Enhancing nursing students’ reflection through Padlet: an action research

Background Reflective practice is encouraged amongst healthcare students, including nursing students. However, students do not have a ‘safe space’ to practice reflection before being assessed. Padlet is an interactive platform that can potentially facilitate students’ reflection via its features that enables anonymous participation, asynchronous participation and collaborative learning environment. This study aims to explore the influence of current reflection teaching method on students’ reflective practice and how Padlet can facilitate students’ reflective practice. Methods An action research was undertaken with 22 first year nursing students from Feb to May 2023. Participants answered questions anonymously pre-class and post-class in two Padlet boards. The researcher gave constructive feedback and signposted good examples of reflection to participants thus enabling ‘champion’ students to emerge during the process. Anonymous texts from two Padlet boards were analysed using reflexive thematic analysis technique. Results Three themes were generated: i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers. Students joined the study with different presumptions and understanding of reflection, ranging from descriptive understanding of the concept, a total misunderstanding of the concept and in-depth understanding of reflection. They all indicated a changed understanding of reflection post-class and emphasized the benefits of a socially constructed learning process. Participants suggested the use of reflective tools (via reflective models) and triggers (via probing questions and feedback) as useful to facilitate their reflection. Conclusions This study indicates that the current teaching materials enable students to enhance their understanding of reflection. Nevertheless, students could potentially benefit from tools and triggers that will initiate and support their reflection. To that end, Padlet proves a promising tool to enhance students’ reflection via its function to enable anonymity, asynchronous participation and socially constructed learning environment.


Introduction
Reflection is a metacognitive skill that facilitates lifelong learning as well as professional competencies [1][2][3] .Reflection is encouraged via reflective practice to continuously enhance individuals' capacity to reflect 3 .Reflective practice is encouraged amongst healthcare students since it can enhance students' metacognition which will lead to better learning outcomes, satisfaction with their learning and better long-term professional performances 1,4 .Moreover, reflective practice increases students' self-awareness and long-term professional self-development 5 .In the UK, the Nursing and Midwifery Council suggests the continuous use of reflective practice as one of the strategies to sustain and improve nurses' professional competence 6 .Consequently, it is beneficial to enhance and foster the reflective practice process for nursing students.
It is challenging to teach reflective practice to students and appropriately determine their capability to reflect: First, reflective practice is a complex activity which can be taught and demonstrated in various forms such as verbally or in writing.Reflective practice can also happen in various contexts such as at bedside between students and patient, in a lecture hall or small group discussion 1,7,8 .However, the assessment tends to focus on students' capability to demonstrate their reflective practice in writing.This is problematic because it is challenging to differentiate the students who need more support on their externalisation i.e. their 'writing skills' and students who need more support on internalisation i.e., 'reflection skills' 5,8,9 .Second, reflective practice is often positioned as an individual activity; the notion of group reflection, social interactions and their impact on individuals reflection skills tend to be undervalued 1,7,8 .Third, writing is often a complex activity.Students need to organise and develop ideas and information while using the accurate vocabulary to deliver their ideas without ambiguity 10 .As such, without an appropriate examples nor peer-support and scaffolding, students may not be aware of the quality of their writing.
Given that students are incentivised to have good grades, they might emulate certain phrases to emulate reflections to achieve that 11 .This is challenging to ascertain if students were actually reflecting or became a 'reflective zombie' who 'displays all the outer traits of reflection, without having actually reflected' (de la Croix and Veen, 2018, p. 394).To investigate these overlapping issues further, it is appropriate to determine how the current teaching method and delivery have influenced students' reflective practice skill in writing.This will be explored via the use of Padlet.This study aims to explore the influence of current reflection method and materials on students' reflective practice and how Padlet can facilitate students' reflective practice.
The research question is: How can Padlet facilitates students capability to demonstrate their reflective writing before and after the reflection teaching session?

Context
The School where this study was undertaken has several undergraduate nursing programmes: The Ordinary degree, Honours degree and Master degree.Despite various training duration and background, all students will study similar modules in their first year, including the Professional and Academic Skills and Knowledge 1 (PASK 1) module.Currently, reflective practice has been introduced to all students as a part of the PASK1 module and has one designated week for teaching activities related to reflection.
The reflection teaching week partly addressed two intended learning outcomes of the PASK1 module.That is, upon completion of the module, students will be able to: 3. Demonstrate understanding of the need for different academic and professional skills, including professional communication, documentation and person-centred care.

Discuss professionalism in the context of being a nursing student
By the end of the week, students should be able to: • define reflection • understand the role of reflection in professional learning • introduce the idea of reflective practice • be able to distinguish between reflection and reflective practice • discuss the role of reflective practice in improving professional effectiveness Students have access to asynchronous learning materials two weeks prior to the class which consists of reading materials, introduction videos to reflection and probing questions posted in discussion board.Asynchronous study materials included three YouTube videos which focus on reflective practice, reflective writing and critical reflection reading materials on reflective practice, guide to reflective writing and a peer-reviewed rapid review discussing reflective practice in crisis situations.
During the designated teaching week of reflection, students joined smaller 90-minutes group tutorials (30-35 students per group) and participated in two group activities.Students were split into smaller groups.The first activity focused on writing and their reflective accounts.Written examples were provided along with explanation of which examples were considered reflective writing.The second activity was based on students' recent clinical placement experiences.Guidance and probing questions were provided to enable them to reflect on their experiences.After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development.
The researcher noticed from his marking in this module in the past few years that students' performance regarding their reflective writing was hugely variable.Students who underperformed or failed tended to recite the contents that they deemed appropriate with almost no reflection or produced an incoherent piece of writing.As such, it is unclear if they need further support for their externalisation or internalisation.Conversely, top performers can eloquently reflect in writing yet it is not possible to ascertain if they actually reflect or are one of the 'reflective zombies'; this led to the conception of the study.

