discovery and practice.

2. Importance of Reflective Writing in Nursing

This is an important process for student nurses because it leads them towards practice that is ‘safe, effective, and caring’ by providing them with the knowledge not just in theory but in practice and how this can be applied to patient care (Taylor, 2008). Although this is in conflict with reflection as a nurse is leveling their practice against a standard or criteria, Schutz (2007) criticizes the use of this saying that it forces the practitioner to see knowledge as a technical application when in fact all knowledge is gained through life experiences and when in a new or difficult situation a practitioner may fall back on personal experiences. Reflection allows a practitioner to analyze see how their own personal experiences and knowledge have influenced their practice. This concept of reflection and LevVett’s (2003) ROL (reflection on learning) model will be further explored in this essay.

Reflection in nursing is one of the most confusing topics to get your head around. Do you want to simply know what is reflective writing? There are many definitions of reflection, but the one a student nurse should look to is the one by Somerville and Keeling (2004). This suggests that the goal of reflection is to develop self-awareness, to look at the events and how an individual perceived them, to promote the sense of self-reality, and to understand the factors that have influenced events. This is a complex process, and Somerville and Keeling (2004) explore this further by looking at the concept of how our past experiences and knowledge affect how we interpret new experiences. All of these are important concepts for a student nurse to understand and can take a lifetime to master.

Reflective writing is an important process in nursing and can take many forms. It allows for thoughtful practice, a chance to consider patient care, and an exploration of self as a nurse. It is a process of self-enquiry looking at practice (Caldwell & Grobbel, 2013).

3. Techniques for Effective Reflective Writing

Learning from an experience is affected by the ability of an individual to utilise and process information. As nurses need to continually update and reflect on practice, it is essential that they are able to identify and articulate personal responses to situations and experiences that may have occurred several years previously. As discussed in section 1, reflection is a tool that helps an individual make sense of a situation in order to learn from it. The skill of storytelling is a powerful tool and it is recommended that nurses develop their skills in the art of narrative in order to structure their reflections. The constructive process of “How to Write and Publish a Scientific Paper” by Day and Gastel recommends writing with a delayed structure as this allows the writer to convey the significance of what has been learned. In order to do this, it is recommended that the writer uses a different coloured pen for freewriting a raw account of the situation followed by delayed writing in which the writer analyses the situation and drafts a more comprehensive piece of writing. This is an excellent way to distinguish between description and reflection and a skill learnt can easily be transferred to a practice setting using key points or summaries on scrap paper on a ward at the end of shift for a patient situation on which there is intention to reflect later. Using a personal SWOT analysis when reflecting on a particular incident is another good technique to ensure that the reflective account stays detailed, focused on the issue and balanced in its consideration of both the positive and negative aspects of that event.

4. Examples of Reflective Writing in Nursing

One of the most common models for reflection, unsurprisingly, is Rolfe et al’s (2001) which consists of a 3-stage process of description, feelings and evaluation, conclusion and action plan. The descriptive stage is a crucial first step and involves the need for the reflector to explain the experience to date. Not only may this take the form of a factual account, indicating what has happened, but it may also involve the reflector detailing what they were thinking, and what has led them to act in a certain way. While the second stage (which can be split into 2 sections concerning both expression of the good and the bad) involves the need to express honest feelings about what has happened. This can again help increase understanding of why things have occurred, and then lead to improved self-awareness during a similar experience at a later date. The next stages involve the need to evaluate the experience, and to make conclusions and act upon them; a cycle which is constant. Another model for reflection is Gibbs (1988) which is cyclical and follows a similar process to Rolfe et al with an additional stage of analysis of the cause of the events. Whilst Gibbs model given the relative simplicity is attractive there is evidence to suggest that Rolfe et al’s descriptive and what, so what, now what cycle is more easily learned and embraced by healthcare students (Price 2004). An area which requires further research in nursing is the use of reflective models as a means of assessing competence. While some elements of reflection such as the encouragement of self-awareness can be hard to measure, the use of Rolfe et al’s descriptive questions can largely point assessors to evidence that meets particular criteria. This approach may be particularly useful for recently qualified staff who can find it difficult to compile initial critical incidents and to reflect in a way that truly lets them understand the experience.

5. Conclusion

Reflective practice is an important aspect of nursing management, and in this essay, we discuss the importance of reflection in the nursing profession. It is important to discuss the means in which the reflection was facilitated, as this would help in bettering the future competence in professional handling of the patients. We investigated the evidence of how effective nurses’ reflective practices were after attending the NSW Wound Management Innovation Program. The reflection model used in this program was substantiated by the transformed practice and immediate success rates when thirty skin tear patients were managed over a three-month period. It was evidenced that using a reflection model to facilitate practice change was effective, and the clients’ outcomes improved due to the change in practice of the registered nurse. Given that self-reflection is not typically a desirable goal for health professionals, it is interesting to note the nurses’ enthusiasm for the reflective discussions. The nurses involved in the study had a desire for practice development, job satisfaction, and maintenance of their professional competence. They recognized a need to change their wound management practices and believed that the reflection model was an opportunity for developing a strategic change in practice. The nurses displayed no enthusiasm for recording personal feelings or making an artistic or creative expression of their experiences. This is consistent with the identified characteristics of successful nurses, who are described as having an ability to think critically, creatively, and possessing a high level of theoretical knowledge.