Is Reflective Practice a Useful Task for Student Nurses? Reflective Practice a Useful Task ... despite the perceived barrier to good reflective ... Is Reflective Practice a Useful Task for Student Nurses?

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  • 111Asian Nursing Research September 2009 Vol 3 No 3


    Is Reflective Practice a Useful Task for Student Nurses?

    Mei Chan Chong*

    Nursing Sciences Unit, Department of Allied Health Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Background Reflective practices have been advocated as a method to bridge the gap between nursingtheory and practice, and as a tool to develop knowledge embedded in practice.Aim The aim of this study was to examine the perceptions of student nurses towards reflective practicein their clinical practice.Methods A cross sectional descriptive survey was carried out to examine the perception of a cohort of108 final year, pre-registration Diploma of Nursing students towards reflective practice. A structured ques-tionnaire was used to collect the quantitative data. The questionnaire consisted of two parts; part A: per-ception of students towards reflective practice; and part B: issues reflected by students. Data collectedwere analyzed using descriptive statistics. All (n = 98) students completed the questionnaire.Results The mean score of perception to reflective practice was 4.07. Students found reflective practiceuseful to them with a mean score of 3.82, despite the perceived barrier to good reflective practice with amean of 3.60. The perception on the appropriateness of reflective practice as a tool to assess was 3.47. Thevalidity of reflective practice as an assessment tool for practical examinations was not conclusive, as themean score was only 3.47.Conclusion The results indicated that even though some students were skeptical with reflective prac-tice, they found it useful. The College of Nursing should review the content of reflective practice and pre-pare nurse educators for their role in teaching this subject more effectively. [Asian Nursing Research 2009;3(3):111120]

    Key Words nursing students

    *Correspondence to: Mei Chan Chong, Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.E-mail:


    Reflective practice has become a key issue which ismentioned regularly within the context of nursing andnurse education programs (Smith, 1998; Gustafsson,Asp, & Fagerberg, 2007; Howe, 2006). There hasbeen a great increase in interest of reflective practice

    in the field of nursing and many researchers haveemphasized and enlighten us on the advantage ofreflective practice (Smith, 2005; Chamney, 2008;Clouder & Sellars, 2004; Platzer, Blake, & Ashford,2000). Reflective practice has been used to over-come the gap between nursing theory and practices,and to articulate and develop nursing knowledge

    Received: June 18, 2009 Revised: June 18, 2009 Accepted: September 9, 2009

  • embedded in practice (Johns, 2002). Reflectioncould be the means to challenge and change valuesor beliefs (Green, 2002). Gustafsson et al. assertedthat the capability of reflective practice is vital indelivery and improving ethical and holistic nursingcare. The definition of reflective practice and reflec-tion remains debatable despite regular citations in theliterature of practice professions. What is reflectivepractice?

    DefinitionThe definition of reflection is thinking deeply andcarefully, especially about possibilities and opinions(Cambridge International Dictionary of English,1995). In the area of education reflection, JohnDewey (1933) as cited by Cotton (2001), haddefined reflection as the active, persistent and care-ful consideration of any belief or supposed form ofknowledge, in light of the grounds that support it andthe further consequences to which it leads. Deweysconceptualization of reflection is supported by Schon(1987), that it is an important learning strategy tohelp professionals become aware of their implicitknowledge base. Maclean (2006), describes reflectionas involving thinking about, and critically analyzingour experiences and actions, with the goal of improv-ing our professional practice.

    As for nursing, Johns (2002), has defined reflec-tion as, a window through which the practitionercan view and focus themselves within the contextof her own lived experience in ways that enable herto confront, understand and work towards resolvingthe contradictions within her practice, between whatis desirable and actual practice. Through the conflictof contradiction, the commitment to realize desirablework and understandingwhy things are as they are,the practitioner is empowered to take more appro-priate action in future situations. In short, reflectivepractice is associated with relationships and to indi-vidual needs and to a larger extent emotional andpersonal feelings that have impacted on the intel-lectual reflective learning (Boud & Walker, 1998;Mezirow, 1998). Nurses could be empowered throughreflective practice (Issitt, 2003), to enable them torender nursing care with better understanding, foster

    self awareness, become more competent, and tomotivate changes and improve the quality of holisticnursing care (Gustafsson & Fagerberg, 2004; Marrow,Hollyyoake, Hamer, & Kenrick, 2002).

