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How to Write a Nursing Reflective Essay as a BSN Nursing Student

• Author Jermaine Huey
• Published November 29, 2023

Welcome to NursingWriters.net, your go-to resource for expert information and guidance on writing nursing essays. In this article, we will provide you, as a BSN nursing student , with a comprehensive guide on how to write a compelling nursing reflective essay. Reflective essays are a personal reflection on your experiences in the nursing profession, and we are here to help you navigate this writing challenge.

As a busy nursing student, we understand that you may have limited time to spare. That’s where NursingWriters.net comes in, empowering you to excel in your BSN program by providing expert guidance on different writing and comprehension challenges you may face. Let’s dive into the world of nursing reflective essays and discover how you can effectively express your thoughts and insights.

Key Takeaways:

• Reflective essays allow nursing students to reflect on their experiences and personal growth in the profession.
• A nursing reflective essay is different from a personal statement, focusing on self-reflection rather than academic achievements.
• Key elements to include in a nursing reflective essay are the inciting incident, personal reflections, vivid details, and actions taken.
• The introduction should grab the reader’s attention and provide a clear thesis statement.
• The body paragraphs should delve into the writer’s reflections and emotions with specific examples and anecdotes.

What Is a Reflective Essay in Nursing?

A reflective essay in nursing is a powerful tool that allows nursing students to analyze their experiences, emotions, and actions related to their nursing practice. It provides an opportunity for self-reflection, critical thinking, and personal growth. Reflective writing can help nurses develop a deeper understanding of their own practice, improve patient care, and enhance their professional development.

Reflective essays in nursing differ from personal statements in that they focus on specific experiences and their impact on the writer’s growth and development. These essays require the writer to critically reflect on their actions, emotions, and thoughts, and identify ways to improve their practice. By examining their experiences and applying reflective frameworks, nursing students can gain valuable insights into their strengths, weaknesses, and areas for growth.

When writing a reflective essay in nursing , it is important to follow a structured approach. This includes describing the incident or experience, analyzing personal thoughts and feelings, exploring the actions taken, and reflecting on the outcomes and implications. By structuring the essay effectively, nursing students can communicate their reflections in a clear and organized manner.

Key Elements to Include in a Nursing Reflective Essay

When writing a nursing reflective essay, it is important to include key elements that will make your essay comprehensive and impactful. These elements will help you convey your thoughts and experiences clearly, allowing the reader to gain a deeper understanding of your reflections on nursing practice.

Inciting Incident or Event

The first key element to include in your nursing reflective essay is the inciting incident or event. This is the moment or experience that triggered your reflection and made a significant impact on your practice. It could be a challenging patient encounter, an ethical dilemma, or a personal realization. By describing this event in detail, you set the stage for your reflective journey.

Personal Reflections

Your nursing reflective essay should also include personal reflections on the experience. This is where you delve into your thoughts, feelings, and emotions related to the inciting incident. Reflect on how the event made you feel, what you learned from it, and how it has influenced your growth as a nursing professional. Be honest and vulnerable in your reflections, as this will allow the reader to connect with your experience on a deeper level.

Vivid Setting and Descriptive Details

To create a vivid and engaging narrative, include specific details that paint a picture of the setting and the people involved. Describe the physical environment, the interactions between healthcare professionals and patients, and any other relevant details that contribute to the overall context of the experience. This will help the reader visualize the situation and understand the complexities of the event.

Actions Taken

Finally, it is important to describe the actions you took in response to the inciting incident. Discuss how you applied your nursing knowledge and skills to address the challenges or opportunities presented by the event. Reflect on the effectiveness of your actions and whether there were any areas for improvement. This demonstrates your ability to critically analyze your own practice and make informed decisions.

By including these key elements in your nursing reflective essay, you can create a comprehensive and impactful piece of writing that showcases your growth and development as a nursing professional.

How to Write the Introduction of a Nursing Reflective Essay

The introduction of a nursing reflective essay plays a crucial role in capturing the reader’s attention and setting the tone for the entire essay. It should provide a concise overview of the main points that will be discussed and create a sense of curiosity and engagement. Here are some tips to help you write an effective introduction for your nursing reflective essay:

• Start with an intriguing opening line: Begin your introduction with a captivating statement or anecdote that relates to the topic of your essay. This will grab the reader’s attention and make them eager to continue reading.
• Provide context and background information: Give a brief overview of the event or experience that you will be reflecting on in your essay. This will help the reader understand the context and significance of your reflections.
• Present a clear thesis statement: Your thesis statement should clearly state the main purpose of your essay and the specific points or themes that you will be exploring. This will give the reader a preview of what to expect in the body of the essay.

By following these tips, you can craft an introduction that captivates the reader and sets the stage for a compelling nursing reflective essay.

“As I walked into the busy hospital ward on my first day of clinical rotation, I couldn’t help but feel a mix of excitement and nervousness. Little did I know that this experience would become a pivotal moment in my nursing journey, shaping my understanding of empathy, communication, and patient-centered care. In this reflective essay, I will delve into the details of this encounter and explore the personal and professional growth that resulted from it.”

With an attention-grabbing opening, providing context, and presenting a clear thesis statement, your introduction will set the stage for a compelling nursing reflective essay that captures the reader’s attention and lays the foundation for your reflections.

Nursing Reflection Essay Tips and Examples

Writing a nursing reflective essay requires careful consideration and thoughtful analysis. Here are some tips to help you craft an impactful and meaningful reflection essay as a BSN nursing student . Additionally, we will provide examples to illustrate how these tips can be applied.

Tips for Writing a Nursing Reflection Essay:

• Start by choosing a specific experience or event that had a significant impact on your nursing practice. This could be a challenging patient encounter, a critical incident, or a personal realization that transformed your perspective.
• Reflect on the experience and consider how it affected your emotions, thoughts, and actions. What did you learn from the experience? How has it shaped your growth as a nursing professional?
• Focus on the key aspects of the experience that were particularly impactful or meaningful to you. Avoid including unnecessary details or deviating from the main message of your reflection.
• Use specific examples, anecdotes, or patient scenarios to support your reflections. This will make your essay more engaging and relatable to the reader.
• Consider the ethical implications of the experience and reflect on how it has influenced your approach to patient care and decision-making.
• End your essay with a reflection on the implications of your learning for future nursing practice. How will you apply the lessons learned to provide better care and improve patient outcomes?

Now, let’s take a look at two examples of nursing reflective essays to further illustrate these tips:

“During my clinical rotation in the Intensive Care Unit (ICU), I encountered a complex patient case that challenged my critical thinking skills and decision-making abilities. The patient was a middle-aged woman who had undergone a complicated surgery and experienced numerous post-operative complications. This experience taught me the importance of collaboration within the healthcare team and the significance of advocating for the patient’s best interests…”

“One of the most significant experiences during my nursing education was my time spent in the pediatric oncology unit. Witnessing the resilience and bravery of children facing life-threatening illnesses had a profound impact on my perspective as a nurse. It taught me the importance of providing holistic care, not only addressing physical needs but also supporting emotional well-being and promoting a positive environment for healing…”

These examples demonstrate how personal reflections, specific details, and professional insights can be incorporated to create a compelling nursing reflective essay. Remember to structure your essay in a clear and organized manner, ensuring that your reflections flow logically and coherently.

By following these tips and utilizing examples, you can create a compelling nursing reflective essay that showcases your growth and development as a nursing professional.

How to Conclude a Nursing Reflective Essay

The conclusion of a nursing reflective essay serves as the final reflection on the writer’s growth and learning from the experience. It is an essential part of the essay that summarizes the main points discussed and leaves a lasting impression on the reader. The reflective essay conclusion should bring closure to the essay by restating the thesis statement and highlighting the key takeaways from the essay.

To write a strong and impactful conclusion, start by restating the thesis statement in a clear and concise manner. This reminds the reader of the main focus of the essay and reinforces its significance. Next, summarize the key points discussed in the body paragraphs, highlighting the most important insights and reflections. This helps to reinforce the main ideas and ensures that they are not overlooked in the final reflection.

In addition to summarizing the main points, a thought-provoking statement or future outlook can be included to provide a sense of closure and leave the reader with something to ponder. This can be a reflection on how the experience has influenced the writer’s future practice or a call to action for continued personal and professional growth. By ending the essay on a strong and meaningful note, the conclusion enhances the overall impact of the nursing reflective essay.

A well-crafted conclusion is essential for a nursing reflective essay as it reinforces the main ideas, leaves a lasting impression on the reader, and provides a sense of closure. By following these tips, nursing students can create a powerful and impactful conclusion that enhances the overall effectiveness of their reflective essays.

Tips for Writing a Nursing Reflective Essay

Writing a nursing reflective essay can be a challenging task, but with the right approach, it can also be a rewarding experience. Here are some helpful tips and strategies to guide nursing students in their essay writing process:

• Start early: Give yourself plenty of time to brainstorm ideas, reflect on your experiences, and write and revise your essay. Starting early will help you avoid last-minute stress and allow for a more thoughtful and polished essay.
• Conduct thorough self-reflection: Before you begin writing, take the time to reflect on your experiences and emotions related to your nursing practice. Consider how these experiences have shaped your growth and development as a nurse, and what lessons you have learned along the way.
• Organize your thoughts and ideas: Create an outline or a rough structure for your essay to ensure a logical flow of ideas. Group similar thoughts and reflections together to create cohesive paragraphs, and use headings or subheadings to further organize your essay.
• Seek feedback: Share your essay with trusted peers or instructors and ask for their feedback. They can offer valuable insights, provide constructive criticism, and help you refine your essay to make it stronger and more impactful.

Additionally, it is important to pay attention to the technical aspects of your essay:

• Grammar and spelling: Proofread your essay carefully to ensure it is free of any grammatical or spelling errors. Use grammar and spell-check tools, and consider asking someone else to review your essay for a fresh perspective.
• Coherent writing style: Use clear and concise language to convey your thoughts and reflections. Avoid excessive jargon or technical terms, and focus on communicating your ideas effectively.
• Formatting guidelines: Follow any formatting guidelines provided by your instructor or institution. Pay attention to font style, size, spacing, and citation style if required.

By following these tips and strategies, nursing students can approach their reflective essay writing with confidence and produce compelling and insightful essays that showcase their growth and development in the nursing profession.

Reflective Tools and Models for Nursing Reflective Essays

Reflective tools and models can provide structure and guidance for nursing students when writing reflective essays. These tools help organize thoughts and experiences, allowing for a more comprehensive and meaningful reflection. By utilizing reflection models , nursing students can enhance their reflective writing skills and deepen their understanding of their own growth and development as healthcare professionals.

Gibbs’ Reflective Model

“Reflective practice is both an art and a science that requires ongoing commitment and practice.” – Gibbs

Gibbs’ Reflective Model is a widely used reflection framework in nursing. It consists of six stages: description, feelings, evaluation, analysis, conclusion, and action plan. This model encourages a structured approach to reflection, allowing the writer to systematically explore their thoughts and emotions, analyze the situation, and identify areas for improvement or further development.

Dewey’s Reflective Thinking Model

“We do not learn from experience, we learn from reflecting on experience.” – Dewey

Dewey’s Reflective Thinking Model focuses on the importance of reflection as a tool for learning and growth. It emphasizes the need to actively engage with experiences, thoughts, and emotions, and to critically evaluate them in order to gain deeper insights and understanding. This model encourages nursing students to think analytically and develop a continuous learning mindset.

Kolb Reflective Model

“Knowledge results from the combination of grasping experience and transforming it.” – Kolb

The Kolb Reflective Model is based on the concept of experiential learning. It consists of four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. This model encourages nursing students to engage in a cyclical process of learning, where they actively participate in experiences, reflect on them, conceptualize their insights, and apply their learning in real-life situations.

Schön Reflective Model

“Reflection-in-action is the heart of the learning process.” – Schön

Schön Reflective Model emphasizes the importance of reflection in the midst of action. It focuses on the ability to think and adapt in real-time, making decisions based on professional knowledge and experiences. This model encourages nursing students to develop a reflective mindset that allows them to learn and grow while actively engaging in their practice.

Benefits of Reflective Writing in Nursing

Reflective writing plays a crucial role in nursing practice, offering numerous benefits for nursing students and professionals alike. By engaging in reflective writing, nurses can enhance their self-awareness, develop their critical thinking skills, and gain a deeper understanding of patient experiences. This section will explore the advantages of reflective writing in nursing and its significance in healthcare.

Enhanced Self-Awareness

Reflective writing fosters self-reflection, allowing nurses to examine their thoughts, emotions, and actions in various clinical situations. Through this process, they gain a deeper understanding of their strengths, weaknesses, and areas for improvement. This heightened self-awareness enables nurses to provide more effective and compassionate patient care, fostering a patient-centered approach.

Improved Critical Thinking

Reflective writing encourages nurses to think critically about their experiences and the impact of their actions. It requires them to analyze and evaluate the effectiveness of their decision-making and problem-solving skills. By reflecting on past experiences, nurses can identify areas where they can enhance their clinical practice and make informed decisions based on evidence and best practices.

Increased Empathy and Understanding

Through reflective writing, nurses develop a deeper empathy and understanding of patient experiences. By reflecting on their interactions with patients, nurses can recognize the emotions, fears, and challenges faced by individuals in their care. This increased empathy enables nurses to provide more holistic and patient-centered care, improving the overall healthcare experience for patients.

Continuous Professional Development

Reflective writing is an essential tool for nurses’ continuous professional development. It allows them to document their growth, learning, and achievements throughout their nursing career. By regularly engaging in reflective writing, nurses can identify areas for further development, set goals for improvement, and ensure they are providing the best possible care to their patients.

Overall, reflective writing in nursing is a powerful tool that empowers nurses to enhance their self-awareness, critical thinking skills, and empathy. By engaging in this practice, nurses can continuously improve their clinical practice, provide high-quality patient care, and contribute to the ongoing development of the nursing profession.

Nursing Reflective Essay Examples

Looking for inspiration for your nursing reflective essay? Here are some examples that showcase different experiences, reflections, and growth in the nursing profession.

These examples demonstrate how nursing reflective essays can provide valuable insights into personal experiences, reflections, and professional growth. They serve as excellent references to help nursing students develop their own reflective writing skills and gain a deeper understanding of the nursing profession.

Writing a Nursing Reflective Essay for Nursing School Application

A nursing reflective essay can be a powerful tool for nursing school applications. It allows applicants to showcase their self-awareness, critical thinking skills, and passion for the nursing profession. When writing a nursing reflective essay for a nursing school application, there are a few key tips to keep in mind.

Reflect on your passion for nursing

Start by reflecting on what drew you to the nursing profession and why you are passionate about it. Consider your personal experiences, such as volunteering or shadowing healthcare professionals, and how they have shaped your desire to become a nurse. Highlight your commitment to providing compassionate and quality patient care.

Share personal experiences in healthcare settings

Provide specific examples of your experiences in healthcare settings, such as clinical rotations or internships. Reflect on the challenges you faced, the lessons you learned, and how those experiences have impacted your growth and development as a future nurse. Discuss any significant interactions with patients, healthcare teams, or mentors that have shaped your understanding of the nursing profession.

Align with the nursing school’s values and mission

Research the nursing school’s values, mission, and educational philosophy. Ensure that your reflective essay aligns with these principles and demonstrates your commitment to the school’s mission. Use the nursing school’s prompts or essay questions as a guide to structure your essay and address the specific criteria they are looking for in applicants.

By following these tips, you can write a compelling nursing reflective essay that effectively conveys your passion for nursing, showcases your experiences, and aligns with the nursing school’s values. Remember to proofread your essay carefully for grammar and spelling errors and seek feedback from mentors or trusted individuals in the nursing profession to ensure your essay is clear, concise, and impactful.

(Table) Tips for Writing a Nursing Reflective Essay for Nursing School Application

Writing a nursing reflective essay can be a transformative experience for BSN nursing students. It allows them to gain valuable insight into their own growth and development as future healthcare professionals. Throughout this comprehensive guide, we have provided expert information and guidance on how to write a compelling nursing reflective essay.

By understanding the purpose of a reflective essay and the key elements to include, nursing students can effectively showcase their personal experiences and reflections. Incorporating reflection models such as Gibbs’ Reflective Model or Kolb Reflective Model can also provide structure and depth to their essays.

At NursingWriters.net, we are dedicated to empowering busy nurses and providing them with the tools they need to excel in their BSN programs. Whether it’s writing a reflective essay or any other writing challenge, we are here to support and guide nursing students towards success.

What is a nursing reflective essay?

