Exploring reflection as a process embedded in experienced nurses' practice: a qualitative study

Abstract

This article is a report of a study aimed at obtaining an in-depth description of how experienced acute care staff nurses perceive and use reflection in clinical practice. Reflection is viewed as a critical component of professional practice. The basic assumption is that reflection involves a deliberate process of thinking about a clinical situation which leads to insight and a subsequent change in practice. Several prescriptive models for reflection exist to provide a guide for reflection, however, few are grounded from an empirical examination of reflection in practice. There is a dearth of empirical data on what is actually happening in practice. Descriptive, qualitative. In-depth interviews with 12 experienced acute care staff nurses in a community hospital in Northeastern USA was used to address the study aims. Data were collected between November 2009-May 2010. Examples of reflection were embedded in patient situations needing immediate nursing intervention. Reflection was a process involving four phases: Framing of the Situation, Pausing, Engaging in Reflection, and Emerging Intentions. Experienced nurses used a process of reflection-on-action in practice. They gained insight and formulated intentions for change in nursing practice. Structured facilitated reflection might assist nurses in achieving a depth of reflection necessary to move from their intentions to changes in practice.