reflective practice critical care nursing

• Click here - to use the wp menu builder

• Privacy Policy
• Refund Policy
• Terms Of Service
• Nursing notes PDF
• Nursing Foundations
• Medical Surgical Nursing
• Maternal Nursing
• Pediatric Nursing
• Behavioural sciences
• BSC NURSING
• GNM NURSING
• MSC NURSING
• PC BSC NURSING
• HPSSB AND HPSSC
• Nursing Assignment

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.

Leave a Reply Cancel reply

Recent articles, lower respiratory tract-acute bronchitis, exploring 5 definitions and models of health, the advantages of electronic health records, nursing care plan for coma: comprehensive guide for effective patient support, the vital role of nurses in nutrition education: promoting health and preventing disease, uses of cheatle forceps in gynecology, download nursing notes pdf, staff nurse syllabus and exam pattern question bank -ii, study material nurse recruitment exam solved paper pdf – ii, medical surgical nursing ii notes (pdf), human anatomy introduction nursing pdf, human skeletal system nursing, mental health nursing diagnosis care plan pdf, obstetrics & gynaecology pdf notes, human nervous system nursing pdf, more like this, what is a nursing diagnosis, what is acute care: a comprehensive guide, the importance of genetics in nursing, the role and qualities of mental health and psychiatric nurses, child pediatric health nursing notes -bsc nursing, mid-wifery pdf notes for nursing students, national health programmes in india pdf, reproductive system nursing notes pdf, primary health care nursing notes pdf, psychology note nursing pdf, nursingenotes.com.

• STUDY NOTES
• SUBJECT NOTES

A Digital Platform For Nursing Study Materials

Latest Articles

Gifts for nursing home residents, gift ideas for nursing students, crystalloid and colloid: differences and when to use each, most popular.

© Nursingenotes.com | All rights reserved |

ANA Nursing Resources Hub

Search Resources Hub

Nurturing Leadership: 4 Key Strategies for Reflective Practice in Nursing

5 min read • February, 21 2024

Nursing leaders play a pivotal role in guiding change to enhance patient care and improve professional practice environments. Reflective practice stands out as a cornerstone for effective leadership, allowing nursing professionals to evaluate their experiences critically and foster continuous improvement. This article delves into four key reflective practices that can empower nursing leaders to drive meaningful change.

The Power of Reflection in Nursing Change

Reflective practice is more than a method; it's a mindset that enables nursing leaders to learn from their actions, make informed decisions, and engage their teams in the journey towards excellence. By incorporating reflective practices into their leadership approach , nurses can better navigate the complexities of healthcare, adapt to challenges, and implement strategies that align with their goals and values.

Understanding Your Change Goals

Q: What did you say you were going to do? A: Begin by revisiting your initial objectives. Clear articulation of your goals lays the foundation for accountability and sets the stage for impactful change. Reflect on the scope of the changes you envisioned and the outcomes you aimed to achieve. This honest appraisal is your first step towards meaningful progress.

Assessing Your Actions

Q: What did you actually do? A: Reality often diverges from our plans. Assessing your actions with candor enables you to identify discrepancies between your intentions and your actual practices. Acknowledge both your achievements and the areas where you fell short. This recognition is crucial for realistic self-assessment and sets the groundwork for authentic growth.

Learning from Experience

Q: What did you learn? A: Every step in the change process offers valuable lessons. Reflect on the insights gained from your experiences and how they can inform future strategies. These lessons are the silver lining, providing clarity and direction for your next moves.

Planning Your Next Steps

Q: What do you need to do next? A: Armed with new knowledge, plan your forward strategy. Consider who needs to be involved, the resources required, and the timeline for implementation. This step is about translating insights into actionable plans that drive further change.

Incorporating Reflective Practice into Your Routine

Integrating reflective practice into your leadership routine doesn't have to be daunting. Start small with regular reflection sessions, encourage team discussions that foster collective learning, and set aside time for personal and professional development. Embracing reflection as a habit can transform your leadership approach and significantly impact your team's performance and well-being.

Reflective practice is an invaluable tool for nursing leaders seeking to navigate the complexities of healthcare and drive positive change. By focusing on these four essential aspects of reflection, you can enhance your leadership effectiveness, improve patient care , and foster a culture of continuous learning and improvement . Start today by taking a moment to reflect on your practice and empower yourself and your team for the challenges and opportunities ahead.

Images sourced from Getty Images

You May Also Like

Specialty Certifications

Nurse Executive Certification (NE-BC®)

Price From: $395.00

ANA Member Price: $295.00

Nurse Executive, Advanced Certification (NEA-BC®)

Want to learn more?

Discover how ANA Consultation Services can help you maintain and improve nursing excellence by signing up for a FREE organizational assessment.

Related Resources

Item(s) added to cart

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

The PMC website is updating on October 15, 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Int J Environ Res Public Health

Development of Critical Reflection Competency Scale for Clinical Nurses

1 College of Nursing, Ewha Womans University, Seoul 03760, Korea; rk.ca.ahwe@9111jss (S.S.); moc.liamg@621emaneht (E.H.); moc.revan@1220yjd (J.D.); moc.revan@0643275sm (M.S.L.)

Eunmin Hong

Mee sun lee, youngsun jung.

2 Department of Nursing, Asan Medical Center, Seoul 05505, Korea; ten.liamnah@2076yppah

Inyoung Lee

Associated data.

The data are not publicly available due to the information contained that could compromise the privacy of research participants.

Critical reflection develops nurses’ critical thinking and clinical reasoning competency. It is necessary to develop a validated scale to measure critical reflection competency considering the clinical situation and nursing context. Therefore, this study analyzed the concept of critical reflection, developed a scale to measure critical reflection competency, and verified its validity and reliability. The concept of critical reflection and components of the scale were confirmed through literature review and results of previous studies on content analysis. A total of 64 preliminary items were derived on a 5-point Likert scale. The adequacy of vocabulary and expression was checked, and a content validity test was conducted. An I-CVI value of 0.88–1.00 was computed. Construct validity was conducted through an exploratory factor analysis, and data collected from 296 clinical nurses were analyzed. Five factors and nineteen items were derived, and the explanatory power was found to be 53.02%. Cronbach’s α of the scale was 0.853. Future studies need to develop a critical reflection education program and utilize this concept as an educational strategy. We propose a study to verify the effect of applying an educational program using the critical reflection competency scale developed in this study.

1. Introduction

Critical reflection can be used as an educational strategy that systematically integrates experiences, praxes, and theories in clinical practice [ 1 ]. It narrows the gap between theory and practice and improves professional development and nursing practice based on nurses’ experience, because it helps them critically evaluate and change their nursing practice [ 2 ]. Through critical reflection, nurses reflect on their experiences and ask the “why” question about the nursing situation, expanding their thinking and understanding the context of the situation in depth. Deep learning that connects theory and practice occurs through critical reflection, which allows nursing practice to be applied and developed in a desirable way [ 3 , 4 ]. Critical reflection helps nurses understand and judge clinical situations based on evidence and enhances their problem-solving ability [ 4 ]. It also provides insight into the clinical situation and one’s own nursing performance through metacognition, reduces the risk of errors [ 5 ], and improves communication with patients and colleagues [ 6 , 7 ]. In addition, it helps nurses deeply understand and effectively manage the negative emotions and stresses they experience at work [ 8 , 9 ]. In particular, critical reflection can be facilitated by positive feedback and can prove useful in forming positive relationships with colleagues and adjusting to work, because it is based on an open attitude [ 3 , 4 ]. As such, it is important for clinical nurses to develop critical reflection competency because it can promote their individual growth by developing nursing work competency and professionalism and have a positive effect on patient care outcomes.

However, despite the positive effects of critical reflection, studies on critical reflection in nursing remain limited. Research identifying the concept of reflection [ 10 , 11 ], exploring the level of reflective thinking as a factor in improving nursing competency, and confirming the relationship between them [ 12 ] has been focused on the concept of comprehensive reflection, which includes critical reflection. Further, there are studies confirming the positive educational effects of critical reflection, such as helping improve critical thinking and nursing practice competencies [ 4 , 13 , 14 ]. Another study reported that critical reflection using reflective journaling as an educational strategy is effective in improving critical thinking disposition and problem-solving abilities [ 15 ]. Most nursing studies primarily measured self-reflection, which resulted in the improvement of clinical competence in nursing students [ 16 ]. Furthermore, a correlation between clinical reasoning competency was confirmed [ 17 ]. In previous studies, the level of critical reflection was evaluated and analyzed based on qualitative data collected through reflection journals and interviews [ 18 , 19 ]. Rather than reflecting the clinical situation of nurses through critical reflection, the scales used measured general self-reflection or reflective thinking, such as self-reflection and insight [ 20 ], and reflective thinking [ 21 ]. These scales were developed and widely used in the fields of pedagogy, psychology, and business administration [ 20 , 21 , 22 , 23 ]. It may be generally suitable for measuring overall reflection, but it is limited in measuring critical reflection competency that reflect the specific situations of clinical nursing practice in clinical settings. Although critical reflection is widely recognized as a crucial element in individual and organizational learning in nursing education, not many instruments exist to measure critical reflection in the context of nursing care.

Critical reflection in nursing is a process that connects theory or research with practice by transforming thoughts from an existing situation to a new one and converting intuition into knowledge through an in-depth understanding of the situation [ 24 ]. Critical reflection is the highest level of reflection that includes the aspect of recognizing problem situations and finding solutions through critical thinking [ 25 ]; it is different from reflection centered on individual behavior and consciousness. However, despite these differences, many nursing studies tend to use critical reflection and reflection without distinction [ 26 ]. In addition, most reflection-related scales were mainly used for self-reflection and insight to evaluate one’s own thoughts, emotions, and actions, rather than for critical reflection [ 20 , 27 ]. As such, they were limited to a comprehensive evaluation of critical reflection. Since critical reflection can promote critical thinking and clinical reasoning competency, which are essential for nurses’ role performance, it is crucial to measure the critical reflection of clinical nurses. Up to now there has been a lack of scales to identify differences in individual capabilities of critical reflection in clinical nursing care situations. Therefore, it was necessary to develop more sensitive and specific scales to measure critical reflection competency that reflects the clinical situation and context of the specific field of nursing. In this study, we aimed to develop a scale for measuring the critical reflection competency of clinical nurses and to verify its validity and reliability.

2. Materials and Methods

2.1. study design.

This was a methodological study to develop and validate a scale to measure the critical reflection competency of clinical nurses.

2.2. Study Methods

2.2.1. scale development.

• Concept Definition and Preliminary Item Composition: The concept of critical reflection and the components of the scale were identified through a literature review related to critical reflection and the results of previous research [ 3 ] of the content analysis on critical reflection by this research team. The results of the literature review and previous research showed that critical reflection competency is a process of restructuring through connection with prior experiences by contemplating the meaning of experiences in clinical situations. It was found that the factor that promotes critical reflection is the improvement of confidence through open mindedness and positive feedback. Based on the concepts and characteristics derived in this way, a total of 64 preliminary items were constructed to measure critical reflection competency.
• Content Validity: The adequacy of vocabulary and expressions for the 64 preliminary items was checked with the advice of an expert from the National Institute of Korean Language. Content validity was conducted on the 64 items by an eight-member panel of experts, comprising of two nursing professors, and six clinical nurses with experience in critical reflection training. Its validity was evaluated using the content validity index (CVI) according to the criteria that a CVI of 0.78 or higher is appropriate in the case of 6 to 10 experts [ 28 ].
• Selection of a Response Format: The Likert scale was used as a response scale for the preliminary items. A scale with less than four categories is too small, and one with more than six is difficult to distinguish [ 29 ]. Therefore, in this study, a five-point Likert scale was used, ranging from one point (“not at all”) to five points (“strongly agree”).

