example reflective essay using rolfe reflective model

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• Rolfe et al’s Framework for Reflective Learning
• Exploring Different Types of Reflection Models with Examples

Professor Gary Rolfe and colleagues gave a self-reflective model in the book ‘Framework for Reflective Practice’ in 2001. It is one of the simplest reflection models that helps to answer three simple questions i.e. What? So what? Now what? Now, you must be thinking that Rolfe et al’s framework is quite similar to Driscoll’s model of reflection. Then, what is the difference? The difference lies in questions considered in reflecting on using each model. Rolfe et al’s framework encompasses three phases which include descriptive, knowledge-building, and action-oriented.

Table of Contents

• Stages of Rolfe framework for reflection
• Example of Rolfe framework for reflection

Three stages of Rolfe framework for reflection

Stage 1: what.

The first stage of Rolfe et al’s Framework is a descriptive phase that focuses on analyzing a situation. This stage of the model helps readers in explaining the context of the situation to the readers. This stage can be explained by determining the following

• What happened? At this stage, you will explain the context of the situation to the reader by giving them factual information about the incident you reflect upon.
• What did you feel? In this, you are supposed to highlight the overall feelings you felt throughout the situation.
• What did you and the others do? While answering this question, you will highlight your and others’ contribution to the situation.
• What were the expected outcomes? In this, you will focus on the outcomes that you are expecting from the incident you are reflecting upon.
• What were the results? After explaining your expectations from the outcome, you will present the actual results of the actions you took in the situation.
• What were the good and bad aspects related to the experience? While answering this question, you will highlight both the positive and the negative impacts or sides of the experience you are reflecting on.

Stage 2: So what?

The second stage includes an analysis phase that focuses on determining the impacts or learnings of the actions. This section can be defined by the following questions.

• What did you learn? In this, you will highlight your learnings throughout the situation you are reflecting on.
• What was going through your mind? While answering this, you will highlight the thoughts that were going through your mind during the occurrence of an event.
• On what basis did you take your actions? On what basis did you take your actions?
• What is your new understanding? In this, you will highlight the new learnings you gained from the situation and ways in which you perceived these learnings.

Stage 3: Now what?

This is the last stage of this reflective model which determines actions that can be taken to improve future outcomes. This stage includes consideration of skills that need to be developed to improve future actions. Also, in this stage, the individual can answer

• What techniques can you use to deal with similar situations in the future? In this, you will highlight the ways in which you deal with situations like these in the future.

This model is specifically developed for reflective writing in nursing and health care as this model helps learners and practitioners in nursing and healthcare settings to improve the quality of care (Rolfe et al's, 2001). Now, let us take a situation of medication error to report and reflect on the learnings gained from this situation using Rolfe et al’s Framework.

Rolfe reflective model real example

Case assessment - This reflective example will highlight the experience of a medical practitioner giving medication to a patient suffering from depression and migraine . This reflective example will focus on the challenges faced by the nurse during diagnosing a patient in the hospital.

On 01-11-2021, one patient with depression and migraine pain visited a hospital. When the patient came to me, I prescribed fluoxetine medicine for relieving depression and sumatriptan to relieve a migraine. However, after 3-4 hours of it, my senior doctor came round and asked me which medicine I had prescribed. Then, a doctor guided me that prescribing both medications altogether can affect serotonin which then can lead to various life-threatening situations such as confusion, increased body temperature, and rapid heart rate. I actually expected that giving him the fluoxetine medicine would help me in relieving the pain of migraine. In horror, we filled up an incident form but the patient didn’t suffer any ill effects from fluoxetine and sumatriptan. I was very threatened when I realized the life-threatening effects of giving both medications altogether. While we filled out the incident form, we also informed family members about this incident which resulted in some disputes as well (Gibbon, 2002). I became very nervous but my senior doctor handled the situation very effectively by reassuring family members about the whole situation. Also, my senior doctor undertook various actions to avoid further complications. I was actually relieved that my senior did not file an official complaint regarding this and helped me a lot in handling the situation very well.

The whole situation helped me to identify the importance of the right drugs for the right patients. I learned the importance of remaining careful with drugs and their dosage. Moreover, I identified that proper communication with senior doctors in advance could have helped to prevent this event from taking place. Further, I also recalled various legislations such as the Health and Social Care Act 2008, Human Medicines Regulations 2012, and NMC Standards for medicines management (2010), to determine the importance of patient safety and prevention of medication errors. I felt the best way to solve this problem would be contacting my senior and I knew that he would definitely be able to solve my problem. That was the reason I felt relieved when I found that a patient survived an overdose due to the strong knowledge and health management skills of my senior doctor. Through this whole situation, I got to know the right suitable drugs for depression and migraine which will definitely help me in the later years of life.

After engaging in a medication error, I decided that I will be very careful with drug prescriptions to ensure that the right drugs are prescribed. Also, I found that I could have reviewed drugs in reference books while prescribing to prevent medication errors. In addition to this, I will also engage in proper communication with my supervisors or senior nursing staff to further ensure the delivery of high-quality health care services.

How does Rolfe et al's framework differ from other models of reflective learning?

Rolfe et al's framework is distinct in its simplicity and focus on action. While many other models exist, this framework centers on three key questions that facilitate a straightforward and actionable reflective process, making it easy to apply in various contexts.

Can Rolfe et al's framework be combined with other reflective models or theories?

Yes, Rolfe et al's framework can be effectively combined with other reflective models or theories to enrich the reflective process. The simplicity and adaptability of the three-question approach make it compatible with various theoretical perspectives, enabling a more comprehensive and multi-dimensional reflection.

Previous Model

Rolfe et al's (2001) Reflective writing: Rolfe, LibGuides. Available at: https://libguides.hull.ac.uk/reflectivewriting/rolfe (Accessed: November 23, 2022).

Gibbon, B. (2002) “Critical reflection for nursing and the helping professions. A user’s guide critical reflection for Nursing and the helping professions. A user’s guide,” Nursing Standard, 16(20), pp. 29–29. Available at: https://doi.org/10.7748/ns2002.01.16.20.29.b305.

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Model of reflection: The Rolfe et al. model

The Rolfe et al. (2001) model of critical reflection is a framework developed by Professors Gary Rolfe, Dawn Freshwater and Melanie Jasper. The model aims to support practitioners to reflect on their experiences, feelings, and actions, and developing practice accordingly. The model was developed as a ‘how to reflect’ guide for nursing and other health care practitioners, however, its simplicity has seen applications to a range of disciplines and stages of career.

The Rolfe et al. model attempts to demystify the reflection process by offering a simple, practical model consisting of three key questions:

These questions aim to surface learning through the stages of describing an event, analysing the implications and considering future possibilities as a result of these new insights.

The Rolfe et al. (2001) model was inspired by the foundational work of Terry Borton (1970), who used the ‘What-So What-Now What?’ reflective prompts for developing educational materials. These prompts can also be seen through the work of John Driscoll (2007) who adopted the model for healthcare professionals and endorsed using the three questions for individual and collective reflection in clinical practice.

In the video below, Suzi Villeneuve-Smith speaks to implementing the Rolfe et al. model. 

So my name is Suzi Villeneuve-Smith, and I teach in the undergraduate nursing space. This year we have 640 students in our cohort, and I've been teaching for approximately ten years. So the reason we embed reflection into our nursing curriculum is twofold. Professionally and personally. Professionally, we're invited by our NMBA standards for practice to include reflection in the seven standards that we have. This enables us to become critical thinkers, and it also enables us to provide safe, patient care. The second benefit is personally, we're able to reflect on our own personal values and morals and how we can link those in to on nursing practice. This allows us to provide holistic, safe, patient care with good outcomes so everybody is happy. The structured model of reflection that I embed into my first year nursing subjects is the Rolfe model of reflection. We've chosen this model because it's simple. It's easy to access and it doesn't overwhelm our students. It comes with three distinct headings, What? So what? And now what? The what aspect of the model is a descriptive model. This allows the students to write their thoughts and their feelings about a situation or experience that they've had. The so what section of the model allows them to really bring across some theory into it?

So what was going on in my mind during this situation? Allows them to give a little bit of depth to where they're at and how they feel they were within the experience. The last aspect of the model is the now what we like to call a reflexive way of thinking, and it's forward-thinking. Now, what have I learned from that situation? Now what do I need to do to do better next time? Now what do I need to look at to research to expand my clinical knowledge? The way we embed this into our subjects is really quite exciting. So during our other three subjects, they learn a little bit about this model. But right at the end of the semester, our students take up 80 hours of workplace experience in the clinical environment and they take an assessment book with them. Yes, they have to do clinical skills along with their clinical placement, but they also need to reflect on why they're doing what they're doing. And again, this is twofold, professional and personal.

