reflective essay on ethical dilemma in nursing

10 Examples of Ethical Dilemmas in Nursing

When caring for human lives, the decisions you have to make as a nurse are anything but black and white. In addition to taking vital signs and doing dressing changes, there are a realm of tough choices and ethical dilemmas that nurses have to face every day.

Picture this: a nurse finds himself torn between respecting a patient's right to refuse treatment and their deteriorating health. Moral puzzles like these leave even the most experienced nurses scratching their heads and feeling caught between a rock and a hard place. However, understanding how to handle ethical dilemmas isn't just a theoretical exercise. It's a crucial skill that nurses need to have in their toolkits. 

The nursing code of ethics acts as a guide for nurses to help in these decisions, but it can be helpful to see actual examples of ethical dilemmas in nursing and what a nurse should do with each of them. That’s exactly what this article is about. 

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10 common ethical dilemmas in nursing .

While there are many different situations in which a nurse may find themselves dealing with an ethical dilemma, here are 10 common ethical dilemmas in nursing to consider and how a nurse might deal with them:

1. Patient Autonomy vs. Beneficence

Balancing a patient's right to make decisions about their own care with the nurse's duty to promote their overall well-being.

Let's say a patient diagnosed with diabetes refuses to take insulin, despite it being essential for controlling their blood sugar levels and preventing serious complications. 

In dealing with this situation, a nurse should follow the nursing code of ethics and take the following steps:

Respect Autonomy: Respect the patient's right to make decisions about their own care, even if they disagree with those decisions. 

Provide Information: Ensure the patient has accurate and comprehensive information about the treatment, including its benefits, risks, and alternatives. This allows the patient to make an informed decision.

Assess Understanding: Engage the patient in open and non-judgmental communication to assess their understanding of the treatment and the potential consequences of refusing it. 

Collaborative Decision-Making: Engage the patient in collaborative decision-making. Involve them in discussions and explore alternatives that align with their values and preferences. This approach fosters a sense of working together and mutual respect.

Seek Additional Perspectives: If the patient's decision still conflicts with the nurse's professional judgment and poses a significant risk to the patient's health, the nurse should seek guidance from the healthcare team and the nurse manager or supervisor they report to.

Document the Process: Throughout the decision-making process, carefully document all discussions, assessments, and the patient's decisions. This documentation serves as evidence that the nurse has fulfilled their ethical and professional responsibilities.

>> Related: What is Autonomy in Nursing?

2. Confidentiality vs. Duty to Warn 

Struggling with maintaining patient confidentiality while also considering the potential harm to others if vital information is not shared.

Imagine a scenario where a nurse working in a mental health facility becomes aware that a patient with a history of violent behavior has confided in the nurse about their plan to cause harm to their former partner. 

The nurse finds themselves in a challenging ethical dilemma: on one hand, they have a duty to maintain the confidentiality of the patient's personal information, and on the other hand, they have an obligation to protect other people from harm.

To deal with this situation, the nurse should take the following steps:

Evaluate the Severity of the Threat: Carefully assess the level of risk involved in the patient's intentions. Is there an immediate and credible threat to the safety of the potential victim? Consider factors such as the patient's history, current mental state, and access to means for carrying out the harm.

Engage in a Therapeutic Relationship: Explore the underlying issues and reasons behind the patient's harmful intentions. Attempt to address any underlying issues or triggers that may contribute to their behavior and encourage them to seek alternative ways to cope.

Seek Supervision and Consultation: It’s important for the nurse to consult with their supervisor or team members about the appropriate course of action to ensure the safety of the potential victim.

Follow Legal and Ethical Guidelines: Be aware of local laws and regulations regarding the duty to warn or protect. If there is a legal obligation to disclose information in order to prevent harm, the nurse should adhere to those requirements while minimizing the breach of confidentiality to the extent possible.

Document the Process: Document all steps taken, including the patient's disclosure, assessments, consultations, and decisions made. This documentation serves as evidence that the nurse acted ethically, responsibly, and in line with professional standards.

3. End-of-Life Care

Managing the ethical complexities around decisions about withdrawing or withholding life-sustaining treatment, considering the patient's wishes, quality of life, and family dynamics.

For example, consider the situation where a nurse is caring for an elderly patient with a terminal illness. The patient expresses the desire to die a peaceful death without aggressive interventions. However, the patient’s family opposes this and wants “everything medically possible” to be done to save the patient’s life. 

The nurse finds themselves in a complex ethical dilemma, torn between honoring the patient's wishes and respecting the concerns of the family.

Here’s how the nurse might address this situation:

Communication and Education: Engage in open and compassionate communication with both the patient and the family about the patient's medical condition. Discuss the patient’s prognosis, available treatment options, and the potential benefits and downsides of continuing or discontinuing life-sustaining measures. 

Respect for Autonomy: Advocate for the patient's right to self-determination and respect their wishes regarding end-of-life care.

Collaboration and Mediation: Facilitate a respectful and open dialogue, promoting a collaborative decision-making process. The nurse can involve the healthcare team, including palliative care specialists and social workers, to provide support, guidance, and mediation to resolve this situation.

Consider Ethical Decision-Making Frameworks: The nurse should use ethical principles in the nursing code of ethics, such as beneficence, non-maleficence, autonomy, and justice, to analyze the situation and guide their actions. By considering the patient's values, goals, and potential impact on their quality of life, the nurse can advocate for the most ethically appropriate course of action.

Supportive Care: Regardless of the final decision made, the nurse should provide holistic and supportive care to the patient and their family. This includes addressing physical, emotional, and spiritual needs, ensuring optimal comfort, and facilitating open communication to foster a sense of trust and understanding.

4. Resource Allocation

Facing the difficult task of distributing limited resources fairly and ethically among patients, especially during times of scarcity or emergencies.

Consider this scenario: During a severe flu outbreak, a nurse working in a hospital emergency department faces the ethical dilemma of resource allocation. The hospital is overwhelmed with patients and the available resources, such as beds, ventilators, and medications are limited. The nurse must make decisions about which patients receive the resources, balancing the needs of the patients in their care while also considering the needs of other patients in the hospital.

The nurse should manage this situation with fairness and transparency, using the following steps:

Prioritization and Triage: Follow established guidelines and protocols for triaging patients based on the severity of their condition and their likelihood of benefiting from the available resources. This ensures that decisions are made based on clinical needs rather than personal biases.

Open Communication: Maintain open and transparent communication with patients and their families. Explain the challenges faced due to limited resources and the criteria being used for resource allocation. This promotes understanding and trust, even in difficult circumstances.

Collaboration and Consultation: Work collaboratively with the healthcare team, including physicians and hospital administrators, to make informed decisions about resource allocation. Seeking input from multiple perspectives helps ensure fairness and accountability.

Consider Ethical Decision-Making Frameworks: Use the ethical principles of fairness and justice in the nursing code of ethics to guide the nurse’s actions. By considering factors like the potential benefits, risks, and overall impact on patients and the community, the nurse can strive to allocate resources in an equitable and ethical manner.

Advocacy and Support: Advocate for the well-being and rights of their patients, even when difficult decisions must be made. 

5. Informed Consent

Ensuring patients have a clear understanding of the risks, benefits, and alternatives of proposed treatments or procedures before they provide consent.

Here’s an example of how this ethical dilemma could occur: A nurse assists a physician who is rushing to obtain informed consent for a surgical procedure, despite the patient's pain and anxiety. However, the nurse quickly recognizes the patient's limited understanding of the procedure’s implications, raising ethical dilemmas regarding informed consent.

To handle this situation, the nurse should follow these steps:

Ensure Adequate Information: Intervene respectfully but assertively and ask the physician to slow down and provide the patient with complete information about the procedure, risks, benefits, potential outcomes, and available alternatives. 

Clarify Patient Understanding: Speak with the patient and assess their understanding of the information provided. Encourage the patient to ask questions and address any concerns they may have. 

Advocate for Time and Support: If the patient appears overwhelmed or is struggling to comprehend the information, the nurse should advocate for additional time or resources, such as involving a family member or providing educational materials or an interpreter (if appropriate) to support the patient in making an informed decision. 

Document the Process: Document the steps taken to address the concerns related to informed consent. Be sure to include any discussions, explanations provided, patients' questions, and their ultimate decision. Accurate documentation demonstrates the nurse's commitment to upholding ethical standards and professional accountability.

6. Cultural and Religious Beliefs

Navigating conflicts between a patient's cultural or religious values and the standard practices or protocols of healthcare.

In a multicultural society, nurses often encounter ethical dilemmas when a patient's cultural or religious beliefs clash with the standard practices or protocols of healthcare. An example is when a nurse is caring for a patient from a cultural background who strongly believes in traditional healing methods and is hesitant to accept Western medicine.

In this situation, the nurse should have a culturally sensitive discussion with the patient and demonstrate respect for diversity. Here are the steps the nurse should take:

Culturally Competent Assessment: Conduct a culturally competent assessment to understand the patient's cultural and religious beliefs, values, and preferences regarding healthcare. This requires active listening, open-mindedness, and avoiding assumptions or stereotypes.

Establish Trust and Rapport: Build a trusting relationship with the patient by acknowledging and respecting their cultural and religious beliefs. This can be achieved through effective communication, empathy, and demonstrating cultural humility.

Collaborative Decision-Making: Engage the patient and their family in collaborative decision-making regarding their healthcare. Respectfully discuss the patient's beliefs and preferences, and explore opportunities to integrate traditional healing practices with evidence-based Western medicine. 

Consultation and Education: If there are concerns about the patient's well-being or the appropriateness of certain traditional healing methods, the nurse should seek guidance from a cultural consultant, interpreter, or healthcare team. 

Advocacy and Liaison: Serve as an advocate for the patient, ensuring their cultural and religious rights are respected within the healthcare system. This may involve facilitating communication between the patient and healthcare providers, ensuring the provision of culturally competent care, and addressing any cultural or religious barriers that may arise.

7. Impaired Colleague

Grappling with the ethical responsibility of reporting concerns about a colleague's impairment due to substance abuse or mental health issues.

This situation might occur when a nurse becomes aware that a nursing colleague is impaired while on duty. The impaired nurse exhibits erratic behavior and smells strongly of alcohol. The nurse who witnesses this behavior finds themselves in a challenging ethical dilemma, torn between their duty to ensure patient safety and their loyalty to their colleague.

Nevertheless, the nurse needs to prioritize patient safety and act professionally by following these steps:

Immediate Concern for Patient Safety: The nurse's primary responsibility is to ensure the safety and well-being of patients. If they observe signs of impairment in their colleague that could compromise patient safety, they should take immediate action.

Reporting: The nurse should report their observations and concerns to the appropriate authority within the healthcare facility, such as the nurse manager or supervisor. This report should be made objectively without personal judgments or assumptions and with a focus on patient safety.

Confidentiality and Professionalism: Maintain confidentiality throughout the reporting process, being mindful not to disclose personal details of the impaired colleague unless necessary for the investigation.

Collaboration and Support: Collaborate with the healthcare team and support the impaired colleague's well-being by encouraging them to seek appropriate help and support, such as employee assistance programs or counseling services. 

Ethical Obligation: Nurses have an ethical obligation to protect the welfare of patients and maintain the standards of the nursing profession. This includes recognizing and addressing impairment issues among colleagues to ensure safe and quality care.

8. Professional Boundaries

Striking a balance between providing compassionate care and maintaining appropriate professional boundaries, particularly when it comes to personal relationships with patients.

In this example, let’s look at a scenario where a nurse develops a close friendship with a patient and begins sharing too many personal details about their own life unrelated to the patient’s healthcare needs.