Methods
This study utilises social constructionist research paradigm; truths and knowledge are socially constructed and there exist multiple realities 12,13 .As such, students will co-construct their learning through their interactions with each other.The focus of the study was on writing activities since the majority of student' assessments will be via their writing.Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing.Padlet was chosen as a platform to support and scaffold this socially constructed reflective learning process.
Padlet is a platform that allows users to interactively participate in virtual walls and the contents that are posted there 14 .
The platform has been widely used in education with both undergraduate and postgraduate students from various fields due to several advantages 10,[15][16][17][18][19][20] .For this study, the benefits of Padlet include anonymity 17,18 which enhanced students' learning process without any fear of repercussion or from asking 'stupid question' 20,21 .Next, Padlet enables asynchronous engagement, meaning that students can choose their preferred time and location to study the materials thus fostering a more inclusive learning environment.Moreover, Padlet promotes a supportive and collaborative learning environment for students 16,17,21 .Students can learn from the responses of their peers thus improving their own understanding of the subject.
Finally, Padlet is the most appropriate platform currently available at the university that will allow students to develop their reflection skills.It is the only tool that provides a non-threatening, anonymous and inclusive learning space.The process of group learning within Padlet will enhance students' group reflective practice as they gain insights from others' answers.Students can learn from their 'mistake' and identify 'ideal answers' from their peers.This process should, subsequently, enhance students' individual reflective practice 1,5 .Table 1 summarises the benefits of Padlet over other learning tools within the university.
Action Research (AR) approach was utilised under this social constructionist research paradigm.AR is a cyclical approach for researchers to evaluate and investigate their works which often lead to tangible actions from the research within the higher education contexts 22,23 .During the study conception stage, the researcher asked the PASK 1 module lead as well as the School's programme leads regarding the justification and relevancy of this project; all agreed with the justification of this project as well as the use of Padlet.Students were contacted via the year representative regarding their opinions of the project; none replied.
The study gained an ethical approval from the Skills Hub Research Ethics Committee in December 2022.Convenience sampling technique 24 was used to recruit first year nursing students in the academic year 22-23.An advert about the study was circulated via email by an administrator team member to the first year students to ensure that they were not coerced to join the study and that the participation was voluntary.Participants information sheets and informed consent forms were sent to students who were interested to participate via emails.Those who consented to join the study were provided instructions on how to use Padlet boards along with the link to the first Padlet board before the reflection teaching week.Guided questions were posted on the first Padlet board to facilitate participants' answers and determine their pre-class understanding of reflection (see Extended data for the questions asked 25 ).Participants then wrote their answers anonymously and could edit their answers as often as they preferred.The pre-class board became a read-only board once the teaching week of the introduction to reflective practice commenced.
Participants were encouraged to engage with the asynchronous materials provided within the PASK1 module and attended the face-to-face tutorial sessions before they proceeded with this study.The link to the second Padlet board was sent to participants once the reflection teaching week finished.Guided questions were also posted on the second Padlet board to determine participants' understanding of reflection post-class.
The researcher provided constructive feedback to students' answers and asked them to expand unclear answers as necessary; they had no obligation to reply.Ideal, constructive reflective answers were 'liked' to enable champions to emerge from this process and signposted good examples of reflective practice to other students.No new insights were generated after fourteen participants wrote their answers.

Ethics
The study gained an ethical approval from the ethical committee in the University.Written informed consent were sought before the data generation process.

Data analysis process
Anonymised pre-class texts and post-class texts were uploaded into Atlas.Ti.The researcher analysed the texts using Reflexive Thematic Analysis approach 26 .The analytical process involved six recursive phases: • Familiarising myself with the dataset o Texts in both padlet boards were read and reread along with written memos to interpret what participants expressed (semantic meaning) or wanted to express (latent meaning).
• Coding o Initial codes from the texts were coded and compared to Gibb's six stages of reflective cycle: Description; Feelings; Evaluation; Analysis; Conclusion and Action plan 1,27 .
• Generating initial themes o Initial themes were developed and analysed deductively, linking to Gibb's reflective cycle.This model was chosen to determine the students' reflective practice skill pre-class and post-class since it is one of the two recommended reflection models for nursing students and has been widely used in education due to its practicality to ascertain healthcare students' capability to reflect 1 .
• Developing and reviewing themes o Themes were reread and examined for additional insights.
• Refining, defining and naming themes o Themes were revised to make them more meaningful.During this stage, the initial themes -based on Gibb's reflective cycle -were unable to meaningfully capture the findings nor fully answered the research question.Consequently, all themes were refined to make them more reflective to the findings.