    Components of reflective practiceReflective practice should be a continuous cycle in which experience and reflection on experiences,are inter-related. This is illustrated by a modeldeveloped by Boud, Keogh, & Walker (1985) thatreflection involves returning to the experience,attending to the feelings and re-evaluating the expe-rience based on current knowledge and intent andintegrating this new knowledge into your conceptualframework. There are more examples of models inthe literature by Burnard, 1991; Gibbs, 1988a, andMezirow, 1998. Burns, Bulman and Palmer (2000),suggest that Gibbs (1988) model is useful becausemany practitioners have used it and found it to besuccessful.

    The reflective cycleReflective practice is a dynamic process whichrequires a cyclical approach. Gibbs (1988) modelillustrates a framework for experiential learning andguides the user through a series of questions whichprovides a structure for a reflective experience.

    Emerging interest of reflective practice, has beenrecognized as an important concept to consider in thereview of the Nursing Diploma Programme curricu-lum by the University of Malaya Medical Centre.Reflective practice based on Gibbs (1988) modelhas been integrated into the three year program,since 2003. The first group of students who wereinvolved in the practice, are now in their final yearof the program. Every semester, reflective practiceis used to assess the students clinical performanceas a continuous assessment of their practical exami-nations.A majority of the students did not do well intheir reflective practice. Only a minority of studentsfelt comfortable with reflection, as the course pro-gressed. The implementation of reflective practicein the Diploma of Nursing Programme has not beenevaluated, hence this study was carried out to exam-ine the student nurses perception and to find out

    M.C. Chong

    112 Asian Nursing Research September 2009 Vol 3 No 3

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    the strengths and weaknesses in implementation ofreflective practice during practicum.

    The aim of this paper is to report on how agroup of student nurses perceived and interpretedreflective practice in a preregistration nursing cur-ricula in a college of nursing, in a teaching hospitalin Malaysia.


    Study settingThe study setting was in the College of Nursing, Uni-versity of Malaya Medical Centre. The college offersa preregistration Diploma of Nursing program witha student population of 600, with three year levels:Year 1, Year 2 and Year 3. Reflective practice wasintegrated into the curriculum and the main concernwas in the clinical area, as it focused on practice.Students were encouraged to write or record as manyreflections as possible with a minimum target ofone every two weeks, with supervision in level oneof one posting per semester. Subsequently, studentswere encouraged to write one report at each postingin the clinical area.There were tutors in each respec-tive area of clinical placement, to assist students.The ratio of tutors to students was approximately1:20. There was no specific time allocated duringclinical hours for reflective writing and studentswere supposed to record/write their reports afterworking hours. Discussion on the outcome of theirreflection was scheduled for students.

    This study setting was chosen because theresearcher had been involved in teaching nursingstudents in the Diploma program and participatedin the advocacy of reflective practices.

    Study designA cross sectional descriptive study was carried outto examine the perception of the final year prereg-istration Diploma of Nursing students towards theusefulness of reflective practice.

    Population and samplingIn this study, the target population was 108 prereg-istration student nurses who were enrolled in 2003and underwent a three year Diploma of Nursingprogram. They were in semester 3 of their final yearand had experienced writing reflectively since year 1,semester 1. They were assessed on reflective prac-tices in year 1, semester 2 and 2 and year 2, semester1, 2 and 3. This cohort was selected because theywere the first group of students to have reflectivepractice integrated in their nursing practice. Studentswho were involved in the pilot study were excludedfrom this study. The sampling method was universalconvenience sampling.The sample selection criterionwas to include students who had written at leastfive reflections.

    Ethical considerationThe Director of the University of Malaya MedicalCentre gave a permission to undertake the study.Approval from an Ethics Committee was not required

    Is Reflective Practice a Useful Task for Student Nurses?

    Asian Nursing Research September 2009 Vol 3 No 3

    Action planIf i