Reflective Learning: A TeachingStrategy for Critical ThinkingCharles R. Baker, RN

ABSTRACT

Most nurse educators claim that ability to critiqueone's clinical practice is a skill which must be acquired ifnursing students are to continue to learn and develop aspractitioners after they have graduated. This skill is ofparticular relevance for nurses who will be working inde-pendently in the community. The author reviews recentliterature on critical thinking and reflective learning andidentifies the results of one baccalaureate nursingschool's use of reflective journals.

Reflective learning has been described as a processwhereby an individual responds to a lived experience andcognitively reviews and explores the experience in such away as to create and clarify meaning in terms of self(Boyd & Fales, 1983). This process, in turn, leads toincreased self-awareness, increased sensitivity to theenvironment, and a change in conceptual perspective.

Such a process not only improves critical thinkingskills, but also contributes to growth in self-awareness,self-actualization (Maslow, 1979) and the development ofnew knowledge (Boyd & Fales, 1983). Despite these bene-fits, reflective learning has not been well discussed in theNorth American nursing literature to the extent that ithas been reviewed in British nursing literature.

Charles R. Baker, RN, is Professor, Centennial College and a staffnurse at Scarborough Grace Hospital, Scarborough, Ontario,Canada.

This article was written while the author was completing a mas-ter's degree in community nursing at D'Youville College, Buffalo,New York.

Address reprint requests to Charles R. Baker, RN, PO Box 613,Station A, Scarborough, Ontario, Canada M1K 5E9.

Reflective learning has been partially addressed in thenursing literature on critical thinking, although it hasonly been listed in the Cumulative Index of Nursing andAllied Health Literature (CINAHL) since 1989 (Hartley &Aukamp, 1994). As nursing moves into more autonomouscommunity-based practice, the challenge for nurse educa-tors is to assist students to develop greater critical think-ing skills, improve awareness of self and environment,and to facilitate nurses' ongoing learning from their dailypractice.

Critical Thinking

Numerous authors have proposed definitions for criti-cal thinking relative to their own disciplines. One of theearlier teams to write about critical thinking viewed it asa composite of knowledge, skills, and attitudes (Watson &Glaser, 1964). This team went on to develop the Watson-Glaser Critical Thinking Appraisal tool which is present-ly used by researchers of critical thinking in nursing(Hartley & Aukamp. 1994; Pless & Clayton, 1993). Thistool measures skill in performing inference, recognition ofassumptions, deduction, interpretation, and evaluation ofarguments, all of which are used during the process ofreflection. In fact, some theorists believe critical thinkingis a cognitive process grounded in reflection (Jones &Brown, 1993).

Reflection

Boyd and Fales (1983) provide a working definition ofreflection which suggests that it is a process of thinkingabout and exploring an issue of concern, which is trig-gered by an experience. The aim of one's deliberations isto make sense or meaning out of the experience and toincorporate this experience into one's view of the self andthe world. The exploration of an experience to create

January 1996, Vol. 35, No. 1 19

REFLECTIVE LEARNING

meaning (reflection) inevitably focuses on something ofcentral importance to the individual where there is poten-tial for significant learning and growth.

Part of the uniqueness of reflection lies in the fact thatit has the potential for generating new knowledge, where-as application of content knowledge does not (Boyd &Fales, 1983). This quality is an important feature fornurse educators to keep in mind as they develop curricu-la and teaching strategies to assist nurses to work asindependent clinicians and researchers in the community.

Reflective Learning

The work of Boyd and Fales (1983) assigned the fol-lowing six aspects to the process of refiective learning:

1. A sense of inner discomfort is triggered from somelife experience. It has been described as being similar tothe experience of knowing there is something that onemust do but being unable to remember what it is.

2. Identification or clarification of the concern makesthe nature of the problem or issue more evident. The con-ceptualization of the problem in relation to the individualis what distinguishes refiective learning from other cog-nitive activities.

