Reflective Writing as a Crucial Counterweight to Clinical Experience

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

Kevin V. Pxl/Flickr

Kevin V. Pxl/Flickr

When I first started working as a nurse, I didn’t write much. My shifts, twelve hours of chaos, weren’t stories to be told, just days to survive. I wrote only when, after a traumatic event surrounding a patient’s death, I felt like I didn’t know who I could talk to about it. I had always written in a journal, but I hadn’t really thought of writing as a tool for healing—I just knew that I felt better after banging on the keyboard a bit.

Other than this single instance, I didn’t make writing a regular practice during my first year of nursing—a choice I still regret. I covet all of those forgotten lessons, missed descriptors, and stories that I might use in my writing now, but mostly, I wish I had known that moving my pen on a piece of paper might’ve helped me heal from the consistent stress of my new work.

A few years ago, by then a relatively experienced ICU nurse as well as a graduate student, I took a class called, “Writing, Communication, & Healing.” Taught by a poet and health care journalist, Joy Jacobson, it came at a time when I needed to learn how to write—for me, that is. I wrote for professors and for blogs; I even scribbled in a journal before sleeping each night. But during that semester I learned—in both practical and theoretical terms—the benefits of writing for my own healing through a technique called reflective, or expressive, writing.

In class, we focused on the research of James W. Pennebaker, who has studied the beneficial effects that this particular type of writing has on writers’ health, behavior, and emotional stability. His work spans many disciplines, and is a frequent topic in mainstream media; it is also easy and cost-effective to implement, and has been used in problem-based learning curriculums, and quality improvement projects.

I began my practice of reflective writing in this class. Now, after almost a decade of care, and three years of graduate study, I write regularly about my work. Many of my words make it out to others, but each night, I practice ten minutes of reflective scribbling—for me. I do it for memory, but mostly for healing and for processing my work as a nurse.

The practice of reflective writing is simple and focuses on understanding events, both traumatic and ordinary. In her book, which was one of my class textbooks, Writing As a Way of Healing: How Telling Our Stories Transforms Our Lives, writer Louise DeSalvo gives concrete steps on channeling reflection and narrative towards health. By “linking feelings to events,” particularly when dealing with trauma, we allow ourselves to tell a complete story and understand what we may have learned from our pain.

Pennebaker and other researchers suggest writing about something that you might describe as the most traumatic event in your life, or just about an event that you can’t seem to get out of your thoughts. But your reflection doesn’t have to focus only on negative experiences; you might write about a dream, or even an action that you’ve been procrastinating on.

Whatever topic you decide to write reflectively about, it is important to practice consistently and carefully. Many experts in reflective narrative offer very simple instructions, all cautioning that initial feelings after writing might bring temporary feelings of sadness or depression and that pacing yourself in the practice is important.

During my first experience using reflective writing, I focused on a recent stressful experience in my personal life that was taking up the majority of my waking thoughts. My professor gave me the following steps, directly from Pennebaker’s research tool:

Find a time and place where you won’t be disturbed. Ideally, pick a time at the end of your workday or before you go to bed.

Promise yourself that you will write for a minimum of 15 minutes a day for at least 3 or 4 consecutive days.

Once you begin writing, write continuously. Don’t worry about spelling or grammar. If you run out of things to write about, just repeat what you have already written.

You can write longhand or you can type on a computer. If you are unable to write, you can also talk into a tape recorder.

You can write about the same thing on all 3-4 days of writing or you can write about something different each day. It is entirely up to you.

I’ve used reflective writing to process job changes, life events, personal triumphs and failures, and general growth. My evening ritual helps me organize story ideas, as well as things that have stayed on my mind throughout the day. In a typed-and-texted world full of performance and measurements, the simple act of pushing a pen across a paper brings a sense of calming closure to my worries and work.

Having learned reflective writing’s benefit to nurses, I started an event last year called the Bedpan Confessionals, a literary reading of nurse narrative, sponsored by the Nurses Writing Project at Hunter-Bellevue School of Nursing. One aim is to help the public understand what nurses do at the bedside. But my deeper, more passionate goal is to promote reflective writing in nurses, and in doing so, the mental health of our profession.

The event will be broadcast on WBAI Radio NYC, and all narratives will be published on HealthCetera, the blog of the Center for Health, Media & Policy, or submitted to the publication of each writer’s choosing with the assistance of the Nurses Writing Project.

(For those in New York City, here’s info on attending: October 9, 2015, 7:30-9:30 PM, the Organic Soul Café, Sixth Street Community Center. bit.ly/bedpan2015.)

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About the Author:

I'm a nurse with a critical care background who works in administration in Manhattan. My blog is This Nurse Wonders. I also blog for Off the Charts and Healthcetera, and tweet as @ajandersonrn.

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