2.2.2. Scale Validation

In this phase, the validity and reliability of the preliminary scale were verified to confirm the critical reflection competency scale for clinical nurses.

• Sample: The participants of this study were clinical nurses with more than one year of experience working in a medical institution, and the sample was extracted by the convenience sampling method. If the sample size required for factor analysis for construct validity verification is 200 or more, it is evaluated as stable [ 30 ]. Based on the evidence that a sample size 3 to 20 times the number of items is appropriate [ 31 ], 301 participants were required for the study, considering the dropout rate of 15% based on 256, which is a quadruple of 64 questions. A total of 298 participants responded to the survey, of which the data of 296 were used for the final analysis, as one respondent did not want to participate in the study, and another had less than one year of clinical experience.
• Measures: A preliminary scale derived through this study, a scale for critical thinking disposition [ 32 ], and a scale for clinical reasoning competence [ 33 ] were used. Critical thinking disposition is the motivation, desire, or attitude to think critically and value critical thinking [ 32 ]. The scale for critical thinking disposition is intended to measure the affective domain of critical thinking. Each subfactor had five questions on “intellectual eagerness/curiosity”, four questions on “prudence”, four items on “self-confidence”, three items on “systematicity”, four items on “intellectual fairness”, four items on “healthy skepticism”, and three items on “objectivity”, consisting of a total of 27 items, seven factors, and a five-point Likert scale. At the time of development, the Cronbach’s α was 0.84 [ 32 ], and it was 0.77 in this study. For the Korean version of the nurse clinical reasoning competence scale, the Nurse Clinical Reasoning Competence (NCRC) scale, which was developed by Liou et al. [ 34 ] and translated into Korean by Joung and Han [ 33 ], was used to verify validity and reliability. It consisted of a total of 15 items of one factor on a five-point Likert scale. The Cronbach’s α was 0.93 in the study of Joung and Han [ 33 ] and 0.81 in this study.
• Data Collection: An online survey was conducted from 13 September to 1 November 2021. The purpose and method of the study were explained to the nursing department of the institution that provided critical reflection education, and the recruitment document for participants was posted after permission was obtained to collect data. In addition, data were collected by posting recruitment documents on the online community for nurses. Recruitment documents included the purpose and method of the study, the period and procedure for participation, compensation for loss of hours during participation, and the URL of the online questionnaire. The duration of the survey was between 10 and 15 min.
• Data Analysis: Data were analyzed using SPSS/WIN Statistics 27.0, and frequency and percentage, mean and standard deviation were calculated by performing frequency analysis and descriptive statistics for the general characteristics of participants. Item analysis and exploratory factor analysis were performed to verify the construct validity of the scale. For item analysis, the corrected item-to-total correlation coefficient and the change in Cronbach’s α value when an item was deleted were analyzed. A correlation coefficient of less than 0.40 meant that the item had a low degree of discrimination [ 35 ]. Further, the sample fit of Kaiser-Meyer-Oklin (KMO) was checked and Bartlett’s sphericity test performed [ 36 ] to determine its suitability for factor analysis. As a factor estimation method, an exploratory factor analysis was performed using the principal component analysis method by varimax rotation, which is an orthogonal rotation. According to Kaiser’s rule, the eigenvalue of the sample correlation matrix was set to be 1.0 or more, and the criterion for each factor was 0.40 or more factor loading and 0.30 or more in communality [ 37 ]. Furthermore, for the criterion-related validity test of the scale, the correlation between the scale and critical thinking disposition scale and the scale and clinical reasoning competence scale were analyzed using the Pearson correlation coefficient. Critical thinking is an essential element for clinical reasoning, and the two scales can be seen as measuring attributes similar to the critical reflection competency. When the correlation coefficient between tools is calculated as r = 0.40–0.80, it can be considered that the criterion validity of the tool is secured [ 38 ]. The testing reliability of the scale and sub-factor scale was confirmed using Cronbach’s α for internal consistency reliability. In addition, reliability was calculated when items were removed, and the extent to which each item represents the concept to be measured was analyzed.

2.3. Ethical Considerations

For the ethical protection of the participants, the study was conducted after securing approval from the Institutional Review Board (IRB No. ****-202011-0005-03) of the university to which the researcher belongs. The purpose and methods of the study were explained to the participants, and a guarantee of anonymity was posted on the online survey. Written informed consent was exempted by the IRB, as participation in the survey itself was considered as consent. In addition, participants were informed that they could opt out of the survey at any time, and that data withdrawn in the middle of the survey would not be used. After the survey was completed, a mobile gift voucher was provided to the participants who agreed to the collection of their mobile phone numbers. It was explained that the archived files and completed questionnaires would be kept for three years after the end of the study, after which the documents would be discarded, and files permanently deleted in a way that they could not be restored.

3.1. General Characteristics

The general characteristics of the participants are shown in Table 1 . Of them, 95.9% were women, with the average age being 33.13 years. A total of 37.5% had more than 5 years and less than 10 years of clinical experience, with an average experience of 94.86 months. In addition, 28.7% had experienced critical reflection education, and 81.2% of such participants had used critical reflection in clinical practice.

General Characteristics ( N = 296).

3.2. Validity

3.2.1. content validity.

The item-level content validity index (I-CVI) of the preliminary items was 0.88–1.00, and none of the questions showed an I-CVI of less than 0.78. S-CVI/Ave (averaging), the average of the scale-level content validity index (S-CVI) was 0.96, which was above the standard value of 0.90. Accordingly, 64 preliminary items were derived without correction or deletion.

3.2.2. Construct Validity

Scree Plot Eigenvalues of Exploratory Factor Analysis.

Ten items showed a factor loading of 0.40 or less in all factors, and three items showed a communality of 0.30 or less. There were three items with two or less items per factor, and 11 items were deleted according to the judgment of the research team for the cross-loading items, and a total of 29 items were deleted through an iterative factor analysis process. Finally, five factors were extracted from the final 19 questions and were found to explain 53.02% of the total variance ( Table 2 ).

Items and Factor Loadings from Exploratory Factor Analysis ( N = 296).

Correlation among critical reflection competency, critical thinking disposition, and clinical reasoning competence ( N = 296).

** p < 0.01.

3.3. Reliability

The reliability, measured by Cronbach’s alpha, was 0.853 for the whole scale, with the different factors varying from 0.515–0.738 ( Table 4 ).

Number of Items and Reliability ( N = 296).

4. Discussion

This study aimed to develop a scale to measure the critical reflection competency of clinical nurses and to verify its validity and reliability. The study developed a total of 19 items with a Cronbach’s α of 0.853, ensuring internal consistency. To verify the criterion-related validity, the correlation between critical thinking disposition and clinical reasoning competence was analyzed; the results were statistically significant at 0.726 and 0.774, respectively. According to Cohen’s criteria [ 39 ], a high correlation was established, thus confirming it as a valid scale for measuring the critical reflection competency of clinical nurses. This is consistent with the results of previous studies that reflection positively effects the improvement of critical thinking disposition [ 40 , 41 , 42 ]. However, the factor for which a statistically significant correlation was not confirmed among the sub-factors of the critical thinking disposition scale was “prudence”. Based on the results of previous studies [ 3 ], critical reflection in nursing clinical education is defined as a cyclical process leading to learning that recognizes problems, reconstructs experiences and brings changes through deliberation. This is because the scale pursues changes in critical reflection and measures continuous and cyclical characteristics, rather than the aspect of prudence, which suspends judgment until sufficient evidence is secured and persistently pursues results [ 32 ].

Following factor analysis, five factors were extracted from the final 19 items in this study. However, through literature review, the concept of critical reflection was deduced as a continuous process, which involved contemplating the meaning of experiences in clinical situations and restructuring them through connection with prior experiences. In addition, as factors that promote critical reflection, the improvement of confidence through an open mind and positive feedback was identified, and items were written based on this. Therefore, this study was based on the conceptual framework that defined critical reflection as an organically combined cyclical process rather than as a step-by-step process with independent components. Furthermore, developing a single-factor scale without clearly dividing the five factors was determined to be reasonable. It is recommended that the final 19 items be used as a single-factor scale.

Among the 64 preliminary items, certain items were removed due to the low corrected item-to-total correlation coefficient in the item analysis; they included “I participate in education such as conferences and workshops to improve nursing work competency”, and “I participate in research activities for the development of nursing work performance”. These items were derived as it was deemed necessary to expand the practical problem to the research and theoretical realm. However, most nurses have little experience in conducting research [ 43 ]. There are barriers to the use of research in clinical settings, such as lack of time to participate in research or read research work, and lack of autonomy to utilize and apply the results of research [ 44 ]. As such, it is considered to be the result of reflecting the passive aspect of nurses’ participation in research for linking research with clinical practice.

In addition, among the items removed, many were related to work errors such as “I take other people’s mistakes as a cornerstone of accountability”, “I do not cover up mistakes or act defensively”, “I check whether routine nursing tasks are based on evidence”, “I propose alternatives from various perspectives on the nursing phenomenon”, and “If I have any questions during work, I do not hesitate to ask”. These items included content that raised questions about routine work, actively expressed problems, and suggested alternatives. This suggests that the cultural characteristics that emphasize standardized work and place importance on hierarchy may have influenced it. Results of previous studies suggest that among the characteristics that cause conflict in a nursing organization, the hereditary hierarchical structures that tend to force conformity also lead to giving up on solving the problem of unjust customs [ 45 , 46 ].

The critical reflection competency scale was developed based on a focus group interview [ 3 ] with nurses who received training on critical reflection and used it in the training of new nurses. The items of the scale were derived from the qualitative data of clinical nurses with in-depth understanding of the concept of critical reflection. As such, the properties of critical reflection in clinical situations were well reflected. Critical reflection in a nursing clinical situation can be said to be a way for nurses to look back on their own practical actions, derive the contextual meaning of the situation they experienced, and change it to a desirable practical direction [ 2 , 4 ]. Unlike the existing scales that focused on self-reflection [ 20 , 47 ], the critical reflection competency scale included items about nursing activities and reflection on work in clinical situations. These items included “I think about the reason for the importance of nursing care implemented in the line of duty based on evidence”, “I think deeply about what I find important about my work”, “I think about the nursing care that I will be providing before I actually provide it”, among others. In addition, the reflection-in-action aspect of reflecting on one’s work during nursing practice, and the reflection-on-action aspect of reflecting on the work performed after completing the nursing activities [ 2 ] was included. These items consisted of, “I implement nursing care while keeping its purpose in mind”, “I think specifically about the outcomes of nursing care”, ”I look back on the tasks I have carried out and identify things I did well and things I did badly”, “I look back on the nursing care that I provide based on my experiences”, and “I give meaning to nursing work and feel rewarded for it”. In addition, it is thought that the items reflecting that nurses learn based on their experiences in clinical situations and change to a desirable practical direction can measure critical reflection competency in an integrated way. These items were, “I make efforts to apply the work-related knowledge that I have learned to my nursing practice”, and “I apply what I have learned from experience to future work situation”.

