REFLECTIVE THINKING AND WRITING

Introduction
“Reflection in the context of learning is a generic term for those intellectual
and affective activities in which individuals engage to explore their experiences in
order to lead to new understandings and appreciations”
Boud 1985

In order to learn via experience, reflection is an essential part of professional

practice. Reflection has long been seen as an important nursing concept. Reflection
has been embraced in nursing education as a vital method to help nursing students
learn from experience (Jootun & McGarry, 2014). Additionally, it is believed that
reflection is important for nurses to provide patients with the best care possible
(Caldwell & Grobbel, 2013). The process of reflecting is a thorough examination of a
beneficial scenario or experience, which may include a critique of one's own
emotions, thoughts and behaviours. It involves cognitive processes like
characterization, critical analysis, assessment, and planning. A clinical condition or
experience be learned from through reflection as well. It is a method for bringing
about changes in attitudes, behaviours and/or feelings. Additionally, reflection is a
dynamic and active activity. It involves contemplation prior to action, contemplation
during the action, contemplation after action, and contemplation after action. Lastly,
the process of reflecting is circular. When making plans for future learning or acting
in the future, future understanding, thought, or perspective about a clinical scenario or
experience is taken into account.
A comprehensive view of learning that takes into account experience,
perception, cognition, and behaviour is offered by Kolb's Model for Experiential
Learning. The concept has changed greatly since educational researcher David Allen
Kolb originally introduced his Learning Style Inventory (LSI) and Experiential
Learning Cycle in 1984 as knowledge about how people learn has increased.
We can organize a piece of reflective writing around the four stages of David
Kolb's learning cycle. They are such as experience, reflect, conceptualize, and apply
in this instance.

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 Experience
In the first stage of this cycle, consider the circumstance we are reflecting on,
our sentiments at the time, and what we think about it. Then, write it down. Our
contemplation will have a strong foundation thanks to this. (Concrete experience:
This occurs when a new experience of situation is encountered or a re-interpretation
of existing experience showed up.)

Reflect
What worked effectively after describing the circumstance? What failed to
work? What factors do we think contributed to this experience's triumphs or failures?
What influenced our actions or our contribution to the event? (Reflective observation
of the new experience: This involves reflection observation of the new experience of
particular importance and any inconsistencies between experience and
understanding.)

Conceptualize
We’ll take the reflection to a higher level at this point, deeper level by
attempting to comprehend. The encounter unfolded as it did. Now is the time, we may
apply some theoretical concepts to obtain some understanding of the situation.

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(Abstract conceptualization: Here reflection gives rise to a new idea, or a
modification of an existing abstract concept.)

Apply
After analyzing the encounter, at this point, we will devise a strategy for how
we may act in a different way. We could also have the opportunity to test our new
strategy in a pertinent setting. (Active experimentation: Here the learner applies the
new ideas to the world around them to see what results. To Kolb, effective learning is
seen when a person progresses through a cycle of four stages mentioned above. The
last stage is used to test hypotheses in future situations, and results in new
experiences.)

Reflect effectively on things that went well or things that went badly in our
department current clinical scenario
In my opinion, the most crucial aspect of reflection is reflective analysis
because it is essential for converting a description of practice into knowledge about
practice. For instance, Cristicos (1993, p. 161) says that in order to move from a
description of experience to the articulation of practice knowledge, accounts of
practice need to be "arrested, scrutinized, analyzed, considered, and rejected," based
on the work of Aitchison and Graham (1989). Additionally, according to Boyd and
Fales (1983, p. 100), this effort must establish and define meanings "in terms of self,"
or, more specifically, in terms of the practitioner that I am. Additionally, the
possibility for reflection to change practice is started within and through analysis
(Rolfe). I want to briefly digress before discussing the methods I use to analyze my
practice experience in order to draw some implications for educational practice from
this viewpoint. In my opinion, it is very important to value the role that a thorough
description of practice and the process of practice analysis play in educational
practice.
During my work in last 17 years, I have experienced many activities and
thereby I have gained lots of experiences. Those experiences were mainly gained
because of situations created with a patient, relative, or co‐worker, as well as mentors
or other members of the multidisciplinary team. While working in a surgical ward, I
experienced a situation where I had to engage with a patient for the first time with the
COVID virus. When the COVID virus was spreading around society as the first wave,
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there were many methods practiced by hospitals at the reception stage onwards to
trace down corona patients. However, it was observed a patient was admitted to the
ward by indicating that patient is COVID negative. When the preliminary
investigations were conducted, it was known that the patient was not tested for rapid
antigen testing (RAT) due to the false information given based on his background
exposure. This is the first situation I am going to explain and in the second situation, I
take the example of the occasion I happened to work in an Ambulance as a nurse.