When the nurse realizes what’s happening, they need to prioritize maintaining professional boundaries and act in the best interest of the patient by following these steps:

Recognize the Boundary Issue: Use personal reflection to recognize when professional boundaries are being crossed or compromised. Acknowledging this ethical dilemma is the first step toward resolving it.

Reflect on the Nurse-Patient Relationship: The nurse should remind themselves of their professional role, the duty of care, and the need to maintain objectivity and professional distance.

Reestablish Boundaries: Take appropriate actions to reestablish and reinforce professional boundaries with the patient. This may involve redirecting conversations back to the patient's healthcare needs, avoiding personal disclosures, and focusing on the patient's well-being.

Seek Guidance and Supervision: If the situation becomes challenging to resolve alone, the nurse should seek help from a supervisor, nurse manager, or experienced nursing team member. Consulting with experienced professionals can provide valuable insights and support in addressing this ethical dilemma.

Continuous Professional Development: Engage in ongoing professional development and education regarding nursing ethics and setting professional boundaries. Staying current on ethical guidelines and participating in discussions and training on maintaining professional boundaries can help prevent future boundary issues with patients.

9. Whistleblowing

Facing the ethical dilemma of reporting concerns about wrongdoing or unethical practices within the healthcare system, despite potential professional and personal repercussions.

An example of whistleblowing would be when a nurse becomes aware that a colleague is stealing controlled substances from the medication supply. The nurse decides to report this to their supervisor because it compromises patient safety and violates professional and legal standards. However, the nurse is worried about their colleague being disciplined and possibly losing their license.

Here are the steps the nurse should follow:

Gather Evidence: Collect factual evidence such as documentation discrepancies in medication records, witnessing the colleague's actions, or capturing any other supporting documentation. 

Consult with Colleagues: Seek advice from trusted colleagues, supervisors, or mentors within the healthcare organization. Discuss the situation and determine the best course of action. It’s important to maintain confidentiality during these discussions to protect both the patient and the nurse making the report.

Follow the Proper Chain of Command: Follow the established reporting channels within their healthcare organization. This typically involves reporting concerns to a supervisor, nurse manager, or a designated ethics or compliance hotline. Ensure that the report is made in writing and contains all relevant details and evidence.

Protection and Confidentiality: Be familiar with the whistleblower protection policies and laws in their jurisdiction. The nurse should ensure that their report is treated confidentially and that appropriate steps are taken to protect them from retaliation.

Documentation: Keep a detailed record of all actions taken, including the date and time of the incident, any conversations or consultations, and copies of the report submitted. This documentation helps demonstrate the nurse's commitment to reporting and acting in accordance with professional and ethical standards.

10. Ethical Use of Technology

Considering the ethical implications of using technology in healthcare, such as maintaining patient privacy and security, avoiding biases in algorithms, and ensuring equitable access to care.

An example of this ethical dilemma could occur when a nurse becomes concerned about potential biases in an algorithm and decides to report this to her supervisor. She recognizes that an algorithm where she works may disproportionately allocate resources based on patient factors such as age, race, and gender, resulting in inequitable access to care.

The nurse should advocate for equitable care by taking these steps:

Investigate and Evaluate: Become familiar with the AI algorithm being used and investigate its development process. Assess whether the algorithm has been validated and tested for biases and fairness. 

Raise Concerns: If the nurse identifies biases or inequities in the algorithm, they should communicate their concerns to the appropriate individuals, such as nurse leaders, healthcare administrators, or the technology implementation team. 

Collaborate for Improvement: Engage in collaborative discussions with the healthcare team, including the nursing supervisor, IT specialists, and data scientists. Work with the team to develop strategies to eliminate biases and ensure equitable use of the technology for all patients.

Promote Patient Advocacy: Advocate for the rights and well-being of the patients who may be affected by the technology. This involves ensuring informed consent and transparency regarding the use of AI algorithms. Patients should have the opportunity to understand and discuss the potential biases and their impact on their care.

Continuous Evaluation: Advocate for ongoing evaluation and monitoring of all AI technology being used in patient care to identify and resolve biases or unintended consequences. 

Ethical dilemmas are common in nursing and can be difficult to deal with. But you don’t have to make the decisions about these issues alone. Seek out the support and input of your nursing colleagues, supervisor, or nurse manager. By doing so, you will feel more comfortable and confident about how to handle the ethical dilemma you find yourself in.

*This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease.

Leona Werezak BSN, MN, RN is the Director of Business Development at NCLEX Education. She began her nursing career in a small rural hospital in northern Canada where she worked as a new staff nurse doing everything from helping deliver babies to medevacing critically ill patients. Learning much from her patients and colleagues at the bedside for 15 years, she also taught in baccalaureate nursing programs for almost 20 years as a nursing adjunct faculty member (yes! Some of those years she did both!). As a freelance writer online, she writes content for nursing schools and colleges, healthcare and medical businesses, as well as various nursing sites.

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How to Write a Nursing Reflective Essay (Guide for Nurse Students)

If you are a nursing or medicine student, you are aware that you will come across or have already come across assignments requiring you to write a nursing reflection essay. At first, such a task always appears challenging, but given the understanding of the steps, things flat out, and you can write reflective essays and get better grades.

Reflective practice is highly encouraged in nursing. Reflection entails making sense of situations, events, actions, and phenomena in the workplace.

As a nursing student, you will be asked to write a reflective essay on your clinical placement, practicum, shadowing experience, shadow health DCE activities, personal nursing philosophy, why you want to become a nurse, nursing program, ethical dilemma, knowledge, skills, and abilities, systems, and processes.

The easiest way to complete the reflective essay assignment is by first determining what reflective writing entails, its significance, its steps, and some of the best tips that form the core of this ultimate guide.

Basics of Reflective Writing in Nursing

Reflective writing is an analytical writing practice where the writer describes a real or imaginary event, scene, phenomenon, occurrence, or memory, including their takeaway. It entails the critical analysis of an experience, including recording how it has impacted you and what you intend to do with the new knowledge or how to act when such an occurrence recurs.

As you document the encounter, you can use first-person pronouns and write subjectively and objectively. This means that you can decide to either use personal experiences alone or support these experiences using citations from scholarly sources.

When writing a reflective essay in nursing, you must recount the events and give critical detail of how the events shaped your knowledge acquisition. Reflection helps nursing students develop skills in self-directed learning, which is directly associated with high motivation and improved quality of care .

In most cases, reflection occurs on what went well and what went wrong. It could be a successful operation, a thank you note from a patient, a patient who regained their health faster, or a new nursing care plan that worked. However, it can also be about adverse events such as death, postoperative complications, death of an infant at birth, dissatisfied patient, medical error, or a failed procedure.

As a nursing student, when you learn to reflect on situations, you grow to become a professional nurse who diligently does their noble duty.

When writing a reflective essay, you begin by setting the scene (explaining what, where, how, and who-the situation), detailing how you felt (emotional state), why it happened (making sense of the situation), critical review and development of insights, a note on what was learned, and strategies to address future recurrence.

Your professor may ask you to write a nursing reflective paper about various topics in your course or your experience working in a group, how you solved a problem, a healthcare issue, or clinical practice. Consider the following example of a reflective statement in nursing; in my clinical practices, I realized I focused more on the technical aspects but failed to explain what it was doing to improve their health. I would like to understand more about listening to patience and their concerns to better care for them.

As you will notice later, these reflective stages are structured into different reflective models and frameworks that we will explore in-depth. So, with the understanding of what comprises reflective writing and its importance in nursing, let's now get solid on the structure.

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Structure of a Reflective Essay in Nursing

A reflective essay is an analytical writing piece describing and evaluating encounters or experiences. When asked to write one, you should know that an excellent reflective essay consists of different parts, just like a typical academic essay. It comprises the cover or title page, introduction, body paragraphs, conclusions, and a references page.

The title page contains information about the assignment. If you are writing the reflective essay in APA, include these on the title page:

• Title of the reflective essay
• Course code and name
• Instructors name
• Name of your institution
• Date of submission

When writing in Harvard format, the title or the cover page will consist of the following:

• Title of the essay in title case and the page number (upper right margin),
• Title of the essay in CAPS,
• Name of class or course,
• Name of the instructor,
• Name of your school,
• City and state where your school is located and,
• The date of submission.

Introduction

The introduction begins with an attention grabber or a hook sentence to attract readers' attention. It should then explain the essay's purpose and signpost the ideas that will come later in the essay. The introduction also has a thesis statement at the end of the paragraph- the last sentence. The thesis is concise, clear, and relatable and should reflect your position.

Body Paragraphs

The body paragraphs of a reflective essay can be three or more, depending on the length of the essay. Essentially, the body comprises 80% of the total word count.

The first paragraph is where you describe the situation, including the events, why they occurred, how they occurred, and those involved.

The second paragraph entails your personal feelings or reaction to the situation and how it made you feel.

The third paragraph can include making sense of the situation. You have to think about why things happened the way they did. You should also critically review and develop insights based on the situation. Finally, think of the factors that could have influenced the situation.

The next paragraph should explain how the event or situation will change your practice, approach, decisions, perspective, or perception. This is where you evaluate the experience by detailing the knowledge and skills you took from the experience.

The last body paragraph should entail a critical reflection on the learning opportunities. First, describe the situation and what it made you learn. Next, elaborate on how you intend to make yourself better poised to address such situations.

Mostly, you should structure the body of your essay as per the preferred nursing reflective model.

After everything else falls into place, you need to summarize the information you presented in the essay. Then, finally, restate your thesis and have a call to action to bring a sense of closure to your readers.

Steps for Writing a Nursing Reflection Essay � The Guide

When assigned to write a reflective essay for your nursing class, here are the surefire steps to get you to success.

Read the instructions

The first step after receiving an assignment is to begin reading the instructions. as you read, note what your instructor or professor expects in the paper you will submit for marking.

Reading instructions helps you to get informed on the scope of the paper, word count, number of references and pages, and the formatting style to use.

Besides, you also get to plan your paper with the deadline highlighted in the instructions.

You need to get a conducive environment where you can start writing.

The first step of writing is to brainstorm about situations during your clinical hours when you were shadowing a Nurse Practitioner or one you have read about.

Assess whether the situation or scenario you have thought, encountered, or chosen can help you write a reflective essay that meets the requirements.

Research and Plan

After choosing a scenario, the next step is researching the best reflective model.

You can use your class text, the instructions, the college library, course readings, and online nursing journals to get articles and resources with information about specific reflective models.

Select the best reflective model and take notes on the steps it entails.

As you research, write down notes on how to address your paper based on your selected framework or model of reflection . Additionally, research nursing journal articles with information you can use when critically analyzing a situation.

Plan how you will handle the paper as well. For instance, as you research, develop a thesis statement that grounds your entire paper, then draft an outline on how to develop the thesis.

Write an Outline

Outlining is a crucial aspect of writing. It helps you envision how you will meet the objective of writing a reflective essay. As an essential part of the essay writing process, outlining helps create a good flow of ideas and can come in handy in helping you overcome writer's block. Your outline should comprise the following:

• The hook or attention grabber
• Thesis statement
• Main points of each body paragraph (topic sentence, evidence, examples, illustrations, etc.)
• Conclusion (restated thesis and call-to-action)

With the outline done, you should take a break and resume writing your first draft of the nursing reflection essay. Writing with an outline helps avoid mistakes and also helps you write faster.

Describe the Experience

Once you have identified the relevant experience, begin describing it chronologically.

Describe the experience that prompted you to consider nursing your ideal career goal. Think of this experience's key elements, such as the setting, patient demographics, and significant events that impacted you.

Show how these events changed your perspective on life. Ensure you are as descriptive as possible to paint a clear picture for readers.

Consider the following questions to come up with a good description:

• What happened?
• Was there someone involved? If yes, what part did they play?
• Where did the event take place?
• What actions did you take?

