1. Verklan, M. Terese PhD, CCNS, RNC, FAAN

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Like so many of you, I too am a "seasoned" nurse. My neonatal nursing career began in the early 80s when there was very little known about the high-risk infant. Computers were those huge machines sitting in very cooled areas that took up a warehouse of space. Because the age of miniaturization was still someone's dream, neonatal intensive care units fought hard to adapt adult equipment to meet the needs of its sick patients. No one thought of evidence-based practice-there was not any evidence to speak of. Practices were built on anecdotal evidence and trial and error. Because of concerns regarding patient outcomes, quality of care, costs of care, and efficiency, quality improvement and evidence-based practices should be abounding in our hospitals today.


Thus, I was somewhat surprised that the 2012 toolkit developed by the International Council of Nurses was Closing the Gap: From Evidence to Action1. Are nurses collectively not critiquing their practice, adding to the science, and enhancing practice? Perhaps, the burdens on our clinical time leave few moments to reflect on the actual care we are providing. The great majority of us have easy access to computers or personal digital assistants from which we can scour a library or Internet resources in search of the best evidence. Accurate information on a wide variety of topics can be found by retrieving information from The Cochrane Collaboration. More than 28 000 researchers from more than 100 countries work in partnership to construct systematic reviews on the state of the science for all healthcare areas.2 Also, an independent not-for-profit organization, the Joanna Briggs Institute, collaborates internationally to support the utilization of evidence to improve healthcare practices worldwide.3 While we make clinical decisions on the basis of the individual's clinical picture and our expertise and values/judgments, there needs to be room for incorporating research findings along with a critique of practice to promote clinical outcomes. Florence Nightingale has already led the way by demonstrating how data positively impact healthcare professionals, patients, the healthcare facility, and public policy.


One way to constructively examine our practice to facilitate learning may be through the use of Johns' model of reflection.4 The model was developed to provide a way for healthcare providers to discuss, using questions based on detailed reflection, information gained or used in the context of providing that care. In essence, the questions provide prompts or signals to assist the provider in making sense of the situation and learning from the experience (see Box 1).

Box 1 - Click to enlarge in new windowBox 1. Johns' model of reflection

Perinatal nursing is a subspecialty that is learned "on the job" as well as in advanced nursing programs. However, nurses with a degree less than a master's preparation come to us poorly prepared to deliver optimal perinatal care. By taking the time to reflect on practice, we may incorporate a better understanding of the evidence. As role models, preceptors, and providers of care, we can talk through the questions as we foster clinical learning experiences for these less experienced nurses and engage them in reflection of what they can do to enhance their practice and patient outcomes.


-M. Terese Verklan, PhD, CCNS, RNC, FAAN


Professor and Neonatal Clinical Nurse Specialist


University of Texas Medical Branch


School of Nursing and Graduate School of Biomedical Sciences


Galveston, Texas




1. International Council of Nurses. Closing the Gap: From Evidence to Action. Geneva, Switzerland: International Council of Nurses; 2012. [Context Link]


2. The Cochrane Library. Accessed June 1, 2012. [Context Link]


3. The Joanna Briggs Institute. Accessed June 1, 2012. [Context Link]


4. Johns C. Nuances of reflection. J Clin Nurs. 1994;3(2):71-74. [Context Link]