Only 28.7% of the participants responded that they had received education related to critical reflection. It can thus be inferred that the education on critical reflection, which connects theory and practice based on experience, and has been confirmed as an effective educational means for developing the nursing profession [ 24 , 48 ], is not widely used. Additionally, the developed scales were for nurses with in-depth understanding of critical reflection. However, as shown in this survey, more than half the participants had no experience in critical reflection education. The limitation of this study is that it is possible that the responses were given without an in-depth understanding of critical reflection. Therefore, it is necessary for future studies to verify construct validity by conducting a confirmatory factor analysis targeting nurses who have understanding of critical reflection. Further, it is necessary to reconfirm the validity of this scale through a study that tests the difference in critical reflection competency according to the experience of critical reflection education. In addition, we propose an experimental study to provide critical reflection education and test its effectiveness. Also, most of the participants in this study were women; gender differences in critical reflection may not have been considered. Studies are needed to determine whether there are gender differences in critical reflection ability through expanding the sample size of male nurses. Lastly, since the participants of this study were nurses working in South Korea, it is necessary to validate of this scale by reflecting various cultural contexts and realities.

5. Conclusions

Clinical nurses need critical thinking ability to make accurate nursing decisions based on empirical evidence in clinical situations, and critical reflection competency to look at problems from a new perspective. Improvement of critical reflection competency can positively influence not only the individual growth of nurses but also the outcomes of patient care. Therefore, it is necessary to measure the nursing-specific critical reflection ability sensitively in nursing care situations. However, the existing scales for measuring reflection have limitations in reflecting the characteristics of clinical and nursing situations. Therefore, to develop a validated scale to measure critical reflection competency by reflecting the clinical situation and context in the nursing field, this study analyzed the concept of critical reflection in clinical nurses and developed a critical reflection competency scale. In addition, its validity and reliability were verified. The items of this scale extracted for measuring critical reflection ability in nursing care situations from the interview of nurses having experience of critical reflection. Therefore, it can measure critical reflection ability in a nursing situation more sensitively than other scales. It can be used to validate the effectiveness of nurses’ educational programs or nurses’ critical reflection competency in clinical settings. The results of this study can promote the use of critical reflection as an educational strategy for nurses and provide fundamental knowledge for the development of nursing educational programs that can further improve the quality of nursing care.

Author Contributions

Conceptualization, S.S.; methodology, E.H., I.L., J.D., Y.J., M.S.L. and S.S.; validation, E.H., I.L. and S.S.; formal analysis, E.H., I.L. and S.S.; investigation, E.H. and I.L.; writing—original draft preparation, E.H., I.L., J.D., Y.J., M.S.L. and S.S.; writing—review and editing, E.H., I.L., J.D., Y.J., M.S.L. and S.S.; visualization, E.H.; supervision, S.S.; project administration, S.S. All authors have read and agreed to the published version of the manuscript.

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2020R1F1A1057096).

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Ewha Womans University (IRB No. ewha-202011-0005-03, 4 September 2021).

Informed Consent Statement

We were confirmed by the IRB to exempt the written informed consent. If the participants clicked ‘I agree’ on the first page of the online survey and filled out the questionnaires, this was considered as consent.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Remote Access
• Save figures into PowerPoint
• Download tables as PDFs

Introduction

• Download Chapter PDF

Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy.

Download citation file:

• Search Book

Jump to a Section

Reflective practice: reimagining ourselves, reimagining nursing, changing the learning paradigm, reflective practices: emphasizing qsen, caring science, the new essentials, and diversity, equity, and inclusion.

• Full Chapter
• Supplementary Content

WAYS TO USE THIS BOOK

What's in this book, part i: the development and evolution of the nurse through reflective practice, part ii: self-reflection: building our capacity for introspection and intentional practice in academic and clinical settings, part iii: reflecting with others, part iv: reflective practice in organizations and communities, part v: regeneration and renewal.

–Sara Horton-Deutsch, PhD, RN, FAAN, ANEF, SGAHN –Gwen D. Sherwood, PhD, RN, FAAN, ANEF

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

Please Wait

• Cancer Nursing Practice
• Emergency Nurse
• Evidence-Based Nursing
• Learning Disability Practice
• Mental Health Practice
• Nurse Researcher
• Nursing Children and Young People
• Nursing Management
• Nursing Older People
• Nursing Standard
• Primary Health Care
• RCN Nursing Awards
• Nursing Live
• Nursing Careers and Job Fairs
• CPD webinars on-demand
• --> Advanced -->

• Clinical articles
• CPD articles
• CPD Quizzes
• Expert advice
• Clinical placements
• Study skills
• Clinical skills
• University life
• Person-centred care
• Career advice
• Revalidation

CLINICAL transcultural nursing Previous     Next

Using reflection in a critical care unit, catherine ganner staff nurse, cardiothoracic intensive care unit, walsgrave nhs trust hospitals, coventry.

This article describes how reflective practice can be used to ensure the best care is given to patients under difficult circumstances

Reflection is an aptitude which can be used and refined by nurses to underpin their practice. It can also help nurses develop their practice by identifying and analysing nursing events to produce an understanding that will strengthen or change actions. This enables practice to become grounded in theory, thus narrowing the theory- practice gap.

Nursing Standard . 10, 15, 23-26. doi: 10.7748/ns.10.15.23.s34

> REFLECTIVE PRACTICE - > INTENSIVE CARE - > DEATH AND DYING - > RELATIVES

User not found

Want to read more?

Already have access log in, 3-month trial offer for £5.25/month.

• Unlimited access to all 10 RCNi Journals
• RCNi Learning featuring over 175 modules to easily earn CPD time
• NMC-compliant RCNi Revalidation Portfolio to stay on track with your progress
• Personalised newsletters tailored to your interests
• A customisable dashboard with over 200 topics

Alternatively, you can purchase access to this article for the next seven days. Buy now

Are you a student? Our student subscription has content especially for you. Find out more

09 January 1996 / Vol 10 issue 15

TABLE OF CONTENTS

DIGITAL EDITION

• LATEST ISSUE
• SIGN UP FOR E-ALERT
• WRITE FOR US
• PERMISSIONS

Share article: Using reflection in a critical care unit

We use cookies on this site to enhance your user experience.

By clicking any link on this page you are giving your consent for us to set cookies.

• Open access
• Published: 16 March 2023

Effectiveness of a critical reflection competency program for clinical nurse educators: a pilot study

• Sujin Shin 1 ,
• Inyoung Lee 2 ,
• Jeonghyun Kim 3 ,
• Eunyoung Oh 4 &
• Eunmin Hong 1  

BMC Nursing volume  22 , Article number:  69 ( 2023 ) Cite this article

12k Accesses

9 Citations

Metrics details

Critical reflection is an effective learning strategy that enhances clinical nurses’ reflective practice and professionalism. Therefore, training programs for nurse educators should be implemented so that critical reflection can be applied to nursing education. This study aimed to investigate the effects of a critical reflection competency program for clinical nurse educators on improving critical thinking disposition, nursing reflection competency, and teaching efficacy.

A pilot study was conducted using a pre- and post-test control-group design. Participants were clinical nurse educators recruited using a convenience sampling method. The program was conducted once a week for 90 min, with a total of four sessions. The effectiveness of the developed program was verified by analyzing pre- and post-test results of 26 participants in the intervention group and 27 participants in the control group, respectively. The chi-square test, independent t-test, Mann-Whitney U test, and analysis of covariance with age as a covariate were conducted.

The critical thinking disposition and teaching efficacy of the intervention group improved after the program, and the differences between the control and intervention groups were statistically significant (F = 14.751, p  < 0.001; F = 11.047, p  < 0.001). There was no significant difference in the change in nursing reflection competency between the two groups (F = 2.674, p  = 0.108).

The critical reflection competency program was effective in improving the critical thinking disposition and teaching efficacy of nurse educators. Therefore, it is necessary to implement the developed program for nurse educators to effectively utilize critical reflection in nursing education.

Peer Review reports

The critical thinking of clinical nurses is essential for identifying the needs of patients and providing safe care through prompt and accurate judgment [ 1 , 2 , 3 ]. Critical thinking can be practiced through critical reflection [ 4 ], a dynamic process in which nurses reflect on their nursing behavior to improve their perspective on a situation and change future nursing practices in a desirable direction [ 5 ]. Through critical reflection, nurses grasp the contextual meaning of a situation and reconstruct their experiences to apply their learning in practice, thereby identifying the meaning of nursing [ 3 ]. In other words, critical reflection can help nurses convert their experiences into practical knowledge [ 6 ]. Thus, critical reflection may be an effective learning strategy linking theory and practice in clinical nursing education [ 7 ].

Studies have reported that critical reflection is effective in improving nurses’ reflective practices and professionalism. Teaching methods that use critical reflection can improve nurses’ knowledge, communication skills, and critical thinking abilities [ 1 , 8 , 9 ]. These methods can be effective in improving clinical judgment and problem-solving abilities by providing new nurses with opportunities to apply their theoretical knowledge in clinical practice [ 10 , 11 ]. In addition, critical reflection has positive effects on the professionalism of new graduate nurses and reduces reality shock during the transition from university to clinical practice [ 12 ]. These advantages have led to the increasing application of critical reflection in training programs for new graduate nurses, including nursing residency programs [ 13 , 14 , 15 ].

In order to facilitate new nurses’ reflective thinking and practice by clinical nurse educators, educators must be trained to strengthen their critical thinking disposition, nursing reflection, and teaching efficacy competency. Educators help new nurses adapt and develop their expertise in clinical settings [ 16 , 17 ]. Moreover, continuing education for nurses to improve their teaching competency relates to the satisfaction of learners and nurse educators, which improves the quality of clinical nursing education [ 18 ]. Therefore, opportunities for nurse educators to develop teaching competency for critical reflection in education should be provided [ 19 ] and educational support for nurse educators to improve critical reflection competency is needed.

However, although there have been studies that have evaluated the effectiveness of the educational interventions concerning critical reflection to new nurses, few studies have been conducted on educational interventions on the critical reflection competencies of clinical nurse educators in charge of educating new nurses. Therefore, this study aimed to investigate the effects of a critical reflection competency program for clinical nurse educators on improving critical thinking disposition, nursing reflection competency, and teaching efficacy.

Study design

A pilot study was conducted with a pre- and post-test control group design to investigate the effects of the critical reflection competency program on the critical thinking disposition, nursing reflection competency, and teaching efficacy of nurse educators. The conceptual framework in this study was proposed that the critical reflection competency program will improve critical thinking disposition, nursing reflection, and teaching efficacy of clinical nurse educators [Fig.  1 ].

Conceptual Framework

Participants were clinical nurse educators in hospitals who were recruited using a convenience sampling method. Nurse educators were eligible to participate if they had dedicated nursing education in a clinical setting. They dedicated to nursing education focused on staff development of current nurses, especially the education for new nurses. They also included those who completed all four sessions of the program and participated in the data collection before and after the program. A recruitment document was sent to hospitals to recruit the participants, hospitals were selected with concerning role of clinical nurse educators. Participants were recruited from two hospitals of different sizes and the number of participants differed for each hospital, and they were allocated according to the order of registration.