A nursing reflective essay is a personal essay where the writer reflects on their own experiences and how those experiences have shaped their growth and development in the nursing profession.

How is a reflective essay in nursing different from a personal statement?

While a reflective essay in nursing focuses on the writer’s personal experiences and reflections, a personal statement is more of a formal document that highlights the writer’s qualifications, achievements, and future goals in the nursing profession.

What are the key elements to include in a nursing reflective essay?

The key elements to include in a nursing reflective essay are the inciting incident or event, personal reflections on the experience, specific details to create a vivid setting, and a description of the actions taken by the writer. It is important to avoid including academic details and excessive focus on emotions.

How should I write the introduction of a nursing reflective essay?

To write an engaging and informative introduction for a nursing reflective essay, you can grab the reader’s attention with an intriguing opening line, provide context and background information, and present a clear thesis statement. Focus on the specific event or experience that will be the main focus of the essay.

How should I structure the body paragraphs of a nursing reflective essay?

The body paragraphs of a nursing reflective essay should have a clear structure. Use the first paragraph to present the thesis statement and provide background information on the event. Use subsequent paragraphs to explore your reflections, emotions, and actions taken. Use specific examples and anecdotes to make the essay more engaging.

How should I conclude a nursing reflective essay?

To write a strong conclusion for a nursing reflective essay, you can summarize the main points discussed in the essay, provide a final reflection on your growth and learning from the experience, restate the thesis statement, and leave the reader with a thought-provoking statement or future outlook.

What are some tips for writing a nursing reflective essay?

Some tips for writing a nursing reflective essay include starting early, conducting thorough self-reflection, organizing your thoughts and ideas, and seeking feedback from peers or instructors. Pay attention to proper grammar and spelling, coherent writing style, and adhere to any formatting guidelines provided.

How can reflective tools and models help with nursing reflective essays?

Reflective tools and models provide structure and guidance for nursing students when writing reflective essays. Models such as Gibbs’ Reflective Model, Dewey’s Reflective Thinking Model, Kolb Reflective Model, and Schön Reflective Model can be used as frameworks for organizing thoughts and experiences in a nursing reflective essay.

What are the benefits of reflective writing in nursing?

Reflective writing in nursing offers benefits such as enhanced self-awareness, improved critical thinking skills, increased empathy and understanding of patient experiences, and continuous professional development. It promotes lifelong learning and helps improve patient care.

Where can I find nursing reflective essay examples?

You can find nursing reflective essay examples that showcase different experiences, reflections, and growth. These examples incorporate personal reflections, specific details, and professional insights into nursing practice. They demonstrate the diversity of topics and experiences that can be explored in nursing reflective essays.

How can I write a nursing reflective essay for nursing school applications?

To write a nursing reflective essay for nursing school applications, reflect on your passion for nursing, personal experiences in healthcare settings, and future goals in the nursing profession. Address specific prompts and align the content with the nursing school’s values and mission.

How can writing a nursing reflective essay benefit BSN nursing students?

Writing a nursing reflective essay allows BSN nursing students to gain insight into their own growth and development as future healthcare professionals. It helps improve critical thinking skills, self-awareness, and understanding of patient experiences. It also promotes continuous professional development.

Jermaine Huey

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How to Write a Nursing Reflective Essay (Guide for Nurse Students)

If you are a nursing or medicine student, you are aware that you will come across or have already come across assignments requiring you to write a nursing reflection essay. At first, such a task always appears challenging, but given the understanding of the steps, things flat out, and you can write reflective essays and get better grades.

Reflective practice is highly encouraged in nursing. Reflection entails making sense of situations, events, actions, and phenomena in the workplace.

As a nursing student, you will be asked to write a reflective essay on your clinical placement, practicum, shadowing experience, shadow health DCE activities, personal nursing philosophy, why you want to become a nurse, nursing program, ethical dilemma, knowledge, skills, and abilities, systems, and processes.

The easiest way to complete the reflective essay assignment is by first determining what reflective writing entails, its significance, its steps, and some of the best tips that form the core of this ultimate guide.

Basics of Reflective Writing in Nursing

Reflective writing is an analytical writing practice where the writer describes a real or imaginary event, scene, phenomenon, occurrence, or memory, including their takeaway. It entails the critical analysis of an experience, including recording how it has impacted you and what you intend to do with the new knowledge or how to act when such an occurrence recurs.

As you document the encounter, you can use first-person pronouns and write subjectively and objectively. This means that you can decide to either use personal experiences alone or support these experiences using citations from scholarly sources.

When writing a reflective essay in nursing, you must recount the events and give critical detail of how the events shaped your knowledge acquisition. Reflection helps nursing students develop skills in self-directed learning, which is directly associated with high motivation and improved quality of care .

In most cases, reflection occurs on what went well and what went wrong. It could be a successful operation, a thank you note from a patient, a patient who regained their health faster, or a new nursing care plan that worked. However, it can also be about adverse events such as death, postoperative complications, death of an infant at birth, dissatisfied patient, medical error, or a failed procedure.

As a nursing student, when you learn to reflect on situations, you grow to become a professional nurse who diligently does their noble duty.

When writing a reflective essay, you begin by setting the scene (explaining what, where, how, and who-the situation), detailing how you felt (emotional state), why it happened (making sense of the situation), critical review and development of insights, a note on what was learned, and strategies to address future recurrence.

Your professor may ask you to write a nursing reflective paper about various topics in your course or your experience working in a group, how you solved a problem, a healthcare issue, or clinical practice. Consider the following example of a reflective statement in nursing; in my clinical practices, I realized I focused more on the technical aspects but failed to explain what it was doing to improve their health. I would like to understand more about listening to patience and their concerns to better care for them.

As you will notice later, these reflective stages are structured into different reflective models and frameworks that we will explore in-depth. So, with the understanding of what comprises reflective writing and its importance in nursing, let's now get solid on the structure.

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• Nursing Theories and Theorists.

Structure of a Reflective Essay in Nursing

A reflective essay is an analytical writing piece describing and evaluating encounters or experiences. When asked to write one, you should know that an excellent reflective essay consists of different parts, just like a typical academic essay. It comprises the cover or title page, introduction, body paragraphs, conclusions, and a references page.

The title page contains information about the assignment. If you are writing the reflective essay in APA, include these on the title page:

• Title of the reflective essay
• Course code and name
• Instructors name
• Name of your institution
• Date of submission

When writing in Harvard format, the title or the cover page will consist of the following:

• Title of the essay in title case and the page number (upper right margin),
• Title of the essay in CAPS,
• Name of class or course,
• Name of the instructor,
• Name of your school,
• City and state where your school is located and,
• The date of submission.

Introduction

The introduction begins with an attention grabber or a hook sentence to attract readers' attention. It should then explain the essay's purpose and signpost the ideas that will come later in the essay. The introduction also has a thesis statement at the end of the paragraph- the last sentence. The thesis is concise, clear, and relatable and should reflect your position.

Body Paragraphs

The body paragraphs of a reflective essay can be three or more, depending on the length of the essay. Essentially, the body comprises 80% of the total word count.

The first paragraph is where you describe the situation, including the events, why they occurred, how they occurred, and those involved.

The second paragraph entails your personal feelings or reaction to the situation and how it made you feel.

The third paragraph can include making sense of the situation. You have to think about why things happened the way they did. You should also critically review and develop insights based on the situation. Finally, think of the factors that could have influenced the situation.

The next paragraph should explain how the event or situation will change your practice, approach, decisions, perspective, or perception. This is where you evaluate the experience by detailing the knowledge and skills you took from the experience.

The last body paragraph should entail a critical reflection on the learning opportunities. First, describe the situation and what it made you learn. Next, elaborate on how you intend to make yourself better poised to address such situations.

Mostly, you should structure the body of your essay as per the preferred nursing reflective model.

After everything else falls into place, you need to summarize the information you presented in the essay. Then, finally, restate your thesis and have a call to action to bring a sense of closure to your readers.

Steps for Writing a Nursing Reflection Essay � The Guide

When assigned to write a reflective essay for your nursing class, here are the surefire steps to get you to success.

Read the instructions

The first step after receiving an assignment is to begin reading the instructions. as you read, note what your instructor or professor expects in the paper you will submit for marking.

Reading instructions helps you to get informed on the scope of the paper, word count, number of references and pages, and the formatting style to use.

Besides, you also get to plan your paper with the deadline highlighted in the instructions.

You need to get a conducive environment where you can start writing.

The first step of writing is to brainstorm about situations during your clinical hours when you were shadowing a Nurse Practitioner or one you have read about.

Assess whether the situation or scenario you have thought, encountered, or chosen can help you write a reflective essay that meets the requirements.

Research and Plan

After choosing a scenario, the next step is researching the best reflective model.

You can use your class text, the instructions, the college library, course readings, and online nursing journals to get articles and resources with information about specific reflective models.

Select the best reflective model and take notes on the steps it entails.

As you research, write down notes on how to address your paper based on your selected framework or model of reflection . Additionally, research nursing journal articles with information you can use when critically analyzing a situation.

Plan how you will handle the paper as well. For instance, as you research, develop a thesis statement that grounds your entire paper, then draft an outline on how to develop the thesis.

Write an Outline

Outlining is a crucial aspect of writing. It helps you envision how you will meet the objective of writing a reflective essay. As an essential part of the essay writing process, outlining helps create a good flow of ideas and can come in handy in helping you overcome writer's block. Your outline should comprise the following:

• The hook or attention grabber
• Thesis statement
• Main points of each body paragraph (topic sentence, evidence, examples, illustrations, etc.)
• Conclusion (restated thesis and call-to-action)

With the outline done, you should take a break and resume writing your first draft of the nursing reflection essay. Writing with an outline helps avoid mistakes and also helps you write faster.

Describe the Experience

Once you have identified the relevant experience, begin describing it chronologically.

Describe the experience that prompted you to consider nursing your ideal career goal. Think of this experience's key elements, such as the setting, patient demographics, and significant events that impacted you.

Show how these events changed your perspective on life. Ensure you are as descriptive as possible to paint a clear picture for readers.

Consider the following questions to come up with a good description:

• What happened?
• Was there someone involved? If yes, what part did they play?
• Where did the event take place?
• What actions did you take?

Set the context of this experience by giving relevant background information. Ensure you are objective and pay attention to the facts.

Provide a Reflection

Talk about your feelings and thoughts concerning the particular experience you went through. You have to be honest and open up about your initial expectations and challenges you faced at each stage of the experience. The following questions can help you come up with a good reflection:

• What was I trying to achieve?
• What prompted me to act the way I did?
• Are there any consequences for my actions? If yes, what are they?
• How did I feel about this event as it was happening?
• How did those around me react to it?
• How do I know how those around me felt about it?

Analyze the Experience

Description of an experience is essential, but so is analysis. You have to move beyond the surface and give a critical analysis of your experience.

State your actions, and your overall experience will give insights into your experience. Think of how the experience has impacted your actions, feelings, and thoughts.

Give an Evaluation

Evaluate the skills and knowledge you got from the experience. Show how you can apply these skills and knowledge in your nursing practice. Also, state the actions and interventions you took during the nursing experience.

State whether you achieved the desired outcome and if there are any specific areas that you need to improve on.

Talk about how you built or improved skills like communication, teamwork, and critical thinking.

As you evaluate the experience, identify what you believe to be your strengths and weaknesses in the nursing experience. What have you learned from the experience? State the areas where you excelled and what abilities contributed to your success.

Talk about how those you were with during the clinical experience complimented you. Similarly, acknowledge your weaknesses.

What kind of mistakes did you make, and how did you improve them? Talk about the tasks that drain you most during the experience.

Illustrate Learning

Demonstrate elements of deeper thought and reflection levels. This is a great point to include nursing theories in your reflection essay to support analysis of your experience.

Relate your experiences to the theoretical frameworks you were taught in class. This is effective learning and will demonstrate your ability to apply knowledge to real-life nursing situations.

Doing this will also show that you can effectively deduce different things from observations made during the reflection process.

Ensure you also demonstrate a change in perspective, as this will prove that you learned something from the experience.

Write Your Conclusion

Conclude by summarizing your points and highlighting the lessons learned.

The lessons you reached as part of your reflection should support your overall conclusion.

Also, restate your thesis statement.

Come Up with an Action Plan

Now that you have learned from your reflection develop an action plan for future nursing practice.

This part should contain all the details you have learned and actions needed to improve when faced with a similar situation. Consider the following questions:

• What would I change if faced with a similar situation?
• How can I develop the necessary skills needed to face this situation?
• How can I act differently in a similar situation?  

Ensure you identify areas to improve and set realistic goals to enhance your nursing skills. Discuss how you intend to seek additional education, training, or mentorship to address your shortcomings.

Finally, end the essay with a happy note so readers know you learned something from the experiences.

Proofread, Edit, and Polish

After doing your first draft, take a break to relax and get out of the writing mood - it helps you to become objective.

You can then resume reading out loud to yourself, make necessary tweaks, and ensure that every part you include meets the rubric requirements.

Edit for grammar, punctuation, tenses, voice, spelling, and use of language. You should also proofread the essay to adhere to the style, organization, and presentation requirements.

Ensure that all the in-text citations are accounted for in the reference list and are up-to-date. You are good to go when you have an essay that meets all the instructions.

Finally, you can submit the paper for grading.

Writing is not everyone's cup of tea. For that reason, you can hire a nursing reflection essay writer from our website to assist you in crafting a top-grade paper. In addition, we have nursing writers whose forte is writing various nursing papers.

Choosing the suitable Reflective Model or Framework

As you can see above, many reflective models are used for your reflective essay. We have not exhaustively listed and expounded on all of them. Other reflective models and frameworks you can also consider when writing a reflective essay in nursing include:

• Bouds Reflective Model
• Brookfield Reflective Model
• Pender's Health Promotion Model
• Roper Logan and Tierney Model
• Driscoll Reflective Model
• The Johari window model

Note that most nursing instructors will often suggest the models they prefer for you to use in your essay.

For example, in most nursing reflective essays. Whichever the case, readily available information expands on each model to make it easier to write a reflection essay on a specific aspect of nursing education or practice.

Read the assignment rubric and instructions to understand the specific model. If it is unclear, ask for clarification from your instructor early enough.

Tips for Writing a Good Nursing Reflective Essay

As you try to figure out how to write a nursing reflective essay, keep the following tips in mind.

Choose the Right Topic

If the instructions from your professors involve choosing a topic for the reflective essay, you must select one that is meaningful to you.

This will ensure you can easily write and easily develop relevant elements about the topic. Therefore, take time to pick a topic that you find interesting.

As you write, ensure you stay on topic, whether sharing a one-off event or a recurrent story.

Use the Right Tone

A reflective essay is more personal, unlike other types of academic essays. This means you don't need a strict or formal tone.

Since this is about your experiences, use personal pronouns such as I and Me.

Be Vulnerable

You must be extremely vulnerable to learn how to write a reflective essay in nursing.

Be open about your thoughts, feelings, and beliefs about something you went through that sparked an interest in nursing.

It's okay to share mistakes or things you did wrong that eventually led you to this career path.

Choose the Right Focus

A reflection essay is all about narrating your experience during the nursing experience.

While including other people in your experience is okay, please let them not be the center of your reflection.

This is your essay, so you should be the focus of attention.

Keep it Brief

A good nursing reflection essay should be between 300 and 800 consciously written words. Because of this length, you must only write relevant information about your reflection. Refrain from lengthy reflections, as they make it difficult to pass your points across.

Convey Your Information Wisely

Even though a nursing reflection essay is about your personal experiences, it doesn't mean you should reveal everything about yourself. Ask yourself whether something is appropriate before including it in your paper.

Mistakes to Avoid When Writing a Reflection Essay in Nursing

A good reflection essay involves reflecting on your nursing studies and practices throughout school and career to demonstrate your competence. For this reason, there are certain mistakes you should be aware of when writing an essay.

Not including a Personal Story

Like food tastes bland without salt, so does a reflection essay without a personal story. At the center of a reflection essay is You. This means the essay should focus on your personal story that led you to want a nursing career. A lot of times, students miss out on this instead of talking about their story. You need more than just the personal qualities you think will be a great fit for the nursing program; you must also share a story that shows how well you contributed to nursing care.

Failing to Share Your Experience

You will lose points when you fail to include nursing-related experiences in your reflection essay. Mentioning that you want to be a nurse is great, but failing to show specific events that led to the desire will cost you a great point.

Plagiarizing Your Essay

Plagiarism is a serious academic offense because it is considered taking other people's ideas and using them as your own without crediting the author. So, provide relevant citations and references for any ideas that aren't your own. Also, an AI will not write your essay as a human writer would. 

