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. 2026 Oct 4;13(10):e70874. doi: 10.1002/nop2.70874

Reflective Practice and Related Factors Among Specialty Nurses in Tertiary General Hospitals Across China: A Latent Profile Analysis

Songyao Li 1,2,3, Wenqiong Lin 4, Panpan Zhang 1, Yaru Li 1, Ziru Fang 1, Yuning Wang 2,3, Hongmei Zhang 1,✉
PMCID: PMC13634610  PMID: 42829985

ABSTRACT

Aim

To identify distinct subgroups of reflective practice among specialty nurses in tertiary general hospitals using latent profile analysis (LPA), and to explore the influencing factors associated with subgroup classification.

Design

Cross‐sectional study.

Methods

Study participants were recruited via convenience sampling. An online questionnaire survey was conducted using the basic information questionnaire, the reflective practice questionnaire, and the workplace spirituality scale. Latent profile analysis (LPA) was used to identify subgroups of specialty nurses' reflective practice. Additionally, univariate analysis and logistic regression were conducted to find the predictive factors of different categories.

Data Sources

Data were collected from 817 eligible specialty nurses across 13 tertiary general hospitals in China from April to June 2024.

Results

A total of 817 specialty nurses were included, identifying three categories of reflective practice: low reflective practice group (23.38%), moderate reflective practice group (37.58%) and high reflective practice group (39.04%). Specialty nurses who were married, held positions, had higher monthly incomes, and exhibited stronger workplace spirituality were more likely to have higher levels of reflective practice than the other profiles.

Conclusion

The majority of specialty nurses fell into the moderate and high reflective practice groups. The marital status, job position, monthly income and workplace spirituality of specialty nurses were associated with reflective practice. Targeted interventions may help enhance the reflective practice of specialty nurses.

Implications for the Profession and/or Patient Care

The findings of this study offer an evidence base for nursing administrators to design tailored intervention programmes. Particular emphasis should be placed on specialty nurses in the low reflective practice group, whose reflective practice may be improved through the enhancement of workplace spirituality via structured mentorship, foundational reflective training and supportive organizational strategies.

Impact

The heterogeneity and predictive factors related to specialty nurses' reflective practice in tertiary general hospitals provide valuable evidence for the formulation of individualized interventions. Nursing administrators should understand the importance of reflective practice, offer performance rewards and educational opportunities for specialty nurses, implement magnetic management strategies to enhance workplace spirituality, thereby effectively improving the level of reflective practice among specialty nurses.

Reporting Method

This study was reported in accordance with the EQUATOR guidelines and followed the STROBE statement for cross‐sectional studies.

Patient or Public Contributions

No patient or public contributions.

Keywords: general hospitals, latent profile analysis, nurses, reflective practice, specialties

1. Introduction

Tertiary general hospitals are a crucial component of advanced healthcare services in China's medical system, offering specialized care and treating complex illnesses (Zhang et al. 2024). Within these hospitals, specialty nurses are extensively involved in critical care management and advanced nursing practice, playing a significant role in delivering high‐quality patient care and promoting continuous improvement in medical practices (Hussain Rawther et al. 2020; Locatelli 2019). Consequently, enhancing the performance of specialty nurses has attracted widespread global attention. Reflective practice, as a competency for ongoing professional development, holds significant importance within clinical nursing practice (Barbagallo 2020). Through reflective practice, specialty nurses are able to critically analyse and integrate their clinical experiences, incorporate feedback and develop innovative approaches to improve patient outcomes (Wu et al. 2022; Ziebart and MacDermid 2019; O'Neill et al. 2019; Bolden et al. 2011). Therefore, strengthening reflective practice competency among specialty nurses represents an essential strategy for enhancing clinical nursing expertise, optimizing nursing decision‐making, and ensuring patient safety and quality of care. Currently, reflective practice has been recognized by many countries as an essential core competency for specialty nurses and serves as a key professional quality to ensure the steady improvement of nursing quality (Zuo 2003; Yu et al. 2019). Despite its recognized importance, research on reflective practice among specialty nurses in China's tertiary general hospitals remains limited, and several important gaps remain unresolved. First, previous studies have predominantly evaluated reflective practice among specialty nurses using total or mean scores, thereby treating specialty nurses as a relatively homogeneous group and overlooking the substantial within‐group heterogeneity in clinical roles, professional responsibilities, and psychological resources. Second, existing research has paid insufficient attention to psychological and organizational factors—particularly those modifiable through management strategies—which limits the translational value of findings for nursing practice. Third, although one study has recently employed latent profile analysis to preliminarily explore reflective practice among Chinese specialty nurses and provided initial evidence of its heterogeneity, that investigation was confined to a single‐city sample and lacked a theoretical framework to explain the formation mechanisms of different profiles. Collectively, these limitations constrain the explanatory depth of existing conclusions and hinder the translation of research evidence into actionable nursing management and educational strategies. It is worth noting that in recent years, research on workplace spirituality has provided a new perspective for deepening reflective practice. Workplace spirituality, as an inner experience that transcends the self and is closely interconnected with the professional system, is formed after employees deeply identify with the value of their work, the mission of the team, and the organizational culture (Li et al. 2022). It can facilitate nurses in achieving the integration of the self and the organization, thus fostering reflective abilities (Hou et al. 2019; Zhu, Wang, Fang, Wang, et al. 2023; Zhu, Wang, Fang, Yan, et al. 2023). Furthermore, workplace spirituality is a modifiable organizational variable that can be enhanced through management strategies such as fostering team connectedness, clarifying organizational values, and empowering meaningful work. Investigating the relationship between workplace spirituality and reflective practice profiles can therefore provide nursing administrators with direct practical evidence for developing evidence‐based strategies to improve nurses' reflective capacity. However, research specifically examining the relationship between workplace spirituality and reflective practice among specialty nurses remains scarce. Accordingly, drawing on the person‐organization fit theory and incorporating workplace spirituality as a predictor, this study employs latent profile analysis to identify distinct profiles of reflective practice among specialty nurses in Chinese tertiary general hospitals, with the aim of informing the development of more precise and stratified interventions. Furthermore, the results may offer nursing administrators a clear pathway to enhance specialty nurses' reflective practice by optimizing the organizational psychological environment, thereby promoting specialty nurses' professional development and ultimately improving the quality and safety of patient care.

2. Background

Reflective practice, originally introduced by American educator Donald Schon, can be defined as the ability to solve problems in specific situations while engaging in reflection during action, thereby acquiring practical knowledge, which includes both ‘reflection in action’ and ‘reflection on action’, and serves as a vital metacognitive skill for individuals (Schön 1983; Ming et al. 2023). Research indicates that reflective practice is highly effective in resolving the complex problems encountered in practice (Ziebart and MacDermid 2019). It not only enhances individuals' adaptability, judgement, and critical‐thinking abilities but also deepens their professional knowledge base, ultimately improving service quality and job satisfaction (O'Neill et al. 2019; Bolden et al. 2011). With its broad adoption in specialized training within medical education, cultivating reflective practice has become a key strategy for advancing the implementation of patient‐centred nursing (Ziebart and MacDermid 2019; Wu et al. 2022).

The National Nursing Development Plan (2021–2025) states that strengthening the construction of specialized nursing teams is regarded as an important measure to improve specialized nursing levels and is a key requirement of ‘Healthy China 2030’ (National Health Commission of the People's Republic of China 2022). Specialty nurses are registered nurses with substantial clinical experience who hold relevant qualifications obtained through structured education in specialized knowledge and practical skills, enabling them to resolve clinical nursing issues within a particular specialty (Ma and Li 2022). In China, specialty nurses demonstrate higher professional competencies and skills than general nurses, with their professional scopes covering multiple core specialty areas such as critical care, emergency care, blood purification, oncology, operating room nursing and so on (Ministry of Health of the People's Republic of China 2012). They play a crucial role in specialized practice, research, teaching, management, outpatient services, and the consultation and discussion of complex cases (Dong et al. 2023). Tertiary general hospitals are responsible for treating substantial numbers of patients with complex or critical illnesses, and their nursing work involves multiple specialized fields (Hwang 2022; Chen et al. 2023). Consequently, tertiary general hospitals need to cultivate sufficient high‐quality specialty nurses to meet the demands of clinical specialized nursing services. Providing direct patient care is a fundamental competency that specialty nurses must possess, which requires ongoing knowledge and skill updates. This involves openly reflecting on and analysing their experiences and understanding how these experiences affect themselves and others while addressing complex healthcare challenges, thereby fostering and consistently enhancing their reflective practice abilities, which is crucial in the training of specialty nurses (Feng et al. 2020; Wu et al. 2022).

