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Exploring the role of reflection in nurse education and practice


  • 1 Waterside Campus, University of Northampton, Northampton, England.
  • PMID: 35403391
  • DOI: 10.7748/ns.2022.e11605

Reflection is an essential element in every nurse's practice and is embedded in the Nursing and Midwifery Council's code of conduct - the UK nursing regulatory body's code of professional standards of practice and behaviour. The application of reflection to practice has clear advantages, for example it enables nurses to learn from clinical events and adapt and enhance their skills. This article explores the role of reflection in nursing practice, considers the use of reflective models and explores how nurses can overcome barriers to reflection in their everyday practice. These barriers include psychological stress or discomfort when revisiting challenging clinical experiences, which may have been exacerbated during the coronavirus disease 2019 (COVID-19) pandemic.

Keywords: COVID-19; continuing professional development; coronavirus; education; mental health; professional; reflection; stress.

© 2022 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

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Conflict of interest statement

None declared

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Reflective practice skills reading list

Reflective practice reading list.

This reading list covers a range of reflective practice skills. Some resources may only be available to RCN programme participants and RCN members.

Use the menu on the left hand side to view more pages within the reading list.

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The power of reflection in nursing

Lizzie Ette. Lecturer in Nursing, The University of Hull

reflection in nursing uk essay

This week’s EBN Twitter Chat is on Wednesday 1st February between 8-9 pm (UK time).

The chat will be led by Lizzie Ette ( [email protected] ), Lecturer in Pre-registration Nursing, The University of Hull.

Participating in the Twitter chat requires a Twitter account; if you do not have one you can create an account at  www.twitter.com . Once you have an account, contributing is straightforward. You can follow the discussion by searching links to  #ebnjc , or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ adding  #ebnjc  (the EBN Twitter chat hash tag) to your tweet, this allows everyone taking part to view your tweets

As is so often the case, professional and personal lives are intricately related, and the recent experience of losing our family cat Reggie, following a road traffic accident at Christmas, really got me to reconsider the power of reflection on a personal level, and this got me thinking deeply about how important reflection is in my professional capacity, as a nurse.

reflection in nursing uk essay

Caring for Reg as I did in his last days of life was a positive experience and looking back I feel confident that I did a good job in caring for our lovely old cat. Unfortunately, my experience of supporting three young children through the demise of their much loved pet was not quite so successful. I had no experience to draw on here and found myself feeling pretty self –critical of my actions. However, having now spent some time reflecting and reading related material online, I realised how much it taught me about how different my children’s needs are from my own, and from one another’s. I can acknowledge how I would now do things differently. Sadly, only when we have another bereavement of some sort can I get to test out my new learning, that all-important step of doing things better next time.

Boud et al. (1985, p.19) offer a simple definition of reflection,

‘Reflection is an important human activity in which people recapture their experience, think about it, mull over & evaluate it. It is this working with experience that is important in learning’.

reflection in nursing uk essay

The importance of reflection in nursing cannot be understated. It can be used on many levels; to reflect on a specific incident, a moment in time even, and the actions, thoughts and feelings associated with that moment, or can be used to help create an understanding of a more general time period, by breaking down, considering, analysing and critiquing the who, what, why, when and how of the events of that time ( Gibbs (1988), ; Johns (1995) ; Driscoll (2007) ). It can be used to reflect on situations as they occur – reflection in action – and on events from the past – reflection on action (Schön, 1983). Additionally, it can be used to recognise new skills and articulate planned new approaches. All of these mechanisms are thought to improve a nurse’s practice.

However, some are critical of reflective practice in its current form. Rolfe (2014), for example, argues that reflective practice has had a disappointing impact upon nurse education and practice, suggesting that it is the poor interpretation and implementation of reflective practice that has resulted in this lack of progress. Likewise, Nelson (2012) suggests that the present wide acceptance of ‘institutionally governed’ reflection is ironic given Schön and other’s original intentions for the use of reflection.

Despite this, reflection does indeed form a major element of nurses’ ability to renew their professional registration (revalidation). The NMC states that for successful revalidation…

“You must have prepared five written reflective accounts in the three year period since your registration was last renewed or you joined the register. Each reflective account must be recorded on the approved form and must refer to:

  • an instance of your CPD, and/or
  • a piece of practice-related feedback you have received, and/or
  • an event or experience in your own professional practice and how they relate to  the Code .”

Taken from the NMC (2017) , the above demonstrates a key driver for understanding the importance of reflection in nursing: the need for nurses to engage in reflection in order to secure ongoing professional registration.