Related Readings:

• How to write a student nurse resume with no experience.
• PICOT examples and guides

Sample of a Nursing Reflective Essay 

The following is a sample of a nursing Reflective essay using Gibb's Model of Reflection. Use this sample to guide you when writing your own.

Introduction  Communication is an important element in healthcare practice as it determines patient satisfaction and treatment outcomes. This essay will focus on reflecting on an experience I went through with a 40-year-old diabetic patient who also had a foot infected with an ulcer. When I approached the patient to sign the consent form, I noticed that he wasn't happy because of the news given to him about his health. I concluded that there must be a communication dilemma. I will reflect on the experience using Gibb's Model of Reflection. Using this model, I will identify and discuss the actions taken to resolve the issue. Description  This incident happened a few months ago when I was working as a wound nurse in a Methodist hospital in my hometown. I was part of a care team handling the case of a 40-year-old male patient with diabetes and an infected diabetic foot ulcer. After careful examination, a team comprising various specialists concluded that his leg needed amputation below the knee. After making this decision, the team left, and I was asked to give the patient a consent form to sign. When I came back from retrieving the form, I noticed the patient looked sorrowful because of the news given to him. Feelings  As soon as I saw the patient, I knew what he was going through. He perceived the situation to be irreparable, but I wasn't sure whether to console the patient or not. I was powerless and couldn't imagine what he was going through. At the same time, I was startled that the team left without showing any compassion. They could have handled the situation more delicately. I, on the other hand, could have relayed the information better. I wasn't sure whether my approach would be acceptable or appropriate. Evaluation  I always go back to that particular situation and wonder whether I could have acted better. The situation helped me better understand the importance of good communication in patient care, particularly in therapeutic care. Before the incident, I didn't acknowledge the role of nurses play in caring for patient's emotional needs. I realized nurses must show compassion and console patients in their low moments.  Analysis  Most healthcare professionals do not know how to deliver bad news to patients. They find the process extremely challenging and always feel psychologically unprepared. This has a negative impact on patients and could lead to bad health outcomes. Furthermore, how information is relayed could impact a patient's adherence to treatment. Because of these effects, multiple protocols and approaches were developed to help with communicating bad news to patients. One of the approaches that was proposed is emotion-centered. This proposes that a healthcare provider acknowledges how sad the patient is and builds a professional relationship based on empathy and sympathy. Action Plan I now understand the essence of communicating bad news with compassion. The experience allowed me to look closely at different aspects of my professional development that needed more improvement. Thus, I plan to be more empathetic and speak up in support of patient's emotional and psychological well-being, especially when presented with traumatic news about their health. Additionally, I now understand I am not powerless when dealing with a sorrowful patient. I believe I have learned from my experience, and I'm not able to communicate well with patients any more. Conclusion  The experience allowed me to value good communication in nursing and the need to incorporate it into daily nurse-patient interaction. Nurses must learn how to deliver bad news and manage patient's sorrow. This has been and will continue to be my biggest priority in patient care. References Street Jr, R. L., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient education and counselling, 74(3), 295-301. Buckman, R. (1992). Breaking bad news: why is it still so difficult? BMJ: British Medical Journal, 304(6842), 886. Ptacek, J. T., & Eberhardt, T. L. (1996). Breaking bad news: a review of the literature. The Journal of the American Medical Association, 276(6), 496-502.

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Nursing Reflective Essay: Examples + Useful Writing Tips [2024]

Do you need to write a reflective nursing essay? Whether you are a nursing student or already working, we know that you may be too busy writing papers. We’ve prepared information for you about reflection models and nursing reflective essay examples, writing instructions, and templates for the outline. This article will teach everything you need to make writing your essay easier.

So, how do you write an academic reflective essay?

What Is a Reflective Essay?

15 best reflective essay topics: nursing, nursing reflective essay examples, reflective tools and models, reflective essay writing tips, reflective essay body paragraphs, how to conclude a reflective essay.

In a reflective essay, you express your thoughts based on your knowledge, beliefs, reflections, and experiences. A reflective essay is best described as an exceptional and personal essay: you will have a lot to think about, comprehend, and explain. You have to demonstrate the feelings that you have experienced before. It should be honest. If you have any opposing thoughts and feelings about the topic, you should write them.

The peculiarity of a reflective essay, unlike an analytical one, is in the expression of thoughts based on personal experience.

How long does a reflective essay last? It’s simple. It depends on your topic and how you express your thoughts. But you have to remember that this is a highly brief type of essay, and you can do it with a few pages.

You can check out the 100% free essay samples to see it all.

What Is a Reflection in Nursing Essay?

Nursing involves many aspects of work, and reflection is one of the critical tools for developing professional competence and personal skills. In nursing, reflection is important because it provides all the prerequisites for further personal growth. It is a reflection that will allow you to take a broader look at your strengths and weaknesses and assess your prospects.

Think of your nursing reflective essay as a chance to reflect on your career, skills, and personality, which will lead to further improvement.

• Empathy and support in nursing.
• Communication with patients is one of a nurse’s most important tasks.
• Nursing is the art of caring for the patient during illness.
• The key is not to cause harm but to help afterward.
• Time management in nursing.
• The Patient’s Interests Come First.
• Why did I become a nurse?
• Doctor- patient confidentiality in nursing.
• The importance of enhancing soft skills for the nurse.
• Nursing knowledge should not be limited to narrowly professional information.
• Reflective essay on the internship .
• Nursing culture and ethics .
• Deontology of nursing and its synthesis with my personal experience.
• Nursing clinical reflection essay.
• Nursing issues for the elderly.

To better understand what reflexivity is, let’s look at examples based on these articles:

Scientists from different fields of science invented many models to simplify the process of reflection. Below are reflection models you can use in your essay nursing writing practice.

Gibbs’ Reflective Model

In 1998, Graham Gibbs introduced his reflexive model to the world. Gibbs’ model is a cycle and, therefore, excellent for analyzing repetitive experience.

It covers 6 stages:

• Description. What happened? Don’t judge or try to conclude yet; just describe.
• Feelings. What were your reactions and emotions? Again, don’t begin to analyze them yet.
• Evaluation. What was good or bad about the experience? Make value judgments.
• Analysis. Were different people’s experiences similar or different in importance?
• Conclusions. What conclusions can you draw in a general sense from this experience and your analysis? What conclusions can you draw about your particular, unique personal situation or way of working?
• Personal action plans. What steps are you going to take based on what you have learned? What are you going to do differently in this situation next time?

Dewey’s Reflective Thinking Model

John Dewey believed that reflective thinking is the active, persistent, and careful evaluation of a belief or assumed form of knowledge, the grounds for that knowledge, and the additional conclusions to which knowledge leads.

John Dewey’s Reflective Model was one of the first and has been the foundation for many other models. He identified five steps of reflective thinking:

• Step 1: Identify the problem.
• Step 2: Investigate the issue.
• Step 3: Generate several possible solutions.
• Step 4: Evaluate the options and select the best answer from the combination of solutions.
• Step 5: Test and implement the solution.

Kolb Reflective Model

The Kolb Reflective Model or “Kolb cycle” focuses on transforming information into knowledge. The basic four steps of the Kolb model are as follows:

• Concrete experience. Anyone should already have experience in the field or area they want to learn.
• Observation and reflection . This stage implies analyzing the person’s experience and knowledge .
• Forming abstract concepts . A model describing the information and expertise is built at this stage . Ideas are generated, interrelations are made, and new information is added concerning how everything works and is arranged.
• Testing in new situations . The last stage implies experimentation and testing the model’s applicability and concept . The result of this stage is a direct unique experience. Then the circle closes.

Schön Reflective Model

Donald Schön’s reflexive model was described in the book ‘ The Reflexive Practitioner .’ He explained how professionals solve problems with a kind of improvisation that is perfected through practice.

Schön’s reflective model , like his writings, is based in many ways on the Dewey we already know

• Action reflection involves reflecting on an experience you have already had or an action you have already taken. It involves considering what could have been done differently and the positive aspects of that interaction.
• Reflection in action involves reflecting on your efforts as you make them and considering issues such as best practices throughout the process.

Bouds Reflective Model

David Bouds paired with Schön to explore the limits of reflective practice. This model is based on learning by doing. By analyzing his own experience, the practitioner begins to understand better how to improve certain things.

Bouds suggests that by reflecting, a person may be unconsciously learning. In reassessing the events of his life, he systematizes and classifies emotions, ideas, and results, as well as results, and compares past goals with results.

Past experiences, experiences, and ideas require constant analysis attention to feelings. This leads to new perspectives, commitment to action overall positive changes in behavior.

Driscoll Reflective Model

John Driskoll proposed a simple model of reflection at the beginning of the 21st century. It involves reflection through extended answers to questions we are already familiar with. The scholar linked the three basic questions to the stages of the experiential learning cycle and then added trigger questions that must be answered to complete the process of reflection.

Step 1: What? Sets out to recall what happened as objectively as possible, without criticizing anything that happened

• What exactly happened?
• What exactly did you do?
• Was anyone else involved?
• Was it a good experience? Or a bad experience? Or both? And why?

Step 2: So what? It requires you to slow down and start looking for patterns or meaningful moments. The key here is to bring in concepts that help shed light on what is going on.

• How did you feel at that particular moment?
• How did you react?
• Why did you react that way?
• Did you feel the same way about the situation then as you do now?
• Did you experience conflict with your values?
• Do you think past cases influenced your experiences in this situation?
• Who else was involved in the situation? How did they feel? And how did they react? And why did they react that way?

Step 3: Now what? Encourages beginning to transfer new knowledge into future situations and other contexts.

• What did you learn from reflecting on this situation/experience/incident?
• Could you have prevented the negative consequences?
• And how might you have done so?
• What would you have done differently if a similar situation arose in the future?
• What could you have done to better prepare for it?
• Where did things go wrong last time, and what would you focus on now?

5R Framework

The 5R Framework was developed in 2002 by a group of scientists as a universal system of reflection, later modified.

It focuses on five basic steps, each addressing one aspect of reflection. Thinking through the five stages, an individual will engage all of the major reflection components, allowing you to create a critically meaningful review based on your experience.

• Report. What do you see and hear? Write it all down.
• React. What do you think is happening? What works well and what doesn’t? How do you feel about the situation you are reflecting on? What is it about this situation that makes you feel this way?
• Relate. How do my perceptions of this situation relate to my personal and professional experiences? How do they relate to my knowledge and skills? Through what “lens” do you view this situation? From the perspective of classroom management or collaborative learning? Do you need professional development in terms of content knowledge?
• Reason. Do you relate your point of view to someone else’s and how it affects the situation? Does sound practice support your strategies, or do you use different approaches? How does your point of view affect how you understand the problem? Could another point of view be helpful?
• Reconstruct. What did you learn from this observation, and how will it affect your practice?

CARL framework

The CARL framework of reflection involves going through four stages: context, action, results, and learning. The vastness of this model gives a lot of information, and even at the first stage, you can already get a lot of valuable data. But this is also its main disadvantage because it makes the model more complex.

The framework has four steps:

• Context : Description of the context of the experience.
• Action : Explanation of the action taken.
• Results : Explanation of what your actions led to.
• Learning : Identification of the experience and knowledge gained.

Now that we’ve covered the basic concepts let’s write a reflective nursing essay.

Reflective Essay Outline

How to make a reflective essay? First, write an outline.

Any reflective essay is a statement of thoughts about something, and the outline acts as a sketch in which you write them down. Creating it is the first step to creating high quality and vivid essay.

What would make a good outline structure for a reflection essay? Structure all your knowledge. Write what you want to see in the introduction, body, and conclusion.

Here is the reflective essay outline template:

• Hook: Use a catchy statement to set the tone and introduce the article.
• Mention the main points.
• Thesis statement: Include all the important points and ideas in one statement.
• Topic sentence: Carefully explain the first idea in one sentence.
• Proof of topic or idea: Use authoritative sources to support the idea.
• Idea analysis: Apply logic and rational thought to the idea and information from the source.
• Topic sentence: Carefully explain the second idea in one sentence.
• Topic sentence: Carefully explain the third idea in one sentence.
• Repeat the statement of the thesis.
• Review the main ideas
• Final, concluding sentence

Reflective Essay Thesis

A thesis statement is a condensed version of the paper in which you must briefly explain your position. The point is for your audience to read it and understand your work.

To make a good thesis statement for a reflective essay, you need to formulate your thought on paper. To begin with, think well about the problem, and develop your attitude toward it. That’s why the thesis statement should be created after writing the outline. It is unnecessary to give everything out in advance to the reader because later, you will unfold this thought more broadly.

After successfully developing the thesis statement, you can proceed to the actual writing.

And so, below, you can see examples of the reflective essay introduction and conclusion. Learn what its body of it is.

How to Start a Reflective Essay? Examples

You need to start any paper in the right way. How to write a reflective essay introduction? Check these examples:

• Practice and theory do not always agree. Not all of the medical reference books that I have been able to study are fully applicable in practice. John Kimble’s case is a testament that it is often necessary to rely on them and consider the specific situation. He complained of dizziness, and the doctors advised him to get a blood iron test. The test showed that there was nothing wrong. But as it turned out later, this was an erroneous result because Kimble had eaten redfish rich in iron the day before, which temporarily raised the iron in his blood.
• I had always dreamed of becoming a nurse, but my fear of blood robbed me of all desire to study. But still, my passion and ambition made me pull my will into a fist. I had to change and forget what fear of blood was. I lived my dream, which helped me overcome one of my fears.
• A few years ago, I went through a severe emotional crisis. I had always dreamed of going to the University of California, as it is one of the most prestigious medical universities in the United States. But unfortunately, I failed my entrance exams, so I had to study at the university in my hometown. My failure seemed like a disaster, but now I realize it was a real blessing.

The essay’s body carries arguments, explanations of the topic, and the main body of information.

Each paragraph should begin with short introductory sentences, and the body of the sections should be divided into several parts. This will help you better structure what you have written and help the reader navigate through the text.

It is worth remembering about argumentation. There should be several things that you rely on in your position. Describe each of them in detail in a separate paragraph. Observe the semantic sequence. A mistake, in this case, will be to repeat twice the same argument in different words. It will give the reader the impression that there is nothing to say.

You should also remember about transitions in a reflective essay. Move smoothly from one aspect to another and take your time.

How to end a reflective essay? In conclusion, you should focus on pulling together all of the material, summarizing all of the points made and what you have learned. Try to include a few moments about why and how your attitudes and behaviors changed. Here are some examples:

• Was the practice of volunteer nursing helpful to me? Absolutely! I was grateful for these weeks because I learned a lot. But most of all, I have learned my Soft skills, which will help me get used to my professional activities.
• At that moment, I thought about who would be the priority in that situation, and I still believe it was the patient. If the same problem were to arise again, I think I would do nothing but speak up and justify my decisions. I recognize and know that time management and prioritization are essential skills in nursing, and I hope that my skills will improve with practice.
• I reflected on how personal values can affect professional practice from the incident. Still, it is crucial to consider that the organization has its own set of values to follow, regardless of personal values. Finally, in reflecting on the incident, I was able to discuss the importance of quality assurance monitoring and health care evaluation both in general and during the incident, which allowed me to consider what conclusions were drawn from the incident and how to prevent similar situations occurring again.

So, now you have examples and an idea for writing a reflective nursing essay. Writing your paper will become many times easier and faster.

If this article was helpful, share it with your friends and colleagues!

❓ What Is the Purpose of Writing a Reflective Essay?

A reflective essay aims to express one’s thoughts about a previous experience, including how one changed in the process and what one learned. It is often described in a diary entry; they are intended to demonstrate how the author’s thoughts have changed over time.

❓ What Makes a Good Reflective Essay?

A reflective essay is a combination of both objective and subjective elements. We mix scholarly analysis with personal experiences. This type of paper should explain to readers how our experience influences our behavior and what lessons we learned.

❓ What Are the 3 Basic Parts of Reflection Paper?

An essay should have a clear structure and must contain three parts. It should have a clear introduction reflecting the problem, then the central part with an analysis of the causes, and the conclusion with possible solutions to the problem or how it affected the author.

❓ What Is the Best Reflective Model to Use in Nursing?

One of the best options for nurses is the Gibbs model. The model is accessible and extremely simple. Therefore it can be operated without any problems in any situation.

