439chapter NINETEEN
Refl ective Response
Rosalie O. Mainous
Reflection should be a component of nursing curricula at all levels of nursing practice,
but it is also essential for doctorally prepared advanced practice nurses. As expert cli-
nicians, consumers of research, and skilled in evidence- based practice, those with the
professional practice doctorate must utilize reflection to bring together what is known,
what is clinically relevant, and what can be improved on.
The author identifies several key components of reflective practice. First, the
unlearning of old ways of doing to allow for a new paradigm to emerge is critical.
Those who are pursuing a doctorate in nursing practice must examine the “old” prac-
tice and apply a new skill set, while reflecting upon progress towards improved patient
outcomes. Self- awareness is also necessary; as we are self- aware, we are cognizant of
our strengths and weaknesses in any given situation. Mindfulness, that is being in the
moment and totally present to the clinical scenario faced, is taking on an increasingly
important role. Johns’s model of structured reflection (Exhibit 19.1) clearly demon-
strates the connections among self- awareness, mindfulness, and the “unpacking” of
knowledge understood.
The author describes the way most new knowledge reaches the bedside. It has
been driven by the work of theorists and researchers, moving from the general to the
specific with the generation of middle range theories. These theories are then tested
clinically, and may be altered or give rise to new theoretical constructs. Generation of
new knowledge has indeed been unidirectional. However, while many theories are
developed in a practice vacuum, there is great support for a new model whereby new
knowledge and translational work is performed by interprofessional teams that include
clinical researchers, practicing clinicians, and a cadre of scientists from a variety of disci-
plines. The theory– practice gap, which continues to exist, is due in part to the underuse
of new knowledge and the slow translation of science to the bedside. The author makes
the point that much of the work generated by the PhD, or those with research doctorates
(one step removed from the clinical setting), contributes to the gap as the knowledge
generated is not easily used at the bedside. Reduction of this theory– practice gap is
now a national priority. When teams are formulated with Doctors of Nursing Practice
(DNPs) and PhDs, the researchers (PhDs) trained in specific research methodologies
together with expert practitioners (DNPs) pose a clinical question for testing; practitio-
ners test the theory utilizing a researcher formulated design in the clinical setting and