gibbs reflective cycle and nursing

Reflective practice: a learning tool for student nurses

Affiliation.

• 1 School of Health and Social Care, University of Lincoln, Brayford Pool.
• PMID: 18773590
• DOI: 10.12968/bjon.2008.17.11.29644

Reflection is a vital skill in contemporary nursing with student nurses expected to engage in reflective learning from the very beginning of the nurse educational programme. This article demonstrates the meaningful learning that resulted as a consequence of using critical reflection on practice. Gibbs' (1988) cycle aided the process highlighting the practical application of this cyclical framework to the author - a first-year student nurse. Matters concerning gender issues in nursing and professional conduct emerged from the analysis and were inherently explored. The article concludes by demonstrating the personal benefits of using Gibbs' (1988) cycle to varying situations and thus promoting its excellence as a learning tool for student nurses worldwide as a consequence.

• Education, Nursing*
• Middle Aged
• Nurse-Patient Relations*
• Nurses, Male / psychology
• Postoperative Care / nursing
• Problem-Based Learning / methods*
• Self-Assessment
• United Kingdom
• Vulvar Neoplasms / nursing
• Vulvar Neoplasms / psychology
• Vulvar Neoplasms / surgery

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• v.9(2); 2023 Feb

Master of nursing specialist experiences of an internship through the use of written reflections: A qualitative research study

Ting-ting zhan.

a Department of Brain Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, No. 117 Meishan Street, Hefei, 230031, Anhui, China

b School of Nursing, Anhui University of Chinese Medicine, No. 103 Meishan Street, Hefei, 230031, Anhui, China

Cai-jie Sun

Associated data.

Data included in article/supp. material/referenced in article.

Reflective practice is an educational strategy and an essential part of the professional development of nurses. However, there are few reflective journals in the master of nursing specialist program or clinical nursing education.

Based on Gibbs' reflective cycle theory, masters of nursing specialists (MNS) will use a diary to record their reflections on a particular clinical event. The purpose of this study was to identify reflective practice as tool to help MNS improve their professional and personal development.

A descriptive qualitative study.

The purposive sampling method was used in the qualitative study. The data were derived from the master of nursing specialist who interned at the hospital from June to December 2021. After completing the job rotation and relevant course training within 6 months, a clinical experience was selected as a reflection. The traditional qualitative content analysis method was applied to analyze the collected data in the research.

A total of 10 reflective diaries completed by ten students were analyzed. This qualitative study demonstrated that the Gibbs' reflective cycle is valuable and helpful in the clinical practice of master of nursing specialists. This program helps master of nursing specialists reflect on their clinical practice and translate real-life experiences into valuable learning experiences for developing their professional development and personal skills.

Conclusions

By writing reflection diaries, master of nursing specialists can reflect on the problems encountered during clinical rotations and take action following that reflection, which can assist them in improving their professional development and personal skills to handle clinical nursing aspects in the future, as well as improve their full participation in clinical practice.

1. Introduction

Reflective practice is not only an educational strategy [ 1 ] but also a core skill for the professional development of nursing students [ 2 ]. Research has shown [ 1 ] that reflection provides caregivers with the ability to learn from clinical experiences through critical thinking. This helps stimulate learning and add new knowledge to clinical practice, facilitating practice transformation and the development of new insights [ 1 ]. The study also found that it can use scientific knowledge, personal knowledge, and experiential knowledge to solve complicated problems in practice [ 3 ]. Moreover, studies have shown that reflective practice, as a cognitive skill that nurses learn from experience, can improve the knowledge and skills of nursing students, novice nurses, and experienced nurses in clinical practice, improve the professional practice of nurses and positively improve the health outcomes of patients [ 1 , 4 ]. It has also been reported that reflective practice can enhance a clinician’s competence through a critical review of clinical practice [ 5 ]. Additionally, an integrative review has demonstrated that nursing professions at all levels are influenced by reflective practices, adding value to the nursing profession [ 6 ].