• Reflection toolkit: The University of Edinburgh
• Essay Conclusions: University of Maryland
• Thesis Statements: UNC Writing Center
• A short guide to reflective writing: University of Birmingham
• Outlining: Harvard College Writing Center
• Reflective Practice in Nursing: ZU
• Critical self-reflection for nurse education: NCBI
• Essay Structure: Harvard College Writing Center
• Essay Structure: UAGC Writing Center
• General tips for academic reflections: The University Of Edinburgh
• Reflective essays – ANU
• Writing An Essay Title – Illinois Valley Community College
• Nursing Essay Help: Medical Essay Writing Service in UK
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A guide to nursing students' written reflections for students and educators

Affiliations.

• 1 Murray State University, United States. Electronic address: [email protected].
• 2 Murray State University, United States. Electronic address: [email protected].
• PMID: 28437690
• DOI: 10.1016/j.nepr.2017.04.004

Experiences from the clinical setting are ideal for building critical thinking skills if reflection is used as a teaching tool. Reflective writing is the purposeful and recurring inspection of thoughts, feelings, and occurrences that coordinate with experiences during practice. Reflecting on clinical experiences develops critical thinking ability, fosters self-understanding, facilitates coping, and leads to improvement in clinical practice (Kennison, 2006). Reflective writing allows students to combine clinical experiences and takeaways with didactic material to better understand both practice and instruction. Reflective writing is defined as an assignment that is focused on students' experiences, like textbook readings, clinical experiences, or group activities, that highlights what the student has taken from the activity (McGuire et al., 2009). This study will explore reflective writing from the perspective of the nursing student and the nurse educator. The following questions will be answered: What are the benefits of reflective writing? Why would nurse educators want to use reflective writing in their nursing courses, both clinical and didactic? What are the barriers to using reflective writing for students and educators? What is the role of the nurse educator in student reflection?

Keywords: Clinical education; Critical thinking; Reflective writing.

Copyright © 2017 Elsevier Ltd. All rights reserved.

• Education, Nursing, Baccalaureate
• Faculty, Nursing / psychology*
• Nursing Education Research
• Problem Solving
• Students, Nursing / psychology*

Enhancing nursing students’ reflection through Padlet: an action research

Tharin Phenwan Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

This article is included in the Technology-Enhanced Learning in Medical Education collection.

Reflective practice is encouraged amongst healthcare students, including nursing students. However, students do not have a ‘safe space’ to practice reflection before being assessed. Padlet is an interactive platform that can potentially facilitate students’ reflection via its features that enables anonymous participation, asynchronous participation and collaborative learning environment. This study aims to explore the influence of current reflection teaching method on students’ reflective practice and how Padlet can facilitate students’ reflective practice.

An action research was undertaken with 22 first year nursing students from Feb to May 2023. Participants answered questions anonymously pre-class and post-class in two Padlet boards. The researcher gave constructive feedback and signposted good examples of reflection to participants thus enabling ‘champion’ students to emerge during the process. Anonymous texts from two Padlet boards were analysed using reflexive thematic analysis technique.

Three themes were generated: i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers. Students joined the study with different presumptions and understanding of reflection, ranging from descriptive understanding of the concept, a total misunderstanding of the concept and in-depth understanding of reflection. They all indicated a changed understanding of reflection post-class and emphasized the benefits of a socially constructed learning process. Participants suggested the use of reflective tools (via reflective models) and triggers (via probing questions and feedback) as useful to facilitate their reflection.

Conclusions

This study indicates that the current teaching materials enable students to enhance their understanding of reflection. Nevertheless, students could potentially benefit from tools and triggers that will initiate and support their reflection. To that end, Padlet proves a promising tool to enhance students’ reflection via its function to enable anonymity, asynchronous participation and socially constructed learning environment.

Reflection, Undergraduate, Nurses, Qualitative research, Action research, Padlet, Technology

Revised Amendments from Version 1

Title: The title has been changed Introduction: The first paragraph has been rewritten along with additional references. Context: More information regarding the teaching materials and in-class activities were added Method: The justification of this project and the use of Padlet were added Data analysis: more texts were added for clarity Researcher reflexivity: more texts were added for clarity Results: all three themes were renamed; feedback section was merged with theme 2.

See the author's detailed response to the review by Rosanne Coutts See the author's detailed response to the review by Kim Walker See the author's detailed response to the review by Alison Ledger

Introduction

Reflection is a metacognitive skill that facilitates lifelong learning as well as professional competencies 1 – 3 . Reflection is encouraged via reflective practice to continuously enhance individuals’ capacity to reflect 3 . Reflective practice is encouraged amongst healthcare students since it can enhance students’ metacognition which will lead to better learning outcomes, satisfaction with their learning and better long-term professional performances 1 , 4 . Moreover, reflective practice increases students’ self-awareness and long-term professional self-development 5 . In the UK, the Nursing and Midwifery Council suggests the continuous use of reflective practice as one of the strategies to sustain and improve nurses’ professional competence 6 . Consequently, it is beneficial to enhance and foster the reflective practice process for nursing students.

It is challenging to teach reflective practice to students and appropriately determine their capability to reflect: First, reflective practice is a complex activity which can be taught and demonstrated in various forms such as verbally or in writing. Reflective practice can also happen in various contexts such as at bedside between students and patient, in a lecture hall or small group discussion 1 , 7 , 8 . However, the assessment tends to focus on students’ capability to demonstrate their reflective practice in writing. This is problematic because it is challenging to differentiate the students who need more support on their externalisation i.e. their ‘writing skills’ and students who need more support on internalisation i.e., ‘reflection skills’ 5 , 8 , 9 . Second, reflective practice is often positioned as an individual activity; the notion of group reflection, social interactions and their impact on individuals reflection skills tend to be undervalued 1 , 7 , 8 . Third, writing is often a complex activity. Students need to organise and develop ideas and information while using the accurate vocabulary to deliver their ideas without ambiguity 10 . As such, without an appropriate examples nor peer-support and scaffolding, students may not be aware of the quality of their writing.

Given that students are incentivised to have good grades, they might emulate certain phrases to emulate reflections to achieve that 11 . This is challenging to ascertain if students were actually reflecting or became a ‘reflective zombie’ who ‘displays all the outer traits of reflection, without having actually reflected’ (de la Croix and Veen, 2018, p. 394). To investigate these overlapping issues further, it is appropriate to determine how the current teaching method and delivery have influenced students’ reflective practice skill in writing. This will be explored via the use of Padlet. This study aims to explore the influence of current reflection method and materials on students’ reflective practice and how Padlet can facilitate students’ reflective practice.

The research question is: How can Padlet facilitates students capability to demonstrate their reflective writing before and after the reflection teaching session?

The School where this study was undertaken has several undergraduate nursing programmes: The Ordinary degree, Honours degree and Master degree. Despite various training duration and background, all students will study similar modules in their first year, including the Professional and Academic Skills and Knowledge 1 (PASK 1) module. Currently, reflective practice has been introduced to all students as a part of the PASK1 module and has one designated week for teaching activities related to reflection.

The reflection teaching week partly addressed two intended learning outcomes of the PASK1 module. That is, upon completion of the module, students will be able to:

3. Demonstrate understanding of the need for different academic and professional skills, including professional communication, documentation and person-centred care.

5. Discuss professionalism in the context of being a nursing student

By the end of the week, students should be able to:

• define reflection
• understand the role of reflection in professional learning
• introduce the idea of reflective practice
• be able to distinguish between reflection and reflective practice

discuss the role of reflective practice in improving professional effectiveness

Students have access to asynchronous learning materials two weeks prior to the class which consists of reading materials, introduction videos to reflection and probing questions posted in discussion board. Asynchronous study materials included three YouTube videos which focus on reflective practice, reflective writing and critical reflection reading materials on reflective practice, guide to reflective writing and a peer-reviewed rapid review discussing reflective practice in crisis situations.

During the designated teaching week of reflection, students joined smaller 90-minutes group tutorials (30–35 students per group) and participated in two group activities. Students were split into smaller groups. The first activity focused on writing and their reflective accounts. Written examples were provided along with explanation of which examples were considered reflective writing. The second activity was based on students’ recent clinical placement experiences. Guidance and probing questions were provided to enable them to reflect on their experiences. After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development.

The researcher noticed from his marking in this module in the past few years that students’ performance regarding their reflective writing was hugely variable. Students who underperformed or failed tended to recite the contents that they deemed appropriate with almost no reflection or produced an incoherent piece of writing. As such, it is unclear if they need further support for their externalisation or internalisation. Conversely, top performers can eloquently reflect in writing yet it is not possible to ascertain if they actually reflect or are one of the ‘reflective zombies’; this led to the conception of the study.

This study utilises social constructionist research paradigm; truths and knowledge are socially constructed and there exist multiple realities 12 , 13 . As such, students will co-construct their learning through their interactions with each other. The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing. Padlet was chosen as a platform to support and scaffold this socially constructed reflective learning process.

Padlet is a platform that allows users to interactively participate in virtual walls and the contents that are posted there 14 . The platform has been widely used in education with both undergraduate and postgraduate students from various fields due to several advantages 10 , 15 – 20 . For this study, the benefits of Padlet include anonymity 17 , 18 which enhanced students’ learning process without any fear of repercussion or from asking ‘stupid question’ 20 , 21 . Next, Padlet enables asynchronous engagement, meaning that students can choose their preferred time and location to study the materials thus fostering a more inclusive learning environment. Moreover, Padlet promotes a supportive and collaborative learning environment for students 16 , 17 , 21 . Students can learn from the responses of their peers thus improving their own understanding of the subject.

Finally, Padlet is the most appropriate platform currently available at the university that will allow students to develop their reflection skills. It is the only tool that provides a non-threatening, anonymous and inclusive learning space. The process of group learning within Padlet will enhance students’ group reflective practice as they gain insights from others’ answers. Students can learn from their ‘mistake’ and identify ‘ideal answers’ from their peers. This process should, subsequently, enhance students’ individual reflective practice 1 , 5 . Table 1 summarises the benefits of Padlet over other learning tools within the university.

Table 1. Benefits of Padlet over other learning tools.

Action Research (AR) approach was utilised under this social constructionist research paradigm. AR is a cyclical approach for researchers to evaluate and investigate their works which often lead to tangible actions from the research within the higher education contexts 22 , 23 . During the study conception stage, the researcher asked the PASK 1 module lead as well as the School’s programme leads regarding the justification and relevancy of this project; all agreed with the justification of this project as well as the use of Padlet. Students were contacted via the year representative regarding their opinions of the project; none replied.

The study gained an ethical approval from the Skills Hub Research Ethics Committee in December 2022. Convenience sampling technique 24 was used to recruit first year nursing students in the academic year 22–23. An advert about the study was circulated via email by an administrator team member to the first year students to ensure that they were not coerced to join the study and that the participation was voluntary. Participants information sheets and informed consent forms were sent to students who were interested to participate via emails. Those who consented to join the study were provided instructions on how to use Padlet boards along with the link to the first Padlet board before the reflection teaching week. Guided questions were posted on the first Padlet board to facilitate participants’ answers and determine their pre-class understanding of reflection (see Extended data for the questions asked 25 ). Participants then wrote their answers anonymously and could edit their answers as often as they preferred. The pre-class board became a read-only board once the teaching week of the introduction to reflective practice commenced.

Participants were encouraged to engage with the asynchronous materials provided within the PASK1 module and attended the face-to-face tutorial sessions before they proceeded with this study. The link to the second Padlet board was sent to participants once the reflection teaching week finished. Guided questions were also posted on the second Padlet board to determine participants’ understanding of reflection post-class. The researcher provided constructive feedback to students’ answers and asked them to expand unclear answers as necessary; they had no obligation to reply. Ideal, constructive reflective answers were ‘liked’ to enable champions to emerge from this process and signposted good examples of reflective practice to other students. No new insights were generated after fourteen participants wrote their answers.

The study gained an ethical approval from the ethical committee in the University. Written informed consent were sought before the data generation process.

Data analysis process

Anonymised pre-class texts and post-class texts were uploaded into Atlas.Ti. The researcher analysed the texts using Reflexive Thematic Analysis approach 26 . The analytical process involved six recursive phases:

Familiarising myself with the dataset

Texts in both padlet boards were read and reread along with written memos to interpret what participants expressed (semantic meaning) or wanted to express (latent meaning).

Initial codes from the texts were coded and compared to Gibb’s six stages of reflective cycle: Description; Feelings; Evaluation; Analysis; Conclusion and Action plan 1 , 27 .

Generating initial themes

Initial themes were developed and analysed deductively, linking to Gibb’s reflective cycle. This model was chosen to determine the students’ reflective practice skill pre-class and post-class since it is one of the two recommended reflection models for nursing students and has been widely used in education due to its practicality to ascertain healthcare students’ capability to reflect 1 .

Developing and reviewing themes

Themes were reread and examined for additional insights.

Refining, defining and naming themes

Themes were revised to make them more meaningful. During this stage, the initial themes – based on Gibb’s reflective cycle – were unable to meaningfully capture the findings nor fully answered the research question. Consequently, all themes were refined to make them more reflective to the findings.

Researcher reflexivity

The researcher is a family doctor (general practitioner) and have been working as a lecturer for more than 10 years. His research and teaching focus are medical education and experiential learning. He teaches the concept of reflection regularly with healthcare students including medical students, nursing students, and beyond in both undergraduate and postgraduate levels thus have a good understanding of the concept. This study was conducted as a part of the professional development that the researcher undertook. The use of Padlet to facilitate students’ reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1 ). Moreover, the researcher is a team member of the PASK1 module. He is involved with the design of weekly teaching methods, teaching materials and marking. He also led some of the small group tutorials. Consequently, he positioned himself as an ‘insider’ due to these backgrounds as well as his current position as a lecturer at the university.

From February to May 2023, 22 students out of 495 joined the study and wrote in the first Padlet board; 16 students continued to contribute in the second Padlet board. Three themes were generated: i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers. Verbatim texts were used to expand and facilitate the discussion under each theme.

Unpacking variation in students baseline understanding of reflection

Participants joined this project with different presumption and understanding of reflection. Their understanding could be rather descriptive or a misunderstanding of the concept:

‘Reflection is thinking and writing down how I feel about a situation or event at work, home, placement or anywhere. ’

Conversely, some expressed a more in-depth understanding of the concept:

‘[reflection is]… the ability to look back on a time, event, situation and consider factors which made it a positive, negative situation and how to improve things in order to move on from it and determine how things could positively be changed for future events.’

This variable understanding might be partially explained by the diverse background of the first-year students which included mature students, students who already have a university degree or students who joined the nursing programme right after they had finished their schools. As such, they all would have different exposure and experiences around reflection.

Unfortunately, the teaching materials provided were prepared with an implicit assumption that that students would have a similar understanding of reflection. This is problematic since the existing teaching materials may not be fully useful to students who already have some understanding of the concept. Nevertheless, all participants expressed similar expectation that they would have a different understanding of reflection post-class.

Co-constructed understanding of reflection

The majority of participants (14/16) expressed positive feedback in relation to the use of Padlet to facilitate their learning of reflection. Two advantages were indicated by participants. They preferred the asynchronous element of Padlet and seemed to allow them to be more engaged with the process:

‘I like that you can take your time to put your ideas down.’

The benefits of anonymity and confidentiality in Padlet were also suggested:

‘…Padlets provide a good platform of confidentiality, anonymity and willingness to share. For learning and understanding reflection, it compliments the class and learning materials, and reading answers and feedback to responses has helped contribute to my understanding .’

Furthermore, all participants expressed a different understanding of reflection post-class; that is, they understood that reflection could happen in any situations and that they could reflect from non-negative experiences as well as how to ensure similar outcomes. This finding differed from the first theme since most participants indicated that they tended to ‘ignore’ their feelings when they reflect or focus mainly on negative experiences. The majority of participants also suggested how they had learnt through others’ answers thus indicating the co-constructed learning element within Padlet boards:

‘…I agree with a couple of the other comments. I saw reflection as something which is done after a negative experience but I can see now that it can be used following any kind of experience. Why was something good, why did that situation turn out so well, how can we repeat that outcome.’

This new co-constructed understanding was also reflected in their answers when they explained how they would apply the concept in the future beyond the learning context, resonating with the Action stage of Gibb’s reflective cycle:

‘By reflecting frequently and using a journal for reflective practice which will help recognise thought patterns, attitudes, behaviours, emotions etc. This information can help improve how I personally deal with future situations/events professionally.’

