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Reflecting on health and wellbeing as a student nurse: a personal journey

09 August, 2021

One student nurse’s personal reflection and experience of the theoretical and lay understanding of the factors that contribute to health and wellbeing

This article presents a reflection of my personal health journey since starting university as a student nurse. Focusing on social, physical and psychological aspects of health, it explores the impact of stress and the cessation of exercise on my health and wellbeing. The similarities and differences of lay and theoretical definitions of health are examined, and a personal definition of health is presented. The discussion presents my understanding of health as a student nurse, and analyses how loneliness has impacted on my health and wellbeing during the first two terms of university.

Citation: Power C, Andrewes T (2021) Reflecting on health and wellbeing as a student nurse: a personal journey. Nursing Times [online]; 117: 8, 22-24.

Authors: Caela Power is student nurse, Tanya Andrewes is lecturer in adult nursing; both at Bournemouth University.

• This article has been double-blind peer reviewed
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Introduction

My experience in the first two terms of university as a student nurse led me to reflect on our understanding of health and wellbeing from a theoretical and lay perspective. A better personal understanding of managing health and wellbeing can support student nurses in their role of helping patients to explore and improve their health.

Theoretical perspectives

Defining health is complex due to the high number of factors that contribute to it. The World Health Organization (1946) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Yet, this definition has been criticised for being limited in its scope, on the basis that there are many other factors to consider beyond disease and infirmity: as discussed below (Warwick-Booth et al, 2012).

Theoretical models are developed and tested by experts through the collection of research evidence (Topolski, 2009), and enable us to understand different dimensions of health. As shown in Box 1, the four main models of health are medical, social, holistic and biopsychosocial, each of which explains the impact of different factors on health and wellbeing (Warwick-Booth et al, 2012).

Box 1. Four theoretical models of health

• Medical – focuses on physiological aspects of health
• Social – takes into account external factors such as those that are environmental, cultural and economic
• Holistic – places the individual at the centre
• Biopsychosocial – features an awareness of the balance between psychological, social, biological and spiritual influences

The medical model focuses on physiological aspects of health. The theory has developed from scientific evidence about the impact of illness on the systems of the body and the impact of medical/surgical interventions as a response to it. The emphasis in the medical model is on diagnosis and treatment from an expert (Warwick-Booth et al, 2012). If a medically defined illness is absent, then health is considered to be good.

The medical model focuses on biomedical influences on an individual’s health alone, without consideration of the social and psychological dimensions. Blaxter (2010) acknowledged that, while medicine has a place for supporting individuals to achieve their maximum physiological health potential, other theoretical models need to be considered if nurses are to support holistic health and wellbeing that takes into account social and psychological dimensions of health.

The social model of health takes a more holistic approach, viewing the individual as a social, complex being. In the social model, external factors such as environmental, cultural and economic influences are considered in terms of their impact on people’s health and wellbeing (Michaelson, 2013). According to the social model, how individuals perceive their life can affect their ability to cope with stresses (Blaxter, 2010). This internal capacity to cope and overcome adversity is known as resilience.

In contrast to both the medical and social models, the holistic and biopsychosocial models focus on the interplay between the psychological, social, biological and spiritual influences on individuals, reinforcing the need for a healthy balance between all these factors to achieve good health. The holistic and biopsychosocial models consider each person as a unique individual, subject to discrete circumstances, experiences and expectations (Lehman et al, 2017).

The holistic model places the individual at the centre, empowering them to enhance their own health and wellbeing through what Blaxter (2010) called alternative therapies. This approach is supported in the UK by a report from the Government Office for Science (GOS), which introduced the Five ways to Wellbeing model; individuals are encouraged to:

• Connect with others;
• Take notice;
• Keep learning;
• Give (GOS, 2008).

All these activities support holistic and/or biopsychosocial health and wellbeing.

Lay perspectives

The lay perspectives on health, some characteristics of which are summarised in Box 2, refer to informal definitions or a general understanding of what good health means, with a recognition that the understanding varies between individuals. Yuill et al (2010) highlighted that lay perspectives are informed by class-based, generational traditions and norms, often based on personal and familial experiences; Kolderup Hervik (2016) suggested that lay perspectives are gendered and contextual.

Box 2. Characteristics of lay perspectives on health

• Informal definitions or an understanding of good health that varies between individuals
• Informed by class-based, generational traditions and norms, and often based on personal and familial experiences
• In the past, dismissed as being ill informed and subjective; now more likely to be seen as valid, even in the absence of an evidence base

Lay perspectives reflect a non-expert view, in which some beliefs and understandings about health and illness exist in the absence of research evidence. They inform people’s experiences of health, their interpretations of the causes and effects of illness, and their responses to it. One such example is the understanding in the Middle Ages that illness was caused by evil spirits, with the ‘treatment’ involving driving out the spirits by torturing the body (Yuill et al, 2010).

In the past, lay knowledge of good health has been dismissed as being ill informed and subjective; however, as it has developed over time, some individuals, including Warwick-Booth et al (2012), have proposed that lay perspectives are valid, even in the absence of an evidence base. This is because individuals have the best insight into their own health and wellbeing, factors that affect it and actions that help to support it.

For some, health is viewed as physical; for others, it is psychological or sociological and/or holistic (Yuill et al, 2010). Blaxter (2010) explored lay perspectives of health among participants from the UK and revealed five key areas of understanding – namely, that being healthy means being not ill and having vitality, physical fitness, social relationships and psychosocial wellbeing.

Similarities

Theoretical and lay perspectives share some similarities, in part because theoretical influences contribute to lay perspectives of health (Entwistle et al, 1998). Medicine has a powerful influence on a person’s perspective of health and the evidence base of the medical model offers a strong and reliable foundation for understanding physiological illness (Blaxter, 2010) – it is easy to understand the positive impact being physically fit has on health. Indeed, if individuals can maintain physical fitness, they can reduce their chances of developing some illnesses, for example, cardiac disease (Warwick-Booth et al, 2012).

The theory underpinning the social model is reflected in lay perspectives that link good health with a good social life, including the ability to maintain relationships, have a secure socioeconomic status and financial stability (GOS, 2008). Some lay beliefs are more holistic, incorporating aspects of the holistic and biopsychosocial models in which health is viewed as a balance between the biological, social and psychological.

Differences

There are some significant differences between theoretical and lay perspectives of health. Firstly, theoretical perspectives are grounded in evidence, whereas it is usual that lay beliefs are unconsciously developed as a result of individual life experiences and relationships, alongside social influences such as the media (Yuill et al, 2010).

Another key difference is that theoretical perspectives do not necessarily change significantly over time but, instead, evolve with the further collection of research data around their use. By contrast, lay perspectives commonly change in time due to individuals being exposed to varied life experiences, alongside factors such as increasing age (Rydstedt et al, 2004). Theoretical perspectives are used to underpin healthcare policies because they are based on evidence, but lay perspectives tend to be more informal (Blaxter, 2010).

A personal definition

My own definition of health is focused on achieving the maximum quality of life, emotionally, spiritually, physically and socially, and feeling a regular sense of contentedness in all four interlinked aspects. I believe this can, or should, be achieved by taking a natural, holistic approach, while also understanding the importance of biomedicine and its place in improving health.

My personal beliefs about health reflect the biopsychosocial model, as I believe in taking a person-centred approach to improving health with the consideration of one’s interlinking psychological, social and physical circumstances. In addition, I believe spirituality plays a vital role in a person’s health and deserves equal focus to physiological aspects.

Since moving far from my family home to study for an adult nursing degree, my health has become increasingly important to me. Moving to a new area was daunting and had many impacts on my health and wellbeing. Initially, I stayed with family friends, life was exciting and I felt positive about my prospects as a university student and a nurse. I was happy, I socialised regularly and had an exercise routine.

As time passed, however, I began to feel the pressures of academic expectation and I socialised less. I lacked motivation to complete academic work, leading to assignments being submitted late. The resulting high levels of stress and anxiety had an impact on my psychological wellbeing: I felt socially isolated, began to feel extremely low in confidence and lonely, and lacked the motivation to exercise. I was also beginning to make unhealthy food choices. All these changes had a negative impact on my physical state.

I was worried I wouldn’t cope with being on placement; conversely, however, the placement provided a sense of purpose and confirmed my passion for nursing, as well as teaching me some coping strategies to enhance my wellbeing.

Dealing with loneliness

Making new friends is a challenging and sometimes difficult experience. I rely on connecting with others – a feature of the Five Ways to Wellbeing model – to help maintain my wellbeing and maximise life enjoyment. However, after starting university I found it difficult to make friends and connect with people, which reduced my self-confidence and created feelings of insecurity. Loneliness had a negative impact on my psychological state and mental health, causing some anxiety and a depressive mood.

Vasileiou et al (2019) have pointed out that loneliness among university students is a recognised problem, with 64% of students admitting to feeling lonely during their studies; loneliness and social isolation has also been closely linked to poor mental health and a reduced sense of wellbeing while studying at university.

The low levels of confidence I had because of loneliness led to depressive feelings and my increasingly unhealthy diet, as well as significantly reducing my physical activity. Despite understanding the situation, I found it extremely difficult to change my mindset and lifestyle. My motivation to study and my potential to enjoy being a nursing student were severely compromised. I recognised the imperative to change, so I was well enough to care for others in my student nursing role.

Once I understood that I was lonely, I worked to overcome this. I explored my spirituality and began to meditate, which helped me to appreciate solitude, and worked to identify how I could improve my health and wellbeing through deep exploration of my feelings/thoughts. Zollars et al (2019) have promoted the use of meditation to reduce stress and increase overall good health and, as my mental health improved, I began to socialise and connect with others.

My self-confidence and mood improved and I exercised again, setting myself challenges; this gave me purpose, a sense of self-fulfilment and self-confidence. My positive experience of physical activity supports Herbert et al’s (2020) finding that it improves the mental health, wellbeing and physiological health of university students.

The Covid-19 pandemic has forced several lockdowns, with significant restrictions on social activities, a factor known to increase mental ill health and reduce wellbeing (Dawson and Golijani-Moghaddam, 2020). I knew lockdown would interfere with the coping techniques I was using to overcome my loneliness, such as exercising with others and social interactions in the workplace. Not only did all social activities stop, I was removed from practical placement. I turned to meditation and lengthy outdoor exercise to cope, which helped preserve my resolve to maintain a healthy mindset and lifestyle.

Although my wellbeing has fluctuated over the past year, my increased self-awareness has led to me to take prompt action at the early signs of decline, such as feeling withdrawn and unsociable, under increasing pressure from academic assignments and having a general sense of unease that I am not managing.

Individuals who engage in wellness programmes experience reduced stress and increased functionality at work (Couch, 2014). My self-led meditation practice reduced my stress and increased my engagement in my university course. It has enabled me to analyse links between my physiological and psychological health, and understand the multifaceted influences on health and wellbeing. The importance of maintaining a balance between physical, psychological, social and spiritual aspects is clear.

Without analysing my situation in the context of theoretical and lay perspectives of health, I could not have developed the self-awareness about my loneliness, or my purposeful actions to overcome it. This understanding has implications for my nursing practice as I can draw on my experience to empathise with my patients and ask them questions to help them analyse what is happening and how it affects their health and wellbeing and what small positive changes they can make to bring improvement.

Analysing theoretical and lay perspectives of health, in the context of my personal experience of health and wellbeing since starting university, has enabled me to explore how the different dimensions of health are fundamentally linked and affect each other. I have realised how complex the meaning of good health is, and that it means different things to different people. As such, I appreciate the importance of understanding what health means for me and for those people I will support as a nurse.

