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Japan Journal of Nursing Science (2013) 10, 170–179 doi:10.1111/j.1742-7924.2012.00222.x

REVIEW ARTICLE

Concept analysis of reflection in nursing professional

development jjns_222 170..179

Junko TASHIRO,1 Yoko SHIMPUKU,1 Kazuko NARUSE,2 Maftuhah1 and

Miwako MATSUTANI1
1
St Luke’s College of Nursing, Tokyo and 2Kobe City College of Nursing, Hyogo, Japan

Abstract
Aim: The aim of this concept analysis was to describe attributes, antecedents, and consequences of reflection
in nursing professional development, as well as surrogate terms and a model case to inform nursing
educators, students, and nurses about developing reflective skills.
Methods: Rodgers’ evolutionary cycle for concept analysis was used. The published work search was
conducted using five databases: Education Resources Information Center (ERIC), Medline, Cumulative
Index to Nursing and Allied Health Literature (CINAHL), Ichushi, and British Nursing Index. The inclusion
criteria were: (i) academic articles; (ii) written in English or Japanese; and (iii) including descriptions about
reflection. From the pool of extant published work, 50 articles were selected for the thematic analysis.
Results: For the concept of reflection in nursing professional development, four antecedents were identified:
(i) theory and practice gap; (ii) expansion of the role and competency in nursing; (iii) educational and
learning needs; and (iv) educational responsibility. The major attribute was the process of learning from
experience, and the circular process included emotional reaction, description, internal examination, critical
analysis, evaluation, and planning new action. The consequences were transforming new perspective,
enhanced communication, professional development, and quality of care.
Conclusion: Reflection is used as a method or tool that connects knowledge and experiences. Through the
process of reflection, students/nurses become aware of themselves, which helps them review and improve
clinical skills. They also become more able to communicate with patients and colleagues. Reflection
enhances self-directed learning and professional maturity. Nurses who use reflection can be better positioned
to provide excellent patient care.
Key words: nursing, professional competence, professional education, professional practice, reflection.

INTRODUCTION Healthcare providers empower people to promote their

In 2007, the World Health Organization (WHO)
Western-Pacific Regional Office (WPRO) proposed
“People-Centered Health Care (PCHC)”. PCHC was a
carefully chosen concept not to be conceptually substi-
tuted as patient-centered care (PCC). It is patient care
across all levels of healthcare systems (WHO WPRO,
2006). Hence, PCHC includes PCC as the first domain.
Correspondence: Junko Tashiro, St Luke’s College of
Nursing, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044,
Japan. Email: junko-tashiro@slcn.ac.jp
Received 5 September 2011; accepted 21 May 2012.
own health and select health care for themselves. In
other words, in the new model of health care, people
create their health in collaborative relationships with
professionals, rather than the more traditional and
paternalistic focus of professionals contributing to peo-
ple’s health. This is a fundamental change in the power
relationships between clients or patients and healthcare
providers. It also requires a shift in responsibilities.
Implementing this change in responsibility and power-
base, requires that healthcare providers including
nurses acquire professional attitudes and skills to
empower and to collaborate with people in the
community.

© 2012 The Authors

Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science
Japan Journal of Nursing Science (2013) 10, 170–179
In Japan, a leading nursing educational institution
began aligning with the concept of PCHC, and in 2009
started a new curriculum for undergraduates with
PCHC at its core. This new curriculum aimed at devel-
oping nurses in higher education. In addition, graduate
programs, especially in the area of advanced practice,
expanded widely to develop nurses with specialized
skills. This change promoted the expansion of nurses’
roles and produced a new challenge in nursing education
to develop nurses’ autonomy and professionalism.
Indeed, the Quality and Safety Education for Nurses
(QSEN) project in the USA also identified developing
PCC, which recognizes the patient as the source of
control and partner in collaboration, as a core compe-
tency for both undergraduate and graduate education to
improve quality and safety of the healthcare system
(QSEN, 2012). In addition, professional development is
a recommended strategy to attract nurses to stay in their
career (Buchan & Aiken, 2008). Nurses tend to remain
in work because of the opportunities to develop profes-
sionally (Buchan & Aiken, 2008; Buchan & Calman,
2006).