Moreover, the aspect of socially constructed learning was suggested by several participants when they mentioned how their reflection improved after reading other’s answers, including the researcher’s feedback:

‘I have really enjoyed reading other peoples views, and how they reflect. I have found it very interesting how we each experience situations differently and have a different outlook in general. I believe I am gaining knowledge from others reflecting and glad I joined this study. Thank you’

Prompting reflective practice through tools and triggers

The findings suggested that participants seemed to become aware that reflection models could be used as a tool to facilitate their reflection process:

‘It [how I reflect post-class] has changed because i didnt know there are models of reflection. I also learned there is alot of emphasis on feelings in a situation.’

This finding resonates with the literature since students found structured approach more beneficial to enhance the reflection process and their writing 1 , 14 , 28 . As such, the use of reflective model should be further utilised in this module and beyond. Moreover, certain triggers seemed to enable participants to express their reflections. Such triggers were probing questions that the researcher outlined in both Padlet boards and his comments:

[Q: how would you use reflection to facilitate your learning?]

‘…To try and reflect regularly, using Rolfe's model […] Examples might be reflecting on why I'm apprehensive about starting difficult subject matter and procrastinating over essays...’

The findings suggested that both the reflective tools and triggers from educators could potentially be beneficial to foster students’ reflection. This might relate to the scaffolding process in learning where educators could support the students and their current capabilities 5 , 29 .

Findings from the study resonate with the literature and suggest that Padlet is conducive to enhance students’ reflection and also their capability to demonstrate their reflective writing. That is, participants strongly preferred the notion of being anonymous. This is beneficial for the reflective practice process which is often a personal recount of students’ poignant experience. As such, the anonymity in Padlet enables them to participate without any fear of being perceived as ‘stupid’ or have reflection publicly ‘invalidated’. The anonymity also increased students’ engagement with each other thus enabling them to create a more supportive and collaborative learning environment 16 , 17 , 21 .

Another benefit of Padlet is the asynchronous aspect which allows participants to contribute the study anytime. Although findings do not indicate this benefit, it can be implied that Padlet is useful to foster - or force - thinking time for students over other available learning tools. For instance, Mentimeter is another popular education tool that is widely used in higher education due to its interactivity and engagement with students 30 . Yet Mentimeter might not be fully useful for reflection since students would need more ‘thinking time’ to conceptualise and making sense of their reflection which is not likely to occur spontaneously.

Finally, the notion of socially-constructed learning environment was strongly indicated by participants. The researcher could provide constructive feedback to participants without knowing their identity. This is useful for participants to identify ‘ideal’ constructions of reflective writing hence the process should scaffold their learning and also empowered ‘champion’ students for their contribution 29 . The socially-constructed learning environment was further emphasised when participants and the researcher could ‘like’ certain answers to indicate preferred examples of insightful reflective writing thus further validating their contribution. As a result, the process of knowledge co-construction should enhance students’ deep cognitive engagement which proves beneficial for their future academic mastery 16 .

Findings also strongly indicated that participants are not ‘reflective zombies’. That is, they have no incentive to get good grade from this study yet they meaningfully shared their reflections in writing based on their learning or clinical experiences. As such, the focus to facilitate students’ reflection should be how we can enhance their ability to reflect. Based on the findings, students seem to have a better reflection with the use of reflection tools (e.g., Gibb’s or Rolfe’s reflective models) and triggers from me (via structured questions in Padlet and my comments and feedback) hence this practice could be continued and encouraged.

Strengths and limitations of the study

To his knowledge, this is the first study to determine the influence of Padlet over nursing students’ reflective practice. The action research approach via Padlet also enables rich depictions of how students co-construct their understanding of reflection in a non-threatening environment thus offering more insights on how we can empower students to reflect. Nevertheless, the study also poses several limitations:

The study had a very low participation rate (22 participants out of 495). This limitation might stem from the restricted timeframe for this project in Semester 2. During that time, the students were doing their clinical placement outside the university hence might be less inclined to participate. However, since the study employed the qualitative approach, the numbers of participants were less relevant; participants also provided relatively insightful writing that contributed to meaningful analysis afterwards. Moreover, the concept of information power, suggested by Malterud et al . (2016), was applied to ensure the rigour of the findings 31 . They indicate that the ‘larger information power the sample holds, the lower N is needed and vice versa’ (Malterud et al ., 2016, p.2). Given that this study has a very specific focus and research questions, the sample size needed was smaller.

Next, the researcher positioned himself as an insider. This insider positionality might influence how he engaged with and analysed the data 32 , 33 . He mitigated this issue by keeping track of written memos. The focus was to examine how he - as an insider - analysed certain aspects from the data. He also iteratively immersed with the datasets, as a part of the reflexive thematic analysis technique, to ensure that the final findings were robust.

Finally, due to the nature of action research that focuses on practical issues of the researchers, the findings might be less generalisable 22 , 27 . However, parts of the findings can still be conceptually transferable due to the underlying theory that has been utilised 34 .

Future implications for practice

Findings was disseminated to stakeholders within the School via academic seminars and meetings. Proposed changes for teaching reflection include revision of learning materials to ensure that the materials are customised to students with various background. All students will have mandatory learning materials. Students who enrolled under the Honour and Master degrees will have additional learning materials that are customised to their levels. Padlet is also proposed to be used as a tool to teach and facilitate reflection in the upcoming academic year.

Future implications for research

Future studies could be designed as a longer longitudinal study and explore the changed understanding of students’ reflection over time. To enable students who come from diverse background, future studies could also examine the different students’ needs especially amongst mature students whose learning strategies and barriers to successful learning differ from non-mature students 35 .

Furthermore, based on the findings, students seem to appreciate the use of Padlet since it enables them to develop their reflective practice anonymously. This is compounded with the co-construction of understanding of their reflection with others. As such, These two perceived benefits – anonymity and co-constructed learning element- should be further utilised beyond the use of Padlet.

This study indicates that the reflection materials in the PASK 1 module seems to enable students to improve their understanding of reflection. Nevertheless, students could potentially benefit from tools and triggers that will initiate and support their reflection. To that end, Padlet is a platform that can potentially facilitate and enhance nursing students’ reflection skills. The benefits of using Padlet as a learning platform, as indicated by participants, mirrors the literature. That is, they overwhelmingly expressed positive feedback for Padlet, especially how they can learn and improve their understanding of reflection from others via anonymised answers and social interactions.

Data availability

Underlying data.

Even though de-identified, the raw data transcripts of this qualitative study are not publicly available due to information that could compromise the privacy of research participants and as such requests for the data must be approved by Research Ethics Committee before access can be obtained. Methods described in this paper will allow the reader to emulate the study in their own setting. The data that support the findings of this study are available on request from the corresponding author, [TP].

Extended data

Discovery: Pre-class and post-class questions.pdf. https://doi.org/10.15132/10000239 25 .

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

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Comments on this article Comments (0)

Open peer review.

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: I am an experienced medical education academic, with particular expertise in qualitative research methods.  I have also taught and assessed reflective writing across different institutions.

• Respond or Comment
• COMMENT ON THIS REPORT
• Typo - To his knowledge , this is the first study to determine the influence of Padlet over nursing students’ reflective practice.  
• Second, reflective practice is often positioned as an individual activity; the notion of group reflection, social interactions and their impact on individuals reflection skills tend to be undervalued 1
• The researcher noticed from his marking in this module in the past
• Remove this word -  'hugely '.  
• Change and have been working to 'and has been working'.

Reviewer Expertise: Teaching and Learning

Is the work clearly and accurately presented and does it cite the current literature?

Is the study design appropriate and is the work technically sound?

Are sufficient details of methods and analysis provided to allow replication by others?

If applicable, is the statistical analysis and its interpretation appropriate?

Not applicable

Have any limitations of the research been acknowledged?

Are all the source data underlying the results available to ensure full reproducibility?

Are the conclusions drawn adequately supported by the results?

Reviewer Expertise: I have significant experience in clinical education research.

• Author Response 16 Jan 2024 Tharin Phenwan , School of Health Sciences, University of Dundee, Dundee, UK 16 Jan 2024 Author Response 1. It would have been helpful to have a fuller explanation of why this was considered action research and perhaps why this route was chosen.   I have added ... Continue reading 1. It would have been helpful to have a fuller explanation of why this was considered action research and perhaps why this route was chosen.   I have added more contextual information in the context as well as methods sections: ‘…The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing. Padlet was chosen as a platform to support and scaffold this socially-constructed reflective learning process.’ 2. It is unclear why Padlet was chosen as the key conduit. There was some mention about the use of Padlet in the University but further clarity regarding its general use may help in terms of the the recruitment of participants. This would strengthen the paper and methodology section and perhaps give some insight into the participant numbers. If it was a new tool, then this could impact on those volunteering compared with being a common tool that everyone is familiar with. There is some mention in the discussion around other methods, e.g. Mentimeter but it was only fleeting and further discussion on this would be of benefit.    I have added more contextual information in the context as well as methods sections:     ‘…The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing. Padlet was chosen as a platform to support and scaffold this socially-constructed reflective learning process.’ ‘…During the study conception stage, the researcher asked the PASK 1 module lead as well as the School’s programme leads regarding the justification and relevancy of this project; all agreed with the justification of this project as well as the use of Padlet. Students were contacted via the year representative regarding their opinions of the project; none replied.’ 3. You state you are an "insider" but again more clarity around this would be beneficial as you seem to suggest it is due to your background and role as a lecturer rather than an active participant.   -I have added more texts to clarify this point: ‘…The use of Padlet to facilitate students’ reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1). Moreover, the researcher is a team member of the PASK1 module. He is involved with the design of weekly teaching methods, teaching materials and marking. He also led some of the small group tutorials. Consequently, he positioned himself as an ‘insider’ due to these backgrounds as well as his current position as a lecturer at the university.’   4.It is unclear from the results the extent of the benefit of Padlet compared with the standard teaching. Were the same types of activities carried out in the group activities? The study was not designed to be a comparative study of the traditional teaching activities vs Padlet activities. Rather, it is to determine how does the current teaching materials and activities influence students’ RP. And Padlet was chosen as a tool to capture that.   -I also added more information regarding group activities for clarifications: ‘… Students were split into smaller groups. The first activity focused on writing and their reflective accounts. Written examples were provided along with explanation of which examples were considered reflective writing. The second activity was based on students’ recent clinical placement experiences. Guidance and probing questions were provided to enable them to reflect on their experiences. After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development. ’   5. Thematic analysis can be undertaken in several ways and Braun & Clarkes approach in often used. However, it is unclear why Gibbs six stages of reflective cycle were used for the coding since outputs should reflect the research questions. Qualitative data can be themed in different ways and hence the results presented are only your views. It is beneficial to have any analysis looked at a by a third party as part of a sense check. Further information on the themes in the results would strengthen this paper. The initial analysis was to deductively approach the data and compare them to Gibb’s reflective cycle. During the later stages, it was clear that the initial themes were unable to meaningfully capture the findings hence themes were subsequently renamed: ‘…During this stage, the initial themes – based on Gibb’s reflective cycle –  were unable to meaningfully capture the findings nor fully answered the research question. Consequently, all themes were refined to make them more reflective to the findings.’ 1. It would have been helpful to have a fuller explanation of why this was considered action research and perhaps why this route was chosen.   I have added more contextual information in the context as well as methods sections: ‘…The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing. Padlet was chosen as a platform to support and scaffold this socially-constructed reflective learning process.’ 2. It is unclear why Padlet was chosen as the key conduit. There was some mention about the use of Padlet in the University but further clarity regarding its general use may help in terms of the the recruitment of participants. This would strengthen the paper and methodology section and perhaps give some insight into the participant numbers. If it was a new tool, then this could impact on those volunteering compared with being a common tool that everyone is familiar with. There is some mention in the discussion around other methods, e.g. Mentimeter but it was only fleeting and further discussion on this would be of benefit.    I have added more contextual information in the context as well as methods sections:     ‘…The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing. Padlet was chosen as a platform to support and scaffold this socially-constructed reflective learning process.’ ‘…During the study conception stage, the researcher asked the PASK 1 module lead as well as the School’s programme leads regarding the justification and relevancy of this project; all agreed with the justification of this project as well as the use of Padlet. Students were contacted via the year representative regarding their opinions of the project; none replied.’ 3. You state you are an "insider" but again more clarity around this would be beneficial as you seem to suggest it is due to your background and role as a lecturer rather than an active participant.   -I have added more texts to clarify this point: ‘…The use of Padlet to facilitate students’ reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1). Moreover, the researcher is a team member of the PASK1 module. He is involved with the design of weekly teaching methods, teaching materials and marking. He also led some of the small group tutorials. Consequently, he positioned himself as an ‘insider’ due to these backgrounds as well as his current position as a lecturer at the university.’   4.It is unclear from the results the extent of the benefit of Padlet compared with the standard teaching. Were the same types of activities carried out in the group activities? The study was not designed to be a comparative study of the traditional teaching activities vs Padlet activities. Rather, it is to determine how does the current teaching materials and activities influence students’ RP. And Padlet was chosen as a tool to capture that.   -I also added more information regarding group activities for clarifications: ‘… Students were split into smaller groups. The first activity focused on writing and their reflective accounts. Written examples were provided along with explanation of which examples were considered reflective writing. The second activity was based on students’ recent clinical placement experiences. Guidance and probing questions were provided to enable them to reflect on their experiences. After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development. ’   5. Thematic analysis can be undertaken in several ways and Braun & Clarkes approach in often used. However, it is unclear why Gibbs six stages of reflective cycle were used for the coding since outputs should reflect the research questions. Qualitative data can be themed in different ways and hence the results presented are only your views. It is beneficial to have any analysis looked at a by a third party as part of a sense check. Further information on the themes in the results would strengthen this paper. The initial analysis was to deductively approach the data and compare them to Gibb’s reflective cycle. During the later stages, it was clear that the initial themes were unable to meaningfully capture the findings hence themes were subsequently renamed: ‘…During this stage, the initial themes – based on Gibb’s reflective cycle –  were unable to meaningfully capture the findings nor fully answered the research question. Consequently, all themes were refined to make them more reflective to the findings.’ Competing Interests: No competing interests were disclosed. Close Report a concern Reply -->
• Suggest the 1 st sentence of the introduction could be reconsidered or even added to. There are better descriptors that communicate the importance and relevance of reflective practice. Also there is a typo within the sentence.
• Title – suggest ‘Enhancing’ rather than ‘Enhance’.
• The words ‘reflective practice’ and ‘reflective’ are being used interchangeably. Suggest they are different. Would review usage.
• Suggest ‘reflective practice’ could be in the key words.
• Some sentences have repeat words. Suggest reviewing the work for these. For example:
• Would use the full form of reflective practice throughout in preference to RP.
• Suggest the writing be reviewed and all sections written in the 1 st person changed into ‘the researcher’. This would improve the quality of the writing.  
• Some further nursing specific literature for your consideration. These would enhance the manuscript and provide deeper definitions and understanding:
• Burns and Bulman (2000 1 ).
• Clouder (2000 2 ).
• Hong and Chew (2008 3 ).
• Lane and Roberts (2022 4 ).
• McNeill et al. (2010 5 ).
• Williams and Lowes (2001 6 ).
• Author Response 16 Jan 2024 Tharin Phenwan , School of Health Sciences, University of Dundee, Dundee, UK 16 Jan 2024 Author Response 1. Suggest the 1 st  sentence of the introduction could be reconsidered or even added to. There are better descriptors that communicate the importance and relevance of reflective   practice. Also there is a typo ... Continue reading 1. Suggest the 1 st  sentence of the introduction could be reconsidered or even added to. There are better descriptors that communicate the importance and relevance of reflective   practice. Also there is a typo within the sentence. Reflective practice (RP) is a practice of making sense of a situation via reflection and is usually occurs during an unexpected or surprising experience. -I have rephrased the first sentence and also have added additional references. 2. Title – suggest ‘Enhancing’ rather than ‘Enhance’. The title has been renamed as suggested 3. The words ‘reflective practice’ and ‘reflective’ are being used interchangeably. Suggest they are different. Would review usage The phrase reflective practice has been added in the key words as suggested 4.  Some sentences have repeat words. Suggest reviewing the work for these. For example: Yet the assessment of students’ RP tends to focus on their capability to demonstrate their RP in writing. Several sentences were restructured for better readability as suggested. 5.  Would use the full form of reflective practice throughout in preference to RP. The phrase reflective practice has been added and used throughout 6. Suggest the writing be reviewed and all sections written in the 1 st  person changed into ‘the researcher’. This would improve the quality of the writing.   This has been changed as suggested. 7. Some further nursing specific literature for your consideration. These would enhance the manuscript and provide deeper definitions and understanding Thank you for these suggestions. I have added recent literature in the introduction section. 1. Suggest the 1 st  sentence of the introduction could be reconsidered or even added to. There are better descriptors that communicate the importance and relevance of reflective   practice. Also there is a typo within the sentence. Reflective practice (RP) is a practice of making sense of a situation via reflection and is usually occurs during an unexpected or surprising experience. -I have rephrased the first sentence and also have added additional references. 2. Title – suggest ‘Enhancing’ rather than ‘Enhance’. The title has been renamed as suggested 3. The words ‘reflective practice’ and ‘reflective’ are being used interchangeably. Suggest they are different. Would review usage The phrase reflective practice has been added in the key words as suggested 4.  Some sentences have repeat words. Suggest reviewing the work for these. For example: Yet the assessment of students’ RP tends to focus on their capability to demonstrate their RP in writing. Several sentences were restructured for better readability as suggested. 5.  Would use the full form of reflective practice throughout in preference to RP. The phrase reflective practice has been added and used throughout 6. Suggest the writing be reviewed and all sections written in the 1 st  person changed into ‘the researcher’. This would improve the quality of the writing.   This has been changed as suggested. 7. Some further nursing specific literature for your consideration. These would enhance the manuscript and provide deeper definitions and understanding Thank you for these suggestions. I have added recent literature in the introduction section. Competing Interests: No competing interests were disclosed. Close Report a concern Reply -->
• Methodological framing. The work is presented as an action research study. Action research tends to be participatory and collaborative and it is unclear who the project collaborators were in this case. Perhaps the collaborators were the students but this was not made explicit. I suggest the project may be better framed as a scholarly exploration or evaluation project, or a student-staff partnership project. If you do this, perhaps the question could be presented as 'How can Padlet foster reflective writing among nursing students?'  
• Further consideration of ethical issues beyond informed consent. If I have understood correctly, only 22 out of 495 students volunteered for the study and were accessing and interacting with the padlet. Could the padlet and additional feedback be perceived as an advantage for these students in developing reflective practice, over the 473 students who did not have access to this support? How was this risk mitigated?  
• Further detail about your own position in this research. Though you presented yourself as an 'insider', what this meant in practice could be made a little more explicit. Were you the lead for the PASK1 module? Did you facilitate any of the small group tutorials? What led you to Padlet and what did you expect to find through this project?   
• More detail about the reflective practice education more broadly. What were the intended learning outcomes? What topics were covered in the readings provided to students? What happened in the group tutorials and activities? Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript? How was reflective practice assessed? Addressing these questions is important so the reader can consider what outcomes could be attributed to Padlet, and what could be attributed to the influence of the wider programme of education. Addressing these questions may also enable consideration of additional design limitations.  
• Refinement of the theme titles so that they align with the evaluation question presented and are more consistent with Braun and Clarke's reflexive thematic analysis approach. In addressing the question of how does padlet help? I wonder whether some possible theme titles could be: Uncovering variation in students' baseline understandings of reflection, Co-constructing understandings of reflection, and Prompting reflective practice through tools and triggers. These are just suggestions to explain what I mean, feel free to craft theme titles that make sense to you. One further piece of advice would be to think about whether material in the section 'feedback from participants' could be incorporated within the three themes.  
• Ensure that your discussion points are supported by the content in your results section. The first point about the benefits of anonymity are currently not captured in your results section. Were there any quotes from the Padlet that could support this claim? I also wondered whether the first theme could be discussed in greater depth - is there value in knowing students' levels of understanding when they enter training?  
• Consider wider implications beyond Padlet. Though your study was about Padlet, are there other ways that educators could encourage co-construction of understandings and safe ways of developing reflective practice?
• discuss the role of reflective practice in improving professional effectiveness’