• Theoretical and lay perspectives of health enable analysis of the impact of a range of factors on health and wellbeing
• Developing self-awareness allows individuals to identify factors that have a negative impact on health and wellbeing
• Self-awareness of personal health and wellbeing status can help identify coping strategies
• Personal reflection can help guide student nurses’ understanding of health and wellbeing and how it can be improved in those for whom they care

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New Voice: Reflections on Mental Health + Wellbeing

PGCE student, Leanne Tweddle, reflects: Am I affecting their mental health?

Mental health is often a difficult topic for people to discuss especially when discussed in relation to young people. Mental health problems affect approximately 1 in 10 young people. This includes depression, anxiety and eating disorders which are a direct response to what is happening in their lives. Shockingly, around 70% of young people experiencing mental health issues do not have the appropriate interventions at an early enough age in order to have an effective recovery (Good Mental Health for All: Children and Young People).

I chose to write about mental health for this reflective blog, using Boud reflective model (Boud et al, 1985), as I have recently become a youth mental health first aider and it has highlighted to me how many of the young people I work with are affected in some way by poor mental health, and Boud’s model enables me to use this training to gain “new understandings and appreciations” (Boud et.al, 1985, p.19) in relation to this. As a SEN teacher I am aware that young people with learning difficulties are at much greater risk of having mental health problems and in fact they are over 6 times for likely to have a diagnosable psychiatric disorder (Children and Young People with Learning Disabilities: Understanding their Mental Health). I currently have 11 students in my class and over 50% of them have or are suffering with mental health issues and following my training I have been reflecting on how I have been supporting these students within my classroom.

The first issue I want to address is MY behaviour! Both during and since my training I have spent time reflecting on how my actions may have helped or hindered the level of support I was providing to my students who may have mental health concerns. As a busy teacher it is easy to sometimes miss or not allow enough time for an issue which may arise. The training has taught me that when an issue arises it is best to deal with it there and then and take the time to deal with it properly so that the young person feels listened to. When a young person has come to me with issues in the past I have always discussed the issue with them and signposted them to the correct intervention, support or agency but did I always allow the young person time and did I always appear 100% focused in the young person’s perspective? Moving forwards I am going to ensure (to the best of my ability) that I appear and sound approachable, always allow the appropriate amount of time to listen non-judgementally (MHFA, 2017, p. 108) and use my training, reflection and further research to ensure I put the correct next steps in place.

The second thing I felt I needed to reflect on was my knowledge in relation to mental health. I am made aware of the basic background information in relation to my students but I don’t always have as much information as I perhaps need to fully support them and I had perhaps not done enough research into the associated mental health conditions. The training gave me a good insight into the basics of several mental health conditions, and I have used this to go away and conduct further reading and research into the conditions which affect my students. I have also spent more time with pastoral staff in school to share further information regarding students and their mental health wellbeing. Subsequently, I am going to endeavour to continue working more closely with support staff and continue my own personal development in this area so that I have the knowledge to better support my students. Considering the Equality Act (2010), just like student’s Special Educational need, their mental health needs need to be considered to ensure we are making reasonable adjustments in order to meet their needs.

Another thing I want to reflect on is how I promote mental health and wellbeing. As a school we have a relatively good system in place for supporting mental health issues due to the nature of the cohort but was I doing this to the best of my ability? Following the training and after additional research I found myself looking into ways I can improve this, as it is important that I (along with the rest of school) promote good mental wellbeing for all pupils. To do this I need to:

• Be aware of signposting and referral procedures
• Build anti-stress and relaxation into my timetable
• Allow safe spaces for reflection and active listening
• Opportunities for one-to-one interactions

(Avis et al, 2009, p. 73)

This will ensure that I am “maintaining and promoting students’ mental health and not causing undue stress or exacerbating difficulties whilst teaching” (Avis et al, 2009, p. 73).

The final thing I want to reflect on is my own mental health. During my research I read about the impact teachers wellbeing and mental health has on their students. Students are very much attuned to their teacher’s mood and this will have an adverse effect on how they both learn and behave in class (Leeds Beckett University, 2019). This made me think about how my mood may affect my class and I realised the importance of developing my own strategies to manage my own mental health and therefore increase my resilience in dealing with issues.  My resolution for this is to allow myself time to relax, maintain a healthy work-life balance, be aware of my potential triggers, develop effective coping strategies, seek support if needed and discuss any potential issues with management (Avis et al, 2009, p. 73-74). Students often model their behaviour on those around them and if I have a positive mental health I will be a better role model to student and be better equipped to deal with any issues which may arise related to poor mental health.

Avis, J., Fisher, R., & Thompson, R. (2019).  Teaching in Lifelong Learning: A Guide to Theory and Practice  (3rd ed.). London: Open University Press.

Better Outcomes New Delivery. Children and Young People with Learning Disabilities: Understanding their Mental Health. Young Minds: London. Retrieved from https://www.mentalhealth.org.uk/publications/children-and-young-people-learning-disabilities-and-their-mental-health

Boud, D., Keogh, R., & Walker, D. (1985).  Reflection: Turning Experience into Learning . London: Kogan Page.

Department for Education. (November 2018).  Mental health and behaviour in schools  (DFE-00327-2018). Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/755135/Mental_health_and_behaviour_in_schools__.pdf

Leeds Beckett University. (2019).  The impact of teacher wellbeing and mental health on pupil progress in primary schools . Retrieved from https://www.leedsbeckett.ac.uk/-/media/files/schools/school-of-education/teacher-wellbeing–pupil-progress-research.pdf?la=en

Mental Health Foundation. (2020). Good Mental Health for All: Children and Young People. Retrieved from https://www.mentalhealth.org.uk/a-to-z/c/children-and-young-people

Mental Health First Aid (MHFA) England. (2017).  Youth Mental Health First Aid Course Manual.  Retrieved from www.mhfaengland.org.

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Reflection and mental health nursing. Part seven: reflection as a tool for teaching and learning

Reflection is an important skill in the armoury of the mental health nurse. Most nurses are familiar with its use in the review and development of their clinical client-centred practice; however, its use for the nurse's own development is less well appreciated. The author highlights how the elements of a reflective learning process can be used by the clinically based nurse to enhance the support of their students' learning. The principles of reflection before, during and after action are then explored as a tool in enhancing the clinician's own experiential learning, examining the dynamic relationship between experience and reflection.

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Reflection and mental health nursing. part one: is reflection important.

In this new series, John Fowler, a noted nursing author, will explore the use of reflection in mental health nursing. Over the next eight issues, John will be examining some of the techniques that mental health nurses can use to aid their own reflection and how reflection can be applied to clinical practice and management. The series will cover portfolios, reflective learning, reflective evidence, the use of feedback and reflection in all aspects of life.

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Reflective assignments in mental health nursing courses: factors to consider

Affiliation.

• 1 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597. [email protected]
• PMID: 23330801
• DOI: 10.3928/02793695-20130109-05

It is important that mental health educators are clear about the nature and practice of reflective processes and their appropriate uses and inherent challenges. Active reflection was developed as a strategy for professional self-improvement in practice-based disciplines. Some mental health nursing courses use reflective exercises as a formal student assessment component. In this article, the authors draw on their experience and the literature to identify issues relating to aspects of the course, educators, and students that are associated with incorporating reflection-related activities as compulsory assessable items in an undergraduate nursing course.

Copyright 2013, SLACK Incorporated.

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The Importance of Self-Reflection: How Looking Inward Can Improve Your Mental Health

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Dr. Sabrina Romanoff, PsyD, is a licensed clinical psychologist and a professor at Yeshiva University’s clinical psychology doctoral program.

Sunwoo Jung / Getty Images

Why Is Self-Reflection So Important?

When self-reflection becomes unhealthy, how to practice self-reflection, what to do if self-reflection makes you uncomfortable, incorporating self-reflection into your routine.

How well do you know yourself? Do you think about why you do the things you do? Self-reflection is a skill that can help you understand yourself better.

Self-reflection involves being present with yourself and intentionally focusing your attention inward to examine your thoughts, feelings, actions, and motivations, says Angeleena Francis , LMHC, executive director for AMFM Healthcare.

Active self-reflection can help grow your understanding of who you are , what values you believe in, and why you think and act the way you do, says Kristin Wilson , MA, LPC, CCTP, RYT, chief experience officer for Newport Healthcare.

This article explores the benefits and importance of self-reflection, as well as some strategies to help you practice it and incorporate it into your daily life. We also discuss when self-reflection can become unhealthy and suggest some coping strategies.

Self-reflection is important because it helps you form a self-concept and contributes toward self-development.

Builds Your Self-Concept

Self-reflection is critical because it contributes to your self-concept, which is an important part of your identity.

Your self-concept includes your thoughts about your traits, abilities, beliefs, values, roles, and relationships. It plays an influential role in your mood, judgment, and behavioral patterns.

Reflecting inward allows you to know yourself and continue to get to know yourself as you change and develop as a person, says Francis. It helps you understand and strengthen your self-concept as you evolve with time.

Enables Self-Development

Self-reflection also plays a key role in self-development. “It is a required skill for personal growth ,” says Wilson.

Being able to evaluate your strengths and weaknesses, or what you did right or wrong, can help you identify areas for growth and improvement, so you can work on them.

For instance, say you gave a presentation at school or work that didn’t go well, despite putting in a lot of work on the project. Spending a little time on self-reflection can help you understand that even though you spent a lot of time working on the project and creating the presentation materials, you didn’t practice giving the presentation. Realizing the problem can help you correct it. So, the next time you have to give a presentation, you can practice it on your colleagues or loved ones first.

Or, say you’ve just broken up with your partner. While it’s easy to blame them for everything that went wrong, self-reflection can help you understand what behaviors of yours contributed to the split. Being mindful of these behaviors can be helpful in other relationships.

Without self-reflection, you would continue to do what you’ve always done and as a result, you may continue to face the same problems you’ve always faced.

Benefits of Self-Reflection

These are some of the benefits of self-reflection, according to the experts:

• Increased self-awareness: Spending time in self-reflection can help build greater self-awareness , says Wilson. Self-awareness is a key component of emotional intelligence. It helps you recognize and understand your own emotions, as well as the impact of your emotions on your thoughts and behaviors.
• Greater sense of control: Self-reflection involves practicing mindfulness and being present with yourself at the moment. This can help you feel more grounded and in control of yourself, says Francis.
• Improved communication skills: Self-reflection can help you improve your communication skills, which can benefit your relationships. Understanding what you’re feeling can help you express yourself clearly, honestly, and empathetically.
• Deeper alignment with core values: Self-reflection can help you understand what you believe in and why. This can help ensure that your words and actions are more aligned with your core values, Wilson explains. It can also help reduce cognitive dissonance , which is the discomfort you may experience when your behavior doesn’t align with your values, says Francis.
• Better decision-making skills: Self-reflection can help you make better decisions for yourself, says Wilson. Understanding yourself better can help you evaluate all your options and how they will impact you with more clarity. This can help you make sound decisions that you’re more comfortable with, says Francis.
• Greater accountability: Self-reflection can help you hold yourself accountable to yourself, says Francis. It can help you evaluate your actions and recognize personal responsibility. It can also help you hold yourself accountable for the goals you’re working toward.

Self-reflection is a healthy practice that is important for mental well-being. However, it can become harmful if it turns into rumination, self-criticism, self-judgment, negative self-talk , and comparison to others, says Wilson.