As a member of the nursing workforce, a master of nursing specialist (MNS) is expected to have higher levels of professional competence, practical competence, critical and reflective ability, and interpersonal communication when faced with complex clinical environments [ 7 , 8 ]. In direct contact with patients in clinical practice, MNS may encounter unexpected clinical situations leading to stress [ 9 ], and most of these clinical experiences have not been effectively addressed. Therefore, reflective practice is necessary for MNS for patient safety [ 4 ] nurses' own physical and mental health, and coping with future challenges [ 4 ]. Reflective practice improves nurses' understanding of their practice by giving meaning to their experiences [ 4 , 10 ], thereby enhancing their personal and nursing professional development [ 2 ], and narrowing the gap between theory and clinical practice in nursing humanistic care dimension [ 10 ]. The reflective journal is the most commonly used tool in reflective practice [ 9 ], and it is seen as a learning tool in postgraduate medical education [ 11 ]. Studies have shown that the process of writing a reflective journal, through the practice of self-reflection and reflective writing, can help release clinically repressed emotions [ 6 , 9 ]. As a reflection tool, a diary is considered to reflect on oneself and others [ 12 ] during critical clinical events, which can facilitate the learning process, personal growth, and professional development of nursing students [ 13 ] through an in-depth understanding of what clinical experience means [ 12 , 14 ]. It is recommended that participants consider their feelings during the six stages of Gibbs’s framework, such as reflection, description, feeling, evaluation, analysis, conclusion, and action plan [ 2 , 15 ]. The Gibbs’s reflective cycle provides a structured approach that has been successfully applied to nursing majors and nursing students, enabling students to logically reflect on clinical events [ 16 , 17 ]. Structured templates, however, may compromise the quality and authenticity of the data collected. Nevertheless, Gibbs' reflective cycle was found to be an effective, useful, and enjoyable method for teaching clinical education [ 18 , 19 ]. The Gibbs’s reflective cycle [ 19 ] also showed that most people’s knowledge and understanding are obtained from a reflection of the experience, and constantly thinking can lead to a better understanding of things, and the guidance of action.

Based on Gibbs’s reflective cycle, reflective practice has been successfully performed in some countries, such as Japan’s public health graduate and undergraduate students [ 19 , 20 ] and nursing staff in China [ 21 ]. The study found that MNS in China must have the ability to enhance personal reflection and professional ability [ 7 , 8 ], and Gibb’s reflective cycle can be used as a theoretical framework for beginning writers to reflect on their behavior, to improve their performance [ 16 , 17 ]. According to researchers [ 21 ] in China, using Gibbs’s reflective cycle can improve nurses' ability to engage in clinical nursing thinking when dealing with adverse events, especially by helping nurse practitioners who work for 0.5–1 year gain a more comprehensive understanding of adverse events.

However, the theoretical framework of the Gibbs’s reflective cycle has not been applied to the analysis of MNS’ clinical experience. And it is not clear whether reflective practice can improve the professional ability and personal development of MNS. Hence, understanding the clinical experience is essential for the personal and professional development of MNS. Reflections on the clinical experience of MNS were explored in the context of clinical practice in this study.

2.1. Type of research design

A descriptive qualitative study was applied to the study.

2.2. Settings and populations

The purposive sampling method was used in qualitative research because it can improve the transferability of research [ 22 ]. The study subjects were all MNS interning at the hospital. The first author has overseas study experience and participated in Gibbs' Framework training abroad. All four researchers participated in a qualitative research course. Participants interested in the program were invited in person by the program leader at the MNS Academic Salon meeting. Participants then signed written informed consent at the site, and the program leader distributed Gibbs’s reflective cycle course schedule along with a verbal statement asking participants to provide at least one written reflection material via WeChat or email at the end of the program. Out of 13 eligible participants, ten eventually agreed to participate and completed and submitted reflective writing.

The respondents included nine females and one male. To protect participants' privacy, all participants' information is encrypted from P1 through P10. Participants are only required to provide their ages and work experience. The students are between 24 and 30 and have completed 10–12 months of clinical practice at the undergraduate level of nursing education before their postgraduate education. According to China’s internship regulations, all of them have full internship experience including but not limited to the internal medicine department, surgical department, ICU, and operating room. Moreover, none of them had prior nursing-related work experience before becoming MNS, only undergraduate internships. In addition, MNS has a clinical internship of at least six months and is required to take classes related to Gibbs’s reflective cycle. During the six-month internship, they were mainly involved in the care of patients with chronic diseases such as Wilson’s disease and Parkinson’s disease, including intravenous injection and the implementation of traditional Chinese medicine nursing techniques.

2.3. Data sources

The reflective diary based on Gibbs’s framework is used as the original material for this study. In diary writing, the study adopted the structure of Gibbs’s reflective cycle, which consists of six modules: reflection, description, feeling, evaluation, analysis, conclusion, and action plan [ 2 , 15 ]. This model was chosen because of the successful application of the Gibbs Reflection Cycle to reflection in the nursing profession [ 16 ], which not only allowed participants to write a reflection diary step by step but also allowed them to take into account their feelings about clinical events [ 2 , [15] , [16] , [17] ].