First stage of Kolb’s experiential learning theory: Concrete Experience

As per the first stage illustration of Kolb’s learning cycle, a new experience or
situation is encountered, on a reinterpretation of existing experience. Accordingly
during 17 years of working, there were two new situations I have undergone which I
would explain.
As the first experience, I haven’t experienced a situation similar to COVID 19
and experiencing/ treating a patient with COVID 19 was a challenging situation.
Hence, all the nurses including me were also very much keen about the patients
admitted to the ward. Because of this expanding COVID situation, it was challenging
to identify the patients. Therefore, nurses read about the experiences of other nurses
who experienced COVID patients through the internet. Further, technical literature
available within the hospital, the small seminar sessions conducted within the
hospital, all the symptom identification methods, and COVID treatment methods were
studied by me and other nurses in order to treat COVID patients as well as to avoid it
getting infected.
As the second experience, I recalled the situation where I had to be part of the
ambulance team to visit an emergency patient. During this incident, there was a nurse
assigned for ambulance duties but on that particular day, she was suffering from a
sudden fever. Because of this situation, I happened to visit in the ambulance. I
recalled all the teaching material supposed to know when appointed as a nurse for the
ambulance. As it was the first time, I was little nervous about the situation and
panicked. Hence, I was searching for the instructions/ orders promulgated to follow
when performing such kind of a job. At the same time, I inquired about required
details from a nurse who had already engaged with similar duty in a previous
occasion.

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The second stage of Kolb’s experiential learning theory: Observation of
the new experience
In this stage, the learners reflect on the experience prior to making any
judgment.
When considering the first situation, all the nurses were expecting COVID
patients and I too knew that there would COVID patients be identified inside the
ward. When considering the patient situation, based on the experiences which have
been gained, it was suspected that the symptom of the patient is abnormal to the other
patients in the ward. Symptoms like fever, cough, body ache nausea, severe headache
and loss of appetite, etc. Other nurses also had the same experience related to this
particular patient. Because of this reason, Two days were spent keeping the patient at
the ward and gradually it was identified that the situation of the patient was growing
with COVID symptoms.
When considering the second situation, I was informed that the operational
availability of medical equipment to be tested prior to proceeding with any task.
Hence, based on the knowledge gained, I felt very hurry to switch on all the
equipment in the ambulance and to ensure the healthy operation of the equipment. At
the same time, the same time I informed the attendant to get the required
replenishments to function the ambulance up to the fullest standard. Then after some
time, the attendant also confirmed the availability of all required consumables on
board. Upon confirmation of the situation to the relevant doctor, the ambulance
proceeded to the location where the patient was. Upon reaching the location, the
doctor inspected the patient and recommended transferring the patient to the hospital.
By this time, the patient was in stable condition but a little dizzy condition. While
transferring the patient to the hospital doctor recommended providing medical oxygen
to the patient even though the patient was alive. Hence the medical Oxygen supply is
connected to the patient. After a few minutes of medical oxygen supply, the patient
was slowly becoming a little comfortable and it was a great relief for the team.
However, unfortunately, the medical oxygen bottle went empty and the team was
shocked to face to such a situation.