Reviewer Status

Alongside their report, reviewers assign a status to the article:

Reviewer Reports

• Alison Ledger , The University of Queensland, Brisbane, Australia
• Rosanne Coutts , Southern Cross University, Lismore, Australia
• Kim Walker , University of Aberdeen, Aberdeen, UK

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• PMC10792267.1 ; 2023 Oct 4
• ➤ PMC10792267.2; 2023 Dec 28

Enhancing nursing students’ reflection through Padlet: an action research

Tharin phenwan.

1 School of Health Sciences, University of Dundee, Dundee, Scotland, UK

Associated Data

Underlying data.

Even though de-identified, the raw data transcripts of this qualitative study are not publicly available due to information that could compromise the privacy of research participants and as such requests for the data must be approved by Research Ethics Committee before access can be obtained. Methods described in this paper will allow the reader to emulate the study in their own setting. The data that support the findings of this study are available on request from the corresponding author, [TP].

Extended data

Discovery: Pre-class and post-class questions.pdf. https://doi.org/10.15132/10000239 25 .

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Version Changes

Revised. amendments from version 1.

Title: The title has been changed Introduction: The first paragraph has been rewritten along with additional references. Context: More information regarding the teaching materials and in-class activities were added Method: The justification of this project and the use of Padlet were added Data analysis: more texts were added for clarity Researcher reflexivity: more texts were added for clarity Results: all three themes were renamed; feedback section was merged with theme 2.

Reflective practice is encouraged amongst healthcare students, including nursing students. However, students do not have a ‘safe space’ to practice reflection before being assessed. Padlet is an interactive platform that can potentially facilitate students’ reflection via its features that enables anonymous participation, asynchronous participation and collaborative learning environment. This study aims to explore the influence of current reflection teaching method on students’ reflective practice and how Padlet can facilitate students’ reflective practice.

An action research was undertaken with 22 first year nursing students from Feb to May 2023. Participants answered questions anonymously pre-class and post-class in two Padlet boards. The researcher gave constructive feedback and signposted good examples of reflection to participants thus enabling ‘champion’ students to emerge during the process. Anonymous texts from two Padlet boards were analysed using reflexive thematic analysis technique.

Three themes were generated: i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers. Students joined the study with different presumptions and understanding of reflection, ranging from descriptive understanding of the concept, a total misunderstanding of the concept and in-depth understanding of reflection. They all indicated a changed understanding of reflection post-class and emphasized the benefits of a socially constructed learning process. Participants suggested the use of reflective tools (via reflective models) and triggers (via probing questions and feedback) as useful to facilitate their reflection.

Conclusions

This study indicates that the current teaching materials enable students to enhance their understanding of reflection. Nevertheless, students could potentially benefit from tools and triggers that will initiate and support their reflection. To that end, Padlet proves a promising tool to enhance students’ reflection via its function to enable anonymity, asynchronous participation and socially constructed learning environment.

Introduction

Reflection is a metacognitive skill that facilitates lifelong learning as well as professional competencies 1 – 3 . Reflection is encouraged via reflective practice to continuously enhance individuals’ capacity to reflect 3 . Reflective practice is encouraged amongst healthcare students since it can enhance students’ metacognition which will lead to better learning outcomes, satisfaction with their learning and better long-term professional performances 1 , 4 . Moreover, reflective practice increases students’ self-awareness and long-term professional self-development 5 . In the UK, the Nursing and Midwifery Council suggests the continuous use of reflective practice as one of the strategies to sustain and improve nurses’ professional competence 6 . Consequently, it is beneficial to enhance and foster the reflective practice process for nursing students.

It is challenging to teach reflective practice to students and appropriately determine their capability to reflect: First, reflective practice is a complex activity which can be taught and demonstrated in various forms such as verbally or in writing. Reflective practice can also happen in various contexts such as at bedside between students and patient, in a lecture hall or small group discussion 1 , 7 , 8 . However, the assessment tends to focus on students’ capability to demonstrate their reflective practice in writing. This is problematic because it is challenging to differentiate the students who need more support on their externalisation i.e. their ‘writing skills’ and students who need more support on internalisation i.e., ‘reflection skills’ 5 , 8 , 9 . Second, reflective practice is often positioned as an individual activity; the notion of group reflection, social interactions and their impact on individuals reflection skills tend to be undervalued 1 , 7 , 8 . Third, writing is often a complex activity. Students need to organise and develop ideas and information while using the accurate vocabulary to deliver their ideas without ambiguity 10 . As such, without an appropriate examples nor peer-support and scaffolding, students may not be aware of the quality of their writing.

Given that students are incentivised to have good grades, they might emulate certain phrases to emulate reflections to achieve that 11 . This is challenging to ascertain if students were actually reflecting or became a ‘reflective zombie’ who ‘displays all the outer traits of reflection, without having actually reflected’ (de la Croix and Veen, 2018, p. 394). To investigate these overlapping issues further, it is appropriate to determine how the current teaching method and delivery have influenced students’ reflective practice skill in writing. This will be explored via the use of Padlet. This study aims to explore the influence of current reflection method and materials on students’ reflective practice and how Padlet can facilitate students’ reflective practice.

The research question is: How can Padlet facilitates students capability to demonstrate their reflective writing before and after the reflection teaching session?

The School where this study was undertaken has several undergraduate nursing programmes: The Ordinary degree, Honours degree and Master degree. Despite various training duration and background, all students will study similar modules in their first year, including the Professional and Academic Skills and Knowledge 1 (PASK 1) module. Currently, reflective practice has been introduced to all students as a part of the PASK1 module and has one designated week for teaching activities related to reflection.

The reflection teaching week partly addressed two intended learning outcomes of the PASK1 module. That is, upon completion of the module, students will be able to:

3. Demonstrate understanding of the need for different academic and professional skills, including professional communication, documentation and person-centred care.

5. Discuss professionalism in the context of being a nursing student

By the end of the week, students should be able to:

• define reflection
• understand the role of reflection in professional learning
• introduce the idea of reflective practice
• be able to distinguish between reflection and reflective practice
• discuss the role of reflective practice in improving professional effectiveness

Students have access to asynchronous learning materials two weeks prior to the class which consists of reading materials, introduction videos to reflection and probing questions posted in discussion board. Asynchronous study materials included three YouTube videos which focus on reflective practice, reflective writing and critical reflection reading materials on reflective practice, guide to reflective writing and a peer-reviewed rapid review discussing reflective practice in crisis situations.

During the designated teaching week of reflection, students joined smaller 90-minutes group tutorials (30–35 students per group) and participated in two group activities. Students were split into smaller groups. The first activity focused on writing and their reflective accounts. Written examples were provided along with explanation of which examples were considered reflective writing. The second activity was based on students’ recent clinical placement experiences. Guidance and probing questions were provided to enable them to reflect on their experiences. After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development.

The researcher noticed from his marking in this module in the past few years that students’ performance regarding their reflective writing was hugely variable. Students who underperformed or failed tended to recite the contents that they deemed appropriate with almost no reflection or produced an incoherent piece of writing. As such, it is unclear if they need further support for their externalisation or internalisation. Conversely, top performers can eloquently reflect in writing yet it is not possible to ascertain if they actually reflect or are one of the ‘reflective zombies’; this led to the conception of the study.

This study utilises social constructionist research paradigm; truths and knowledge are socially constructed and there exist multiple realities 12 , 13 . As such, students will co-construct their learning through their interactions with each other. The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing. Padlet was chosen as a platform to support and scaffold this socially constructed reflective learning process.

Padlet is a platform that allows users to interactively participate in virtual walls and the contents that are posted there 14 . The platform has been widely used in education with both undergraduate and postgraduate students from various fields due to several advantages 10 , 15 – 20 . For this study, the benefits of Padlet include anonymity 17 , 18 which enhanced students’ learning process without any fear of repercussion or from asking ‘stupid question’ 20 , 21 . Next, Padlet enables asynchronous engagement, meaning that students can choose their preferred time and location to study the materials thus fostering a more inclusive learning environment. Moreover, Padlet promotes a supportive and collaborative learning environment for students 16 , 17 , 21 . Students can learn from the responses of their peers thus improving their own understanding of the subject.

Finally, Padlet is the most appropriate platform currently available at the university that will allow students to develop their reflection skills. It is the only tool that provides a non-threatening, anonymous and inclusive learning space. The process of group learning within Padlet will enhance students’ group reflective practice as they gain insights from others’ answers. Students can learn from their ‘mistake’ and identify ‘ideal answers’ from their peers. This process should, subsequently, enhance students’ individual reflective practice 1 , 5 . Table 1 summarises the benefits of Padlet over other learning tools within the university.

Action Research (AR) approach was utilised under this social constructionist research paradigm. AR is a cyclical approach for researchers to evaluate and investigate their works which often lead to tangible actions from the research within the higher education contexts 22 , 23 . During the study conception stage, the researcher asked the PASK 1 module lead as well as the School’s programme leads regarding the justification and relevancy of this project; all agreed with the justification of this project as well as the use of Padlet. Students were contacted via the year representative regarding their opinions of the project; none replied.

The study gained an ethical approval from the Skills Hub Research Ethics Committee in December 2022. Convenience sampling technique 24 was used to recruit first year nursing students in the academic year 22–23. An advert about the study was circulated via email by an administrator team member to the first year students to ensure that they were not coerced to join the study and that the participation was voluntary. Participants information sheets and informed consent forms were sent to students who were interested to participate via emails. Those who consented to join the study were provided instructions on how to use Padlet boards along with the link to the first Padlet board before the reflection teaching week. Guided questions were posted on the first Padlet board to facilitate participants’ answers and determine their pre-class understanding of reflection (see Extended data for the questions asked 25 ). Participants then wrote their answers anonymously and could edit their answers as often as they preferred. The pre-class board became a read-only board once the teaching week of the introduction to reflective practice commenced.

Participants were encouraged to engage with the asynchronous materials provided within the PASK1 module and attended the face-to-face tutorial sessions before they proceeded with this study. The link to the second Padlet board was sent to participants once the reflection teaching week finished. Guided questions were also posted on the second Padlet board to determine participants’ understanding of reflection post-class. The researcher provided constructive feedback to students’ answers and asked them to expand unclear answers as necessary; they had no obligation to reply. Ideal, constructive reflective answers were ‘liked’ to enable champions to emerge from this process and signposted good examples of reflective practice to other students. No new insights were generated after fourteen participants wrote their answers.

The study gained an ethical approval from the ethical committee in the University. Written informed consent were sought before the data generation process.

Data analysis process

Anonymised pre-class texts and post-class texts were uploaded into Atlas.Ti. The researcher analysed the texts using Reflexive Thematic Analysis approach 26 . The analytical process involved six recursive phases:

• Texts in both padlet boards were read and reread along with written memos to interpret what participants expressed (semantic meaning) or wanted to express (latent meaning).
• Initial codes from the texts were coded and compared to Gibb’s six stages of reflective cycle: Description; Feelings; Evaluation; Analysis; Conclusion and Action plan 1 , 27 .
• Initial themes were developed and analysed deductively, linking to Gibb’s reflective cycle. This model was chosen to determine the students’ reflective practice skill pre-class and post-class since it is one of the two recommended reflection models for nursing students and has been widely used in education due to its practicality to ascertain healthcare students’ capability to reflect 1 .
• Themes were reread and examined for additional insights.
• Themes were revised to make them more meaningful. During this stage, the initial themes – based on Gibb’s reflective cycle – were unable to meaningfully capture the findings nor fully answered the research question. Consequently, all themes were refined to make them more reflective to the findings.

Researcher reflexivity

The researcher is a family doctor (general practitioner) and have been working as a lecturer for more than 10 years. His research and teaching focus are medical education and experiential learning. He teaches the concept of reflection regularly with healthcare students including medical students, nursing students, and beyond in both undergraduate and postgraduate levels thus have a good understanding of the concept. This study was conducted as a part of the professional development that the researcher undertook. The use of Padlet to facilitate students’ reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1 ). Moreover, the researcher is a team member of the PASK1 module. He is involved with the design of weekly teaching methods, teaching materials and marking. He also led some of the small group tutorials. Consequently, he positioned himself as an ‘insider’ due to these backgrounds as well as his current position as a lecturer at the university.

From February to May 2023, 22 students out of 495 joined the study and wrote in the first Padlet board; 16 students continued to contribute in the second Padlet board. Three themes were generated: i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers. Verbatim texts were used to expand and facilitate the discussion under each theme.

Unpacking variation in students baseline understanding of reflection

Participants joined this project with different presumption and understanding of reflection. Their understanding could be rather descriptive or a misunderstanding of the concept:

‘Reflection is thinking and writing down how I feel about a situation or event at work, home, placement or anywhere. ’

Conversely, some expressed a more in-depth understanding of the concept:

‘[reflection is]… the ability to look back on a time, event, situation and consider factors which made it a positive, negative situation and how to improve things in order to move on from it and determine how things could positively be changed for future events.’