Researcher reflexivity
The researcher is a family doctor (general practitioner) and have been working as a lecturer for more than 10 years.His research and teaching focus are medical education and experiential learning.He teaches the concept of reflection regularly with healthcare students including medical students, nursing students, and beyond in both undergraduate and postgraduate levels thus have a good understanding of the concept.This study was conducted as a part of the professional development that the researcher undertook.The use of Padlet to facilitate students' reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1).Moreover, the researcher is a team member of the PASK1 module.He is involved with the design of weekly teaching methods, teaching materials and marking.He also led some of the small group tutorials.Consequently, he positioned himself as an 'insider' due to these backgrounds as well as his current position as a lecturer at the university.This variable understanding might be partially explained by the diverse background of the first-year students which included mature students, students who already have a university degree or students who joined the nursing programme right after they had finished their schools.As such, they all would have different exposure and experiences around reflection.

From
Unfortunately, the teaching materials provided were prepared with an implicit assumption that that students would have a similar understanding of reflection.This is problematic since the existing teaching materials may not be fully useful to students who already have some understanding of the concept.Nevertheless, all participants expressed similar expectation that they would have a different understanding of reflection post-class.

Co-constructed understanding of reflection
The majority of participants (14/16) expressed positive feedback in relation to the use of Padlet to facilitate their learning of reflection.Two advantages were indicated by participants.They preferred the asynchronous element of Padlet and seemed to allow them to be more engaged with the process: 'I like that you can take your time to put your ideas down.' The benefits of anonymity and confidentiality in Padlet were also suggested: '…Padlets provide a good platform of confidentiality, anonymity and willingness to share.For learning and understanding reflection, it compliments the class and learning materials, and reading answers and feedback to responses has helped contribute to my understanding.' Furthermore, all participants expressed a different understanding of reflection post-class; that is, they understood that reflection could happen in any situations and that they could reflect from non-negative experiences as well as how to ensure similar outcomes.This finding differed from the first theme since most participants indicated that they tended to 'ignore' their feelings when they reflect or focus mainly on negative experiences.The majority of participants also suggested how they had learnt through others' answers thus indicating the co-constructed learning element within Padlet boards: '…I agree with a couple of the other comments.I saw reflection as something which is done after a negative experience but I can see now that it can be used following any kind of experience.Why was something good, why did that situation turn out so well, how can we repeat that outcome.' This new co-constructed understanding was also reflected in their answers when they explained how they would apply the concept in the future beyond the learning context, resonating with the Action stage of Gibb's reflective cycle: 'By reflecting frequently and using a journal for reflective practice which will help recognise thought patterns, attitudes, behaviours, emotions etc.This information can help improve how I personally deal with future situations/events professionally.' Moreover, the aspect of socially constructed learning was suggested by several participants when they mentioned how their reflection improved after reading other's answers, including the researcher's feedback:

Prompting reflective practice through tools and triggers
The findings suggested that participants seemed to become aware that reflection models could be used as a tool to facilitate their reflection process:

'It [how I reflect post-class] has changed because i didnt know there are models of reflection. I also learned there is alot of emphasis on feelings in a situation.'
This finding resonates with the literature since students found structured approach more beneficial to enhance the reflection process and their writing 1,14,28 .As such, the use of reflective model should be further utilised in this module and beyond.Moreover, certain triggers seemed to enable participants to express their reflections.Such triggers were probing questions that the researcher outlined in both Padlet boards and his comments: [Q: how would you use reflection to facilitate your learning?] '…To try and reflect regularly, using Rolfe's model […] Examples might be reflecting on why I'm apprehensive about starting difficult subject matter and procrastinating over essays...' The findings suggested that both the reflective tools and triggers from educators could potentially be beneficial to foster students' reflection.This might relate to the scaffolding process in learning where educators could support the students and their current capabilities 5,29 .

Discussion
Findings from the study resonate with the literature and suggest that Padlet is conducive to enhance students' reflection and also their capability to demonstrate their reflective writing.That is, participants strongly preferred the notion of being anonymous.This is beneficial for the reflective practice process which is often a personal recount of students' poignant experience.As such, the anonymity in Padlet enables them to participate without any fear of being perceived as 'stupid' or have reflection publicly 'invalidated'.The anonymity also increased students' engagement with each other thus enabling them to create a more supportive and collaborative learning environment 16,17,21 .
Another benefit of Padlet is the asynchronous aspect which allows participants to contribute the study anytime.Although findings do not indicate this benefit, it can be implied that Padlet is useful to foster -or force -thinking time for students over other available learning tools.For instance, Mentimeter is another popular education tool that is widely used in higher education due to its interactivity and engagement with students 30 .Yet Mentimeter might not be fully useful for reflection since students would need more 'thinking time' to conceptualise and making sense of their reflection which is not likely to occur spontaneously.
Finally, the notion of socially-constructed learning environment was strongly indicated by participants.The researcher could provide constructive feedback to participants without knowing their identity.This is useful for participants to identify 'ideal' constructions of reflective writing hence the process should scaffold their learning and also empowered 'champion' students for their contribution 29 .The socially-constructed learning environment was further emphasised when participants and the researcher could 'like' certain answers to indicate preferred examples of insightful reflective writing thus further validating their contribution.As a result, the process of knowledge co-construction should enhance students' deep cognitive engagement which proves beneficial for their future academic mastery 16 .
Findings also strongly indicated that participants are not 'reflective zombies'.That is, they have no incentive to get good grade from this study yet they meaningfully shared their reflections in writing based on their learning or clinical experiences.
As such, the focus to facilitate students' reflection should be how we can enhance their ability to reflect.Based on the findings, students seem to have a better reflection with the use of reflection tools (e.g., Gibb's or Rolfe's reflective models) and triggers from me (via structured questions in Padlet and my comments and feedback) hence this practice could be continued and encouraged.

