Utilization of Reflective Practice by Nurses Working in the Critical Care Units at Kenyatta National Hospital, Nairobi City County, Kenya
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Date
2025-10
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Kenyatta University
Abstract
This study investigated the utilization of reflective practice among Critical Care Nurses (CCNs) at Kenyatta National Hospital (KNH) to address its inconsistent implementation despite its recognized benefits. Using a quantitative cross-sectional design in March 2021, data were collected from 154 CCNs via a structured questionnaire. The study aimed to determine the level of reflective practice utilization, nurses' perceptions, and the influence of nurse characteristics and facility-related factors. Data analysis, performed using SPSS version 25.0, involved logistic regression and Chi-square tests. Key findings revealed that 51.3% of respondents held a higher diploma in CCN, and 68.2% lacked formal reflective practice training; however, formal training significantly increased utilization (92.6% of trained nurses vs. 47% of untrained). While nurses aged 50 and above had a lower utilization rate (42.9%), age showed no statistically significant relationship with reflective practice utilization. Most respondents (64.5%) were familiar with at least one reflective model, with Gibbs' model being the most common (67.2%). Higher qualifications (BScN/MScN) and a perception of improved nursing practice due to reflection (68.2%) correlated with greater utilization. Identified barriers included a lack of designated reflection spaces (88.2%), unsupportive institutional policies (76.3%), insufficient training opportunities (80.8%), and workload-related obstacles (68.7%). Logistic regression indicated that nurses who perceived practice improvement due to reflection were 2.123 times more likely to utilize it (p=0.062). The presence of a designated reflection space was strongly associated with utilization (OR = 6.487), although this was not statistically significant (p=0.95). Additionally, a perception of being free from victimization or negative institutional influence was associated with higher odds of utilization (OR = 1.968, p=0.072), suggesting that a psychologically safe environment encourages reflective behaviours. The study concludes that reflective practice is vital for professional nursing, emphasizing the critical importance of formal training, supportive institutional policies, and dedicated reflection spaces to enhance utilization among KNH CCNs. Recommendations include implementing tailored training programs in reflective practice models and allocating protected time for reflection during shifts, integrating it into routine clinical schedules
Description
A Thesis Submitted in Partial Fulfilment of the Requirements for the Award of the Degree of Master of Science in Nursing (Critical Care), in the School of Health Sciences of Kenyatta University, October, 2025
Supervisor:
1.Sarah Bett