The concept and steps of the Gibbs reflective cycle, application cases in the clinical field of nursing, and writing principles were explained by the project leader. There are eight classes, each lasting about 20 min. The research team leader at any stage of the study didn’t affect the MNS internship phase of the score, also won’t for internship experience in an oral or written judgment. Gibbs’s reflective course is taught face-to-face in the classroom. Gibbs' reflective practice courses and reflective writing are guided by nursing professionals or program leaders with at least ten years of experience. After six months of clinical practice, participants were asked to describe their feelings about clinical events based on the Gibbs reflection cycle model. In addition, students were required to complete and submit at least one clinical experience diary about their reflective learning experience.

2.4. Data analysis

Qualitative research data was conducted from ten independent texts with a total of 11, 899 Chinese characters. The writing template of all manuscripts was A4 paper size, the Chinese font was required to be Song style, the size of the font was 4, and the line spacing was 1.5 times. Traditional content analysis, which aims to describe a phenomenon, is often used in qualitative research designs [ 23 ]. All the researchers through qualitative research training, study the authenticity of the data, data collecting, sorting, and analysis by different researchers. Initially, the texts were entered into NVivo 12 software, by the researchers (second author) on the material number and document, personally involved in the data sorting, repeated readings, and immersed in the data, to have an integral feeling of the information. Then, data are analyzed and coded based on Gibbs’s framework, and categories and topics are extracted by two researchers (second and third authors), respectively. At the same time, the two researchers have professional accomplishments and social relations, making it can grasp the role and status of the research team, to enhance the reliability of the author. In this process, the researchers will be meaningful words, phrases, sentences, or passages marked, and begin to open coding. Subsequently, the categories and subcategories were discussed and evaluated by the members of all the studies, and the final themes were identified. After this stage, to encode the original material, the researchers carried out the coding system will be the same or similar coding classification form a category or categories. The study design is designed under the framework of the Gibbs’s reflective cycle, so will be the same or similar code, again classified to the Gibbs’s framework. When data after the complete category, the researchers again take out each category file, read all the excerpts, and ensure that materials and categories, can find corresponding extracted from the data sample. Encoding steps above all by two different researchers (second and third authors) for the first time after coding, and face-to-face to check coding categories, after carefully discussion decided to subject classification. If any disagreement, after discussing with the fourth author and project director. Additionally, to guarantee data integrity and authenticity, a compiled manuscript subject was returned to participants for comment and/or correction. The whole data analysis process was conducted in Chinese and finally translated into English. The consolidated criteria for reporting qualitative research (COREQ) were followed by this study [ 24 ].

2.5. Establishment of trustworthiness

Studies have reported [ 22 , 25 ] that researchers can use Lincoln and Cuba’s criteria, including credibility, reliability, confirmability, and transferability, to ensure the trustworthiness of qualitative research. First, credibility refers to confidence in the authenticity of the information from the participant’s point of view [ 25 ]. In this study, all nursing graduate students participating in the study had at least ten months of nursing clinical practice experience during their undergraduate years, as well as at least six months of clinical practice experience in different departments for MNS postgraduates, to ensure that participants had authentic experience and opinions about the clinical practice experience, thus ensuring the credibility of the study. Second, reliability refers to data stability in different places at different times [ 25 , 26 ]. The study ensures the reliability of the data collection process by carefully describing the investigator’s recruitment and reflective practice courses so that readers can see the content of the entire research process. Third, conformability refers to the objectivity or neutrality of the data and refers to the agreement of independent people on the relationship or significance of the data [ 25 ]. The Gibbs reflective cycle framework is applied to the reflective process and is used for data analysis, making the writing structure visible. In addition, the two authors (the second and fourth authors) analyzed and encoded the text data independently. If there is any disagreement during the analysis, discuss it with the third author (first author) and resolve it through negotiation. Fourth, transferability refers to the significance of the research results for other groups in similar situations, also known as suitability, meaning the extensibility of the data [ 25 ]. Gibbs’s theory is applied to this qualitative research, and if it is based on the same approach, it can be applied to similar research.