The Third stage of Kolb’s experiential learning theory: Abstract

conceptualization

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 This stage highlights how learners can reflect and provide a new idea or make
modifications to an existing abstract concept.
When considering the first situation, based on our own experiences, in order to
minimize the interaction of patients, all nurses agreed upon reduce the number of beds
in the ward and arrange sufficient space between available beds. Then patients were
also divided into groups and nurses were also divided into separate groups. In this
way, one team of nurses planned to handle one selected number of patients without
interacting with all patients in the ward. The patient who visited ward indicating
COVID negative also planned to keep isolated from other patients and only two
nurses were engaged in treating.
When considering the second situation, the ambulance team was shocked by
the non-availability of medical oxygen. But the doctor was very closely observing the
patient and found the patient was stable. However, there was a need for supplying
medical oxygen to the patient continuously as still, it will take about half an hour to
travel to the hospital. Therefore, we noticed that it needs some method of breathing air
supply to the patient in regular intervals. Considering the above situation, I was
thinking about the alternative actions which could be taken to supply breathing air.

Fourth stage of Kolb’s experiential learning theory: Active

experimentation
This stage highlights how the learners apply acquired experience to the world
around them to see what can be the results.
When considering the fourth situation, I have taken actions to arrange RAT for
this patient as soon as possible. Other nurses around me also suspected the behavior
of the patient and all recommended arranging a RAT as soon as possible. By that
time, there was another nurse directly exposed to the particular patient and hence that
particular nurse was also asked to be isolated within the ward premises. The results of
the RAT indicated that the patient was positive for COVID 19. Hence, the actions
were taken promptly to transfer the patient to the isolation ward immediately.
However, due to this reason, all the ward premises was cleaned using TCL which is a
disinfectant.
When considering the second situation, suddenly It came to my mind that,
there should be an Ambu Bag in the Ambulance. Hence, I inquired same from the
attendant and he indicated there is a bag with some equipment which haven’t been

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used in a regular basis. So I got that bag and opened it and noticed there was an Ambu
Bag inside. I was very happy and the same was taken out of the bag. Then the doctor
was also recommended to connect the same to the patient after a thorough cleaning.
Therefore, the Ambu bag was cleaned thoroughly and connected to the patient. The
team was able to make the patient comfortable till taken to the hospital premises and
it was the a satisfactory situation for all of us.
These two situations symbolize the application of Kolb’s theory during
working and it was really helpful in understanding how we reflect on some situations.
It reminds us to be well aware on these steps as we may have to face similar new
experiences/ situations without prior notice. Our experiences, knowledge and
situational approach would be the most amicable solutions while handling such kind
of situations.
When I first began to write about my experience, however, I discovered that
the account alone was adequate to inform me about my practice. Making an account
of an experience has a certain intrinsic value since it made the artistic and practice
process clear. Reading about my practice also struck a chord with me. I was
frequently astounded by the high human cost of disease and care, as well as by the
overwhelming sense of vicarious experience these narratives elicited—how they made
me want to relive the experience. In a previous edition, I provided one of the earliest
written accounts of my practice to show this (Duke 2000).
Contrary to what I have learned through reflecting, as well as my enthusiasm
and support for reflective practice, my experience of feeling the weight of reflection
and the difficulties of being reflective, is completely opposite. As a result of this
thoughtful investigation, my sense of expertise is already more balanced. The scales
will tip more in favor of the satisfaction of contemplation and of being a nurse than in
favor of the emotional weight of these events as I incorporate this information into my
conception of myself as a nurse and as possessing expertise.

References
Jootun, D., & McGarry, W. (2014). Reflection in Nurse Education. Journal of
Nursing & Care, 3(2). https://doi.org/10.4172/2167-1168.1000148
Lauren Caldwell, Claudia C. Grobbel (2013) International Journal of Caring
Sciences September - December 2013 Vol 6 Issue 3

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 Kolb, D. A. (1984). Experiential learning: Experience as the source of
learning and development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall
Cristicos, C. (1993). Experiential learning and social transformation for a post
apart heid learning future. In: Boud, D., Cohen, R. and Walker, D. (eds) Using
Experience for Learning. Open University Press, Buckingham, pp.157–168.
Aitchinson, J. and Graham, P. (1989) Potato crisp pedagogy. In: Cristicos, C.
(ed) Experiential Learning in Formal and Non-formal Learning. University of Natal
Media Resource Centre, Durban, pp.15–21.
Boyd, E.M. and Fales, A.W. (1983) Reflecting learning: key to learning from
experience. Journal of Humanistic Psychology, 23(2), 99–117.
Duke, S. (2000) The experience of becoming reflective. In: Burns, S. and
Bulman, C. (eds) Reflective Practice in Nursing, 2nd edn. Blackwell Science, Oxford,
pp.137–155.