Specialty nurses face numerous challenges while working in tertiary general hospitals. First, the rapid advancement of medical technology requires specialty nurses to continuously update their knowledge and skills to cope with complex clinical situations. According to the metacognitive model of capability development, behaviour‐based reflective practice is considered an important way to enhance individual behavioural competencies (Tibken et al. 2022). Effective reflection in practice can help specialty nurses closely integrate theoretical knowledge with practical experience, thereby achieving their desired nursing goals and improving care quality (Hou et al. 2019). Additionally, studies have shown that specialty nurses experience higher role stress than general nurses, making them more susceptible to fatigue and anxiety at work (Zhang et al. 2024). Through reflection, specialty nurses can better identify the causes of their emotional changes and learn how to adjust their mindset to enhance workplace well‐being and job satisfaction (Contreras et al. 2020). Reflective practice not only helps specialty nurses enhance clinical knowledge and skills and effectively respond to emergencies but also fosters their self‐growth and insight, reduces anxiety and depression levels, and improves care quality (Patel and Metersky 2022; Contreras et al. 2020; O'Neill et al. 2019; Davey et al. 2021). Accurately assessing reflective practice is a crucial foundation for cultivating and developing specialty nurses (Wu et al. 2022). Therefore, it is important to attend to the level of reflective practice among specialty nurses, analyse its influencing factors, and develop targeted intervention measures to promote their physical and mental health while improving care quality.

Workplace spirituality is an internal self‐awareness, referring to the inner experience employees gain after recognizing the values of their work, team, and organization—an experience that transcends self‐interest and fosters a sense of connectedness with these collectives (Li et al. 2022). As a psychological resource, workplace spirituality can effectively replenish the resource depletion caused by emotional labour, thereby alleviating the negative impact of resource consumption (Ke et al. 2014). Moreover, the level of workplace spirituality also plays an important role in stabilizing nursing talent and improving nursing quality (Zhou et al. 2021). Workplace spirituality encompasses three dimensions: meaningful work, a sense of community and consistency with organizational values (Ke et al. 2014). These dimensions may influence reflective practice through multiple pathways. A deeper understanding of work meaning can activate nurses' intrinsic motivation, prompting them to achieve self‐worth through reflection. The supportive environment created by team connectivity can reduce the psychological costs of reflection, thereby facilitating the exchange of experiences. Alignment with organizational values enhances the sense of professional mission, making reflection an intrinsic need for actively optimizing nursing practices. The person‐organization fit theory also suggests that when nurses' goals and internal values align with those of the organization, they perceive their values as being recognized. This recognition can transform into sustained reflective behaviour, thereby strengthening their sense of organizational identification, better understanding the meaning of their work and contributing to the organization (Zhu, Wang, Fang, Wang, et al. 2023; Zhu, Wang, Fang, Yan, et al. 2023). As a result, they exhibit more positive attitudes and behaviours. In light of this, we hypothesize that there may be a relationship between workplace spirituality and the level of reflective practice among specialty nurses. However, research on the relationship between workplace spirituality and reflective practice remains scarce.

Currently, research on reflective practice among specialty nurses in tertiary hospitals is relatively limited. A study by Wu et al. (2022) indicated that the level of reflective practice among specialty nurses is influenced by factors such as years of work experience, professional title, job position, employment nature and membership in multidisciplinary teams. A study by Hu et al. (2025) on specialty nurses in wound and ostomy care in Sichuan Province revealed that factors such as years of work experience, educational level, professional title, whether the nurse is a full‐time wound ostomy nurse, whether they serve as a mentor, the level of wound ostomy training attended, and professional identity influence the reflective practice behaviours of wound ostomy specialty nurses. Furthermore, a study by Cao et al. (2024) on geriatric specialty nurses in three tertiary‐A hospitals in Henan Province found that reflective practice among geriatric specialty nurses is affected by age, educational background, professional title, years of work experience, monthly income and employment nature. Although these studies have identified some influencing factors, most have used total scores or average scores as evaluation indicators, without distinguishing specific thresholds for different levels. This has hindered the implementation of targeted interventions by managers (Cao et al. 2024; Wu et al. 2022; Gustafsson et al. 2021). Xu et al. (2024) employed latent profile analysis to examine reflective practice among Chinese specialty nurses; however, their investigation was based solely on a single‐city sample and focused exclusively on demographic and structural factors, without exploring modifiable psychological and organizational factors. Latent profile analysis (LPA) is an individual‐centred research method that classifies people into subgroups based on differences in various variables within the same group and through strict objective fitting criteria. This method allows for a more accurate identification of the characteristics of different subgroups (Yin et al. 2020). This study utilizes latent profile analysis to assess the level of reflective practice among specialty nurses, exploring the differences in reflective practice across different categories of nurses. This approach helps to accurately identify target populations in need of intervention and can be used to examine the impact of multi‐level factors, including individual characteristics and workplace spirituality factors, on the reflective practice levels of specialty nurses. The findings are expected to provide valuable insights for managers in developing targeted training and intervention strategies.

3. Methodology

3.1. Aims

The purpose of this study was to explore the subtypes of reflective practice among specialty nurses in Chinese tertiary general hospitals based on latent profile analysis and to analyse the influencing factors of different subtypes.

3.2. Design

A cross‐sectional design was adopted.

3.3. Participants

From April to June 2024, participants were recruited via convenience sampling. Thirteen tertiary general hospitals across China were selected using stratified screening criteria: (1) geographical coverage of Eastern, Central and Western China; (2) a minimum of 800 open hospital beds; (3) mature specialty nursing systems offering no fewer than five core specialty nursing services. In total, 817 specialty nurses working at the 13 hospitals were included in this study.

The inclusion criteria were as follows: (1) being a registered nurse, (2) having participated in specialty nurse training and passed the assessment to obtain a qualification certificate, (3) possessing more than 1 year of experience in specialty nursing and (4) consenting to participate. Participants who took sick or maternity leave or were absent for more than 6 months were excluded.

3.4. Sample Size

This study investigated the latent profiles of reflective practice among specialty nurses. According to the principles of latent profile analysis, a sample size of 500 was appropriate for identifying the number of latent profiles. Additionally, a larger sample size may improve the statistical power for detecting the ‘true’ number of latent categories (Bagby et al. 2021; Nylund et al. 2007). Thus, this study established a minimum sample size of 500. The sample size of 817 participants in this study met this requirement.

3.5. Data Collection

This study utilized the Wenjuanxing platform (https://c.aiiz.cn/k9AdeK) to distribute the questionnaires. Prior to the survey, the researchers contacted the heads of the nursing departments of 13 tertiary general hospitals to provide a detailed explanation of the study's purpose, target respondents, and questionnaire completion methods. After obtaining permission, we sent the link to the questionnaire to the nursing department heads, who then distributed it via WeChat groups to the specialty nurses who met the inclusion criteria. The backend was set to permit each IP address to fill out the questionnaire only once to avoid repeated submissions. All options in the questionnaire were mandatory, and submission was allowed only after all items were completed. Two researchers from the team monitored the data in the Wenjuanxing backend in real time and exported the data after a continuous week without new submissions. A total of 832 questionnaires were collected in this study, with 817 being valid, resulting in an effective recovery rate of 98.20%. The criteria for invalid questionnaires included selecting the same option for 10 or more items; responding in a patterned manner; and completing the questionnaire in 3 min or less.

3.6. Instruments

3.6.1. Socio‐Demographic Information

This study employed a self‐designed questionnaire to collect participants' socio‐demographic information, including gender, age, marital status, monthly income, work experience, professional title, job position, highest education level and employment type.