This variable understanding might be partially explained by the diverse background of the first-year students which included mature students, students who already have a university degree or students who joined the nursing programme right after they had finished their schools. As such, they all would have different exposure and experiences around reflection.

Unfortunately, the teaching materials provided were prepared with an implicit assumption that that students would have a similar understanding of reflection. This is problematic since the existing teaching materials may not be fully useful to students who already have some understanding of the concept. Nevertheless, all participants expressed similar expectation that they would have a different understanding of reflection post-class.

Co-constructed understanding of reflection

The majority of participants (14/16) expressed positive feedback in relation to the use of Padlet to facilitate their learning of reflection. Two advantages were indicated by participants. They preferred the asynchronous element of Padlet and seemed to allow them to be more engaged with the process:

‘I like that you can take your time to put your ideas down.’

The benefits of anonymity and confidentiality in Padlet were also suggested:

‘…Padlets provide a good platform of confidentiality, anonymity and willingness to share. For learning and understanding reflection, it compliments the class and learning materials, and reading answers and feedback to responses has helped contribute to my understanding .’

Furthermore, all participants expressed a different understanding of reflection post-class; that is, they understood that reflection could happen in any situations and that they could reflect from non-negative experiences as well as how to ensure similar outcomes. This finding differed from the first theme since most participants indicated that they tended to ‘ignore’ their feelings when they reflect or focus mainly on negative experiences. The majority of participants also suggested how they had learnt through others’ answers thus indicating the co-constructed learning element within Padlet boards:

‘…I agree with a couple of the other comments. I saw reflection as something which is done after a negative experience but I can see now that it can be used following any kind of experience. Why was something good, why did that situation turn out so well, how can we repeat that outcome.’

This new co-constructed understanding was also reflected in their answers when they explained how they would apply the concept in the future beyond the learning context, resonating with the Action stage of Gibb’s reflective cycle:

‘By reflecting frequently and using a journal for reflective practice which will help recognise thought patterns, attitudes, behaviours, emotions etc. This information can help improve how I personally deal with future situations/events professionally.’

Moreover, the aspect of socially constructed learning was suggested by several participants when they mentioned how their reflection improved after reading other’s answers, including the researcher’s feedback:

‘I have really enjoyed reading other peoples views, and how they reflect. I have found it very interesting how we each experience situations differently and have a different outlook in general. I believe I am gaining knowledge from others reflecting and glad I joined this study. Thank you’

Prompting reflective practice through tools and triggers

The findings suggested that participants seemed to become aware that reflection models could be used as a tool to facilitate their reflection process:

‘It [how I reflect post-class] has changed because i didnt know there are models of reflection. I also learned there is alot of emphasis on feelings in a situation.’

This finding resonates with the literature since students found structured approach more beneficial to enhance the reflection process and their writing 1 , 14 , 28 . As such, the use of reflective model should be further utilised in this module and beyond. Moreover, certain triggers seemed to enable participants to express their reflections. Such triggers were probing questions that the researcher outlined in both Padlet boards and his comments:

[Q: how would you use reflection to facilitate your learning?]

‘…To try and reflect regularly, using Rolfe's model […] Examples might be reflecting on why I'm apprehensive about starting difficult subject matter and procrastinating over essays...’

The findings suggested that both the reflective tools and triggers from educators could potentially be beneficial to foster students’ reflection. This might relate to the scaffolding process in learning where educators could support the students and their current capabilities 5 , 29 .

Findings from the study resonate with the literature and suggest that Padlet is conducive to enhance students’ reflection and also their capability to demonstrate their reflective writing. That is, participants strongly preferred the notion of being anonymous. This is beneficial for the reflective practice process which is often a personal recount of students’ poignant experience. As such, the anonymity in Padlet enables them to participate without any fear of being perceived as ‘stupid’ or have reflection publicly ‘invalidated’. The anonymity also increased students’ engagement with each other thus enabling them to create a more supportive and collaborative learning environment 16 , 17 , 21 .

Another benefit of Padlet is the asynchronous aspect which allows participants to contribute the study anytime. Although findings do not indicate this benefit, it can be implied that Padlet is useful to foster - or force - thinking time for students over other available learning tools. For instance, Mentimeter is another popular education tool that is widely used in higher education due to its interactivity and engagement with students 30 . Yet Mentimeter might not be fully useful for reflection since students would need more ‘thinking time’ to conceptualise and making sense of their reflection which is not likely to occur spontaneously.

Finally, the notion of socially-constructed learning environment was strongly indicated by participants. The researcher could provide constructive feedback to participants without knowing their identity. This is useful for participants to identify ‘ideal’ constructions of reflective writing hence the process should scaffold their learning and also empowered ‘champion’ students for their contribution 29 . The socially-constructed learning environment was further emphasised when participants and the researcher could ‘like’ certain answers to indicate preferred examples of insightful reflective writing thus further validating their contribution. As a result, the process of knowledge co-construction should enhance students’ deep cognitive engagement which proves beneficial for their future academic mastery 16 .

Findings also strongly indicated that participants are not ‘reflective zombies’. That is, they have no incentive to get good grade from this study yet they meaningfully shared their reflections in writing based on their learning or clinical experiences. As such, the focus to facilitate students’ reflection should be how we can enhance their ability to reflect. Based on the findings, students seem to have a better reflection with the use of reflection tools (e.g., Gibb’s or Rolfe’s reflective models) and triggers from me (via structured questions in Padlet and my comments and feedback) hence this practice could be continued and encouraged.

Strengths and limitations of the study

To his knowledge, this is the first study to determine the influence of Padlet over nursing students’ reflective practice. The action research approach via Padlet also enables rich depictions of how students co-construct their understanding of reflection in a non-threatening environment thus offering more insights on how we can empower students to reflect. Nevertheless, the study also poses several limitations:

The study had a very low participation rate (22 participants out of 495). This limitation might stem from the restricted timeframe for this project in Semester 2. During that time, the students were doing their clinical placement outside the university hence might be less inclined to participate. However, since the study employed the qualitative approach, the numbers of participants were less relevant; participants also provided relatively insightful writing that contributed to meaningful analysis afterwards. Moreover, the concept of information power, suggested by Malterud et al . (2016), was applied to ensure the rigour of the findings 31 . They indicate that the ‘larger information power the sample holds, the lower N is needed and vice versa’ (Malterud et al ., 2016, p.2). Given that this study has a very specific focus and research questions, the sample size needed was smaller.

Next, the researcher positioned himself as an insider. This insider positionality might influence how he engaged with and analysed the data 32 , 33 . He mitigated this issue by keeping track of written memos. The focus was to examine how he - as an insider - analysed certain aspects from the data. He also iteratively immersed with the datasets, as a part of the reflexive thematic analysis technique, to ensure that the final findings were robust.

Finally, due to the nature of action research that focuses on practical issues of the researchers, the findings might be less generalisable 22 , 27 . However, parts of the findings can still be conceptually transferable due to the underlying theory that has been utilised 34 .

Future implications for practice

Findings was disseminated to stakeholders within the School via academic seminars and meetings. Proposed changes for teaching reflection include revision of learning materials to ensure that the materials are customised to students with various background. All students will have mandatory learning materials. Students who enrolled under the Honour and Master degrees will have additional learning materials that are customised to their levels. Padlet is also proposed to be used as a tool to teach and facilitate reflection in the upcoming academic year.

Future implications for research

Future studies could be designed as a longer longitudinal study and explore the changed understanding of students’ reflection over time. To enable students who come from diverse background, future studies could also examine the different students’ needs especially amongst mature students whose learning strategies and barriers to successful learning differ from non-mature students 35 .

Furthermore, based on the findings, students seem to appreciate the use of Padlet since it enables them to develop their reflective practice anonymously. This is compounded with the co-construction of understanding of their reflection with others. As such, These two perceived benefits – anonymity and co-constructed learning element- should be further utilised beyond the use of Padlet.

This study indicates that the reflection materials in the PASK 1 module seems to enable students to improve their understanding of reflection. Nevertheless, students could potentially benefit from tools and triggers that will initiate and support their reflection. To that end, Padlet is a platform that can potentially facilitate and enhance nursing students’ reflection skills. The benefits of using Padlet as a learning platform, as indicated by participants, mirrors the literature. That is, they overwhelmingly expressed positive feedback for Padlet, especially how they can learn and improve their understanding of reflection from others via anonymised answers and social interactions.

[version 2; peer review: 1 approved, 2 approved with reservations]

Funding Statement

The author(s) declared that no grants were involved in supporting this work.

Data availability

• Version 2. MedEdPublish (2016). 2023; 13: 204.

Reviewer response for version 2

Alison ledger.

1 Academy for Medical Education, Medical School, The University of Queensland, Brisbane, Queensland, Australia

This paper is much improved with further detail and justification, thank you.  The articulation of the themes is also now more consistent with a reflexive thematic analysis approach.

In future writing, I encourage you to not only explain  who you were in this research, but also  how this position may have influenced the research process in positive or negative ways.  You could be a little more explicit about your assumptions/expectations and whether these were reflected in the research findings.

I still have reservations about this being presented as an action research study.  Instead, it appears to be a scholarly evaluation of the use of padlet to enhance nursing students' understanding of reflection.

However, on balance, I think this paper will be useful to others who are grappling with the persistent challenge of how to promote reflective practice.  Padlet may offer a way to enable students to collaboratively develop their understandings of reflection.  I thank you for sharing your practice with others.

Have any limitations of the research been acknowledged?

Is the work clearly and accurately presented and does it cite the current literature?

If applicable, is the statistical analysis and its interpretation appropriate?

Not applicable

Are all the source data underlying the results available to ensure full reproducibility?

Is the study design appropriate and is the work technically sound?

Are the conclusions drawn adequately supported by the results?

Are sufficient details of methods and analysis provided to allow replication by others?

Reviewer Expertise:

I am an experienced medical education academic, with particular expertise in qualitative research methods.  I have also taught and assessed reflective writing across different institutions.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Rosanne Coutts

1 Southern Cross University, Lismore, New South Wales, Australia

I have reviewed  Enhancing nursing students’ reflection through Padlet: an action research. The authors have made a number of changes that have enhanced the work, particularly providing further justification for the work. The themes have been renamed and, in my view, present a clearer depiction of the outcomes.  This research project supports the development of reflective practice and demonstrates a methodology or ‘how to’ that encourages student learning in nursing.

To consider: some typos:

• Typo - To his knowledge , this is the first study to determine the influence of Padlet over nursing students’ reflective practice.
• Second, reflective practice is often positioned as an individual activity; the notion of group reflection, social interactions and their impact on individuals reflection skills tend to be undervalued 1

Replace with – 'impact on an individual’s reflective skills, tend'.

• The researcher noticed from his marking in this module in the past

Change to – 'researcher noticed when assessing in this module'.

• Remove this word -  'hugely '.
• Change and have been working to 'and has been working'.

Teaching and Learning

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Reviewer response for version 1

1 University of Aberdeen, Aberdeen, Scotland, UK

This is an interesting study as reflective practice (RP) is sometimes a difficult area to teach and research. The introduction highlighted the complexity of assessing RP in terms of reflection and/or writing skills. However there are some areas in the paper which would benefit from greater clarity and depth of information.  

It would have been helpful to have a fuller explanation of why this was considered action research and perhaps why this route was chosen.

It is unclear why Padlet was chosen as the key conduit. There was some mention about the use of Padlet in the University but further clarity regarding its general use may help in terms of the the recruitment of participants. This would strengthen the paper and methodology section and perhaps give some insight into the participant numbers. If it was a new tool, then this could impact on those volunteering compared with being a common tool that everyone is familiar with. There is some mention in the discussion around other methods, e.g. Mentimeter but it was only fleeting and further discussion on this would be of benefit. 

You state you are an "insider" but again more clarity around this would be beneficial as you seem to suggest it is due to your background and role as a lecturer rather than an active participant.  

It is unclear from the results the extent of the benefit of Padlet compared with the standard teaching. Were the same types of activities carried out in the group activities?

Thematic analysis can be undertaken in several ways and Braun & Clarkes approach in often used. However, it is unclear why Gibbs six stages of reflective cycle were used for the coding since outputs should reflect the research questions. Qualitative data can be themed in different ways and hence the results presented are only your views. It is beneficial to have any analysis looked at a by a third party as part of a sense check. Further information on the themes in the results would strengthen this paper.

I have significant experience in clinical education research.

• Sub-article

Health Sciences, University of Dundee, Dundee, Scotland, UK

1. It would have been helpful to have a fuller explanation of why this was considered action research and perhaps why this route was chosen.   I have added more contextual information in the context as well as methods sections: ‘…The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing. Padlet was chosen as a platform to support and scaffold this socially-constructed reflective learning process.’ 2. It is unclear why Padlet was chosen as the key conduit. There was some mention about the use of Padlet in the University but further clarity regarding its general use may help in terms of the the recruitment of participants. This would strengthen the paper and methodology section and perhaps give some insight into the participant numbers. If it was a new tool, then this could impact on those volunteering compared with being a common tool that everyone is familiar with. There is some mention in the discussion around other methods, e.g. Mentimeter but it was only fleeting and further discussion on this would be of benefit.    I have added more contextual information in the context as well as methods sections:     ‘…The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing. Padlet was chosen as a platform to support and scaffold this socially-constructed reflective learning process.’ ‘…During the study conception stage, the researcher asked the PASK 1 module lead as well as the School’s programme leads regarding the justification and relevancy of this project; all agreed with the justification of this project as well as the use of Padlet. Students were contacted via the year representative regarding their opinions of the project; none replied.’ 3. You state you are an "insider" but again more clarity around this would be beneficial as you seem to suggest it is due to your background and role as a lecturer rather than an active participant.   -I have added more texts to clarify this point: ‘…The use of Padlet to facilitate students’ reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1). Moreover, the researcher is a team member of the PASK1 module. He is involved with the design of weekly teaching methods, teaching materials and marking. He also led some of the small group tutorials. Consequently, he positioned himself as an ‘insider’ due to these backgrounds as well as his current position as a lecturer at the university.’   4.It is unclear from the results the extent of the benefit of Padlet compared with the standard teaching. Were the same types of activities carried out in the group activities? The study was not designed to be a comparative study of the traditional teaching activities vs Padlet activities. Rather, it is to determine how does the current teaching materials and activities influence students’ RP. And Padlet was chosen as a tool to capture that.   -I also added more information regarding group activities for clarifications: ‘… Students were split into smaller groups. The first activity focused on writing and their reflective accounts. Written examples were provided along with explanation of which examples were considered reflective writing. The second activity was based on students’ recent clinical placement experiences. Guidance and probing questions were provided to enable them to reflect on their experiences. After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development.’   5. Thematic analysis can be undertaken in several ways and Braun & Clarkes approach in often used. However, it is unclear why Gibbs six stages of reflective cycle were used for the coding since outputs should reflect the research questions. Qualitative data can be themed in different ways and hence the results presented are only your views. It is beneficial to have any analysis looked at a by a third party as part of a sense check. Further information on the themes in the results would strengthen this paper. The initial analysis was to deductively approach the data and compare them to Gibb’s reflective cycle. During the later stages, it was clear that the initial themes were unable to meaningfully capture the findings hence themes were subsequently renamed: ‘…During this stage, the initial themes – based on Gibb’s reflective cycle –  were unable to meaningfully capture the findings nor fully answered the research question. Consequently, all themes were refined to make them more reflective to the findings.’

Thank you for the opportunity to review and make comment upon the research manuscript entitled: Enhance nursing students’ reflection through Padlet: an action research.

Reflective practice is an integral skill for clinical learning, both as a student and for all professionals responsible for patient care. The work represents a reflective practice learning activity with a small group of nursing students. Particular focus is given to the use of Padlet as an interactive program where students can without ‘pressure,’ practice their reflections prior to formal assessment. Thematic or qualitative approaches were taken to analysis. The complexities of the enactment of the skill of reflective practice were well considered in the introduction. Important to note that the actual skill was focused on and evaluated as a written activity rather than a verbal or intuitive process. Therefore, reflective skills were being assessed via written activities only. The section on the context clearly presented the issues about actually knowing how well students are engaging in meaningful reflective practice. The analysis was well considered and outlined. The co-constructed reflection section was well considered and presented. Overall interesting research about an important and relevant lifelong skill.

Further considerations and suggestions.

• Suggest the 1 st sentence of the introduction could be reconsidered or even added to. There are better descriptors that communicate the importance and relevance of reflective practice. Also there is a typo within the sentence.

Reflective practice (RP) is a practice of making sense of a situation via reflection and is usually occurs during an unexpected or surprising experience.