If nurses are obliged to undertake this activity, the evidence suggests that it is highly beneficial for them to commit to doing it wholeheartedly, and to the best of their ability, in order to maximise the genuine learning that can be gained from doing so.

Some simple guides to reflection and reflective writing skills can be found here and here and you can complete a free online module in order to develop your skills of reflection here

The questions I will be posing via the Twitter chat are as follows:

  • How important do you think reflection is in nursing?
  • How have you benefitted professionally from undertaking reflective practice?
  • How useful has reflection been for the purposes of revalidation, for you/others?
  • What needs to be done to improve reflective practices, if anything?

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

Driscoll, J. (2007) Practicing Clinical Supervision: A Reflective Approach for Healthcare Professionals. 2 nd ed. Edinburgh: Balliere Tindall Elsevier.

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

Johns, C. (1995) Framing learning through reflection within Carper’s fundamental ways of knowing in nursing.  Journal of Advanced Nursing . 22: 226-34

Nelson, S. (2012) The lost path to emancipatory practice: towards a history of reflective practice in nursing.  Nursing Philosophy.  13(3) 202-213

Rolfe, G. (2014) Rethinking reflective education: What would Dewey have done? Nurse Education Today . 34 (8) 1179 – 1183

Schön, D. (1983) The Reflective Practitioner: How professionals think in action. London: Temple Smith

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How to reflect on your practice for revalidation

How to reflect on your practice for revalidation

  • Team meetings.
  • Reading a journal or article about a topic and then applying the learning to your practice.
  • Discussion with other clinical staff about critical incidents or near misses including lessons learned and good practice.
  • Compliments and complaints from patients, which may involve changing practice or policies and procedures.
  • GP case conferences where complex patients are discussed.
  • CPD sessions that relate to your role.
  • What went well?
  • What did not go so well?
  • What would you do differently next time?
  • An instance of your CPD
  • A piece of practice-related feedback you have received
  • An event or experience in your own professional practice and how this relates to the code
  • Practice-related feedback

You see Patient A for their regular asthma check. They ask you about a new treatment they have read about on the internet and wonder if it is something they could have prescribed by the NHS. You advise them that you are not aware of this new treatment and that they should continue with their current medication.

This was an experience from my practice where I had a consultation with a patient.

I felt I gave the patient the correct advice. It is in the patient’s best interests to keep taking the medication prescribed for them rather than searching for new treatments on the internet that may not be available
to them.

However, I felt I dismissed the patient’s query quite quickly. I could have taken more time to listen to the patient and perhaps ask some probing questions as to why they were seeking alternative treatments. Maybe they were experiencing symptoms or side-effects with their current treatment and finding them difficult to deal with.

When patient A returns for their follow-up appointment I will check if they have any concerns about their current treatment regime and explore the perceived benefits of the treatment the patient has found on the internet. I also know the local hospital often have clinical trials patients can participate in so I am going to find out more and whether my patient might be eligible.

If I am faced with this situation again I will make sure I take more time to understand why my patient was searching for alternative treatments on the internet and ensure I offer more tailored support and advice.

This is relevant to:

2 Listen to people and respond to their preferences and concerns.

To achieve this, you must:

2.1 Work in partnership with people to make sure you deliver care effectively.

6 Always practise in line with the best available evidence.

To achieve this, you must:

6.1 Make sure that any information or advice given is evidence based, including information relating to using any health and care products or services.

  • Make time to reflect.
  • Value the benefits it may bring to your practice.
  • Use a structure only if you feel comfortable doing so.
  • Write notes – even if these are short, bullet points and in informal language, that is fine

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Reflective model guides

During your nursing studies, you will often have to reflect on your practice and experiences using reflective models. Many UK universities will ask you to use models of reflection to help you critically reflect on your practice as a nursing student, and are used as a guide to make informed decisions in your personal and professional life as a nurse. Take a look at our reflective guides, which aim to help you understand the different methods of reflective practice and can help you in writing your next reflective essay.

If you are looking for professional assistance with your studies, take a look at our services section:

Choose a reflective model from the sections below

Atkins and Murphy Model

The Atkins and Murphy model of reflection is a circular model, which requires you to think deeply about your actions, why you acted in a certain way and how your own knowledge and beliefs may have affected you.

Brookfield Reflective Model

In Brookfield's reflective model, we should consider reflection from four perspectives: from our own standpoint,from that of our learners, from that of our colleagues, and from its relationship to wider theory. Only from the consideration of multiple points of view can we deepen our reflection.

