Similar to the physician studies, nurses described an anticipatory or pre-reflection, occurring before an activity, as central to their practice. They also described reflection both ‘‘in’’ their practice and ‘‘on’’ it. Participants reflected on ethical considerations, on situa- tions that required courage and novel situations requiring creative approaches. They reported guidance and supervision as key to reflection. Teekman (2000) studied ten registered nurses, and analyzed ten non-routine nursing situations for the presence of reflective thinking. In complex situations, reflection included a variety of cognitive activities, framing and self-questioning. Supervision was a key factor. Teekman identified three hierarchical levels of reflection: reflective thinking-for- action (what to do here and now);.
