Reflection is the process of thinking back or recalling a situation or event to rediscover its meaning. It helps you to seek and understand the relationships among information, con- cepts, and principles and to apply them in future clinical or testing situations. Reflection can be conducted internally as quiet thoughtful consideration, in a one-on-one discussion with 6 FUNDAMENTALSSUCCESS: A Q & A REVIEWAPPLYINGCRITICALTHINKING TOTESTTAKING
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experiences, personal and educational, that influence your development as a licensed nurse.
Your personal experiences include activities using verbal and written communication, such as delegating tasks to family members or coworkers, setting priorities for daily activities, using mathematics when shopping or balancing a checkbook, and so on. A nursing program of study incorporates courses from a variety of other disciplines, such as anatomy and physiology, chemistry, physics, psychology, sociology, reading, writing, mathematics, and informatics. Every single experience is a potential valuable resource for future learning.
Recognize the value of the “you” you bring to your nursing education and incorporate it into your reflective processes.
Engaging in reflection is a highly individualized mental process. One form of reflection is writing a journal. A journalis an objective and subjective diary of your experiences. It is a chronicle that includes cognitive learning, feelings, and attitudes; and it requires you to actively develop skills related to assessing, exploring the meaning of critical incidents, doc- umenting, developing insights into thoughts and actions that comprise clinical practice, and evaluating. Journal writing is a rich resource that provides a written record of where you have been, where you are, and where you are going. It helps you to incorporate experiences into the development of your professional being. After an examination, explore your feelings and attitudes regarding the experience. Be honest with yourself. Did you prepare adequately for the test? Did you find the content harder or easier than content on another test? Were you anxious before, during, or after the test and, if so, was your anxiety low, medium, or high? What would a low score or high score on the test mean to you? When you were confronted with a question that you perceived as difficult, how did you feel and how did you cope with the feeling? You do not necessarily have to ask yourself all of these questions. You should ask yourself those questions that have meaning for you.
Another form of reflection is making mental pictures. Mental picturesare visual images that can be recalled in the future. For example, when caring for a patient who has Parkinson’s disease, compare the patient’s signs and symptoms to the classic clinical manifestations asso- ciated with the disease. Then make a visual picture in your mind. Visualize the pill-rolling tremors, mask-like face, drooling, muscle rigidity, and so on, so that in the future you can recall the visual picture rather than having to remember a memorized list of symptoms.
Retrospective (after the event) reflectioninvolves seeking an understanding of rela- tionships between previously learned information and the application of this information in patient-care situations or testing experiences. This type of reflection helps you to judge your personal performance against standards of practice. A self-assessment requires the willingness to be open to identifying one’s successful and unsuccessful interventions, strengths and weaknesses, and knowledge and lack of knowledge. The purpose of retrospec- tive reflection is not to be judgmental or to second-guess decisions but rather to learn from the situation. The worth of the reflection depends on the abilities that result from it. When similar situations arise in subsequent clinical practice, previous actions that were reinforced or modified can be accessed to have a present successful outcome.
A clinical postconferenceis an example of retrospective reflection. Students often meet in a group (formally or informally) after a clinical experience to review the day’s events. During the discussion, students have an opportunity to explore feelings and attitudes, consider in- terventions and alternative interventions, assess decision-making and problem-solving skills, identify how they and other students think through a situation, and so on. You can also review your own thinking when reviewing a patient experience by speaking aloud what you were thinking. For example,
“When I went into the room to take my postoperative patient’s vital signs I realized that the patient had an IV in the right arm. I knew that if I took a blood pressure in the arm with an IV it could interfere with the IV so I knew I had to take the blood pressure in the left arm. When I looked at my patient, he looked very pale and sweaty. I got a little nervous but I continued to get the other vital signs. I put the thermometer in the patient’s mouth and started to take his pulse. It was very fast and I knew that this was abnormal so I paid special attention to its rhythm and volume. It was very thready but it was regular. The temperature and respirations were within the high side of the expected range.” A beginning nursing student may immediately respond by saying, “I don’t know what is going on here so I better take this information to my instructor.”
A more advanced student might say, “What could be happening? Maybe the patient is bleed-
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When you review an experience like this example, you can identify your thinking skills.