3.6.2. Reflective Practice Questionnaire

The reflective practice questionnaire was developed by Australian scholars Priddis and Rogers in 2018 to measure reflective practice competencies, strengths and potential weaknesses (Priddis and Rogers 2018). The Chinese version of Reflective Practice Questionnaire, comprising 33 items, was expressed by Wu et al. (2022) to evaluate the level of reflective practice among specialty nurses. The questionnaire consists of five dimensions: reflective practice ability and desire for improvement (14 items; e.g., ‘I am eager to gain more experience to improve my ability in patient care’), self‐confidence (7 items; e.g., ‘I possess all the theoretical knowledge required for effective communication with patients’), job satisfaction (4 items; e.g., ‘My work provides me with a great sense of accomplishment’), sensitivity to reflective practice (5 items; e.g., ‘When reflecting on my work with others, I become aware of aspects I had never considered before’), and stress associated with reflective practice (3 items; e.g., ‘Sometimes, after communicating with patients, I feel a sense of frustration’). The scale uses a 6‐point Likert scoring system, with values ranging from 1 to 6 corresponding to ‘strongly disagree’ to ‘strongly agree’. Higher scores indicate a higher level of reflective practice (range: 33–198). The questionnaire demonstrates good reliability and validity, with an I‐CVI value ranging from 0.86 to 1.00, an S‐CVI of 0.98, and a Cronbach's α coefficient of 0.950 (Wu et al. 2022). In this study, the Cronbach's α coefficient for the entire questionnaire was 0.847. The slight decrease in Cronbach's α coefficient may be attributed to differences in sample characteristics and contextual factors. Nonetheless, a value of 0.847 still indicates acceptable internal consistency for research purposes.

3.6.3. Workplace Spirituality Scale

This study utilized the workplace spirituality scale developed by Ke et al. (2014) to assess the level of workplace spirituality among specialty nurses. The scale consists of 27 items in 3 dimensions: meaningful work (9 items; e.g., ‘This work often provides me with a great sense of mental fulfillment’), a sense of community (9 items; e.g., ‘I often have a sense of like‐mindedness with my colleagues’), and consistency with organizational values (9 items; e.g., ‘My organization is an ethically responsible entity’). The scale uses a 5‐point Likert scoring system, with values ranging from 1 to 5 corresponding to ‘strongly disagree’ to ‘strongly agree’. A higher score indicates better workplace spirituality of the respondent (range: 27–135). The Cronbach's α coefficient for the scale was 0.90, with Cronbach's α coefficients for each dimension ranging from 0.87 to 0.89; the test–retest reliability was 0.77. In this study, the Cronbach's α coefficient for the entire scale was 0.813. This discrepancy may be attributed to cultural differences in the understanding and expression of workplace spirituality between Chinese nurses and the original study sample. Despite the slightly reduced reliability, the Cronbach's α coefficient remains above the acceptable threshold, indicating adequate internal consistency for the current sample.

3.7. Data Analysis

Latent profile analysis was conducted using Mplus 8.3, with the five dimensions of the specialty nurse reflective practice questionnaire as manifest indicators. This study employed the following fit indices to determine the optimal number of profile models: (1) Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and sample‐size Adjusted Bayesian Information Criterion (a BIC), where smaller values of AIC, BIC, and a BIC indicate a better fit (Xia et al. 2018). (2) Information Entropy (Entropy), which is used to assess classification accuracy, ranging from 0 to 1, with values closer to 1 indicating higher classification accuracy (DeMartini and Fucito 2014). (3) Lo–Mendell–Rubin likelihood ratio test (LMR) and Bootstrapped likelihood ratio test (BLRT), where a statistically significant result (p < 0.05) indicates that the n‐class model is better than the (n−1)‐class model (Zhang et al. 2018). It is noteworthy that, although these indices provide guidance for selecting the profile models, the interpretability and practical significance of each latent class must also be considered when deciding on the final model (Collier and Leite 2017).

All subsequent analyses employed the most likely profile grouping. First, descriptive statistics for all profiles were calculated using SPSS 27.0. The Χ 2 test was performed to compare demographic differences between profiles. Analysis of variance (ANOVA) was conducted to assess differences in workplace spirituality between profiles. A multivariate logistic regression model was employed to analyse the relationship between reflective practice, demographic data and workplace spirituality. The statistical significance threshold was established at p < 0.05 with a two‐sided test, indicating statistical significance.

4. Results

4.1. Participant Characteristics

Valid questionnaires indicated that the sample comprised 752 female (92.04%) and 65 male (7.96%) specialty nurses. Among them, 636 (77.85%) were married, with an average age of 32.62 ± 5.13 years. A total of 350 (42.84%) had a monthly income of 5000–10,000 yuan, and 493 (60.34%) had less than 10 years of work experience. Additionally, 429 (52.51%) held the title of charge nurse, 47 (5.75%) served as head nurses, 722 (88.37%) had a bachelor's degree, and 486 (59.49%) were employed as personnel agents. Table 1 presents the other demographic details of the sample.

TABLE 1.

General information for specialty nurses (n = 817).

Variables Classification N (%)
Gender Male 65 (7.96)
Female 752 (92.04)
Age (years) < 30 216 (26.44)
30 ~ 40 552 (67.56)
> 40 49 (6.00)
Marital status Married 636 (77.85)
Single 181 (22.15)
Monthly income (yuan) < 5000 308 (37.70)
5000 ~ 10,000 350 (42.84)
> 10,000 159 (19.46)
Work experience (years) < 10 493 (60.34)
10 ~ 20 300 (36.72)
> 20 24 (2.94)
Professional title Junior nurse 66 (8.08)
Senior nurse 295 (36.11)
Nurse in charge 429 (52.51)
Deputy chief nurse and above 27 (3.30)
Job position Not have 770 (94.25)
Manager 47 (5.75)
Highest education level Junior college degree 80 (9.79)
Bachelor degree 722 (88.37)
Master degree 15 (1.84)
Employment type Permanent staff 117 (14.32)
Personnel agency 486 (59.49)
Contract 214 (26.19)
Workplace spirituality score (mean ± SD, points) 3.75 ± 0.36
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4.2. Latent Profiles of Reflective Practice

The average scores of each dimension of the specialty nurse reflective practice questionnaire were used as manifest indicators, and latent class models from 1 to 6 were sequentially fitted, with the fit indices for each shown in Table 2. As the number of classes increased, the AIC, BIC and aBIC values gradually decreased, reaching a minimum at Model 6. However, the LMR test result for Model 6 was not significant. In Models 4 and 5, there were groups that contained only 3.8% and 3.7% of the cases, respectively, which were too small to ensure good classification accuracy and lacked practical significance. Compared with Model 2, Model 3 had smaller AIC, BIC and aBIC values, with an entropy value of 0.917, exceeding the threshold of 0.900. Therefore, after comprehensive consideration, the 3‐class model was chosen as the best fitting model.

TABLE 2.

Model fitting indexes for LPA in reflective practice (n = 817).

Model AIC BIC aBIC Entropy LMR (p) BLRT (p) Probabilities of classes (%)
1 11792.408 11839.464 11807.708
2 9771.158 9846.449 9795.639 0.920 0.000 0.000 34.6/65.4
3 8965.602 9069.126 8999.263 0.917 0.008 0.000 23.6/37.1/39.2
4 8367.740 8499.497 8410.580 0.942 0.003 0.000 23.4/3.8/38.4/34.4
5 8062.707 8222.699 8114.728 0.935 0.000 0.000 23.3/3.7/32.4/14.0/26.6
6 7913.875 8102.100 7975.076 0.943 0.124 0.000 4.3/0.5/31.9/23.1/13.7/26.5
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Note: The LMR test result for Model 6 was not significant. In Models 4 and 5, one latent class in each contained an excessively small sample size, rendering them lack practical significance. Model 3 had smaller AIC, BIC and aBIC values than Model 2, with an entropy value greater than 0.9. Therefore, Model 3 was selected as the optimal fitting model.

Abbreviations: aBIC, sample‐size Adjusted Bayesian Information Criterion; AIC, Akaike Information Criterion; BIC, Bayesian Information Criterion; BLRT, Bootstrapped likelihood ratio test; LMR, Lo–Mendell–Rubin likelihood ratio test.