Set the context of this experience by giving relevant background information. Ensure you are objective and pay attention to the facts.

Provide a Reflection

Talk about your feelings and thoughts concerning the particular experience you went through. You have to be honest and open up about your initial expectations and challenges you faced at each stage of the experience. The following questions can help you come up with a good reflection:

• What was I trying to achieve?
• What prompted me to act the way I did?
• Are there any consequences for my actions? If yes, what are they?
• How did I feel about this event as it was happening?
• How did those around me react to it?
• How do I know how those around me felt about it?

Analyze the Experience

Description of an experience is essential, but so is analysis. You have to move beyond the surface and give a critical analysis of your experience.

State your actions, and your overall experience will give insights into your experience. Think of how the experience has impacted your actions, feelings, and thoughts.

Give an Evaluation

Evaluate the skills and knowledge you got from the experience. Show how you can apply these skills and knowledge in your nursing practice. Also, state the actions and interventions you took during the nursing experience.

State whether you achieved the desired outcome and if there are any specific areas that you need to improve on.

Talk about how you built or improved skills like communication, teamwork, and critical thinking.

As you evaluate the experience, identify what you believe to be your strengths and weaknesses in the nursing experience. What have you learned from the experience? State the areas where you excelled and what abilities contributed to your success.

Talk about how those you were with during the clinical experience complimented you. Similarly, acknowledge your weaknesses.

What kind of mistakes did you make, and how did you improve them? Talk about the tasks that drain you most during the experience.

Illustrate Learning

Demonstrate elements of deeper thought and reflection levels. This is a great point to include nursing theories in your reflection essay to support analysis of your experience.

Relate your experiences to the theoretical frameworks you were taught in class. This is effective learning and will demonstrate your ability to apply knowledge to real-life nursing situations.

Doing this will also show that you can effectively deduce different things from observations made during the reflection process.

Ensure you also demonstrate a change in perspective, as this will prove that you learned something from the experience.

Write Your Conclusion

Conclude by summarizing your points and highlighting the lessons learned.

The lessons you reached as part of your reflection should support your overall conclusion.

Also, restate your thesis statement.

Come Up with an Action Plan

Now that you have learned from your reflection develop an action plan for future nursing practice.

This part should contain all the details you have learned and actions needed to improve when faced with a similar situation. Consider the following questions:

• What would I change if faced with a similar situation?
• How can I develop the necessary skills needed to face this situation?
• How can I act differently in a similar situation?  

Ensure you identify areas to improve and set realistic goals to enhance your nursing skills. Discuss how you intend to seek additional education, training, or mentorship to address your shortcomings.

Finally, end the essay with a happy note so readers know you learned something from the experiences.

Proofread, Edit, and Polish

After doing your first draft, take a break to relax and get out of the writing mood - it helps you to become objective.

You can then resume reading out loud to yourself, make necessary tweaks, and ensure that every part you include meets the rubric requirements.

Edit for grammar, punctuation, tenses, voice, spelling, and use of language. You should also proofread the essay to adhere to the style, organization, and presentation requirements.

Ensure that all the in-text citations are accounted for in the reference list and are up-to-date. You are good to go when you have an essay that meets all the instructions.

Finally, you can submit the paper for grading.

Writing is not everyone's cup of tea. For that reason, you can hire a nursing reflection essay writer from our website to assist you in crafting a top-grade paper. In addition, we have nursing writers whose forte is writing various nursing papers.

Choosing the suitable Reflective Model or Framework

As you can see above, many reflective models are used for your reflective essay. We have not exhaustively listed and expounded on all of them. Other reflective models and frameworks you can also consider when writing a reflective essay in nursing include:

• Bouds Reflective Model
• Brookfield Reflective Model
• Pender's Health Promotion Model
• Roper Logan and Tierney Model
• Driscoll Reflective Model
• The Johari window model

Note that most nursing instructors will often suggest the models they prefer for you to use in your essay.

For example, in most nursing reflective essays. Whichever the case, readily available information expands on each model to make it easier to write a reflection essay on a specific aspect of nursing education or practice.

Read the assignment rubric and instructions to understand the specific model. If it is unclear, ask for clarification from your instructor early enough.

Tips for Writing a Good Nursing Reflective Essay

As you try to figure out how to write a nursing reflective essay, keep the following tips in mind.

Choose the Right Topic

If the instructions from your professors involve choosing a topic for the reflective essay, you must select one that is meaningful to you.

This will ensure you can easily write and easily develop relevant elements about the topic. Therefore, take time to pick a topic that you find interesting.

As you write, ensure you stay on topic, whether sharing a one-off event or a recurrent story.

Use the Right Tone

A reflective essay is more personal, unlike other types of academic essays. This means you don't need a strict or formal tone.

Since this is about your experiences, use personal pronouns such as I and Me.

Be Vulnerable

You must be extremely vulnerable to learn how to write a reflective essay in nursing.

Be open about your thoughts, feelings, and beliefs about something you went through that sparked an interest in nursing.

It's okay to share mistakes or things you did wrong that eventually led you to this career path.

Choose the Right Focus

A reflection essay is all about narrating your experience during the nursing experience.

While including other people in your experience is okay, please let them not be the center of your reflection.

This is your essay, so you should be the focus of attention.

Keep it Brief

A good nursing reflection essay should be between 300 and 800 consciously written words. Because of this length, you must only write relevant information about your reflection. Refrain from lengthy reflections, as they make it difficult to pass your points across.

Convey Your Information Wisely

Even though a nursing reflection essay is about your personal experiences, it doesn't mean you should reveal everything about yourself. Ask yourself whether something is appropriate before including it in your paper.

Mistakes to Avoid When Writing a Reflection Essay in Nursing

A good reflection essay involves reflecting on your nursing studies and practices throughout school and career to demonstrate your competence. For this reason, there are certain mistakes you should be aware of when writing an essay.

Not including a Personal Story

Like food tastes bland without salt, so does a reflection essay without a personal story. At the center of a reflection essay is You. This means the essay should focus on your personal story that led you to want a nursing career. A lot of times, students miss out on this instead of talking about their story. You need more than just the personal qualities you think will be a great fit for the nursing program; you must also share a story that shows how well you contributed to nursing care.

Failing to Share Your Experience

You will lose points when you fail to include nursing-related experiences in your reflection essay. Mentioning that you want to be a nurse is great, but failing to show specific events that led to the desire will cost you a great point.

Plagiarizing Your Essay

Plagiarism is a serious academic offense because it is considered taking other people's ideas and using them as your own without crediting the author. So, provide relevant citations and references for any ideas that aren't your own. Also, an AI will not write your essay as a human writer would. 

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Sample of a Nursing Reflective Essay 

The following is a sample of a nursing Reflective essay using Gibb's Model of Reflection. Use this sample to guide you when writing your own.

Introduction  Communication is an important element in healthcare practice as it determines patient satisfaction and treatment outcomes. This essay will focus on reflecting on an experience I went through with a 40-year-old diabetic patient who also had a foot infected with an ulcer. When I approached the patient to sign the consent form, I noticed that he wasn't happy because of the news given to him about his health. I concluded that there must be a communication dilemma. I will reflect on the experience using Gibb's Model of Reflection. Using this model, I will identify and discuss the actions taken to resolve the issue. Description  This incident happened a few months ago when I was working as a wound nurse in a Methodist hospital in my hometown. I was part of a care team handling the case of a 40-year-old male patient with diabetes and an infected diabetic foot ulcer. After careful examination, a team comprising various specialists concluded that his leg needed amputation below the knee. After making this decision, the team left, and I was asked to give the patient a consent form to sign. When I came back from retrieving the form, I noticed the patient looked sorrowful because of the news given to him. Feelings  As soon as I saw the patient, I knew what he was going through. He perceived the situation to be irreparable, but I wasn't sure whether to console the patient or not. I was powerless and couldn't imagine what he was going through. At the same time, I was startled that the team left without showing any compassion. They could have handled the situation more delicately. I, on the other hand, could have relayed the information better. I wasn't sure whether my approach would be acceptable or appropriate. Evaluation  I always go back to that particular situation and wonder whether I could have acted better. The situation helped me better understand the importance of good communication in patient care, particularly in therapeutic care. Before the incident, I didn't acknowledge the role of nurses play in caring for patient's emotional needs. I realized nurses must show compassion and console patients in their low moments.  Analysis  Most healthcare professionals do not know how to deliver bad news to patients. They find the process extremely challenging and always feel psychologically unprepared. This has a negative impact on patients and could lead to bad health outcomes. Furthermore, how information is relayed could impact a patient's adherence to treatment. Because of these effects, multiple protocols and approaches were developed to help with communicating bad news to patients. One of the approaches that was proposed is emotion-centered. This proposes that a healthcare provider acknowledges how sad the patient is and builds a professional relationship based on empathy and sympathy. Action Plan I now understand the essence of communicating bad news with compassion. The experience allowed me to look closely at different aspects of my professional development that needed more improvement. Thus, I plan to be more empathetic and speak up in support of patient's emotional and psychological well-being, especially when presented with traumatic news about their health. Additionally, I now understand I am not powerless when dealing with a sorrowful patient. I believe I have learned from my experience, and I'm not able to communicate well with patients any more. Conclusion  The experience allowed me to value good communication in nursing and the need to incorporate it into daily nurse-patient interaction. Nurses must learn how to deliver bad news and manage patient's sorrow. This has been and will continue to be my biggest priority in patient care. References Street Jr, R. L., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinicianpatient communication to health outcomes. Patient education and counselling, 74(3), 295-301. Buckman, R. (1992). Breaking bad news: why is it still so difficult? BMJ: British Medical Journal, 304(6842), 886. Ptacek, J. T., & Eberhardt, T. L. (1996). Breaking bad news: a review of the literature. The Journal of the American Medical Association, 276(6), 496-502.

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How to Write a Nursing Reflective Essay as a BSN Nursing Student

• November 29, 2023

Welcome to NursingWriters.net, your go-to resource for expert information and guidance on writing nursing essays. In this article, we will provide you, as a BSN nursing student , with a comprehensive guide on how to write a compelling nursing reflective essay. Reflective essays are a personal reflection on your experiences in the nursing profession, and we are here to help you navigate this writing challenge.

As a busy nursing student, we understand that you may have limited time to spare. That’s where NursingWriters.net comes in, empowering you to excel in your BSN program by providing expert guidance on different writing and comprehension challenges you may face. Let’s dive into the world of nursing reflective essays and discover how you can effectively express your thoughts and insights.

Key Takeaways:

• Reflective essays allow nursing students to reflect on their experiences and personal growth in the profession.
• A nursing reflective essay is different from a personal statement, focusing on self-reflection rather than academic achievements.
• Key elements to include in a nursing reflective essay are the inciting incident, personal reflections, vivid details, and actions taken.
• The introduction should grab the reader’s attention and provide a clear thesis statement.
• The body paragraphs should delve into the writer’s reflections and emotions with specific examples and anecdotes.

What Is a Reflective Essay in Nursing?

A reflective essay in nursing is a powerful tool that allows nursing students to analyze their experiences, emotions, and actions related to their nursing practice. It provides an opportunity for self-reflection, critical thinking, and personal growth. Reflective writing can help nurses develop a deeper understanding of their own practice, improve patient care, and enhance their professional development.

Reflective essays in nursing differ from personal statements in that they focus on specific experiences and their impact on the writer’s growth and development. These essays require the writer to critically reflect on their actions, emotions, and thoughts, and identify ways to improve their practice. By examining their experiences and applying reflective frameworks, nursing students can gain valuable insights into their strengths, weaknesses, and areas for growth.