Professionally, we align these sections of the models, the what, so what and now what and align them with the Orenstein is of practice. Our students select a challenge and an achievement, and they write about those in alignment with our seven standards. The personal aspect of reflection comes right at the end of their clinical placement, where they're invited to write a short reflection.

They can use the headings to guide their work to describe their overall experience of their placement. I read Reflections on clinical aspects about how exciting it was to do an accurate manual blood pressure on a real person for the very first time, or how they felt they were learning how to develop therapeutic relationships. As I sat with family members while their patients were in theatre. So it's been a really valuable experience for them. I also use a model in my workshops, so prior to placement I will always lead activities with three questions that align with the model.

So by the time they get to really digging into what reflection looks like for them, we've already been doing it, but they haven't necessarily known they've been doing it. What I've learned through teaching reflection is that every single one of our students does it. They know how to do it, but it's not necessarily done in a structured way. And they often allow emotions to overtake what actually happened and seeing them grow and learn personally and professionally is a real joy and a delight. And I've had the pleasure and privilege of working with some fantastic clinicians who are able to reflect on their practice on the ward and reflect personally in the tea room. It's a very rewarding experience.

The advice that I would like to offer to any educator who would really be interested in embedding reflection into their subjects is to meet the students where they are, not where you think they ought to be. There are some incredible models of reflection out there, and we may personally resonate with one or more of them. I know that I do, but these models may also overwhelm, confuse and put students off reflection. We want them to engage with reflection. We want them to love it. So pick the model that resonates with them, meet them where they are.

Reflective prompts adapted from Rolfe et al.’s (2001) model of critical reflection.

• … happened today?
• … was my initial reaction?
• … were the reactions of others?
• … was the problem or issue?
• … was good or challenging about the experience?
• … feelings did it bring up for me?
• … was I expecting?
• … does this teach me about myself?
• … does this teach me about my knowledge or skills to respond to the situation and to others?
• … literature/ scholarship/ theories/ standards align to or explain this experience?
• … should I have done differently to make it better?
• … do I know about myself that will inform my career?
• … do I know about myself that shapes my perceptions of my strengths and interests?
• … do I need to do to improve my behaviour/ knowledge/ skills for the future?
• … steps shall I take to advance my career?
• … steps shall I take to source others who can help me?

Borton, T. (1970).  Reach, touch, and teach; student concerns and process education.  New York, Mcgraw-Hill

Driscoll, J. (2007).  Practising Clinical Supervision: a Reflective Approach for Healthcare Professionals (2nd ed). Edinburgh, Baillière Tindall Elsevier

Rolfe., G et al. (2001) Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke, Palgrave Macmillan

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WS1006 Self in Professional Helping Guide: Reflective Writing Exemplar

• 1. Getting Started
• 2. Finding Information
• 3. Effective Reading
• 4. Reflective Writing
• 5. Referencing
• Reflective Writing Exemplar
• Case Study Response

Warning: This is a past WS1006 critically reflective writing task essay. Assignment task requirements may have changed since this was written, but it continues to provide a good example of what a critically reflective writing task response could look like.

Instructions: Mouse over the text below to see annotations giving explanations and information on the writing process, parts of a blog post, in-text citations and referencing.

An exercise of critial reflection in informal helping

Description

Action Plan

References Some good information sources have been used in this essay. The author is clearly trying hard with his/her APA references and in-text citations – still some work to do to get them right.

Grade: High Distinction

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• Last Updated: Apr 3, 2024 11:31 AM
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Through the looking glass: a review of the literature surrounding reflective practice in dentistry

Faith campbell.

41415106785001 Glasgow Dental Hospital and School; Glasgow, UK; Honorary Clinical Teacher in Paediatric Dentistry, Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK

Helen Rogers

41415106785002 School of Dental Sciences, Newcastle University, UK

Reflection is an essential component of the learning process that helps to elicit deeper learning. In healthcare, this uses experiential activities to produce knowledge that compels the clinician to change their practice. Deep reflection allows one to explore emotions associated with challenging learning experiences, empowering reinterpretation of these experiences and removing barriers to further learning. Reflection is a key requirement of dental education at all stages. This paper aims to explore the existing literature on reflective practice in dentistry and identify areas for further research to improve reflective practice within dentistry.

Traditional methods of reflecting through written means are not facilitating the deep reflection which is desired. A systematic overhaul of reflective practice is suggested, involving a shift away from structured written reflections. There is little evidence to inform the most appropriate format for reflective practice in dental education. There is a need for further research to determine the effectiveness of reflective practice in dental education, particularly as a move away from structured written reflection to more creative reflective opportunities are encouraged. Greater exploration of barriers to reflection in dentistry is indicated, with consideration to how these may be overcome and a need to engage regulatory bodies in system-wide changes.

• Reflection is an essential aspect of the learning process, with deep reflection eliciting deeper learning.
• Deep reflection is desirable for learners at all stages, from undergraduate students to experienced clinicians, as it allows exploration of the emotions associated with the learning experience, removing barriers to learning and supporting wellbeing.
• Further research to explore the barriers and facilitators to deep reflection in dentistry is indicated in order to support the planning and implementation of a systematic overhaul of current and often ineffective methods of reflection.

Introduction

Reflection is an essential component of the learning process. It has been defined as 'the active, persistent and careful consideration of any belief, or supposed form of knowledge in the light of grounds that support it and the further conclusion to which it tends'. 1 It is considered to be a deliberate and structured process requiring one to recapture and contemplate on real experiences and challenge existing beliefs. 2 , 3

Reflection can help learners to bridge the gap between theory and practice, allowing them to find answers that they are unable to access through formal learning. 4 In healthcare, reflection uses authentic, experiential activities to elicit a deeper form of learning, allowing the generation of 'transformative knowledge'; new knowledge that compels the clinician to change their practice behaviour. 5 , 6

The practice of reflection is considered to offer broad and multi-faceted benefits. Deeper and more meaningful reflection has been associated with improved self-awareness, for holistic and lifelong learning. 2 For dental students, reflection can help to develop professional identity and self-confidence, alongside challenging assumptions and stereotypes, improving communication skills and providing an enhanced awareness of the complexity of their patients' lives. 7 Furthermore, it may help students to commit to the provision of service by providing quality care to make a difference, by gaining insight into the communities and lives of the patients that they care for. 7 As such, reflection is essential for all practitioners of dentistry, from the undergraduate student to the hospital consultant or general dental practitioner.

A further benefit of reflection relates to wellbeing, a priority during the COVID-19 pandemic in particular. Learning in a clinical environment for healthcare professions such as dentistry can be especially stressful, causing negative impacts on students' physical and mental health. 8 , 9 Dental students may feel insecure regarding their contribution to patient care and their role within the dental team, which in turn, may present as a barrier to learning. 10 Through exploring their feelings associated with a challenging learning experience, without external judgement, a student can be empowered to reinterpret these experiences in light of their inner strength and wisdom. 1 , 11

Despite the well-evidenced advantages of reflective practice, it is clear that there are some inherent challenges in reflecting. Reflection itself is often not straightforward and requires underlying knowledge. Furthermore, it takes time and practice for the necessary skills to be developed, with Rolfe arguing that students can only learn to become reflective practitioners when they are in practice and supported to do so. 12 Moreover, the ongoing need to evidence the value gained from reflection can be repetitive and lack meaning.

This paper aims to explore the existing literature on reflective practice in dentistry and identify areas for further research to improve reflective practice within dentistry. Key areas discussed will be: the requirement of reflection in dentistry; models of reflection that are relevant to dentistry; reflection through traditional means such as structured written reflections, logbooks and portfolios; reflective essays; and reflection with assessment. Furthermore, more novel methods of reflection including journals will be discussed, alongside barriers to reflection and recommendations for the future with respect to reflection in dentistry.

This is a narrative review of the literature for which the StarPlus database was searched. This is a University of Sheffield database which includes Google Scholar, PubMed, Medline, Ovid, Scopus, SAGE and ScienceDirect. The initial search on StarPlus was based upon the key words 'reflective practice', 'reflection', 'dental' and 'education'. This was expanded to include 'creative reflection' and 'healthcare' to explore more novel approaches that may not yet have been applied to dental education. Relevant legislative- and registration-related literature on reflective practice in dentistry was hand searched. The search was undertaken on 26 February 2020. The search results were reviewed by one author (FC) for relevance. The included studies were reviewed by both authors and a narrative review produced using the Scale for the Assessment of Narrative Review Articles (SANRA) criteria for quality of narrative reviews. 13

This method has limitations in that some key literature may have been missed; however, this was intended to be an accessible and informative summary of the relevant literature, rather than a systematic review.