Here’s what that could look like:

• Rumination: Experiencing excessive and repetitive stressful or negative thoughts. Rumination is often obsessive and interferes with other types of mental activity.
• Self-judgment: Constantly judging yourself and often finding yourself lacking. 
• Negative self-talk: Allowing the voice inside your head to discourage you from doing things you want to do. Negative self-talk is often self-defeating.
• Self-criticism: Constantly criticizing your actions and decisions.
• Comparison: Endlessly comparing yourself to others and feeling inferior.

Kristin Wilson, LPC, CCTP

Looking inward may activate your inner critic, but true self-reflection comes from a place of neutrality and non-judgment.

When anxious thoughts and feelings come up in self-reflection, Wilson says it’s important to practice self-compassion and redirect your focus to actionable insights that can propel your life forward. “We all have faults and room for improvement. Reflect on the behaviors or actions you want to change and take steps to do so.”

It can help to think of what you would say to a friend in a similar situation. For instance, if your friend said they were worried about the status of their job after they gave a presentation that didn’t go well, you would probably be kind to them, tell them not to worry, and to focus on improving their presentation skills in the future. Apply the same compassion to yourself and focus on what you can control.

If you are unable to calm your mind of racing or negative thoughts, Francis recommends seeking support from a trusted person in your life or a mental health professional. “Patterns of negative self-talk, self-doubt , or criticism should be addressed through professional support, as negative cognitions of oneself can lead to symptoms of depression if not resolved.”

Wilson suggests some strategies that can help you practice self-reflection:

• Ask yourself open-ended questions: Start off by asking yourself open-ended questions that will prompt self-reflection, such as: “Am I doing what makes me happy?” “Are there things I’d like to improve about myself?” or “What could I have done differently today?” “Am I taking anything or anyone for granted?” Notice what thoughts and feelings arise within you for each question and then begin to think about why. Be curious about yourself and be open to whatever comes up.
• Keep a journal: Journaling your thoughts and responses to these questions is an excellent vehicle for self-expression. It can be helpful to look back at your responses, read how you handled things in the past, assess the outcome, and look for where you might make changes in the future.
• Try meditation: Meditation can also be a powerful tool for self-reflection and personal growth. Even if it’s only for five minutes, practice sitting in silence and paying attention to what comes up for you. Notice which thoughts are fleeting and which come up more often.
• Process major events and emotions: When something happens in your life that makes you feel especially good or bad, take the time to reflect on what occurred, how it made you feel, and either how you can get to that feeling again or what you might do differently the next time. Writing down your thoughts in a journal can help.
• Make a self-reflection board: Create a self-reflection board of positive attributes that you add to regularly. Celebrate your authentic self and the ways you stay true to who you are. Having a visual representation of self-reflection can be motivating.

You may avoid self-reflection if it brings up difficult emotions and makes you feel uncomfortable, says Francis. She recommends preparing yourself to get comfortable with the uncomfortable before you start.

Think of your time in self-reflection as a safe space within yourself. “Avoid judging yourself while you explore your inner thoughts, feelings, and motives of behavior,” says Francis. Simply notice what comes up and accept it. Instead of focusing on fears, worries, or regrets, try to look for areas of growth and improvement.

“Practice neutrality and self-compassion so that self-reflection is a positive experience that you will want to do regularly,” says Wilson.

Francis suggests some strategies that can help you incorporate self-reflection into your daily routine:

• Dedicate time to it: it’s important to dedicate time to self-reflection and build it into your routine. Find a slot that works for your schedule—it could be five minutes each morning while drinking coffee or 30 minutes sitting outside in nature once per week.
• Pick a quiet spot: It can be hard to focus inward if your environment is busy or chaotic. Choose a calm and quiet space that is free of distractions so you can hear your own thoughts.
• Pay attention to your senses: Pay attention to your senses. Sensory input is an important component of self-awareness.

Nowak A, Vallacher RR, Bartkowski W, Olson L. Integration and expression: The complementary functions of self-reflection . J Pers . 2022;10.1111/jopy.12730. doi:10.1111/jopy.12730

American Psychological Association. Self-concept .

Dishon N, Oldmeadow JA, Critchley C, Kaufman J. The effect of trait self-awareness, self-reflection, and perceptions of choice meaningfulness on indicators of social identity within a decision-making context . Front Psychol . 2017;8:2034. doi:10.3389/fpsyg.2017.02034

Drigas AS, Papoutsi C. A new layered model on emotional intelligence . Behav Sci (Basel) . 2018;8(5):45. doi:10.3390/bs8050045

American Psychological Association. Rumination .

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Positive Mental Health EU

Reflection and Reflective Practices for Promoting Positive Mental Health

Uncategorized

By Angelica Paci

REFLECTION AS A KEY ELEMENT FOR PROCESSING THE EXPERIENCE

Every day, young people face life’s experiences, some pleasant and some not so. These experiences can be opportunities for personal development and learning when young people are equipped with the competences to process them in a fruitful and positive way. However, even though experiences are the basis of one’s learning, they are not necessarily always constructive or educative. According to Dewey, there are both educative and “mis-educative” experiences. A mis-educative experience is one that “arrests or distorts growth” and leads to “routine action,” thus “narrowing the field of further experience,” and limiting the “meaning-horizon”(1). Routine actions suggest that one acts without an awareness of the effect of one’s actions on the environment, including others and self. Routine actions turn into habits that dominate us, rather than us having control over them. We thus become unaware of the impact the environment might have on us, and the cycle of growth that results from this two-way interaction is halted. 

What can support young people to transform an experience into grounded awareness? How can an experience be processed in a way that allows learning more about themselves, others and the context they interrelate in? If we look at Kolb’s learning cycle (2) (figure 1), what turns experience into experiential learning is the reflection process, as it gives time to look at what one sees, feels and thinks after the event has happened. Reflection is an introspective act in which the learner, individually or in a group setting, integrates the new experience with previous ones, making sense of what happened.

Supporting young people in developing a reflective attitude, nurturing what Howard Gardner defined as intra and interpersonal intelligences (3), is, therefore, of vital importance for deepening their awareness about themselves, others and the context they are in. Awareness is a powerful tool to deal with the changes and challenges of everyday life. J. Dewey stated that the main function of reflection is to make meaning and to formulate “relationships and continuities”(4) with the elements of an experience – the links between the experience and prior experiences, between the experience and one’s knowledge, and between that knowledge and the knowledge of other individuals.

Most of the time, many of  our thoughts and feelings go unobserved, leading to repetitive, negative patterns in our lives. Developing the ability to slow down, observe and reflect is crucial for gaining understanding, transforming actions and finding forward momentum in life and relationships. The more practiced and capable one is at reflecting on thoughts, feelings, sensations and interactions, the better one is at transforming actions and improving relationships. Reflective practice is empowering and, over time, allows one to become skilful in making informed judgements and more accurate decisions (Robins et al. 2003). We are a learning species and our survival depends on our ability to adapt, not only in the reactive sense of fitting into the physical and social worlds, but also in the proactive sense of creating and shaping those worlds.

REFLECTION AS A HOLISTIC PROCESS

Reflection is very often equated to the evaluation of a certain situation, experience, assignment or process and is used in educational contexts as a means to promote learning. This is, of course, very useful, as it gives the opportunity to look at facts and analyse them in order to check what is working and what is needed, with the aim of improving performance or knowledge. In this case, the focus is mostly on integrating previous knowledge and experiences into new ones, with the purpose of acquiring new skills. This way of looking at reflection gives only a partial idea of the enormous potential embedded in this process, including its applicability. Reflection is, in fact, much more than just a logical cause-and-effect process, as it is subjective and is concerned with feelings and beliefs. Reflection is a resource that can be used in any life context and situation, such as family, group of friends/peers, work, etc. It allows young people to get in touch with themselves and reveal complex thoughts and attitudes. Reflection can include evaluation as part of the process, but goes much deeper, taking different perspectives into account and looking at underlying reasons. Reflection is intended to explore subtle inner and relational processes, with the purpose of revealing causes and personal triggers. When reflection is promoted as a regular practice, either during a planned non-formal activity or in informal contexts, it supports young people facing more complex or uncertain events and behaviours to “dig deeper” and uncover explanations, and possibly solutions, that are not obvious. Dewey claims that the process of reflection moves the learner from a disturbing state of perplexity or ”disequilibrium” to a harmonious state of settledness or “equilibrium”(5).  Perplexity is generated when the meaning of the experience has not been fully recognised nor assessed yet. It is a yearning for balance that, in turn, drives the learner to do something to resolve it, thus starting the process of inquiry or reflection(6). 

Reflection is therefore no longer conceived as a mere evaluation or logic process of cause-and-effect, but rather as a holistic process of discovery and deep insight. It is a process in which individuals connect body and mind to become more aware of who they are, what they feel, what they think and how they relate to others and the context they are in. “Therefore, reflection is usually indicated by some kind of emotional intensity in which learners demonstrate the connection between themselves and that-which-is-at-stake (the actual topic of reflection). This intensity can sometimes be expressed only in their non-verbal body language. As thinking involves more logic and rationality, this emotional intensity is usually missing.”

FACILITATING REFLECTION

Facilitating reflection is one of the key competences in youth work and one of the most empowering processes that young people can experience. It’s about questioning what is at stake by asking young people when and where things happened, who was there, what did people do, what the outcome of the situation was and what they wanted to happen. It continues with exploring their feelings before, during and after the experience, so that they become aware of what made them feel good (perhaps making them want to feel the same way in other experiences) and what made them feel bad (perhaps making them not wanting to feel the same way in other experiences). Looking into bodily sensations and emotions helps young people to identify underlying needs and wishes, and meeting those needs and wishes helps them create fulfilment. In fact, feelings are spontaneous and emotional responses to what is being experienced and provide essential information about what is actually going on. A warm feeling on the face might mean one is embarrassed, butterflies in the tummy can mean one is nervous or excited and clenched teeth might signify one is angry. Being aware of physical signals allows young people to better identify how they are feeling, and by engaging with how they are feeling, to gain an insight into what they like, what makes them feel anxious, uncomfortable or angry, what makes them feel satisfied or joyful.

As natural progression of those insights, young people can investigate what made things go well and what didn’t in terms of behaviour and attitudes, in order to draw the “lesson” the experience provides, or to better to integrate the learning for themselves. “In action” reflection questions would be “what didn’t I do that I could have done?” and “what could I do that I haven’t done yet?”. Schön was the first to talk about reflection-in-action, claiming that in this process “the practitioner allows himself to experience surprise, puzzlement, or confusion in a situation which he finds uncertain or unique. He reflects on the phenomenon before him, and on the prior understandings which have been implicit in his behaviour. He carries out an experiment which serves to generate both a new understanding of the phenomenon and a change in the situation”(7).

All this new learning about themselves, others and their context allows young people to think of possible little steps they can take in order for change to happen. Scientific research(8) suggests that children who are better at reflection are also more successful in all competences in the cognitive domain. Questioning is indeed an important tool to direct the reflective attention of young people, working like a torch in the night, shedding light over what is not processed at a conscious level. Is there a correct sequence or a right question to ask? Questions are shaped in relation to what is happening in the here and now, taking into account the learning context as well as the purpose of the learning experience itself. To build a “reflective space”(9), questioning should be driven by a genuine interest about the learner(s), with an attitude of non-judgmental curiosity with regards to how people see, think and feel about what is at stake. Answers can convey important information for a new question, creating a process of reflection that can lead people to start a dialog with their internal and external ‘companions’ by allowing some distance from their initial thoughts and feelings. In doing so, people will naturally start building the space to reflect within (both individually and collectively), where a co-created dialogue can happen and where silence and “not knowing” are valued. According to Kessels, this not-knowing helps learners to progressively unfold a good quality dialogue with themselves, constructing ‘poetic arguments’ that are quite different from ‘logical reasons’. Reflection is, in fact, a process where part of the information is elaborated unconsciously. Tom Luken claims that “the conscious works serial whereas the unconscious brain works with parallel processes. The conscious brain should necessarily limit itself to a few aspects, whereby there is always a certain arbitrariness. […] Conscious thinking is inclined to use logic, also for questions, paradoxes and dilemmas that can’t be answered with logical thinking. One of the consequences is that in order to get to a solution, inconsistent information gets ‘pushed away’, whereby the eventual decision is based on a distorted representation [of reality].”(10)

Reflection is more effective when it’s conceived as part of a learner-centred approach, as what is being elaborated by the individual is retained in a more authentic and personalized way. The learning comes out of the learners’ frames-of-reference, which determine how they perceive themselves, others and/or the world(s) they live in. This allows young people to take ownership of content, to determine what is useful or relevant to them and build the cognitive connections to allow the learning to be retained.