When writing a reflective essay in nursing , it is important to follow a structured approach. This includes describing the incident or experience, analyzing personal thoughts and feelings, exploring the actions taken, and reflecting on the outcomes and implications. By structuring the essay effectively, nursing students can communicate their reflections in a clear and organized manner.

Key Elements to Include in a Nursing Reflective Essay

When writing a nursing reflective essay, it is important to include key elements that will make your essay comprehensive and impactful. These elements will help you convey your thoughts and experiences clearly, allowing the reader to gain a deeper understanding of your reflections on nursing practice.

Inciting Incident or Event

The first key element to include in your nursing reflective essay is the inciting incident or event. This is the moment or experience that triggered your reflection and made a significant impact on your practice. It could be a challenging patient encounter, an ethical dilemma, or a personal realization. By describing this event in detail, you set the stage for your reflective journey.

Personal Reflections

Your nursing reflective essay should also include personal reflections on the experience. This is where you delve into your thoughts, feelings, and emotions related to the inciting incident. Reflect on how the event made you feel, what you learned from it, and how it has influenced your growth as a nursing professional. Be honest and vulnerable in your reflections, as this will allow the reader to connect with your experience on a deeper level.

Vivid Setting and Descriptive Details

To create a vivid and engaging narrative, include specific details that paint a picture of the setting and the people involved. Describe the physical environment, the interactions between healthcare professionals and patients, and any other relevant details that contribute to the overall context of the experience. This will help the reader visualize the situation and understand the complexities of the event.

Actions Taken

Finally, it is important to describe the actions you took in response to the inciting incident. Discuss how you applied your nursing knowledge and skills to address the challenges or opportunities presented by the event. Reflect on the effectiveness of your actions and whether there were any areas for improvement. This demonstrates your ability to critically analyze your own practice and make informed decisions.

By including these key elements in your nursing reflective essay, you can create a comprehensive and impactful piece of writing that showcases your growth and development as a nursing professional.

How to Write the Introduction of a Nursing Reflective Essay

The introduction of a nursing reflective essay plays a crucial role in capturing the reader’s attention and setting the tone for the entire essay. It should provide a concise overview of the main points that will be discussed and create a sense of curiosity and engagement. Here are some tips to help you write an effective introduction for your nursing reflective essay:

• Start with an intriguing opening line: Begin your introduction with a captivating statement or anecdote that relates to the topic of your essay. This will grab the reader’s attention and make them eager to continue reading.
• Provide context and background information: Give a brief overview of the event or experience that you will be reflecting on in your essay. This will help the reader understand the context and significance of your reflections.
• Present a clear thesis statement: Your thesis statement should clearly state the main purpose of your essay and the specific points or themes that you will be exploring. This will give the reader a preview of what to expect in the body of the essay.

By following these tips, you can craft an introduction that captivates the reader and sets the stage for a compelling nursing reflective essay.

“As I walked into the busy hospital ward on my first day of clinical rotation, I couldn’t help but feel a mix of excitement and nervousness. Little did I know that this experience would become a pivotal moment in my nursing journey, shaping my understanding of empathy, communication, and patient-centered care. In this reflective essay, I will delve into the details of this encounter and explore the personal and professional growth that resulted from it.”

With an attention-grabbing opening, providing context, and presenting a clear thesis statement, your introduction will set the stage for a compelling nursing reflective essay that captures the reader’s attention and lays the foundation for your reflections.

Nursing Reflection Essay Tips and Examples

Writing a nursing reflective essay requires careful consideration and thoughtful analysis. Here are some tips to help you craft an impactful and meaningful reflection essay as a BSN nursing student . Additionally, we will provide examples to illustrate how these tips can be applied.

Tips for Writing a Nursing Reflection Essay:

• Start by choosing a specific experience or event that had a significant impact on your nursing practice. This could be a challenging patient encounter, a critical incident, or a personal realization that transformed your perspective.
• Reflect on the experience and consider how it affected your emotions, thoughts, and actions. What did you learn from the experience? How has it shaped your growth as a nursing professional?
• Focus on the key aspects of the experience that were particularly impactful or meaningful to you. Avoid including unnecessary details or deviating from the main message of your reflection.
• Use specific examples, anecdotes, or patient scenarios to support your reflections. This will make your essay more engaging and relatable to the reader.
• Consider the ethical implications of the experience and reflect on how it has influenced your approach to patient care and decision-making.
• End your essay with a reflection on the implications of your learning for future nursing practice. How will you apply the lessons learned to provide better care and improve patient outcomes?

Now, let’s take a look at two examples of nursing reflective essays to further illustrate these tips:

“During my clinical rotation in the Intensive Care Unit (ICU), I encountered a complex patient case that challenged my critical thinking skills and decision-making abilities. The patient was a middle-aged woman who had undergone a complicated surgery and experienced numerous post-operative complications. This experience taught me the importance of collaboration within the healthcare team and the significance of advocating for the patient’s best interests…”

“One of the most significant experiences during my nursing education was my time spent in the pediatric oncology unit. Witnessing the resilience and bravery of children facing life-threatening illnesses had a profound impact on my perspective as a nurse. It taught me the importance of providing holistic care, not only addressing physical needs but also supporting emotional well-being and promoting a positive environment for healing…”

These examples demonstrate how personal reflections, specific details, and professional insights can be incorporated to create a compelling nursing reflective essay. Remember to structure your essay in a clear and organized manner, ensuring that your reflections flow logically and coherently.

By following these tips and utilizing examples, you can create a compelling nursing reflective essay that showcases your growth and development as a nursing professional.

How to Conclude a Nursing Reflective Essay

The conclusion of a nursing reflective essay serves as the final reflection on the writer’s growth and learning from the experience. It is an essential part of the essay that summarizes the main points discussed and leaves a lasting impression on the reader. The reflective essay conclusion should bring closure to the essay by restating the thesis statement and highlighting the key takeaways from the essay.

To write a strong and impactful conclusion, start by restating the thesis statement in a clear and concise manner. This reminds the reader of the main focus of the essay and reinforces its significance. Next, summarize the key points discussed in the body paragraphs, highlighting the most important insights and reflections. This helps to reinforce the main ideas and ensures that they are not overlooked in the final reflection.

In addition to summarizing the main points, a thought-provoking statement or future outlook can be included to provide a sense of closure and leave the reader with something to ponder. This can be a reflection on how the experience has influenced the writer’s future practice or a call to action for continued personal and professional growth. By ending the essay on a strong and meaningful note, the conclusion enhances the overall impact of the nursing reflective essay.

A well-crafted conclusion is essential for a nursing reflective essay as it reinforces the main ideas, leaves a lasting impression on the reader, and provides a sense of closure. By following these tips, nursing students can create a powerful and impactful conclusion that enhances the overall effectiveness of their reflective essays.

Tips for Writing a Nursing Reflective Essay

Writing a nursing reflective essay can be a challenging task, but with the right approach, it can also be a rewarding experience. Here are some helpful tips and strategies to guide nursing students in their essay writing process:

• Start early: Give yourself plenty of time to brainstorm ideas, reflect on your experiences, and write and revise your essay. Starting early will help you avoid last-minute stress and allow for a more thoughtful and polished essay.
• Conduct thorough self-reflection: Before you begin writing, take the time to reflect on your experiences and emotions related to your nursing practice. Consider how these experiences have shaped your growth and development as a nurse, and what lessons you have learned along the way.
• Organize your thoughts and ideas: Create an outline or a rough structure for your essay to ensure a logical flow of ideas. Group similar thoughts and reflections together to create cohesive paragraphs, and use headings or subheadings to further organize your essay.
• Seek feedback: Share your essay with trusted peers or instructors and ask for their feedback. They can offer valuable insights, provide constructive criticism, and help you refine your essay to make it stronger and more impactful.

Additionally, it is important to pay attention to the technical aspects of your essay:

• Grammar and spelling: Proofread your essay carefully to ensure it is free of any grammatical or spelling errors. Use grammar and spell-check tools, and consider asking someone else to review your essay for a fresh perspective.
• Coherent writing style: Use clear and concise language to convey your thoughts and reflections. Avoid excessive jargon or technical terms, and focus on communicating your ideas effectively.
• Formatting guidelines: Follow any formatting guidelines provided by your instructor or institution. Pay attention to font style, size, spacing, and citation style if required.

By following these tips and strategies, nursing students can approach their reflective essay writing with confidence and produce compelling and insightful essays that showcase their growth and development in the nursing profession.

Reflective Tools and Models for Nursing Reflective Essays

Reflective tools and models can provide structure and guidance for nursing students when writing reflective essays. These tools help organize thoughts and experiences, allowing for a more comprehensive and meaningful reflection. By utilizing reflection models , nursing students can enhance their reflective writing skills and deepen their understanding of their own growth and development as healthcare professionals.

Gibbs’ Reflective Model

“Reflective practice is both an art and a science that requires ongoing commitment and practice.” – Gibbs

Gibbs’ Reflective Model is a widely used reflection framework in nursing. It consists of six stages: description, feelings, evaluation, analysis, conclusion, and action plan. This model encourages a structured approach to reflection, allowing the writer to systematically explore their thoughts and emotions, analyze the situation, and identify areas for improvement or further development.

Dewey’s Reflective Thinking Model

“We do not learn from experience, we learn from reflecting on experience.” – Dewey

Dewey’s Reflective Thinking Model focuses on the importance of reflection as a tool for learning and growth. It emphasizes the need to actively engage with experiences, thoughts, and emotions, and to critically evaluate them in order to gain deeper insights and understanding. This model encourages nursing students to think analytically and develop a continuous learning mindset.

Kolb Reflective Model

“Knowledge results from the combination of grasping experience and transforming it.” – Kolb

The Kolb Reflective Model is based on the concept of experiential learning. It consists of four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. This model encourages nursing students to engage in a cyclical process of learning, where they actively participate in experiences, reflect on them, conceptualize their insights, and apply their learning in real-life situations.

Schön Reflective Model

“Reflection-in-action is the heart of the learning process.” – Schön

Schön Reflective Model emphasizes the importance of reflection in the midst of action. It focuses on the ability to think and adapt in real-time, making decisions based on professional knowledge and experiences. This model encourages nursing students to develop a reflective mindset that allows them to learn and grow while actively engaging in their practice.

Benefits of Reflective Writing in Nursing

Reflective writing plays a crucial role in nursing practice, offering numerous benefits for nursing students and professionals alike. By engaging in reflective writing, nurses can enhance their self-awareness, develop their critical thinking skills, and gain a deeper understanding of patient experiences. This section will explore the advantages of reflective writing in nursing and its significance in healthcare.

Enhanced Self-Awareness

Reflective writing fosters self-reflection, allowing nurses to examine their thoughts, emotions, and actions in various clinical situations. Through this process, they gain a deeper understanding of their strengths, weaknesses, and areas for improvement. This heightened self-awareness enables nurses to provide more effective and compassionate patient care, fostering a patient-centered approach.

Improved Critical Thinking

Reflective writing encourages nurses to think critically about their experiences and the impact of their actions. It requires them to analyze and evaluate the effectiveness of their decision-making and problem-solving skills. By reflecting on past experiences, nurses can identify areas where they can enhance their clinical practice and make informed decisions based on evidence and best practices.

Increased Empathy and Understanding

Through reflective writing, nurses develop a deeper empathy and understanding of patient experiences. By reflecting on their interactions with patients, nurses can recognize the emotions, fears, and challenges faced by individuals in their care. This increased empathy enables nurses to provide more holistic and patient-centered care, improving the overall healthcare experience for patients.

Continuous Professional Development

Reflective writing is an essential tool for nurses’ continuous professional development. It allows them to document their growth, learning, and achievements throughout their nursing career. By regularly engaging in reflective writing, nurses can identify areas for further development, set goals for improvement, and ensure they are providing the best possible care to their patients.