Reflection as a requirement

Reflective practice is a key component of policy documents for providers of undergraduate dental courses, both in the UK and further afield. 14 , 15 , 16 In the UK, this includes evidencing that reflective practice has been undertaken by students throughout their five years of training. The American Dental Association states in their Accreditation Standards for Dental Education Programmes that becoming a competent professional involves daily reflective practice. 16 The benefits beyond undergraduate qualification have also been acknowledged by professional dental regulatory bodies globally, whereby it is understood that the development and maintenance of professional standards and skills involves rigorous self-assessment and reflection on one's current practice. 3 , 15 , 16 , 17 In the UK, upon registration with the General Dental Council (GDC), registrants are required to undertake meaningful experiential learning on an ongoing basis and should be able to explain the importance of critical reflection. 15 , 18

Furthermore, the GDC encourages qualified dentists to be reflective practitioners, whereby they should consider their experiences to gain insight into their practice to support the continual improvement of the quality of their care. In 2018, the GDC introduced the Enhanced Continuing Professional Development (ECPD) scheme, which requires all registrants to keep a record of relevant learning, including mandatory demonstration of reflection. 19 The Australian Dental Board encourages continual reflection on current practice in directing one's continuing professional development (CPD), with some Australian boards detailing reflection as a requirement of the CPD. 17 , 20 Reflection on the everyday clinical experience facilitates experiential learning and professional development and has been shown to have great value in complementing CPD for both individuals in recognised speciality training programmes and the experienced practitioner. 21

Models of reflection

A large range of reflective models have been proposed in the literature, varying in terms of the focus of the reflection (the person or the situation), the depth of the reflection (superficial or deep) and the perspective taken (individual or otherwise). 4 , 22 , 23 , 24 , 25 , 26 It is beyond the scope of this paper to explore these models in detail. Nonetheless, one important model with significant relevance to dental education, described by Schön, proposes two aspects of reflection: reflection-in-action, which occurs during experience where one can respond by modifying behaviour immediately; and reflection-on-action, after the experience with consideration of the event with thought and feeling on this. 4 Further to this, reflection-before-action has been described in nursing, where one reflects on what they want to do and how they intend to do it before they do it in order to avoid error and to provide an important opportunity for feedback. 27

Rolfe identified the advantages of reflection-on-action in managing wicked problems: those unique and complex situations that one cannot prepare for in advance, whereby an individual must generate their own theory on how best to proceed and test it out in an on-the-spot experiment. 12 In order to evaluate the outcome of the chosen approach, this reflective practice should be undertaken with others as a partnership or team. 4 , 12 Rolfe acknowledges that while these types of challenges are not uncommon in any field of healthcare, the opportunity to reflect with others may be less available for some practitioners. 12 The dental team is typically broad, comprising dentists, dental nurses, dental therapists, dental hygienists, dental technicians and administrative staff, though the majority of care is provided in much smaller units. The varied settings and teams within which dental care is provided may impact upon the opportunities an individual may have for reflective practice with colleagues. 12 For example, a small team working within a dental practice may potentially have fewer opportunities for group reflective practice when compared to a large team within a dental hospital. Nonetheless, the coordination of time together for larger groups to reflect may be a challenge, when a small team may be able to organise more consistent, regular sessions for practice. Further research is necessary to explore this area.

Reflective practice in dentistry

Traditional methods of reflection, structured written reflections.

The literature regarding reflective practice in dental education has been limited, yet the overwhelming majority of this investigates the use of structured written reflections. 28 , 29 , 30 One study explored the use of structured written reflections to assess the learning provided by a placement in conscious sedation for undergraduate dental students in the UK. 30 The results suggested that this method engaged the students in reflecting on the challenges of the learning experience, with some providing strategies to overcome these in future. 30 The students were given frameworks using both Rolfe and Gibbs cues, though only students whose structured written reflections were guided by Gibbs discussed their confidence. The frameworks can be seen in Table 1 . 30

Examples of structures for written reflections that have been applied to research in undergraduate dental education based on Johns' Framework, Gibbs' Reflective Cycle and Rolfe's Model of Reflection 30 , 31

Examples of headings used in structured reflections in these studies are shown in Table 1 . Similarly, structured written reflections undertaken by dental hygiene and therapy students in the UK through worksheets have been shown to evidence both superficial 'descriptive' and deeper reflection. This form of reflection alone can only hope to facilitate reflection-on-practice, as discussed earlier. 26 , 31 Nonetheless, presently this remains the mainstay of reflective practice in many aspects of healthcare. 12

Logbooks and portfolios

One common form of structured written reflection in dental education is the integration of reflection into a logbook or portfolio in which to record experiential learning and examples of reflective activity. Traditionally, logbooks are 'a collection of learning objectives and additional information concerning a specific educational period'. 32 They are a record for the student and educator that help to structure clinical learning, with an overview of the requirements of training, including those outstanding and inform and include setting of learning plans. 32 Meanwhile, a portfolio focuses on 'students' documentation and self-reflection of their learning activities'.

It is acknowledged that logbooks facilitate immediate and ongoing communication between learner and educator in the clinical environment, alongside providing a feedback loop for evaluating the learning activity and a method of continuous assessment. 33 However, logbooks can often be inadequate, for reasons such as a learner perception of logbooks being boring, bureaucratic and an exercise in collecting signatures with no consequence for improper completion and a misalignment of clinical experience and logbook requirements. 32 , 34 Logbook completion is often compulsory, with reflections being completed alongside target setting.

Written forms of reflection such as logbooks have been combined with group discussion, mentorship and used as a facilitator for reflective discussions, with these additional elements being beneficial in promoting learning and facilitating reflection. 31 , 35 , 36 These discussions and feedback between educators and learners which frequently occur in dental education during and after clinical sessions can be beneficial in stimulating internal reflection; however, this is not studied in the literature as a method of reflection. Furthermore, a qualitative study with undergraduate dental students undertaking clinical attachments in paediatric dentistry in the UK found that written reflection using logbooks alone may not facilitate reflection at all, due to barriers such as a perceived lack of understanding of and preparation for reflection and a greater emphasis placed by students and educators on learning through experience rather than reflection. 34

Portfolios may also be used with undergraduate dental students to facilitate reflective practice. 37 However, it has been acknowledged that students need support in learning to reflect in this manner. 37 Assessment or review of these by staff is also labour and time intensive and students may have anxiety surrounding the opinion of those who can see this portfolio. 37

Confidentiality concerns have been reported to affect the depth of reflection achieved by dental students in both the UK and Australia when using portfolios and written logbooks. 32 , 34 , 36 Dental students in the UK reflecting through a written portfolio described that they modified reflections because they knew that their mentor was going to read it. 36 Recent events in the UK have also threatened to undermine the safety of reflective practice in healthcare professions, whereby a reflective portfolio was utilised in a fitness to practise case for a junior doctor investigated for negligence in a manslaughter case. 38 Although the reflections were not used in the criminal case proceedings, understandably this has led to heightened caution during reflective practice in healthcare, including dental education.

Reflective essays

There is plenty of evidence regarding the use of reflective essays on clinical experiences with medical students. 39 , 40 , 41 They have been shown to be rewarding and to have enhanced the learning experience when medical students completed reflective essays on their experience during clinical placements in palliative care. 42 These students, however, reported that the additional work of a reflective essay was burdensome, hoop jumping, contrived and intrusive. 42 Furthermore, medical students in the UK and Australia have reported not reflecting honestly when required to do so through written essays and finding difficulty in expressing emotion. 42 , 43

The term 'reflective essay' implies that reflection has taken place but it is uncertain whether it has and whether any reflection within the constraints of a formal essay is deep or meaningful. The reflective essay has often been used in medical education to assess student learning rather than to evidence reflective practice. 40 It is interesting to note that the use of the reflective essay for dental students has not been studied in detail; however, in one study in the USA, undergraduate dental students and their educators did find value in reflective essays on critical incidents in facilitating reflection. 7 , 28 Undergraduate dental education is frequently more focused on practical skills with greater and earlier clinical experiences than in medical education. This may invoke different emotions associated with the learning experience and thus require a different approach to reflective practice.

Reflection with assessment

Assessment of written reflections, such as essays, may cause students to modify what they write and give them a feeling that they were writing their reflection for someone other than themselves. 44 Focus on assessment criteria can overtake that of reflecting deeply. 43 Self-censorship of student reflection has been found to be more likely when students feel that what they are writing may be deemed by evaluators of the reflection as negative, which was demonstrated in the evaluation of reflection through worksheets by UK dental students. 31 , 45 This has led to debate on whether reflective writing should be assessed at all. 46 The potential for reflective activities, such as poetry and storyboarding, to form the basis of assessments has also been explored with nursing and physiotherapy students and was demonstrated to be successful in facilitating reflection. 47 , 48 , 49 Nonetheless, the compulsory nature of an assessment and the need for it to satisfy marking criteria may preclude the depth of reflection being undertaken by learners.