Using a three‐class model, Figure 1 illustrates the mean scores of each category under each dimension of the specialty nurse reflective practice questionnaire. In this model, the first class includes 191 specialty nurses (23.38%), the second class includes 307 specialty nurses (37.58%), and the third class includes 319 specialty nurses (39.04%). The higher the score in the specialty nurse reflective practice questionnaire, the higher the level of reflective practice. Therefore, based on the profile scores, we named Class 1 as the low reflective practice group, Class 2 as the moderate reflective practice group, and Class 3 as the high reflective practice group.

FIGURE 1.

FIGURE 1

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Latent profiles for different reflective practice. Q1: Reflective practice ability and desire for improvement; Q2: Self‐confidence; Q3: Job satisfaction; Q4: Sensitivity to reflective practice; Q5: Stress associated with reflective practice.

4.3. Predictors of Latent Profiles of Reflective Practice

The univariate analysis shows that there are statistically significant differences in age (χ 2  = 17.305, p = 0.002), marital status (χ 2  = 15.654, p < 0.001), monthly income (χ 2  = 26.286, p < 0.001), job position (χ 2  = 8.335, p = 0.015) and workplace spirituality scores (F = 363.445, p < 0.001) among specialty nurses in different categories of tertiary general hospitals, as shown in Table 3. Subsequently, the statistically significant variables from the univariate analysis were included in a multivariate logistic regression model, with the high reflective practice group as the reference group. The results indicated that married specialty nurses were more likely to be classified into the high reflective practice group (OR = 0.439, 95% CI = 0.228–0.845), while specialty nurses without positions were more likely to be classified into the low reflective practice group (OR = 4.924, 95% CI = 1.128–21.502). Specialty nurses with a monthly income between 5000 and 10,000 yuan were more likely to be classified into the moderate reflective practice group (OR = 2.437, 95% CI = 1.362–4.364). Workplace spirituality was identified as a factor influencing high reflective practice among specialty nurses (p < 0.05), as shown in Table 4.

TABLE 3.

Demographic results of specialty nurses based on different reflective practice profiles (n = 817).

Variables Classification Overall C1 (n = 191) C2 (n = 307) C3 (n = 319) χ 2 /F p
N (%) N (%) N (%) N (%)
Gender Male 65 (7.96) 11 (5.76) 25 (8.14) 29 (9.09) 1.835 a 0.400
Female 752 (92.04) 180 (94.24) 282 (91.86) 290 (90.91)
Age (years) < 30 216 (26.44) 68 (35.6) 81 (26.38) 67 (21.00) 17.305 a 0.002
30 ~ 40 552 (67.56) 114 (59.69) 213 (69.38) 225 (70.53)
> 40 49 (6.00) 9 (4.71) 13 (4.23) 27 (8.46)
Marital status Married 636 (77.85) 132 (69.11) 236 (76.87) 268 (84.01) 15.654 a 0.000
Single 181 (22.15) 59 (30.89) 71 (23.13) 51 (15.99)
Monthly income (yuan) < 5000 308 (37.70) 83 (43.46) 117 (38.11) 108 (33.86) 26.286 a 0.000
5000 ~ 10,000 350 (42.84) 79 (41.36) 149 (48.53) 122 (38.24)
> 10,000 159 (19.46) 29 (15.18) 41 (13.36) 89 (27.9)
Work experience (years) < 10 493 (60.34) 121 (63.35) 195 (63.52) 177 (55.49) 7.459 a 0.114
10 ~ 20 300 (36.72) 66 (34.55) 106 (34.53) 128 (40.13)
> 20 24 (2.94) 4 (2.09) 6 (1.95) 14 (4.39)
Professional title Junior nurse 66 (8.08) 19 (9.95) 20 (6.51) 27 (8.46) 11.752 a 0.068
Senior nurse 295 (36.11) 69 (36.13) 126 (41.04) 100 (31.35)
Nurse in charge 429 (52.51) 100 (52.36) 153 (49.84) 176 (55.17)
Deputy chief nurse and above 27 (3.30) 3 (1.57) 8 (2.61) 16 (5.02)
Job position Not have 770 (94.25) 188 (98.43) 287 (93.49) 295 (92.48) 8.335 a 0.015
Manager 47 (5.75) 3 (1.57) 20 (6.51) 24 (7.52)
Highest education level Junior college degree 80 (9.79) 25 (13.09) 28 (9.12) 27 (8.46) 6.694 a 0.153
Bachelor degree 722 (88.37) 163 (85.34) 270 (87.95) 289 (90.60)
Master degree 15 (1.84) 3 (1.57) 9 (2.93) 3 (0.94)
Employment type Permanent staff 117 (14.32) 27 (14.14) 48 (15.64) 42 (13.17) 3.499 a 0.478
Personnel agency 486 (59.49) 107 (56.02) 178 (57.98) 201 (63.01)
Contract 214 (26.19) 57 (29.84) 81 (26.38) 76 (23.82)
Workplace spirituality score (mean ± SD, points) 3.75 ± 0.36 3.54 ± 0.18 3.55 ± 0.11 4.06 ± 0.38 363.445 b 0.000
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Note: Bold numbers: p < 0.05.

Abbreviations: C1, low reflective practice group; C2, moderate reflective practice group; C3, high reflective practice group.

a

χ 2 .

b

F.

TABLE 4.

Logistic regression of different reflective practice profiles (N = 817).

Variables Classification B p OR 95% CI
C1 (ref.C3)
Age (years) (ref. > 40) < 30 −0.392 0.537 0.676 0.195–2.343
30 ~ 40 −0.716 0.213 0.489 0.159–1.506
Marital status (ref. Single) Married −0.822 0.014 0.439 0.228–0.845
Job position (ref. Manager) Not have 1.594 0.034 4.924 1.128–21.502
Monthly income (yuan) (ref. > 10,000) < 5000 0.440 0.184 1.553 0.811–2.974
5000 ~ 10,000 0.610 0.064 1.840 0.964–3.512
Workplace spirituality score −6.223 0.000 0.002 0.001–0.006
C2 (ref.C3)
Age (years) (ref. > 40) < 30 0.088 0.881 1.093 0.343–3.483
30 ~ 40 0.059 0.910 1.061 0.377–2.987
Marital status (ref. Single) Married −0.587 0.063 0.556 0.299–1.033
Job position (ref. Manager) Not have −0.054 0.912 0.947 0.361–2.483
Monthly income (yuan) (ref. > 10,000) < 5000 0.557 0.066 1.745 0.964–3.159
5000 ~ 10,000 0.891 0.003 2.437 1.362–4.364
Workplace spirituality score −5.670 0.000 0.003 0.001–0.009
C2 (ref.C1)
Age (years) (ref. > 40) < 30 0.481 0.379 1.617 0.554 ~ 4.724
30 ~ 40 0.775 0.127 2.172 0.803 ~ 5.876
Marital status (ref. Single) Married 0.235 0.338 1.265 0.782 ~ 2.047
Job position (ref. Manager) Not have −1.648 0.015 0.192 0.051 ~ 0.729
Monthly income (yuan) (ref. > 10,000) < 5000 0.117 0.686 1.124 0.638 ~ 1.978
5000 ~ 10,000 0.281 0.324 1.325 0.757 ~ 2.317
Workplace spirituality score 0.553 0.331 1.739 0.570 ~ 5.307
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Note: Nagelkerke R 2: 0.502, classification accuracy (%): 62.67%. Bold numbers: p < 0.05.

Abbreviations: B, unstandardized coefficient; C1, low reflective practice group; C2, moderate reflective practice group; C3, high reflective practice group; CI, confidence interval; OR, odds ratio; ref., reference group.

