Application of Shared Reflective Cycles to Develop Clinical Judgment

Overview

This resource is intended to provide faculty with an evidenced-based, post-clinical conference activity to support the development of clinical judgment skills in pre-licensure nursing students. This activity is designed to develop clinical judgment skills by applying Gibbs Reflective Cycle to encourage student self-reflection as well as collaborative learning (Gibbs 1988). This activity is appropriate for use in any clinical course.

How to Use

  1. Faculty should instruct students to write their reflections on paper using the prompts provided by Gibbs Reflective Cycle.  Instruct them to answer each question before moving on to the next (Gibbs, 1988).  Reassure students that there is no right or wrong way to complete the reflection; it is about their own thoughts and experiences.  Providing structured questions will guide the students through the reflection process and encourage deeper, more meaningful reflection.  
     
  2. For hour-long post-conference sessions, faculty should give students10-15 minutes to write their reflections individually to process their clinical day quietly and increase personal learning.  
     
  3. Next, have students read their reflections aloud.  Faculty should use a round-robin sharing style to allow each student to talk and maximize the shared learning.  Assign one student to go first, then move around the room, giving each student time to share. Students should be allotted five minutes to discuss their reflections and answer questions their peers/faculty pose to them.  Sharing can challenge students’ critical thinking, help students relate to similar situations, and give students alternative ways to approach concepts.  
     
  4. The physical setting should be comfortable, private, and away from the clinical unit.  A meeting or conference room is ideal to allow students a safe place to share their feelings about the patient care that occurred that day, as well as process their interprofessional interactions.    
     
  5. Faculty should manage the time in post-conference.  Most post-conferences are one hour long; keeping students on topic during discussions is essential.  There is limited time for each student when you have six to eight students in a group.  Faculty should reinforce, remind, and redirect students back on topic as needed to allow time for all students to share.      
     
  6. Faculty may want to provide a topic or lens to focus students' thoughts.  Providing topics will help prompt student reflection and clinical reasoning development (see below: “Exemplars”).    

Integrative Learning Strategies

  • The activity is intended to be used in post-clinical conferences.  
  • The activity is best completed for in-person post-clinical experiences.  
  • For a one-hour post-clinical conference, with six to eight nursing students:
    • Learners should spend 10-15 minutes completing individually written reflections.  
    • Each student has approximately five minutes to share their reflection in a round-robin style.  
      Any remaining time is used for faculty-led group discussions about student reflections.  

Assessment Strategies

Clinical judgment is best measured over time; faculty should complete this activity regularly throughout the semester to assess the development of critical thinking and decision-making skills.  Faculty may track individual students’ clinical reasoning ability over time by applying the Lasater Clinical Judgment Rubric to reflections (Lasater and Nielsen 2009).

This should be a pass/fail activity to allow students to focus on reflection instead of performance. A passing response includes the following:  

  • The student participated in the writing and verbal sharing of the reflection.  
  • The student displays thoughtfulness in each reflection section, particularly the analysis and action plan.  
  • The student was respectful of everyone’s time during the shared reflection portion.  

Exemplar

Example topics may include but are not limited to:  

  • How students integrated concepts such as pain control  
  • The role of early ambulation in post-op clients  
  • How including family members in patient care may?impact outcomes  
  • The role of the nurse and impact of client education    
  • How empathy played a role in patient care  
  • How time management impacted patient?care  
  • The communication and teamwork noticed with the unit staff and how that impacts client care  
  • How did communication barriers impact client care  
  • How clients' social determinants of care impact health and outcomes  
  • How technology was used in clinical and what impact that may have had? 

Possible Courses

This tool may be implemented within a variety of pre-licensure clinical courses. Reflection prompts should align with AACN Essentials and/or clinical course objectives.  

Additional Resources/Publications

Gibbs, Graham. 1988. Learning by Doing: A Guide to Teaching and Learning Methods.  

“Gibbs’ Reflective Cycle.” 2020. The University of Edinburgh. November 11, 2020. https://www.ed.ac.uk/reflection/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle.  

Lasater, Kathie. 2007. “Clinical Judgment Development: Using Simulation to Create an Assessment Rubric.” Journal of Nursing Education 46 (11): 496–503. https://doi.org/10.3928/01484834-20071101-04.

Lasater, Kathie, and Ann Nielsen. 2009. “Reflective Journaling for Clinical Judgment Development and Evaluation.” Journal of Nursing Education 48 (1): 40–44. https://doi.org/10.3928/01484834-20090101-06.

Maffucci, Jennifer, Kathryn J. Vanderzwan, and Leah Burt. 2023. “Evaluating a Shared Reflective Practice to Develop Nursing Student Clinical Judgment.” Nurse Educator, December. https://doi.org/10.1097/nne.0000000000001570.

Manetti, Wendy. 2018. “Evaluating the Clinical Judgment of Prelicensure Nursing Students in the Clinical Setting.” Nurse Educator 43 (5): 272–76. https://doi.org/10.1097/nne.0000000000000489.

Nguyen-Truong, Connie Kim Yen, Andra Davis, Cassius Spencer, Melody Rasmor, and Lida Dekker. 2018. “Techniques to Promote Reflective Practice and Empowered Learning.” Journal of Nursing Education 57 (2): 115–20. https://doi.org/10.3928/01484834-20180123-10.

Tyo, Mirinda Brown, and Mary K. McCurry. 2019. “An Integrative Review of Clinical Reasoning Teaching Strategies and Outcome Evaluation in Nursing Education.” Nursing Education Perspectives 40 (1): 11–17. https://doi.org/10.1097/01.nep.0000000000000375. 

 

Sub-competencies for entry-level professional nursing education:

  • 1.2b Demonstrate intellectual curiosity.  
  • 1.2d Examine influence of personal values in decision making for nursing practice.  
  • 1.3a Demonstrate clinical reasoning.  
  • 1.3b Integrate nursing knowledge (theories, multiple ways of knowing, evidence) and knowledge from other disciplines and inquiry to inform clinical judgment.  
  • 1.3c Incorporate knowledge from nursing and other disciplines to support clinical judgment.  
     
  • 10.2a Engage in guided and spontaneous reflection of one’s practice.  
  • 10.2c Commit to personal and professional development.  
  • 10.2d Expand personal knowledge to inform clinical judgment.  
  • 10.3f Modify one’s own leadership behaviors based on guided self-reflection.
Posted: August 23, 2024
Submitted by:

Jennifer Maffucci, EdD, RN, ANCS-BS, Teaching Assistant Professor, University of Illinois Chicago 
Leah Burt, PhD, APRN, ANP-BC, CHSE, Clinical Assistant Professor, University of Illinois Chicago 

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