The impact of this may vary depending on whether the reflective piece is assessed formatively or summatively, but more research is needed to determine this. It has also been suggested that reflection-based assignments would be better suited for low-risk, formative types of assessment. 49 A recent qualitative study exploring reflective practice for undergraduate dental students found enthusiasm from learners and educators in moving towards assessing engagement with the reflective process rather than assessment of the reflective practice itself, a move which would have to satisfy relevant regulatory bodies. 34 Furthermore, the use of structured reflection to inform target setting, for example creating learning action points, has been shown to elicit an emphasis on negative aspects of the learning experience in dental therapy students. 31

Novel and creative methods of reflecting

There is a growing interest in the use of alternative and more creative modes of reflective practice in other fields. 50 Application in nursing, for example, has suggested creative reflective practice, such as poetry, storyboards and artwork, may offer numerous advantages to structured written reflection, particularly for the development of emotional awareness surrounding issues such as death and serious illness. 47 , 51 , 52 , 53 A particular advantage of these methods over traditional methods is the facilitation of the learner reflecting through a voice other than their own, allowing greater freedom to explore feelings. 53 While these advantages were also observed with the use of a storyboarding reflective technique with student nurses, the researchers reported that this approach was both staff and time intensive, with particular attention necessary to develop a climate of trust and safety. 53 Outside of healthcare, poetry has been shown to support reflective practice in a group of student teachers, particularly in reflecting on their motivation for choosing that profession. 54 Similarly, creative approaches have been employed with sports coaching students, where they were found to be useful in facilitating reflection on prior learning and the formation of action plans. 48

The integration of journals, also referred to in the literature as reflective diaries, into undergraduate dental courses has been reported to assist in formalising reflection, providing an outlet for personal feelings and an opportunity for feedback about students' experience of the course and a means to provide insight for both students and educators into the learning process. 35 , 55 There are, however, issues with the application of reflective journals in dentistry with respect to confidentiality and assessment, thus careful consideration must be given to fostering a trusting environment for reflecting through journals and appropriate education in their use. 35

In dentistry, the literature has indicated that the processes of 'blogging' or keeping a clinical journal may be useful reflective learning tools, yet there is currently little evidence to support the effectiveness of these approaches or the use of more creative methods in this field. 29 , 56 One study with dental students in the USA encouraged methods including the use of photography of the clinical setting but not the procedure or clinical experience directly, alongside discussion of the images captured and small group reflective discussions, in addition to more traditional methods of reflection. 28 Students reported that it made their clinical experience more meaningful, interesting and rewarding. 28 When blogging was used with dental hygiene students in the USA, quantitative analysis found an improvement in the depth of reflection reached by students practising blogging, in turn developing critical thinking skills, assessed through the California Critical Thinking Skills Test. 56 However, this study had a small sample size, with only 11% of students participating in the study completing the blogs. 56

The use of short video vignettes as a reflective exercise for undergraduate dental students in the UK was successful in facilitating reflection for both individuals when they were creating the video and for peers when viewing the video together. 57 The learning experience, including that of holistic care, was enhanced and reinforced and students learnt about the benefits of reflecting on more negative experiences, with enhanced depth of reflection. 57 This was viewed positively by student participants; however, it was acknowledged that this approach will not suit everyone, such as more introverted students, with some expressing feeling camera shy and nervous of sharing their feelings. 57 Despite a growing body of evidence to support the use of creative approaches to reflection in other fields of healthcare and education, there is a need for further research to determine the applicability, relevance and success of these techniques in dental education.

Barriers associated with all methods

There are barriers to reflective practice in its various forms that may preclude some individuals from engaging.Further to the aforementioned limitation in opportunities for those working in small teams to reflect with others, a key barrier to reflection is the requirement for protected, dedicated time to undertake reflective practice. 3 , 32 The literature suggests that the setting and time available for reflection can affect the depth of reflection undertaken. 5 Moreover, the learner must be motivated to reflect, acknowledging that the process of reflection itself may produce an 'inner sense of discomfort', which may deter them from proceeding. 58 It has also been suggested that learners may avoid reflective queries that require additional effort to process or access the necessary information. 31 Most importantly, the ability to reflect is not innate; it is considered to be a skill that should be both taught and practised, a perception echoed in groups of students and educators in dentistry. 5 , 32

Students have reported not knowing how to reflect, with a lack of formal teaching on this, contributing to knowledge being a perceived barrier to reflective practice for both student learners and educators in a qualitative exploration of reflective practice among undergraduate dental students. 34 Improved and formalised teaching on reflective practice to ensure learners and educators have a good understanding of what reflection is and its importance may combat the instinct to focus reflection on negative learning experiences. Despite the emphasis on reflective practice from all stakeholders involved in dental education, there is a lack of clarity on how best to practically implement the facilitation of effective methods of deep reflection.

It has been frequently reported that students do not appreciate the value of reflection, nor enjoy reflecting, 31 , 34 with 'the language of reflection being alien to most students'. 59 However, it must be noted that the process does not need to be enjoyable for it to be valuable to students, yet lack of enjoyment is likely to be a barrier to completing an 'onerous' activity. 31 Furthermore, when solely reflecting on a clinical scenario, students often focus on negative emotions and perceived weaknesses. 60

Reflection is a compulsory aspect of dental education in the UK. 14 , 15 When reflection is mandatory, undergraduate dental students have reported feelings of resentment towards it. 31 , 35 The requirement for individuals to be open and honest may provoke a strategic and sometimes hostile response to reflection, which has led to questions on whether reflective practice should be a compulsory exercise at all. 61

Recommendations for the future

The traditional methods of reflecting in dentistry discussed in this paper are so ingrained in students, educators and practising dentists, so heavily utilised by education providers and so extensively relied upon by regulatory bodies, that a systematic overhaul would be required in order to introduce more effective means of facilitating deep reflection. It has been suggested that reflection can be effectively learnt when students feel that they are in a safe and caring environment and are not at risk of being penalised. 62 Thus, creating a safe space for reflection that is not assessed is necessary.

This overhaul would involve a shift away from structured written reflections, more research into creative approaches of reflection to demonstrate the ability to facilitate deep reflection in dental education and the exploration of alternatives to compulsory assessed reflective practice. This may include greater student autonomy on how and when they reflect, with varied opportunities to reflect being offered. While the GDC doesn't specify how practising dentists should reflect, or evidence this within ECPD in the UK, it must be established whether regulatory bodies would approve of these alternative methods of reflection being integrated into the undergraduate dental curriculum; more specifically, assessing student engagement with the reflective process, rather than the content of the reflection.

In conclusion, reflective practice has a clear role throughout dental education, from undergraduate level to ongoing registration with regulatory bodies. The benefits of reflective practice identified from educational research and studies in other areas of healthcare may be easily relatable to dentistry, though there is little evidence to inform the most appropriate format for reflective practice in dental education. There is a need for further research to determine the effectiveness of reflective practice in dental education where there is arguably less available evidence, particularly as a move away from structured written reflection to more creative reflective opportunities are encouraged. Dental and dental hygiene and therapy students are unique within healthcare education, owing to their clinical exposure, experience and responsibility in providing operative treatment to their own patients at an early stage in their undergraduate training. Furthermore, dentists and dental care professionals encounter different challenges in their practice. Unlike medical or nursing students, most dental students will immediately assume a management and leadership role in their team within a dental surgery. Moreover, greater exploration of the barriers to reflection in dentistry is indicated, with consideration to how these may be overcome and a need to engage regulatory bodies in system-wide changes.

Author contributions

Faith Campbell undertook the review of the literature and paper selection, wrote the first draft of the paper and further iterations and assessed the paper for meeting the SANRA criteria for narrative reviews. Helen Rogers co-wrote the first draft of the paper, assisted with revising and editing drafts of the paper and assessed the paper for meeting the SANRA criteria for narrative reviews.

Ethics declaration

The authors declare no conflicts of interest.

Writing a Research Using Rolfe Reflective Model Research Paper

Introduction, reflection on the literature review, choosing an appropriate research topic and research question, identifying an appropriate scientific methodology, data collection techniques, data analysis.

The process of creating the research proposal will be evaluated using the Rolfe reflective model, which has three major steps; that is, what, so what and now what. First, one must determine what the problem, difficulty, situation, or achievement is in a project; this is a descriptive reflective level. Thereafter, one must establish what the issue teaches implies or means. In other words, it is necessary to analyze what one has learned from the process on a theoretical level. Step two may entail deducing the attitudes, actions, relationships, and knowledge that apply to the situation. Finally, one ought to focus on action orientation. Here, one should carve out a strategy for improving outcomes in the future.