2.6. Ethical issues

This study was approved by the ethics committee of the First Affiliated Hospital of Anhui University of Chinese Medicine. The Declaration of Helsinki [ 27 ] was used to follow the ethical guidelines for this study, which mainly analyzed the empirical reflection of MNS in clinical practice and had no impact on patient care. All data were anonymously encoded and then analyzed to ensure the participants' privacy. Participants received detailed oral and written information about the research presented by the researchers (first and second authors) during the course. All willing students were asked to sign an informed consent form after the researchers introduced the purpose of the study and how the data were collected. Although all participants were required to sign a written informed consent form, they were also informed that anyone was free to withdraw from the study at any time.

3. Findings

Based on Gibbs’s framework, the topic categories of this study are proposed. This paper summarizes the reflections on the clinical practice experience of MNS, as shown in Table 1 .

Participants' reflections.

3.1. Descriptions of the clinical practice experience

The traditional qualitative content analysis of reflective journals indicated that MNS most frequently described the clinical practice experience as the three themes of adverse events, professional knowledge, and nurse-patient conflict. First, the adverse events were described by the MNS as the use of the wrong medication when the patient received the treatment and the scalding of the patient due to the failure to assess the patient’s skin condition in time or unclear account. Second, participants described their lack of professional expertise in clinical practice, including insufficient theoretical preparation and unskilled operation skills, and the lack of professional knowledge caused inevitable pain to patients or made them feel embarrassed when facing patients. Third, nurse-patient conflict was described as patient bias towards MNS clinical practice and a lack of communication and feedback between nurse-patient.

3.2. Feelings

Negative emotions associated with the clinical practice were anxiety, guilt, worry, and nervousness. For example, when nursing graduate students were involved in the care of patients with scalds that were not immediately detected and treated by nursing staff, participants often experienced feelings of anxiety and guilt. Worry and nervousness usually arise when MNS care for patients with a lack of professional skills, resulting in patients being exposed to certain risks. Such as, participants described feeling guilty about giving patients the wrong medication or the wrong infusion, as well as feeling nervous and worried about patient safety.

Conversely, in clinical practice, positive emotions of happiness are also mentioned. The participants described their feelings after answering the patients' nursing knowledge of a particular specialty. For example, when the participants were trusted by the patients and successfully solved the patients' questions by seeking relevant literature, they were generally recognized by the patients, thus feeling the value of the internship and having a happy mood. These unique experiences motivate the participants.

P4: “Although I don't care much about what other people think, I am happy to be acknowledged by patients. I also felt self-worth as a nursing graduate student, although people always have a skeptical attitude towards nursing graduate students. ”

Moreover, the safety of the patients and understanding of the situation was often described by participants when referring to thoughts during and after this situation. In this situation, participants usually remain calm, such as quickly ending the unfair treatment or infusion of the patient, and removing some potential risk factors that may endanger the patient’s safety. In addition, participants will try to understand and find the cause of the event and then evaluate the harm their behavior has caused the patient.

P10: “ I could not bear the consequences if other special drugs were changed by mistake. ”

P9: “But the scalding incident proved me wrong and I felt very guilty for causing such a young child to suffer.”

3.3. Evaluation

The evaluation consists mainly of two aspects: what was a good experience and what was a bad experience. In clinical practice, good experience primarily referred to the response of nursing graduate students to conflict. Participants reported that they were able to quickly disengage from a conflict situation and remain calm when confronted with a conflict, which impressed them when they administered an infusion or hot compress of Traditional Chinese medicine. This similar experience enabled participants to learn how to deal with these situations encountered in clinical practice, such as help from clinical teachers and seeking forgiveness from patients and families.

P2: “The patient’s infusion sequence was disrupted. The conversation with the patient went well, and she finally showed understanding. I also explained this matter to the superior teacher later.”

The bad experiences were associated with concerns about the situation. When participants participate in patient care in ineffective or unprofessional ways, this interaction often leads to some distress for the patient. For example, nursing graduate students lack the skills to perform infusion operations, leading to the behavior of secondary puncture, even if the patient understands, but also increases the patient’s physical pain. Patients also often suffer the negative consequences of medication errors, burns, and other physical and mental injuries.

3.4. Analysis

What was done well and what was done wrong were described by participants in clinical practice. Seeking help from clinical teachers and being empathetic to patients were described by participants as doing well in clinical practice. For instance, when the participants found that the patients had burns, they immediately sought the help of clinical teachers to relieve the patient’s pain. In addition, personal unprofessional behavior not only increased the cost of patient treatment but also caused patients to bear different degrees of physical and mental pain. The participants were able to be patient-centered, understand the patient’s feelings of dissatisfaction, and empathize with the patient’s experience.