To promote professional development, the new cur-
riculum included reflective skills as one of the required
competencies. Schön (1983) was instrumental in
describing the role of reflection in professional educa-
tion and explained reflection as a significant tool to
facilitate learning from one’s experiences. Professionals
can surface, criticize, restructure, and embody the
understandings in further action through reflection on
action (Schön, 1983). From an educational viewpoint,
Reid (1993) defined reflection as “a process of reviewing
an experience of practice in order to describe, analyze,
evaluate and so inform learning about practice”
(p. 306).
Nursing, as a practical science, has emphasized reflec-
tive learning in clinical practice in terms of nurse–patient
relationship (Neary, 2000). Reflection has been utilized
and researched in nursing education in England and
the USA (Bulman & Schutz, 2008; Freshwater, Taylor,
& Sherwood, 2008; Johns, 2004; Mezirow, 1991;
Mezirow & Taylor, 2009). It has been introduced to
Japan and used in clinical practicums at the undergradu-
ate level or for reviewing a specific clinical practice
(Ueda & Miyazaki, 2010). However, the concept of
reflection within the context of nursing professional
development has not been defined adequately to identify
educational and research indicators. Therefore, this
concept analysis aims to address the broader context:
reflection in nursing professional development; it
describes attributes, antecedents, and consequences of
© 2012 The Authors
Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science
Concept analysis reflection
reflection in nursing professional development, as well
as surrogate terms and a model case. The clinical rel-
evance is to add clarity for nursing educators in using
the findings for the systematic development of profes-
sional nurses from undergraduate to graduate programs
for advanced practice.
METHODS
Study design
When developing and clarifying the base of knowledge,
concepts play a crucial role to promote the organization
of practice, to facilitate communication among commu-
nities, and to enable the recall of phenomena cognitively
(Rodgers, 1989). In nursing, approaches for concept
analysis were introduced to advance nursing theory and
practice in the early 1980s with Chinn & Jacobs (1983,
1987) and Walker & Avant (1983, 1988) adapting Wil-
son’s approach (1969), and Rodgers (1989) informed by
Toulmin (1972) and Wittgenstein (1968). Rodgers’ posi-
tion (1989) that concepts are contextually bound and
therefore subject to continuous change as contexts
change, rather than being characterized by a fixed set of
conditions identified through strict rules was appropri-
ate for examining reflective learning in a new context;
therefore, the authors followed Rodgers’ (1989) proce-
dure of concept analysis: the evolutionary cycle based on
an essentialist orientation. The purpose is not to provide
the definitive answer, but to identify a consensus or the
“state of art” of the concept. Rodgers (1989) suggested
exploring the contexts within which the concept is used,
collecting the data from the references of the concept,
and identifying antecedents, attributes, and conse-
quences of the concept. The authors adopted the dispo-
sitional theory of concepts, described by Rodgers
(2000). The context the present authors chose was
the scientific use of reflection as it appears in the pub-
lished work opposed to the colloquial term in everyday
speech (Risjord, 2009). Therefore, the authors chose
the concept of reflection, as it was understood and
researched within specific nursing educational contexts
as delineated in the published work search.
Published work search
The authors searched the published work in five data-
bases: Education Resources Information Center (ERIC),
Medline, Cumulative Index to Nursing and Allied
Health Literature (CINAHL), Ichushi (Japan Medical
Abstracts Society), and British Nursing Index, using
combinations of the key words “reflection”, “nursing”,
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J. Tashiro et al.
“nursing education”, “nursing student journaling/
journal writing”, “critical thinking”, “e-learning”, and
“service learning”. The authors included articles written
only in English or Japanese because of their language
ability. The authors did not limit or exclude articles from
the beginning to collect a wide range of documents. In
order to select articles that represented the entire range,
the authors listed all the results of their published work
search and selected every fifth article using systematic
sampling. The authors excluded duplicates, non-
academic articles, and unavailable articles. This proce-
dure resulted in a list containing 86 articles. The authors
then included those articles containing concepts of
reflection including attributes, antecedents, conse-
quences, surrogate terms, and/or relevant aspects in
nursing education, and excluded articles that had none.