REFLECTIVE PRACTICES

Reflective practice is the process of making meaning from experience and transforms insights into practical strategies for personal growth. It implies listening, observing and paying attention to oneself, others and context, noticing patterns and facing one’s assumptions, with the purpose of changing the way one looks at things. Reflective practice is a way of recognising and expressing what one is learning in the present moment.

It needs to be captured and represented in different forms (verbal, written, pictorial, sculptural, etc), as learning from experience comes from the process of representing the reflection itself.  

Reflective practices are an essential part of developing a healthy habit of reflecting on what happens either at personal or community levels. At a deeper stage, they strongly contribute to the development of young people’s capacity to identify and regulate emotions, respond to challenges, cope with stress, establish healthy relationships, make timely decisions and build new skills. Young people, as well as adults supporting them, can benefit from making use of reflective practices, as in doing so they increase their self awareness, nurture their emotional intelligence and their capacity for emotional regulation.

Reflective practices contribute to the development of young peoples’ leadership, allowing them to:

• build the capacity of making decisions that show a systemic awareness;
• become more able to motivate themselves, to influence others and to be an inspiration for their peers;
• develop the capacity to generate innovation through open questioning and attending to the answers with open mindedness;
• become able to be compassionate to self and others;
• inspire trust through demonstrating trustworthiness. 

REFLECTION AS A WAY TO INCREASE AWARENESS

“Reflection is a multi-layered process of identifying, clarifying, exploring that which is-at-stake. It’s a process in which one goes deeper, making connections and meaning, gaining insights between different meaningful ‘events’ (in the broadest possible sense, both internal and external to the reflecting person). As such it leads one to greater awareness”(11) and supports young people, as well as adults, to become more conscious about their relationship with themselves and/or the outer world. The World Health Organisation defines wellbeing as “the state in which individuals realise their own abilities” in order to express their full potential and make a concrete contribution in their community. This means that, first of all, they need to become aware of what their strengths are and understand their own values, beliefs, personal preferences, needs, tendencies, habits and everything else that makes them the unique individual that they are. By becoming self-aware and understanding strengths and limitations, new opportunities open up that just aren’t available otherwise. When young people have a better understanding of themselves, they are able to experience themselves as unique and separate individuals. They become more authentic and tend to have more honest and genuine relationships, as others will be attracted to who they really are. They are empowered and more able to make changes and build on their areas of strength.

THE POWER OF SELF-AWARENESS

Self-awareness has the potential to enhance every experience young people have, as it’s a tool and a practice that can be used anywhere, anytime, to ground oneself in the moment, realistically see oneself and the situation, and help them make good choices.

Research shows that self-awareness is directly related to emotional intelligence, and making it easier to identify what one’s stressors are and use this information to build effective coping mechanisms. Goleman claims that good emotional and social competences give the child the possibility to be effective and to use their cognitive capabilities, while children who do not regulate their emotions remain focused on themselves and not are capable of learning or thinking. Self-awareness as seen by practitioners and researchers is both a primary means of alleviating psychological distress and the path of self-development for psychologically healthy individuals. Fenigstein et al. wrote that “increased awareness of the self is both a tool and a goal.”(12). Being self-aware also means acknowledging that one is not one’s thoughts but the entity observing the thoughts, which gives a great sense of freedom.

To conclude, reflection allows for greater self awareness about one’s unique strengths and limitations, for better being equipped to face challenges, solve problems, make decisions, and predict the outcomes of those decisions. Furthermore, this process helps to analyse the differences and similarities between individuals, with the further benefit of developing interpersonal relationships and of being able to direct one’s communication towards the needs of the others.

References:

(1) Dewey, J. (1938). Experience and education. New York: Collier Books, Macmillan

(2) Kolb, D. (1994) Experiential Learning: Experience as the Source of Learning and Development. Engelwoods Cliffs, NJ: Prentice–Hall.

(3) Gardner H. (1983) Frames of mind. The Theory of multiple intelligences. Basic Books

(4) Dewey, J. (1933). How we think. Buffalo, NY: Prometheus Books. (Original work published 1910)

(5) Dewey, J. (1933) How We Think. Buffalo, NY: Prometheus Books.

(6) Jakube Aurelija, Jasiene Ginte,Taylor Mark, Vandenbussche Bert (eds), Holding the space. Facilitating reflection and inner readiness for learning. Erasmus+ project REFLECT 2014-2015 publication.

(7) Schön, Donald. 1983 The Reflective Practitioner, Basic Books Inc.

(8) Milica Tošić-Radev et all (2016). Capacity For Reflection As A Predictor Of Children’s Readiness For Elementary School. Conference Paper of the 7th International Conference on Education and Educational Psychology.

(9) Ringer, Martin. (2008). Group Action: the dynamics of groups in therapeutic, educational and corporate settings. London: Jessica Kingsley

(10)  Luken, Tom. (2010). Problemen met reflecteren. De risicos van reflectie nader bezien. In Luken, Tom & Reynaert, W. (2010) Puzzelstukjes voor een nieuw paradigma?  Aardverschuiving in loopbaandenken. Eindhoven-Tilburg: Lectoraat Career Development Fontys Hogeschool HRM en Psychologie

(11) Jakube Aurelija, Jasiene Ginte,Taylor Mark, Vandenbussche Bert (eds), Holding the space. Facilitating reflection and inner readiness for learning. Erasmus+ project REFLECT 2014-2015 publication.

(12) Fenigstein A., Scheier M. F., Buss A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Counselling and Clinical Psychology. 

Image credits:

For figure 1 source is https://www.pugetsound.edu/academics/experiential/create-experiential-learning-opportunities/available-resources/creating-critical-reflection-assignments/design-models/kolbs-learning-cycle/

For figure 2-4 Torben Grocholi for the Erasmus+ project REFLECT

For figure 5 source is https://www.worldpulse.com/community/users/gitajayakumar/posts/62911

On this website we will keep you up-to-date about our project advances on the promotion of youth wellbeing. As well, you will find plenty of free resources for professionals and their organisations, both for the school sector and the out-of-school youth sector. The resources are developed as part of three different international strategic partnerships, co-funded by the European Union. Under the 'about' section you will find more information about each of the projects.

• Research article
• Open access
• Published: 22 July 2021

Health professionals and students’ experiences of reflective writing in learning: A qualitative meta-synthesis

• Giovanna Artioli   ORCID: orcid.org/0000-0002-1810-0857 1 ,
• Laura Deiana 2 ,
• Francesco De Vincenzo 3 ,
• Margherita Raucci 1 ,
• Giovanna Amaducci 1 ,
• Maria Chiara Bassi 1 ,
• Silvia Di Leo 1 ,
• Mark Hayter 4 &
• Luca Ghirotto 1  

BMC Medical Education volume  21 , Article number:  394 ( 2021 ) Cite this article

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Reflective writing provides an opportunity for health professionals and students to learn from their mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless. This systematic review addresses the following question: “What are the experiences of health professionals and students in applying reflective writing during their education and training?”

We performed a systematic review and meta-synthesis of qualitative studies. Our search comprised six electronic databases: MedLine, Embase, Cinahl, PsycINFO, Eric, and Scopus. Our initial search produced 1237 titles, excluding duplicates that we removed. After title and abstract screening, 17 articles met the inclusion criteria. We identified descriptive themes and the conceptual elements explaining the health professionals’ and students’ experience using reflective writing during their academic and in-service training by performing a meta-synthesis.

We identified four main categories (and related sub-categories) through the meta-synthesis: reflection and reflexivity, accomplishing learning potential, building a philosophical and empathic approach, and identifying reflective writing feasibility. We placed the main categories into an interpretative model which explains the users’ experiences of reflective writing during their education and training. Reflective writing triggered reflection and reflexivity that allows, on the one hand, skills development, professional growth, and the ability to act on change; on the other hand, the acquisition of empathic attitudes and sensitivity towards one’s own and others’ emotions. Perceived barriers and impeding factors and facilitating ones, like timing and strategies for using reflective writing, were also identified.

Conclusions

The use of this learning methodology is crucial today because of the recognition of the increasing complexity of healthcare contexts requiring professionals to learn advanced skills beyond their clinical ones. Implementing reflective writing-based courses and training in university curricula and clinical contexts can benefit human and professional development.

Peer Review reports

Education of healthcare professionals supportstheir transformation into becoming competent professionals [ 1 ] and improves their reasoning skills in clinical situations. In this context, reflective writing (RW) is encouraged by both universities, and healthcare training providersencourage reflective writing (RW) since its utility in helping health students and professionals nurture reflection [ 2 ], which is considered a core element of professionalism. Furthermore, the ability to reflect on one’s performance is now seen to be a crucial skill for personal and professional development [ 3 ]. Writing about experiences to develop learning and growth through reflection is called ‘reflective writing’ (RW). RW involves the process of reconsidering an experience, which is then analyzed in its various components [ 4 , 5 ]. The act of transforming thoughts into words may create new ideas: the recollection of the experience to allow a deeper understanding of it, modifying its original perception, and creating new insights [ 6 ]. RWis the focused and recurrent inspection of thoughts, feelings, and events emerging from practice as applied to healthcare practice [ 7 ].

Reflection may be intended as a form of mental processing or thinking used by learners to fulfill a purpose or achieve some anticipated outcome [ 2 ]. This definition recalls Boud and colleagues’ view of reflection as a purposive activity directed towards goals [ 8 ]. For those authors, reflection involves a three-stage process, including recollection of the experience, attending to own feelings, and re-evaluating the experience. This process can be facilitated by reflective practices, among which RW is one of the main tools [ 9 ].

Between reflection-on-action (leading to adjustments to future learning and actions) and reflection-in-action (where adjustments are made at the moment) [ 10 ], RW can be situated in the former. It involves theprofessional’s reflections and analysis of experiences in clinical practice [ 11 , 12 ]. Mainly,RWinvolves the recurrent introspection ofone’s thoughts, feelings, and events within a particular context [ 13 ]. Several studies highlight how RWinfluencespromoting critical thinking [ 14 ], self-consciousness [ 15 ], and favors the development of personal skills [ 16 ], communication and empathy skills [ 4 , 17 ], and self-knowledge [ 3 ]. Thanks to the writing process, individuals may analyze all the components of their experience and learn something new, giving new meanings [ 5 ]. Indeed, putting down thoughts into words enables the individual to reprocess the experience, build and empower new insights, new learnings, and new ways to conceive reality [ 6 , 18 , 19 , 20 ].

Furthermore, RW provides an opportunity to give concrete meaning to one’s inner processes, mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless [ 21 , 22 ]. The reflective approach of RW allows oneself to enter the story, becoming aware of our professional path, with both an educational and therapeutic effect [ 23 ].