5. Discussion

Reflective practice is of great significance in promoting the professional growth and personal development of specialty nurses (Wharton et al. 2021). Previous studies have predominantly examined the overall level or related influencing factors of reflective practice among specialty nurses from a variable‐centred perspective, with limited attention paid to the potential heterogeneity across different subgroups of specialty nurses. This study provides additional evidence regarding reflective practice among specialty nurses. The study identified three subgroups of reflective practice: low reflective practice group (23.38%), moderate reflective practice group (37.58%), and high reflective practice group (39.04%). Overall, the majority of specialty nurses (76.62%) exhibited moderate to high levels of reflective practice, which is largely consistent with previous studies (Wu et al. 2022; Gustafsson et al. 2021). This suggests that the reflective practice level of specialty nurses in tertiary hospitals in China is generally satisfactory. However, this study further revealed that reflective practice among specialty nurses is not homogeneously distributed, with nearly a quarter of nurses still falling into the low‐level reflective practice group, suggesting that reporting only the overall mean level may obscure the actual developmental needs of different subgroups. The study not only reveals the latent stratified characteristics of reflective practice among specialty nurses but also provides an evidence base for implementing stratified and precise nursing education and management interventions. Nursing managers should pay more attention and take effective measures to further improve the reflective practice levels of specialty nurses, especially focusing on those in the ‘low reflective practice group’, and encourage them to utilize available resources and opportunities to enhance their reflective practice.

As shown in Figure 1, the dimension of ‘reflective practice ability and desire for improvement’ scored the highest among the three categories, while the dimension of ‘stress associated with reflective practice’ scored the lowest, which is similar to the findings of Cao et al. (2024) and Xu et al. (2024). This may indicate that specialty nurses in tertiary general hospitals have some understanding of the concept of reflective practice and consider it important, with a desire for improvement. This not only helps improve nurses' self‐efficacy and the quality of nursing care but also stimulates their enthusiasm for work, encouraging them to adopt more effective methods to solve patient problems, improve nurse–patient relationships and enhance job satisfaction. However, as research on reflective practice among healthcare professionals in China is still in its early stages, the application of this concept among specialty nurses is relatively lagging, and nurses may not yet fully realize the potential negative impacts of reflective practice in its practical application (Wu et al. 2022). For example, overemphasizing reflective practice may bring additional stress to nursing work and create a sense of uncertainty about the job (Koshy et al. 2017; Nicol and Dosser 2016). Therefore, nursing educators and managers should place greater emphasis on the cultivation of reflective practice, providing more relevant training opportunities, such as holding regular seminars, workshops, and using tools like the Gibbs reflective cycle to enhance specialty nurses' reflective practice abilities. Furthermore, it is essential to increase awareness of the potential negative effects of reflective practice, avoid placing excessive emphasis on it, reduce occupational uncertainty and stress, and thus ensure the sustained improvement of nursing quality.

In terms of sociodemographic characteristics, this study found that married specialty nurses are more likely to be classified into the high reflective practice group, which is consistent with the findings of Xu et al. (2024), further supporting the association between marital status and nurses' reflective practice levels. For specialty nurses, a stable marital relationship helps them obtain sustained emotional support and psychological comfort, alleviate stress, fatigue, and negative emotions in clinical work, and thereby invest more psychological resources in examining the nursing process, analysing clinical problems, and proactively seeking practice improvement (Dong et al. 2024; Yildiz and Elibol 2021). Therefore, marital status may not directly enhance reflective practice competence, but rather provide the necessary psychological foundation for reflective practice by improving individuals' emotional regulation and psychological resource levels. Furthermore, married specialty nurses play multiple roles in their family lives, requiring them to balance work and family. The planning skills, sense of responsibility, communication abilities and caregiving experience developed in this process may be transferable to clinical nursing practice, enabling them to pay greater attention to the interconnections among patient needs, nursing processes, and patient outcomes, thereby promoting systematic review and critical thinking about clinical practice (Wang et al. 2024). Therefore, nursing managers can create a supportive environment to encourage married specialty nurses to share the reflective practice experiences and strategies they have gained from family life, helping them translate these experiences into positive impacts in the workplace. Through sharing and discussion, nurses can learn from each other and progress together, fostering a more positive work atmosphere and higher work standards.

Additionally, we found that specialty nurses without positions are more likely to be classified into the low reflective practice group. This is largely consistent with the findings of Wu et al. (2022). This may be because specialty nurses in managerial positions typically have more learning opportunities and stronger motivation to learn, such as participating in conferences, receiving training, and securing research funding, all of which contribute to reflective practice (Wang et al. 2018). Furthermore, specialty nurses with managerial positions often take on responsibilities such as ward management and quality improvement, which require continuous reflection and optimization of nursing practices (Zhou et al. 2022). In contrast, specialty nurses without positions are often constrained in their access to resources, with their daily work focusing primarily on passive execution of clinical tasks and lacking the external support and internal motivation for deep reflection. Compared with previous traditional regression analyses that verified the linear correlation between job position and reflective practice, this study adopted a person‐centred perspective using latent profile analysis, revealing the independent predictive role of job position in the stratified classification of reflective practice among specialty nurses, thereby transcending the traditional research limitation of focusing solely on inter‐variable associations. Furthermore, it validated the generalizability of Wu et al. (2022) regionally limited findings at the national level, providing more representative empirical evidence for the subsequent development of stratified strategies to enhance reflective capacity. Therefore, nursing managers should pay attention to the career development, experience accumulation, resource access, and team role positioning of non‐managerial specialty nurses, provide more learning opportunities such as mentorship and peer review, address the reflective practice deficiencies of specialty nurses in non‐managerial positions, and promote the balanced enhancement of reflective capacity across all levels of the specialty nursing workforce.

This study suggests that specialty nurses with a monthly income between 5000 and 10,000 yuan are more likely to be classified into the moderate reflective practice group, which contradicts the previous conclusion that ‘higher income is associated with lower levels of reflective practice’ (Cao et al. 2024). This discrepancy may be due to differences in the social and cultural environments, occupational structures, and sample selection of the research subjects. In this study, specialty nurses in this income range are usually in a transitional stage of their career development—having accumulated substantial clinical experience and acquired a professional foundation for routine practice review, yet not having progressed to senior specialty nurse or management positions, and thus not having developed mature systematic reflective capabilities. At the same time, this group is situated precisely at the peak period of occupational burnout, where heavy clinical workloads consume the energy required for deep reflection, ultimately resulting in a ‘moderate reflection’ state characterized by ‘having the foundation but struggling to go deeper’ (Modaresnezhad et al. 2021). In contrast, the high‐income group in previous studies may have reduced motivation for active reflection due to abundant resources, decision‐making inertia, or the entrenchment of their social status. Using a nationally representative large sample of specialty nurses, this study revealed a non‐linear stratified association between income and reflective practice, correcting the biassed conclusions derived from previous linear analyses, while precisely identifying mid‐career specialty nurses with moderate income as a critical intervention target—addressing the intervention gap in prior studies that focused only on the extreme high and low ends of the income spectrum. Therefore, nursing managers may consider establishing a reasonable compensation system and salary incentive mechanisms, offering more training, time support, and career development opportunities to assist this group in overcoming the career plateau bottleneck, facilitating their transition from the moderate to the high reflective practice group, and ultimately achieving a balanced enhancement of reflective capacity across all levels of the specialty nursing workforce.

It is worth noting that we found workplace spirituality to be a key factor in promoting high levels of reflective practice among specialty nurses, which is consistent with previous findings in general clinical nurses (Chen et al. 2024), yet revealed a unique pattern in its stratified effects that has not been previously reported. The reasons may be as follows. Meaningful work, a sense of community and consistency with organizational values are important elements of workplace spirituality (Ke et al. 2014). According to social exchange theory and person‐organization fit theory, good organizational support and a strong person‐organization match help to enhance an individual's workplace spirituality (Cropanzano and Mitchell 2005; Chen et al. 2016). Critically, specialty nurses assume greater role stress and more intricate clinical responsibilities compared with general nurses. When the personal goals of specialty nurses are aligned with the core values of the organization, they perceive recognition within their work environment, enhancing their sense of organizational belonging and boosting their enthusiasm for work. The core of workplace spirituality is transcendence, which encourages specialty nurses to pursue excellence in their work, continually challenge themselves and surpass themselves (Ehrhart et al. 2021). This pursuit of excellence can inspire specialty nurses to engage in reflective practice, constantly seeking ways to improve work quality while also prompting them to continue learning and improving themselves to meet the challenges of modern nursing (Wu et al. 2022). However, this study found that the difference in workplace spirituality between the moderate reflective practice group and the low reflective practice group was not significant. This is because workplace spirituality may function as a ‘threshold variable’, which can significantly distinguish between ‘extreme categories’ and ‘non‐extreme categories’ but fails to differentiate between two ‘non‐extreme categories’. This reflects the differential sensitivity of external variables to different latent profiles. Therefore, nursing managers should focus on empowering high‐potential groups through organizational value alignment, fostering a positive specialty nursing organizational culture, strengthening team belonging and establishing professional platforms that support nurses' self‐actualization. These strategies can deepen nurses' identification with organizational values, guide them to actively pursue professional self‐improvement and address negative emotions, thereby helping more nurses surpass the threshold of workplace spirituality and transition into the high reflective practice group. Ultimately, these efforts will effectively enhance the overall reflective practice level of specialty nurses and achieve a holistic upgrade of core competencies within the specialty nursing workforce.

