Duke and Appleton (2000) examined 160 nursing assignments in the context of a one year palliative care program. The development of reflective skills over time was assessed by a Wilcoxon paired signed-rank test on data from 51 students who took two modules in different terms during the year. The results suggested that reflective practice did develop over time. Students could readily provide descriptive information about their practice but found the analysis of knowledge and the context of care more difficult. Williams and Wessel (2004) reported evidence of development of reflective thinking in their analysis of 48 physical therapy students’ journal writing during an 8-week academic unit in a 24-month.