The sample size required for the analysis was calculated using the G* Power 3.1.9.4. program with an effect size of 0.80, a significance level of 0.05, and a power of 0.80, following the literature [ 20 ]. By applying a self-reflection program for intensive care unit nurses [ 20 ], we calculated the effect size as large. Both the intervention and control groups required 26 participants. Considering a dropout rate of 20%, a total of 63 participants, including 32 in the intervention group and 31 in the control group, were recruited. From the intervention group, six participants who participated in the pre-test and completed all programs, but did not participate in the post-test, were excluded. In the control group, four participants who participated in the pre-test but not in the post-test were excluded. Thus, 26 and 27 participants in the intervention and control groups, respectively, were included in the final analysis [Fig.  2 ]. The pre-test for both groups was conducted in May 2021. Post-tests for the two groups were performed four weeks after the pre-test.

Flowchart of the study

Intervention

The intervention was developed and delivered by the first author, who has more than 15 years of teaching experience in nursing education, including critical reflection. The intervention was conducted between May 2021 and June 2021. Following previous studies that applied critical reflection in medical education [ 21 , 22 ], the intervention was conducted once a week for 90 min, with a total of four sessions. Owing to COVID-19, real-time online sessions were used to minimize contact between participants working in medical institutions. Every week before the sessions, the contents of the session, schedule, and Uniform Resource Locator (URL) were sent to participants via e-mail.

The intervention consisted of the following three steps in four sessions: (1) understanding critical reflection, (2) strategies to use critical reflection, and (3) practical uses of critical reflection [Fig.  3 ]. Synchronous online lectures were conducted in the first and second sessions. The contents of the first session included understanding of critical reflection and the clinical judgment process through critical reflection. Based on the content of the first session, the second outlined educational strategies using critical reflection in nursing education and the direction of critical reflection. In the third and fourth sessions, clinical nurses with experience of critically reflecting on themselves were invited as guest speakers to share their experiences and facilitate online discussions. Online discussions were also conducted in real time, and feedback from guest speakers and the author was immediately provided.

Critical reflection program for clinical nurse educators

Online self-report surveys were conducted before and after the program to assess the program’s effects. In both pre- and post-tests, critical thinking disposition, nursing reflection competency, and teaching efficacy were assessed, as well as information about participants, such as gender, age, experience in nursing education, and the type of institution and the number of beds they affiliated with.

Critical thinking disposition was measured using Yoon’s Critical Thinking Disposition Scale [ 23 ]. This scale comprises 27 items: 5 on “intellectual eagerness/curiosity,” 4 on “prudence,” 4 on “self-confidence,” 3 on “systematicity,” 4 on “intellectual fairness,” 4 on “healthy skepticism,” and 3 on “objectivity.” The items were evaluated on a five-point Likert scale (one point for “strongly disagree” to five points for “strongly agree”); a higher score indicated greater critical thinking disposition. The scale has good reliability as evidenced by a Cronbach’s alpha of 0.84 at the time of the development versus the reliability of the scale in this study was Cronbach’s alpha of 0.78.

Nursing reflection competency was assessed using the Nursing-Reflection Questionnaire, developed by Lee et al. [ 24 ]. This scale comprises four factors with 15 items, including 6 items on “review and analysis nursing behavior,” 5 on “development-oriented deliberative engagement,” 2 on “objective self-awareness,” and 2 on “contemplation of behavioral change.” Each item was evaluated on a five-point Likert scale (one point for “strongly disagree” to five points for “strongly agree”), with a higher score indicating greater nursing reflection competency. The scale has good reliability as evidenced by a Cronbach’s alpha of 0.86 at the time of the development versus the reliability of the scale in this study was Cronbach’s alpha of 0.82.

Teaching efficacy was evaluated using the Teaching Efficacy Scale developed by Park and Suh [ 25 ] to evaluate clinical nursing instructors. This scale consisted of six sub-factors with 42 items, including 12 items on “student instruction,” 9 on “teaching improvement,” 7 on “application of teaching and learning,” 7 on “interpersonal relationship and communication,” 4 on “clinical judgment,” and 3 on “clinical skill instruction.” Each item was evaluated on a five-point Likert scale (one point for “strongly disagree” to five points for “strongly agree”), with a higher score indicating greater teaching efficacy. The scale has good reliability as evidenced by a Cronbach’s alpha of 0.97 at the time of the development versus the reliability of the scale in this study was Cronbach’s alpha of 0.93.

Ethical considerations

This study was approved by the Institutional Review Board (IRB) of Ewha Womans University (IRB no. ewha-202105-0022-02). The need of written informed consent was exempted by IRB of Ewha Womans University. All methods were performed in accordance with the relevant guidelines and regulations. A description of the study, including its purpose, methods, and procedures, was posted on an online pre-test survey. Only those participants who agreed to participate were allowed to complete the questionnaire. The participants were also informed that they could withdraw from the study at any time and that the data of withdrawn participants would not be included in the final analysis. After the survey was completed, a mobile gift voucher was provided to those who agreed to provide their mobile phone number. Data were collected by researchers who did not participate in the program.

Data analysis

The collected data were analyzed using SPSS for Windows (version 28.0). Non-normally distributed data were analyzed using non-parametric tests. Descriptive statistics were used to calculate the frequency, percentage, mean, and standard deviation of participants’ general and institutional characteristics. Chi-square, independent t-, and Mann-Whitney U tests were conducted to test the homogeneity of the general characteristics and pre-test scores. The Shapiro-Wilk test was conducted to test the normality of the data. To test the difference between the pre- and post-tests for each group, analysis of covariance (ANCOVA) was used. As there was a significant difference in age between the intervention and control groups, an ANCOVA with age as a covariate was conducted for the difference in changes in test scores between the pre- and post-test.

Homogeneity test of general characteristics and dependent variables

All participants were female, with a mean nursing education experience of 27 and 23 months in the intervention and control groups, respectively. The homogeneity test of general and institutional characteristics, such as gender, nursing education experience, affiliated institution types, and the number of beds, were not statistically significant. However, the age differed significantly between the two groups. In the test for homogeneity of the pre-intervention scores, there were no significant differences in critical thinking disposition, nursing reflection competency, or teaching efficacy between the two groups, suggesting homogeneity of the dependent variables between the groups [Table  1 ].

Effects of critical reflection competency program

The effects of the critical reflection competency program are shown in Table  2 .

In the post-intervention phase, scores of critical thinking disposition, nursing reflection competency, and teaching efficacy all improved compared to the pre-intervention phase, and were higher in the experimental group than in the control group. The critical thinking disposition scores before and after the intervention were 3.61 ± 0.26 vs. 3.87 ± 0.04 in the intervention group and 3.76 ± 0.21 vs. 3.77 ± 0.04 in the control group, respectively. The nursing reflection competency scores before and after the intervention were 57.00 ± 3.42 vs. 60.86 ± 0.95 in the intervention group and 59.63 ± 5.24 vs. 59.04 ± 0.89 in the control group. The teaching efficacy scores before and after the intervention were 157.04 ± 10.60 vs. 171.98 ± 2.54 in the intervention group and 161.59 ± 14.77 vs. 160.48 ± 2.46 in the control group.

Age, which was significantly different between the intervention and control groups, was treated as a covariate to conduct the ANCOVA. The changes in critical thinking disposition (F = 14.751, p  < 0.001) and teaching efficacy (F = 11.047, p  < 0.001) scores were significantly different between the two groups. However, there was no significant difference in the change in the nursing reflection competency (F = 2.674, p  = 0.108) score between the two groups.

Reflective practice is crucial to clinical nurses’ professionalism. Reflective practice enables positive learning experiences through deep and meaningful learning, and is essential for integrating theory and practice. It also enables nurses to implement what they have learned into practice, understand their expertise, and develop clinical competencies [ 26 ]. In this respect, it is important for clinical nursing educators to have critical reflection competencies and promote experiential learning among new nurses. In this study, a critical reflection competency program was developed to enhance clinical nurse educators’ critical thinking and teaching competency.

This program was effective in improving critical thinking disposition. In interventions for critical reflection, various aspects, including the introduction of critical reflection and guidelines to promote critical reflection, such as small group discussions and feedback, can be considered [ 27 ]. The program reflected these aspects and helped improve participants’ critical thinking disposition. In the third and fourth sessions, synchronous discussions on sharing experiences of critical reflection were effective. This is consistent with previous studies in which discussions improved reflective competencies [ 21 , 28 ]. Therefore, sharing experiences in the discussion section should be a key element of future educational interventions for critical reflection competency.

Furthermore, the program was effective in improving teaching efficacy. Teaching efficacy is the instructor’s belief in one’s own ability to organize and implement teaching [ 29 ], and is closely related to age, clinical experience, educational experience, professional development, and teaching competency [ 30 , 31 , 32 ]. Nurses who are more clearly aware of their roles as instructors tend to exhibit higher confidence in their teaching abilities [ 33 , 34 ]. That is, the participants in this study were clearly aware of their roles and developed confidence by sharing their educational experiences about critical reflection.

However, the program did not have a significant effect on nursing reflection competencies. In a previous study [ 10 ], reflective practitioners (RPs) received four weeks of critical reflection training and trained new nurses for six months. During training, new nurses wrote critical reflective journals and RPs provided feedback and shared their experiences. In this study, it seems that the methods and frequency of using critical reflection in nursing education varied for each participant, resulting in insignificant results for nursing reflection competency. It is necessary to provide educational materials or guidelines so that nurse educators can use critical reflection in nursing education.

In this pilot study, the program was found to be effective in improving critical thinking disposition and teaching efficacy. The results show that the program can enhance the critical thinking disposition of nurse educators and help them develop teaching competency by critically reflecting on their educational experiences as instructors [ 35 , 36 ]. Therefore, various educational programs and training systems related to critical reflection are required [ 37 ]. However, many medical institutions find it difficult to provide sufficient educational support to nurses because of limited costs, time, and physical space [ 38 ]. Online real-time lectures and case-based discussions of the developed program can be useful alternatives to overcome barriers to nursing education support. Additionally, more effective educational content and platforms using e-learning can be developed based on the results of this study.

In this study, the critical reflection competency program for clinical nurse educators was developed and conducted. The program was an educational intervention to improve the critical reflection competency of clinical nurse educators in real time online. Several limitations must be considered when interpreting the present findings. The developed program did not affect nursing reflection competencies. Further, the post-test was conducted shortly after program completion. Therefore, there may be limitations to evaluating whether the developed program improves the quality of nursing education. In addition, the participants in this study were allocated regardless of their hospital’s characteristics. Considering variables such as the size of the hospitals, the number of new nurses, and the number of participants per hospital, it is necessary to assign nurse educators the intervention and control groups and to verify the effects of the program. Future studies should consider improving the study design to measure the long-term effects of the program and randomize the participants.

The effects of the program on critical thinking disposition, nursing reflection competency, and teaching efficacy were assessed. The results showed that the program was effective in improving the critical thinking disposition and teaching efficacy of nurse educators. However, there was no significant difference in nursing reflection competency, but it may vary depending on the methods or time of using critical reflection in nursing education. Therefore, it is necessary to provide the critical reflection utilization strategies that can be used by clinical nurse educators in the clinical settings. In addition, further research, such as evaluating the reflective practice of new nurses trained by clinical nurse educators, is needed. This suggests that the critical reflection competency program should be expanded in the future for nurse educators. It is necessary to develop e-learning content and educational platforms to expand the program, and it should be possible to share the experience of critical reflection in various forms. Also, sufficient support for competency improvement of nurse educators is needed to effectively use critical reflection in nursing education. Nursing leaders in hospital and healthcare settings should recognize the importance of using critical reflection in clinical practice and improving the competency of clinical nursing educators who educate new nurses, and make efforts to improve the quality of nursing education through support for these. Lastly, based on the results of this study, we recommend further longitudinal and randomized studies to evaluate additional effects of the program.