ASSIGNMENT QUESTION 2

1. Critically reflect on two (2) current professional development activities in your own
working area and record them using the following reflective portfolio template.  
2. Reflect on an experience in your working area as stipulated in the portfolio template.

Activity 01
Title of Current Learning Burn patient management
Activity:

Location:   National Hospital Sri Lanka, Burns unit

lecture hall
Unit and Name of Institution

Date and Time: 12 September 2021

Complete Description of Learning Burn injuries may cause damage to skin, which
Activity: serves as the main barrier against infection.
Cardiogenic, hypovolemic, and distributive
shock can result from burn injuries. Numerous
extremely fatal consequences, both local and
systemic, may affect a burn victim. There is a
probability of widespread edema in tissues
other than the injured ones when the injury

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Key Learning Points from this
activity:
What did you learn as a result of
undertaking this activity?
Impact on Your Practice:
What areas of your practice have
you changed or improved?
covers more than 25 to 30 percent of the total
body surface area (TBSA). Major burns can be
effectively managed via fluid resuscitation. In
the view of the experts, fluid resuscitation
should begin in adults with 15% burns and
kids with 10% burns.
This learning activity includes the
identification of wounds caused by burns,
classification of those burns, determination of
the depth of burns, types of burns,
complications associated with burns, and burns
management.
After completing this module I was able to
identify different layers of the skin, the effect
of burn injuries on the integumentary system,
common causes of burn injuries, Categorizing
different depths of burn injuries, identify the
typical burn life cycle for each burn injury
type, common concerns associated with burn
injuries and Outline general treatment options
and dressing choices available for burn
injuries.
The pain may be brought on by direct
stimulation or damage to the nociceptors found
in the dermis and epidermis. C fibers and A-
delta then cause nerve impulses to travel to the
dorsal horn of the spinal cord. The brain's
peripheral stimuli and descending influences
both determine how much an impulse is
modulated (Castro et al., 2013). According to
the nature and intensity of pain, in burn
patients, the most effective treatment is drug
administration. Hence, I learned about modern
drugs available for pain management during
this course. Further, prior to undergoing this
training, pain management time was not taken
into much consideration by me. But After
following this course, I understood the
necessity of pain management of the patient
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within the shortest time period.

In the management of major burns, effective

fluid resuscitation is very important.
Intravenous fluids should be given “on the
scene,” in case of 25% burn. After more than 2
attempts at cannulation transfer should not be
delayed (Enoch et al., 2009). Hence, it was an
eye opener for me on how fluid management
during the first 24 hrs of treatment.

It was taught about the impact of burns on the

body and the psychological retardation of the
patient. Hence, during treatments, more
attention was given to improving the patient’s
psychological aspects.

Vital dyes, tissue samples, and

ultrasonography are the techniques that I have
learned during my basic training as the
methods to measure burn depths. These
techniques can identify dead or damaged
collagen. However, during this module, I
learned modern methods such as Fluorescein
perfusion fluoroscopy, laser Doppler
flowmetry, and thermography techniques as
new methods employed to assess changes in
blood flow. Nuclear magnetic resonance can
also be used to determine burn depth as per
Adam J. Singer and Jimmy Toussaint, 2014.

Non-pharmacological therapies such as in

ancient times, for the management of burn
honey, has been used. Maternal milk, a
mixture of gums and goat’s hair had been used
by Egyptians for the treatment of burns. Since
the 20th century, various local medications
have been used. Due to its hepatotoxicity, the
use of tannic acid spray was rejected in 1942

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 (Justin-Temu et al., 2008). In the management
of pain and anxiety in burn patients non-
pharmacological therapy is complementary

Future Actions or Areas of During future handling of patients, it is

Development: recommended to direct all burnt patients to one
location by establishing a burn treatment unit
in all hospitals. By doing so, vertical
specialization in burns treatment of nurses will
improve and it will directly help effective care
and treatment of patients.