Overall, reflective writing in nursing is a powerful tool that empowers nurses to enhance their self-awareness, critical thinking skills, and empathy. By engaging in this practice, nurses can continuously improve their clinical practice, provide high-quality patient care, and contribute to the ongoing development of the nursing profession.

Nursing Reflective Essay Examples

Looking for inspiration for your nursing reflective essay? Here are some examples that showcase different experiences, reflections, and growth in the nursing profession.

These examples demonstrate how nursing reflective essays can provide valuable insights into personal experiences, reflections, and professional growth. They serve as excellent references to help nursing students develop their own reflective writing skills and gain a deeper understanding of the nursing profession.

Writing a Nursing Reflective Essay for Nursing School Application

A nursing reflective essay can be a powerful tool for nursing school applications. It allows applicants to showcase their self-awareness, critical thinking skills, and passion for the nursing profession. When writing a nursing reflective essay for a nursing school application, there are a few key tips to keep in mind.

Reflect on your passion for nursing

Start by reflecting on what drew you to the nursing profession and why you are passionate about it. Consider your personal experiences, such as volunteering or shadowing healthcare professionals, and how they have shaped your desire to become a nurse. Highlight your commitment to providing compassionate and quality patient care.

Share personal experiences in healthcare settings

Provide specific examples of your experiences in healthcare settings, such as clinical rotations or internships. Reflect on the challenges you faced, the lessons you learned, and how those experiences have impacted your growth and development as a future nurse. Discuss any significant interactions with patients, healthcare teams, or mentors that have shaped your understanding of the nursing profession.

Align with the nursing school’s values and mission

Research the nursing school’s values, mission, and educational philosophy. Ensure that your reflective essay aligns with these principles and demonstrates your commitment to the school’s mission. Use the nursing school’s prompts or essay questions as a guide to structure your essay and address the specific criteria they are looking for in applicants.

By following these tips, you can write a compelling nursing reflective essay that effectively conveys your passion for nursing, showcases your experiences, and aligns with the nursing school’s values. Remember to proofread your essay carefully for grammar and spelling errors and seek feedback from mentors or trusted individuals in the nursing profession to ensure your essay is clear, concise, and impactful.

(Table) Tips for Writing a Nursing Reflective Essay for Nursing School Application

Writing a nursing reflective essay can be a transformative experience for BSN nursing students. It allows them to gain valuable insight into their own growth and development as future healthcare professionals. Throughout this comprehensive guide, we have provided expert information and guidance on how to write a compelling nursing reflective essay.

By understanding the purpose of a reflective essay and the key elements to include, nursing students can effectively showcase their personal experiences and reflections. Incorporating reflection models such as Gibbs’ Reflective Model or Kolb Reflective Model can also provide structure and depth to their essays.

At NursingWriters.net, we are dedicated to empowering busy nurses and providing them with the tools they need to excel in their BSN programs. Whether it’s writing a reflective essay or any other writing challenge, we are here to support and guide nursing students towards success.

What is a nursing reflective essay?

A nursing reflective essay is a personal essay where the writer reflects on their own experiences and how those experiences have shaped their growth and development in the nursing profession.

How is a reflective essay in nursing different from a personal statement?

While a reflective essay in nursing focuses on the writer’s personal experiences and reflections, a personal statement is more of a formal document that highlights the writer’s qualifications, achievements, and future goals in the nursing profession.

What are the key elements to include in a nursing reflective essay?

The key elements to include in a nursing reflective essay are the inciting incident or event, personal reflections on the experience, specific details to create a vivid setting, and a description of the actions taken by the writer. It is important to avoid including academic details and excessive focus on emotions.

How should I write the introduction of a nursing reflective essay?

To write an engaging and informative introduction for a nursing reflective essay, you can grab the reader’s attention with an intriguing opening line, provide context and background information, and present a clear thesis statement. Focus on the specific event or experience that will be the main focus of the essay.

How should I structure the body paragraphs of a nursing reflective essay?

The body paragraphs of a nursing reflective essay should have a clear structure. Use the first paragraph to present the thesis statement and provide background information on the event. Use subsequent paragraphs to explore your reflections, emotions, and actions taken. Use specific examples and anecdotes to make the essay more engaging.

How should I conclude a nursing reflective essay?

To write a strong conclusion for a nursing reflective essay, you can summarize the main points discussed in the essay, provide a final reflection on your growth and learning from the experience, restate the thesis statement, and leave the reader with a thought-provoking statement or future outlook.

What are some tips for writing a nursing reflective essay?

Some tips for writing a nursing reflective essay include starting early, conducting thorough self-reflection, organizing your thoughts and ideas, and seeking feedback from peers or instructors. Pay attention to proper grammar and spelling, coherent writing style, and adhere to any formatting guidelines provided.

How can reflective tools and models help with nursing reflective essays?

Reflective tools and models provide structure and guidance for nursing students when writing reflective essays. Models such as Gibbs’ Reflective Model, Dewey’s Reflective Thinking Model, Kolb Reflective Model, and Schön Reflective Model can be used as frameworks for organizing thoughts and experiences in a nursing reflective essay.

What are the benefits of reflective writing in nursing?

Reflective writing in nursing offers benefits such as enhanced self-awareness, improved critical thinking skills, increased empathy and understanding of patient experiences, and continuous professional development. It promotes lifelong learning and helps improve patient care.

Where can I find nursing reflective essay examples?

You can find nursing reflective essay examples that showcase different experiences, reflections, and growth. These examples incorporate personal reflections, specific details, and professional insights into nursing practice. They demonstrate the diversity of topics and experiences that can be explored in nursing reflective essays.

How can I write a nursing reflective essay for nursing school applications?

To write a nursing reflective essay for nursing school applications, reflect on your passion for nursing, personal experiences in healthcare settings, and future goals in the nursing profession. Address specific prompts and align the content with the nursing school’s values and mission.

How can writing a nursing reflective essay benefit BSN nursing students?

Writing a nursing reflective essay allows BSN nursing students to gain insight into their own growth and development as future healthcare professionals. It helps improve critical thinking skills, self-awareness, and understanding of patient experiences. It also promotes continuous professional development.

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20 Common Examples of Ethical Dilemmas in Nursing + How to Deal With Them

If you are a nurse, chances are you have faced situations where you had to make decisions based on your belief of whether something is right or wrong, safe or unsafe. This type of decision is based upon a system of ethical behavior. It is essential that all nurses develop and implement ethical values into nursing practice. If this sounds familiar, you may be asking, "What are the common examples of ethical dilemmas in nursing?" There are many things that could be considered an ethical dilemma in nursing, and it is important for nurses to know how to address them when they occur. In this article, I will share the 20 most common examples of ethical dilemmas in nursing and offer some insight into handling them.

What is an Ethical Dilemma in Nursing?

5 main reasons why nurses face with ethical dilemmas in nursing.

1. Patients or their loved ones must make life or death decisions 2. The patient refuses treatment 3. Nursing assignments may contradict cultural or religious beliefs 4. Nursing peers demonstrate incompetence 5. Inadequate staffing

How to Identify Ethical Dilemmas in Nursing?

What are the common examples of ethical dilemmas in nursing, example #1: pro-life vs. pro-choice, ethical dilemma:, how to deal with this ethical dilemma:, example #2: protecting the adolescent’s right to privacy, example #3: empirical knowledge vs. religious beliefs, example #4: parent refuses to vaccinate child, example #5: personal and professional boundaries related to social media, example #6: nurse is instructed to have patient with low literacy level to sign consent for treatment, example #7: end-of-life decision-making, example #8: inadequate resources to provide care, example #9: former patients - to date or not to date, example #10: informed consent, example #11: inadequate staffing, example #12: spirituality vs. science, example #13: patient addicted to prescription pain medication, example #14: duty and compassion do not align with facility safety protocols, example #15: patient does not have an advanced directive, example #16: incompetence among nursing peers, example #17: disclosing the seriousness of medical conditions, example #18: questioning physician orders, example #19: asked to work in a department without training, example #20: beneficence vs. autonomy, 4 consequences of avoiding ethical dilemmas in nursing, 1. nurses can quickly experience burnout., 2. avoiding ethical dilemmas in nursing can lead to legal issues., 3. nurses who avoid ethical dilemmas could lose their jobs., 4. loss of licensure:, my final thoughts.

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Ethical dilemmas and illicit acts in nursing: reflections on the legal (dis)order

Dilemas éticos y actos ilícitos en la enfermería: reflexiones sobre la (des)orden jurídica, dilemas éticos e atos ilícitos na enfermagem: reflexões sobre a (des)ordem jurídica, alex coelho da silva duarte.

I Universidade Federal do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil

Sandra Conceição Ribeiro Chicharo

II Universidade Castelo Branco. Rio de Janeiro, Rio de Janeiro, Brazil

Thiago Augusto Soares Monteiro da Silva

Alexandre barbosa de oliveira, objectives:.

to reflect on aspects of the legal system that involve situations of ethical dilemmas and illegal acts applied in legal proceedings related to nursing professionals.

theoretical-reflective essay anchored in conceptions issued by a Brazilian nursing class body, based on technical opinions, in articulation with examples extracted from judges of the Superior Court of Justice.

the legal sources demonstrated the need to support nursing practices through a due and clear understanding of the notions addressed. Indeed, ethical dilemmas linked to professional practice usually refer to the psychological impact of having to act differently from what feels morally, ethically, or professionally appropriate.

Final Considerations:

the reflection was guided by conceptual and legal issues involving nursing practice, pointing to the need to monitor the effects of legal disorder caused by current legislation, which may have implications for the legal security of professionals.

refletir sobre aspectos do ordenamento jurídico que envolvem situações de dilemas éticos e atos ilícitos aplicadas em processos judiciais relacionados a profissionais de enfermagem.

Métodos:

ensaio teórico-reflexivo ancorado em concepções emitidas por órgão de classe da enfermagem brasileira, embasado pelos pareceres técnicos, em articulação com exemplos extraídos de julgados do Superior Tribunal de Justiça.

Resultados:

as fontes jurídicas demonstraram a necessidade de se respaldarem as práticas de enfermagem por meio da compreensão devida e clara das noções abordadas. Com efeito, os dilemas éticos ligados à prática profissional geralmente se referem ao impacto psicológico de ter que agir diferente do que se sente moral, ética ou profissionalmente apropriado.

Considerações Finais:

a reflexão foi orientada por questões de cunho conceitual e legal que envolvem a prática de enfermagem, apontando para a necessidade de vigilância dos efeitos da desordem jurídica provocada pela legislação vigente, os quais podem trazer implicações para a segurança jurídica dos profissionais.

reflexionar sobre aspectos del ordenamiento jurídico que implican situaciones de dilemas éticos y actos ilícitos aplicadas en procesos judiciales relacionados a profesionales de enfermería.

ensayo teórico-reflexivo ancorado en concepciones emitidas por órgano de enfermería brasileña, basado por pareceres técnicos, en articulación con ejemplos extraídos de juzgados del Superior Tribunal de Justicia.

las fuentes jurídicas demostraron la necesidad de respaldar prácticas de enfermería mediante la comprensión debida y clara de las nociones abordadas. Efectivamente, los dilemas éticos relacionados a práctica profesional generalmente referidos al impacto psicológico de tener que actuar diferente del que se siente moral, ética o profesionalmente apropiado.

Consideraciones Finales:

la reflexión fue orientada por cuestiones de acuño conceptual y legal que implican la práctica de enfermería, apuntando para la necesidad de vigilancia de los efectos de la desorden jurídica provocada por legislación vigente, los cuales poden traer implicaciones para la seguridad jurídica de los profesionales.