Based on that, the authors chose 50 articles from the list.
Rodgers’ suggested including at least 30 articles to reach
the common use of the concept; therefore, the authors
of the current study determine that their sampling
was adequate. Additionally, the database was further
strengthened by including five landmark scholarly
works (Bulman & Schutz, 2008; Freshwater et al.,
2008; Mezirow, 1991; Mezirow & Taylor 2009; Schön,
1983) for analysis.
Analysis
Fifty articles and five books were analyzed using the-
matic analysis (Rodgers, 2000) and the language used in
the relevant published work was examined to determine
a trend by asking: “what is common in the use of a
word?” From the descriptions of reflection found in the
selected published work, the authors picked: (i) anteced-
ents (those events most likely to happen prior to the
occurrence of the concept); (ii) attributes (characteristics
associated with the definition of the concept); and (iii)
consequences (those events or results occurring because
of the antecedents and attributes) (Rodgers, 1989). They
were put into a matrix format to examine similarities
among the published work and continuously organized
and reorganized to generate a cohesive, comprehensive,
and relevant system of each aspect of the concept. The
authors identified a model case of the concept using the
antecedents, attributes, and consequences, then con-
structed a conceptual model based on the findings
(Fig. 1).
RESULTS
Many of the reviewed articles cited definitions of older
works, such as Dewey (1933), Schön (1983), Kolb
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Japan Journal of Nursing Science (2013) 10, 170–179
(1984), Boud, Keogh, and Walker (1985), Johns (1995),
and Alfaro-LeFevre (1995) Some landmark published
work noted that the concept of reflection was difficult to
define, and consequently scholars interpreted it in
slightly different ways (Bulman & Schutz, 2008; Fresh-
water et al., 2008). The authors of the present study
needed to be clear that their purpose was to describe the
current trend of reflection. A proposed definition was
provided using the major pattern formed from descrip-
tions in the current published work grounded in the
earlier works noted above. The results are presented
based on the conceptual model (Fig. 1).
Antecedents
Theory and practice gap
When nursing students enter into the practice environ-
ment, they soon face a gap between what they have
learned in the classroom and what they see in the real
world (DeBourgh, 2002). This gap triggers perplexity or
dilemmas that lead to the process of reflection (Epp,
2008). Many authors mentioned use of reflection
because of the need to integrate theory and practice.
Grant, Kinnersley, Metcalf, Pill, and Houston (2006)
stated that, as students, they “can examine their under-
standing for any gaps or inconsistencies”, and they
“address any identified gaps” (p. 379–380).
Hence, reflective learning does not necessarily occur
when students just review clinical or other experiences.
One needs to inquire about the difference between the
reality and what they have learned. When they realize
the theory–practice gap, a reflective process begins.
Therefore, the theory–practice gap is the core antecedent
of reflection. Tamura (2008) pointed out that the gap
must come from interactions with others. The following
includes more background of nursing education that
potentially widens the theory–practice gap and height-
ens the need for reflection.
Expansion of the role and competency in nursing
As nurses expand and shift their role in advanced prac-
tice and community-focused approach, the theory–
practice gap that they experience may be wider than
before because they are required to act more autono-
mously and make the appropriate clinical judgments
(Chirema, 2007). Daroszewski, Kinser, and Lloyd
(2004a) point out that in advanced practice, nurses are
required to apply specialized knowledge independently
or collaboratively, and that it is more complex in com-
munity health as their skills need to be used in various
environments and with different populations within a
© 2012 The Authors
Japan Journal of Nursing Science (2013) 10, 170–179
Figure 1 Concept of reflection in nursing professional development.
community. This change leads to increased needs for
reflection in nursing education.