3.Openness to new information from internal andexternal sources, with the ability to observe and take infi-om a variety of perspectives, is a hallmark of refiectivelearning. This openness implies that time is needed inorder to take in information from a variety of sources andthen allow it to "percolate" for a period. One must be will-ing to forego a quick resolution or closure (Boyd & Fales,1983) on the issue and allow for lateral thinking by read-ing things that are apparently unrelated to the issue,postponing decisions until the issue can be looked at fromall sides, and involving oneself in different types of activ-ity, such as shifting from mental to physical pastimes.

4. Resolution is the "aha" stage where one feels he orshe has changed or learned something that is personallysignificant. Although it may not be a final answer, it pro-vides the individual with a comfortable position in rela-tion to the issue (Boyd & Fales, 1983). Resolution is spon-taneous, unpredictable, and a manifestation of creativity.It usually comes when one is alone and not actively seek-ing it, yet is psychologically ready to see the new perspec-tive. The new view has meaning, affords a new perspec-tive, and is self-affirming. The individual is rewarded witha sense of joy that comes at the moment of closure.

5. As a result of intemalization of a new perspective,there is a change in oneself One attempts to explain howthe new self relates to or can be explained in terms of theold self. Establishing continuity of oneself with the past,present, and future provides integrity and connectednesswithin a changing world.

6. Deciding whether to act on the outcome of the refiec-tive process most closely parallels decision-making andproblem-solving (Boyd & Fales, 1983). It is here that thechanged perspective or new insight is analyzed for its

ability to be operationalized. How would it work in prac-tice? Would it fit my values and goals? How would it bereceived by others? After some deliberation, a decision ismade to incorporate the changed perspective or newinsight into behavior immediately or to simply allow it toexist without acting on it.

Reflective Learning and Nursing EducationThe nursing process has emerged from the scientific

method which has long been regarded as the only legiti-mate means of problem-solving in medicine (Jones &Brown, 1993). Indeed, nursing textbooks, most nursingcurricula, many state boards of nursing, and the NationalCouncil Licensure Examination for Registered Nurses(NCLEX-RN) are all modeled on the nursing process(Jones & Brown, 1993). Recently, there has been anincreasing awareness that the exclusive use of reduction-istic Cartesian thinking, which is inherent in the scientif-ic method and nursing process, does not adequately servethe nursing profession in its efforts to work with individ-uals and communities holistically. Nursing decisions arenot only the result of linear problem solving but are alsoarrived at through a process of synthesizing differentpoints of view and contradictory lines of reasoning (Pless& Clayton, 1993). Refiective learning tends to supportsuch a holistic synthesis (Palmer, Bums, & Bulman,1994).

Reflective Journals: A Strategyin Nursing Education

The writer notes that in one baccalaureate nursingprogram, students are instructed and guided in stnic-tured refiective-joumal writing during their clinical expe-riences. Students are directed to include the follov r̂ingfour components in each joumal entry: (1) identification,(2) description, (3) significance, Eind (4) implications.Students refiect upon activities, conversations, events,and thoughts or feelings experienced during or inresponse to clinical practice. Because "identification" isthe beginning point, one is frequently not conscious ofwhat experience would provide the richest growth. Toassist in raising issues to a conscious level, students areencouraged to write poems, tell stories, and/ or draw pic-tures. Next, students subjectively and objectively"describe" in detail what they have felt, thought, and donein that particular moment. Students are encouraged to becreative in expressing this description in a manner whichmost suits their unique experience. For example, drawingpictures might be used for a portion of a joumal entry to'describe' what was felt during a particular experience.Next, the student analyzes the 'significance' of the experi-ence by considering feelings, thoughts, and uncoveringpossible meanings from the experience. Finally, studentsare asked to address at least one of the following 'impli-cations' of their experience in terms of their: (1) own clin-

20 Journal of Nursing Education

BAKER

ical practice, (2) self-perceptions as nurse and/or learner,and (3) own learning as a human heing.

