Reflection on practice by nursing students during early clinical experiences

Education for professional practice is a complex process. In recent years, increasing attention has focused on the importance of reflection as a significant component of preparation for practice. However, empirical evidence shedding light on the process of learning to reflect on practice is comparatively sparse. Practice-based attempts to systematically describe essential aspects of the process as it occurs in nursing students during early experiences with clients have been Virtually nonexistent. This exploratory study was undertaken to investigate reflection on practice by first year nursing students during early patient care experiences. Reflection, for purposes of the study, was considered a multi-step process consisting of three phases: awareness, critical analysis, and synthesis (emergence of changed perspectives). Constructivism, a theoretical position which focuses attention on the creation or construction of knowledge by the learner, provided the theoretical framework for the research. Particular attention was directed to describing aspects of the situation on which student reflections focused, how the reflection process changed over time, and ways of facilitating related learning. Twenty-five students enrolled in the first year of a college-based nursing program, located in the downtown core of a large metropolitan area, volunteered to participate in this research. Data were collected during clinical conferences, focus groups, and individual interviews as participants reflected on practice in the course of a ten week block of early experiences with adult clients in acute care settings. Reflection was found to be a frequently occurring, fundamentally important activity among this group of participants. Principal foci of reflections were care-giving activities at the bedside, and the process of learning a professional role. Basic changes were noted in two major aspects of the reflecting process: participant input, and patterns of interaction during group sessions. Factors which were found to facilitate or impede reflection exerted their influence either directly by impacting reflecting activities while conferences, focus groups, and interviews were in progress, or indirectly by effecting the quality and quantity of practice-related information brought by participants to these sessions. Findings underlined the potential significance of a number of factors in enhancing participant reflecting skills: growing ability to attend to, attach meaning to, interpret, and verbally describe essential aspects of patient care situations; ongoing opportunities to reflect and receive pertinent feedback; increased understanding of clinical expectations; and concurrent attendance at classes presenting relevant theoretical material. Questions about whether these factors are, in fact responsible for the changes noted, the extent of their relative importance, and the possible presence of other significant influences in these situations suggest fertile territory for further research