Reflective Practice-The Frameworks Suitable for all levels of nurse students This can be used in...
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Reflective Practice-The Frameworks Suitable for all levels of nurse students This can be used in conjunction with the practice exercise for reflective practice in the ORC Nursing: Communication Skills in Practice, edited by Lucy Webb Exercise for chapter 16: Continuing Professional Development in Communication
Reflective Practice-The Frameworks Suitable for all levels of nurse students This can be used in conjunction with the practice exercise for reflective
Reflective Practice-The Frameworks Suitable for all levels of
nurse students This can be used in conjunction with the practice
exercise for reflective practice in the ORC Nursing: Communication
Skills in Practice, edited by Lucy Webb Exercise for chapter 16:
Continuing Professional Development in Communication
Slide 2
Introduction Reflective practice is associated with learning
from experience, and is viewed as an important strategy for health
professionals who embrace life long learning The act of reflection
is seen as a way of promoting the development of autonomous,
qualified and self- directed professionals Engaging in reflective
practice is associated with the improvement of the quality of care,
stimulating personal and professional growth and closing the gap
between theory and practice.
Slide 3
Introduction cont. The process of reflective writing leads to
more than just a gain in your knowledge; it should also challenge
the concepts and theories by which you make sense of knowledge When
you reflect on a situation you do not simply see more, you see
differently. This different way of viewing a situation is reflected
in statements about a commitment to action
Slide 4
Schon (1983) The Effective reflective practitioner is able to
recognise and explore confusing or unique (positive or negative)
events that occur during practice The Ineffective practitioner is
confined to repetitive and routine practice, neglecting
opportunities to think about what he/she is doing
Slide 5
Reflective process There are numerous frameworks for
structuring the process of reflection. All reflective models
comprise of three fundamental processes: Retrospection: thinking
back on events Self-evaluation: attending to feelings
Reorientation: re-evaluating experiences
Slide 6
Models/Frameworks
Slide 7
Gibbs Reflective Cycle The Gibbs (1988) reflective cycle is
considered fairly straightforward It encourages a clear description
of the situation, analysis of feelings, evaluation of the
experience, analysis to make sense of the experience, conclusion
where other options are considered and reflection upon experience
to examine what you would do if the situation arose again
Slide 8
Gibbs reflective cycle DESCRIPTION (What happened) Action Plan
Feelings (If it arose again (What were you what would you do?)
thinking + feeling?) Conclusion Evaluation (What was good and bad?)
Description (What sense can you make of the situation)
Slide 9
Stage 1: Description of the event Describe in detail the event
you are reflecting on Include: where you were; who else was there;
why you were there; what you were doing; what other people were
doing; what the context of the event was; what happened; what your
part was; what parts the other people played; what the result
was
Slide 10
Stage 2: Feelings Try to recall and explore what was going on
inside your head i.e. why does this event stick in your mind?
Include: how were you feeling when the event started; what you were
thinking about at the time; how it made you feel; how other people
made you feel; how you felt about the outcome of the event; what
you think about it now
Slide 11
Stage 3: Evaluation Try to evaluate or make a judgement about
what has happened. Consider what was good about the experience and
what was bad about the experience, or didnt go so well
Slide 12
Stage 4: Analysis Break the event down into its component parts
so they can be explored separately You may need to ask more
detailed questions about the answers to the last stage Include:
what went well; what you did well; what others did well; what went
wrong or did not turn out how it should have done; the way you, or
others, contributed to this
Slide 13
Stage 5: Conclusion This differs from the evaluation stage in
that now you have explored the issue from different angles and have
a lot of information to base your judgement It is here that you are
likely to develop insight into your own and other peoples behaviour
in terms of how they contributed to the outcome of the event
Slide 14
Conclusion cont. Remember the purpose of reflection is to learn
from an experience Without the detailed analysis and honest
exploration that occurs during all the previous stages, it is
unlikely that all aspects of the event will be taken into account
Therefore valuable opportunities for learning can be missed During
this stage you should ask yourself what you could have done
differently
Slide 15
Stage 6: Action Plan During this stage you should think about
encountering the event again and plan what you would do would you
act differently or would you be likely to do the same? Here the
cycle is tentatively completed and suggests that should the event
occur again it will be the focus of another reflective cycle
Slide 16
Other models of reflection There are other models of reflection
and there are brief explanations for some in the next few slides
Johns model of reflection The What? model of structured reflection
by Driscoll
Slide 17
John s model of structured reflection Johns model can be used
as a guide for analysis of a critical incident or general
reflection on experience. This would be useful for more complex
decision making and analysis at levels 3 & 4 He supports the
need for the learner to work with a supervisor throughout their
learning experience He refers to this as guided reflection, and
recommends that students use a structured diary
Slide 18
John s model of structured reflection cont. John feels that
through sharing reflections on learning experiences, greater
understanding of those experiences can be achieved than by
reflection as a lone exercise John also uses Carpers (1978) four
patterns of knowing, aesthetics, personal, ethics and empirics
adding a fifth pattern reflexivity
Slide 19
Driscolls The What? model (2000) A description of events (What?