6. Implications

This study identified three heterogeneous latent profiles of reflective practice among specialty nurses and confirmed workplace spirituality as a key factor distinguishing between different profiles, providing multidimensional, in‐depth guidance for clinical practice and offering solid evidence to support nursing‐policy formulation and the advancement of professional practice. In terms of clinical practice, identifying these three latent profiles allows specialty nurses to clearly recognize their own reflective‐practice levels, conduct self‐assessment of their strengths and weaknesses, and promptly correct biassed clinical decision‐making and habitual nursing behaviours, thereby enhancing their understanding of professional development pathways. It also encourages them to proactively participate in targeted training, facilitating their transformation from passive implementers into active thinkers and lifelong learners, ultimately standardizing clinical practice and ensuring patient safety. In terms of nursing administration and policy, the finding of workplace spirituality as a ‘threshold variable’ brings new perspectives for improving nursing human‐resource management policies. Workforce development policies should extend beyond demographic and structural factors to incorporate psychosocial dimensions of the organizational environment. Nursing managers can optimize the organizational psychological environment by implementing structured team‐building activities and clarifying core organizational values, thereby elevating nurses' overall reflective capacity. Furthermore, this study provides a scientific basis for managers to develop individualized and precise training programmes for specialty nurses at different reflective practice levels, facilitating the shift toward refined nursing human resource management through data‐driven profile identification rather than intuition‐based judgements. In terms of nursing education, the differentiated characteristics of reflective practice among specialty nurses offer empirical evidence for competency‐based nursing training. Nursing educators can design tiered, targeted training curricula according to different reflective profiles, focusing on improving the reflective weaknesses of low‐level groups while consolidating the reflective strengths of high‐level groups, with low‐profile nurses receiving structured reflective tools and supervised practice, and high‐profile nurses being engaged as peer mentors, thereby enhancing the overall effectiveness of specialty nurse training. Future research could further focus on longitudinally tracking the career development and patient outcomes associated with different levels of reflective practice among specialty nurses, developing reflective practice training programmes based on workplace spirituality, and conducting comparative studies across regions or hospital tiers. These efforts would provide deeper theoretical and practical support for accurately enhancing the reflective practice abilities of specialty nurses and promoting the development of the nursing discipline.

7. Strengths and Limitations

This study employs an innovative statistical method—Latent Profile Analysis (LPA), which enables the identification of individual heterogeneity and multidimensional features in specialty nurses' reflective practice. To the best of our knowledge, this is the first study adopting latent profile analysis to explore reflective practice among specialty nurses in tertiary general hospitals nationwide in China. Furthermore, our sample covers Eastern, Central and Western China, ensuring favourable geographical representativeness. Importantly, workplace spirituality was incorporated as a novel influencing factor, broadening the analytical scope of prior research. Drawing upon person–organization fit theory as the theoretical framework, this study offers an in‐depth theoretical explanation regarding how workplace spirituality facilitates reflective practice. Collectively, these contributions deliver new empirical evidence and theoretical support for nursing administrators to develop precise, targeted intervention strategies.

Nevertheless, this study has several limitations. First, data collection was performed via an online survey, which may lead to sample selection bias. Moreover, because we were unable to obtain data from non‐respondents, we could not conduct a statistical test for non‐response bias. Second, only specialty nurses from tertiary general hospitals were recruited. Further verification is needed to examine whether the findings are applicable to nurses in specialist hospitals or other types of healthcare institutions. Third, the influencing factors included in this study may not be comprehensive, and further exploration is needed. In addition, restricted by time and other practical constraints, the number of participating hospitals was limited. Future research should expand the number of hospitals and geographical coverage to improve the generalizability of the results. Finally, the slightly lower reliability of the reflective practice questionnaire and workplace spirituality scale (compared to their original versions) may have marginally reduced the precision of measuring the latent constructs and could have attenuated the strength of associations between workplace spirituality and reflective practice profiles, though the core findings regarding subgroup identification remain robust given the scales' acceptable internal consistency.

8. Conclusions

This study adopted a person‐centred approach to classify the reflective practice of specialty nurses in tertiary general hospitals into three subgroups: low reflective practice group, moderate reflective practice group and high reflective practice group. Moreover, this study indicates that the vast majority of specialty nurses belong to the moderate to high categories of reflective practice, and there is still a need for further enhancement. Additionally, the study found significant differences among specialty nurses in terms of marital status, job position, monthly income and workplace spirituality. Based on these findings, it is recommended that nursing managers focus on the development of reflective practice and implement tiered training strategies for specialty nurses at different levels. For those in the low reflective practice group, targeted training in basic skills and reflective tools should be provided, while for those in the moderate to high reflective practice groups, interdisciplinary communication platforms and advanced thinking development opportunities should be established. In addition, a reasonable compensation system should be established, and career development paths should be optimized. In terms of nursing education, it is suggested that the cultivation of reflective practice be combined with the development of workplace spirituality. This can be achieved through curriculum design and clinical teaching practices to enhance specialty nurses' reflective awareness and professional value recognition. Collectively, these findings underscore the importance of shifting from a one‐size‐fits‐all approach to a stratified, person‐centred paradigm in specialty nurse development, with workplace spirituality serving as a promising leverage point for fostering reflective capacity and advancing both professional growth and patient care quality.

Author Contributions

Songyao Li: conceptualization, methodology, software, data curation, investigation, validation, project administration, writing – original draft, writing – review and editing. Wenqiong Lin: data curation, investigation, software, methodology, conceptualization, writing – review and editing. Panpan Zhang: conceptualization, methodology, funding acquisition, investigation, data curation, validation, writing – review and editing. Yaru Li: writing – original draft, investigation, writing – review and editing. Ziru Fang: writing – review and editing, project administration, validation. Yuning Wang: writing – review and editing, investigation. Hongmei Zhang: resources, project administration, funding acquisition, supervision, writing – review and editing, formal analysis, validation, conceptualization, methodology.

Funding

This study was funded by the Henan Provincial Medical Education Research Project (No. WJLX2024028), and Henan Province Key Research Development and Promotion Project (Science and Technology) (No. 232102310235). The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.

Disclosure

The authors confirm that this submission conforms to the journal's statistical guidelines. There is a statistician on the author team: Professor Hongmei Zhang. This author takes responsibility for the statistical analyses in this manuscript.

Ethics Statement

The study was reviewed and approved by the ethics committee of Zhengzhou University (ZZUIRB2023192) on May 15, 2023. All participants took part in this study voluntarily after fully understanding the research content. Written informed consent was obtained by participants selecting the option of ‘agree to participate in this survey’ in the questionnaire. All questionnaires were completed anonymously. After participants submitted the online questionnaire, the data were directly transmitted to the research team without the involvement of any third party, thereby ensuring the confidentiality of all personal information.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgements

The authors extend their deepest gratitude to the director of the Henan Province Nursing Quality Control Center and the specialty nurses who assisted with data collection in the study. AI Acknowledgment: AI tools were used solely for English language polishing and grammatical correction in this study. The study design, data analysis, interpretation of results and all substantive manuscript content were independently completed, reviewed and finalized by the authors. No AI tools were involved in data generation, statistical analysis or the formulation of scientific conclusions.

Data Availability Statement

The data will be available from the corresponding author upon request.