Teachers look for developmental trends and give feed-back based on the six aspects of reflection outlined byBoyd and Fales (1983). Teachers report that the analyti-cal aspects of the reflection, such as, "openness to newinformation," "resolution," "establishing continuity ofself," and "deciding whether to take action" may all hedelayed if the new perspective has major implications forchanging the existing pattern of one's life. Students musthe guided to see that closure is not likely to come as a neatpackage with every joumal entry. Attempts to rush clo-sure will close the student off from new information andreduce chances of a satisfactory resolution and integra-tion of the present self with the past self

Teachers' comments tend to be very supportive, non-judgmental, and do not confirm right or wrong thinking.Comments are intended to assist the student to focus orencourage deeper analysis of a halance of thoughts andfeelings. A "rule of thumb" is that, what the student hasuncovered as significant to reflect upon, is accepted by theteacher as the appropriate focus.

Responses to Reflective Learning StrategiesThe nursing faculty report that students opt for the

reflective joumal versus other learning strategies hasedon the kind of the clinical setting they are in and the indi-vidual student's personality. Students more frequentlyelect to write reflective joumails when they feel there is alarger affective component to their clinical learning suchas in mental health nursing. On the other hand, studentswho naturally tend to he more reflective opt for reflectivejournals more often. Initially, students' entries are large-ly descriptive with little analysis (resolution, establishingcontinuity, and deciding on action). Many students losefocus before they have clarified the concern and the reflec-tive process does not evolve. Teachers report that stu-dents' concern about covering all the course objectivesoflen distracts students from genuine reflection. Anxietyabout meeting course objectives inhibits some studentsfrom listening to their sense of inner discomfort. Thesewritings tend to lack the emotional energy or passion, andthe focus is lost before reaching the stage of analysis.

Many teachers have reported they are overwhelmed bythe entries that describe feelings of helplessness andguilt, particularly related to interactions with physicianswho would not acknowledge assessments and clinicaljudgments of the nurse. Occasionally, students haveviewed the relating of feelings in their joumal as an inva-sion of privacy. For these students, it is helpful to takespecific examples and demonstrate that exploration of theaffective domain is an essential part of reflection andlearning. On a positive note, teachers generally agree thatstudents who use the reflective process explore a greatervariety of issues than those who use other learning strate-gies. Teachers also find it easier to identify important

themes for conference discussions. Much passion has cen-tered around students' reflections on caring for clients,dealing with ethical dilemmas, being assertive to resolveor move a conflict forward, and around the growth in self-awareness.

Students report that they enjoy the reflective processand find greater meaning in what they are doing in theclinical area. Students who continue to practice part timeas nurses report "the reflective joumal has helped me toview my work in a new way," "I am thinking about issuesat work, instead of just going home," "work has becomemore than a means to a salary," "I find I can make agreater impact on my colleagues than I thought possible,"and "I actually enjoy writing the analyses."

It is significant to note that students tend to use writ-ten text exclusively to express their reflections. Whenasked why they have not incorporated other modes ofexpression, students indicate that they feel very self-con-scious ahout doing so and are afraid they may appear"childish." It is crucial then, to incorporate specific exer-cises involving the use of a variety of visual, oral, andaural media to facilitate students' use of a greater vzuietyof forms of expression in their reflective journals.

Reflective Journals and Critical ThinkingIn recent years there has been a shift away from what

Schon (1983) refers to as "technical rationality" and whatDreyfijs and Dreyfus (1985) call "calculative rationality."These ways of thinking are characterized by their focus on"ohjectivity," "detached," "analytic stance" (Darhyshire,1993), and linear thinking. This approach to prohlem solv-ing is taught in most schools (Van Manen, 1991) but thisapproach is not always helpful to nurses who must con-sider cognitive and affective variahles in a holistic non-detached manner rather than a detached linear fashion.Reflective journaling offers a teaching strategy whichhelps provide balance to the objectification and linearthinking skills that we currently develop.