trigger questions) An analysis of events (So What? trigger)
Proposed actions following events (Now What? trigger)
Slide 20
Reminder - why we should reflect Reduces the theory-practice
gap (Perkins 1996; Fonteyn & Cahill 1998; Getliffe 1996; Foster
& Greenwood 1998; Smith 1998; Burton 2000; Carney 2000; Duke
& Appleton 2000; Maudsley & Scrivens 2000b; Stewart &
Richardson 2000; Koh 2002). Encourages critical thinking ability
(Patton et al 1997; Durgahee 1998; Foster & Greenwood 1998;
Burton 2000; Maudsley & Scrivens 2000b; Cotton 2001) Helps
practitioners to make more sense of difficult and complex practice
(Driscoll & Teh 2001)
Slide 21
Reminder - why we should reflect cont. Enhances personal
development by leading to self-awareness (Cotton 2001) The focus of
reflection is improvement in patient care therefore it helps to
expand and develop clinical knowledge and skills (Graham 2000;
Platzer et al 2000; Driscoll & Teh 2001; Paget 2001) Slows down
activity thereby providing time to process material of learning and
link it to previous ideas (Moon 2002)
Slide 22
Reminder - why we should reflect cont. Enables greater
ownership of the learning taking place (Moon 2002) Promotes optimum
effectiveness and efficiency in an ever evolving and complex health
care system through practitioners auditing their own practice
(Degazon & Lunney 1995; Carr 1996; Clark et al 1996; Durgahee
1996; Heath 1998; Hinett & Weeden 2000) Reminds qualified
practitioners that there is no end point to learning about their
everyday practice (Driscoll & Teh 2001: 98).
Slide 23
Top tips for reflecting (Taylor 2000) Be spontaneous it is from
the frank and honest self that important insights arise Express
yourself freely you dont need to observe the normal academic
practices involved in writing Remain open to ideas early
conclusions can inhibit further insights and solutions
Slide 24
References and Bibliography Atkins, S., Murphy, K. (1993)
Reflection: A Review of the Literature. Journal of Advanced
Nursing, Vol.18 (8), pp.1188 1192 Bulman, C., Schutz, S. (2004)
Reflective Practice in Nursing. 3rd ed. Oxford, Blackwell
Publishing Burnard, P. (2002) Learning Human Skills: An
Experiential and Reflective Guide for Nurses and Health Care
Professionals. 4th ed. Oxford, Butterworth Heinemann Burton, A.J.
(2000) Reflection: Nursings practice and education panacea?,
Journal of Advanced Education, Vol. 31 (5) pp.1009-1017 Carney, M.
(2000) The development of a model to manage change: reflection on a
critical incident in a focus group setting. An innovative approach,
Journal of Nursing Management, Vol. 8, pp.265-272 Carper, B.A.
(1978) Fundamental patterns of knowing in nursing. Advances in
Nursing Science-Practice Orientated Theory, Vol. 1 (1) pp.13-23
Carr, E. (1996) Reflecting on clinical practice: hectoring talk or
reality? Journal of Clinical Nursing, Vol.5, pp. 289-295 Clark, B.,
James, C., Kelly, J. (1996) Reflective practice; reviewing the
issues and refocusing the debate, International Journal of Nursing
Studies, Vol. 33 (2) pp. 171-180.
Slide 25
References and Bibliography cont. Cotton, A.H. (2001) Private
thoughts in public spheres: issues in reflection and reflective
practices in nursing, Journal of Advanced Nursing, Vol. 36 (4) pp.
512-519 Degazon, C.E., Lunney, M. (1995) Clinical journal: a tool
to foster critical thinking for advanced levels of competence,
Clinical Nurse Specialist, pp.270-274 Driscoll, J., Teh, B. (2001)
The potential of reflective practice to develop individual
orthopaedic nurse practitioners and their practice, Journal of
Orthopaedic Nursing, Vol. 5, pp. 95-103 Duke, S., Appleton, J.