Strengths and limitations of the study
To his knowledge, this is the first study to determine the influence of Padlet over nursing students' reflective practice.The action research approach via Padlet also enables rich depictions of how students co-construct their understanding of reflection in a non-threatening environment thus offering more insights on how we can empower students to reflect.Nevertheless, the study also poses several limitations: The study had a very low participation rate (22 participants out of 495).This limitation might stem from the restricted timeframe for this project in Semester 2. During that time, the students were doing their clinical placement outside the university hence might be less inclined to participate.However, since the study employed the qualitative approach, the numbers of participants were less relevant; participants also provided relatively insightful writing that contributed to meaningful analysis afterwards.Moreover, the concept of information power, suggested by Malterud et al. (2016), was applied to ensure the rigour of the findings 31 .They indicate that the 'larger information power the sample holds, the lower N is needed and vice versa' (Malterud et al., 2016, p.2). Given that this study has a very specific focus and research questions, the sample size needed was smaller.
Next, the researcher positioned himself as an insider.This insider positionality might influence how he engaged with and analysed the data 32,33 .He mitigated this issue by keeping track of written memos.The focus was to examine how he -as an insider -analysed certain aspects from the data.He also iteratively immersed with the datasets, as a part of the reflexive thematic analysis technique, to ensure that the final findings were robust.
Finally, due to the nature of action research that focuses on practical issues of the researchers, the findings might be less generalisable 22,27 .However, parts of the findings can still be conceptually transferable due to the underlying theory that has been utilised 34 .

Future implications for practice
Findings was disseminated to stakeholders within the School via academic seminars and meetings.Proposed changes for teaching reflection include revision of learning materials to ensure that the materials are customised to students with various background.All students will have mandatory learning materials.Students who enrolled under the Honour and Master degrees will have additional learning materials that are customised to their levels.Padlet is also proposed to be used as a tool to teach and facilitate reflection in the upcoming academic year.

Future implications for research
Future studies could be designed as a longer longitudinal study and explore the changed understanding of students' reflection over time.To enable students who come from diverse background, future studies could also examine the different students' needs especially amongst mature students whose learning strategies and barriers to successful learning differ from non-mature students 35 .
Furthermore, based on the findings, students seem to appreciate the use of Padlet since it enables them to develop their reflective practice anonymously.This is compounded with the co-construction of understanding of their reflection with others.As such, These two perceived benefits -anonymity and co-constructed learning element-should be further utilised beyond the use of Padlet.

Conclusions
This study indicates that the reflection materials in the PASK 1 module seems to enable students to improve their understanding of reflection.Nevertheless, students could potentially benefit from tools and triggers that will initiate and support their reflection.To that end, Padlet is a platform that can potentially facilitate and enhance nursing students' reflection skills.The benefits of using Padlet as a learning platform, as indicated by participants, mirrors the literature.That is, they overwhelmingly expressed positive feedback for Padlet, especially how they can learn and improve their understanding of reflection from others via anonymised answers and social interactions.In future writing, I encourage you to not only explain who you were in this research, but also how this position may have influenced the research process in positive or negative ways.You could be a little more explicit about your assumptions/expectations and whether these were reflected in the research findings.
I still have reservations about this being presented as an action research study.Instead, it appears to be a scholarly evaluation of the use of padlet to enhance nursing students' understanding of reflection.
However, on balance, I think this paper will be useful to others who are grappling with the persistent challenge of how to promote reflective practice.Padlet may offer a way to enable students to collaboratively develop their understandings of reflection.I thank you for sharing your practice with others.
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: I am an experienced medical education academic, with particular expertise in qualitative research methods.I have also taught and assessed reflective writing across different institutions.
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
It is unclear why Padlet was chosen as the key conduit.There was some mention about the use of Padlet in the University but further clarity regarding its general use may help in terms of the the recruitment of participants.This would strengthen the paper and methodology section and perhaps give some insight into the participant numbers.If it was a new tool, then this could impact on those volunteering compared with being a common tool that everyone is familiar with.
There is some mention in the discussion around other methods, e.g.Mentimeter but it was only fleeting and further discussion on this would be of benefit.
You state you are an "insider" but again more clarity around this would be beneficial as you seem to suggest it is due to your background and role as a lecturer rather than an active participant.
It is unclear from the results the extent of the benefit of Padlet compared with the standard teaching.Were the same types of activities carried out in the group activities?
Thematic analysis can be undertaken in several ways and Braun & Clarkes approach in often used.However, it is unclear why Gibbs six stages of reflective cycle were used for the coding since outputs should reflect the research questions.Qualitative data can be themed in different ways and hence the results presented are only your views.It is beneficial to have any analysis looked at a by a third party as part of a sense check.Further information on the themes in the results would strengthen this paper.