References

  1. Bagby, R. M. , Sanches M., Carnovale M., and Taylor G. J.. 2021. “An Evaluation of Alexithymia Subtypes Using Latent Profile Analysis.” Psychiatry Research 299: 113840. 10.1016/j.psychres.2021.113840. [DOI] [PubMed] [Google Scholar]
  2. Barbagallo, M. S. 2020. “Nursing Students' Perceptions and Experiences of Reflective Practice: A Qualitative Meta‐Synthesis.” Teaching and Learning in Nursing 16: 24–31. 10.1016/j.teln.2020.07.006. [DOI] [Google Scholar]
  3. Bolden, L. , Cuevas N., Raia L., Meredith E., and Prince T.. 2011. “The Use of Reflective Practice in New Graduate Registered Nurses Residency Program.” Nursing Administration Quarterly 35, no. 2: 134–139. 10.1097/NAQ.0b013e31820feb5e. [DOI] [PubMed] [Google Scholar]
  4. Cao, Y. B. , Zhang W. Q., Zheng S., Wang X. Y., Song J. L., and Wang H. J.. 2024. “Correlation Between Reflective Practice and Personal Growth Initiative in Gerontological Nurse Specialists.” Nursing Research 38, no. 8: 1445–1449. 10.12102/j.issn.1009-6493.2024.08.024. [DOI] [Google Scholar]
  5. Chen, M. , Wang A., and Zhou B.. 2023. “Exploring the Core Competencies of Clinical Nurses in Chinese Tertiary Hospitals: A Qualitative Content Analysis.” BMC Nursing 22, no. 1: 166. 10.1186/s12912-023-01337-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chen, P. , Sparrow P., and Cooper C.. 2016. “The Relationship Between Person‐Organization Fit and Job Satisfaction.” Journal of Managerial Psychology 31, no. 5: 946–959. 10.1108/JMP-08-2014-0236. [DOI] [Google Scholar]
  7. Chen, X. J. , Hu F., Tang L., and Tan X. M.. 2024. “Analysis of Reflective Practice Level and Its Influencing Factors in Clinical Nurses.” Chinese Nursing Education 21, no. 9: 1120–1125. 10.3761/j.issn.1672-9234.2024.09.015. [DOI] [Google Scholar]
  8. Collier, Z. , and Leite W.. 2017. “A Comparison of Three‐Step Approaches for Auxiliary Variables in Latent Class and Latent Profile Analysis.” Structural Equation Modeling 24, no. 6: 819–830. 10.1080/10705511.2017.1365304. [DOI] [Google Scholar]
  9. Contreras, J. A. , Edwards‐Maddox S., Hall A., and Lee M. A.. 2020. “Effects of Reflective Practice on Baccalaureate Nursing Students' Stress, Anxiety, and Competency: An Integrative Review.” Worldviews on Evidence‐Based Nursing 17, no. 3: 239–245. 10.1111/wvn.12438. [DOI] [PubMed] [Google Scholar]
  10. Cropanzano, R. , and Mitchell M. S.. 2005. “Social Exchange Theory: An Interdisciplinary Review.” Journal of Management 31, no. 6: 874–900. 10.1177/0149206305279602. [DOI] [Google Scholar]
  11. Davey, B. R. , Byrne S. J., Millear P. M., Dawber C., and Medoro L.. 2021. “Evaluating the Impact of Reflective Practice Groups for Nurses in an Acute Hospital Setting.” Australian Journal of Advanced Nursing 38: 220. 10.37464/2020.381.220. [DOI] [Google Scholar]
  12. DeMartini, K. S. , and Fucito L. M.. 2014. “Variations in Sleep Characteristics and Sleep‐Related Impairment in At‐Risk College Drinkers: A Latent Profile Analysis.” Health Psychology 33, no. 10: 1164–1173. 10.1037/hea0000115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Dong, Y. , Guan Q. Y., Cai S. Z., et al. 2024. “Statues Quo and Influencing Factors of Empathy for Pain Among Clinical Nurses in Tumor Specialized Hospitals.” Nursing Research 38, no. 2: 344–348. 10.12102/j.issn.1009-6493.2024.02.027. [DOI] [Google Scholar]
  14. Dong, Z. Y. , Wei L., Sun X. G., et al. 2023. “Experiences of Nurses Working in Nurse‐Led Clinics in Traditional Chinese Medicine Hospitals: A Focused Ethnographic Study.” Nursing Open 10: 603–612. 10.1002/nop2.1326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ehrhart, M. G. , Shuman C. J., Torres E. M., et al. 2021. “Validation of the Implementation Climate Scale in Nursing.” Worldviews on Evidence‐Based Nursing 18, no. 2: 85–92. 10.1111/wvn.12500. [DOI] [PubMed] [Google Scholar]
  16. Feng, H. X. , Li G. H., Xu C. R., and Fan H.. 2020. “Cultivation and Use of Specialty Nurses Based on Post Competence.” Chinese Nursing Education 28, no. 8: 681–684. 10.3761/j.issn.1672-9234.2020.08.002. [DOI] [Google Scholar]
  17. Gustafsson, S. , Engström Å., Lindgren B. M., and Gabrielsson S.. 2021. “Reflective Capacity in Nurses in Specialist Education: Swedish Translation and Psychometric Evaluation of the Reflective Capacity Scale of the Reflective Practice Questionnaire.” Nursing Open 8, no. 2: 546–552. 10.1002/nop2.659. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hou, M. X. , Wang F. J., Yue L. X., et al. 2019. “A Qualitative Research on How Clinical Nurses Conduct Reflective Practice.” Chinese Journal of Nursing Education 16, no. 12: 937–941. 10.3761/j.issn.1672-9234.2019.12.013. [DOI] [Google Scholar]
  19. Hu, R. , Ma Y. F., Chen J. L., Wang C. Y., He F., and He M.. 2025. “Status Quo of Reflective Practice in Wound and Ostomy Specialist Nurses and Its Enlightenment to Wound and Ostomy Specialist Nursing Training.” Chinese Nursing Research 39, no. 9: 1513–1518. 10.12102/j.issn.1009-6493.2025.09.016. [DOI] [Google Scholar]
  20. Hussain Rawther, S. C. , Pai M. S., Fernandes D. J., Mathew S., Chakrabarty J., and Devi E. S.. 2020. “Specialist Nurse Initiated Interventions in Breast Cancer Care: A Systematic Review of Randomised Controlled Trials.” Journal of Clinical Nursing 29, no. 13–14: 2161–2180. 10.1111/jocn.15268. [DOI] [PubMed] [Google Scholar]
  21. Hwang, E. 2022. “Effect of Stress on Quality of Life of Shift Nurses in Tertiary General Hospital: The Mediating Effect of Mindfulness.” Health 11, no. 1: 71. 10.3390/healthcare11010071. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Ke, J. L. , Sun J. M., and Wang J.. 2014. “Development and Validation of the Workplace Spirituality Scale.” Chinese Journal of Clinical Psychology 22, no. 5: 826–830. [Google Scholar]
  23. Koshy, K. , Limb C., Gundogan B., Whitehurst K., and Jafree D. J.. 2017. “Reflective Practice in Health Care and How to Reflect Effectively.” International Journal of Surgery Oncology 2, no. 6: e20. 10.1097/IJ9.0000000000000020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Li, F. F. , Zeng T. Y., Chen D. Q., and Li M.. 2022. “Analysis of the Status Quo and Influencing Factors of Nurses' Workplace Spirituality.” Chinese Evidence‐Based Nursing 8, no. 1: 61–65. 10.12102/j.issn.2095-8668.2022.01.012. [DOI] [Google Scholar]
  25. Locatelli, G. 2019. “The Multifaceted Role of the Epilepsy Specialist Nurse: Literature Review and Survey Study on Patient and Medical Staff Perceptions.” Professioni Infermieristiche 72, no. 1: 34–41. 10.7429/pi.2019.720134. [DOI] [PubMed] [Google Scholar]
  26. Ma, C. W. , and Li G. H.. 2022. “Research Progress on the Use and Management of Specialist Nurses at Home and Abroad.” Chinese Journal of Modern Nursing 28, no. 3: 415–420. 10.3760/cma.j.cn115682-20210609-02548. [DOI] [Google Scholar]