Educational and learning needs
Traditional educational approaches based on the posi-
tivist paradigm and its methodologies of inquiry became
less effective in promoting those professional skills that
recognized “self” and others required in developing
more complex assessments (Cash, Brooker, Penney,
Reinbold & Strangio, 1997). Nakata et al. (2002) also
emphasized “self-awareness” of nurses so that they can
properly assess others and situations surrounding them
so that they provide care based on the assessment.
Maeda and Tsuda (2008) further discussed that nurses
need to understand that caring is a product of the inter-
action with others and practiced intentionally to achieve
their own self-actualization. The authors stated that
nursing professional development requires enhancement
of self-efficacy and self-respect. The new approach,
reflection, is about pasts, presents, and individual and
© 2012 The Authors
Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science
Concept analysis reflection
collective futures, containing the possibilities for nurses
individually and collaboratively in their relationship
with others (Cash et al., 1997).
Educational responsibility
As healthcare complexities such as aging societies and
people-centered care increase, the educational side of
responsibility also becomes larger to meet this demand.
For nurses to function in more complex situations that
may require new pattern recognition or strong collabo-
rative skills to gain necessary data, they need to be able
to think critically. Reflection is a necessary component
of critical thinking (Lindeman, 1999). Numerous
authors discussed the nursing educator’s responsibility
to enable students to learn from their experience, which
requires reflective skills. Palmer et al. (cited in Parker,
Webb, & D’Souza, 1995) said that “nursing educators
must ensure that students learn from their clinical expe-
rience and must be well versed in the use of reflection”
(p. 111). To this end, nursing education has shifted from
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J. Tashiro et al.
traditional educational approaches based on the positiv-
ist paradigm to methodologies of inquiry (Cash et al.,
1997). It is a necessary and preferable change that nurse
educators respond to the needs of education.
Attributes of reflection
Tools or methods of educational approach
Many authors described reflection as a method or tool
for education with various educational approaches used
to promote students’ reflective learning. The majority of
educators used reflective journals including e-journals,
portfolio, and narrative reflection. Horn and Freed
(2008) used journaling and dialogue pairs. Several
authors used unique teaching strategies. For example,
Bradbury-Jones, Hughes, Murphy, Parry and Sutton
(2009) used the “Peshkin approach” to reflection, which
asked students to reflect on a situation based on their
emotions and thoughts systematically, focusing on
six “subjective I’s”. Daroszewski, Kinser, and Lloyd
(2004b) used the “Socratic method”, in which a teacher
does not give information directly but asks a series of
probing questions to elicit meaning and truth. Oterholm
(2009) used a collaborative e-learning method in which
students exchanged comments on challenging incidents
during their fieldwork. Some authors incorporated
reflection in service learning (Bailey, Carpenter, & Har-
rington, 2002; Eyler, 2002).
Process of learning from experience
The most common attribute of reflection among the
reviewed published work was a process of learning from
experience. Tamura (2008) stated that, conceptually,
reflection is a systematic cognitive process originating
from Dewey’s educational philosophy. In reflection, one
deeply understands their experience through internal
examination so that one can improve their behavior or
practice. The model and/or framework of the process
varied among the authors.
Freshwater et al. (2008) described that Gibbs’s (1988)
and Kolb’s (1984) non-linear, circular nature of reflec-
tion illustrated the ongoing development of the practi-
tioner and then, by synthesizing some of the former
authors’ work, identified three stages of the reflective
process: (i) awareness of uncomfortable feelings and
thoughts; (ii) critical analysis of the situation; and (iii)
development of a new perspective.
Whereas other authors finished the process at the
acquisition of a new perspective or action plan stage,
Mezirow (1991) and Mezirow and Taylor (2009) iden-
tified 10 steps for transformation, which included build-
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Japan Journal of Nursing Science (2013) 10, 170–179
Figure 2 Circular process of reflection.
ing competence and confidence in new roles and
reintegration of one’s new perspective into one’s life.
The components of models and frameworks depended
on how the authors categorized or conceptualized sets of
factors in the reflective process.