• Title – suggest ‘Enhancing’ rather than ‘Enhance’.
• The words ‘reflective practice’ and ‘reflective’ are being used interchangeably. Suggest they are different. Would review usage.
• Suggest ‘reflective practice’ could be in the key words.
• Some sentences have repeat words. Suggest reviewing the work for these. For example:

Yet the assessment of students’ RP tends to focus on their capability to demonstrate their RP in writing.

• Would use the full form of reflective practice throughout in preference to RP.
• Suggest the writing be reviewed and all sections written in the 1 st person changed into ‘the researcher’. This would improve the quality of the writing.  
• Some further nursing specific literature for your consideration. These would enhance the manuscript and provide deeper definitions and understanding:
• Burns and Bulman (2000 1 ).
• Clouder (2000 2 ).
• Hong and Chew (2008 3 ).
• Lane and Roberts (2022 4 ).
• McNeill et al. (2010 5 ).
• Williams and Lowes (2001 6 ).

1. Suggest the 1 st  sentence of the introduction could be reconsidered or even added to. There are better descriptors that communicate the importance and relevance of reflective   practice. Also there is a typo within the sentence. Reflective practice (RP) is a practice of making sense of a situation via reflection and is usually occurs during an unexpected or surprising experience. -I have rephrased the first sentence and also have added additional references. 2. Title – suggest ‘Enhancing’ rather than ‘Enhance’. The title has been renamed as suggested 3. The words ‘reflective practice’ and ‘reflective’ are being used interchangeably. Suggest they are different. Would review usage The phrase reflective practice has been added in the key words as suggested 4.  Some sentences have repeat words. Suggest reviewing the work for these. For example: Yet the assessment of students’ RP tends to focus on their capability to demonstrate their RP in writing. Several sentences were restructured for better readability as suggested. 5.  Would use the full form of reflective practice throughout in preference to RP. The phrase reflective practice has been added and used throughout 6. Suggest the writing be reviewed and all sections written in the 1 st  person changed into ‘the researcher’. This would improve the quality of the writing.   This has been changed as suggested. 7. Some further nursing specific literature for your consideration. These would enhance the manuscript and provide deeper definitions and understanding Thank you for these suggestions. I have added recent literature in the introduction section.

Thank you for the opportunity to read your manuscript. The introduction captured the complexities of fostering students' reflective practice well and cited key literature in this area. The focus on padlet emphasised the value of students co-constructing understandings of reflection in a safe environment, which is a useful finding for other educators grappling with how best to include reflection in their curricula. 

I have several suggestions for making this manuscript even better.

• Methodological framing. The work is presented as an action research study. Action research tends to be participatory and collaborative and it is unclear who the project collaborators were in this case. Perhaps the collaborators were the students but this was not made explicit. I suggest the project may be better framed as a scholarly exploration or evaluation project, or a student-staff partnership project. If you do this, perhaps the question could be presented as 'How can Padlet foster reflective writing among nursing students?'
• Further consideration of ethical issues beyond informed consent. If I have understood correctly, only 22 out of 495 students volunteered for the study and were accessing and interacting with the padlet. Could the padlet and additional feedback be perceived as an advantage for these students in developing reflective practice, over the 473 students who did not have access to this support? How was this risk mitigated?
• Further detail about your own position in this research. Though you presented yourself as an 'insider', what this meant in practice could be made a little more explicit. Were you the lead for the PASK1 module? Did you facilitate any of the small group tutorials? What led you to Padlet and what did you expect to find through this project? 
• More detail about the reflective practice education more broadly. What were the intended learning outcomes? What topics were covered in the readings provided to students? What happened in the group tutorials and activities? Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript? How was reflective practice assessed? Addressing these questions is important so the reader can consider what outcomes could be attributed to Padlet, and what could be attributed to the influence of the wider programme of education. Addressing these questions may also enable consideration of additional design limitations.
• Refinement of the theme titles so that they align with the evaluation question presented and are more consistent with Braun and Clarke's reflexive thematic analysis approach. In addressing the question of how does padlet help? I wonder whether some possible theme titles could be: Uncovering variation in students' baseline understandings of reflection, Co-constructing understandings of reflection, and Prompting reflective practice through tools and triggers. These are just suggestions to explain what I mean, feel free to craft theme titles that make sense to you. One further piece of advice would be to think about whether material in the section 'feedback from participants' could be incorporated within the three themes.
• Ensure that your discussion points are supported by the content in your results section. The first point about the benefits of anonymity are currently not captured in your results section. Were there any quotes from the Padlet that could support this claim? I also wondered whether the first theme could be discussed in greater depth - is there value in knowing students' levels of understanding when they enter training?
• Consider wider implications beyond Padlet. Though your study was about Padlet, are there other ways that educators could encourage co-construction of understandings and safe ways of developing reflective practice?

I hope you find this feedback helpful and encourage you to continue developing this work.

Comments Locations Reviewer 1     Thank you for the opportunity to read your manuscript. The introduction captured the complexities of fostering students' reflective practice well and cited key literature in this area. The focus on padlet emphasised the value of students co-constructing understandings of reflection in a safe environment, which is a useful finding for other educators grappling with how best to include reflection in their curricula.  Thank you for your feedback   Methodological framing. The work is presented as an action research study. Action research tends to be participatory and collaborative and it is unclear who the project collaborators were in this case. Perhaps the collaborators were the students but this was not made explicit. I suggest the project may be better framed as a scholarly exploration or evaluation project, or a student-staff partnership project. If you do this, perhaps the question could be presented as 'How  can  Padlet foster reflective writing among nursing students?' -The main collaborators were the module leader and programme leads. During the study conception, I asked for their opinions in terms of the relevancy of the project, the challenges around reflection teaching. All agreed with the justification of this project as well as the use of Padlet. -I also reached out to few students during the study conception but as discussed in the limitation section, they were at their placements outside the university hence were rather occupied; none replied to my inquiries. I have added more texts in the manuscript to clarify this point: ‘… During the study conception stage, the researcher asked the PASK 1 module lead as well as the School’s programme leads regarding the justification and relevancy of this project; all agreed with the justification of this project as well as the use of Padlet. Students were contacted via the year representative regarding their opinions of the project; none replied.’   -The research question was amended as suggested. Context section Further consideration of ethical issues beyond informed consent. If I have understood correctly, only 22 out of 495 students volunteered for the study and were accessing and interacting with the padlet. Could the padlet and additional feedback be perceived as an advantage for these students in developing reflective practice, over the 473 students who did not have access to this support? How was this risk mitigated? -That is correct. Only 22 consented to join the project. I anticipate that these students may have more short-term benefit since they received additional feedback as well as saw others’ reflective writing. However, all students will not be assessed in reflective writing in this module. They will be assessed in other modules hence the benefits could be minimal e.g., these 22 students may have a better understanding of reflection at the beginning but all should have similar understanding once they have started their reflective practice assignments.  - Further detail about your own position in this research. Though you presented yourself as an 'insider', what this meant in practice could be made a little more explicit. Were you the lead for the PASK1 module? Did you facilitate any of the small group tutorials? What led you to Padlet and what did you expect to find through this project?  -I have added more texts to clarify this points:   ‘… The researcher is a team member of the PASK1 module. He is involved with the design of weekly teaching methods, teaching materials and marking. He also led some of the small group tutorials.’   -‘The use of Padlet to facilitate students’ reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1).’ Researcher reflexivity More detail about the reflective practice education more broadly. What were the intended learning outcomes? What topics were covered in the readings provided to students? What happened in the group tutorials and activities? Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript? How was reflective practice assessed? Addressing these questions is important so the reader can consider what outcomes could be attributed to Padlet, and what could be attributed to the influence of the wider programme of education. Addressing these questions may also enable consideration of additional design limitations. What were the intended learning outcomes? ‘The reflection teaching week partly addressed two ILOs of the PASK1 module. That is, upon completion of the module, students will be able to: 3. Demonstrate understanding of the need for different academic and professional skills, including professional communication, documentation and person-centred care. 5. Discuss professionalism in the context of being a nursing student By the end of the week, students should be able to:

• discuss the role of reflective practice in improving professional effectiveness’

  What topics were covered in the readings provided to students? ‘…Asynchronous study materials included three YouTube videos which focus on reflective practice, reflective writing and critical reflection reading materials on reflective practice, guide to reflective writing and a peer-reviewed rapid review discussing reflective practice in crisis situations.’ What happened in the group tutorials and activities? ‘…Students were split into smaller groups. The first activity focused on writing and their reflective accounts. Written examples were provided along with explanation of which examples were considered reflective writing. The second activity was based on students’ recent clinical placement experiences. Guidance and probing questions were provided to enable them to reflect on their experiences. After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development.’   Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript? ‘The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing.’ How was reflective practice assessed? Students’ reflective practice will not be marked in the PASK1 module; they will be assessed in other modules in each academic year. Moreover, they will be assessed during their clinical placements by their assessors which will be beyond the scope of this study and the PASK1 module. Context section Refinement of the theme titles so that they align with the evaluation question presented and are more consistent with Braun and Clarke's reflexive thematic analysis approach. In addressing the question of how does padlet help? I wonder whether some possible theme titles could be: Uncovering variation in students' baseline understandings of reflection, Co-constructing understandings of reflection, and Prompting reflective practice through tools and triggers. These are just suggestions to explain what I mean, feel free to craft theme titles that make sense to you. One further piece of advice would be to think about whether material in the section 'feedback from participants' could be incorporated within the three themes. I have added more texts to clarify these points:   ‘…During this stage, the initial themes – based on Gibb’s reflective cycle –  were unable to meaningfully capture the findings nor fully answered the research question’   -I also rename the themes to : i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers   -The feedback section was incorporated into the existing themes Data analysis process, Results Ensure that your discussion points are supported by the content in your results section. The first point about the benefits of anonymity are currently not captured in your results section. Were there any quotes from the Padlet that could support this claim? I also wondered whether the first theme could be discussed in greater depth - is there value in knowing students' levels of understanding when they enter training? -I have added more quotes to support the benefit of Padlet around anonymity ‘…Padlets provide a  good platform of confidentiality, anonymity and willingness to share.  For learning and understanding reflection, it compliments the class and learning materials, and reading answers and feedback to responses has helped contribute to my understanding.’   -More texts were added under theme 1: ‘…Unfortunately, the teaching materials provided were prepared with an implicit assumption that that students would have a similar understanding of reflection. This is problematic since the existing teaching materials may not be fully useful to students who already have some understanding of the concept.’ Results section Consider wider implications beyond Padlet. Though your study was about Padlet, are there other ways that educators could encourage co-construction of understandings and safe ways of developing reflective practice? -I have added more texts to clarify this points ‘Furthermore, based on the findings, students seem to appreciate the use of Padlet since it enables them to develop their reflective practice anonymously. This is compounded with the co-construction of understanding of their reflection with others. As such, These two perceived benefits – anonymity and co-constructed learning element- should be further utilised beyond the use of Padlet.’ Future implications for research

• Sub-article 2

Apologies- I have copied and pasted from a table in Microsoft Words file and the responses are very hard to read. Here they are:   1. Methodological framing. The work is presented as an action research study. Action research tends to be participatory and collaborative and it is unclear who the project collaborators were in this case. Perhaps the collaborators were the students but this was not made explicit. I suggest the project may be better framed as a scholarly exploration or evaluation project, or a student-staff partnership project. If you do this, perhaps the question could be presented as 'How  can  Padlet foster reflective writing among nursing students?' -The main collaborators were the module leader and programme leads. During the study conception, I asked for their opinions in terms of the relevancy of the project, the challenges around reflection teaching. All agreed with the justification of this project as well as the use of Padlet. -I also reached out to few students during the study conception but as discussed in the limitation section, they were at their placements outside the university hence were rather occupied; none replied to my inquiries. I have added more texts in the manuscript to clarify this point: -The research question was amended as suggested. 2. Further consideration of ethical issues beyond informed consent. If I have understood correctly, only 22 out of 495 students volunteered for the study and were accessing and interacting with the padlet. Could the padlet and additional feedback be perceived as an advantage for these students in developing reflective practice, over the 473 students who did not have access to this support? How was this risk mitigated? That is correct. Only 22 consented to join the project. I anticipate that these students may have more short-term benefit since they received additional feedback as well as saw others’ reflective writing. However, all students will not be assessed in reflective writing in this module. They will be assessed in other modules hence the benefits could be minimal e.g., these 22 students may have a better understanding of reflection at the beginning but all should have similar understanding once they have started their reflective practice assignments.  3. Further detail about your own position in this research. Though you presented yourself as an 'insider', what this meant in practice could be made a little more explicit. Were you the lead for the PASK1 module? Did you facilitate any of the small group tutorials? What led you to Padlet and what did you expect to find through this project?  I have added more texts to clarify this points in the researcher reflexivity section: ‘… The researcher is a team member of the PASK1 module. He is involved with the design of weekly teaching methods, teaching materials and marking. He also led some of the small group tutorials.’ -‘The use of Padlet to facilitate students’ reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1).’ 4.  More detail about the reflective practice education more broadly. What were the intended learning outcomes? What topics were covered in the readings provided to students? What happened in the group tutorials and activities? Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript? How was reflective practice assessed? Addressing these questions is important so the reader can consider what outcomes could be attributed to Padlet, and what could be attributed to the influence of the wider programme of education. Addressing these questions may also enable consideration of additional design limitations.   What were the intended learning outcomes? ‘The reflection teaching week partly addressed two ILOs of the PASK1 module. That is, upon completion of the module, students will be able to: 3. Demonstrate understanding of the need for different academic and professional skills, including professional communication, documentation and person-centred care. 5. Discuss professionalism in the context of being a nursing student By the end of the week, students should be able to:

  What topics were covered in the readings provided to students? ‘…Asynchronous study materials included three YouTube videos which focus on reflective practice, reflective writing and critical reflection reading materials on reflective practice, guide to reflective writing and a peer-reviewed rapid review discussing reflective practice in crisis situations.’ What happened in the group tutorials and activities? ‘…Students were split into smaller groups. The first activity focused on writing and their reflective accounts. Written examples were provided along with explanation of which examples were considered reflective writing. The second activity was based on students’ recent clinical placement experiences. Guidance and probing questions were provided to enable them to reflect on their experiences. After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development.’   Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript? ‘The focus of the study was on writing activities since the majority of student’ assessments will be via their writing. Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing.’ How was reflective practice assessed? Students’ reflective practice will not be marked in the PASK1 module; they will be assessed in other modules in each academic year. Moreover, they will be assessed during their clinical placements by their assessors which will be beyond the scope of this study and the PASK1 module.   5.  Refinement of the theme titles so that they align with the evaluation question presented and are more consistent with Braun and Clarke's reflexive thematic analysis approach. In addressing the question of how does padlet help? I wonder whether some possible theme titles could be: Uncovering variation in students' baseline understandings of reflection, Co-constructing understandings of reflection, and Prompting reflective practice through tools and triggers. These are just suggestions to explain what I mean, feel free to craft theme titles that make sense to you. One further piece of advice would be to think about whether material in the section 'feedback from participants' could be incorporated within the three themes.   I have added more texts to clarify these points: ‘…During this stage, the initial themes – based on Gibb’s reflective cycle –  were unable to meaningfully capture the findings nor fully answered the research question’ -I also rename the themes to : i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers -The feedback section was incorporated into the existing themes 6. Ensure that your discussion points are supported by the content in your results section. The first point about the benefits of anonymity are currently not captured in your results section. Were there any quotes from the Padlet that could support this claim? I also wondered whether the first theme could be discussed in greater depth - is there value in knowing students' levels of understanding when they enter training? -I have added more quotes to support the benefit of Padlet around anonymity ‘…Padlets provide a  good platform of confidentiality, anonymity and willingness to share.  For learning and understanding reflection, it compliments the class and learning materials, and reading answers and feedback to responses has helped contribute to my understanding.’ -More texts were added under theme 1: ‘…Unfortunately, the teaching materials provided were prepared with an implicit assumption that that students would have a similar understanding of reflection. This is problematic since the existing teaching materials may not be fully useful to students who already have some understanding of the concept.’   7. Consider wider implications beyond Padlet. Though your study was about Padlet, are there other ways that educators could encourage co-construction of understandings and safe ways of developing reflective practice? -I have added more texts to clarify this points ‘Furthermore, based on the findings, students seem to appreciate the use of Padlet since it enables them to develop their reflective practice anonymously. This is compounded with the co-construction of understanding of their reflection with others. As such, These two perceived benefits – anonymity and co-constructed learning element- should be further utilised beyond the use of Padlet.’