Objectives
Evaluate the impact of reflective writing on the critical thinking, clinical decision-making, empathy, and communication skills of nursing students and nurses, and their usage experience.
Design
Mixed method systematic review.
Data sources
Nine databases (PubMed, EMBASE, Cochrane Library, CINAHL, Scopus, Web of Science, CBMdisc, CNKI, Wangfang) and reference lists were searched from database inception to April 22, 2025.
Review methods
Qualitative, quantitative, and mixed-methods studies were included. The Mixed Methods Appraisal Tool was used to evaluate the quality of the included primary studies. A convergent segregated approach was followed to synthesize qualitative and quantitative evidence. Reporting followed the PRISMA guidelines.
Results
A total of 55 studies were included (29 quantitative, 23 qualitative, 3 mixed-method). Meta-analysis of the quantitative data indicated that reflective writing significantly enhances critical thinking (SMD = 1.03, 95 % CI: 0.68–1.38), clinical decision-making (SMD = 1.98, 95 % CI: 0.56–3.39), empathy (SMD = 0.43, 95 % CI: 0.17–0.69), and communication skills (SMD = 1.57, 95 % CI: 0.41–2.74) among nursing students and nurses. These findings must be interpreted with caution due to limited data volume and study quality. The qualitative data yielded four syntheses across 16 subcategories, elucidating how reflective writing promotes the development of critical thinking, clinical decision-making, empathy, and communication skills, as well as the experiences of nursing students and nurses in utilizing reflective writing. Furthermore, the integrated results emphasize that reflective writing is an educational strategy with significant potential, which can be integrated into nursing curricula and clinical practice.
Conclusion
This review confirms that reflective writing is beneficial to the core competence development and professional growth of nursing students and nurses, emphasizing that nursing educators need to provide personalized, continuous feedback and systematic support when implementing it. Future research should explore factors hindering its use as a lifelong learning tool.
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