Is the work clearly and accurately presented and does it cite the current literature? Partly
Is the study design appropriate and is the work technically sound?Partly

Are sufficient details of methods and analysis provided to allow replication by others? Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Have any limitations of the research been acknowledged? Partly
Are all the source data underlying the results available to ensure full reproducibility?Partly

Are the conclusions drawn adequately supported by the results? Partly
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: I have significant experience in clinical education research.
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
active participant.-I have added more texts to clarify this point: '…The use of Padlet to facilitate students' reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1).Moreover, the researcher is a team member of the PASK1 module.He is involved with the design of weekly teaching methods, teaching materials and marking.He also led some of the small group tutorials.Consequently, he positioned himself as an 'insider' due to these backgrounds as well as his current position as a lecturer at the university.' 4.It is unclear from the results the extent of the benefit of Padlet compared with the standard teaching.
Were the same types of activities carried out in the group activities?The study was not designed to be a comparative study of the traditional teaching activities vs Padlet activities.Rather, it is to determine how does the current teaching materials and activities influence students' RP.And Padlet was chosen as a tool to capture that.-I also added more information regarding group activities for clarifications: '…Students were split into smaller groups.The first activity focused on writing and their reflective accounts.Written examples were provided along with explanation of which examples were considered reflective writing.
The second activity was based on students' recent clinical placement experiences.Guidance and probing questions were provided to enable them to reflect on their experiences.After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development.' 5. Thematic analysis can be undertaken in several ways and Braun & Clarkes approach in often used.However, it is unclear why Gibbs six stages of reflective cycle were used for the coding since outputs should reflect the research questions.Qualitative data can be themed in different ways and hence the results presented are only your views.It is beneficial to have any analysis looked at a by a third party as part of a sense check.Further information on the themes in the results would strengthen this paper.The initial analysis was to deductively approach the data and compare them to Gibb's reflective cycle.During the later stages, it was clear that the initial themes were unable to meaningfully capture the findings hence themes were subsequently renamed: '…During this stage, the initial themes -based on Gibb's reflective cycle -were unable to meaningfully capture the findings nor fully answered the research question.Consequently, all themes were refined to make them more reflective to the findings.' Competing Interests: No competing interests were disclosed.
Reviewer Report 04 December 2023 https://doi.org/10.21956/mep.21185.r35177 Thank you for the opportunity to review and make comment upon the research manuscript entitled: Enhance nursing students' reflection through Padlet: an action research.
Reflective practice is an integral skill for clinical learning, both as a student and for all professionals responsible for patient care.The work represents a reflective practice learning activity with a small group of nursing students.Particular focus is given to the use of Padlet as an interactive program where students can without 'pressure,' practice their reflections prior to formal assessment.Thematic or qualitative approaches were taken to analysis.The complexities of the enactment of the skill of reflective practice were well considered in the introduction.Important to note that the actual skill was focused on and evaluated as a written activity rather than a verbal or intuitive process.Therefore, reflective skills were being assessed via written activities only.The section on the context clearly presented the issues about actually knowing how well students are engaging in meaningful reflective practice.The analysis was well considered and outlined.The co-constructed reflection section was well considered and presented.Overall interesting research about an important and relevant lifelong skill.
Further considerations and suggestions.Suggest the 1 st sentence of the introduction could be reconsidered or even added to.There are better descriptors that communicate the importance and relevance of reflective practice.Also there is a typo within the sentence. 1.

Reflective practice (RP) is a practice of making sense of a situation via reflection and is usually occurs during an unexpected or surprising experience.
Title -suggest 'Enhancing' rather than 'Enhance'.1.
The words 'reflective practice' and 'reflective' are being used interchangeably.Suggest they are different.Would review usage.

2.
Suggest 'reflective practice' could be in the key words.

3.
Some sentences have repeat words.Suggest reviewing the work for these.For example: 4.

Yet the assessment of students' RP tends to focus on their capability to demonstrate their RP in writing.
Would use the full form of reflective practice throughout in preference to RP. 1.
Suggest the writing be reviewed and all sections written in the 1 st person changed into 'the researcher'.This would improve the quality of the writing.

2.
Some further nursing specific literature for your consideration.These would enhance the manuscript and provide deeper definitions and understanding:

Are the conclusions drawn adequately supported by the results? Yes
Competing Interests: No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
practice.Also there is a typo within the sentence.Reflective practice (RP) is a practice of making sense of a situation via reflection and is usually occurs during an unexpected or surprising experience.-I have rephrased the first sentence and also have added additional references.2. Title -suggest 'Enhancing' rather than 'Enhance'.The title has been renamed as suggested 3. The words 'reflective practice' and 'reflective' are being used interchangeably.Suggest they are different.Would review usage The phrase reflective practice has been added in the key words as suggested 4. Some sentences have repeat words.Suggest reviewing the work for these.For example: Yet the assessment of students' RP tends to focus on their capability to demonstrate their RP in writing.Several sentences were restructured for better readability as suggested.5. Would use the full form of reflective practice throughout in preference to RP.The phrase reflective practice has been added and used throughout 6.Suggest the writing be reviewed and all sections written in the 1 st person changed into 'the researcher'.This would improve the quality of the writing.This has been changed as suggested.7. Some further nursing specific literature for your consideration.These would enhance the manuscript and provide deeper definitions and understanding Thank you for these suggestions.I have added recent literature in the introduction section.