Reflection as practically sustained by RW commonly overlaps with the process of reflexivity. As noted elsewhere [ 24 ], reflection and reflexivity originate from different philosophical traditionsbut have shared similarities and meanings. In the context of this article, we adopt two different working definitions of reflection and reflexivity. Firstly, we draw from the work of Alexander [ 25 ]: who explains reflection as the deliberation, pondering, or rumination over ideas, circumstances, or experiences yet to be enacted, as well as those presently unfolding or already passed [ 25 ]. Reflexivity at a meta-cognitive level relates to finding strategies to challenge and questionpersonal attitudes, thought processes, values, assumptions, prejudices, and habitual actions to understand the relationships’ underpinning structure with experiences and events [ 26 ]. In other words, reflexivity can be defined as “the self-conscious co-ordination of the observed with existing cognitive structures of meaning” [ 27 ].

Given those definitions,a philosophical framework for helping health trainees and professionals conduct an exercise that can be helpful to them, their practice, and – ultimately – their patients can be identified. There is a growing body of qualitative literature on this topic – which is valuable – but the nature of qualitative research is that it creates transferrable and more generalizableknowledge cumulatively. As such, bodies of qualitative knowledge must besummarized and amalgamated to provide a sound understanding of the issues – to inform practice and generate the future qualitative research agenda. To date, this has not been done for the qualitative work on reflective writing: a gap in the knowledge base our synthesis study intends to address by highlighting what connects students and professionals while using RW.

This systematic review addresses the following question: “What are the experiences of health professionals and students in applyingRWduring their education and training?”

This systematic review and meta-synthesis followed the 4-step procedure outlined by Sandelowski and Barroso [ 28 , 29 ], foreseeing a comprehensive search, appraising reports of qualitative studies, classification of studies, synthesis of the findings. Systematic review and meta-synthesis referto the process of scientific inquiry aimed at systematically reviewing and formally integrating the findings in reports of completed qualitative studies [ 29 ].

The article selection processwas summarized as a PRISMA flowchart [ 30 ]; the search strategy was based on PICo (Population, phenomenon of Interest, and Context),and the study results are reported in agreement with Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines [ 31 ].

Selection criteria

Inclusion criteria for the meta-synthesis were:

Primary qualitative studies published in peer-reviewed English journals.

With health professionals or health studentsas participants.

UsingRW in learning contexts (both pre-and in-service training).

Mixed methods where the qualitative part can be separated.

Articles should report the voice of participants (direct quotations).

Given the meta-synthesis indications, we excluded quantitative studies, non-primary research articles, meta-synthesis of qualitative studies, literature and systematic reviews, abstracts, unpublished reports, grey literature. In addition, we also excluded studies where participants were using RW in association with other learning tools and where the personal experience was not about using RW exclusively.

Data sources and searches

An experienced information specialist (MCB) performed the literature search on Medline, Embase, Cinahl, PsycInfo, Eric, and Scopus for research articles published from Jan 1st, 2008 to September 30th, 2019,to make sure we incorporated studies reflecting contemporary professional health care experience. Additional searchinginvolved reviewing the references or, and citations to, our included studies.

We filled an Excel file with all the titles and authors’ names. A filter for qualitative and mixed methods study was applied. Table  1 shows the general search strategy for all the databases based on PICo.

Four reviewers (GAr, MR, GAm, LD) independently screened titles and abstracts of all studies, then checked full-text articles based on the selection criteria. We also searched the reference lists of the full-text articles selected for additional potentially relevant studies. Any conflict was solved through discussion with three external reviewers (LG, MCB,SDL, and MH).

Quality appraisal

We used the Critical Appraisal Skills Programme (CASP): it provides ten simple guiding questions and examples to examine study validity, adequacy, and potential applicability of the results of qualitative studies. Guided by the work of Long and colleagues [ 32 ] and previously used in other meta-synthesis [ 33 ], we created 30 items from the 10 CASP questions on quality to ensure we could provide a detailed appraisal of the studies. FDV and LD independently assessed the quality of included studies with any conflicts solved by consulting a third reviewer (MCB and LG). Researchers scored primary studies weighingthe proposed items and ranking the quality of each included study [ 34 ] on high ( n  > 20 items positively assessed), moderate (10 <  n  < 20), or low quality ( n  < 10).

Analysis and synthesis

MCB created a data extraction table, GAr, GAm, and MRdescribed the included articles (Table  2 ). Quotations were extracted manually from the “results/findings” sections of the included studies by GAr, MCB, LDand inserted into adatabase. GAr, GAm, MR, and FDVperformed a thematic analysis of those sections, along with participants’ quotations. Then, they inductively derived sub-themes from the data, performing a first interpretative analysis of participants’ narratives (i.e., highlighting meanings participants interpreted about their experience). The sub-themes were compared and transferred across studies by adding the data into existing sub-themes or creating new sub-themes. Similar sub-themes were then grouped into themes, using taxonomic analysisto conceptually identify the sub-categories and the categories emerging from the participants’ narratives. This procedure allowed us to translate the themes identified from the original studies [ 28 ] into interpretative categories that could amalgamate and refine the experiences of health professionalsor health students on the use of RW [ 29 ]. The final categories are based on the consent of all the authors.

Literature search and studies’ characteristics

A total of 1488 articles were retrieved. Duplicates ( n  = 251) were removed. Then, articles ( n  = 1237) were identified and reviewed by title and abstract. We excluded n  = 1152 articles because they did not match the specified inclusion criteria, based on the title and abstract. Consequently, we assessed 85 full-text articles. Sixty-eight records did not meet the inclusion criteria. At the end of the selection process, 17 reportsof qualitative research were selected. Figure  1 illustrates the search process.

PRISMA flow diagram

Table 2 shows the characteristics of the included studies. Eleven studies involved healthcare students (58%, including nurses, midwives, physiotherapists, doctors, dentists, and oral health students), and six (32%, including doctors, occupational and radiation therapists) were referred to health professionals. In thirteen studies, participants were trained on RW before using it: this information could not be retrieved from the remaining articles.

Five articles reported studies conducted in the US, three in Australia, two in Canada, and two in Israel. The other studies were carried out in Italy, UK, Korea, Taiwan, and Sweden.

Critical appraisal results

We critically evaluatedall 17 studies to highlight the methodological strengthsand weaknesses of the selected studies. No article was removed on a quality assessment basis. Results of the quality appraisal are reported in Table 2 .

Meta-synthesis findings

Through the meta-synthesis, we identified four main categories (and related sub-categories): (i) reflection and reflexivity; (ii) accomplishing learning potential; (iii) building a philosophical and empathic approach; (iv) identifying reflective writing feasibility (for the complete dataset, please refer to supplemental material , where we have listed a selection of meaningful quotations of categories and sub-categories).

Given such categories, we developed an interpretative meta-synthesis model (Fig.  2 ) to illustrate the commonalities of the experience of using RW according to both students and professionals: RWas a vehicle for discovering reflection and allowing users to enter personal reflexivity to fulfillone’s learning potential, alongside the building of a philosophical and empathic approach. In their experience, reflection and reflexivity generate different skills and competencies: reflection matures skills such as professional skills and the ability to activate change and innovation. Reflexivity allows students and professionals to reach higher levels of competencyconcerning inner development and empathy reaching. Finally, from our analysis, participants, while recognizing the value of RW, also defined factors that could encourage or limit its use. Differences among participants’ groups are also outlined.

Meta-synthesis model: RW as experienced by health professionals and students

Reflection and reflexivity

Within this category, we collected the users’ narratives about the experience of applying RW and its disclosing capacity. By using RW, participants confronted themselves with both reflection and reflexivity. This category includes two sub-categories we named: discovering reflection and entering personal reflexivity.

Discovering reflection

The sub-category shows that experiencingRW deepened their reflection on experiences, practice, and profession. Thanks to RW, professionals, and students could explore previously unexplored topics and learn more about themselves.

“ Writing initiated me to think about my experiences … ” (professional) [ 46 ]. “ I think it’s good for physicians to reflect on what we’re doing ” (professional) [ 50 ]

The analysis showed that RW was considered reflective when it provided an opportunity for those who applied it to stop, reflect and conduct an inner discourse on topics never considered before [ 44 , 46 , 50 ]. Some students affirmed:

“ Helped (me) reflect on positive aspects ” (student) [ 40 ]. “ I don’t usually think too much about what happens to me, but through critical reflective journaling, I was able to think carefully about things happening around me. This activity helped me to look into my mind ” (student) [ 44 ]

This sub-category explains transversal meanings coming from uniformly professionals and students.

Entering personal reflexivity

This sub-category includes data about RW enabling users’reflexivity. In this context, RW was considered training for reflexivity as it enabled participants to question themselves more often [ 48 ], reflect on their experiences [ 35 ], attitudes, actions [ 38 , 45 ], and also reconsider their actions and identify their strengths and weaknesses [ 40 , 44 ].

“ The questions in this study do make me stop and think about things – how I feel about what I’m doing in residency ”(professional) [ 46 ]. “ Helped me ID (identify) my strengths and weaknesses ” (student) [ 40 ] RW also helped eradicate the background noise that my mind does not yet know how to filter out [ 51 ] .

Interesting to note that this sub-category is more present in students’ narratives. While professionals referred to self-reflection practices (probably already acquired in other contexts), students often reported how RW helped them discover reflexivity.

Accomplishing learning potential

Our analysis showed how users RW used the technique to “Accomplish learning potential.”

According to the studies’ participants, RWcan enable a learning performancethat would be difficult to reach otherwise. In this context, participants addressed RW as a tool for“accomplishing learning potential.”Within this category, three sub-categories were highlighted: the improvement of skills, personal and professional growth, and assisting the change and development process.

Improvement of skills

Participants agreed that the development of skills and abilities through RWwas aimed at their clinical skills and –in relevant areas such as question asking – encouraged reflection and research [ 35 , 46 ]. Communication skills were also enhanced, as were their relationship with patients, family,colleagues, and friends [ 35 , 38 , 46 ].

Participants said:

“ Through reflective journal writing, my attitude towards learning has changed. I have been encouraged to be a proactive learner. (...) I have been able to identify necessary places for improvement and through research, question asking, goal-setting (...). I have improved my skills in relevant areas” (student) [ 35 ]. “I feel that it [participation in the study] has been a positive experience by motivating me to improve on my clinical, communication skills, and also my relationships with colleagues, patients, family, and friends ” (professional) [ 46 ]

Participants also reported that,in their experience, RWprovided an opportunity to assess and improve themselves and to enhance their self-confidence [ 38 , 40 ]. Cognitive skills, includinggaining more profoundknowledge and problem-solving, along withtime-management [ 35 , 40 , 46 , 49 ], were also enhanced: RW,therefore,represented a learning mode [ 45 ].

“ Without reflection, I absolutely believe these skills would be more unattainable for me ”(student) [ 35 ]

This sub-category applies more to students’ narratives. Health students mentioned the tools helping them most to develop their skills. Professionals focused principally on what RWcould improve (communication skills or organizational skills).

Personal and professional growth

Participantsidentifiedthat RWhad promoted personal [ 51 ] and professional growth [ 35 , 46 ]. RW meant for participants:an ameliorated attitude towards work [ 46 ]; a development path for one’s job potential [ 38 ]; an enhancement of their introspective knowledge [ 51 ]; an enrichment of their expressive capability [ 38 ];an improvement of their interpersonal relationships with patients and colleagues [ 50 ] and developed their use of critical and reflective thinking [ 38 ].

