Kristina Thomas Dreifuerst: Teaching nurses to reason and reflect in patient care

Kristina Thomas Dreifuerst, PhD, RN, CNE, ANEF, FAAN and senior associate dean for academics (Vanderbilt University)

Kristina Thomas Dreifuerst is passionate about teaching what she considers the key to high-quality nursing practice: weaving knowledge, skills, experience and reflection to create clinical reasoning. She brings her decades of research and advanced teaching methods on clinical reasoning to the Vanderbilt University School of Nursing as senior associate dean for academics.

"Clinical reasoning is really the highest order of thinking," she said.

"We can teach information and skills, but teaching them how to incorporate what they've learned to another level and develop individualized, appropriate plans of care is a challenge. So I have focused my research on how to best do that."

Dreifuerst has spent her career researching the best ways to teach clinical reasoning by examining the cognitive brain science behind how people learn, as well as incorporating innovative ways to use technology to engage students.

LEVELS OF REFLECTION

One of the key tools Dreifuerst encourages is exercising three kinds of reflection-reflection in action, reflection on action, and reflection beyond action.

"Reflection in action is in-the-moment thinking, putting the pieces together," she said.

"Reflection on action is retrospective, reflecting on what occurred through the lens of your training and gaining lessons from that. For example, 'I did this and it didn't go well, so next time I'm going to do this instead.'"

Dreifuerst explains the third reflection, called reflection beyond action, as the relationship between reflection and anticipation. Using a patient experience, whether it was good or bad, and applying it to the next clinical encounter informs practice and thinking like a nurse.

"Reflecting beyond action helps a health care provider challenge their assumptions, so that when they encounter the next patient, we've trained them to be comfortable running through these reflections and asking questions like, 'Does what I'm seeing or what I've done make sense? What else should I be thinking? What am I not considering for this patient?'" she said. "These exercises are more than applying what a student has memorized. They are actively using knowledge, reasoning and critical thinking."

Kristina Thomas Dreifuerst speaks at the Vanderbilt University School of Nursing orientation in August 2025. (Vanderbilt University)

SYNERGY AT VANDERBILT

Dreifuerst comes from a long line of nurses and was in clinical and advanced practice nursing for years before going into teaching and research. When looking for the next advancement in her career, Vanderbilt was a perfect fit.

"There is such synergy with the excellent work already happening here and what I could bring to expand the academic environment," she said. "It just felt right."

ADVICE TO STUDENTS

Students from the Vanderbilt University School of Nursing learn in the simulation lab. (Vanderbilt University)

Through whatever challenges and changes come, Dreifuerst is a champion for the nursing profession and stresses to students that nursing is a career that is constantly evolving. "Embrace change because it keeps the momentum and ensures that we are always striving to provide safe and excellent care."

Dreifuerst goes on to note, "As a nurse, you can do absolutely anything. My career and the many different things I've done, are testament to that," she said. "Beyond patient care and public health, we have nurses who are in politics, industry, education, leadership and more. Nurses contribute to society in a myriad of ways, because our education really prepares us to focus on the needs of others and think beyond."

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