Driscoll Model of Reflection

The Driscoll model of reflection is one of the simplest models you will come across, and involves three stem questions which are; what, so what and now what?

Driscoll Model

Gibbs Reflective Cycle

Gibbs' Reflective Cycle was developed to give structure to learning from experiences, and is perhaps one of the more commonly used reflective cycles for nurses. It offers a framework for examining experiences, and given its cyclic nature lends itself particularly well to repeated experience allowing you to learn and plan from things that either went well or didn’t go well.

Gibbs Reflective Model

Johns Model of Reflection

There are two sets of related processes in Johns model of reflection; looking in, then looking outwards. Johns model is useful in that it encourages reflection taking into consideration a range of standpoints, and that the person reflecting considers the impacts of their actions not only on other people, but also on themselves.

Johns Model

Kolbs Learning Cycle

Kolb's learning cycle takes a somewhat different approach, as it sees reflection as part of a wider set of processes in which the learner seeks to understand their working processes as they move through different stages of engagement with an event, occurrence, or training session and take on relevant aspects of the new material.

Kolbs Model

Pender's Health Promotion Model

Pender’s health promotion model concentrates on three major categories: individual characteristics and experiences, behaviour-specific cognitions and affect and lastly, the behavioural outcomes. Pender emphasised that one’s past actions have a direct link to whether they would partake in future health-promoting behaviours. Personal attributes and habits can also be a barrier to health-promoting behaviours.

Pender's Model

Rolfe Reflective Model

The model was developed initially for nursing and care education, but has become more broad in its subsequent applications, not least because of the clarity of the model and its ease of use.

The three stages of the model ask you to consider, in turn, what happened, the implications of the occurrence, and the consequences for future conduct. The model is cyclic, indicating a continuity. The changes in behaviour or approach which is generated from the reflective thought can then be analysed, and either a further revision made, or else the changes made can be found to have been appropriate.

Rolfe's Model

Roper Logan and Tierney

The purpose of the Roper Logan theory is as an assessment used throughout the patient’s care. As a nurse you should use the model to assess the patient’s relative independence and potential for independence in the 12 activities of daily living. The patient’s independence is looked at on a continuum that ranges from complete dependence to complete independence. This helps to determine what interventions will lead to increased independence as well as what ongoing support is needed to offset any dependency that still exists.

Roper Logan Model

Schon Reflective Model

The Schon reflective model presents the concept of 'reflection in action' and 'reflection on action'. The model asks you to consider why things are as they are, and how they could be. The Schon model also asks you to consider the strengths and areas of development in your own practice as a nurse questioning why learning experiences might be this way and considering how to develop them.

Schon Model

Reflective Essay Writing Service

NursingAnswers also provide a reflective esay writing service for nursing students looking for support with writing their reflective essay.

Each reflective esssay is produced specifically to your requirements and level of study. Find out more about how our service can help you by clicking the button below:

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Complete Guide to Writing a Reflective Essay

3466 words (14 pages)

06/05/20 Reference this

This article, written by the nursing professionals at NursingAnswers.net will show you how to write a reflective essay, and will guide you through the process of writing this specific type of paper. If you have been given a reflective essay assignment for the first time, you might have a lot of questions, such as: ‘ What is the point of this assignment?’, ‘How do I write a reflective essay?’, or ‘ What am I supposed to learn from this?’ The good news is that these are all valid questions, and you should be asking them. In fact, it is exactly these kinds of questions that provide the very foundation of reflective thinking—so if you’re already asking yourself such questions, then congratulations, you are well on your way to becoming a skilled reflective thinker. We will therefore address each of these questions in turn, and more, as we discuss the ins and outs of writing a reflective essay.

Reflective Essay Comparison Table

to Do When Writing a Reflective Essay
Write in the first-personWrite in the third-person
Include a description of the experience or event from your own unique point of viewGather data from various participants, and create an objective account of the event from various subjective perspectives
Include some considerable analysis and reflections of the experience or the eventOnly include an extensive description of the experience or the event
Have a clear structure in place, with: an , , and or a variation of thisWrite it like a diary entry, containing thoughts and emotions, but without any real structure to it
Use a formal tone throughout the pieceUse an informal, conversational tone
Draw from established reflective cycle frameworks, such as Kolb (1984) or Gibb (1988)Do not consider any reflective cycle frameworks

What is the Point of a ‘Reflective Essay’?

