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Reflective Practice in Nursing

Henny Suzana Mediani, MNg, PhD


Faculty of Nursing
Universitas Padjadjaran
Learning outcomes…
Define reflection
Understand reflection in nursing
Recognise models for reflection
What is Reflection?
• Thinking about…..
• Pondering on…..
• Asking yourself questions about…..
• Discussing with yourself…
• Trying to work something out…..
• Making sense of things…
• Learning from experience...
• Helping you plan for the future…..

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Reflection: A Definition (1)

‘Reflection is an important human activity in


which people recapture their experience, think
about it, mull over & evaluate it. It is this
working with experience that is important in
learning’.
Boud, D., Keogh, R. & Walker, D. (1985) p 43 Reflection: Turning Experience into
Learning. London: Kogan Page.
Reflection: A Definition (2)

‘We learn through critical reflection by putting


ourselves into the experience & exploring personal &
theoretical knowledge to understand it & view it in
different ways.

Tate, S. & Sills, M. (eds) (2004) p 126 The Development of Critical Reflection in the
Health Professions. London; Higher Education Authority.
Reflective practice / critical reflection : what is
it?
• Process of review to inform learning (eg:
Schon, etc)
• Active, persistent and careful consideration of
any belief or supposed form of knowledge
(Dewey 1933)
• Mental process of trying to restructure
existing knowledge and insights
(Korthagen 2001)
Reflection in nursing practice…

• “a process of reviewing an experience of


practice in order to describe, analyse and
evaluate, and so, inform learning from
practice”.
(Reid, 1993)
Reflection: Informal & formal
Informal Reflection
• Involves self- questioning
• Develops our awareness of our own assumptions

Formal Reflection
• Draws on research & theory
• Provides guidance & frameworks for practice.
Sources of reflection.
• Everyday events
• Positive experiences
• Negative experiences
• Eventful incidents
• Unusual incidents
• Routine activities
• Important events
• Meaningful events

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So why is it important in Nursing
Practice
Reflection is seen as helping to
 bridge the theory practice gap
 reduce practices based on custom and
practice
 develop and understand your practice,
decisions made, lessons learnt and
implication of these for future practice
 ensure that care remains patient centred
and based in the patient experience
Skills / attitudes for reflection
• Willing to learn from experience and
change things
• Able to make time for reflection
• Being open and honest
• Willing to share and discuss your
experiences
• Being motivated to replay / describe /
analyse experiences
• Able to make an action plan

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WHAT does the process of REFLECTION
involve?
By engaging in reflection people are usually engaging in a
period of thinking in order to examine often complex
experiences or situations.

The period of thinking (reflection) allows the individual to


make sense of an experience, perhaps to liken the
experience to other similar experiences and to place it in
context.

Faced with complex decisions, thinking it through (reflecting)


allows the individual to separate out the various influencing
factors and to come to a reasoned decision or course of
action
Clarke and Graham (1996:26)
Critically reflective practice:
key components
 Rethinking / deconstructing power
 Awareness of values and implications
for practice
 Exploring emotions / emotional intelligence
 Drawing on knowledge / developing knowledge
and practice wisdom
 Self awareness
 Creating uncertainty through dynamic
questioning – willingness to live with
that uncertainty
Reflection is significant because…
• It can help us to challenge
practice rather than ‘working on
automatic pilot’.

• This matters because people


matter!

• We need to deliver AND


constructively consider the care
we give to our clients.

• WE NEED TO SUPPORT OUR


STUDENTS TO DO THIS.
I want to encourage you to:
• Critically think about your
practice

• Learn from your experiences

• Make sense of your experiences

• Come to understand the effects


of your practice
In order to:
• Learn from your mistakes,
because they matter to people.

• Move on and do better next


time.

• Build up a repertoire of practice


experiences that are useful to
you.

• Keep on improving and


challenging practice.
Skills for reflection
• Developing skills for reflection is
• Self-awareness
essential.
• Description
• Critical Analysis
• You will have developed these
skills as part of your practitioner • Synthesis
and mentor education and as • Evaluation
you have progressed in your
practice career.