Alison Ledger
Academy for Medical Education, Medical School, The University of Queensland, Brisbane, Queensland, Australia Thank you for the opportunity to read your manuscript.The introduction captured the complexities of fostering students' reflective practice well and cited key literature in this area.The focus on padlet emphasised the value of students co-constructing understandings of reflection in a safe environment, which is a useful finding for other educators grappling with how best to include reflection in their curricula.
I have several suggestions for making this manuscript even better.
Methodological framing.The work is presented as an action research study.Action research tends to be participatory and collaborative and it is unclear who the project collaborators were in this case.Perhaps the collaborators were the students but this was not made explicit.I suggest the project may be better framed as a scholarly exploration or evaluation project, or a student-staff partnership project.If you do this, perhaps the question could be presented as 'How can Padlet foster reflective writing among nursing students?' 1.
Further consideration of ethical issues beyond informed consent.If I have understood correctly, only 22 out of 495 students volunteered for the study and were accessing and interacting with the padlet.Could the padlet and additional feedback be perceived as an advantage for these students in developing reflective practice, over the 473 students who did not have access to this support?How was this risk mitigated? 2.
Further detail about your own position in this research.Though you presented yourself as an 'insider', what this meant in practice could be made a little more explicit.Were you the lead for the PASK1 module?Did you facilitate any of the small group tutorials?What led you to Padlet and what did you expect to find through this project? 3.
More detail about the reflective practice education more broadly.What were the intended learning outcomes?What topics were covered in the readings provided to students?What happened in the group tutorials and activities?Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript?How was reflective practice assessed?Addressing these questions is important so the reader can consider what outcomes could be attributed to Padlet, and what could be attributed to the influence of the wider programme of education.Addressing these questions may also enable consideration of additional design limitations.

4.
Refinement of the theme titles so that they align with the evaluation question presented and are more consistent with Braun and Clarke's reflexive thematic analysis approach.In addressing the question of how does padlet help?I wonder whether some possible theme titles could be: Uncovering variation in students' baseline understandings of reflection, Coconstructing understandings of reflection, and Prompting reflective practice through tools and triggers.These are just suggestions to explain what I mean, feel free to craft theme titles that make sense to you.One further piece of advice would be to think about whether material in the section 'feedback from participants' could be incorporated within the three themes.

5.
Ensure that your discussion points are supported by the content in your results section.The first point about the benefits of anonymity are currently not captured in your results section.Were there any quotes from the Padlet that could support this claim?I also wondered whether the first theme could be discussed in greater depth -is there value in knowing students' levels of understanding when they enter training?6.
Consider wider implications beyond Padlet.Though your study was about Padlet, are there other ways that educators could encourage co-construction of understandings and safe ways of developing reflective practice?
I hope you find this feedback helpful and encourage you to continue developing this work.

Is the work clearly and accurately presented and does it cite the current literature? Partly
Is the study design appropriate and is the work technically sound?

Are sufficient details of methods and analysis provided to allow replication by others? Partly
If applicable, is the statistical analysis and its interpretation appropriate?Not applicable

Have any limitations of the research been acknowledged? Partly
Are all the source data underlying the results available to ensure full reproducibility?Partly