To begin with then, your first question might be that of deriving the point of a reflective essay. The first thing you should know then, is that very essence of a reflective essay, at its most fundamental level, is that it should reflect on an experience that you have had—hence the name. This reflection will obviously vary depending upon your field of study, but the principle is the same: you will have had a particular experience in the field, or in life in general, and you will then write about it, and reflect upon it will various analyses. More specifically, you will do this by first briefly describing what happened, from your own unique point of view, before reflecting upon this, and trying to learn something from the experience by putting this in the context of any perspectives or theories that you have studied, or simply by analysing the experience after the event in a little more depth, and trying to understand what happened.

If you know in advance that you are going to write a reflective essay about a particular experience, then it can be useful to keep a journal as you go along, so that you’re not relying exclusively on your memories (as memories can be malleable, and are not as accurate as most people believe), and this journal might also include some reflections as you go along too, so that you have an immediate record of how you felt or viewed the events at the moment they unfolded. Indeed, on this subject, there can be said to be two main types of reflection, in: (1) reflections made during an event, and (2) reflections made after an event. So, you may need to decide which type of reflections you are going to focus on—but you will only be able to choose if you first know that you will be writing a reflective essay, before an event occurs. The bottom line is though, that the underlying point of writing a reflective essay is so that you can learn something about yourself, and about your field of study, by drawing on a practical experience.

reflection in nursing uk essay

How Do I Write a Reflective Essay?

Thinking About Tenses

As a result of talking about your personal experience, unlike traditional essays, which almost always use the third-person, a reflective essay will typically use the first-person style of writing (which means using the pronoun ‘I’ a lot, and talking from your own individual point of view). To clarify then, if you are not completely familiar with the third and first-person viewpoints, an example of a third-person and first-person account, is as follows:

THIRD PERSON: “Observations were made of the research participants, and notes were kept via a secure, password-protected, laptop computer”.

FIRST PERSON: “I made observations of the research participants, and I kept notes via a secure, password-protected, laptop computer”.  

This change in tense then, is the first clear distinction to be made between a traditional academic essay, and a reflective essay—so in order to write a reflective essay, you need to become adept at this first-person style of writing. Fortunately, though, most people find this first-person approach to writing much easier and more natural than the third-person viewpoint, so this should not be a major problem.

If you need help with your reflective writing then take a look at the reflective essay writing service at NursingAnswers.net.

Thinking About the Structure of Your Paper

Next, you need to think about the structure of your paper. A good reflective essay should describe an event or an experience, while it should also analyse what the experience means, and what you have learned from it. Simply by discussing and then analysing a past event, this in itself makes the piece reflective, by definition. However, there are various ways that you might go about this, from a structural point of view. For example, you might have a section that first briefly describes the experience or event, from your own point of view, before going on to an analysis section; or, you might decide to insert reflections and analyses as you go along, so that the reflective element is also contained within the description part—it’s up to you. In the end, there is no right or wrong answer, but the important thing is that you do include some significant reflective elements, and some analyses of the experience; otherwise, it is simply a descriptive piece, and not a reflective one. Therefore, the basic format of a reflective essay will be a standard: Introduction , Main Body , and Conclusion . However, as noted, you might split the main body into a distinct descriptive section and an analysis section, or you could merge the two.

  • Essay Structure 1: Introduction, Main Body, Conclusion
  • Essay Structure 2: Introduction, Description of Event, Analysis, Conclusion

Thus, if you choose to go with Essay Structure 1, then you will need to merge your description and reflective analysis, and you can do this by having a topic sentence (detailing this particular part of your experience), followed by some analysis and supporting details, and then by adding a paragraph-ending mini conclusion—and then you can follow this micro-structure within each proceeding paragraph in your Main Body. As such, in Essay Structure 1, each paragraph of your Main Body might look something like this:

  • Topic Sentence: Describe this part of your experience and what happened
  • Analysis and Supporting Details: Reflect upon this particular part of the experience (and try to explain it with the use of various theories, perspectives, or supporting evidence)
  • Paragraph-Ending Mini Conclusion: Round off the paragraph by making some conclusions based upon the reflections

However, for many people, Essay Structure 2 might be easier to handle, as by taking this approach, you can simply write a description of your experience in full, and then analyse everything, in more general terms, and pick out particular parts that you find especially interesting. In the end, the approach you take is very much a personal preference, and you should not be marked down by taking either approach—unless, of course, your assignment has specifically requested a particular structure from the outset.