P1: “ The pain caused by the swelling of the arm caused by the improper operation is unbearable to the patient. The patients and their families are not satisfied with me, but I can understand the discomfort caused by the patient ’ s pain and sincerely apologize to the patients and their families. ”

P9, P6, P8: “Even though the patient understands my unprofessional nursing practices, I still feel empathy for the patient, and I feel guilty.”

In clinical nursing, the lack of professional skills (theoretical or operational skills) and the lack of information communication and feedback between nurses and patients, nursing postgraduates, and clinical teachers lead to some undesirable phenomena. Such as, participants reported that a lack of professional skills or poor communication led to scalds or nurse-patient conflicts. Furthermore, it has also been reported that ignoring a patient’s emotions can lead to dissatisfaction with the caregiver, even if the individual’s behavior does not negatively affect the patient’s health.

P3: “I felt deeply guilty and uneasy about my actions. At that time, I found that I did not change the wrong liquid, ignoring the patient’s psychological feelings, and deliberately playing down this matter. As a result, the patient complained.”

3.5. Conclusions

Based on Gibbs’s reflective cycle, the good clinical practice includes good communication skills and respect, solid medical knowledge, and clinical teacher support. Good communication skills were considered to be one of MNS the necessary skills [ 28 ]. Especially for nursing graduate students with bias, timely and effective transfer of professional nursing knowledge and the situation that may arise from it, to maintain a good nurse-patient relationship. The study suggested that respect is mutual [ 29 ], the respect and understanding shown by participants towards patients increase the patients' respect towards them. Moreover, solid medical knowledge for MNS of clinical practice was mentioned, as a good clinical practice requires both theoretical and operational expertise, solid medical knowledge can answer the questions of patients and how to complete the operation accurately. It also mentioned the problem of treating patients' intellectual blind spots or emotional distress seriously, not ignoring them, but responding to the literature carefully or paying attention to the patient’s emotions in time. In addition, participants sought help from clinical instructors [ 30 ] to reduce unnecessary problems when their behavior might lead to changes in a patient’s condition or verbal conflict.

P1: “With the accumulation of clinical practice, I realized my shortcomings at that time. I should pay more attention to the patient’s expression and body language, carefully evaluate the patient’s clinical indicators and performance, and learn more skills from teachers should not be blind operation to prevent some of the side effects of scraping. When there are side effects, I should also ask my supervisor to evaluate the situation and do what I can.”

Besides, conclusions about participants' abilities were based on their evaluations of their behavior during and after clinical practice. Participants said they were aware of their professional responsibilities and the severe consequences of their deficiencies, such as the need to improve their attitudes and improve skills in assessing patients in clinical practice [ 30 ]. Through this reflection, the researchers also believe that their lack of crisis awareness [ 31 ], and failure to do an excellent job in nursing which is due to their usual learning and working attitude caused.

In addition, participants' needs for knowledge were related to medication safety, patients' psychological status, and respect for and empathy with patients. Some graduate nursing students who have just participated in clinical nursing practice lack basic knowledge of self-discipline, respect and compassion, medication safety [ 32 ], and clinical work procedures. Therefore, the need for this knowledge was considered valuable and necessary in clinical practice.

3.6. Action plan

It is clear from Gibbs' analysis of reflective data that MNS is sometimes satisfied with their behavior because their performance is professional, and they can gain experience from clinical practice. Respecting and empathizing with the physical and mental suffering of patients, providing timely feedback and effective treatment, paying attention to drug safety [ 32 ], and listening to and understanding the needs of patients were mentioned as being professional behavior.

P7: “I should stop this from happening at the source, communicate with the patient and give feedback to the higher level, provide adequate treatment to the patient, and make sure we have the support and understanding of the patient and the family. At the same time, I should also learn more to strengthen their professional skills. ”

Recommendations for improving action include timely feedback and communication, being patient-oriented, strengthening clinical skills, and following the nursing code of conduct. One suggestion for timely feedback and communication is to maintain effective communication with patients and supervisors when conflicts or adverse events occur and to provide timely feedback on outcomes [ 28 ]. Communication and feedback should also be patient-oriented when the patient’s physical and mental integrity is compromised. Researchers believe that [ 33 ] MNS should have prospective thinking in clinical practice, which is to evaluate the patient’s physical and psychological status comprehensively, observe more during treatment, and reduce the risk of adverse events. Participants also mentioned that when problems are encountered in future clinical practice, they should be more proactive in paying attention to the specific needs of patients and consulting experienced clinical teachers [ 30 ].

