429chapter NINETEEN
Enhancing the Doctoral Advanced
Practice Nursing Role With
Refl ective Practice
Graham Stew
By three methods we may learn wisdom: first, by reflection, which is the noblest; second
by imitation, which is the easiest; and third by experience, which is the bitterest.
— Confucius
This chapter is addressed to the advanced practice nurse (APN) studying at a doctoral
level, and it explores the concept of reflective practice and its relevance for you and your
work. This chapter examines definitions of reflective practice and how the art and sci-
ence of nursing can be combined with reflection to produce praxis— advanced nursing
practice based on scholarship, expertise, and critical thinking. The teaching of reflective
practice appears to be more predominant in nursing curricula outside of the United
States, and so some of these concepts may be new to you. However, this chapter hope-
fully reminds you that there is no end point to learning, and that reflection can support
further exploration of your practice.
■ WHAT IS REFLECTION AND REFLECTIVE PRACTICE?
The challenge for most writers in this field is to agree on a satisfactory definition of re-
flection, and the literature is full of worthy attempts. Despite differences in these texts
and the plethora of definitions, one dominant assumption among these writers is that
reflection is worthwhile and can enhance practice. In the context of learning, reflection is
a generic term for intellectual and affective activities in which individuals engage their
experience to create and clarify meaning in terms of self, which results in a changed
conceptual perspective (Boud, Keogh, & Walker, 1985). John Dewey (1938) summarized
the process: “we learn by doing and realizing what came of what we did” (p. 12). Is it
simply learning from experience?
Over the years, experienced nursing professionals like yourselves have devel-
oped practical knowledge and working intelligence as you made sense of your work