“ Reflecting introduces a new aspect to clinic that focuses on the individual’s learning experience ” (student) [ 35 ]. “I think that it does change the way that you think about the practice of medicine and your own personal tendencies and your interactions with your patients and colleagues. And I think it can be a really powerful driver of culture change ” (professional) [ 50 ]

This sub-category is more represented among students than professionals. Students are ‘surprised’ at how important RW was to their learning. Professionals still recognized how RW was an essential driver of change for their clinic activities.

Assisting the change and development process

We labeledthe third sub-category“assisting the change and development process.”The changeinvolvedintroducing modifications tothe way of working [ 48 ], assessing what needed to be changed to achieve a work-life balance [ 51 ], understanding elements that did not allow change, and how to act on them in the future, and also considering new and important issues [ 46 ], further information [ 51 ] and new ways of thinking. This sub-category equally explained the meaning given to RW by students and professionals.

“ I think writing answer to some of these questions has allowed me to reflect back on the year and think about specific important topics that I might not have thought about again.” (professional) [ 46 ]. (Reflective journaling encouraged) “Assessing and focusing on the changes that need to be done to achieve the balance in my life and being able to integrate that with my family and in my work as a nurse.” (Student 16/RJ2) [ 51 ]

However, thischange process could not be possible without witnessing change and becoming aware of it [ 38 , 46 ]. This allowedparticipants to ‘see one’slearning history and path of growth,‘have a picture of the problem, handle things differently, and broadening their vision of the problem [ 48 ].

Building a philosophical and empathic approach

The “Reflection and reflexivity” category is closely aligned with the “Building a philosophical and empathic approach” category. Participants defined RW as a means for nurturing an intimate and profound level of learning, i.e., a philosophical and empathic approach towards real-life professional issues. The third category consists of three sub-categories: the ability to find benefits in negativity/adversity, assuming an empathetic attitude, and the awareness of things, experiences,emotions.

Finding benefits in negativity/adversity

According to participants, RWexerted a therapeutic effect by encouraging professionals and students to focus on the present (43)strictly. It seemed that RWeventually reduced their emotional stress [ 44 , 51 ]. Likewise,in the contextofnegative experiences [ 49 ], its practice acted as a catharsis [ 46 ] that could even allow them tolook back at those experiencesafresh – enabling a change in perspective [ 39 ].

“While writing the journal entry, I felt like I was unloading something from inside myself and being set free. This process made me feel better ” (student) [ 44 ]. “It is always good to pause to reflect on my experiences. The most cathartic question was a few months back when I got to describe my really bad experience.” (professional) [ 46 ] “Very therapeutic. I wrote on a bad experience, but at the end, we were laughing at it.” (professional) [ 49 ]

This specific approach allowed the practitioner/trainee to improve their self-care and focus on work objectives [ 51 ]:

“Self-reflection and reflective journaling promote self-understanding and is another part of self-care.” (Student 5/RJ3) [ 51 ]

Even if more emerging from students’ voices, professionals appeared genuinely amazed at how learning can be generated out of negativity.

Assuming an empathetic attitude

Study participants stressed the fact that RWhelped them develop empathetic attitudes. It seems that RWemphasized the importance of sensitivity and empathy by trying ‘to be in someone else’sshoes,’ especially that of patients or colleagues [ 36 , 37 , 44 ].

“How reflecting on patient encounters through field notes allowed her to “take a walk in someone else’s shoes ” (student) [ 36 ]. “It helps you see the humanity... ” (professional) [ 50 ]

This approach also applied in contexts outside of work and helped the practitioner take off his/her‘white coat’ and understand that before being a professional,he/shewas a person and a human being [ 36 , 37 , 46 , 50 ].

“ Which has made me more open to other’s ideas and thoughts ” (professional) [ 46 ]

As previously mentioned, according to the participants’ statements, awareness was the cornerstone to effective personal and professional growth [ 40 , 51 ].

This sub-category is equivalently present among the participants’ groups. Nonetheless, different meaningscould also be highlighted. Students appreciated RWby stressing its value of allowing them to enter deeply ‘into the other’ inner world (mainly patients). Professionals claimed they could recognize the profession’s human and relational aspects, whichcould also be helpful for their extra-professional relationships (family members, friends).

Awareness of things, experiences, emotions

Impartially balanced among professionals and students, awareness was cited in terms of ‘how things have affected me rather than simply continuing to work in a robotic manner’ [ 46 ], the awareness of who one was and who one has become thanks to the process of change [ 51 ]. This professional and relational awareness made it possible to think clearly about one’s practice and the health resources present in the context of belonging [ 50 ].

“Just being aware of what I know now and what I’ll know by the end of the semester … is a great way to learn who I am and what I can change about me for the better.” (Student 9/RJ1) [ 51 ]

The process of awareness that was facilitated by how their RW allowedthem to transform shapeless and straightforward ideasinto words and givethem a specific value and emotional charge [ 36 , 47 , 51 ]: it wasan authentic opportunity to turn emotions and feelings into something tangible –a journey of discovery and personal acceptance [ 43 ].

“ After two years or so, when you look back, it’s like, oh,that’s how I was feeling at the time, and right now, I feel differently. There is also this level of satisfaction. Like you have matured out of this thinking ” (professional) [ 47 ]

Identifying RW feasibility

The fourth category consists of three sub-categories: perceived barriers/impeding factors, facilitating factors, and when and how to use RW. Students and healthcare professionals who had the experience of practicing the RW in their work identified both limitations and facilitating factors and indications about when and how to use RW.

Perceived barriers/impeding factors

Some study participants (almost entirely students) identified several barriers to their activity. Some students could not see the benefits and thought RW was a waste of time [ 35 , 38 , 51 ]. However, others, who did see the potential benefits still felt that they lacked the time needed to devote to RW [ 42 ] or, sufficient mental space to report and describe a work situation, an excessive similarity of this activity to the regular working practice and, consequently, a lack ofmotivation to write [ 47 , 51 ]. In addition, some described the strainthey felt in writing down personal/professional experiences [ 47 ]. A lack of privacy was another problem, both for the concern about sharing the reflection and for the respect of confidentialityin writing itself [ 51 ]. Taken together,it appeared that some study participants did not recognizeRW as an effective means of help [ 39 , 50 ]. Althoughrealizing the potential of RW,others felt that their tutors did not provide noticeably clearexplanations of the aim of RW– which they would have found useful and motivating [ 45 ].

“ To be honest, not a great deal ( … ) it wasn’t really some revelation ” (professional) [ 50 ]. “ I got a hard time referring it [my experience] to citations … I could have sat and cried yesterday when I did my essay … when I actually read it [my essay] I thought, oh I don’t know what it means, myself ” (Female 2 - student) [ 42 ]

Facilitating factors

This sub-category was exclusively interpreted from students’ narratives. They valued the perspectives to use RWin their practice seeing it as a valuable tool to be applied throughout their career [ 35 , 45 ],with many students reporting that they would continue with this technique [ 38 ]. Studentssaw RW as a valuable means of staying focused on their own goals and needs [ 40 , 51 ]. They remarked that it helped them reduce stress, gain clarity in one’s life and practice [ 41 ], and spiritually connect with themselves [ 45 , 51 ]. Furthermore, RW enabled studentsto discover more information about their health and well-being, ‘it also helped me tie in ideas and beliefs from different sources and relate it to my own’ [ 51 ]. RWhelped maintain awareness and recall the medical being/human being dichotomy [ 37 ]. It remindedstudentsof the difference between studying literature and refining manual skills and the ability to learn from experience and mistakes [ 35 ].

“ During the interview, I felt an element of being more like a ‘normal person’ having a ‘normal conversation’ with another human being. This was a strange realization because it reminded me of the dichotomy that physicians may experience, being doctor versus human ” (student) [ 37 ]

When and how to use RW

Health professionals (a few) and many students finally mentioned the time considered most appropriate to use RW, underlining its usefulness primarilywas during hardship rather than daily practice [ 47 ].Moreover,RWshould not be forced onto someone in any given moment but instead left to individual choice based on one’s spirit of the moment [ 40 , 46 ].

“. .. like if you had a patient die; that would be the only time you might write it down ” (professional) [ 47 ]

Otherparticipantsconsidered instructions on RW to be too forceful and notapplicable to their own experience of reflection [ 40 ]. ‘Reflection wasn’t just signing on the line.’ It allowed constructive feedback for the trainee or the professional. Constructive feedback could be positive or negative, but it was a powerful tool for thinking and examining things [ 45 ].

In this meta-synthesis of qualitative studies, we have interpreted the experiences of health professionals and students who used RWduring their education and training. Given the number of studies included, RW users’ experience was predominately investigated in students. This result, although not surprising, raises the question of whether RW in professional training is being used. RW is not used in professional training as often as it is in the academic training of healthcare students.

As to this review’s aim, we could highlight continuities and differences from study participants’ narratives. Our findings offer a conceptualization of usingRW in health care settings. According to the experience of both students (from different disciplines) and health professionals, RW allows its exponents to discover and practice reflectionas a form of cognitive processing [ 2 ] and enablethem to develop a better understanding of their lived situation. We also interpreted that RW allows users to make a ‘reflexive journey’ that involves them practicing meta-cognitive skills to challengetheir attitudes, pre-assumptions, prejudices, and habitual actions [ 24 , 26 ]. This was particularly true for students: “entering personal reflexivity” appears to be newer for them than for the professionals who are likely to acquire reflexivity during academic training. Students seemed more focused on tools than RW-related results. This consideration makes us affirm that reflective capacity is in progress for them.

Challenging pre-assumptions and entering reflexivityenabledRWusers to realize how RW may develop their learning potential to improve skills and personal/professional growth. Skills to be enhanced are quoted mainly by students. Conversely, professionals could comprehend the final purpose of learning, achievable through RW, in terms of communication or organizational abilities. Professionals interpreted skills from RW as abilities to apply in the clinical activities to find new solutions to problems.

The category “Accomplishing learning potential”confirms what many authors highlight: putting thoughts into words not only permits a deeper understanding of events [ 6 ], enhances professionalism [ 52 ] but also improves personal [ 16 ], communication, and empathy skills [ 4 , 17 ]. In this context, RW fulfills its mandate by letting human sciences [ 53 ] and evidence-based health disciplines affect clinical practice. As noted [ 54 ], students and health professionals’RW training allowed integrating scientific knowledge with behavioral and sociological sciences to supporttheir learning [ 55 ].

Users understood that RWcould be a powerful means of developing empathy and developing their philosophy of care: this consideration is in line with a recent study from Ng and colleagues [ 24 ]. Additionally, some authors [ 4 , 17 ] stressed these empathetic skills and “humanistic”competencies as essential to care for patients effectively [ 56 ]. Professionals were amazed how negativity could generate learning through RW. On the other hand, by recognizingand writing experienced negative situations, students could free themselves from feelings impeding empathy.

By employing RW, users reported factors that could encourage or limit its use. These findings further illustrate that RW is not always a tool that is easy to use without adequate training [ 57 ]. Almost exclusively, students reported hindering factors (limited time, difficulty in writing and understanding assignments, privacy issues, feeling bored or forced). As to professionals, few describedRW as a very stressful activity. Although students could identify impeding factors, they also recognized many positive ones. For professionals, RW was not to be used every day but in ‘extreme’ situations, requiring reflection and reflexivity to be applied. In general, enhancing motivation to write reflectively [ 58 ] should be the first goal of any training to make the process acceptable and profitable for trainees. If this first stage is not accomplished, it will reduce RW’sapparent professional and personal effectiveness among health professionals and students substantially.