Modern methods on scar management can be

educated and rehabilitation locations can be
established to improve the treatment of
patients.

As a nurse, I learnt the proper procedure to be

followed when treating burn patients. Apart
from that, I learnt the importance of fluid
management and wound care during the early
stage of treating patients.

Activity 02
Title of Current Learning Pain management Lecture
Activity:

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Location:   National Hospital Sri Lanka, Neuro Trauma
Unit and Name of Institution
Date and Time:
Complete Description of
Learning Activity:
Lecture Hall
26 March 2022
A complicated experience, pain includes
elements that are physiological, sensory,
emotional, cognitive, and behavioral. The
interplay of physical, psychological, cultural,
and spiritual variables affects how much pain a
person feels. Even while reducing pain is a key
component of any endeavor to alleviate
suffering, and even though pain and suffering
are closely related, they are still separate
concepts.
A psychosocial viewpoint that defines
suffering as a subjective phenomenon that can
be altered by biological, psychological, and
social processes has been used in this effort.
While a patient may experience excruciating
pain while not suffering (as during labor),
physical pain is not the only form of suffering.
In addition to pain, additional elements that
cause suffering in patients include anxiety,
sadness, nightmares, changes in how they see
their bodies, and adjustments to their social and
occupational functioning.
This learning activity includes
Definition of pain,
What is suffering?
Nociception and innervation
Neuropathic pain
Innervation of the urogenital system
Pain evaluation and measurement
Pain evaluation
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Key Learning Points from this
activity:
What did you learn as a result of
undertaking this activity?
Impact on Your Practice:
What areas of your practice have
you changed or improved?
Assessing pain intensity and quality of life
After completing this module I was able to
identify the following points as key learning
points.
 Unrelieved postoperative pain remains
common despite enormous technological
advances, substantial research into pain
management, and the existence of effective
pain relief strategies.
 Two significant barriers to effective
postoperative pain relief, identified from a
literature review, are the beliefs and attitudes
of both patients and nurses and nurses’ time
management.
 Auditing pain assessment and
management is the key to successful pain
assessment and management in clinical
practice.
 Pain should be assessed both before and
after the administration of analgesics;
moreover, pain scales should be utilized in
practice to measure the effects of pain
management in an empirical manner, and
pain scores should be documented in the
patient’s chart.
 Nurses spend the most time of all health
professionals with patients and are therefore
in a unique position to assess and manage
pain.
 By following this module I have
improved myself in
 Acknowledging and accepting the
patient’s pain;
 Identifying the most likely source of the
patient’s pain;
 Assessing pain at regular intervals, with
each new report of pain or when pain is
expected to occur or reoccur.
 Reporting the patient’s level of pain;
 Developing the patient’s plan of care
that includes an interdisciplinary plan for
effective pain management involving the
patient, family, and significant other;
 Implementing pain management
strategies and indicated nursing interventions
including
a) Aggressive treatment of side effects
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 (i.e. nausea, vomiting, constipation,
pruritus, etc),
b). Educating the patient, family, and
significant other(s) regarding,
(i) Their role in pain management,
(ii) The detrimental effects of
unrelieved pain,
(iii) Overcoming barriers to
effective pain management,
(iv) The pain management plan and
expected outcome of the plan;
 Evaluating the effectiveness of the
strategies and the nursing interventions
 Documenting and reporting the
interventions, patient’s response, outcomes;
and
 Advocating for the patient and family
for effective pain management

Future Actions or Areas of It is learnt that pain management is a crucial

Development: component of patient management. However,
very limited attention is given to this aspect in
the Sri Lankan context. Therefore, pain
management has to be digested by the nurses in
order to improve the status of treatments.

Furthermore, the recording/ documentation of

pain assessment to be improved in the present
scenario. There is very limited documentation
part undertaken at most hospitals and this must
be developed.