4. Discussion

This study aims to promote the learning, personal, and professional development of MNS by reflecting on clinical experiences based on the Gibbs’s framework. Reflective writing by MNS was applied to this study. The study indicated that MNS most frequently described the clinical practice experience as the themes of adverse events, professional knowledge, and nurse-patient conflict. MNS was expected to be the leaders or managers of the nursing profession [ 33 ]. Still, the gap between school education and clinical practice [ 33 ] may lead to the problem of insufficient professional knowledge and communication ability of MNS in clinical practice, at the same time, MNS were not Down to Earth in clinical work, which can lead to adverse events.

MNS had complex emotions in clinical practice, including negative feelings, such as anxiety, worry, tension, guilt, and positive emotions of happiness. Despite the emotional challenges of communicating with patients in clinical practice, the majority of MNS said they understood the feelings in clinical practice and were concerned about patient safety. The study help to understand the feelings and thoughts of MNS as they emerge from complex clinical experiences during clinical work. This is consistent with the results of another study from Taiwan in China, which reported that participants reflected on events with both positive and negative thoughts [ 34 ].

Participants also felt that reflective writing helped them to learn from their experiences and promote professional development [ 2 , 34 ]. Such as being able to remain calm and quickly deal with incidents during conflicts in clinical practice while seeking help from clinical faculty [ 30 ], and seeking understanding and empathy from patients and families. In addition, participants described concerns about the adverse consequences of MNS in the clinical setting due to ineffective and unprofessional communication with patients. This is in line with the concept of “patient-centered improvement of medical service quality” proposed by the National Health Supervision Commission of the People’s Republic of China and reflects the professional concept of nursing staff to take the safety and interests of patients as the criterion at all times.

Although the clinical practice settings described by participants varied, possibly due to the study’s use of Gibbs’s reflective cycle, the study found that reflection was seen as beneficial for participants' feelings, thoughts, and actions [ [18] , [19] , [20] ]. Participants felt it was meant to reflect on events in clinical practice to help them do things the next time they faced a similar situation [ 20 ]. Generally, for MNS, it is not only necessary to master solid clinical expertise but also to learn the ability to communicate and feedback information [ 33 ] so that learn to reduce the impact of adverse events on personal emotions and to think about clinical events more positive and mature way [ 34 ]. The findings of this study suggest that increased reflective writing is necessary for future clinical education in MNS. As in previous studies [ 1 , 2 ], participants in this study were able to gain experience from the clinical experience and provide advice for future action. In summary, reflective learning is not only a valuable learning strategy for MNS in clinical practice but is also seen as a helpful tool for MNS learning, personal ability, and professional development.

4.1. Limitations

This study has some limitations. First, the sample size was small and came from MNS interning at the same hospital, and it is unknown whether the study results apply to different clinical Settings in different countries. In addition, the study did not include the reflection of other clinical populations, such as how clinical teachers and MNS mentors evaluated the content of MNS reflection and whether it promoted the development of the clinical profession. Moreover, the rationality and effectiveness of the reflection practice curriculum design need to be further discussed.

5. Conclusion

This qualitative study presents an analysis of the self-reflective relevance of MNS in clinical practice. MNS needs to deal with complicated and unexpected clinical events in clinical practice. To deal with and cope with these situations on time, MNS needs to have good nursing professional skills, such as theoretical and operational skills, and a good mentality to understand and care for patients [ 33 ]. In this qualitative study, it was demonstrated that the Gibbs’s reflective cycle is helpful in the clinical practice of MNS. It helps MNS reflect on clinical practice and translates clinical experience into a valuable experience for developing personal and professional development.

Author contribution statement

Ting-ting Zhan: Conceived and designed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Li-li Wang: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.

Yan Wang; Cai-jie Sun: Analyzed and interpreted the data.

Funding statement

Ting-ting Zhan was supported by Provincial Quality Engineering Project for Higher Education Institutions of Anhui Province in China [2020JYXN1053].

Data availability statement

Declaration of interest’s statement.

The authors declare no conflict of interest.

Acknowledgments

The authors would like to appreciate the support from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, China and all the researchers and participants involved in this study for their support.