Critical Reflection

  • Larry PurnellEmail author


Critical reflection, sometimes referred to as cultural self-awareness, is a purposeful, vital, careful evaluation of one’s own values, beliefs, and cultural heritage in order to have an awareness of how these qualities can influence patient care. However, critical reflection goes beyond solely awareness by examining and critiquing the assumptions of one’s values and beliefs. It includes an examination of one’s own cultural values that have the potential to be in conflict with the values of others and, as a result, hinder therapeutic relationships and effective patient care outcomes. A number of models related to critical thinking are reviewed and include Dewey’s model of reflective learning, Habermas’s model of critical reflection, Kolb’s model of experiential learning, and feminist theory. In addition, recommendations for clinical practice, administration, education and training, and research are addressed. Tools to help practitioners assess their views and values related to bias are included as appendices.


  1. Akers M, Grover P (2017) What is emotional intelligence? Psych Central. Accessed 2 June 2017
  2. American Association of Colleges of Nursing (2006) Essentials of doctoral education in advanced practice nursing. Accessed 5 June 2017
  3. American Nurses Association (2015) Code of ethics for nurses with interpretive statements. Author, Silver SpringGoogle Scholar
  4. Andrews MM, Boyle JS (eds) (2016) Transcultural concepts and nursing care, 7th edn. Wolters Kluwer, PhiladelphiaGoogle Scholar
  5. Calvillo E, Clark L, Purnell L, Pacquiao D, Ballantyne J, Villaruel S (2009) Cultural competencies in health care: emerging changes in baccalaureate nursing education. J Transcult Nurs 20(2):137–145CrossRefPubMedGoogle Scholar
  6. Canadian Nurses Association (2010) Position statement: promoting cultural competence in nursing. Accessed 2 June 2017
  7. Carper BA (1978) Fundamental patterns of knowing in nursing. Adv Nurs Sci 1(1):13–23CrossRefGoogle Scholar
  8. Chinn P (2018) Critical theory and emancipatory knowing. In: Butts JB, Rich KL (eds) Philosophies and theories for advanced nursing practice. Jones & Bartlett LearningGoogle Scholar
  9. Chinn PL, Kramer MK (2015) Knowledge development in nursing theory and process, 9th edn. Elsevier, St. LouisGoogle Scholar
  10. Cholle FP (2011) What is intuition, and how do we use it? Accessed 2 June 2017
  11. Cuellar N (2017) Unconscious bias. What is yours? J Transcult Nurs 28(4):333CrossRefPubMedGoogle Scholar
  12. Dewey J (1933) How we think: a restatement on the relation of reflective thinking to the educative process. D.C. Health, New YorkGoogle Scholar
  13. Douglas M, Rosenketter M, Pacquiao D, Clark Callister L et al (2014) Guidelines for implementing culturally competent nursing care. J Transcult Nurs 25(2):109–221CrossRefPubMedGoogle Scholar
  14. Ghoshal RA, Lippard C, Ribas V, Muir K (2013) Beyond bigotry: teaching about unconscious prejudice. Teach Sociol 41(2):130–143. Accessed 11 July 2017CrossRefGoogle Scholar
  15. Goleman D (2005) Emotional intelligence: why it can matter more than IQ. Bloomsbury Publishing, LondonGoogle Scholar
  16. Hickson H (2011) Critical reflection: reflecting on learning to be reflective. Reflect Pract Interprof Multidiscip Perspect 12(6):829–839CrossRefGoogle Scholar
  17. How We Think: John Dewey on the Art of Reflection and Fruitful Curiosity in an Age of Instant Opinions and Information Overload (n.d.) Accessed 2 June 2017Google Scholar
  18. ICN Code of Ethics for Nurses (2012) Accessed 2 June 2017
  19. Johns C (1995) Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. J Adv Nurs 22:226–234CrossRefPubMedGoogle Scholar
  20. Mezirow J (1990) Fostering critical reflection in adulthood. Jossey-Bass, San FranciscoGoogle Scholar
  21. Miettinen R (2000) The concept of experiential learning and John Dewey’s theory of reflective thought and action. Int J Lifelong Educ 19(1):54–72. Accessed 7 June 2017CrossRefGoogle Scholar
  22. Purnell L, Salmond S (2013) Individual cultural competence and evidence-based practice. In: Purnell L (ed) Transcultural health care: a culturally competent approach, 4th edn. F.A. Davis, PhiladelphiaGoogle Scholar
  23. Rogers C (2002) Dewey’s model of reflective learning. Teach Coll Rec 104(4):842–866. file:///D:/dewey.pdf. Accessed 2 June 2017CrossRefGoogle Scholar
  24. Schon DA (2014) The theory of inquiry: Dewey’s legacy to education. Curric Inq 22(2):119–139. Accessed 2 June 2017CrossRefGoogle Scholar
  25. Sullivan-Marx EM (2013) The bear and the canyon: toward an understanding of personal leadership. Nurs Sci Q 26(4):373–375CrossRefPubMedGoogle Scholar
  26. The Critical Theory of Jurgen Habermas (n.d.) Accessed 4 June 2017
  27. Theory of Nursing Knowldege. Accessed March 10, 2018
  28. Timmins F (2006) Critical practice in nursing care: analysis, action and reflexivity. Nurs Stand 20:49–54CrossRefPubMedGoogle Scholar
  29. Tong R (2018) Feminist ethics: some applicable thought for advance practice nurses. In: Butts JB, Rich KL (eds) Philosophies and theories for advanced nursing practice. Jones & Bartlett LearningGoogle Scholar
  30. Ways of Knowing: Faith (2017) Accessed 3 June 2017
  31. Ways of Knowing: Theory of (2017) Accessed 2 June 2017

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of NursingUniversity of DelawareNewarkUSA
  2. 2.Florida International UniversityMiamiUSA
  3. 3.Excelsior CollegeAlbanyUSA

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