INTRODUCTION

The ethical and legal precepts incorporated in the core of nursing practices (discipline committed to the health and quality of life of people, families, and communities) involve respect for life, dignity, and human rights in all dimensions. Such precepts function as normative provisions and rules of codes of the profession in question, adding or including certain principles, meanings, and concepts of legal jurisdiction ( 1 ) .

In Brazil, in addition to being a discipline of professional training and governed under the terms of higher education, nursing is a legitimate social practice and is regulated by specific legislation. Therefore, it is subject to regulatory norms and legal impositions somewhat formalized, according to ethical or deontological terms and precepts, which are also of logical and legal relevance to specific professional actions ( 1 ) .

Because it is still a new profession still passing through the process of being recognized, the nurse and philosopher Vilma de Carvalho, emerita professor at the Federal University of Rio de Janeiro, says that the texts of judicial proceedings have been presenting conceptual dissonance and problems involving the legal system. Given this, the reflection developed here confers with plausible expositions, especially about the arguments and justifications that help in the understanding of professional activities, to add more clarity in the legal approach to illegal acts (negligence, malpractice, and imprudence) and especially the ethical dilemmas related to the actions of nursing professionals.

In the context of contemporary ethical problems, it is a priority to discuss the use of the term “dilemma,” especially concerning the particularities and intersections of the fields of nursing and law. This theme refers to the award-winning literary work “Sofia’s choice,” by William Styron, in 1979, in which a mother, a prisoner in the Auschwitz concentration camp during World War II, receives a cruel order to choose which of his two sons should be executed and which should remain alive ( 2 ) . The work frames the dilemma as a problem that has, as a rule, two solutions: one about what is allowed to do and the other about what the personal feeling, at the moment faced, indicates to do ( 2 ) . The two solutions end up not being complete as a whole: behold, between what can be done and what one wants to do, some doubts end up arising.

On the polysemic word “ethics,” the Brazilian philosopher Mário Sérgio Cortella considers it synthetically as:

the set of values and principles we use to answer three big questions in life: (1) Do I want to? (2) should I? and (3) can I? For not all that I want, I can; not all that I can, I must; and not everything I should, I want. You have peace of mind when what you want is both what you can and what you should ( 3 ) .

When articulating these two terms, “ethical dilemmas,” we understand that they refer to the psychological impact of having to act other than what feels morally, ethically, or professionally appropriate ( 4 ) . Ethical dilemmas are related to everyday issues present in the work of nursing professionals, who face sensitive situations in their practice in the context of interpersonal relationships between professionals and patients-families-communities.

Indeed, the ethical processes related to nursing practices established within the scope of oversight bodies of the profession have revealed a high frequency of infractions committed predominantly by professionals at the beginning of their careers, most commonly nursing technicians and those in activities that are not within their competence or that involve illicit acts of negligence, malpractice, and imprudence ( 5 ) . This perspective demarcates the need for (re)knowledge of current legislation, the proper use of certain notions and concepts that bring potential implications in the legal field, but also a critical and well-considered (re)vision of the legal system regarding the competencies of nursing professionals in the country.

Based on the approach of the notion of “ethical dilemmas,” it is also necessary to clarify why dissatisfaction with the profession and labor problems themselves do not correspond to what is understood by an ethical dilemma. Thus, delays in rendering, accumulation of service, lack of personnel in the sector, and personal issues with other professionals are not legally understood as ethical dilemmas since these do not put vulnerability in the decision-making capacity between what can and what should be done. It is also necessary to pacify the idea that unintentional error (willful deception) due to malpractice, recklessness, and/or negligence should not be characterized as ethical dilemmas, but infractions subject to deontological, civil, and criminal punishment.

This imbroglio is constantly observed in legal texts, including technical ones, which report cases involving nursing professionals, which is a sensitive aspect of this study. Thus, it is based on the premise that nursing professionals need to work according to the laws governing the profession, ensuring the well-being of the team, the necessary items for their protection, as well as the patients assistance, avoiding damage to human and collective health. It demands (re)knowledge of their legislation to advance the ethical/citizen consciousness and political-social responsibility that are embedded in their practices. Therefore, the understanding and reflection on the legally correct use of the notions mentioned here seek to help in the approach of certain ethical-legal aspects related to the specific activities of the profession in the complex universe of health while demonstrating the need to consider the legal system that considers such activities.

To reflect on aspects of the legal system that involve situations of ethical dilemmas and illegal acts applied in legal proceedings related to nursing professionals.

This is a theoretical-reflective essay anchored in conceptions issued by the Cofen/Coren system responsible for the supervision of the nursing profession in Brazil, based on the technical opinions of this system in conjunction with examples extracted from judges of the Superior Court of Justice (STJ).

For its development, cases with decisions in the last three years (from 2020 to 2022) were accessed, using the keywords “nursing,” “imprudence,” “malpractice,” and “negligence,” in the electronic address: https://www.stj.jus.br . In total, it identified 1,059 cases, of which, after full reading, selected three that fit the objective set for this study.

The discussion was guided by the use of the Conglobant Typicity Theory of Eugenio Raúl Zaffaroni ( 6 ) , which highlights the need to observe the legal system as a whole to typify conduct as anti-legal, i.e., the conglobant typicity demonstrates what is prohibited by a specific legal device, seeking to avoid, in this way, that a norm prohibits what another norm orders or promotes.

The text is structured in a single thematic axis, namely: ethical dilemmas and illicit acts in the field of nursing and legal issues.

Ethical dilemmas and illicit acts in the field of Nursing and legal issues

To approach the notions of recklessness, malpractice, and negligence as illegal acts, those put in the technical opinion 03/2020 of the Regional Nursing Council of the Federal District - Coren-DF are listed, with examples extracted from decisions of the STJ:

Recklessness is rash conduct. While, in a negligence situation, the error is in the omission (not doing), in recklessness, the error is precisely in the activities conducted, but without the due caution and wisdom that the situation requires. The risk involved is known, but security measures are either not taken or are conducted without the necessary rigor. That is, the nursing team exercises its care practices without the due care that the situation requires ( 1 ) .

To exemplify the legal application concerning recklessness, this study mention a case of an accident that occurred in the classroom. It is the decision of Minister Ricardo Villas Bôas Cueva, in which a nursing undergraduate student who volunteers to play a victim during a practical first aid class and ends up accidentally hit by another student, suffering severe injuries, as shown in the following highlights:

It is an incontrovertible fact in the records that the applicant was a student of the Nursing Course at the requested University and suffered the accident in the classroom during the practical class of said nursing course on 04/16/2017. During the practical class, the student had to lie down on the ground to demonstrate first aid, and another student, who was also a volunteer in the demonstration, ended up falling on the appellant-author’s hand, which caused her too much pain, requiring medical assistance, as reported by the parties and confirmed by the witnesses (p. 664-696). The applicant also demonstrates that she was diagnosed with post-traumatic Reflex Sympathetic Dystrophy since 04/16/17, which would have been caused by the aforementioned accident that occurred in the classroom (p. 39). The author was unable to work and exercise her activities for a long period in 2007 and 2008 due to problems with her right hand (p. 35-51). So much so that she even received a sick pay benefit, given his incapacitation from work (p. 52-59). The witnesses reported that there were about twenty (20) students in the room at the time of the accident and that the teacher divided the class into groups, but with poorly organization. They narrated that they were not warned to maintain a certain safety distance or about the necessary precautions and possible risks of the simulation. They considered that it was difficult for the teacher to dominate a class with so many students, especially in a practical class. They maintain that the author became a joke in the class because of the accident and the resulting physical limitation (p. 673-682 and 682-691) ( 7 ) .

The highlighted excerpt, according to the witnesses’ report, reveals that the teacher taught the practical class without specific precautions to the characteristics of the educational intervention being taken, i.e., the students were not guided and warned about the potential risks involved in the development of that practical activity.

Believing that the teacher in question had previous professional practice and competence to assume such responsibility, by assumption, she knew the risk involved but, as evidenced, did not take the appropriate safety measures with the rigor that the situation required, configuring her recklessness, which led to the mentioned accident.

Imprudence is distinguished from malpractice, as the latter, there is a lack of qualification to perform a specific action or procedure, as can be seen below:

Malpractice refers to a lack of technical skill. As in situations of recklessness, when there is malpractice, the condemnable act is in the action and not in the omission. Malpractice is checked when an activity is conducted by a professional without proper qualification and training, theoretical or practical. He/she is taking a risk on himself/herself and others. Malpractice generates civil and criminal liability for the professional who performed the actions ( 1 ) .

The decision of Minister Humberto Martins of the STJ brings a clear example of malpractice, as can be seen from the prominence of the decision:

[...] there was a medical indication for the preservation of the right upper limb, considering the presence of hemangioma at the site. Nevertheless, the medical advice was not observed by the nursing team, a fact that led to an ulcerated lesion in the right upper limb of the minor author due to extravasation of calcium chloride serum, which culminated in a scar of 10 cm long by 2 cm wide. In the complementary report, the expert confirmed the medical determination to preserve the right upper limb, avoiding puncture of this segment. (mov. 189.1). Nevertheless, analyzing the medical record of the minor, it is found that there was a puncture in venous access in the right upper limb of the minor (mov. 24.13). Therefore, the hospital’s nursing team failed to comply with medical advice, which resulted in physical damage to the minor (ulcerated necrotic lesion). In addition, as the expert pointed out, in addition to disobedience to medical advice, there was malpractice of the hospital nursing team, configured by the extravasation of glucose serum and destruction of the arteriovenous fistula (p. 933/934) ( 7 ) .

In addition to the non-observance of the express guidance, as can be seen from the excerpts, there was the infusion of venous fluids in a non-proper route, the arteriovenous fistula, which characterized the lack of qualification and training of members of that nursing team, that is, its malpractice.

Concerning the notion of negligence, the following excerpt reports aspects to be highlighted:

Negligence is the lack of due attention, the result of the omission of the individual (professional), as well as the passivity in a situation that causes a particular result, whereas this professional should conduct some action. Some definitions also consider the lack of care or inattention in the execution of a particular task as negligence, as well as indifference ( 6 ) .

To exemplify the use of this notion, the following excerpt from the decision of Minister Humberto Martins, also from the STJ, stands out:

...However, the nursing staff would be responsible for letting patient “S” (mother of “M” and “R”, and the author’s spouse, “J”), fall from her height during a bath that was prescribed to her. This negligence is the great stimulus of the present action, the subject of a police report, made while the patient was still alive, where she, represented by her daughter, narrates that she was put to bathe alone because the wheelchair was not suitable to be wet, so they took her out of the chair and put her on her feet in the shower box, balancing on one leg since the other had lost in an accident, which is why she fell injuring her spleen and fracturing her femur. Nothing that compromises the conduct of the defendant doctor, Dr. “F”. Only, the nurses’, for whom the hospital is responsible... ( 7 ) .

In this case, the judge was guided by an expert report (opinion issued by a medical professional appointed to the case), which emphatically stressed the failure of the nursing staff: “... because, in the case of a patient with only one lower limb, she could not have been left alone to take a bath or another activity inside the room. The risk of falling was predictable” ( 7 ) .

Despite the inconsistency of the example extracted from the jurisprudence, the negligence of the members of the nursing team was characterized and, unless better judgment, clear from the ethical-legal point of view, although the expert report is issued by a professional without the due technical competence to evaluate nursing service, as provided for by the current law on professional practice in Brazil.