Strengths, limitations, and research relaunches

This review may enrich our knowledge about providing RW as an educative tool for health students and professionals. However, the findings must be applied,taking into account some limitations. We focused our attention only on recent, primary, peer-reviewed studies within the time and publication limits. Qualitative studies often are available as grey literature: considering it may result in a different interpretation of students’ and professionals’ experience in using RW. Therefore, our conceptualization should be read bearing in mind a publication bias and the need to expand the literature search to other sources. Besides limiting the risk of missing published qualitative studies, we reviewed the reference listsof included studies for additional items. Our meta-synthesis is coherent to the interpretation of the included studies’ findings.

At least two reviewers have conducted each step of this systematic review. We purposely did not exclude studies based on a quality assessment to maintain a robust qualitative study sample size and valuable insights.

During analysis, all possible interpretations were screened by authors, and an agreement was reached. Nonetheless, we did not cover all the possible ways to interpret the voices of students and professionals.

Since RW is not used in professional training as often as it is in the academic training of healthcare students, a research relaunch could be investigatingwhether and to what extent RW is being used in in-service training programs. Moreover, the studies included in this review were conducted within Western countries. Students’ and professionals’ perspectives from Africa and Asia are underrepresented within the qualitative literature about experiences of using RW. Therefore, geographicalgeneralizations from the present meta-synthesis should be avoided, and our paper reveals the necessity for RW research in other cultures and settings. Nonetheless, authors of primary studies have paid little attention to cultural and regionaldiversity. Therefore, we recommend furtherinvestigations exploring the differences between cultural backgrounds and howRW is recognized within training programs in different countries. Finally, additional qualitative and quantitative research is required to deepen our understanding of RW’s clinical and psycho-social outcomes in high complexity health practice contexts.

Our analysis confirms the crucial role of RW in fostering reasoning skills [ 59 ] and awareness in clinical situations. While its utility in helping health students and professionals to nurture reflection [ 2 ] has been widely theorized, this meta-synthesis provide empirical evidence to support and illustrate this theoretical viewpoint. Finally, we argue that RWis even more critical given the increasing complexity of modern healthcare, requiringprofessionals to develop advanced skills beyond their clinical ones.

Practical implications

Two important implications can be highlighted:

students and professionals can recognize the potential of RW in learning advanced professional skills. ImplementingRW in academic training as well as continuing professional education is desirable.

Despite recognizing the effectiveness of RW in healthcare learning, students and professionals may face difficulties in writing reflectively. Trainers should acknowledge and address this.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Critical appraisal skills programme

Enhancing transparency in reporting the synthesis of qualitative research

Population, phenomena of interest and context

Preferred reporting items for systematic reviews and meta-analyses

Reflective writing

Mlinar Reljić N, Pajnkihar M, Fekonja Z. Self-reflection during first clinical practice: The experiences of nursing students. Nurse Educ Today. 2019;72:61–6. https://doi.org/10.1016/j.nedt.2018.10.019 .

Article   Google Scholar  

Moon JA. A handbook of Reflective and experiential learning: theory and practice. London: Routledge; 2004. p. 264.

Google Scholar  

Borgstrom E, Morris R, Wood D, Cohn S, Barclay S. Learning to care: medical students’ reported value and evaluation of palliative careteaching involving meeting patients and reflective writing. BMC Med Educ. 2016;16:306.

Nelms Edwards C, Mintz-Binder R, Jones MM. When a clinical crisis strikes: lessons learned from the reflective writings ofnursing students. Nurs Forum. 2019;54(3):345–51. https://doi.org/10.1111/nuf.12335 .

Haugland BØ, Lassen RM, Giske T. Professional formation through personal involvement and value integration. Nurse Educ Pract. 2018;29:64–9. https://doi.org/10.1016/j.nepr.2017.11.013 .

Launer J. What’s the point of reflective writing? Postgrad Med J. 2015;91(1076):357 LP – 358. Available from: http://pmj.bmj.com/content/91/1076/357.abstract

Naber J, Markley L. A guide to nursing students’ written reflections for students and educators. Nurse Educ Pract. 2017;25:1–4. https://doi.org/10.1016/j.nepr.2017.04.004 .

Boud D, Keogh R, Walker D. Reflection, turning experience into learning [Internet]. 1985. Available from: http://www.123library.org/book_details/?id=110587

Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: acritical narrative review. Med Educ. 2015;49(5):461–75. https://doi.org/10.1111/medu.12680 .

Mann K V. Reflection’s role in learning: increasing engagement and deepening participation. Perspect Med Educ. 2016;5(5):259–261. Available from: https://doi.org/ https://doi.org/10.1007/s40037-016-0296-y , 2016.

Jasper M, Rosser M, Mooney GP. Professional development, reflection and decision-making in nursing and health care. 2nd ed. London: Wiley-Blackwell; 2013. p. 254.

Burkhardt C, Crowl A, Ramirez M, Long B, Shrader S. A Reflective assignment assessing pharmacy students’ Interprofessional CollaborativePractice exposure during introductory pharmacy practice experiences. Am J Pharm Educ. 2019;83(6):6830. https://doi.org/10.5688/ajpe6830 .

Wilson H, Warmington S, Johansen M-L. Experience-based learning: junior medical students’ reflections on end-of-life care. Med Educ. 2019;53(7):687–697. Available from: https://doi.org/ https://doi.org/10.1111/medu.13907 .

Naber J, Wyatt TH. The effect of reflective writing interventions on the critical thinking skills anddispositions of baccalaureate nursing students. Nurse Educ Today. 2014;34(1):67–72. https://doi.org/10.1016/j.nedt.2013.04.002 .

Allan EG, Driscoll DL. The three-fold benefit of reflective writing: improving program assessment, student learning, and faculty professional development. Assess Writ [Internet]. 2014;21:37–55. Available from: https://www.sciencedirect.com/science/article/pii/S1075293514000087 . https://doi.org/10.1016/j.asw.2014.03.001 .

Peterson WJ, House JB, Sozener CB, Santen SA. Understanding the struggles to be a medical provider: view through medical StudentEssays. J Emerg Med. 2018;54(1):102–8. https://doi.org/10.1016/j.jemermed.2017.09.014 .

Liu GZ, Jawitz OK, Zheng D, Gusberg RJ, Kim AW. Reflective Writing for medical students on the surgical clerkship: oxymoron orAntidote? J Surg Educ. 2016;73(2):296–304. https://doi.org/10.1016/j.jsurg.2015.11.002 .

Craft M. Reflective writing and nursing education. J Nurs Educ. 2005;44(2):53–7. https://doi.org/10.3928/01484834-20050201-03 .

Tharenos CL, Hayden AM, Cook E. Resident self-portraiture: a reflective tool to explore the journey of becoming a doctor. J Med Humanit. 2019;40(4):529—551. Available from: https://doi.org/ https://doi.org/10.1007/s10912-018-9545-x .

Tsuruwaka M, Asahara K. Narrative writing as a strategy for nursing ethics education in Japan. Int J Med Educ. 2018 Jul;9:198–205. https://doi.org/10.5116/ijme.5b39.d5d2 .

Launer J. Managing the threat to reflective writing. Postgrad Med J. 2018 ;94(1111):314 LP – 315. Available from: http://pmj.bmj.com/content/94/1111/314.abstract

Rojí R, Noguera-Tejedor A, Pikabea-Díaz F, Carrasco JM, Centeno C. Palliative care bedside teaching: A qualitative analysis of medical Students’Reflective writings after clinical practices. J Palliat Med. 2017;20(2):147–54. https://doi.org/10.1089/jpm.2016.0192 .

Artioli G, Artioli F. Autobiografia e apprendimento in tirocinio [autobiography and learning in traineeship]. In: Alastra V, editor. Ambienti narrativi, territori di cura e formazione [Narrative settings, care and education territories]. Milano: FrancoAngeli; 2016. p. 114–25.

Ng SL, Wright SR, Kuper A. The divergence and convergence of critical reflection and critical reflexivity:implications for health professions education. Acad Med. 2019;94(8):1122–8. https://doi.org/10.1097/ACM.0000000000002724 .

Alexander PA. Reflection and reflexivity in practice versus in theory: challenges of conceptualization, complexity, and competence. Educ Psychol. 2017;52(4):307–314. Available from: https://doi.org/ https://doi.org/10.1080/00461520.2017.1350181 .

Verdonk P. When I say … reflexivity. Med Educ. 2015;49(2):147–8. https://doi.org/10.1111/medu.12534 .

Siraj-Blatchford I, Siraj-Blatchford J. Reflexivity, social justice and educational research. Cambridge J Educ. 1997;27(2):235–248. Available from: https://doi.org/ https://doi.org/10.1080/0305764970270207 , Reflexivity, Social Justice and Educational Research.

Sandelowski M, Barroso J, Voils CI. Using qualitative metasummary to synthesize qualitative and quantitative descriptive findings. Res Nurs Health. 2007;30(1):99–111. Available from: https://pubmed.ncbi.nlm.nih.gov/17243111 . https://doi.org/10.1002/nur.20176 .

Sandelowski M, Barroso J. Handbook for synthesizing qualitative Research. New York, NY, US: Springer Publishing Company; 2006. p. 312.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med. 2009;6(7):e1000097. Available from: https://doi.org/ https://doi.org/10.1371/journal.pmed.1000097 .

Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12(1):181. https://doi.org/10.1186/1471-2288-12-181 .

Long HA, French DP, Brooks JM. Optimizing the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res Methods Med Heal Sci. 2020;1(1):31–42. Available from: https://doi.org/ https://doi.org/10.1177/2632084320947559 .

Barisone M, Bagnasco A, Hayter M, Rossi S, Aleo G, Zanini M, et al. Dermatological diseases, sexuality and intimate relationships: A qualitativemeta-synthesis. J Clin Nurs. 2020;29(17–18):3136–53. https://doi.org/10.1111/jocn.15375 .

Boeije HR, van Wesel F, Alisic E. Making a difference: towards a method for weighing the evidence in a qualitativesynthesis. J Eval Clin Pract. 2011;17(4):657–63. https://doi.org/10.1111/j.1365-2753.2011.01674.x .

Tsang AKL, Walsh LJ. Oral health students’ perceptions of clinical reflective learning--relevance totheir development as evolving professionals. Eur J Dent EducOff J AssocDent Educ Eur. 2010;14(2):99–105. https://doi.org/10.1111/j.1600-0579.2009.00598.x .

Wald HS, Reis SP, Monroe AD, Borkan JM. “The loss of my elderly patient:” interactive reflective writing to support medicalstudents’ rites of passage. Med Teach. 2010;32(4):e178–84. https://doi.org/10.3109/01421591003657477 .

Garrison D, Lyness JM, Frank JB, Epstein RM. Qualitative analysis of medical student impressions of a narrative exercise in thethird-year psychiatry clerkship. Acad Med. 2011;86(1):85–9. https://doi.org/10.1097/ACM.0b013e3181ff7a63 .

Kuo C-L, Turton M, Cheng S-F, Lee-Hsieh J. Using clinical caring journaling: nursing student and instructor experiences. J Nurs Res. 2011;19(2):141–9. https://doi.org/10.1097/JNR.0b013e31821aa1a7 .

Bagnato S, Dimonte V, Garrino L. The reflective journal: A tool for enhancing experience- based learning in nursing students in clinical practice. J Nurs Educ Pract. 2013;3(3):102–11.

Constantinou M, Kuys SS. Physiotherapy students find guided journals useful to develop reflective thinkingand practice during their first clinical placement: a qualitative study. Physiotherapy. 2013;99(1):49–55. https://doi.org/10.1016/j.physio.2011.12.002 .