Overall, the authors of the present study identified six
components that are essential for reflection: (i) emo-
tional reaction; (ii) description; (iii) internal examina-
tion; (iv) critical analysis; (v) evaluation; and (vi)
planning new action (see Fig. 2). They are presented
next in more detail.
Emotional reaction
On many occasions, the theory–practice gap triggers
emotional reactions. Mezirow (1981, 1991) named the
first step of reflection a “disorienting dilemma”, which is
caused by some pressing external events that are likely
to facilitate a perspective transformation. Nursing
professionals often encounter tragic events, such as
struggles, concerns, depression, and deaths of patients
(Maeda & Tsuda, 2008). They sometimes encounter
their own mistakes, incidents, and accidents, as well as
disagreements with colleagues or other healthcare pro-
viders. Recognition or awareness of one’s emotional
reactions is the first step of reflection (Freshwater et al.,
2008). This kind of emotional reaction and questioning
spirit underpins reflective practice (Bradbury-Jones,
Hughes, Murphy, Parry, & Sutton, 2009), characterized
by inquiry and finding information to resolve the tension
(Dewey, 1933, cited in Epp, 2008).
© 2012 The Authors
Japan Journal of Nursing Science (2013) 10, 170–179
Description
Educational approaches, such as narrative reflection or
journaling, encourage students/nurses to identify and
describe orally or through writing what happened in the
situation. This requires the ability to recognize and accu-
rately recollect salient events and key features of an
experience (Atkins & Murphy, 1993). Good description
illustrates the situation clearly and accurately, enabling
an understanding of the whole situation (Nakata et al.,
2002).
Internal examination
After describing the situation, students/nurses need to
internally examine their cognitive and affective domains,
namely, consider what they think and feel about the
situation they described. Some of the authors cited Boud
et al.’s (1985) explanation of internal examination as:
“intellectual and affective activities that individuals
engage in, to explore their experience, which leads to
new understandings and appreciations” (cited in
Chirema, 2007; Cooper, Taft, & Thelen, 2005).
Bradbury-Jones et al. (2009) also agreed that “thoughts
and feelings are the core foci” (p. 2486) of reflective
process. Johns (2004) also described reflection as “being
mindful of self . . . as if a window through which the
practitioner can view and focus self” (p. 1). Providing
further rationale for this type of internal examination,
James and Clarke (1994) noted that examining both
thoughts and feelings redresses balance between the
science basis and artistry.
Critical analysis
After describing and examining their internal state,
students/nurses need to re-examine and analyze the situ-
ation, including external factors, from different perspec-
tives. Mezirow’s (1991) called this the third step of
transformation, which was critically examining the
epistemic, sociocultural, or psychic assumptions under-
lying the experience. Lasater and Nielsen (2009) cited
Dewey and said that reflection is essential to learning
from experience, particularly in those situations in
which the issues are ill defined, multilayered, and
complex. As described above, issues that nursing deals
with have become more complex and complicated due
to societal changes and nurses’ role expansion. Hence, it
is necessary to deeply assess and analyze what happened
and what influenced the particular issue. Freshwater
et al. (2008) named this stage critical analysis of the
situation, which includes openness to new information
and perspectives.
© 2012 The Authors
Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science
Concept analysis reflection
Evaluation
Evaluation is making a judgment based on a value
(Bulman & Schutz, 2008). When students/nurses ana-
lyzed and understood both the internal and external
factors, they could objectively evaluate the situation.
They could make sense of what happened in a calm
manner. Cash et al. (1997) stated that reflection could be
“a process of healing and enlightenment” (p. 246). Stu-
dents might have felt pain as they made a mistake, but it
could have been something inevitable. In evaluation,
students/nurses reach their own conclusion and under-
standing of the situation.
Planning new action
In many cases, nurses reflect on their practice because
they want to find what could be done differently for the
next time (Cash et al., 1997). Drevdahl and Dorcy
(2002) quoted Johns (2004) that reflection is “a process
of personal deconstruction and reconstruction” (p. 226)
to take necessary steps to change their perspectives and
practices. This new plan of action may cause emotional
reactions and triggers the circular reflective process
again (see Fig. 2).
