Teaching Reflective Practice Through the Use of Reflection Papers

Submitter Information

Author: Gail Armstrong, ND, RN
Title: Assistant Professor
Institution: University of Colorado Denver College of Nursing
Email: gail.armstrong@ucdenver.edu

Competency Category(s)
Patient-Centered Care

Learner Level(s)
New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN

Learner Setting(s)

Strategy Type
Case Studies

Learning Objectives

  • Integrate understanding of multiple dimensions of patient-centered care: patient/family/community, physical comfort and emotional support.
  • Provide patient-centered care with sensitivity and respect for the diversity of human experience.
  • Value seeing health care situations “though patients’ eyes.”
  • Seek learning opportunities with patients who represent all aspects of human diversity.
  • Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds.
  • Willingly support patient-centered care for individuals and groups whose values differ from own.
  • Describe the limits and boundaries of therapeutic patient-centered care.
  • Appreciate shared decision making with empowered patients and families even when conflicts occur.

Strategy Overview

I ask the students to read two articles before class. These two citations are:
Heath, Helen. (1998). Reflection and patterns of knowing in nursing. Journal of Advanced Nursing. 27, 1054-1059.
Johns, C. (1998). Caring through a reflective lens: giving meaning to being a reflective practitioner. Nursing Inquiry. 5(1), 18-24.
This learning activity on reflective practice is most useful with a class that has a concurrent clinical rotation. I have used it very successfully with a junior Med/Surg class. The foci for the reflection papers should spring from the clinical rotation that accompanies the class.
To introduce reflective practice, I guide the students in a structured group discussion about what constitutes reflective practice in nursing, using Carper, Schön, Johns and Benner for the philosophical/theoretical foundation. This powerpoint is attached.
And then I ask the students to complete a one to two page reflection paper every week of the term (our terms are 8 weeks long). The first reflection paper has a specific focus:
Week One Reflection Paper Assignment:
Write a 1 to 2 page paper that outlines components of your ideal nursing practice. What qualities will define your ideal nursing practice? How will these ideals reveal your core motivation for entering the profession of nursing? What will your patients and their families learn about you as a person from these qualities?
From Week Two to Week Eight, I allow the students to choose their own topic for their weekly 1 to 2 page reflection papers. I use these open ended questions as possible jumping off points for their reflection:
  • Can you tell me about your top three priorities for your nursing practice? What are the barriers you are encountering in your clinical rotation to these priorities?
  • How do you describe your style of caring at the bedside?
  • Can you tell me about an experience from your clinical rotatoin that really affirmed your decision to enter nursing?
  • What was a notable experience from your clinical rotation this week? Why do you think it was an important experience for you?
  • Have you noticed similarities among those individuals that you consider positive role models? Negative role models?
  • Or please write about any other clinical experience that feels significant to you.
The most important element of this learning activity is the instructor’s weekly written response. I use these written responses as a means for an ongoing one-on-one dialogue with the individual student. The emphases of my comments are to support the student in his/her emerging reflective practice, ask more questions, spur deeper consideration of an issue/question, and provide encouragement. I refrain from “correcting” the writing. My focus is to kindle a lively written dialogue between a student and myself about topics that are of keen interest to the student. If a student experiences difficulties every week with one aspect of writing (e.g. spelling), I bring this pattern to the student’s attention and require that the student use the necessary reference material to correct these persistent errors. Similarly if a student has substantive barriers to expressing him/herself in writing, I address those concerns separately and require that the student use the University’s writing center before turning in subsequent reflection papers.
The students quickly figure out that the space created in these reflection papers is a safe space to explore a variety of clinical issues. Some threads that recur in students’ reflective writing include disillusionment with the reality of nursing, the great rewards of providing care, the struggle of working with difficult patient or families and the complexity of what comprises professional nursing practice. In the eight years that I have used this learning activity in Med/Surg I, this assignment has always been among students’ favorite part of class. Consistently students find ongoing reflection engaging and they experience the one-on-one written dialogue as a supportive component of the class.

Submitted Materials

Additional Materials

Evaluation Description

Because of the learning activity’s focus on creating space, honoring this space, and facilitating dialogue, I don’t grade each individual reflection paper. I assign 10% of the class grade to reflection papers, and if a student hands in all 8 reflection papers, then they receive all 100% for that 10% of the class grade. If a student turns in 7 of the 8 reflection papers, he/she receives 88% for that 10% of his/her class grade, etc…