Data availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Kim YH, Min J, Kim SH, Shin S. Effects of a work-based critical reflection program for novice nurses. BMC Med Educ. 2018;18:1–6. https://doi.org/10.1186/s12909-018-1135-0 .

Article   Google Scholar  

Alfaro-LeFevre R. Critical thinking in nursing: a practical approach. Philadelphia, PA: W.B. Saunders; 1995.

Google Scholar  

Do J, Shin S, Lee I, Jung Y, Hong E, Lee MS. Qualitative content analysis on critical reflection of clinical nurses. J Qual Res. 2021;22:86–96. https://doi.org/10.22284/qr.2021.22.86 .

Burrell LA. Integrating critical thinking strategies into nursing curricula. Teach Learn Nurs. 2014;9:53–8. https://doi.org/10.1016/j.teln.2013.12.005 .

Lee M, Jang K. Reflection-related research in korean nursing: a literature review. J Korean Acad Nurs Adm. 2019;25:83–96. https://doi.org/10.11111/jkana.2019.25.2 .

Cox K. Planning bedside teaching. Med J Aust. 1993;158:280–2. https://doi.org/10.5694/j.1326-5377.1993.tb137586.x .

Article   CAS   PubMed   Google Scholar  

Klaeson K, Berglund M, Gustavsson S. The character of nursing students’ critical reflection at the end of their education. J Nurs Educ Pract. 2017;7:55–61. https://doi.org/10.5430/jnep.v7n5p55 .

Pangh B, Jouybari L, Vakili MA, Sanagoo A, Torik A. The effect of reflection on nurse-patient communication skills in emergency medical centers. J Caring Sci. 2019;8:75–81. https://doi.org/10.15171/jcs.2019.011 .

Article   PubMed   PubMed Central   Google Scholar  

Liu K, Ball AF. Critical reflection and generativity: toward a framework of transformative teacher education for diverse learners. Rev Res Educ. 2019;43:68–105. https://doi.org/10.3102/0091732X18822806 .

Shin S, Kim SH. Experience of novice nurses participating in critical reflection program. J Qual Res. 2019;20:60–7. https://doi.org/10.22284/qr.2018.20.1.60 .

Lee M, Jang K. The significance and application of reflective practice in nursing practice. J Nurs Health Issues. 2018;23:1–8.

Monagle JL, Lasater K, Stoyles S, Dieckmann N. New graduate nurse experiences in clinical judgment: what academic and practice educators need to know. Nurs Educ Pers. 2018;39:201–7. https://doi.org/10.1097/01.NEP.0000000000000336 .

Bull R, Shearer T, Youl L, Campbell S. Enhancing graduate nurse transition: report of the evaluation of the clinical honors program. J Cont Educ Nurs. 2018;49:348–55. https://doi.org/10.3928/00220124-20180718-05 .

Cadmus E, Salmond SW, Hassler LJ, Black K, Bohnarczyk N. Creating a long-term care new nurse residency model. J Cont Educ Nurs. 2016;47:234–40. https://doi.org/10.3928/00220124-20160419-10 .

Johansson A, Berglund M, Kjellsdotter A. Clinical nursing introduction program for new graduate nurses in Sweden: study protocol for a prospective longitudinal cohort study. BMJ open. 2021;11:e042385. https://doi.org/10.1136/bmjopen-2020-042385 .

Salminen L, Minna S, Sanna K, Jouko K, Helena LK. The competence and the cooperation of nurse educators. Nurse Educ Today., 2013;33:1376–81. https://doi.org/10.1016/j.nedt.2012.09.008 .

Zlatanovic T, Havnes A, Mausethagen S. A research review of nurse teachers’ competencies. Vocations Learn. 2017;10:201 − 33. https://doi.org/10.1007/s12186-016-9169-0 .

Shinners JS, Franqueiro T. Preceptor skills and characteristics: considerations for preceptor education. J Cont Educ Nurs. 2015;46:233–6. https://doi.org/10.3928/00220124-20150420-04 .

Sheppard-Law S, Curtis S, Bancroft J, Smith W, Fernandez R. Novice clinical nurse educator’s experience of a self-directed learning, education and mentoring program: a qualitative study. Contemp Nurs. 2018;54:208–19. https://doi.org/10.1080/10376178.2018.1482222 .

Kang HJ, Bang KS. Development and evaluation of a self-reflection program for intensive care unit nurses who have experienced the death of pediatric patients. J Korean Acad Nurs. 2017;47:392-405. https://doi.org/10.4040/jkan.2017.47.3.392 .

Hayton A, Kang I, Wong R, Loo LK. Teaching medical students to reflect more deeply. Teach Learn Med. 2015;27:410-6. https://doi.org/10.1080/10401334.2015.1077124 .

Spampinato CM, Wittich CM, Beckman TJ, Cha SS, Pawlina W. Safe Harbor”: evaluation of a professionalism case discussion intervention for the gross anatomy course. Anat Sci Educ. 2014;7:191–8.

Article   PubMed   Google Scholar  

Yoon J. Development of an instrument for the measurement of critical thinking disposition: In nursing[dissertation]. Seoul: Catholic University; 2004.

Lee H. Development and psychometric evaluation of nursing-reflection questionnaire [dissertation]. Seoul: Korea University; 2020.

Park I, Suh YO. Development of teaching efficacy scale to evaluate clinical nursing instructors. Korean J Adult Nurs. 2017;30:18–29. https://doi.org/10.7475/kjan.2018.30.1.18 .

Froneman K, du Plessis E, van Graan AC. Conceptual model for nurse educators to facilitate their presence in large class groups of nursing students through reflective practices: a theory synthesis. BMC Nurs. 2022;21:317. https://doi.org/10.1186/s12912-022-01095-7 .

Uygur J, Stuart E, De Paor M, Wallace E, Duffy S, O’Shea M, Smith S, Pawlikowska T. A best evidence in medical education systematic review to determine the most effective teaching methods that develop reflection in medical students. BEME Guide No 51 Med Teach. 2019;41:3–16. https://doi.org/10.1080/0142159X.2018.1505037 .

McEvoy M, Pollack S, Dyche L, Burton W. Near-peer role modeling: can fourth-year medical students, recognized for their humanism, enhance reflection among second-year students in a physical diagnosis course? Med Educ Online. 2016;21:31940. https://doi.org/10.3402/meo.v21.31940 .

Poulou M. Personal teaching efficacy and its sources: student teachers’ perceptions. Educ Psychol. 2007;27:191–218. https://doi.org/10.1080/01443410601066693 .

Klopfer BC, Piech EM. Characteristics of effective nurse educators. Sigma Theta Tau International: Leadership Connection 2016; 2016.

Dozier AL. An investigation of nursing faculty teacher efficacy in nursing schools in Georgia. ABNF J. 2019;30:50–7.

Kim EK, Shin S. Teaching efficacy of nurses in clinical practice education: a cross-sectional study. Nurse Educ Today. 2017;54:64–8. https://doi.org/10.1016/j.nedt.2017.04.017 .

Wu XV, Chi Y, Selvam UP, Devi MK, Wang W, Chan YS, Wee FC, Zhao S, Sehgal V, Ang NKE. A clinical teaching blended learning program to enhance registered nurse preceptors’ teaching competencies: Pretest and posttest study. J Med Internet Res. 2020;22:e18604. https://doi.org/10.2196/18604 .

Larsen R, Zahner SJ. The impact of web-delivered education on preceptor role self-efficacy and knowledge in public health nurses. Public Health Nurs. 2011;28:349–56. https://doi.org/10.1111/j.1525-1446.2010.00933.x .

Armstrong DK, Asselin ME. Supporting faculty during pedagogical change through reflective teaching practice: an innovative approach. Nurs Educ Pers. 2017;38:354–7. https://doi.org/10.1097/01.NEP.0000000000000153 .

Raymond C, Profetto-McGrath J, Myrick F, Strean WB. Balancing the seen and unseen: nurse educator as role model for critical thinking. Nurse Educ Prac. 2018;31:41–7. https://doi.org/10.1016/j.nepr.2018.04.010 .

Parrish DR, Crookes K. Designing and implementing reflective practice programs–key principles and considerations. Nurse Educ Prac. 2014;14:265–70. https://doi.org/10.1016/j.nepr.2013.08.002 .

Glogowska M, Young P, Lockyer L, Moule P. How ‘blended’ is blended learning?: students’ perceptions of issues around the integration of online and face-to-face learning in a continuing professional development (CPD) health care context. Nurse Educ Today. 2011;31:887–91. https://doi.org/10.1016/j.nedt.2011.02.003 .

Download references

Acknowledgements

Not applicable.

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2020R1F1A1057096).

Author information

Authors and affiliations.

College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, 03760, Seoul, Republic of Korea

Sujin Shin & Eunmin Hong

Department of Nursing, Dongnam Health University, 50, Cheoncheon-ro 74beon-gil, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea

Inyoung Lee

College of Nursing, Catholic University of Pusan, 57 Oryundae-ro, Geumjeong-gu, 46252, Busan, Republic of Korea

Jeonghyun Kim

Department of Nursing, Nursing Administration Education Team Leader, Catholic University of Korea Bucheon ST. Mary’s Hospital, 327, Sosa-ro, 14647, Bucheon-si, Gyeonggi-do, Republic of Korea

Eunyoung Oh

You can also search for this author in PubMed   Google Scholar

Contributions

SS: Conceptualization, Methodology, Formal analysis, Investigation, Data curation, Writing – original draft, Project administration. IL: Conceptualization, Methodology, Formal analysis, Validation, Writing – review & editing. JK: Conceptualization, Methodology, Formal analysis, Validation, Writing – review & editing. EO: Data curation, Validation, Writing – review & editing. EH: Conceptualization, Methodology, Formal analysis, Investigation, Data curation, Writing – original draft, Visualization.

Corresponding author

Correspondence to Eunmin Hong .

Ethics declarations

Ethics approval and consent to participate.

This study was approved by the Institutional Review Board (IRB) of Ewha Womans University (IRB no. ewha-202105-0022-02). The need of written informed consent was exempted by IRB of Ewha Womans University. All methods were performed in accordance with the relevant guidelines and regulations.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Shin, S., Lee, I., Kim, J. et al. Effectiveness of a critical reflection competency program for clinical nurse educators: a pilot study. BMC Nurs 22 , 69 (2023). https://doi.org/10.1186/s12912-023-01236-6

Download citation

Received : 12 December 2022

Accepted : 07 March 2023

Published : 16 March 2023

DOI : https://doi.org/10.1186/s12912-023-01236-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Education professional
• Nursing education research
• Program evaluation

BMC Nursing

ISSN: 1472-6955

• General enquiries: [email protected]

•  Sign into My Research
•  Create My Research Account
• Company Website
• Our Products
• About Dissertations
• Español (España)
• Support Center

Select language

• Bahasa Indonesia
• Português (Brasil)
• Português (Portugal)

Welcome to My Research!

You may have access to the free features available through My Research. You can save searches, save documents, create alerts and more. Please log in through your library or institution to check if you have access.

Translate this article into 20 different languages!

If you log in through your library or institution you might have access to this article in multiple languages.

