Writing reflective accounts that are worth reading

Amara Reflective accounts. I have read a lot of these and most of them are, honestly, quite bad.

Nadia They are, and it is not because the nurses writing them are bad nurses. It is because nobody ever showed them what a good one looks like.

Amara What does the form actually ask?

Nadia Four things. What the CPD, feedback or event was. What you learned from it. How you changed or improved your practice as a result. And how it relates to the Code.

Amara And which one do people skip?

Nadia The third one. Every time. How you changed your practice. A reflection with no change in it has not finished, and that is the commonest reason a confirmer sends one back.

Amara Give me a test I can apply to my own writing.

Nadia Could a reader name one thing you now do differently? If they could not, you have not finished. That is it. One sentence, and it will improve every account you ever write.

Amara You mentioned there are typical ways these go wrong.

Nadia Three, and everybody recognises themselves in one of them. The first is the diary entry. Beautifully detailed account of what happened. Two pages. No analysis, no change. It reads like a handover, not a reflection.

Amara The second?

Nadia The confession. This is the one that worries me most. The writer treats reflection as penance. Lots of guilt, lots of apology, I felt terrible, I should have known better. And still no change.

Amara But surely feeling bad about a mistake is appropriate?

Nadia Feeling it, yes. Writing a portfolio of it, no. Guilt is not learning. And a confirmer reading five accounts of self flagellation is not reassured, they are concerned about you. Which is a fair reaction, incidentally.

Amara And the third?

Nadia The whitewash. Everything went perfectly, the team worked well together, and the learning was that communication is important. Safe, empty, tells the reader nothing at all.

Amara One correction for all three?

Nadia Yes. Spend most of your words on what you now do differently, and be specific enough that somebody could check whether you were doing it.

Amara What should I choose to reflect on? I assume something that went wrong.

Nadia Not necessarily, and this is underused. The NMC explicitly invite reflection on things that went well. Understanding why something worked is more transferable than understanding why something failed.

Amara Give me some strong candidates.

Nadia A piece of feedback that stung and turned out to be right. A guideline change that altered your practice. A difficult conversation with a family that you handled better than you expected. A near miss you caught. A study day that changed one specific technique. And a complaint, whether or not it was upheld.

Amara Last part. Linking to the Code. This is where they all go vague.

Nadia Because people name a theme and think that is the link. This relates to preserve safety. That is a citation, not a link.

Amara So what is a real one?

Nadia Name the specific behaviour and show it. Listen to the difference. This relates to preserve safety, because I had assumed a colleague had escalated and I had not checked. I now state explicitly who is escalating and by when, and I ask them to say it back to confirm.

Amara The second one demonstrates the theme instead of quoting it.

Nadia Exactly. And it is shorter than the padding people usually write. Specificity is not more work. It is less.