The Rolfe model in the literature review is as follows:

When carrying out a literature review, I started with the general topic of cloud computing and then narrowed it down to the research topic. I selected references based on their relatedness to the topic. To eliminate unnecessary work, I settled on authors who had a clear research problem. Furthermore, their research theories needed to resonate with approaches in my field of study. I also wanted to use documents that considered both aspects of the debate. Authors who were too convinced that cloud computing was synonymous with security threats or those who downplayed the importance of security threats were discarded. For journal articles, they needed to have logical arguments that could be well understood. They are also related to the research topic.

The main challenge of using such a rigorous approach was getting consistent themes from all the authors. The literature review needed to flow, so it took a lot of time to read through the documents before picking out the common themes. In addition to the above, plenty of information existed about cloud computing, so it was difficult to weed out the irrelevant pieces and stick to the ones that corresponded to the research question. Furthermore, the broad nature of the topic caused me to place disjointed ideas together in one paragraph. Additionally, the documents I selected for the study all supported my research thesis. No articles offered contrary opinions. My documents were merely collected based on the research topic. I did not make a concept map or diagrammatic illustration of what needed to be done.

In the future, it will be useful to have a concept map that would narrow down the research topic appropriately and conveniently. Additionally, this approach will assist in making the literature review coherent and connected. In line with the latter idea, I should probably place one idea in one paragraph. This can be achieved by identifying the overall direction of the literature and then relating it to what different sources are saying about it. I also need to mind the connection between ideas in my literature review by having an overall story, which I should be elaborating on. I could also enrich future literature reviews by adding sources that do not support the research thesis. In my work, I assumed that security threats are a menace in cloud computing; however, other writers believe that security threats created by the platform are too insignificant to neutralize the benefits created by cloud computing. Consequently, I should include divergent views on the topic. In the future, it will also be wise to focus exclusively on relevant literature. Some of the documents in the piece were too descriptive and they merely mentioned aspects of the research. I need to evaluate, criticize, and even compare different writings on the topic to come up with a comprehensive literature review. I should also have a strong thesis statement in my writing that will guide me throughout the literature review. Nonetheless, I need to keep up with the approach I used to analyze the credibility of peer-reviewed journals as well as other pieces of literature on the research topic.

The three steps of the Rolfe model on the research question is as follows:

I gathered information in the subject area and then set out to establish a research topic. I realized that my topic needed to be relatively narrow. As a result, I had to focus on a geographical area that was reasonable for the time limit of the research. First, I had the general idea of cloud computing. Background research and preliminary reports revealed that lots of researchers are currently working on the subject matter. Some of them are discussing the impact of cloud computing on organizations while others are focusing on architecture and other prerequisites to making cloud computing work for organizations. Others prefer to evaluate the returns of using cloud computing. After examining most research on the topic, it came to my attention that most of the pieces rarely focused on security threats. Furthermore, those that did often mentioned them in passing. However, because the research topic needed to cover a reasonable geographical area, then I had to narrow it down to the US. This was the process by which I came up with the research topic “security threats associated with cloud computing in US firms.”

On the flip side, I spent a lot of time coming up with this research topic. Furthermore, it took too long to narrow it sufficiently, as I had several alternatives to select. Some of the options I had included “Can cloud computing impede organizational functioning?” or “What are the negative consequences of cloud computing?” I did not manipulate keywords to reveal different kinds of information, and this may have undermined the depth of my paper.

The nature of the approach I used was a compromise between a broad topic and a specific one. If I had selected a very narrow topic, then it would have been difficult to find supporting information for my area of interest. On the other hand, if it has been too broad, then chances are that I would not give it the coverage it deserves in a small research project. I may not have paid attention to the way I phrased my research question, but I now realize that using words such as how, why, what, and when can determine the outcome of one’s research. Many theorists believe that research questions starting with why and how are often broad and yield substantial research material than those that start with when, where, what and who. However, ‘what’ can either yield a broad research area or a narrow one depending on how one phrases the question. If the answer will lead to the identification of only one entity, then the researcher should use another word. Conversely, the research question ought to be phrased in a manner that would not provide a simple answer, and this is what I tried to do when choosing my research topic.

In the future, it will be useful to have a concept map that will assist me in making the research topic narrow. Just like the literature review, the concept map will assist in the generation of ideas for the research topic as well as the connection of the various research ideas together. It will also be useful to work hand in hand with members of staff in the school library as well as my classmates as they may have good ideas on how to phrase my research questions appropriately. I should also work with keywords and utilize Google function more efficiently as this will assist in saving time. For instance, paraphrasing keywords will assist in getting new research materials and establishing gaps in current literature. The dictionary would be a good place to start when paraphrasing these words. While security threats in cloud computing may be an interesting topic, I feel that more engaging topics exist in the field. In the future, it will be wise to come up with research topics that interest me. This will probably keep me motivated to complete the assignment. It will also help if I develop a tolerance for uncertainty at the preliminary stage of the research. Instead of looking for answers at the onset, it will be helpful to keep an open mind and embrace changes as I move along. A good idea would be to ask me what kind of information I need and then use this as a guide to developing the research question.

It will also be crucial to consider the wording of my research topic. Words like ‘what’ tend to yield overly descriptive work. I should consider the wording of my research topic in a manner that forms relationships between certain phenomena or variables. Productive researches often encompass balanced perspectives after reading a lot of material in related items. It will be necessary to obtain sufficient information before the development of any topic phrases in the future.

The Rolfe reflective model for scientific methodology is as follows:

The scientific methodologies I could select were either qualitative or quantitative research. I considered the fact that quantitative research yields numerical data and vice versa for qualitative research. The latter focuses on verbal, interpretive, and diagnostic work. My research question required a detailed description of security threats, so it was imperative to adopt such an approach. I could not select experimental methods because of ethical considerations and logistical challenges. I also eliminated observational research because this was not a precursor to another experiment that related to the same. Therefore, I had to contend with opinion-based research as it was the only avenue that was feasible for my research. The major problem was I did not clearly define which scientific approach I was using in the proposal.

My focus on the research collection methods prevented me from talking about the research design in-depth and clarifying the point of view that I was assuming in the research. Additionally, I was too descriptive in the analysis, and this neutralized the analytical nature of my scientific viewpoint. Most of the sections in the paper did not talk about the flaws in the research design, so this made the paper appear as though it did not have a balanced perspective.

In the future, it will be essential to identify the research paradigm and the scientific backing for my choices. Besides this, I need to be less descriptive in the section and talk about the scientific concepts of falsifiability or generalization.

The Rolfe reflective model for data collection is as follows:

When selecting the data collection techniques, I had a choice of several research methods. To come up with the most appropriate responses, I stuck to the ones that were compatible with my research question. It was also essential for me to consider methods that had relatively few shortcomings. My first choice was the survey, which is suitable for my research method as it was partly quantitative. However, it required a lot of logistical input and could not determine the complex security issues that some organizations encounter when using cloud computing. Observational methods were also a possible alternative as they entail getting the first-hand experience of the phenomenon. However, I abandoned the idea because it is not possible to observe the phenomenon of security threats in person. I could have used literature reviews as a method of data collection as it entails a broad array of perspectives. On the other hand, it would not have yielded original material. I was, therefore, left with the interviews as my last alternative. I found out that it would provide me with rich and insightful information. Furthermore, it could be applied to relatively small sample size. The shortfalls that were associated with interviews could be easily overcome using rigorous data analysis techniques and accurate data sampling.

The approach used for the analysis was probably an appropriate one in the selection of the data collection methods. However, I did not mention the reason why all the research methods were not included. Aspects of budget, time, and disciplinary issues were not covered. Furthermore, I did not give an in-depth explanation of how these data collection techniques applied to the research. I should also have chosen the most predominant form of data collection in the discipline. It would make sense to mirror this approach as previous researchers have tangible explanations for selecting such methods.

In the future, it will be necessary to focus on how each data collection technique applies to the research topic. The data collection section should not be overly descriptive, yet mine was. I need to ensure that my choices also relate to the preferred method of data collection in the discipline of cloud computing.

The Rolfe reflective model for data analysis is as follows:

In this section, I selected the method of coding as it corresponded to the interview techniques that I was going to use. I centered largely on the focus groups. However, no mention was made about the quantitative data that would be collected using structured interviews. This was a serious flaw in my research proposal. Additionally, I did not dwell on how the method of coding would be directly applied to my research question. There was no mention of some sample questions or any other approach that would lead to the development of a thorough research design. Furthermore, I did not follow a rigorous procedure for selecting my data analysis techniques. No mention was made of the nature of statistical software I would use, even if it was excel.

