Abstract
Reflection has gained increased recognition in nursing literature as a method to assist nurses enhance knowledge, bridge theory-practice gap, and improve nursing practice. Reflection is particularly relevant for newly graduated nurses (NGNs) as they transition into practice and assimilate fundamental skills and knowledge from the academic setting into the professional practice setting. While there is limited nursing research exploring the use of reflection in the experienced nurse population, there is a dearth of literature related to whether, what extent, or how NGNs reflect on their practice. The purpose of this qualitative descriptive study was to explore the reflective practice of NGNs with less than 18 months clinical practice. The research questions were: (1) how do NGNs perceive and use reflection in clinical practice; (2) in what types of clinical situations do NGNs reflect; (3) what is the nature of the process NGNs use to reflect on clinical practice; and, (4) in what ways do the findings of this study support, refute, or expand Benner's Novice to Expert Model (Benner, 1982; 2001). Ten NGNs were recruited from an acute care teaching hospital in a metropolitan area. The final study sample consisted of mostly female, Caucasian, NGNs ranging from 22-33 years of age. The NGNs practiced in a broad range of clinical practice settings and had completed a precepted orientation between 3 weeks and 5 months prior to participating in the study. Study data was collected through one-hour, audio-taped responsive interviews. Data was analyzed using Rubin and Rubin's (2012) five-step data analysis and was guided by the research questions. Data from each interview were analyzed individually, and then compared to data from remaining interviews. Major themes addressing the research questions emerged from the analysis of transcribed interviews. Although the NGNs had previous experience with reflection, and could define reflection using key terms, they did not consistently use a reflective process to explore clinical experiences. Study participants often confused reflection with the concepts of thinking, worrying, discussing, and complaining. Clinical experiences that prompted a reflective exploration were those that presented as a crisis for the NGN and challenged their knowledge, skills, confidence, and ideal of professional practice. NGNs were not able to articulate an organized process that they used to deconstruct or reflect on their individual clinical experiences. However, through analysis of individual and cross-comparison interview data, a larger reflective process emerged consisting of four phases: (1) experiencing the clinical situation, (2) framing the clinical situation, (3) reflecting on the clinical situation, and (4) emerging thoughts and insights. Study participants appreciated opportunities for learning, although these learning experiences often challenged the NGN skills, knowledge, and confidence; this finding is consistent with NGN practice within Benner's model (Benner, 1982, 2001). Clinical experiences shared by study participants focused on the broad, holistic care of the patient, and acknowledged the role of the patients' family members; this finding is not consistent with the narrow, task focused approach to nursing care attributed to NGN practice in Benner's model (Benner, 1982, 2001). Findings from this study provide a rich description of the reflective practice of NGN. Based on the findings of this study, several implications and recommendations for theory, practice, education, policy, and research are provided..