Timely administration of drugs is another

major aspect of pain management. This also
has to be improved among nurses to have
proper pain management.

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 Record of Reflective Accounts (Using the Gibbs Model, 1988)

Title: Critically reflect on a current situation in which your behavior and

action influence your ability to collaborate with others in your own
working area.

Date: 25 April 2004

Description: During my first year as a nurse practitioner, I was assigned to the

oncology ward, which is when the incident I will be reflecting on
happened. A senior patient with stomach cancer was admitted to the
ward and was one of our service users. When he arrived, we
examined his records, which noted that he had substantial learning
challenges, indicating that he also had communication issues
verbally. The key topics of reflection concern how other nurses and I
use communication to comfort patients and demonstrate compassion,
as well as how we modify our care to meet each patient's specific
requirements. Three members of the public were inspecting the ward
as part of a job recruitment procedure when a nurse entered the ward
with them.

The nurse told the public that the service users in that bay were
undergoing radiation treatments as soon as she entered the patient
bay. The service user became highly upset upon hearing the nurses'
wards and started crying, yelling, and pounding his head backward
on his pillow. It took some time, but another nurse eventually
managed to calm him down by speaking in a soothing manner.

Feelings: I was aware that the nurse was touring the three members of the
public around the oncology unit as part of a job recruitment
procedure before the event. I had only been working on the oncology
ward for six months at the time of the event, so I was still a little
unclear about my place in the group. In the end, I didn't feel
competent or experienced enough to handle this circumstance on my
own. However, it is still true that both my colleagues and I should
have intervened more promptly to ensure the patient was dealt with
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 effectively. I believe my elevated level of concern made it difficult
for me to step in. Furthermore, I was taken aback when the nurse
neglected to take into account the service user's unique needs during
the visit to the ward, as the distress this caused to both the service
user and the general public was unwarranted.

Evaluation: In retrospect, the experience had both positive and negative aspects
that have improved my understanding of the service user experience
and my function as a nurse practitioner on the oncology team. My
responsibilities included conducting physical examinations,
assessing the health of service users, prescribing medication,
explaining its effects, administering it, recommending diagnostic and
laboratory tests, reading the results, managing treatment side effects,
and supporting patients by acting in their best interests.

I believe I fell short of fully fulfilling the latter obligation. The nurse
was not made aware of the service users' communication issues or
the anxiety they were experiencing, which violated her obligation to
protect service users' privacy and ensure their safety. Our inability to
function as a cohesive team by exchanging information and
intervening before a problem got out of hand demonstrates the lack
of group cohesion.

Analysis: People with learning disabilities frequently struggle to adjust to new

settings, which means that when dealing with something outside of
their comfort zone, there is a possibility for bad behavior, according
to the nursing time clinical (2004). However, as stated by the
Nursing Times Clinical (2004), health care professionals should be
knowledgeable about how to connect with individuals who have a
learning disability, and this can be facilitated through regular and
beneficial reflections. It is recommended that experts learn about the
patient's communication style, their likes and dislikes, and address
any potential worries either through dialogue or by allowing the
patient to visit the ward and get to know the nursing staff before the

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 patient is admitted to the hospital.

In order to better care for patients, professionals should make eye

contact, look and listen, spend more time with them, be engaging
and communicative, be patient, and in some circumstances, let
another professional who may have experience with people who
have learning difficulties to do so..

Conclusion: Because of this experience, I am now more aware of how crucial it is

to practice being aggressive and professional in the event that a
circumstance like this arises again in the future. The knowledge I
have received from this experience has made me more conscious of
the necessity of delaying action and the value of acting in the
patients' best interests, even when doing so may require coverage.

Action plan: I intend to practice handling situations more in the future, regardless
of my position within the team or level of expertise, and this
includes handling the frazzled service customer. As I believe there is
a risk to a service user's physical or mental health, I make sure that
timely information is relayed to the appropriate staff and take action
when necessary.

Additionally, I will be sure to employ the various forms of

communication and conduct my own independent study on the needs
of a patient with learning challenges in order to address their
requirements and change how I approach them in the future..

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