(2000) The use of reflection in a palliative care programme: a
quantitative study of the development of reflective skills over an
academic year. Journal of Advanced Nursing Vol.32 (6) pp.1557-1568.
Durgahee, T. (1996) Promoting reflection in post-graduate nursing:
a theoretical model, Nurse Education Today, Vol. 16, pp.419-426
Durgahee, T. (1998) Facilitating reflection: from the sage on the
stage to a guide on the side. Nurse Education Today Vol.18,
pp.158-164
Slide 26
References and Bibliography cont. Fonteyn, M.E., Cahill, M.
(1998) The use of clinical logs to improve nursing students
metacognitions: a pilot study, Journal of Advanced Nursing, Vol.28
(1), pp. 149- 154. Foster, J. & Greenwood, J. (1998)
Reflection: A challenging innovation for nurses, Contemporary
Nurse, Vol.7, pp. 165-172. Getliffe, K.A. (1996) An examination of
the use of reflection in the assessment of practice for
undergraduate nursing students, International Journal of Nursing
Studies, Vol.33 (4), pp. 361-374. Gibbs, G. (1988) Learning by
Doing: A Guide to Teaching and Learning Methods. Oxford, Further
Education Unit, Oxford Polytechnic. Graham, I.W. (2000) Reflective
practice and its role in mental health nurses practice development:
a year-long study. Journal of Psychiatric and Mental Health
Nursing, Vol.7, pp.109-117 Heath, H. (1998) Paradigm dialogues and
dogma: finding a place for research, nursing models and reflective
practice, Journal of Advanced Nursing, Vol. 28 (2) pp.288-294
Hinett, K., Weeden, P. (2000) How am I doing?: developing critical
self-reflection in trainee teachers. Quality in Higher Education,
Vol. 6 (3) pp.245- 257
Slide 27
References and Bibliography cont. Jasper, M. (2003) Beginning
Reflective Practice: Foundations in Nursing and Health, Cheltenham,
Nelsons Thorsens Johns C (1999) Reflection as empowerment? Nursing
Inquiry, Vol. 6 (4) pp.241 - 249 Johns, C. (2000) Becoming a
Reflective Practitioner: A Reflective and Holistic Approach to
Clinical Nursing, Practice Development and Clinical Supervision.
Oxford, Blackwell Publishing. Johns, C. (2004) Becoming a
reflective practitioner. 2nd edn. Oxford, Blackwell Publishing
Johns, C. (2005) Transforming Nursing Through Reflective Practice.
2nd edn. Oxford, Blackwell Publishing. Koh, L.C. (2002)
Practice-based teaching and nurse education, Nursing Standard
Vol.16 (19) pp. 38-42, In- Maudsley, G. & Scrivens, J. (2000b)
Promoting professional knowledge, experiential learning and
critical thinking for medical students. Medical Education Vol.34,
pp.535-544 Moon, J. (2002) PDP Working paper 4: Reflection in
Higher Education Learning. Learning and Teaching Support Network
Generic Centre
http://www.ltsn.ac.uk/genericcentre/projects/pdp/working-papers/
http://www.ltsn.ac.uk/genericcentre/projects/pdp/working-papers/
Slide 28
References and Bibliography cont. Paget, T. (2001) Reflective
practice and clinical outcomes: practitioners views on how
reflective practice has influenced their clinical practice. Journal
of Clinical Nursing, Vol.10, pp.204-214 Patton, J.G., Woods, S.J.,
Agarenzo, T., Brubaker, C., Metcalf, T., Sherrer, L. (1997)
Enhancing the clinical practicum experience through journal
writing. Journal of Nursing Education Vol.36 (5) pp. 238-240
Perkins, J. (1996) Reflective journals: suggestions for educators.
Journal of Physical Therapy Education, Vol.10 (1) pp.8-13 Platzer,
H., Blake, D., Ashford, D. (2000) Barriers to learning from
reflection: a study of the use of groupwork with post-registration
nurses, Journal of Advanced Nursing, Vol.31 (5) pp.1001-1008 Schon,
D. (1983) The reflective practitioner: how professionals think in
action, Basic Books: New York. Smith, A. (1998) Learning about
reflection. Journal of Advanced Nursing Vol.28 (4) pp.891-898
Taylor, B. (2000) Reflective Practice: A Guide for Nurses and
Midwives. Buckingham, Open University Press.