You can find hundreds of example reflective essays at NursingAnswers.net

Thinking About the Tone of Your Reflective Essay

The tone of your reflective essay is also important, and should be formal in nature, without being overly academic, as you will be including your personal thoughts and feelings, which are subjective in nature. Thus, you can include academic elements, and the piece should be referenced like any other academic piece of work if you include in-text citations in the piece, but this should also be balanced by a more subjective and reflective approach, which should naturally come across if you are writing in the first-person. Just remember that this, ultimately, is an essay, and treat it as such. Moreover, it is also important to get this tone right from the outset, as first impressions matter. This can be refined with each proceeding draft though; so don’t worry too much if you’re not able to nail this down right from the start. Therefore, as you progress, you should start to get a feel for what is required, and you can then fine-tune this with further drafts.

What Are You Supposed to Learn From Writing a Reflective Essay?

By going through the process of writing a reflective essay, it is hoped that you will come to some deeper understanding of yourself, of your experience, and that you will develop some insights into what you might do better next time to achieve different results. Therefore, by reflecting upon your experience, and analysing it, you might begin to view the event through a different lens, and this might shape your future experience and thinking. As such, depending upon your field of study, such shifts in your thinking could be extremely important.

For example, if you are working in the field of social work, you might have had an experience with a difficult client, who has physically abused you, and this might have left you confused and questioning your career choice if you do not fully understand why they became violent. However, by reflecting more deeply upon the event, you may come to the conclusion that the client was not involved enough in their own care, and were removed from the decision-making process, making them feel impotent—which in turn led to them lashing out at what they perceived to be someone contributing to that impotence. Thus, in this particular situation, you may come to the conclusion that, if they have the capacity to do so, the client should have more involvement in the decision-making process in respect of their care in the future. As such, these kinds of reflective practices can lead to profound changes in the way that you conduct your work, and in how you think about certain situations.

In addition, by becoming more proficient at reflective writing, you will also become more adept at analysing what you have read, observed, or listened to, and this a skill that will come in useful in other areas of your work, as critical analysis is an important part of most academic writing. Moreover, you will also become more skilled at making connections between academic texts and theories, and your own experiences, which is useful in joining the dots between theory and practice. Thus, if you can make such connections, then you are more likely to be enthusiastic about studying such theories, as you will be more convinced about their application in the real world. Furthermore, you will also become more skilled at subjective writing too, which can come in useful from time to time, even in your academic writing. As an example, on a very simple level, a reflective piece could look something like this:

Title: “ A Reflective Account of Working in a Psychiatric Hospital”

Description: I worked at a psychiatric hospital for a period of six weeks, on a voluntary basis.

Reflection: I was surprised at the severity of some of the patients’ conditions and the level of burnout I experienced as a result of working with them.

As such, based upon this particular reflection, it might be concluded that the writer reflecting on this experience might no longer wish to pursue a career in mental health. Or, they might decide that they would be better suited towards low-level counselling work (such as in a school), rather than working with people with chronic and severe mental health conditions.

Of course, reflective essays are likely to be much more in-depth than this, with your assignment perhaps specifying a particular number of words for the piece, such as 1,500 words, or 3000 words, for example. If this is the case, then you are going to need to go into some considerable depth, and this will likely lead to further revelations as your analysis of your experience becomes more extensive, and as you add theories and different perspectives into the equation.

In the end though, the overall purpose of a reflective essay is for the writer of it to reflect upon their experience, and to ultimately learn something from it. What writing a reflective essay does then, is to help the writer to make sense of their experience, through some in-depth analysis of it, so that some valuable lessons can be learned, moving forwards. In order to achieve this, a number of frameworks have been created over the years, to help guide the writing process of a reflective essay, and so some of these should be considered before you start.

Reflective Frameworks That Can Be Drawn From

There are a number of theoretical frameworks that can be drawn from to construct your reflective essay, and two of the most well known are those of Kolb (1984) and Gibb (1988).

For more detailed guides on the various models of reflection take a look at our reflective models guide on NursingAnswers.net

Kolb’s (1984) ‘Learning Cycle’        

Kolb (1984) reflective framework is known as the ‘Learning Cycle’, and there are four stages to this, in: (1) the concrete experience (a description of the event or experience), (2) a reflective observation (a reflection of the experience, including what was done, and why), (3) an abstract conceptualisation (making conclusions from the experience), and (4) active experimentation (trying out whatever it is you have learned from the process). Thus, the key difference here is that you should not only learn from a reflective experience, but you should also put what you have learned into action. You should note that this framework closely resembles Essay Structure 1 , which we discussed above, with the addition of a more practical element for the final step. Thus, you could try out what you have learned in a practical setting, and then add the result of this into your conclusion section.