Are the conclusions drawn adequately supported by the results? Partly
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: I am an experienced medical education academic, with particular expertise in qualitative research methods.I have also taught and assessed reflective writing across different institutions.
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
the university hence were rather occupied; none replied to my inquiries.I have added more texts in the manuscript to clarify this point: '…During the study conception stage, the researcher asked the PASK 1 module lead as well as the School's programme leads regarding the justification and relevancy of this project; all agreed with the justification of this project as well as the use of Padlet.Students were contacted via the year representative regarding their opinions of the project; none replied.' -The research question was amended as suggested.Context section Further consideration of ethical issues beyond informed consent.If I have understood correctly, only 22 out of 495 students volunteered for the study and were accessing and interacting with the padlet.Could the padlet and additional feedback be perceived as an advantage for these students in developing reflective practice, over the 473 students who did not have access to this support?How was this risk mitigated?-That is correct.Only 22 consented to join the project.I anticipate that these students may have more short-term benefit since they received additional feedback as well as saw others' reflective writing.However, all students will not be assessed in reflective writing in this module.They will be assessed in other modules hence the benefits could be minimal e.g., these 22 students may have a better understanding of reflection at the beginning but all should have similar understanding once they have started their reflective practice assignments.-Further detail about your own position in this research.Though you presented yourself as an 'insider', what this meant in practice could be made a little more explicit.Were you the lead for the PASK1 module?Did you facilitate any of the small group tutorials?What led you to Padlet and what did you expect to find through this project?-I have added more texts to clarify this points: '…The researcher is a team member of the PASK1 module.He is involved with the design of weekly teaching methods, teaching materials and marking.He also led some of the small group tutorials.'-'The use of Padlet to facilitate students' reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1).'Researcher reflexivity More detail about the reflective practice education more broadly.What were the intended learning outcomes?What topics were covered in the readings provided to students?What happened in the group tutorials and activities?Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript?How was reflective practice assessed?Addressing these questions is important so the reader can consider what outcomes could be attributed to Padlet, and what could be attributed to the influence of the wider programme of education.Addressing these questions may also enable consideration of additional design limitations.What were the intended learning outcomes?'The reflection teaching week partly addressed two ILOs of the PASK1 module.That is, upon completion of the module, students will be able to: What topics were covered in the readings provided to students?'…Asynchronous study materials included three YouTube videos which focus on reflective practice, reflective writing and critical reflection reading materials on reflective practice, guide to reflective writing and a peer-reviewed rapid review discussing reflective practice in crisis situations.'What happened in the group tutorials and activities?'…Students were split into smaller groups.The first activity focused on writing and their reflective accounts.Written examples were provided along with explanation of which examples were considered reflective writing.The second activity was based on students' recent clinical placement experiences.Guidance and probing questions were provided to enable them to reflect on their experiences.After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development.'Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript?'The focus of the study was on writing activities since the majority of student' assessments will be via their writing.Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing.'How was reflective practice assessed?Students' reflective practice will not be marked in the PASK1 module; they will be assessed in other modules in each academic year.Moreover, they will be assessed during their clinical placements by their assessors which will be beyond the scope of this study and the PASK1 module.Context section Refinement of the theme titles so that they align with the evaluation question presented and are more consistent with Braun and Clarke's reflexive thematic analysis approach.In addressing the question of how does padlet help?I wonder whether some possible theme titles could be: Uncovering variation in students' baseline understandings of reflection, Co-constructing understandings of reflection, and Prompting reflective practice through tools and triggers.These are just suggestions to explain what I mean, feel free to craft theme titles that make sense to you.One further piece of advice would be to think about whether material in the section 'feedback from participants' could be incorporated within the three themes.I have added more texts to clarify these points: '…During this stage, the initial themes -based on Gibb's reflective cycle -were unable to meaningfully capture the findings nor fully answered the research question' -I also rename the themes to: i) Unpacking variation in students baseline understanding of reflection; ii) Coconstructed understanding of reflection and iii) Prompting reflective practice through tools and triggers -The feedback section was incorporated into the existing themes Data analysis process, Results Ensure that your discussion points are supported by the content in your results section.The first point about the benefits of anonymity are currently not captured in your results section.Were there any quotes from the Padlet that could support this claim?I also wondered whether the first theme could be discussed in greater depth -is there value in knowing students' levels of understanding when they enter training?-I have added more quotes to support the benefit of Padlet around anonymity '…Padlets provide a good platform of confidentiality, anonymity and willingness to share.For learning and understanding reflection, it compliments the class and learning materials, and reading answers and feedback to responses has helped contribute to my understanding.' -More texts were added under theme 1: '…Unfortunately, the teaching materials provided were prepared with an implicit assumption that that students would have a similar understanding of reflection.This is problematic since the existing teaching materials may not be fully useful to students who already have some understanding of the concept.' Results section Consider wider implications beyond Padlet.Though your study was about Padlet, are there other ways that educators could encourage co-construction of understandings and safe ways of developing reflective practice?-I have added more texts to clarify this points 'Furthermore, based on the findings, students seem to appreciate the use of Padlet since it enables them to develop their reflective practice anonymously.This is compounded with the co-construction of understanding of their reflection with others.As such, These two perceived benefits -anonymity and co-constructed learning elementshould be further utilised beyond the use of Padlet.' Future implications for research Competing Interests: No competing interests were disclosed.
Author Response 18 Dec 2023