Get access to 20+ different citations styles

Styles include MLA, APA, Chicago and many more. This feature may be available for free if you log in through your library or institution.

Looking for a PDF of this document?

You may have access to it for free by logging in through your library or institution.

Want to save this document?

You may have access to different export options including Google Drive and Microsoft OneDrive and citation management tools like RefWorks and EasyBib. Try logging in through your library or institution to get access to these tools.

• Document 1 of 1
• More like this
• Scholarly Journal

The Importance of Reflective Practice in Nursing

No items selected.

Please select one or more items.

Select results items first to use the cite, email, save, and export options

Reflection is an essential attribute for the development of autonomous, critical, and advanced practitioners (Mantzoukas & Jasper, 2004). According to Chong (2009), "Reflective practice should be a continuous cycle in which experience and reflection on experiences are inter-related" (p. 112). Studies have shown that nurses who take the time to reflect on their daily experiences provide enhanced nursing care, have a better understanding of their actions, which in return develops their professional skills (Hansebo & Kihlgren, 2001). Reflective practice is the ability to examine ones actions and experiences with the outcome of developing their practice and enhancing clinical knowledge. Reflective practice affects all levels of nursing, from students, to advanced practice nursing students, as well as practicing nurses. Reflective practice is an important component of the nursing curriculum. Research has shown the relationship between student nurses and their mentors is vital. In order for reflection to be effective open-mindedness, courage, and a willingness to accept, and act on, criticism must be present (Bulmam, Lathlean, & Gobbi, 2012). This paper will explore the current literature and implications related to reflective practice in nursing.

Key Words: Caring, Reflection, Nursing, Reflective practice, students

Research Methods

A literature review was conducted utilizing Medline, CINAHL, EBSCO Host and Google Scholar. Search terms used included: reflective practice, reflective practice nursing care, reflective nursing, reflective practice nursing students, and reflective practice students. Additional articles were located from the reference lists of articles obtained from the database search. The search was limited to articles published in English. The time criteria for literature searched was between 2001 and 2012. The inclusion criteria included research articles regarding practicing and student nurses utilizing reflective practice. Articles detailed the outcome of using reflective practice in nursing. Exclusion criteria included articles not written in English and those that lacked of relevance to the search topic. A total of 16 articles, 15 qualitative and one quantitative, were included in the review. A complete summary of all articles that were reviewed is available in Table 1.

Following an analysis of the literature, four themes emerged: Development of Practice, Emotional Impact, Mentor Support, and Barriers in Reflection. The following will be a description of these themes and what the literature reviews.

Development of Practice

Chong (2009) conducted a quantitative study with 98 diploma nursing students to examine the students' perceptions on reflective practice and to discover if it was a useful task. Students were given a structured questionnaire having them rate their feelings towards reflective practice using a five point Likert scale. According to Chong (2009), students viewed reflective practice as playing a major role in applying theory into nursing practice. Students stated that reflective practice helped to develop their nursing practice by allowing them to view the clinical situation from different angles, identify their learning style, and improve their decision making (Chong, 2009). Students felt they developed a greater sense of responsibility and accountability in their practice (Chong, 2009).

Smith (2005) examined eight nursing students' feelings towards reflective practice and whether they believed it was a meaningful activity. A qualitative study was conducted utilizing a web discussion board and focus group interview (Smith, 2005). Findings from the study showed students considered reflection a key component in nursing because it developed their nursing skills and increased their clinical competency (Smith, 2005). As nursing students in the study participated in reflection, they noticed a change in their way of thinking; they became "more selfaware and confident with the process, they realized the benefits of reflecting on achievements and celebrating good practice" (Smith, 2005, p.35).

Bulman, Lathlean, & Gobbi (2011) studied the concept of reflection within nursing. An interpretive ethnographic approach was used to examine reflection from students' and teachers' perspectives. Students also reported reflection was responsible for, "changing and improving" their practice by shifting their thinking and actions (Bulman, Lathlean, & Gobbi, 2011, p. e9). When students are able to recognize their achievements, they become more comfortable in their role as a nurse, allowing them to provide optimal patient care (Bulman, Lathlean, & Gobbi, 2011).

Glaze (2001) explored 14 advanced nurse practitioner students (ANPs) experiences of reflection. A qualitative methodology was used to collect data by conducting interviews and using reflecting learning contracts. The researcher found all but one of the fourteen students found reflection in nursing practice positive. Students described themselves as being more aware, realistic, open and confident and also reported having an increased appreciation for nursing. Development of their nursing practice was seen as ANP students felt liberated and more politically aware from reflecting. ANP students realized it was essential to become educated politically. They realized the importance of becoming involved with the agendas of other practitioners, agencies, and organizations in order incorporate the nursing agenda and to push nursing practice (Glaze, 2001).

Gustadsson & Fagerberg (2004) examined practicing nurses' experience of reflection in relation to many daily nursing care situations. A qualitative study was conducted by interviewing four registered nurses. Gustadsson & Fagerberg (2004) discovered many advantages from reflection in the development of nursing care. Reflection is a tool used to promote courage, to meet the needs of a unique patient, and to help empower nurses (Gustadsson & Fagerberg, 2004). The experienced nurses in the study felt reflection was useful to "develop and mature professionally" (Gustadsson & Fagerberg, 2004, p. 278). Over years of practice and utilizing self reflection, the nurses found they had not only been able to learn from their achievements in nursing, but they also felt competent to educate other nurses (Gustadsson & Fagerberg, 2004). Encouraging nurses to reflect promotes professional development, which will reflect in better care for the patients (Gustadsson & Fagerberg, 2004). Cirocco (2007) also examined practicing nurses' use of reflection in practice and the outcome. Using a qualitative survey, she discovered reflective practice helps to improve nurses' practice by identifying areas of strengths and areas that need improvement (Cirocco, 2007). These studies show that reflection has the potential to enhance the development of the practice of nursing.

Emotional Impact

In a research study conducted by Rees (2012) a nursing student named Jane described how she, "absorbed her patients emotional trauma 'like a sponge, I absorb the lot'" (Rees, 2012, p.3). Reflection allowed Jane to squeeze out the sponge. Jane was able to use reflection to, "deal with the emotional challenges such as fear she frequently felt in practice" (Rees, 2012, p.3). Rees (2012) explored the role of reflective practice in 10 female final year nursing students responding to the emotional challenges of nursing. Data was collected through qualitative interviews in which the students described their feelings. The process of reflection allowed students to recognize the experience that caused them distress or uneasiness in order to gain a better understanding of their personal response, disperse the emotional load, and think deeply about what they learned about themselves and their nursing practice (Rees, 2012). It helped the nursing students discover what it means to them to be a nurse (Rees, 2012). While some students found reflection helpful in understanding themselves and their reactions to different events, others were unable to find the connection and could not make personal sense of a patient's experience. (Rees, 2012). Disembodiment is used by many nurses who do not want to suffer personally while in distressing patient situations (Rees, 2012). Reflection can be useful for students dealing with these new emotions.

O'Donovan (2006) aimed to discover mental health nursing students' perceptions of reflection while in clinicals. A qualitative study was conducted by interviewing five nursing students. The use of reflection "heightened students' awareness of their actions, thoughts, attitudes, and feelings" (O'Donovan, 2006, p. 612). Students spoke of feelings of inadequacy, anxiety, accomplishment and fear while partaking in reflective practice (O'Donovan, 2006). Other students reported that reflecting helped to, "reassure themselves that they handled the situations better than they had thought" (O'Donovan, 2006, p. 612). Exploring these feelings helps to develop more emotionally intelligent nurses.

Barry, Blum, and Purnell (2007) conducted a phenomenological study detailing the experiences of student nurses caring for individuals and families left homeless by hurricanes Katrina and Wilma. Seven first- year junior nursing students reflected on their experiences by completing a written assignment. Reflection enabled students to discuss their experiences and feelings from caring for those displaced by the tragedy. Students were urged "to look inward at core beliefs and outward to living these beliefs in practice (Barry, Blum, & Purnell, 2007, p. 72). This study showed the deep emotional impact nursing can have and how the outlet of reflection helped the students cope with their experiences. The day to day emotional impact of nursing can take a toll on nurses. Reflective practice allows nurses to have a safe outlet to discuss and better understand their feelings and practice.

Mentor Support

As reflective practice becomes more of a staple in the undergraduate nursing curriculum, nursing preceptors have a tremendous role in facilitating the learning process. Duffy (2009) conducted a qualitative descriptive study to explore the experiences of seven preceptors directing student nurses through reflective practice while in clinicals. Semi-structured interviews took place to uncover whether the preceptors felt their experiences with reflective practice affected their practice and added to the preceptorship experience (Duffy, 2009). Duffy (2009) discovered that due to preceptors' perceived lack of experience and knowledge assisting students on reflective practice, education and support are needed to facilitate the process to properly engage students. With proper support preceptors are able to guide students through reflection and in return have an enhanced understanding of the students experience, build trust, and challenge students (Duffy, 2009). It is imperative to provide continuing support to allow preceptors to fulfill their role (Duffy, 2009). According to O'Donovan (2006), students found there was a lack of awareness and lack of culture in reflecting among preceptors and nursing staff in certain clinical placements. Due to the lack of knowledge, students expressed a reluctance to bring up reflection with their preceptor (O'Donovan, 2006). In-service workshops to educate preceptors on student learning strategies, specifically reflection, would nurture the relationship between preceptors and students (O'Donovan, 2006).

The relationship between the student and their mentor is significant for proper reflection in practice. According to Smith (2005), students believed that if trust was established between themselves and their mentor, then they were able to be more honest and share reflections on a more personal level. A lack of support in clinical areas by mentors were seen by students as an obstacle in reflective practice (Chong, 2009). Manning, Cronnin, Monaghan, and Rawlings-Anderson (2008) conducted a qualitative study with nursing students to determine whether reflective groups were an effective means of support for students. Students reported the skills of the preceptor were paramount to the success of the groups (Manning, Cronnin, Monaghan, & Rawlings-Anderson, 2008). Key skills of preceptors noted by students included being non-judgmental, respecting everyone's views, and the ability to offer different perspectives on situations (Manning et al., 2008). With proper guidance and support from mentors students are able to actively participate in meaningful reflection.

In order to truly reap the benefits of reflection, students must have a positive attitude towards the outcomes of reflecting. Ip et al. (2012) conducted a research study with undergraduate Chinese nursing students in Hong Kong to evaluate whether attending a program aimed to improve self-reflection skills helped manage clinical situations more successfully. Ip et al. (2012) found students desire to acquire reflective learning skills was highly related to their perception of the value of reflection. Time constraints were a noticeable barrier in many studies. Students argued that in order to modify their perspective and transform their reflective abilities they needed time; the changes were not able to happen overnight (Chong, 2009). O'Donovan (2006) found that reflection is a purposeful thinking process for students and proper time needs to be allowed in order to reflect.

According to Ip et al. (2012), it is important that mentors provide "sufficient time for students to process their recalled events" as well as the "structure of a safe environment for learning to occur" (p. 260). According to Elmqvist, Fridlund, and Ekebergh (2011) it is important to set time aside for group reflection in the workplace because it supports inter-professional communication.