Jonas-Dwyer DRD, Abbott P V, Boyd N. First reflections: third-year dentistry students’ introduction to reflective practice. Eur J Dent Educ [Internet]. 2013 Feb 1;17(1):e64–9. Available from: https://doi.org/10.1111/j.1600-0579.2012.00763.x.

Bowman M, Addyman B. Academic reflective writing: a study to examine its usefulness. Br J Nurs. 2014 Mar;23(6):304–9. https://doi.org/10.12968/bjon.2014.23.6.304 .

Binyamin G. Growing from dilemmas: developing a professional identity through collaborativereflections on relational dilemmas. Adv Health Sci Educ Theory Pract. 2018 Mar;23(1):43–60. https://doi.org/10.1007/s10459-017-9773-2 .

Hwang B, Choi H, Kim S, Kim S, Ko H, Kim J. Facilitating student learning with critical reflective journaling in psychiatricmental health nursing clinical education: A qualitative study. Nurse Educ Today. 2018;69:159–64. https://doi.org/10.1016/j.nedt.2018.07.015 .

Persson EK, Kvist LJ, Ekelin M. Midwifery students’ experiences of learning through the use of written reflections -an interview study. Nurse Educ Pract. 2018 May;30:73–8. https://doi.org/10.1016/j.nepr.2018.01.005 .

Levine RB, Kern DE, Wright SM. The impact of prompted narrative writing during internship on reflective practice: aqualitative study. Adv Health Sci Educ Theory Pract. 2008;13(5):723–33. https://doi.org/10.1007/s10459-007-9079-x .

Cashell A. Radiation therapists’ perspectives of the role of reflection in clinical practice. J Radiother Pract. 2010/09/15. 2010;9(]):131–141. Available from: https://www.cambridge.org/core/article/radiation-therapists-perspectives-of-the-role-of-reflection-in-clinical-practice/7E45C6571ACD2FDEDA1556A18C82782D

Vachon B, Durand M-J, LeBlanc J. Using reflective learning to improve the impact of continuing education in thecontext of work rehabilitation. Adv Health Sci Educ Theory Pract. 2010;15(3):329–48. https://doi.org/10.1007/s10459-009-9200-4 .

Karkabi K, Wald HS, Cohen Castel O. The use of abstract paintings and narratives to foster reflective capacity in medical educators: a multinational faculty development workshop. Med Humanit. 2013/11/22. 2014;40(1):44–48. Available from: https://pubmed.ncbi.nlm.nih.gov/24273319

Caverly T, Matlock D, Thompson J, Combs B. Qualitative evaluation of a narrative reflection program to help medical trainees recognize and avoid overuse: “Am I doing what’s right for the patient?” Patient Educ Couns. 2018;101(3):475—480. Available from: https://doi.org/ https://doi.org/10.1016/j.pec.2017.09.001 .

Padykula BM. RN-BS students’ reports of their self-care and health-promotion practices in aHolistic nursing course. J Holist NursOff J Am Holist Nurses’Assoc. 2017;35(3):221–46. https://doi.org/10.1177/0898010116657226 .

Bjerkvik LK, Hilli Y. Reflective writing in undergraduate clinical nursing education: A literature review. Nurse Educ Pract. 2019;35:32–41. https://doi.org/10.1016/j.nepr.2018.11.013 .

Ng SL, Mylopoulos M, Kangasjarvi E, Boyd VA, Teles S, Orsino A, et al. Critically reflective practice and its sources: A qualitative exploration. Med Educ. 2020;54(4):312–319. Available from: https://doi.org/ https://doi.org/10.1111/medu.14032 .

Chaudhary ZK, Mylopoulos M, Barnett R, Sockalingam S, Hawkins M, O’Brien JD, et al. Reconsidering Basic: Integrating Social and Behavioral Sciences to Support Learning. Acad Med. 2019 Nov;94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the58th Annual Research in Medical Education Sessions):S73–8.

Wald HS, White J, Reis SP, Esquibel AY, Anthony D. Grappling with complexity: medical students’ reflective writings about challengingpatient encounters as a window into professional identity formation. Med Teach. 2019;41(2):152–60. https://doi.org/10.1080/0142159X.2018.1475727 .

Smith T. Guided reflective writing as a teaching strategy to develop nursing student clinical judgment. Nurs Forum. 2020;n/a(n/a). Available from: https://doi.org/ https://doi.org/10.1111/nuf.12528 , 56, 2, 241, 248.

Whitmore CA, Sakai J, Mikulich-Gilbertson SK, Davies RD. A four-week Reflective Writing program in the psychiatry clerkship: testing Effectson Reflective capacity. Acad psychiatryj Am Assoc DirPsychiatr Resid Train Assoc Acad Psychiatry. 2019;43(2):171–4.

Rajhans V, Eichler R, Sztrigler Cohen O, Gordon-Shaag A. A Novel method of enhancing students’ involvement in reflective writing. Clin Teach. 2020;n/a(n/a). Available from: https://doi.org/ https://doi.org/10.1111/tct.13303 , 18, 2, 174, 179.

Uygur J, Stuart E, De Paor M, Wallace E, Duffy S, O’Shea M, et al. A Best Evidence in Medical Education systematic review to determine the most effective teaching methods that develop reflection in medical students: BEME Guide No. 51. Med Teach. 2019;41(1):3–16. Available from: https://doi.org/ https://doi.org/10.1080/0142159X.2018.1505037 .

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We thank Dr. Silvia Tanzi for her insightful feedback about this work and Manuella Walker for assisting in the final editing of the paper.

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GArwas responsible for the original concept. MCB performed the literature search on databases. MCB, GAr, GAm, LD, MR were responsible of data curation. GAr, MR, GAm, and LD screened titles and abstracts of all studies. LG, MCB, SDL, and MH served as external auditors. FDV and LD assessed the quality of included studies. MCB and LG gave a third opinion in case of disagreement. GAr, GAm, MR, and FDV derived sub-categories from the data. GAr, LG, MH drafted the first version of the manuscript. FDV, LD composed tables, and figures. All authors read and approved the final manuscript.

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Meta-synthesis framework with participants’ narratives.

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Artioli, G., Deiana, L., De Vincenzo, F. et al. Health professionals and students’ experiences of reflective writing in learning: A qualitative meta-synthesis. BMC Med Educ 21 , 394 (2021). https://doi.org/10.1186/s12909-021-02831-4

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Quiet Time: 7 Key Reflective Questions to Ask Yourself

Sometimes we all need to step back and take stock of our work, relationships and health, coach rosie nice offers seven key questions to help you reflect and re-align, we have coaches available to support you here.

The power of reflective silence has long been recognised, enabling us to tune into our thoughts and feelings and find the peace to think clearly about life’s challenges. All major religions embody elements of silence, and mindfulness and meditation are centred around its benefits. I believe that making time in your day to quietly think, without distractions or interruptions, can be transformational.

Quiet reflection enables us to choose thoughtful responses to events in our lives. The power to shape our futures lies in the space between something happening and the way we choose to respond. The value of personal reflection is widely recognised as a key element of personal development in many professions, including counselling, coaching, healthcare and sport, enhancing your self-awareness and helping you process and learn from your experiences. Even spending 5 minutes a day in reflective silence can improve our wellbeing, according to the NHS .

Walking, running, gardening or sitting with a quiet cuppa are all great ways to create time for reflective thought. Some of us enjoy reflecting alone, while others prefer to find their silence in an uninterrupted, reflective conversation with a friend, partner or coach.

To experience the benefits of reflective silence for yourself, find somewhere quiet where you won’t be interrupted, and ask yourself these seven questions. You can ask yourself all the questions in one go, or spaced them out over time, asking one question per day, or one a week. Whatever works for you.

Take your time, record your answers, ideally in writing, and enjoy the peaceful personal reflection. You never know where it might take you!

1. How would I evaluate my life at the moment?

Consider the present.

Start by holding up a metaphorical mirror and reflecting on your life right now.

Firstly, celebrate what is going well and acknowledge all that you have achieved. What are you pleased with, and proud of?

Then, consider things which may not be going so well. Be kind to yourself as you acknowledge elements of your life which you are less pleased with. Show plenty of self-compassion here – the point is not to beat yourself up, but to consider what you can learn for the future.

2. How did I get here?

Consider the past. What are the pivotal moments in your life which have led you to where you are today? Can you pinpoint some ‘sliding doors’ moments where you took action and made decisions which took you along the pathway to your current situation?

Which past actions and decisions are you grateful for, because they enabled you to move forward and achieve success? 

Are there any actions or decisions which you aren’t so pleased about, and which were less helpful? Again, show yourself some kindness here. This is not about regrets; it is about learning.

3. What would I really like to achieve in the future?

Consider the future. 

What you would like to see when you look in this mirror one day. Imagine yourself at the end of this month, year or decade. What achievements would you love to be reflected back at you? 

Dream big as you explore your aspirations   going forward, personally and professionally. What does success look like for you? If you could wave a magic wand, what would you really like to achieve? What would you do if you knew you couldn’t fail? 

Try creating a ‘personal vision statement’ or choose one word to represent your future. This visualisation exercise can be very impactful: imagine yourself living your best life – what are you doing, thinking and feeling?

4. What makes this important to me now?

It can be very insightful to reflect on your personal values and consider what is truly important to you. Your values are your own core, fundamental beliefs about what matters most to you, and they play a key role in determining your priorities and influencing your behaviour. 

Think about the relative importance to you of things like family, relationships, career, status, money, spirituality, health, and other factors. As you reflect, consider whether these truly are your own values, or are they the values of others, maybe your family, peer group, or colleagues? 

Gaining clarity about your values helps you make actions and choices which feel more meaningful, and your aspirations and goals become far more authentic when they consciously align with your values.

5. How can I turn my aspirations into tangible goals?

Next, consider how your aspirations for the future can be used to create some specific, tangible goals to aim for, and set yourself some timescales to work towards. 

See if you can break bigger goals down into smaller mini-goals, or milestones, to mark your progress along the way. Think about exactly what you would like to achieve and by when. 

By the end of this reflection, you will have a clear set of goals, linked to your wider aspirations and aligned with your values and priorities.

6. What ideas do I have to help me achieve this goal?

Now, explore a range of ideas for how you might achieve these goals. What options are available to you? Do you know anyone who has worked towards similar goals and could offer you some help and advice? 

Generate a good list of ideas before selecting those which will work best for you. Consider what has stopped you achieving this goal already and think about how you could overcome any obstacles or barriers which you might encounter.

7. What’s my plan?

We have reflected on the actions you have taken in the past, which have led you to today. Now it is time to reflect on the actions you could take today to make yourself proud and grateful in the future and incorporate these ideas into a clear action plan. 

What will you do, and when, to successfully achieve these aspirations and goals you have so thoughtfully defined? Make your first step very specific, and start with some ‘quick wins’, actions which require little effort but bring big rewards.

These seven questions can guide you through a reflective process, helping you assess your current situation, clarify your values, identify your ideal outcomes, set specific goals, explore potential ideas and create a plan of action. 

Taking time for quiet reflection can increase your self-awareness, and help you learn from your experiences, empowering you to take responsibility for your own development and dramatically increasing your chances of success, whatever you decide that means for you. 

I wish you all the best. Happy reflecting!

Rosie Nice is the  author of  The Magic Happens in the Silence: A Guide to the Art of Reflective Coaching

Further reading

Feeling stuck in midlife here's how to move forward, how presence will help you find peace of mind, enough is enough: is your ambition making you happy, how unconscious forces drive our behaviour at work, how to stick to a daily mindfulness practice, find welldoing therapists near you, related articles, recent posts.

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