reflective writing in nursing education

reflective writing in nursing education

The Importance of Reflective Writing in Nursing Education

1. Introduction

The need for nursing education in the twenty-first century has never been as great or the need for nurses as professionals. According to Wieck, Dols, and Landrum (2002), the nursing shortage has moved nursing education and nursing schools to the forefront like nothing else. Ways to enhance the education of student nurses are more important now than they have ever been in the past. According to Blais and Hayes, there are three forces that are making the relationship between education and practice more visible. These forces are advances in science and technology, societal concerns, and the need to lower health care costs. Amid all of these concerns, both educators and students alike are questioning what type of education will be needed to produce the type of nurse that will be able to handle the complex medical field of today. At this very time, nursing educators are searching for ways to combine theory and practice to give a systematic approach to learning for students that will produce a scientifically based professional nurse. Reflective writing is one way for them to do this. It is commonly known that when students of any discipline use writing as a tool for learning, they are able to use their critical thinking skills to combine theory and practice. Through reflective writing, students are able to organize their thoughts in a systematic and thorough way. Reflective writing is defined as a method of “analyzing an experience with the aim of learning from it” (Fisher, 2001). This is what nurses do on a day-to-day basis, and it helps them think about their thinking and a practice knowledge key to quality patient care. Reflective writing is a skill which will enable more nurses to take the “clinical inquiry” that is they question an aspect of practice in order to develop new knowledge and solutions which is essential if nursing is to progress as a professional discipline.

2. Benefits of Reflective Writing in Nursing Education

Reflective writing also acts as a great resource for reference in the future. In the fast-paced clinical environment, students can often forget about their experiences with patients. In the process of reflecting on an event, students are forced to actively think about a situation and make judgments based on their current knowledge. By recording these thoughts, students can easily go back to previous experiences at a later date. Jasper (2003) identifies this process as a “time for pause” and learning from thinking, improved judgment, and decision-making (p. 10). This sort of thinking is often necessary when trying to deal with patients in a clinical situation. Jasper goes on to describe her model of reflection as a “tangible record of a thinking process to act upon later.” Often in high-stress situations in the clinical environment, it will be necessary for nurses to make quick decisions. If they have had no time to think properly or insufficient preparation for such situations, they may make errors and not fully comprehend the situation. By reflecting and making a record of these thoughts at a later date, students can possibly avoid making the same mistakes in similar situations.

One of the main benefits of reflective writing is that it provides students with the opportunity to think about the patient, the problem, the solution, and how the solution affects the patient. The ability to look back on an experience and link it to learning outcomes is a very useful skill to possess. Ultimately, reflection helps people to learn more from an experience (Jasper, 2003). Jasper (2003) understood this when she said, “Reflective practice has become established as an important, and even indispensable, aspect of nursing” (p. 5). In everyday clinical encounters, there will often be unique experiences, with no clear-cut answer as to how to proceed. If a nurse is able to reflect and piece together information from previous experiences, they may be able to come to a more informed conclusion and later judge how effective that decision was.

3. Strategies for Incorporating Reflective Writing in Nursing Curriculum

The use of reflective writing typically involves the learner’s engagement in more metacognitive processes than those used in traditional clinical learning assessments. However, even in traditional care models, educators are coaching students to consider their practice and the outcome of that practice within a patient-centered framework. As most reflective writing models are based on the work of a single student, there is no evidence in the literature of attempts to use reflective writing to compare beginner with more advanced students, although this would seem feasible given the right environment and resources. Ricouer’s work, although more complex than the basic models, provides a good parallel for the process of a nursing degree, moving from data collection (or practice) to revisiting that data through recollection and re-evaluation, to a final phase of reconfiguration of the original event in an improved manner (or re-establishment of practice). These are ideal skills to be fostered in the nursing student in order to be transferred to their clinical practice. Model-based learning is largely underpinned by constructivism, and it is no surprise to find that reflective writing in the context of said model has been mostly used in the education of those working in more technical or scientific professions. Simulation is another area in which one could easily incorporate reflective writing, using the Gibbs model to guide a post-simulation debriefing exercise. Simulation has become an important teaching tool in healthcare, particularly nursing, and though evidence for its use is lacking, it is assumed that this teaching will be transferred into professional practice. Reflection on practice in this safe environment may serve to make the connections from simulated theory to real practice. Simulation can be an expensive and time-consuming exercise; however, an environment in which the years of learning can be compared in a resource-rich manner may be suitable for this on a larger scale. A study comparing written reflection from two cohorts of students who have received different methods of teaching may also be a suitable way to gauge reflective writing as a teaching method on nursing practice. Such an approach has been used to compare cohorts of students at different academic levels.

4. Challenges and Solutions in Implementing Reflective Writing

There are many potential solutions to these issues. Use of reflection models/diaries and specific reflective prompts can simplify the writing process and structure thought. Providing evidence-based information on the relevance and importance of reflective writing to nursing practices and patient outcomes can convince educators of its significance. The location and timing of reflection can be altered to better motivate students. Inclusion of reflective writing in examinations or using reflection as a feedback tool may convince students of its importance and provide additional writing practice. To avoid students feeling vulnerable or anxious about writing ability, it is important to impart that reflective writing is a subjective tool and that there is no right or wrong answer. Providing continuous feedback and creating a group culture where reflective writing is considered an important learning tool may also change student attitudes.

Motivating students to write and maintaining their initiative through the writing process is a challenge. Writing is a complex process and can lead to cognitive overload. Educators in the area may second guess the significance of reflective writing. The location and timing of reflective writing assignments can also invalidate the nature of reflective writing. Scheduling reflective writing at the end of a busy clinical day may not be successful when students are tired and may engender some students to fill out the assignment quickly in order to leave, resulting in a superficial or insincere reflection. Using reflective writing as an assessment task rather than a learning tool is another major issue. Where students do not perceive a direct link to grades, reflective writing is left ignored. Students may also feel vulnerable when sharing personal thoughts and experiences in a non-private setting, and anxiety over writing abilities may lead students to a negative attitude.

5. Conclusion

Throughout this review, key elements of reflective writing will be discussed, including the process of moving from a situation through to learning and then on to change, along with present levels of writing skills and other factors influencing the learning of reflective writing. These elements all play an important role in the capacity of a student to reflect effectively. In identifying the importance of reflective practice, it has been suggested that there is a need for students to become aware of and clarify the thinking that they already do. This, in itself, is a good reason for students to start learning how to reflect, and putting those thoughts into writing provides a concrete form of documentation of one’s thoughts to be able to revisit and evaluate at a later date. Schon (1991) has called this applying a kind of thinking that focuses on the problematic or troubling situations that are uncertain or unique, and through problem-solving comparing possible “what it is” with “what it should be”. This type of thinking is often carried out by experienced nurses, but students need to be shown how to do this, and reflective writing is an effective tool in doing this.

Writing in nursing education requires skills in communication, reflection, and learning. At the completion of nursing courses, students are able to plan the care of individuals and population groups and work as a member of the healthcare team. This is now evident in many nursing course curriculums that have integrated reflective practice as a key component that will assist in the development of this skill. Reflective writing has been identified as a key tool to develop and demonstrate reflective practice in nursing (Schon, 1991; Tanner, 2006). With the current and increasing interest in reflective practice, it is widely agreed that a core component of learning how to reflect is the use of reflective writing. This article provides a review of the literature to inform instructional strategies promoting the development of reflective practice through expressive writing within the context of nursing education.