Likely, I did not talk about the quantitative aspect of data analysis because I did not go back to the research question as well as the data collection techniques. I may have been overwhelmed by the analytical techniques and rigorous methods used in coding data and this may have caused me to downplay the usefulness of statistical methods in the quantitative section. I was limited by the lack of specific data that would have determined the overall direction of the research. I may have ignored aspects of statistical analysis because I assumed that excel would be sufficient to do everything. However, even if this is true, for my case, I should have given some samples of the approach I would use in the study.

In the future, it will be insightful to always focus on the research question as well as the selected data analysis techniques. One must take the time to elaborate on how the data obtained through all methods will be analyzed. In the future, it would also be more insightful to create some sample data that would give me a rough idea about the nature of data that applies to my analysis. It would probably be effective to look at researches that used my kind of approach to get a typical sample. I should also differentiate between categorical, interval, or ordinal data as each would require a different analytical technique. Therefore, the research proposal should contain a sample of the structured interviews as this would give a tangible direction on how to analyze the data. It would be quite useful to be open to the possibility of analytical limitations in excel. Further, these techniques all relate to the nature of data as well as the design to be used in the research.

Overall, the research proposal was an amalgamation of all the research conducted throughout the course. Because of competing interests between my research area and the recommended approaches to research proposal writing, I had to leave out certain parts. These choices may have compromised the quality of my research proposal because I misfired in critical aspects of the paper. For instance, my literature review and research questions were not as comprehensive as they ought to be because I did not do concept-mapping or proper keyword-searching. Additionally, my methodology and data collection sections were too descriptive because I did not stick to my research question. Those sections contained general information rather than specific descriptions of how the research design applies to my topic. Furthermore, the data collection section had no mention of the quantitative aspect of the research. This also stemmed from the lack of a systematic examination of my research objectives.

In the future, I will benefit greatly from having a strong research thesis that will guide me throughout the research. It will also be necessary to make my literature review coherent and thematic. Furthermore, I should work on balancing perspectives in the literature review. It will be imperative to consider the wording of the research topic and the paraphrasing of keywords. I would write better researches if I use a research paradigm and talk about scientific concepts like a generalization. I should also refrain from being too descriptive in different sections of the research proposal, especially the data collection and data analysis sections.

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Reflective writing: Reflective frameworks

• What is reflection? Why do it?
• What does reflection involve?
• Reflective questioning
• Reflective writing for academic assessment
• Types of reflective assignments
• Differences between discursive and reflective writing
• Sources of evidence for reflective writing assignments
• Linking theory to experience
• Reflective essays
• Portfolios and learning journals, logs and diaries
• Examples of reflective writing
• Video summary
• Bibliography

On these pages:

“A framework ... can help you draw out the learning points from an experience by using a systematic approach” Williams et al., Reflective Writing

There are many frameworks for reflective writing. Being aware of these frameworks (or 'models') can help you to maximise the learning from any experience you have. This is because they assist in the systematic deconstruction of experiences , helping you to ensure you ask the right reflective questions at each stage of an experience. This means frameworks of reflective practice can be used as a basis for the structure of a reflective essay.

Introduction to using frameworks of reflective practice

Often, reflective assessments will require you to use a framework or model for your reflection . Always ensure you read the assignment criteria carefully to make sure you are taking the right approach. You may be given a free choice on which framework to use, or you may be asked to choose from a selection. If you have to choose, you may need to justify your decision, but this is not always the case. Whatever your assignment asks you to do, you need to think critically about which model you use. This guide will later introduce you to the most common frameworks.

Frameworks of reflective practice

If your assignment requires you to make reference to a framework (or 'model') of reflective practice, you will need to choose a framework through which to structure your assignment. Each framework establishes a different approach to reflection and will require you to approach your writing differently. While not an extensive list, the reflective frameworks listed below are the most commonly used and each has its own page on this guide.

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Rolfe’s Reflective Model Sample

Published by Robert Bruce at April 18th, 2023 , Revised On February 2, 2024

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A Reflective Essay using Rolfe’s Reflective Model to Reflect on your Role as a Student Nurse in Medicine Management

Introduction.

The current reflective essay is based on my experience as a student nurse in the application of evidence-based risk assessment tool for quality care to patients of different critical intensities. Evidence based risk assessment tool is a technique used in the provision of quality care and healthcare support which comprises preventive measures taken for patients, or diagnostics and prognostic routes chosen and sometimes even in precision insurance medical decisions (James, 2013).

As per my understanding and my experiences from the evidence-based risk assessment tools, it helps reduce the associated risks to patients by minimising health impact, costs and issues related to legal and ethical concerns. Evidence based risk assessment tools as I have experienced help greatly in exploring the risk magnitude (RM) of different types of patients and assess the mortality prediction and predictable survival of the patient.

This aspect of the risk assessment was important for insurance approval for patients by the hospital. Again, in another aspect, these risk assessment tools also help in assessing the safety settings of the healthcare centre like risk assessment from patient fall evidence (Renfro and Fehrer, 2011; Waxman, 2010).

However, in nursing, I now believe that it is a very important tool for nurses to understand the patients’ conditions and help the specialists understand the patient’s condition or situation. In the following section, I have used Rolfe’s Reflective Model to present my experiences using evidence-based risk assessment tools while interning as a student nurse.

Rolfe’s reflective model

During my experience as a student nurse, out of most tasks I was involved in during the short period, using the evidence-based risk assessment tool was the most critical medicine management process I had encountered. The medicine management system as we know in nursing is the critical process of assessing, controlling and monitoring the medication system for improved performance and quality care (Zipkin et al. 2014).

Evidence based risk assessment tool is an important part of medicine management because it involves assessing the risks of the patients based on evidence of the history of the patient or similar conditions in the past from another patient. The evidence based risk assessment tool also helps in the assessment of the condition of the patient like allergies to certain medications, the criticalness of the patients, the survival chances of the patient, and predicting the treatment efficacy for those critical patients only.

Another technical aspect of these tools is that the hospital setting has also used them for determining the insurance eligibility of patients, these tools have certain measures for each of the medical condition of the patient and using this knowledge and assessment the eligibility of the patient to avail insurance to reduce costs of treatment are used (Nelson et al. 2021).

The evidence.nhs.uk, (2020) or NHS has developed multiple evidence-based tools for risk assessment of the patients using sound methodological and procedural basis and investigative methods to assess the patients’ conditions and improve the provision of quality medical care. Since the NHS has made it mandatory for all healthcare settings to apply risk assessment tools for all types of conditions and settings thus it has become an important activity.

During my experience, I learned how to use and develop a risk assessment tool with the help of a head nurse and another midwife with whom I had to partner during my internship as a student nurse. They taught me how to use different types of tools and their applications. The nurses in the healthcare setting had a format for using the tools that allowed them to rate the patient’s conditions and gather information on the patient’s history.

It further helps the emergency doctors and other specialised doctors better understand the patients to have the correct route for prognosis and diagnosis. I believe with the help of this personal and in-depth association I gained some knowledge on how to investigate patient histories and conditions to effectively use the evidence-based risk assessment tools. This I can further relate to one of the cases that I handled. The case was the patient had a previous history of allergies from certain medications. This was put into the risk assessment tool that helped the doctor approach a different route for medication and treatment of the patient (Westbrook et al. 2011).

My involvement as a student nurse in applying evidence-based risk assessment tools helped me gain knowledge on different aspects like how to investigate the patients and gain information on the patient conditions and history. In one of the areas of risk assessment i.e. to mitigate the fall risk of critical patients, I learnt to use the Morse Fall Scale and the Hendrich II Fall Risk Model that is generally used by the nurses in the hospital setting to reduce the cases of patient falls from trips and involuntary patient actions (Higaonna, Enobi, and Nakamura, 2017).

While using the Morse Fall Scale and the Hendrich II Fall Risk Model, I learnt that these risk scoring tools have different categories that can be used to understand the condition of the patient and based on the risk score the patients are given more care and assistance to ensure that there is low risk to fall. For instance, I understood that these tools use and gather information on the patient’s conditions like confusion or disorientation and depressive state and dizziness of the patient and types of drugs like consumption of benzodiazepines and others.

Patients taking benzodiazepines need special care and support because they risk falling when they move without the assistance of a nurse or other family member. Other information gathered from these assessment tools is the patient’s condition like the use of cane or sticks to move, medical condition of the patient, mental condition of the patient and others (Han et al. 2017).

I also discovered that these scoring tools have various classifications that can be utilised to comprehend the state of the patient and dependent on the danger score the patients are given more consideration and help to guarantee that there is generally safe to fall. I also discovered that these instruments use and assemble data on the patient conditions.