Critical thinking has been defined as "reasonablereflective thinking that is focused on deciding what tohelieve or do" (Ennis, 1987, p. 10) and as "the skill andpropensity to engage in an activity with reflective skep-ticism" (McPeck, 1981, p. 81). Tanner (1993) identifiesthat critical thinking has heen wrongly conceptualized asproblem-solving or the nursing process. Currently, noclear conceptualization of critical thinking in nursing hasbeen established (Pless & Clayton, 1993). However, manyexperts conceptualize critical thinking along the dimen-sions of "cognitive skills" and "affective dispositions"(Facione cited in Pless & Clayton, 1993). The "ideal criti-cal thinker" has heen characterized as heing inquisitive,self-confident in ability to reason, open-minded regard-ing divergent world views, flexible, honest, diligent, andreasonahle (Facione cited in Pless & Clayton, 1993).Reflective joumal writing, as a reflective learning activi-ty, is a teaching strategy which can nurture many of

January 1996, Vol. 35, No. 1 21

REFLECTIVE LEARNING

these qualities and promote mindful and thoughtfulnursing practice.

Summary

Reflective practice is an increasingly valuable tool innursing education where independent practice places agrowing emphasis on the affective and cognitive domainsof learning. Although individual students vary in theextent to which they naturally reflect upon life experi-ences, all students benefit from strategies which developthe skill of reflection. Increased involvement of the affec-tive domain is highly desirable in a humanistic professionsuch as nursing. Reflective joumaling using variousmedia is one strategy that students and nurse educatorsalike find stimulating and rewarding. A key element tothe success of this strategy lies in the fact that it allowsstudents to relate to aspects of their experience whichmost profoundly speak to them at the moment. Tappinginto central concerns creates the greatest potential forgrowth.

References

Boyd, E., & Fales, A. (1983). Reflective learning: Key to learn-ing from experience. Journal of Human Psychology, 23(2), 99-117.

Darbyshire, P. (1993). In the hall of mirrors. Nursing Times,89(49), 26-29.

Dreyfus, J., & Dreyfus, S. (1985). Mind over machine. NewYork: Free Press.

Ennis, R.H. (1987). A taxonomy of critical thinking disposi-tions and abilities. In J.B. Baron & J.J. Stemberg (Eds.). Teachingthinking skills: Theory and practice (pp. 9-26). New York:Freeman.

Hartley, D., & Aukamp, V. (1994). Critical thinking ability ofnurse educators and nursing students. Journal of NursingEducation, 33(1), 34-35.

Jones, S., & Brown, L. (1993). Alternative views on definingcritical thinking through the nursing process. Holistic NursePractitioner, 7(3), 71-76.

Maslow, A. (1979). Humeinistic education: Two articles byAbraham Maslow. Introduction by T. Phillips. Journal of HumanPsychology, 19(3), 13-25.

McPeck, J. (1981). Critical thinking and education. New York:St. Martin's.

Palmer, A., Bums, S., & Bulman, C. (1994). Reflective practicein nursing: The growth of the professional practitioner London:Blackwell Scientific Publications.

Pless, B.S., & Clayton, G.M. (1993). Clarifying the concept ofcritical thinking in nursing. Journal of Nursing Education, 32(9),425-428.

Schon, D. (1983). The reflective practitioner. San Francisco:Basic Books Harper Collins.

Tanner, C.A. (1993). Thinking about critical thinking. Journalof Nursing Education, 32, 99-100.

Van Manen, M. (1991). The tact of teaching: The meaning ofpedagogical thoughtfulness. New York: State University of NewYork Press.

Watson, G., & Glaser, E. (1964). Watson-Glaser critical think-ing appraisal manual. New York: Harcourt Brace & World.

22 Journal of Nursing Education