The method of conducting reflective practice can make a difference in the outcome and success. The two primary methods found to be used were reflective journaling and group discussion. Chirema (2006) examined the use of reflective journals by post-registration nursing students in promoting reflection. 42 students participated in the qualitative study in which the data was collected by journals and interviews (Chirema, 2006). Chirema (2006) found mainly positive views on the use of journals, stating it was cathartic writing about sad and difficult situations. Other students viewed journal writing as difficult and stated they would prefer to talk about issues than write about them (Chirema, 2006). O'Donovan (2006) discovered students found reflective discussions with their preceptors and peers more constructive and easier to do then writing reflections.

Practicing nurses come across barriers along with student nurses taking part in reflection. Mantzoukas & Jasper (2004) conducted an interpretative research study with 16 practicing nurses in England to explore how reflection is viewed by nurses within their daily ward. Nurses felt reflection was a way of enhancing their professional knowledge, but was of limited value due to nurses' limited power to initiate any changes. A major barrier discovered was the power relationship between nurses and physicians. The researchers found that nurses felt belittled and devalued by those with more power. This was considered a major barrier because it prevented nurses from discussing their thoughts and ideas, and impeded the dissemination of important knowledge (Mantzoukas & Jasper, 2004). Acknowledging the barriers that exist with reflective practice will help to make the necessary changes for positive outcomes and success.

Reflection is a critical thought practice. Purposeful reflection provides an opportunity to examine nursing practice and identify new knowledge (Chong, 2009). Reflection is a professional motivator to "move on and do better within practice" with the goal of learning from experiences and examining oneself (Bulman, Lathlean, & Gobbi, 2011). Analysis of the literature revealed four major themes: Development of Practice, Emotional Impact, Mentor Support, and Barriers in Reflection. Development of nursing practice, are those studies that explore the impact reflective practice has on expanding the knowledge and increasing clinical competency. The field of nursing can be emotionally draining and reflection was seen as an outlet to disperse those feelings. Reflection allowed nurses to discuss or write journal entries about their feelings to better understand why they felt a certain way. Mentor support was identified as a crucial theme related to reflection. Students partaking in reflection require appropriate guidance and adequate time. A safe, nonjudgmental environment also needs to be provided to facilitate open communication. The role of the preceptor needs to be given proper support and guidance to provide optimal results. Although barriers exist with reflection, taking the time to discover which reflection style works best for each nursing student or practicing nurse will open the door to amazing learning opportunities.

Reflection has the opportunity to enhance clinical reasoning while having a positive impact on patient care. Further studies are needed to explore the impact of reflective practice and the quality of care received by patients. Additional research also needs to be completed regarding implementing workshops or conferences educating preceptors in proper reflective practice and the impact it has on student's reflective practice outcome. Reflection is an ongoing practice within the field of nursing. There will always be room to develop and mature professionally. From students to practicing nurses, reflection encourages growth and helps nurses continue to provide the best care to patients.

Barry, C.D., Blum, C.A., & Purnell, M.J. (2007). Caring for individuals displaced by Hurricanes Katrina and Wilma: The lived experiences of students nurses. International Journal for Human Caring, 11(2), 67-73.

Bulman, C., Lathlean, J., & Gobbi, M. (2012). The concept of reflection in nursing. Qualitative findings on student and teacher perspectives. Nurse Education Today, 32, e18-e13.

Chirema, K.D. (2007). The use of reflective journals in the promotion of reflection and learning in post-registration nursing students. Nurse Education Today, 27, 192-202.

Chong, M.C. (2009). Is reflective practice a useful task for student nurses? Asian Nursing Research, 3(2), 111-119.

Cirocco, M. (2007). How reflective practice improves nurses' critical thinking ability. Gastroenterology Nursing, 30(6), 405-413.

Duffy, A. (2009). Guiding students through reflective practice- The preceptors experiences. A qualitative descriptive study. Nurse Education in Practice, 9, 166-175.

Elmqvist, C., Fridlund, B., & Ekebergh, M. (2012). Trapped between doing and being: First provider's experience of "front line" work. International Emergency Nursing, 20, 113-119.

Glaze, J.E. (2001). Reflection as a transforming process: student advanced nurse practitioners' experiences of developing reflective skills as part of an MSc programme. Journal of Advanced Nursing, 34(5), 639-647.

Gustafsson, C., & Fagerberg, I. (2001). Reflection, the way to professional development. Journal of Clinical Nursing, 13, 271-280.

Hansebo, G., & Kihlgren, M. (2001). Carers' reflections about their video-recorded interactions with patients suffering from severe dementia. Journal of Clinical Nursing, 10, 737-747.

Ip, W.Y., Lui, M.H., Chien, W.T., Lee, I.F., Lam, L.W., & Lee, D.T. (2012). Promoting selfreflection in clinical practice among Chinese nursing undergraduates in Hong Kong. ContemporaryNursing, 41(2), 253-262.

Manning, A., Cronin. P., Monaghan, A., & Rawlings-Anderson, K. (2009). Supporting students in practice: An exploration of reflective groups as a means of support. Nurse Education in Practice, 9(13), 176-183.

Mantzoukas, S., & Jasper, M.A. (2004). Reflective practice and daily ward reality: a covert power game. Journal of Clinical Nursing, 12, 925-933.

O'Donovan, M. (2006). Implementing reflection: Insights from pre-registration mental health students. Nurse Education Today, 27,610616.

Rees, K.L. (2012). The role of reflective practices in enabling final year nursing students to respond to the distressing emotional challenges of nursing work. Nurse Education in Practice, 1-5.

Smith, A., & Jack, K. (2005). Reflective practice: a meaningful task for students. Nursing Standard, 19(26), 33-37.

Lauren Caldwell, RN, BSN

William Beaumont Hospital Royal Oak, MI, USA

Oakland University School of Nursing, Rochester, MI, USA

Claudia C. Grobbel, DNP, RN

Assistant Professor, School of Nursing, Oakland University, Rochester, MI, USA

Corespondence: Caldwell, Lauren [email protected]

William Beaumont Hospital, 3601 W 13 Mile Road, Royal Oak, MI 48073, USA

Or Caldwell, Lauren [email protected] , Oakland University School of Nursing, 2200 North Squirrel

Road Rochester, MI 48309, USA

You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer

Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer

Copyright Professor Despina Sapountzi - Krepia Publisher of the International Journal of Caring Sciences Sep-Dec 2013

Reflection is an essential attribute for the development of autonomous, critical, and advanced practitioners. According to Chong, "Reflective practice should be a continuous cycle in which experience and reflection on experiences are inter-related". Studies have shown that, nurses who take the time to reflect on their daily experiences provide enhanced nursing care, have a better understanding of their actions, which in return develops their professional skills. Reflective practice is the ability to examine ones actions and experiences with the outcome of developing their practice and enhancing clinical knowledge. Reflective practice affects all levels of nursing, from students, to advanced practice nursing students, as well as practicing nurses. Reflective practice is an important component of the nursing curriculum. Research has shown the relationship between student nurses and their mentors is vital. In order for reflection to be effective openmindedness, courage, and a willingness to accept, and act on, criticism must be present. This article will explore the current literature and implications related to reflective practice in nursing.

Suggested sources

• About ProQuest
• Terms of Use
• Privacy Policy
• Cookie Policy

• SCU Library
• Library guides
• Subject Guides

Reflective Practice

• Examples of reflective practice
• Why use reflective practice?
• When to use reflective practice
• Some models of reflection
• Writing reflectively
• Recommended readings
• Need help? This link opens in a new window

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.

• << Previous: When to use reflective practice
• Next: Types of reflection >>
• Last Updated: Nov 6, 2023 9:23 AM
• URL: https://libguides.scu.edu.au/reflectivepractice

Southern Cross University acknowledges and pays respect to the ancestors, Elders and descendants of the Lands upon which we meet and study. We are mindful that within and without the buildings, these Lands always were and always will be Aboriginal Land.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Critical Reflection Practice in Nursing Health Care Policy Education

• PMID: 36701131
• DOI: 10.3928/01484834-20230105-01

Background: A call to action is in effect for nurses to be change agents and bridge the gaps between the delivery of health care and the social needs of individuals, families, and communities. Response to this charge requires nurses to address long-standing inequity in health care policy and practice realms.

Method: This article describes the creative teaching-learning approach of critical reflection practice as a first step in developing skills and attitude for nurses to do this work.

Results: Early observations of the effect of critical reflection practice on learners show improved appreciation for the intersection of social, economic, and political dimensions operating in health care policy and practice that influence health inequities.

Conclusion: When nurses engage in a practice of critical reflection, they are more likely to identify offensive social determinants, act to ameliorate disparities, and advance the agenda for health equity. [ J Nurs Educ . 2023;62(5):312-315.] .

PubMed Disclaimer

Similar articles

• Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence protocol. MacKinnon K, Marcellus L, Rivers J, Gordon C, Ryan M, Butcher D. MacKinnon K, et al. JBI Database System Rev Implement Rep. 2015 Jan;13(1):14-26. doi: 10.11124/jbisrir-2015-1694. JBI Database System Rev Implement Rep. 2015. PMID: 26447004
• Using Critical Service-Learning Pedagogy to Prepare Graduate Nurses to Promote Health Equity. Bower KM, Alexander KA, Levin MB, Jaques KA, Kub J. Bower KM, et al. J Nurs Educ. 2021 Jan 1;60(1):38-43. doi: 10.3928/01484834-20201217-09. J Nurs Educ. 2021. PMID: 33400807
• A framework for addressing health inequities in sexual and gender diverse populations by nurses. Beckie TM, Lengacher C, Rodriguez C, Pares-Avila J, Turner D, Sanchez M, Nair US. Beckie TM, et al. Nurs Outlook. 2022 Jul-Aug;70(4):651-663. doi: 10.1016/j.outlook.2022.04.001. Epub 2022 Jul 5. Nurs Outlook. 2022. PMID: 35798586
• Equity in Cancer Care: Strategies for Oncology Nurses. Truant T. Truant T. Nurs Clin North Am. 2017 Mar;52(1):211-225. doi: 10.1016/j.cnur.2016.11.003. Nurs Clin North Am. 2017. PMID: 28189164 Review.
• Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory. Kuiper RA, Pesut DJ. Kuiper RA, et al. J Adv Nurs. 2004 Feb;45(4):381-91. doi: 10.1046/j.1365-2648.2003.02921.x. J Adv Nurs. 2004. PMID: 14756832 Review.
• Search in MeSH

LinkOut - more resources

Full text sources.

• Ovid Technologies, Inc.

Miscellaneous

• NCI CPTAC Assay Portal

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

• South Africa
• Nagorno Karabakh
• Cook Island
• Easter Island
• French Polynesia
• New Zealand
• Northern Macedonia
• Transnistria
• Privacy policy

North Ossetia – Birthplace of Mystical Alania

Snow-capped mountains, deep gorges, popular shrines of traditional Ossetian religion, ancient watch tower, Dargvas, the city of dead and the most pleasant capital Vladikavkaz. Yes, rattling off all of North Ossetia’s wonders leaves you breathless, like the natural beauty of this Russian Republic. The place breathes history . Starting with the Alans, ancient warriors of the Caucasus region to World War II, when the Germany attempt to grab the oilfields of the Caucasus region was stopped right there.

Ossetian countryside with an ancient watchtower, so typical for the Caucasus region

Vladikavkaz- Ruler of the Caucasus North Ossetia

It took me a while to pronounce the name of North Ossetia’s lovely capital Vladikavkaz  without difficulty. Only when a local explained its meaning „Ruler of the Caucasus “ , it rolled from my lips like honey . Founded in 1784 as a Russian fortress, it control led the only road linking Russia and Georgia at that time . I am not ashamed to admit that I had not heard of this town before I decided to do this trip. This city is only a two hours flight from Moscow and served as my jumping board for all onward travel.