Tharin Phenwan
Apologies-I have copied and pasted from a table in Microsoft Words file and the responses are very hard to read.Here they are: 1. Methodological framing.The work is presented as an action research study.Action research tends to be participatory and collaborative and it is unclear who the project collaborators were in this case.Perhaps the collaborators were the students but this was not made explicit.I suggest the project may be better framed as a scholarly exploration or evaluation project, or a student-staff partnership project.If you do this, perhaps the question could be presented as 'How can Padlet foster reflective writing among nursing students?' -The main collaborators were the module leader and programme leads.During the study conception, I asked for their opinions in terms of the relevancy of the project, the challenges around reflection teaching.All agreed with the justification of this project as well as the use of Padlet.-I also reached out to few students during the study conception but as discussed in the limitation section, they were at their placements outside the university hence were rather occupied; none replied to my inquiries.I have added more texts in the manuscript to clarify this point: -The research question was amended as suggested.2. Further consideration of ethical issues beyond informed consent.If I have understood correctly, only 22 out of 495 students volunteered for the study and were accessing and interacting with the padlet.Could the padlet and additional feedback be perceived as an advantage for these students in developing reflective practice, over the 473 students who did not have access to this support?How was this risk mitigated?That is correct.Only 22 consented to join the project.I anticipate that these students may have more short-term benefit since they received additional feedback as well as saw others' reflective writing.However, all students will not be assessed in reflective writing in this module.They will be assessed in other modules hence the benefits could be minimal e.g., these 22 students may have a better understanding of reflection at the beginning but all should have similar understanding once they have started their reflective practice assignments.3. Further detail about your own position in this research.Though you presented yourself as an 'insider', what this meant in practice could be made a little more explicit.Were you the lead for the PASK1 module?Did you facilitate any of the small group tutorials?What led you to Padlet and what did you expect to find through this project?I have added more texts to clarify this points in the researcher reflexivity section: '…The researcher is a team member of the PASK1 module.He is involved with the design of weekly teaching methods, teaching materials and marking.He also led some of the small group tutorials.'-'The use of Padlet to facilitate students' reflective practice was based on the initial review of the literature and the thorough considerations of the available teaching tools at the University (see Table 1).' 4.More detail about the reflective practice education more broadly.What were the intended learning outcomes?What topics were covered in the readings provided to students?What happened in the group tutorials and activities?Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript?How was reflective practice assessed?Addressing these questions is important so the reader can consider what outcomes could be attributed to Padlet, and what could be attributed to the influence of the wider programme of education.Addressing these questions may also enable consideration of additional design limitations.What were the intended learning outcomes?'The reflection teaching week partly addressed two ILOs of the PASK1 module.That is, upon completion of the module, students will be able to: 3. Demonstrate understanding of the need for different academic and professional skills, including professional communication, documentation and person-centred care. 5. Discuss professionalism in the context of being a nursing student By the end of the week, students should be able to: define reflection ○ understand the role of reflection in professional learning ○ introduce the idea of reflective practice ○ be able to distinguish between reflection and reflective practice ○ discuss the role of reflective practice in improving professional effectiveness' ○ What topics were covered in the readings provided to students?'…Asynchronous study materials included three YouTube videos which focus on reflective practice, reflective writing and critical reflection reading materials on reflective practice, guide to reflective writing and a peer-reviewed rapid review discussing reflective practice in crisis situations.'What happened in the group tutorials and activities?'…Students were split into smaller groups.The first activity focused on writing and their reflective accounts.Written examples were provided along with explanation of which examples were considered reflective writing.The second activity was based on students' recent clinical placement experiences.Guidance and probing questions were provided to enable them to reflect on their experiences.After these two activities, the tutors discussed with students and provided strategies and tools to facilitate reflection as well as its relevancy with wider professional development.'Why was the focus on reflective writing when the limitations of this were acknowledged in the background section of the manuscript?'The focus of the study was on writing activities since the majority of student' assessments will be via their writing.Additionally, this focus relates to the requirement from the Nursing and Midwifery Council which will assess nurses reflective account in writing.'How was reflective practice assessed?Students' reflective practice will not be marked in the PASK1 module; they will be assessed in other modules in each academic year.Moreover, they will be assessed during their clinical placements by their assessors which will be beyond the scope of this study and the PASK1 module.5. Refinement of the theme titles so that they align with the evaluation question presented and are more consistent with Braun and Clarke's reflexive thematic analysis approach.In addressing the question of how does padlet help?I wonder whether some possible theme titles could be: Uncovering variation in students' baseline understandings of reflection, Coconstructing understandings of reflection, and Prompting reflective practice through tools and triggers.These are just suggestions to explain what I mean, feel free to craft theme titles that make sense to you.One further piece of advice would be to think about whether material in the section 'feedback from participants' could be incorporated within the three themes.I have added more texts to clarify these points: '…During this stage, the initial themes -based on Gibb's reflective cycle -were unable to meaningfully capture the findings nor fully answered the research question' -I also rename the themes to: i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers -The feedback section was incorporated into the existing themes 6. Ensure that your discussion points are supported by the content in your results section.The first point about the benefits of anonymity are currently not captured in your results section.Were there any quotes from the Padlet that could support this claim?I also wondered whether the first theme could be discussed in greater depth -is there value in knowing students' levels of understanding when they enter training?-I have added more quotes to support the benefit of Padlet around anonymity '…Padlets provide a good platform of confidentiality, anonymity and willingness to share.For learning and understanding reflection, it compliments the class and learning materials, and reading answers and feedback to responses has helped contribute to my understanding.' -More texts were added under theme 1: '…Unfortunately, the teaching materials provided were prepared with an implicit assumption that that students would have a similar understanding of reflection.This is problematic since the existing teaching materials may not be fully useful to students who already have some understanding of the concept.' 7. Consider wider implications beyond Padlet.Though your study was about Padlet, are there other ways that educators could encourage co-construction of understandings and safe ways of developing reflective practice?-I have added more texts to clarify this points 'Furthermore, based on the findings, students seem to appreciate the use of Padlet since it enables them to develop their reflective practice anonymously.This is compounded with the co-construction of understanding of their reflection with others.As such, These two perceived benefitsanonymity and co-constructed learning element-should be further utilised beyond the use of Padlet.' Competing Interests: No competing interests were disclosed.

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Williams and Lowes (20016 ).○ Publisher Full Text 3. Hong L, Chew L: Reflective practice from the perspectives of the bachelor of nursing students in International Medical University (IMU).Singapore Nursing Journal.35 (5): 5-15 Reference Source 4. Lane AS, Roberts C: Contextualised reflective competence: a new learning model promoting reflective practice for clinical training.BMC Med Educ.2022; 22 (1): 71 PubMed Abstract | Publisher Full Text 5. McNeill H, Brown JM, Shaw NJ: First year specialist trainees' engagement with reflective practice in the e-portfolio.Adv Health Sci Educ Theory Pract.2010; 15 (4): 547-58 PubMed Abstract | Publisher Full Text 6. Williams GR, Lowes L: Reflection: possible strategies to improve its use by qualified staff.Br J Nurs. 10 (22): 1482-8 PubMed Abstract | Publisher Full Text Is the work clearly and accurately presented and does it cite the current literature?Partly

Competing Interests:
No competing interests were disclosed.Reviewer Report 30 October 2023 https://doi.org/10.21956/mep.21185.r34984© 2023 Ledger A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.