Experienced nurses in this study described how using self-reflection to cope with stress and burnout occurs less in the clinical setting and more when they experience solitude or when they are driving home from work. Participants reported the privacy of an office or being in one’s vehicle as an ideal time and place for genuine self-reflection. Melissa remarked, “You have to find what works for you. We’re all different personalities, and we all have different personal situations growing up that contribute to reflecting on how you cope with a situation” (personal communication, September 2, 2018). Despite the difficulties of using self-reflective practices in the clinical setting, experienced nurses use reflection in a way that works well for them. Five of the six participants mentioned the experience of a nurse-centric reflective practice that began as they walked to their vehicles, entered, and closed the doors. Being alone in a vehicle made the nurses feel safe enough to release their emotions and be true to expressing whatever feelings they suppressed during their shifts. The nurses in this study described the necessity of using self- reflective practices after their shifts ended because they had more time and desire to fully process their feelings and emotions in a safe environment. All nurses, except Amanda who lived
approximately five minutes away from work, described an experience of using self-reflection in vehicles and during the drive home. Beth added:
Whenever I commute and I’m driving, my mind is thinking about things and how I can always improve it or make it better. No one else is there to distract me. I mean except the traffic on the road but I’m driving and I’m alone with my thoughts. That’s where I do
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most of my self-reflecting . . . . When I’m in the car, I have more time to really stop and think about what happened. It’s an uninterrupted 30 minutes of thought. So yeah, I can be deeper. (personal communication, November 29, 2018)
For Beth, driving home was a chance to truly self-reflect. Processing emotions that were
normally hidden away in the clinical setting were exposed in self-reflection as nurses got in their vehicles and began to drive further away from the hospital. Lucy reported:
There will be times I remember we’d lose a patient and on that drive home . . . . Even though I might be stellar at work, you get in that car and those tears come down and I think, okay, I did the best I could. So reflective, the meaning of it is, it’s helpful for me. It’s a release, that venting, talking, that’s one way of releasing it. (personal
communication, October 8, 2018) Emily described a similar experience:
When I drive home, I go over the day in my mind. That’s when I’m able to rehash. That’s when I find myself trying to figure out, what could have been different? What could I have done different? What can I do tomorrow when I go back? (personal communication, September 27, 2018)
Emily said driving home and being encapsulated in her vehicle is a time when she does most of her reflective thinking. Similarly, when Nicole does not have a chance to use self-reflective practices after experiencing the death of one of her patients, she has learned to use the time in her vehicle as a moment to reflect and process her feelings. Nicole stated, “If I can’t, I’ll do it on my drive. I love my drive in the car. It’s probably the most therapeutic time of the day for me” (personal communication, November 16, 2018). Even the type of vehicles or individual routes
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they routinely take to get home give nurses the opportunity to be genuine. Melissa, who has 18 years of clinical experience, stated:
When you go from the hospital to home it’s the true me, raw, no filter. Whatever I feel at that time is when it comes out or if it’s crying or I’m just thinking about the day. Or if I’m so mad and angry that I hit my steering wheel. You just go. I have made it home and gone back in and drove around. I enjoy driving and drive more to finish my anger or frustration. Then, come back and usually go to bed and sleep. (personal communication, October 28, 2018)
Self-reflective practice that occurs away from the clinical setting appears helpful for experienced nurses to feel they are true versions of themselves. In conjunction with using self-reflective practices in the clinical setting, participants in this study described using self-reflective practices when they leave the medical environment and drive away. The essence of using self-reflective practices means learning about who you are as a nurse plus who you are as an individual.
Findings of this qualitative study indicate experienced pediatric oncology nurses with at least 10 or more years of bedside experience use self-reflection in the clinical setting to the extent possible given their busy work environment. Self-reflective practice enables nurses to learn about themselves by relating with others, by thinking about how to care for their patients, or by providing support for colleagues who are showing signs of distress. The main challenge experienced nurses face in the clinical setting is having limited time on the unit to fully engage in using a nurse-centric reflective practice. Experienced nurses described using a nurse-centric reflective practice during moments when they could process thoughts and feelings with adequate time. Additionally, participants appreciate their down time and value the moments when they are left alone with their reflective thoughts. Authentically using a self-reflective practice is a
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phenomenon that nurses experience to a greater extent when they are away from the clinical setting. During moments of solitude, experienced pediatric oncology nurses reflect less on their professional roles and more on their abilities to relate with patients, families, and themselves. Experienced pediatric oncology nurses in this study described their self-reflective practices as a continuous process that moves in a medium between the clinical setting and one’s private life. I discuss these findings in further detail in Chapter 5.
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CHAPTER FIVE – DISCUSSION
My aim for this study was achieved through the analysis of the interview transcripts, which the experienced nurses shared. The influence of self-reflection on each participant’s wellbeing was described. Using self-reflection to process and manage the emotional demands of the workplace occurred when participants were reflecting with other colleagues, when they were away from the clinical environment (e.g., being in a private office), or during the drive home from work. Being reflective with colleagues or reflecting away from the clinical environment helped participants to process their feelings candidly and with enough time. I explored these findings using an inductive approach to understanding how expert-level nurses with 10 or more years of experience described using self-reflective practices in the clinical setting.
In this chapter, I discuss the meaning of the results and embed the findings in the context of the relevant literature. Moustakas (1994) described how developing a “summary section of transcendental phenomenological research” (p. 156) is important and necessary to effectively disseminate findings of a study and provide some opportunities for transferability. To provide a summary of this phenomenological investigation, I arranged Chapter 5 in three sections. In Section 1, I discuss a summary of the entire research project. I provide a detailed discussion of the phenomenon of using self-reflective practices according to the main objectives of this
qualitative investigation in Section 2. Additionally, I compare the results of this study to previous research literature. In Section 3, I share information pertaining to (a) the implications for nursing education, nursing practice, and nursing leadership; (b) the significance and transferability of the study; (c) directions for future research; and (d) the limitations of the study, which will be
followed by (e) the conclusion of the chapter. I begin the following section with a brief summary of the previous chapters.
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