Nursing: Communication Skills in Practice, edited by Lucy

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Reflective Practice-The Frameworks
Nursing Communication Skills in Practice, edited
by Lucy Webb Exercise for chapter 16 Continuing
Professional Development in Communication
Suitable for all levels of nurse students This
can be used in conjunction with the practice
exercise for reflective practice in the ORC
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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.

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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

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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

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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
• 
  
  

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Models/Frameworks
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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

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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)

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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

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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

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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

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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

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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

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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

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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

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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

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Johns 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

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Johns 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

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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)

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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)

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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)

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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).

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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

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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.
•  

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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
•  
•  

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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

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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/w
  orking-papers/

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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.