Gibb’s (1988) ‘Reflection Cycle’

In addition, Gibb (1988) also offers a ‘Reflection Cycle’, which represents an extension of the ideas of Kolb (1984), and provides two more stages to the four already proposed. This is perhaps currently the most well known and popular model used in reflective essays. Thus, this time, the six stages are: (1) description, (2) feelings, (3) evaluation, (4) analysis, (5) conclusions, and (6) action plan. Therefore, the description is fairly self-explanatory, and involves, again, a description of the events. Next, you are to document your feelings about the events, both during the event, and after it; and this should be followed by an evaluation of the experience, and what the pros and cons were, including the reactions by those present, and whether the situation changed in any way. The analysis section can then include pertinent literature, which has relevance with the event, and this will be followed by a conclusion, showing what was learned, and what could have been done differently. The action plan then details what you would do if the situation unfolded again, and what preparations you might go through prior to it. As such, these frameworks provide a useful structure to work from, and this could also be incorporated into the structure of your essay if you prefer, if you work better with a more formulaic approach. This then, more closely resembles Essay Structure 2 , detailed previously, with the analysis section being split into sections on feelings, evaluating these feelings, and then analysing the events, in addition to the action plan suggested by Kolb (1984). Furthermore, the idea with both of these ‘cycles’ is to then also reflect further upon the action plan that has been derived from the initial reflection, so that this process can become finely tuned over time, with further reflections, and can lead to some significant development in the individual (see Figure 1 ).

reflection in nursing uk essay

Figure 1. Gibbs’ ‘Reflective Cycle’ (Source: UKEssays.com )

Final Thoughts…

The reflective essay has become a staple of assessment in educational institutions around the world, and is particularly commonplace on university undergraduate or postgraduate courses—and so it is important to understand the ins and outs of such assessments, so that you are better prepared when you get handed such an assignment. If you can become familiar with the reflective cycles of Kolb (1984) and Gibb (1988), then you will have a good idea of what is expected of you when you receive one of these assignments, and you should be adept at writing in the first person, and in an formal tone, so that you can hit the mark with the kind of style you should be aiming for. There are a number of things that you should and shouldn’t be doing with this kind of essay, and you can refer back to this article, as a reminder, when you begin such an assignment. However, the main thing to remember, when doing such an assignment (in addition to striving to get a good grade!), is that you should be learning something about yourself from the process, and about your field of study. In the end, what your teacher wants to see is that you are reflecting upon your personal experiences, rather than just letting them pass you by, and that you are linking theory with practice, and gaining a deeper understanding of your experiences. If you can do this, and your writing is solid, written in the correct tense, and with the right tone, then you are almost certain to get the grade that you want.

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  • http://orcid.org/0000-0003-4308-4219 David Barrett 1 ,
  • http://orcid.org/0000-0003-2221-1573 Roberta Heale 2
  • 1 Faculty of Health Sciences , University of Hull , Hull , UK
  • 2 School of Nursing , Laurentian University , Sudbury , Ontario , Canada
  • Correspondence to Dr David Barrett, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, UK; D.I.Barrett{at}hull.ac.uk


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One of the characteristics of the COVID-19 pandemic is that much of what is published about it quickly becomes outdated. Such is the rate of change in the pandemic’s course—whether due to the roll-out of the vaccine program globally or the evolution of new variants—that the context in which articles are written may be very different by the time of publication.

Given that, it’s perhaps important to ‘time-stamp’ this editorial and outline the context at the time of writing. We’re writing this in the late summer of 2021; the UK is experiencing a third wave of the pandemic, while simultaneously removing almost all COVID-19 restrictions (such as limits on public gatherings), having fully vaccinated three-quarters of the adult population and partially vaccinated almost 9 out of 10 adults. Although there are differences, the situation is similar within other countries in Europe and North America, with vaccines seemingly weakening the link between infection, serious illness and death, thereby allowing for loosening of social restrictions.

Though the situation at the time you are reading this will no doubt be different, there are some things of which we can be sure. First, COVID-19 has already ‘ … killed millions, affected billions and cost trillions.’ 1 impacting all parts of the globe over a prolonged period. Second, the impact on healthcare services has been immense, whether through the acute pressures on hospital capacity during each wave of the pandemic, the need to redesign service delivery in order to …

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Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

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