Approaching Vladikavkaz by plane

The Saint Petersburg of the Cauacus

Vladikavkaz rightly prides itself of this title. T he streets of the Old City are lined with late grand 19th and early 20th century houses built for Russian army officers and merchants. I spent the hot parts of the days in Kosta Khetagurov Park

and strolled the banks of   River Terek in the evening , I visited picturesque churches and the most beautiful Mukhtarov Mosque .

Mukhtarov Mosque on the Banks of the River Terek

It sits right on the river and I first thought it was a church, since I had never before seen a mosque made of brick stones. I was invited inside by the caretaker , only when I saw the carpet after entering, I realized where I was . Arriving so totally unprepared without a headscarf and short sleeves irritated some men and I spent less time there than I would have liked.

Prospekt Mira (Peace Avenue) with ist 19th century houses

When I got tired of walking Vladikavkaz I hoped on a tram and enjoyed the quiet pace of provincial life from this perspective. Another highlight was watching families in the amusement park overlooking the river . Nobody seemed to be in a hurry. I watched life go by sitting on a tree-covered bench on car-free Prospekt Mira (Avenue of Peace), visited museums or hang out in cafes. Night life was not always, but sometimes is was great. Unforgettable a bar packed with young people, a small band was playing and a local celebrity grabbed the mike. A group of young ladies took me under their wings, and I left with cherished memories.

Vladikavkaz’s nightlife, great music and lovely people

The other must visit is a Retro USSR bar which has been operating for 100 years . People squash into small cubicles holding large mugs of beer that have to be picked up at the counter. Our little group was such a novelty that the regulars keep buying us so many drinks that we could not possible down them all.

Retro USSR bar, locals bought us so much beer we had to pass it on  

Hotel Vladikavkaz- great for people watching

The best place to view the snow-covered mountain peaks surrounding Vladikavkaz was from the Old Bridge or my room at Hotel Vladikavkaz , which was also overlooking Terek R iver and the amusement park . My most exciting moments on my balcony were the arrivals of weeding parties , which was quite a commotion.

Wedding Party arriving a Hotel Vladikavkaz

The convoy of expensive cars could be heard long before they pulled into the parking lots. The honking was deafening once they arrived, young beautiful women and middle aged men were then ushered into the hotel by friends and family clapping and singing. Once I sneaked into one of the posh parties, the noise of the music was earsplitting, and I was not sure if it was that much fun for most of the guests.

The location of the hotel is awesome and its veranda a place to linger forever (great WIFI) and do some serious people watching.

View from my hotel window, amusement park near River Terek

Caucasus wrestlers

Wrestling has a long tradition in the Caucasian Republics of Ossetia, Chechnya and Dagestan. Each has its own statistics that make it the number 1! By pure accident I learned that Vladikavkaz has a famous state-of-the-art wrestling academy. Nothing would have stopped me from visiting. I enjoyed an English-speaking tour through the premises, gyms, top equipment, sauna, pool. The academy hosts teams from all over the world also the USA, the fee is € 50 a day and kids a young as 9 years old start their training here. 

Wrestling Academy Vladikavkaz

Unfortunately, there was no training session while I visited, only a kind of rugby baske t ball match . Life in the region comes to a stand-still, when two champions fight each other in a tournament, especially if it one of them is American.

Wrestling Academy in Vladikavkaz

Vladikavkaz and the Caucasus in World War II  

On the outskirts of Vladikavkaz a memorial reminds of the Russian soldiers fallen in the battle of Vladikavkaz. Right beside the memorial is a huge mass grave, it was exactly here where the Germany army was stopped in the Caucaus . Hitler’s focus was on the rich oilfields of the Caucasus, which ironically supplied the German tanks and plane with fuel between 1939 and 1941. Before Hitler’s invasion of the USSR, Germany received 910.000 tons of oil from Stalin’s USSR, which made the quick advance of the German army and the use of its plane possible.

Words War II Memorial near Vladikavkaz, the front line was right there, this is how far the Germany army advanced

World War II Memorial near Vladikavkaz

Dargavs – The City of the Dead

A grassy hill dotted with little white huts was my first view of Dargavs. The two-hour drive from Vladikavkaz (US30 for the taxi) took me through stunning scenery, snow—capped mountains, greens meadows. Of course, I had prepared myself for this excursion, but I was still overwhelmed by this necropolis. A total of 95 stone crypts rise up the hillside in a very organized manner.  At the back of the complex is a watch tower whose top part has been destroyed. It is said that the tower was placed there to watch over the resting souls.

City of Dead, Dargavs 35 little crypts perched on a h ill

The tombs themselves are shaped like huts with curved roofs going inwards in steps and pointed peaks at the top, typical of Nakh architecture. If there is no pointed peak that means the family had no more surviving sun. The crypts tell even more about a family, the higher they were, the higher was their social status. The really big ones held up to 100 corpses.

City of Dead- Dargavs

The bodies were put in what looked little small canoes and shoved into the tiny opening. In some of the crypts you could peak through tiny openings and see the bones, some even wrapped in fabrics. I was told that until not too long ago the corpses wore rings and necklaces. Unbelievable, but recently visitors lost the respect for the dead and stole these precious bits, so the remaining jewelry was taken to a nearby museum. Actually, the site was closed down two months before my arrival, since visitors took photos of themselves with skulls. Only recently had it reopened.

Body were shoved into the structure in small wooden canoe-like coffins

The drive back to Vladikavkaz was equally spectacular, first through a small gorge following a river and then up an unpaved road with stunning vista of snowcapped mountains.

Ossetia’s countryside

Here in Dargavs I learned there were different types towers: Signal towers were high up in mountain and narrow. Towers served also as fortresses when under attack, they were wider and had up to three floors, since people found shelter there. Also amazing the time span they were being built, starting in the 5th century BC till 18th Century

Modern Monaster ies, Medieval R ock- F ortress and Pagan Saints

Not too far from Vladikavkaz is Fiagdon Monastery, an all-male monastery, which was only completed 2002. The monks collect herbs for making tea and produce cheese and honey. It looks way to modern but since I passed by I stopped to take a look.

our little gang that went to South and North Ossetia together

Much more interesting was the Medieval rock-fortress in the village of Dzivgis , which I would not have recognized as such, since it blends perfectly into the high cliff it was built in. In case of an attack the population of the whole gorge could find protection there.

Medival fortress

The Uastyrdzhi monument  catches the unknow traveler by surprise. In Ossetian folklore Uastyrdzhi   is the name of Saint George. He is the patron of the male sex and travellers. It is forbidden for women to pronounce his name, instead they must call him  “the saint of men”. When following the Ossetian Military Road along the River Ardon, it suddenly pops out of the rock. The horse’s hoof is 120 cm, and the palm of George can fit a man. But that is not all. Another place where he is worshipped looks like a church, especially since two small bells hung from a pole right next to it. The story goes that the people kept the bell but also their ancient belief. Since the end of the USSR the cult of Uastyrdzhi has enjoyed renewed popularity.

Uastyrdzhi Memorial = the name of Saint George.

Every year in fall lots of people gather for a big festival to celebrate Uastyrdzhi. The worshipping involved toasts made by an elderly from a wooden mug, who is assisted by two young men. Inside the small museum was a big painting of the very man with a long white beard riding a white horse, the mug and a chain hanging from the ceiling, so typcial for Ossetia.

Inside little museum where Uastyrdzhi is being worshipped

Three Days of September 2004 – The Siege of Beslan School Nr 1

Beslan is a small quiet town in the Russian Republic of North Ossetia in the Caucasus . Its streets are lined with brick-stone houses shaded by chestnut-trees, well-tended flower gardens adorn the front and vegetable gardens the back. Beslan could serve as a cliché-like model for a pastoral painting, if there had not been those 3 days in September 2004. On September 1st, t he gym of Beslan ’ s School Nr 1 became the epicenter of the hostage taking that resulted in the death of 335 mostly women and children three days later .

The former gym of Beslan School Nr 1, now a memorial to remind the 335 victims that were kept there for three days with water and food

In Beslan neighbors, family and friends sit outside their houses, chat and a random car or person go by. Children play in the street and a stranger like me walking by causes attention. When I took photos of the flower gardens, some locals were so touched, they took me inside to show me the gardens behind, I was offered food, teach and sweets. 

Beslan: beautiful flower gardens in front of the houses

Local family invited me for lunch and showed off their garden

I stayed with a family who fed me during my three day stay since I could not detect any eatery. The woman had learned some basic English and with google translator we managed to communicate.

Natascha cooking in the super hot little kitchen

Tiny tables, require creativity, stool goes sideways

On September 1 st , 2004, n eatly dressed children with balloons and flowers arrived for the traditional first day-of-school ceremony accompanied by parents and relative s . This moment of joy and happiness suddenly turned into a unparallel ed drama that lasted for three day:  more than 1100 children, parents and teachers were taken hostage by a terrorist group demanding independence for Chechnya.

Water bottled remind of the relentless thirst the children and adults suffered from

Forced into the gym where temperatures reached 40 degrees, the hostages were denied water and food, while the over 30 terrorists planted bombs all over the building. On the third day in an abysmal chaos of explosions, fire and gunshots 335 people were killed. In the video „The Children of Beslan“ children who survived remember those three days, the best documentary in my eyes. Unfiltered, the children talk about what seems unspeakable.

The former gym of Beslan school Nr 1.

In the few sequences of the video that show the end of the siege, even the most uninformed viewer immediately realizes the absolute chaos that dominated the event. To this day, countless questions of the parents have remained unanswered.

Photos of the victims on the wall of the Former gym, most of them children, give the horrid numbers a face

The victims were buried in a new cemetery a bit outside of Beslan, all the tomb stone are made of the same stone, symbolizing the same tragic fate. I passed one grave with five tomb stones, all members of the same family. It is impossible to comprehend the grief and pain that still haunts Beslan.

Another tragic story of is the one of Vitaly Kaloyev , an architect and native of Vladikavkaz. He lost lost his wife and two small children when  two planes collided mid-air over Germany on June 1, 2002. Kaloyev held Peter Nielsen, the sole air traffic controller in Switzerland who was handling traffic the night of the collision, responsible. In 2004, Kaloyev travelled to the Swiss  town of Knoten where he killed Nielsen, who had since retired from air traffic work.

Later, after his release from prison, Kaloyev was appointed deputy minister of construction of North Ossetia-Alania . In 2016, upon retirement from the local Ossetian government, Kaloyev was awarded the highest regional medal by that government, the medal “To the Glory of Ossetia”. The medal is awarded for the highest achievements, improving the living conditions of the inhabitants of the region, for educating the younger generation and maintaining law and order.

Vital Kaloyev touching the grave of his wife and two children

Share with:

• Click to share on Facebook (Opens in new window)
• Click to share on Twitter (Opens in new window)
• Click to share on Tumblr (Opens in new window)
• Click to share on Pinterest (Opens in new window)

Beslan , Dargavs , Fiagdon Monastery , Mukhtarov Mosque; Vladikavkaz , Uastyrdzhi , Vladikavkaz , Wrestling Academy

No comments yet.

Leave a reply click here to cancel reply..

Name (required)

Email (will not be published) (required)

Notify me of follow-up comments by email.

Notify me of new posts by email.