By considering these situations and patient scores, better care and support can be provided. Therefore, this process also helped me acquire information on various viewpoints like exploring the patients and gaining data on the patient conditions and history. Furthermore, considering the tools used in risk assessment are not limited to fall assessments but also enable ethical generation for patient treatment (Ondrusek et al. 2015).

In this regard, I can link my skill development experiences whereby I learnt that ethical provision of care is very important and this includes informing the outcomes of the risk assessment and the possible treatment and effectively communicating all the outcomes from the risk assessment of the patient to other specialists as well for effective treatment routes.

Linking my learning to that of Kaya, Ward, and Clarkson, (2019) current risk assessment practice in hospitals there is still a major gap in the risk assessment guidance for using tools to mitigate the risks of wrongful medication or wrongful diagnosis of the patients rising for poor assessment of patient conditions and risks.

Even though the National Health Service in England (NHS England) has developed multiple systems that allow the risk assessment for patients concerning patient compliances, ethical medical practices, treatment processes and patient care and improvement of the patient’s quality care.  There is a significant gap in the effectiveness of applying these tools.

It may be because there are different tools that each of the hospitals uses. Like in my case, as I mentioned, the hospital used two different tools for fall risk assessment of the patients like the Morse Fall Scale and the Hendrich II Fall Risk Model. This resulted in different risk scores by different nurses or the authorised personnel.

Based on these aspects I can say that there is a significant gap in effective evidence based risk assessment tools as hospitals develop or adapt to existing ones based on feasibility and the risk assessment guidelines by the NHS England. Therefore, I believe that the Nursing and Midwifery Council must develop and upgrade its existing risk assessment tools meant for the nurses to use so that a single method of the risk assessment tool is used for different conditions of the patients and improve the patient care.

Applying singular methods or multidimensional risk assessment tools may improve the medical care and medical care support which involves preventive measures taken for patients, or diagnostics and prognostic courses picked, and now and then even inaccuracy protection clinical choices. Furthermore, using a multidimensional and unified use of the risk assessment instruments will help decrease the related dangers to patients by limiting wellbeing effects, expenses, and issues identified with legitimate and moral concerns.

These evaluation tools as I have encountered help extraordinarily in investigating the risk assessments of various kinds of patients and survey the mortality forecast and unsurprising patient endurance. This significant part of the medication the board since it implies surveying the dangers of the patients dependent on proof of the previous history of the patient or comparable conditions in the past from another patient.

The risk appraisal device likewise helps in the evaluation of the state of the patient like sensitivities to specific drugs, the criticalness of the patients, the endurance odds of the patient, and anticipating the treatment adequacy for those basic patients as it were. Applying unified, flexible and multidimensional risk assessment tools will help the nurses moderate the tools as needed for the different conditions of patients and mitigation of risks (Ondrusek et al. 2015).

I believe I was limited to using only fall-related risk assessment tools like Morse Fall Scale and the Hendrich II Fall Risk Model. There are many other risk assessment tools developed for patients suffering from different conditions like patients with severe diabetic conditions and cardiac issues. There are different evidence-based risk assessment tools for these patients.

Therefore, I believe one of the most important skills and knowledge I need to gain is investigating and using them in other conditions. I also have to learn about the application of these tools using technical tools that help in the evaluation of the state of the patient like hypersensitivities to specific drugs, the criticalness of the patients, the endurance odds of the patient, and anticipating the treatment viability for those basic patients as it were.

Another specialised part of these apparatuses is that the emergency clinic setting has likewise utilised them for deciding the protection qualification of the patients, these devices have certain actions for every one of the ailments of the patient and utilising this information and appraisal the qualification of the patient to profit protection to diminish expenses of treatment are utilised.

For instance, the NHS has developed different risk assessment tools for patients suffering from psychiatric and other healthcare issues. I will learn and read these risk assessment tools and understand how they are used or the importance of these tools using literature studies. By interning more in the area of risk assessment for medicine management, it will help me to learn about different numerous other danger evaluation instruments produced for patients experiencing various conditions like patients with extreme diabetic conditions and cardiovascular issues and for these patients, there are diverse risk appraisal tools or measuring systems.

Consequently, I believe engaging more in learning these risk tools will improve my abilities and the information I need to acquire is how to examine and utilise them in different conditions. I need to find out about the utilisation of these instruments that assist in the assessment of the patient’s condition like hypersensitivities to explicit medications, the criticalness of the patients, the perseverance chances of the patient and expecting the treatment suitability for those fundamental patients figuratively speaking.

Another specific piece of these devices are that they have in like manner been used by the crisis facility setting for choosing the insurance capability of the patients, these gadgets have certain activities for all of the diseases of the patient and using this data and its evaluation, the capability of the patient to benefit security to lessen costs of treatment are used. As a student nurse, I plan to achieve these skills and improve through external engagement and internships at different clinical centres.

Evidence based risk assessment tool is the process of assessing the possible risks to patients and developing a route for the patients. There are different ways of providing care to patients and the main activity of the nurses in this case of using evidence based risk assessment tool is to gather first-hand information of the patients’ conditions, medical history like allergies and previous medications and health issues, as well as mental heal of the patients.

There are different types of risk assessment tools for different conditions of patients like psychological or cardiac patient risk assessment tools. In addition, these tools are also used to develop a predictive assessment of the patient’s survivability or death. Based on such outcomes, the route of medication and healthcare is decided. The nurses’ role in this aspect is to include these tools while investigating the patients’ conditions. This helps in effective medicine management by providing effective care and rightful medications and reducing risks of wrongful medications and others.

evidence.nhs.uk, 2020. Risk Assessment Guidelines . Available at https://www.evidence.nhs.uk/search?q=risk+assessment+guidelines .

Han, J., Xu, L., Zhou, C., Wang, J., Li, J., Hao, X., Cui, J., Shao, S. and Yang, N., 2017. Stratify, Hendrich II fall risk model and Morse fall scale were used to predict the risk of falling for elderly in-patients. Biomedical Research .

Higaonna, M., Enobi, M. and Nakamura, S., 2017. Development of an evidence‐based fall risk assessment tool and evaluation of interrater reliability and nurses’ perceptions of the tool’s clarity and usability.  Japan journal of nursing science ,  14 (2), pp.146-160.

James, J.T., 2013. A new, evidence-based estimate of patient harms associated with hospital care.  Journal of patient safety ,  9 (3), pp.122-128.

Kaya, G.K., Ward, J.R. and Clarkson, P.J., 2019. A framework to support risk assessment in hospitals.  International Journal for Quality in Health Care ,  31 (5), p.393.

Nelson, A.J., Ardissino, M., Haynes, K., Shambhu, S., Eapen, Z.J., McGuire, D.K., Carnicelli, A., Lopes, R.D., Green, J.B., O’Brien, E.C. and Pagidipati, N.J., 2021. Gaps in Evidence‐Based Therapy Use in Insured Patients in the United States With Type 2 Diabetes Mellitus and Atherosclerotic Cardiovascular Disease.  Journal of the American Heart Association ,  10 (2), p.e016835.

Ondrusek, N.K., Willison, D.J., Haroun, V., Bell, J.A. and Bornbaum, C.C., 2015. A risk screening tool for ethical appraisal of evidence-generating initiatives.  BMC medical ethics ,  16 (1), pp.1-8.

Renfro, M.O. and Fehrer, S., 2011. Multifactorial screening for fall risk in community-dwelling older adults in the primary care office: development of the fall risk assessment & screening tool.  Journal of Geriatric Physical Therapy ,  34 (4), pp.174-183.

Waxman, K.T., 2010. The development of evidence-based clinical simulation scenarios: Guidelines for nurse educators.  Journal of nursing education ,  49 (1), pp.29-35.

Westbrook, J.I., Rob, M.I., Woods, A. and Parry, D., 2011. Errors in administering intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ quality & safety ,  20 (12), pp.1027-1034.

Zipkin, D.A., Umscheid, C.A., Keating, N.L., Allen, E., Aung, K., Beyth, R., Kaatz, S., Mann, D.M., Sussman, J.B., Korenstein, D. and Schardt, C., 2014. Evidence-based risk communication: a systematic review.  Annals of internal medicine ,  161 (4), pp.270-280.

Frequently Asked Questions

How to use rolfe’s reflective model in reflective essay writing.

Rolfe’s reflective model can be used in reflective essay writing by following these steps:

• Describe an experience
• Analyze feelings and thoughts
• Evaluate the experience
• Identify future actions.