Consequences
Transforming new perspective
Many authors stated that after students/nurses experi-
enced reflection, they experienced changes in themselves
through self-awareness and self-actualization. Many of
the educational approaches in undergraduate nursing
programs are aimed at developing student’s self-
awareness. Ando et al. (2008) stated that by becoming
aware of their beliefs, values, grounding, strengths, and
weaknesses, students become conscious of their person-
alities and learn about themselves. They also gain new
perspectives on their own skills, abilities, and practice
(Drevdahl & Dorcy, 2002; Lauder, 1994). By under-
standing the self, students build values and feelings asso-
ciated with the conduct of care and a view with which
they can strongly agree (Langan & Prendergast, 2008).
Hence, understanding of the self, influences students/
nurses toward self-actualization (Epp, 2008), helps to
improve clinical competency (Kessler & Lund, 2004),
and promotes mindful, thoughtful, caring, and holistic
nursing practice (Fakude & Bruce, 2003; Waldo & Her-
manns, 2009).
The process of reflection has potential for not only
self-awareness, but also knowledge construction by
identifying knowledge and skills that may address prac-
tical problems which cannot be solved by a “technical
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J. Tashiro et al.
rationale” (Maeda & Tsuda, 2008). Through the
process of reflection, students/nurses identify the gap
and reduce it (Langan & Prendergast, 2008). It pushes
students/nurses beyond first impressions and feelings to
thinking more deeply about their experience and by
connecting it to their knowledge and broader experience
(Eyler, 2002). Hence, what they first considered as a gap
may be viewed differently as they gain a new perspec-
tive. Tamura (2008) stated that the consequence requires
attitudinal or behavioral changes that shows personal
value and intellectual growth of the self or of both the
self and others.
Enhance communication
In reflection, students/nurses learn not only their own
values and feelings, but also how these factors influence
others (Nakata, Tamura, Fujiwara, Ishikawa, & Tsuda,
2004). As a result, it improves communication and rela-
tionships with others. In nursing, students/nurses find a
way to establish relationships with patients. At the same
time, reflection connects them with the community of
nurses “united through common interest and need in
caring for each other as well as humanity” (Lauterbach
& Hentz, 2005, p. 34).
Professional development
Reflection is a way to promote the development of
autonomous, qualified, and self-directed professionals
(Stoddart, Cope, Inglis, McIntosh & Hislop 1996;
Epling, Timmons, & Wharrad, 2003). It provides the
means for nursing professionals to realize the value of
nursing knowledge by adapting and transforming
knowledge to meet changing circumstances (Fakude &
Bruce, 2003). As a result, nurses become able to con-
tribute more to the multidisciplinary team as a result of
their enhanced knowledge (Chirema, 2007). Tamura
and Tsuda (2008) identified eight consequences of
reflection in nursing professional development: (i) iden-
tifying their own learning needs; (ii) personal growth;
(iii) professional growth; (iv) growth out of conven-
tional practice; (v) awareness of their own behaviors;
(vi) theory construction by observational judgment; (vii)
support for solving and deciding uncertain phenomena;
and (viii) self-empowerment and emancipation.
Quality of care
Although it is not a direct outcome, reflection is assumed
ultimately to improve the quality of care given by inde-
pendent, thoughtful, and knowledgeable practitioners
(Durgahee, 1996; Epling et al., 2003; Lepp, Zorn,
Duffy, & Dickson, 2003). Epp (2008) stated that a nurse
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Japan Journal of Nursing Science (2013) 10, 170–179
who has improved personal attributes will be an
improved nurse, and better positioned to provide excel-
lent patient care.
Surrogate terms
Transformative learning
Mezirow (1991) used the term “transformative learn-
ing”, which is equivalent to “reflective learning”;
however, the two terms differ in terms of their foci. The
term “transformation” was derived from the area of
cognitive studies focused on “emancipatory” learning
and action (1981, p. 5) described by Habermas. The
concept of emancipatory action is the same as perspec-
tive transformation, or critical self-awareness, in the
sense that people recognize the correct reasons for their
problems.