• They are skills that you can


continue to develop and that
you can nurture in your
students.
Skills for reflection
Self awareness
• enables a person to analyse feelings. It
involves an honest examination of how a
situation has affected the individual and how
the individual has affected the situation.
Description
• involves the ability to recognise and recollect
accurately significant events and key features
of an experience and to give an account of
the situation (TIP: Keep focused with this
bit.)
SKILLS FOR REFLECTION
Critical Analysis
• involves examining the components of a situation, identifying
existing knowledge, challenging assumptions and imagining
and exploring alternatives. A critical analysis of knowledge is
undertaken which involves examining how relevant knowledge
is to an individual situation.
Synthesis
• The integration of new knowledge with previous knowledge. It
can be used in a creative way to solve problems and to predict
likely consequences of actions.
Evaluation
• Enables a judgment to be made about the value of something.
Synthesis and evaluation are crucial in the development of a
new perspective
MORE ON CRITICAL ANALYSIS
• Separation of a whole into its
component parts, detailed
examination of those parts. To make
judgements about the strengths and
weaknesses of the different parts as
well as the whole.

• Identifying existing knowledge


relevant to the situation, exploring
feelings about the situation.
Identifying and challenging
assumptions, imagining and
exploring other courses of action.
SYNTHESIS
• Building up ideas into a
connected and coherent whole

• Original thinking

• Creativity

• Building on our knowledge,


skills and attitudes leads to
fresh insights/new
perspectives on practice
SOME OF THE
TRADITIONAL
MODELS……
22
Reflective FRAMEWORKS
Gibbs (1998) updated by Bulman 2012
Description-
What
Happened?

Final
Evaluation and What were
Action Plan – your Feelings
What would and how did
you do you react?
differently?

Conclusion – Initial
What have you Evaluation of
learnt from the
reflecting on experience –
this What was
experience? Critical good and bad
Analysis – about it?
What sense
did you make
of the
experience?
Williams and Rutter (2007) based on
Gibbs
Description: What happened?
Feelings: What were you thinking and feeling?
Evaluation: What was good and bad about the
experience?
Analysis: What sense can you make of the
situation?
Conclusion: What else could you have done?
Action Plan: What was learnt? If it arose again,
what would you do?
DESCRIPTION
• What happened?

• Describe what
happened.

• Keep focused on your


description; don’t make
judgements or draw
conclusions.
FEELINGS
• What were your
feelings and how did
you react?

• Keep focused on your


emotions, don’t be
tempted to analyse
yet.
INITIAL EVALUATION OF THE EXPERIENCE
• What was good and bad about the experience?
• Evaluate your initial feelings and reactions in
order to get to the heart of what really
concerned you (positive or negative) about the
experience. By doing this, you should be able to
identify and attend to key issue/s which will
allow you to move on to critical analysis.

• NB: It is important to keep focused, so try to


choose just one or two issues. Then you can
move on to develop some in-depth critical
analysis rather than just ‘skim the surface’ of
many.
CRITICAL ANALYSIS
• What sense did you make of the experience?

• Critically analyse what was going on. Were


people’s experiences similar or different to
yours, and in what ways? What themes seem to
be emerging from your analysis? How do these
compare with your previous experiences? Can
you challenge any assumptions now?

• NB: Make use of knowledge/ideas from outside
your experience to develop and inform your
analysis, e.g. experts, mentors, policy, research,
law and ethics, literature, clinical papers,
reviews, discussion papers. How do these
compare with your experience?
CONCLUSIONS

• What have you learnt from reflecting


on this experience?

• What have you learnt about:


yourself, your self-awareness, your
practice?

• What have you learnt that you would


recommend for practice in general
(i.e. social, political, cultural, ethical
issues)?
FINAL EVALUATION AND ACTION PLAN

• What would you do differently?


• What would you do if this type of
situation arose again?

• What steps will you take, based on


what you’ve learnt, to develop your
future practice?

• How will you decide if your practice


has been improved?
Borton (1970)
 What?

 So what?

 Now what?
Boud, Keogh and Walker (1985)

An individual:
 recaptures their experience
 thinks about it
 mulls it over (perhaps with others)
 evaluates it
 acts on the reflection
Korthagen’s reflective onion

o Environment
o Behaviour
o Competences
o Beliefs
o Identity
o Mission
Kolb: Experiential learning
Concrete experience - What was the event?
Reflective Observation - What are your
personal thoughts and
feelings about the
experience?
Abstract Conceptualisation - How can you draw on
previous experiences and on
your knowledge to help you
‘make sense’ of this
experience?
Active Experimentation - If this event were to occur
again, what would you do
differently?
- What additional knowledge
do you need to gain?
Skills for reflection
Self awareness
• enables a person to analyse feelings. It
involves an honest examination of how a
situation has affected the individual and how
the individual has affected the situation.
Description
• involves the ability to recognise and recollect
accurately significant events and key features
of an experience and to give an account of
the situation (TIP: Keep focused with this
bit.)
Any questions???

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