Taking the blood pressure in the left arm and assessing the rate, rhythm, and volume of the pulse were habits because you did not have to figure out a new method when responding to the situation. Remembering the expected range for the various vital signs used the thinking skill of total recall because you memorized and internalized these values. Determining further assessments after obtaining the vital signs required inquiry. You collected and analyzed infor- mation and did not take the vital sign results at just face value. You recognized abnormalities and gaps in information, collected additional data, considered alternative conclusions, and identified alternative interventions.
Another example of retrospective reflection is reviewing an examination. When review- ing each question, determine why you got a question wrong. For example, several state- ments you might make are:
• I did not understand what the question was asking because of the English or medical vocabulary used in the question.
• I did not know or understand the content being tested.
• I knew the content being tested but I did not apply it correctly in the question.
When a limited English or medical vocabulary prevents you from answering a question correctly, you must spend time expanding this foundation. A list of English words that ap- pear repeatedly in nursing examinations is included in a glossary at the end of this textbook.
In addition, nursing/medical keyword lists have been included in each content area in this textbook. You can use these word lists to review key terminology used in nursing-related topics. To expand your vocabulary, keep English and medical dictionaries at your side when studying and look up new words, write flash cards for words you need to learn, and explore unfamiliar words with which you are confronted on tests.
When you answered a question incorrectly because you did not understand the content, make a list so that you can design a study session devoted to reviewing this information.
This study session should begin with a brief review of what you do know about the topic (5 minutes or less). The majority of your efforts should be devoted to studying what you identified as what you need to know. You should do this after reviewing every test. This exercise is based on the axiom strike while the iron is hot.The test is over, so your anxiety level is reduced and how nursing-related content is used in a test question is fresh in your mind.
Study sessions that are goal directed tend to be more focused and productive.
When you know the content being tested but have applied the information incorrectly, it is an extremely frustrating experience. However, do not become discouraged. It is moti- vating to recognize that you actually know the content! Your next task is to explore how to tap into your knowledge successfully. Sometimes restating or summarizing what the ques- tion is asking places it into your own perspective, which helps to clarify the content in relation to the test question. Also, you can view the question in relation to specific past experiences or review the information in two different textbooks to obtain different per- spectives on the same content. Another strategy to reinforce your learning is to use the left page of your notebook for taking class notes and leave the facing page blank. After an examination, use the blank page to make comments to yourself about how the content was addressed in test questions or add information from your textbook to clarify class notes.
How to review thinking strategies in relation to cognitive levels of nursing questions is explored later in this chapter.
Examine your test-taking behaviors. For example, if you consistently changed your ini- tial answers on a test, it is wise to explore what factors influenced you to change your an- swers. In addition, determine how many questions were converted to either right or wrong answers. The information you collect from this assessment should influence your future be- haviors. If you consistently changed correct answers to incorrect answers, you need to ex- amine the factors that caused you to change your answers. If you changed incorrect answers to correct answers, you should identify what mental processes were used to arrive at your second choice so that you can use them the first time you look at a question.
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EFLECTIONReflecting on your knowledge, strengths, and successes is easy, but reflecting on your lack of knowledge, weakness, and mistakes takes courage and humility. Courageis the attitude of confronting anything recognized as dangerous or difficult without avoiding or withdraw- ing from the situation. Courage is necessary because when people look at their shortcom- ings they tend to be judgmental and are their own worst critics. This type of negativity must be avoided because it promotes defensive thinking, interferes with the reception of new information, and limits self-confidence.
Humility is having a modest opinion of one’s own abilities. Humility is necessary because it is important to admit your limitations. Only when you identify what you do and do not know can you make a plan to acquire the knowledge necessary to be success- ful on nursing examinations and practice safe nursing care. Arrogance or a “know-it-all”
attitude can interfere with maximizing your potential. For example, when reviewing examinations with students, the students who benefit the most are the ones who are willing to listen to their peers or instructor as to why the correct answer is correct. The students who benefit the least are the ones who consistently and vehemently defend their wrong answers. A healthy amount of inquiry, thoughtful questioning, and not accepting statements at their face value are important critical-thinking competencies;
however, a self-righteous or obstructionist attitude more often than not impedes, rather than promotes, learning.