In the legal aspect, the notion of ethical-legal dilemmas can be highlighted as a complement to what has been presented so far. For better exemplification, it is considered a recent situation of socio-environmental disaster that occurred in the municipality of Petrópolis, located in the mountainous region of the state of Rio de Janeiro, at the beginning of 2022, in which a voluminous rainfall soaked the ground and caused several landslides, resulting in the collapse of structures and buildings and the burial of several people. It is an extreme situation in which lives can be lost in a second, and professionals readily employed, or volunteers are responsible for carrying out specific advanced life support procedures on victims, many believing they are legally based on their code of professional ethics, which expressly points out the care of critically ill patients with life-threatening conditions among its attributions.

However, this is sometimes against Law 12,842/2013, which defines such a procedure as exclusive to another professional category, and Federal Council of Medicine (CFM) resolution 1,718/2004. Moreover, this legal instrument prevents them from learning certain care practices, providing that “the teaching of private medical acts, in any form of transmission of knowledge, to non-medical professionals, including those relevant to advanced health care support, is prohibited, except the emergency care at a distance, until optimal resources are achieved” ( 8 - 9 ) .

In contradiction, this resolution provides that, in case of emergencies, this “teaching” is allowed in the telemedicine modality until the optimal resources are achieved. In conclusion, the nurse cannot have prior knowledge of the advanced procedures but, in case of emergencies/disasters, this professional can learn how to perform them with authorization/prescription virtually through telemedicine ( 10 ) .

This legal disorder puts the nursing professional in a legal-ethical dilemma in which, on the one hand, will be law 12.842 of 2013, known as the “law of the medical act,” and on the other, life. Therefore, questions for reflection are raised here, such as: “is it plausible to wait for the arrival of moments of chaos, in which lives depend on immediate intervention, to then be taught specific assistance procedures that can, in fact, save lives? When a disaster happens, all local care capacity usually has been exhausted, and complementary reinforcements need to be activated, is it possible to apply care techniques that demonstrably make the difference between life and death”? Consequently, when considering the psychic aspects directly and indirectly involved in such extreme situations, it is believed that this is not the most appropriate time to be taught emergency life-saving and maintenance techniques ( 8 ) .

At this point, it is appropriate to present the ideas of the jurist, professor, and judge of the Inter-American Court of Human Rights, Eugenio Raúl Zaffaroni, who, together with the jurist and prosecutor of the state of São Paulo, José Henrique Pierangelli, developed the “Conglobant Typicity Theory.” ( 9 ) This theory comprises that it cannot be considered as “typical” a conduct that is previously and expressly permitted by the legal system. For the authors, the legal system is sole one, global, covering all areas of law (civil, criminal, commercial, procedural etc.). Therefore, no one can practice a typical fact (crime) if an action allowed by the legal order global is performed ( 9 ) .

When reflecting on the example presented above (of an advanced life support procedure) and based on it consider the aspects of the legal system, we understand that the maintenance of life is being opposed to the normative act that prohibits the teaching of procedures considered exclusive to doctors, however, which can be performed by non-medical professionals in cases of particular situations of emergencies and disasters.

This prohibitive norm is in opposition to all legal systems, and this situation ends up raising doubts, real ethical-legal dilemmas for nursing professionals. It reinforces the need to establish greater legal certainty for actions in cases of emergencies and disasters, for example.

As assumed by the Conglobant Typicity Theory, an act cannot be classified as a crime if it is allowed by another norm constant in the legal system of a given country. In addition, the judgment of typicity imposes, in addition to the legal typicity, the conglobant typicity, which consists in ascertaining the prohibitive scope of the norm, which cannot be taken in isolation, but conglobated in the legal order ( 9 ) .

Notably, ethical dilemmas involve other everyday situations in which the nurse practitioner needs to make a specific decision, usually choosing to act other than what feels morally, ethically, or professionally appropriate. Many of these ethical dilemmas will be directly related to professional practice and will arise from the legal disorder caused by the legislation itself, sometimes divergent, on the same subject. In these cases, one must be borne in mind that life is the legal asset that seeks to preserve and, among the fundamental rights provided for in the Brazilian Federal Constitution, this is undoubtedly the most important because, without life, one cannot enjoy the other rights provided for.

In addition, regarding the Conglobant Typicity Theory, which provides for the analysis of all legal system to characterize the typicity of conduct, the legal disorder can be combated and, consequently, achieve greater legal certainty in the actions of nursing professionals. It is because, currently, there are no legal instruments in the country to give legal support to particular interventions, such as public health emergencies and disasters.

Thus, it is necessary to consider that criminal dogmatics in Brazil has suffered harsh sociological criticism accompanying the idea of the delegitimization of the criminal system, understanding that if it has lost legitimacy, there is no support for criminal dogmatics ( 6 ) .

This is a sober reason to firmly consider how it should be the safe and fair way to better frame contemporary nursing practices in a satisfactory legal system and under a prism of intellectual honesty, which duly supports its professionals to observe the governing foundations of the profession and ethical-humanistic values. Therefore, nursing professionals need to be strongly articulated with the organs of class representation in the assumption of effective and well-sustained strategies.

FINAL CONSIDERATIONS

To guarantee rights, it is necessary to (re)know the laws since they regulate life in society and also guide professional acts; in addition, the notions and concepts that typify, through the ethical spectrum, certain practices must be properly employed. Based on this, the analysis addressed the need to demarcate the specificities of the notions of ethical dilemmas and cases of malpractice, imprudence and negligence since these cases are punishable infractions and not situations in which a decision is questioned in the face of legality in acting in a certain way, as ethical dilemmas are.

The reflection on the use of such notions, in the light of judicial decisions of the STJ, and especially the understanding of the problems of legal order in the national scenario, have the effect of providing nursing professionals with greater decision-making capacity, ethical and legal support for the exercise of their functions without suffering ethical, civil, and criminal sanctions inherent to the position. In addition, they provide the necessary critical review of their legal actions and predictions.

Finally, there is a need to develop new studies on the researched theme, especially those situations not yet properly framed by the available professional legislation, since the profusion of public policies, technologies, practices and innovations in care and management does not always accompany the legal movement of (re)definition of competencies in the face of the new challenges imposed on the nursing profession.

Scholarship granted by the Coordination for the improvement of Higher Education Personnel - CAPES.

EDITOR IN CHIEF: Álvaro Sousa

ASSOCIATE EDITOR: Rafael Silva

• Open access
• Published: 20 June 2023

Problem-based learning versus reflective practice on nursing students’ moral sensitivity

• Toktam Zia 1 ,
• Hakimeh Sabeghi 2 &
• Gholamhossein Mahmoudirad 2  

BMC Nursing volume  22 , Article number:  215 ( 2023 ) Cite this article

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Moral sensitivity is one of the prerequisites for nurses’ professional competency and patient care. It is critical to teach professional ethics in a student-centered manner in order to increase students’ moral sensibility. This study evaluated the effects of professional ethics education via problem-based learning and reflective practice on nursing students’ moral sensitivity.

This experimental study was performed on 74 nursing students who were randomly divided into three groups of problem-based learning, reflective practice and control. Principles of professional ethics were presented for the two intervention groups in four 2-hour sessions using ethical dilemmas scenarios. Participants completed the Moral Sensitivity Questionnaire before, immediately, and three months after the intervention. Data were analyzed using SPSS 16 .

Demographic characteristics of the three groups were similar (p > 0.05). The total moral sensitivity score significantly differed between the groups immediately and three months after the intervention (p < 0.001). The total mean score for moral sensitivity was significantly different between the two groups of problem-based learning and reflective practice, with the mean scores in the problem-based learning group being higher (p = 0.02). The mean score of moral sensitivity decreased statistically significantly in both experimental groups three months after the intervention as compared to immediately after the intervention (p < 0.001).

Nursing students’ moral sensitivity can be increased through reflective practice and problem-based learning. While the results indicated that problem-based learning was more successful than reflective practice, additional research is recommended to confirm the influence of these two strategies on moral sensitivity.

Peer Review reports

Moral sensitivity is one of the prerequisites for nurses’ professional competency and humane principles of patient care [ 1 ]. Nurses face a variety of moral dilemmas as a result of their close interaction with the patients [ 2 ]. Therefore, understanding the codes of ethics is insufficient; nurses must also possess the appropriate value resources in order to practice ethically, which results from sensitivity to ethical principles [ 3 ].

With moral sensitivity as a critical component of ethics, nurses are able to recognize ethical issues in their professional environment, provide effective and ethical care to patients, and make moral decisions [ 4 ]. According to Lutzen et al., moral decision-making consists of four components: moral sensitivity, moral judgment, moral motivation, and moral character [ 5 ]. Based on the results of several studies, the most critical component of moral decision making is moral sensitivity, which helps nurses to recognize ethical issues while delivering patient care and hence make more informed and right decisions when confronted with moral dilemmas [ 6 , 7 , 8 , 9 ]. Moral sensitivity is a personal characteristic and a fundamental need for nurses to recognize, interpret, and respond to ethical issues involving patients, as well as the potential influence of their practices on patients’ health [ 10 ]. Nurse’s strong moral sensitivity and perception of professional roles and responsibilities in ethical circumstances result in an increase in the quality of care and the health of patients [ 5 , 11 ].

Nursing students must also possess a high level of moral sensitivity, since they will be exposed to high-risk ethical situations in their workplace and will be responsible for providing comprehensive care to patients based on ethical decision-making skills [ 12 ]. Existing research indicates that nursing students have a lower level of moral sensitivity than nurses [ 13 , 14 ], which can result in a sense of weakness when confronted with ethical dilemmas in clinical settings [ 15 ]. As a result, nursing students must be equipped to deal with ethical dilemmas in the future [ 16 , 17 , 18 , 19 ]. Nursing students require some form of instruction included in the curriculum that enables them to comprehend and apply ethical principles and issues during their patient care [ 20 ]. By incorporating ethical concepts, codes, and reflection into the nursing curriculum, nursing students can become aware of ethical dilemmas in clinical settings [ 17 ].

Teaching methods of ethics in universities are frequently based on theory and lack a strong connection to clinical practice [ 21 ]. The most frequently used teaching method of ethics is lecture, although existing evidence indicates that this strategy results in passive learning [ 21 , 22 ]. Evidence show that, traditional teaching methods, which rely on principles, laws, theories, and codes of ethics, do not always prepare nurses for ethical decision-making in the clinic, and they are insufficient to improve nurses’ ethical decision-making ability [ 23 , 24 ]. As a result, using student-centered and active learning approaches in nursing education programs for teaching ethical principles is essential [ 25 ].

Problem-based learning is a student-centered teaching method that emphasis on group discussion. It enables students to develop essential skills such as personal communication, critical thinking, decision-making, reasoning, teamwork, cooperation, respect for team members, curiosity, and tolerance in addition to providing in depth learning [ 26 , 27 ].As Jarvis says, “reflective practice is something more than a thoughtful practice, which seeks to problematize many situations of professional performance so that they can become potential learning situations and so the practitioners can continue to learn, grow and develop in and through their practice” [ 28 ]. Reflective learning not only results in the development of knowledge and skills, but also bridges theory and practice, which serves as the foundation for evidence-based, practice [ 29 ]. In ethics education, reflective practice enables students to comprehend the nature of moral dilemmas and their interrelationships [ 30 ].

The application of innovative and active learning strategies in ethics necessitates educational research. To determine which method is more effective in terms of moral sensitivity, the researchers compared and evaluated the effect of professional ethics education via reflective practice and problem-based learning on the moral sensitivity of nursing students.

This randomized controlled experimental study was performed on undergraduate nursing students of Birjand University of Medical Sciences, Iran.

Eligibility criteria

The study included third- and fourth-year nursing students who expressed a desire and satisfaction to participate in the study and had no prior work experience in either of the health care systems. Exclusion criteria were students who did not wish to continue the intervention for any reason during the study, or those who attended only once in training sessions.

