Every shift brings experiences that can teach us something: a patient who deteriorated, a difficult conversation, a medication near-miss, a moment of excellent teamwork. Reflective practice is the structured process of thinking about these experiences to learn and improve. Many regulators, including the UK’s Nursing and Midwifery Council (NMC), require written reflective accounts as part of revalidation, and reflection appears in many exams and interviews abroad.
Gibbs’ reflective cycle (1988)
- Description: What happened? (Facts, briefly.)
- Feelings: What were you thinking and feeling?
- Evaluation: What was good and bad about the experience?
- Analysis: Why did it happen that way? What does theory, evidence or policy say?
- Conclusion: What else could you have done? What have you learned?
- Action plan: What will you do differently next time?
Worked example
Description: During a night shift, I recorded observations for an older patient admitted with a urinary infection. Her NEWS2 score rose from 2 to 5 over four hours. I informed the nurse in charge but delayed calling the doctor because the ward was busy.
Feelings: I felt anxious and unsure whether I was overreacting. I worried about disturbing the busy on-call doctor.
Evaluation: I correctly recognised the rising score and informed a senior. However, escalation to the doctor was delayed by about 45 minutes.
Analysis: NEWS2 guidance recommends urgent review for a score of 5 or more. Delays in escalation are a recognised contributor to harm from sepsis. Workload and hierarchy can inhibit escalation, and structured tools such as SBAR support clear communication.
Conclusion: I should have escalated directly according to the escalation policy. I learned that following the protocol protects patients and isn’t “bothering” colleagues.
Action plan: I will follow the NEWS2 escalation pathway promptly, use SBAR when calling, and have completed sepsis update training.
Other models
- Driscoll’s “What? So what? Now what?”: simple and quick.
- Johns’ model: more detailed, exploring ethics and personal knowing.
- Kolb’s learning cycle.
Confidentiality
Never include information that could identify patients, colleagues or the organisation, including names, dates of birth, exact dates combined with rare conditions, or photographs.
Tips for NMC revalidation
- The NMC requires five written reflective accounts over three years, each linked to CPD, feedback or practice, and to the NMC Code. Use the official form.
- Have a reflective discussion with another NMC registrant.
- Reflections can be about positive experiences too.
- Keep a reflection notebook throughout the year rather than rushing at the end.
See our NMC revalidation guide.
Based on Gibbs (1988) Learning by Doing, NMC revalidation guidance and reflective practice literature. Educational content.