  27. Ming, Y. , Xu S. Y., Wu M. M., Wang J., and Fu J.. 2023. “A Study on the Impact of Retlective Practice Ot Clinical Nurses on Medication Safety Competence.” Chinese Nursing Education 20, no. 8: 914–919. 10.3761/j.issn.1672-9234.2023.08.003. [DOI] [Google Scholar]
  28. Ministry of Health of the People's Republic of China . 2012. “China Nursing Career Development Plan Outline (2011‐2015).” Chinese Nursing Management 12, no. 2: 9–12. 10.3969/j.issn.1006-6411-C.2012.06.004. [DOI] [Google Scholar]
  29. Modaresnezhad, M. , Andrews M. C., Mesmer‐Magnus J., Viswesvaran C., and Deshpande S.. 2021. “Anxiety, Job Satisfaction, Supervisor Support and Turnover Intentions of Mid‐Career Nurses: A Structural Equation Model Analysis.” Journal of Nursing Management 29, no. 5: 931–942. 10.1111/jonm. [DOI] [PubMed] [Google Scholar]
  30. National Health Commission of the People's Republic of China . 2022. “National Nursing Development Plan (2021–2025).” Chinese Nursing Management 22: 6. 10.3969/j.issn.1672-1756.2022.06.001. [DOI] [Google Scholar]
  31. Nicol, J. S. , and Dosser I.. 2016. “Understanding Reflective Practice.” Nursing Standard 30, no. 36: 34–42. 10.7748/ns.30.36.34.s44. [DOI] [PubMed] [Google Scholar]
  32. Nylund, K. L. , Asparouhov T., and Muthén B. O.. 2007. “Deciding on the Number of Classes in Latent Class Analysis and Growth Mixture Modeling: A Monte Carlo Simulation Study.” Structural Equation Modeling 14: 535–569. 10.1080/10705510701575396. [DOI] [Google Scholar]
  33. O'Neill, L. , Johnson J., and Mandela R.. 2019. “Reflective Practice Groups: Are They Useful for Liaison Psychiatry Nurses Working Within the Emergency Department?” Archives of Psychiatric Nursing 33, no. 1: 85–92. 10.1016/j.apnu.2018.11.003. [DOI] [PubMed] [Google Scholar]
  34. Patel, K. M. , and Metersky K.. 2022. “Reflective Practice in Nursing: A Concept Analysis.” International Journal of Nursing Knowledge 33, no. 3: 180–187. 10.1111/2047-3095.12350. [DOI] [PubMed] [Google Scholar]
  35. Priddis, L. E. , and Rogers S. L.. 2018. “Development of the Reflective Practice Questionnaire: Preliminary Findings.” Reflective Practice 19, no. 1: 89–104. 10.1080/14623943.2017.1379384. [DOI] [Google Scholar]
  36. Schön, D. A. 1983. The Reflective Practitioner: How Professionals Think in Action, 31–34. Basic Books. 10.1080/07377366.1986.10401080. [DOI] [Google Scholar]
  37. Tibken, C. , Richter T., Linden N. V. D., Schmiedeler S., and Schneider W.. 2022. “The Role of Metacognitive Competences in the Development of School Achievement Among Gifted Adolescents.” Child Development 93, no. 1: 117–133. 10.1111/cdev.13640. [DOI] [PubMed] [Google Scholar]
  38. Wang, J. , Li P., Wang Y., Zhang Q., Hou M., and Wang Z. F.. 2024. “Organizational Citizenship Behavior of Nurses in Tertiary Grade‐A Hospitals and Its Influencing Factors:A 2,050‐Case Study.” Journal of Nursing Science 31, no. 6: 67–72. 10.16460/j.issn1008-9969.2024.06.067. [DOI] [Google Scholar]
  39. Wang, Z. Y. , Yang H. Y., and Zhou X.. 2018. “Survey and Analysis of Career Planning Status Quo of ICU Specialist Nurses in Shanxi.” Nursing Research 32, no. 17: 2750–2753. 10.12102/j.issn.1009-6493.2018.17.027. [DOI] [Google Scholar]
  40. Wharton, C. , Kotera Y., and Brennan S.. 2021. “A Well‐Being Champion and the Role of Self‐Reflective Practice for ICU Nurses During COVID‐19 and Beyond.” Nursing in Critical Care 26, no. 2: 70–72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Wu, X. , Li Y., Li J., Pang J. M., and Wang Q. J.. 2022. “Reliability and Validity of Reflective Practice Questionnaire of Chinese Version and Its Application in Specialist Nurses.” Chinese Nursing Management 22, no. 6: 898–903. 10.3969/j.issn.1672-1756.2022.06.019. [DOI] [Google Scholar]
  42. Xia, K. L. , Li Z. M., and Mu L.. 2018. “Multiscale Persistent Functions for Biomolecular Structure e.” Bulletin of Mathematical Biology 80, no. 1: 1–31. 10.1007/s11538-017-0362-6. [DOI] [PubMed] [Google Scholar]
  43. Xu, L. C. , Lin L. Y., Guan A. X., et al. 2024. “Factors Associated With Reflective Practice Among Specialist Nurses in China: A Latent Profile Analysis.” Nursing Open 11, no. 12: e70114. 10.1002/nop2.70114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Yildiz, B. , and Elibol E.. 2021. “Turnover Intention Linking Compulsory Citizenship Behaviours to Social Loafing in Nurses: A Mediation Analysis.” Journal of Nursing Management 29, no. 4: 653–663. 10.1111/jonm.13200. [DOI] [PubMed] [Google Scholar]
  45. Yin, K. , Peng J., and Zhang J.. 2020. “The Application of Latent Profile Analysis in Organizational Behavior Research.” Psychological Science in Progress 28, no. 7: 1056–1070. 10.3724/SP.J.1042.2020.01056. [DOI] [Google Scholar]
  46. Yu, H. J. , Ling D. L., and Hu J. L.. 2019. “Advancing the Quality of Care and Nursing Practice Through Emancipatory Reflection.” Frontiers of Nursing 6: 1–4. 10.2478/fon-2019-0002. [DOI] [Google Scholar]
  47. Zhang, P. P. , Li Y. R., Li S. Y., et al. 2024. “Linkage Between Role Stress and Work Engagement Among Specialty Nurses: A Cross‐Sectional Study of China.” BMJ Open 14, no. 8: e079979. 10.1136/bmjopen-2023-079979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Zhang, Z. H. , Abarda A., Contractor A. A., Wang J., and Dayton C. M.. 2018. “Exploring Heterogeneity in Clinical Trials With Latent Class Analysis.” Annals of Translational Medicine 6, no. 7: 119. 10.21037/atm.2018.01.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Zhou, G. H. , Xu H. X., Yang W. H., et al. 2022. “Development of an Evaluation Scale for Head Nurse Role Behaviors Based on Mintzberg's Management Theory.” General Nursing 20, no. 18: 2458–2462. 10.12104/j.issn.1674-4748.2022.18.003. [DOI] [Google Scholar]
  50. Zhou, Z. Z. , Chen Y., Lu S., et al. 2021. “Analysis of Standardized Training Needs of New Nurses in Yunnan Province.” Chinese Journal of Practical Nursing 37, no. 36: 2872–2877. 10.3760/cma.j.cn211501-20201026-04321. [DOI] [Google Scholar]
  51. Zhu, Y. , Wang Z. Y., Fang Z. P., et al. 2023. “Curent Status of Workplace Spirituality in Clinical Nurses and Its Influencing Factors: A 456‐Case Study.” Journal of Nursing 30, no. 5: 7–11. 10.16460/j.issn1008-9969.2023.05.007. [DOI] [Google Scholar]
  52. Zhu, Y. , Wang Z. Y., Fang Z. P., Yan Y. S., Wang J., and Pang X. L.. 2023. “The Correlation Between Nurses' Innovative Behavior and Person‐Organization Fit, Workplace Spirituality in Tertiary Class a Hospitals in Tianjin.” Occupational Health 39, no. 2: 233–238. 10.13329/j.cnki.zyyjk.2023.0042. [DOI] [Google Scholar]
  53. Ziebart, C. , and MacDermid J. C.. 2019. “Reflective Practice in Physical Therapy: A Scoping Review.” Physical Therapy 99, no. 8: 1056–1068. 10.1093/ptj/pzz049. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Zuo, T. X. 2003. Curriculum and Teacher. Education Science Publishing House. [Google Scholar]

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