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Reflective Writing

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Reflective Frameworks & Models

• Compare your experience to the literature
• Critical reflective writing
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There are many reflective frameworks to choose from. The University of Hull has a comprehensive guide on some of the most popular models. When selecting a framework, look at your brief, your word count, and the strengths and weaknesses of each model. You can also justify why you chose the model in the introduction to your essay. This evidences your critical thinking. 

• Reflective Example- Gibbs
• Reflective Example- Rolfe et al.
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Reflective practice toolkit, introduction.

• What is reflective practice?
• Everyday reflection
• Models of reflection
• Barriers to reflection
• Free writing
• Reflective writing exercise
• Bibliography

If you are not used to being reflective it can be hard to know where to start the process. Luckily there are many models which you can use to guide your reflection. Below are brief outlines of four of the most popular models arranged from easy to more advanced (tip: you can select any of the images to make them larger and easier to read).

You will notice many common themes in these models and any others that you come across. Each model takes a slightly different approach but they all cover similar stages. The main difference is the number of steps included and how in-depth their creators have chosen to be. Different people will be drawn to different models depending on their own preferences.

• Reflection 

The cycle shows that we will start with an experience, either something we have been through before or something completely new to us. This experience can be positive or negative and may be related to our work or something else. Once something has been experienced we will start to reflect on what happened. This will allow us to think through the experience, examine our feelings about what happened and decide on the next steps. This leads to the final element of the cycle - taking an action. What we do as a result of an experience will be different depending on the individual. This action will result in another experience and the cycle will continue. 

Jasper, M. (2013). Beginning Reflective Practice. Andover: Cengage Learning.

Driscoll's What Model

By asking ourselves these three simple questions we can begin to analyse and learn from our experiences. Firstly we should describe what the situation or experience was to set it in context. This gives us a clear idea of what we are dealing with. We should then reflect on the experience by asking 'so what?' - what did we learn as a result of the experience? The final stage asks us to think about the action we will take as a result of this reflection. Will we change a behavior, try something new or carry on as we are? It is important to remember that there may be no changes as the result of reflection and that we feel that we are doing everything as we should. This is equally valid as an outcome and you should not worry if you can't think of something to change. 

Borton, T. (1970) Reach, Touch and Teach. London: Hutchinson.

Driscoll, J. (ed.) (2007) Practicing Clinical Supervision: A Reflective Approach for Healthcare Professionals. Edinburgh: Elsevier.

Kolb's Experiential Learning Cycle

• Concrete experience
• Reflective observation
• Abstract conceptualization
• Active experimentation 

The model argues that we start with an experience - either a repeat of something that has happened before or something completely new to us. The next stage involves us reflecting on the experience and noting anything about it which we haven't come across before. We then start to develop new ideas as a result, for example when something unexpected has happened we try to work out why this might be. The final stage involves us applying our new ideas to different situations. This demonstrates learning as a direct result of our experiences and reflections. This model is similar to one used by small children when learning basic concepts such as hot and cold. They may touch something hot, be burned and be more cautious about touching something which could potentially hurt them in the future. 

Kolb, D. (1984) Experiential Learning: Experience as the Source of Learning and Development. Upper Saddle River: Prentice Hall.

Gibb's Reflective Cycle

• Description
• Action plan

As with other models, Gibb's begins with an outline of the experience being reflected on. It then encourages us to focus on our feelings about the experience, both during it an after. The next step involves evaluating the experience - what was good or bad about it from our point of view? We can then use this evaluation to analyse the situation and try to make sense of it. This analysis will result in a conclusion about what other actions (if any) we could have taken to reach a different outcome. The final stage involves building an action plan of steps which we can take the next time we find ourselves in a similar situation. 

Gibbs, G. (1998) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit, Oxford Polytechic .

Think about ... Which model?

Think about the models outlined above. Do any of them appeal to you or have you found another model which works for you? Do you find models in general helpful or are they too restrictive?

Pros and Cons of Reflective Practice Models

A word of caution about models of reflective practice (or any other model). Although they can be a great way to start thinking about reflection, remember that all models have their downsides. A summary of the pros and cons can be found below:

• Offer a structure to be followed
• Provide a useful starting point for those unsure where to begin
• Allow you to assess all levels of a situation
• You will know when the process is complete
• Imply that steps must be followed in a defined way
• In the real world you may not start 'at the beginning'
• Models may not apply in every situation
• Reflective practice is a continuous process 

These are just some of the reflective models that are available. You may find one that works for you or you may decide that none of them really suit. These models provide a useful guide or place to start but reflection is a very personal process and everyone will work towards it in a different way. Take some time to try different approaches until you find the one that works for you. You may find that as time goes on and you develop as a reflective practitioner that you try different methods which suit your current circumstances. The important part is that it works - if it doesn't then you may need to move on and try something else.

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• Using a Model of Reflection in Action

Using a Model of Reflection in Action - Essay Example

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Gibbs' Reflective Cycle

One of the most famous cyclical models of reflection leading you through six stages exploring an experience: description, feelings, evaluation, analysis, conclusion and action plan.

Gibbs' Reflective Cycle was developed by Graham Gibbs in 1988 to give structure to learning from experiences.  It offers a framework for examining experiences, and given its cyclic nature lends itself particularly well to repeated experiences, allowing you to learn and plan from things that either went well or didn’t go well. It covers 6 stages:

• Description of the experience
• Feelings and thoughts about the experience
• Evaluation of the experience, both good and bad
• Analysis to make sense of the situation
• Conclusion about what you learned and what you could have done differently
• Action plan for how you would deal with similar situations in the future, or general changes you might find appropriate.

Below is further information on:

• The model – each stage is given a fuller description, guiding questions to ask yourself and an example of how this might look in a reflection
• Different depths of reflection – an example of reflecting more briefly using this model

This is just one model of reflection. Test it out and see how it works for you. If you find that only a few of the questions are helpful for you, focus on those. However, by thinking about each stage you are more likely to engage critically with your learning experience.

This model is a good way to work through an experience. This can be either a stand-alone experience or a situation you go through frequently, for example meetings with a team you have to collaborate with. Gibbs originally advocated its use in repeated situations, but the stages and principles apply equally well for single experiences too. If done with a stand-alone experience, the action plan may become more general and look at how you can apply your conclusions in the future.

For each of the stages of the model a number of helpful questions are outlined below. You don’t have to answer all of them but they can guide you about what sort of things make sense to include in that stage. You might have other prompts that work better for you.

Description

Here you have a chance to describe the situation in detail. The main points to include here concern what happened. Your feelings and conclusions will come later.

Helpful questions:

• What happened?
• When and where did it happen?
• Who was present?
• What did you and the other people do?
• What was the outcome of the situation?
• Why were you there?
• What did you want to happen?

Example of 'Description'

Here you can explore any feelings or thoughts that you had during the experience and how they may have impacted the experience.

• What were you feeling during the situation?
• What were you feeling before and after the situation?
• What do you think other people were feeling about the situation?
• What do you think other people feel about the situation now?
• What were you thinking during the situation?
• What do you think about the situation now?

Example of 'Feelings'

Here you have a chance to evaluate what worked and what didn’t work in the situation. Try to be as objective and honest as possible. To get the most out of your reflection focus on both the positive and the negative aspects of the situation, even if it was primarily one or the other.

• What was good and bad about the experience?
• What went well?
• What didn’t go so well?
• What did you and other people contribute to the situation (positively or negatively)?

Example of 'Evaluation'

The analysis step is where you have a chance to make sense of what happened. Up until now you have focused on details around what happened in the situation. Now you have a chance to extract meaning from it. You want to target the different aspects that went well or poorly and ask yourself why. If you are looking to include academic literature, this is the natural place to include it.

• Why did things go well?
• Why didn’t it go well?
• What sense can I make of the situation?
• What knowledge – my own or others (for example academic literature) can help me understand the situation?

Example of 'Analysis'

Conclusions.

In this section you can make conclusions about what happened. This is where you summarise your learning and highlight what changes to your actions could improve the outcome in the future. It should be a natural response to the previous sections.

• What did I learn from this situation?
• How could this have been a more positive situation for everyone involved?
• What skills do I need to develop for me to handle a situation like this better?
• What else could I have done?

Example of a 'Conclusion'

Action plan.

At this step you plan for what you would do differently in a similar or related situation in the future. It can also be extremely helpful to think about how you will help yourself to act differently – such that you don’t only plan what you will do differently, but also how you will make sure it happens. Sometimes just the realisation is enough, but other times reminders might be helpful.

• If I had to do the same thing again, what would I do differently?
• How will I develop the required skills I need?
• How can I make sure that I can act differently next time?

Example of 'Action Plan'

Different depths of reflection.

Depending on the context you are doing the reflection in, you might want use different levels of details. Here is the same scenario, which was used in the example above, however it is presented much more briefly.

Adapted from

Gibbs G (1988). Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.