Variables and instruments

The Moral Sensitivity Questionnaire (MSQ) developed by Lutzen (1994) was used to examine students’ moral sensitivity [ 31 ]. Then it has been used in different countries including Iran [ 32 ]. This questionnaire is divided into two sections. The first section contains demographic data. The second section has 25 questions that assess nurses’ ethical decision-making when providing clinical care. Each question is assessed on a five-point Likert scale: strongly agree (4), somewhat agree (3), somewhat disagree (2), strongly disagree (1), and have no idea (0).on a five-point Likert scale from strongly agree to strongly disagree This questionnaire measures moral sensitivity on six dimensions, including the following: 1- modifying autonomy 2-interpersonal orientation, 3-trust in medical knowledge and principles of care, 4- experiencing moral conflict, 5- structuring moral meaning, 6-benevolence. The maximum score is 100, while the minimum score is zero. Accordingly, a total score of 0–50 indicates poor moral sensitivity, 50–75 indicates moderate moral sensitivity, and 75–100 indicates great moral sensitivity [ 32 ]. The questionnaire’s validity and reliability have been confirmed in earlier studies (Cronbach’s alpha: 80%) [ 32 ].

Data collection and procedures

74 undergraduate nursing students in 2019 and 2020 academic years (the 5th and 7th semester) were divided into 12 clinical groups, each group contained an average of 6–7 students. Then these groups were divided into three groups (problem-based learning, reflective practice, and control) using the permuted block technique. All students were randomly assigned to groups if they had informed consent and had no previous clinical work experience. Before the intervention, all students completed the moral sensitivity questionnaire.

Four 2-hour sessions of educational interventions were held. Two nursing professors approved the educational content, which included professional ethics in nursing, nursing codes of ethics, patient rights, ethical decision-making, and professional communication. The educational content was prepared as an educational package (which included a concept map and pamphlet). Additionally, six classic moral dilemma scenarios [ 33 ] were applied.

For the problem-based learning group (PBL) the researcher explained the course objectives, the students’ responsibilities, and the problem-solving approach at the first session using PowerPoint software. The students were then broken into smaller groups of three to four individuals and given the educational package. Two of the six moral dilemma scenarios were given to the groups throughout the second to fourth sessions. They were instructed to discuss and document the following seven PBL steps for each dilemma: 1- Definition of concepts, 2- defining the problem, 3- discussing/analyzing the problem, 4- identifying possible solutions, 5- setting objectives and prioritizing the problem, 6- problem solutions, and 7- problem-solving based on the measures.

The first session for the reflective group was identical to that for the PBL group. Students were instructed on how to conduct reflections and the stages involved. Between the second and fourth sessions, two of the six moral scenarios were allocated to each group, and they were invited to discuss and provide comments on a reflective practice based on Atkins and Murphy’s theory. This structure is comprised of five distinct stages [ 34 ]:

Self-awareness

it entails being conscious of one’s discomforts regarding the scenario.

Description

it includes thoughts and feelings, the key points and characteristics (pros and cons).

it examines the components of a situation in order to identify current knowledge and hypotheses, as well as to challenge, imagine and explore alternative solutions.

Integration

it is associated with a shift in perspective. This stage may result in emotional and cognitive alterations in thinking. At this step, prior knowledge is combined with new knowledge, and creativity is used to address the problem and a new perspective is created.

a decision is made on the worth of something, which frequently entails criteria and standards.

The researcher was present at the small group discussion sessions, so students could seek assistance from the instructor at any time. At the end of each session, participants shared their opinions with the whole group, asked their questions and resolved their ambiguities regarding moral dilemmas.

Each scenario took an average of 15–20 min for participants in both intervention groups. After completing the procedures, the groups discussed the scenario, and then, students were asked to describe similar situations they encountered and how they handled them.

The control group did not receive any instruction until the end of intervention. To ensure compliance with ethical issues, these students were presented with an educational booklet and ethical scenarios at the end of the study. Students in three groups recompleted the Moral Sensitivity Questionnaire immediately and three months after the intervention.

Ethical considerations

After obtaining the code of ethics (Ir.bums.REC.1398.212) from the ethics committee of the University of Medical Sciences in Eastern Iran, the objectives of the study, the duties of the students and the role of the researcher were clearly explained to the participants and their informed written consent was obtained. The students were assured that the information obtained from them would be kept confidential and that they could withdraw from the study at any stage of the study.

Data analysis

Using SPSS for Windows 11.5 (SPSS Inc., Chicago, IL, USA), the collected data were analyzed by descriptive statistics as well as Chi-square, ANOVA, Mann-Whitney, repeated measures ANOVA and Kruskal-Wallis tests.

Participants’ socio-demographics

The mean ages of problem-based learning, reflective practice and control groups were 21.44 ± 0.87, 21.52 ± 1.08 and 21.71 ± 0.90, respectively, which did not show a statistically significant difference (P = 0.60). There was no statistically significant difference in the mean grade average between the three groups of problem-based learning (16.56 ± 0.97), reflective practice (16.32 ± 1.0) and control (16.69 ± 1.05) (P = 0.42). In addition, there was no significant difference in age, sex, semester, marital status and history of participation in the ethics seminar between the three groups (P > 0.05) (Table  1 ).

Except for autonomy (P = 0.02), the one-way analysis of variance revealed no statistically significant difference in the mean scores of moral sensitivity and its dimensions between the groups of problem-based learning and reflective practice and control before the intervention. The mean scores of moral sensitivity and its dimensions improved considerably in PBL and reflective practice groups immediately and three months after the intervention (P < 0.05), with the PBL group improving more than the reflective practice group. The mean scores of moral sensitivity and its dimensions did not increase in control group immediately and three months after the intervention (P > 0.05) (Table  2 ).

When mean scores of moral sensitivity were compared, a two-way repeated measures ANOVA test revealed a statistically significant difference in total score of moral sensitivity and its dimensions scores between the three groups (P < 0.05) (Table  2 ). The Bonferroni test showed a significant difference in the total score of moral sensitivity and its dimensions scores between the PBL and control groups (P < 0.05). When the two groups of reflective practice and control were compared, a significant difference was observed in all dimensions except professional knowledge (P < 0.05). There was no significant difference in all dimensions except moral conflicts between PBL and reflective practice groups (P > 0.05). There was, however, a significant difference in the total mean scores of moral sensitivity (P < 0.05) (Table  3 ).

There was a significant difference in the mean different of total score of moral sensitivity and its dimensions scores between the three groups (P < 0.05). The mean difference of total score of moral sensitivity and its dimensions immediately after the intervention compared to before the intervention is higher than the mean difference in scores three months after the intervention compared to before the intervention. This suggests that the total score for moral sensitivity and its dimensions scores reduced after three months (Table  4 ).

The results of this study indicated a rise in the mean scores of moral sensitivity of PBL students across all stages. Mean moral sensitivity scores had a substantial increase in the PBL group across all stages (P < 0.01). As a result, problem-based ethics education can help develop moral sensitivity. In comparison to many studies which show that PBL is an efficient way for ethics education and can help nursing students to acquire professional competency [ 35 , 36 , 37 , 38 ], Yeom (2017) demonstrated that teaching ethics via lectures, group discussions, and questions and answers had no effect on students’ total moral sensitivity scores [ 4 ]. Carrero et al. also found no difference in participants’ knowledge between problem-based learning and lecture-based groups [ 39 ]. Similarly, the results of a study in the Netherlands showed When PBL and traditional learning methods were compared among nursing students, no significant differences in general and clinical competencies, as well as professional development, were discovered [ 40 ].

One of the reasons for these distinctions could be the way ethics education and problem-based training are delivered. According to prior research, achieving learning objectives requires an appropriate PBL design, coaching, and a framework to promote individual learning [ 41 , 42 ]. Holding such courses involves time and supervision is challenging. However, in the current study, educational courses were held small group format with discussion sessions and in the presence of a mentor.

At all stages of the study, data analysis revealed an increase in the total mean score of moral sensitivity and its dimensions scores in the reflective practice group. Previous researches showed that ethical reflection improved health care workers’ self-confidence, ability to solve problems, and moral awareness [ 43 , 44 ]. Contras (2020) demonstrated that reflective practices had a positive effect on undergraduate nursing students. In nursing practice, reflective approaches minimize stress and anxiety while increasing learning, competency, and self-awareness [ 45 ]. Another study in 2018 also showed that reflection enhanced students’ competency to participate fully in clinical practice [ 46 ]. As previously noted, reflection entails reviewing one’s beliefs and attitudes critically in order to develop self-awareness, self-monitoring, and self-regulation (Mann et al., 2009). It is a means of bridging the gap between idea and action, as well as a means of describing internal processes, evaluating obstacles, and identifying accomplishments [ 47 ].

Teaching method had an effect on students’ moral decision-making skills and produced variable results [ 48 ]. The use of student-centered strategies for lived clinical practice experience is suggested in ethics education [ 49 ].

Although the results of reflective method were nearly identical to PBL, we also found PBL to result in higher mean scores compared to reflective practice.

Although the total score of moral sensitivity and its dimensions scores showed a significant difference in both PBL and reflective practice groups three months after the intervention, they declined compared to immediately after the intervention. This conveys an essential message that ethical lessons alone are not enough, and in order to sustain the effect of this instruction, it is critical to adhere to the teachings presented. Weshel stressed that ethics is a fluid discipline, and learning it all at once is insufficient and repetition and practice of what has been learned are essential [ 50 ]. Several studies, such as Gallager and Choudin’s review studies, as well as Yarbrook and Klotz’s study, indicate that continuing education is required to preserve the efficacy of ethics education [ 2 , 51 ].

According to Rest et al. “no one has yet developed an adequate map of the entire moral universe.” [ 52 ] However, those of us committed to providing good or moral care must seek out the most effective therapies for promoting ethics and increasing moral sensitivities. This study demonstrated that problem-based learning and reflective practice in ethics education could help improve nursing students’ moral sensitivity. As a result, the researchers recommend using PBL and reflective methods to teach ethics to nursing students. Additional research with larger sample sizes and longer time is necessary to confirm the influence of these two techniques on moral sensitivity. Additionally, it is recommended to conduct research on these methods with other medical groups and centers.

Limitations

Among the limitations of the study is the selection of participants from only one nursing school. This is because information might have been exchanged between the groups, although the groups were asked not to share their observations with the other groups in any case.

Data Availability

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

Abbreviations

Problem-based learning

The Moral Sensitivity Questionnaire

Statistical Package for the Social Sciences

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Acknowledgements

This article is result of the research project approved by Birjand University of Medical Sciences, thus, the authors offer their special thanks to vice-chancellor for Research of Birjand University of Medical Sciences and all students who participated in this study.

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TZ and GM conceived and designed the study. TZ, GM and HS prepared the scenarios used in the research. TZ and HS analyzed the data, and TZ wrote the manuscript. TZ and GM recruited the study participants and collected the data. TZ and HS were involved in the interpretation of the data and contributed to the manuscript preparation. GM and HS were involved in title selection, data analysis, and drafting of the manuscript and approved the final manuscript. All authors have read and approved the final version of the manuscript.

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All study participants in the current study were asked for informed consent for their participation.’ The researcher and assistants obtained written informed consent from each participant as one of the criteria for them to join the study. This study was approved by the institutional research ethics committee of Birjand University of Medical Sciences (Ir.bums.REC.1398.212). All methods were performed in accordance with the relevant guidelines and regulations.

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Zia, T., Sabeghi, H. & Mahmoudirad, G. Problem-based learning versus reflective practice on nursing students’ moral sensitivity. BMC Nurs 22 , 215 (2023). https://doi.org/10.1186/s12912-023-01377-8

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Received : 28 August 2022

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DOI : https://doi.org/10.1186/s12912-023-01377-8

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