Experiential learning
Fowler (2008) indicated that all learning lies in the
way of processing experience, namely, the critical
reflection of experience. He cited Kolb (1984) to
explain that the “experiential learning cycle” is the
grasping of experience, which would result in “trans-
formation” of that experience. He also mentioned
Dewey (1933) who had suggested that “experience
plus reflection equals learning”.
DISCUSSION
The authors of the present study identified antecedents,
attributes, and consequences, as well as surrogate terms
of reflection in nursing professional development.
Figure 2 contains a circular model of reflection, but the
process from theory–practice gap and reflection to con-
sequences, as described in the reviewed published work,
is overall more linear.
Proposed definition
Reflection in nursing professional development is an
active process triggered by the theory–practice gap, in
which nursing students or nurses describe the situation,
realize their emotional reaction, examine their thoughts
and feelings internally, critically analyze their behavior
and the situation, evaluate them, and thus plan a new
action. Through the circular process, they become
increasingly more aware of themselves and their clinical
skills, able to produce experiential knowledge, and able
to communicate better with patients and colleagues.
They acquire self-directed learning skills and obtain pro-
fessional maturity. Students or nurses who use reflection
© 2012 The Authors
Japan Journal of Nursing Science (2013) 10, 170–179
can be better positioned to provide excellent patient
care, and therefore reflection should ultimately lead to
improvement of quality of care.
Model case
A second year student nurse has been taking her first
clinical course that requires journal writing to reflect her
experience. She had difficulties in communicating with
nurses in the clinical site because nurses seemed to be
very busy. Whenever she had to report to nurses about
her plan or practice, she felt nervous and intimidated
(emotional reaction). She wrote about her feelings in the
journal (description). When she wrote and read it by
herself (internal examination), she thought that it was
not unusual to feel this way, as this was her first time
communicating with working nurses (critical analysis).
She recognized that she needed to practice how to report
to nurses (evaluation). She asked her faculty to practice
with her (planning new action). The faculty responded
quickly, complementing her on her autonomous action
and practiced with her. She gained confidence and posi-
tive attitudes about reporting and she became more able
to communicate with nurses as the clinical course pro-
ceeded. She became aware that good communication is
important as part of teamwork.
The need for reflection in nursing professional devel-
opment is increasing following the global trend in which
nurses are required more to have autonomy and critical
thinking skills to reach appropriate decisions within the
context of complex social health issues. Developing pro-
fessional identity and maturity is needed as nurses con-
front ethical issues, recognize limits, and perceive the
weight of nurses’ responsibilities (Cooper et al., 2005).
There were several limitations in the present study’s
database that must be noted. Although the authors
aimed to collect a wide range of published work, they
could not retrieve some articles listed. More rigid inclu-
sion and exclusion criteria was needed to collect
published work that focused specifically on nursing pro-
fessional development and then to only select articles
that met rigorous research standards as opposed to
selecting every fifth article. As a next step, it is necessary
to apply the concept to education and research of reflec-
tive learning in nursing professional development.
CONCLUSION
In this global and changing society, the role of nurses is
shifting from traditional institution-based medical assis-
tance to community-based people-centered care. It
requires more autonomy and responsibility as a profes-
© 2012 The Authors
Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science
Concept analysis reflection
sional. As the current authors identified, reflection as a
potential tool or method of educational approach can
help students and nurses transform their perspectives,
enhance communication with patients and colleagues,
develop as professionals, and ultimately improve quality
of care. The identified factors can guide future studies on
reflection in nursing education. The authors hope these
results of concept analysis will inform the nursing
faculty in addressing the changing needs of society and
help students and nurses to become professional nurses.
ACKNOWLEDGMENTS
This study was a part of the research project funded by
Grants in Aid for Scientific Research (KAKENHI) in
Japan from 2009–2011. The authors appreciate Sue
Schutz and Dr Chris Bulman for supporting them and
providing valuable information on reflective practice.
CONFLICTS OF INTEREST
No conflict of interest has been declared by the authors.
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