✎✎✎ Reflective Analysis In Nursing

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Reflective Analysis In Nursing



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What is a Nursing Reflection practice?

In my reflective practice group, I have been able to explore my experience further. I hate not having answers. The doctors do not know what the outcome will be and I know Mary has been told this. Not being able to give her any clear information makes me feel powerless and inadequate. The anxiety I feel is the same as when I am under pressure - like being put on the spot in a meeting. But I also feel the added pressure of responsibility for Mary. I think she might be on her own, as no one ever visits with her. I have worked in a caring role for a large part of my life. Making people feel better is important to me, which means I want to protect people from painful experiences. I realise I wanted to protect Mary from the prospect of losing her mother and felt it would be unbearable for her to talk about the uncertainty of the future.

I now feel more confident dealing with situations where someone is putting me under pressure and there are no clear answers. Elements of reflective practice may already be present in nursing teams, perhaps in private self-reflection or during supervision. However, making it part of a regular, ongoing facilitated group gives the process greater focus, structure and depth.

A group offers individuals the support of others and a shared experience that can help normalise difficult feelings. It also gives a variety of different inputs and insights, which can make discussion more fruitful. The feeling of cohesion and identity given by the group is important at a time when work pressures can make nurses feel isolated or undervalued. Containment is a process, whereby a person conveys their state of mind to others, so it is transformed into something tolerable and meaningful Spurling, Far from being about restriction or limitation, containment is an enabling process.

It happens when people show by their response, tone of voice and expression that they are listening with care to what the person says Spurling, A facilitated reflective practice group allows the facilitator and the group to fulfil the containing function. This increases the capacity of the individual to share and contain their experience, so difficult feelings are less likely to spill over at work. The group experience allows tolerance of uncertainty and difficult feelings to be felt and talked about, so people become more self-aware.

This experience of being contained not only makes individuals more able to contain themselves but also enables them to be a better container for others. The reality of implementing reflective practice groups in the NHS is shown by the experience of Elmien Brink, a health professional who runs multidisciplinary reflective practice groups as part of her staff support role Box 2.

Box 2. Implementing reflective practice groups. I started this work after attending a training day on how to be a reflective practice facilitator. Many staff have attended the groups, and there has been a lot of positive feedback. During the group meetings, there is a validation of feelings and the opportunity to gain insight into how colleagues work and what they feel and think about their practice. When reflecting on a particular incident, staff find it especially helpful to hear supportive words from people who were not themselves involved, and can therefore look at the situation more objectively. Setting up the groups takes careful preparation and there are obstacles.

Shift patterns mean people have to come early or stay late to attend the groups. This is not ideal, but in the absence of a reflective culture at work, it is a necessary compromise. The ground rules have to be very clear. The groups take time to embed and for all the staff to trust in them. We have won a grant for research into the effectiveness of reflective practice in preventing staff burn-out, which will help us build up a case to run regular monthly reflective practice groups. All participants are asked to complete a questionnaire at the start of the groups, and then a gain after a year of attending so we can justify starting the monthly meetings.

Her work suggests there is a demand for reflective practice, with facilitated groups fulfilling an important function for staff. She shows the benefits to staff and their practice, as well as highlighting how resistance to implementing reflective practice groups can be overcome through initiative, perseverance and creative thinking. It is a structured process that benefits staff and their practice, and is most effective in facilitated groups. Trying it out in individual teams is a useful first step in showing the benefits and establishing an evidence base before rolling it out more widely and embedding it into NHS culture. The Guardian ; 1 April. Ford S Stress levels at work making nurses ill, finds survey. Nursing Times ; 10 December.

Oxford: Oxford Brookes University. Johns C Becoming a Reflective Practitioner. Chichester: Wiley-Blackwell. Winnicott DW Primitive emotional development. London: Tavistock, Sign in or Register a new account to join the discussion. Borton's model was later adapted by practitioners outside the field of education, such as the field of nursing and the helping professions. Learning theorist David A. Kolb was highly influenced by the earlier research conducted by John Dewey and Jean Piaget. Single-loop learning is when a practitioner or organisation, even after an error has occurred and a correction is made, continues to rely on current strategies, techniques or policies when a situation again comes to light.

Double-loop learning involves the modification of objectives, strategies or policies so that when a similar situation arises a new framing system is employed. Firstly, reflection-on-action, which involves reflecting on an experience that you have already had, or an action that you have already taken, and considering what could have been done differently, as well as looking at the positives from that interaction. Doubt brings about a way of thinking that questions and frames situations as "problems".

Through careful planning and systematic elimination of other possible problems, doubt is settled, and people are able to affirm their knowledge of the situation. Then people are able to think about possible situations and their outcomes, and deliberate about whether they carried out the right actions. Learning researcher Graham Gibbs discussed the use of structured debriefing to facilitate the reflection involved in Kolb's experiential learning cycle.

Gibbs presents the stages of a full structured debriefing as follows: [22]. Gibbs' suggestions are often cited as "Gibbs' reflective cycle" or "Gibbs' model of reflection", and simplified into the following six distinct stages to assist in structuring reflection on learning experiences: [23]. Professor of nursing Christopher Johns designed a structured mode of reflection that provides a practitioner with a guide to gain greater understanding of his or her practice. Johns highlights the importance of experienced knowledge and the ability of a practitioner to access, understand and put into practice information that has been acquired through empirical means.

Reflection occurs though "looking in" on one's thoughts and emotions and "looking out" at the situation experienced. Johns draws on the work of Barbara Carper to expand on the notion of "looking out" at a situation. Johns' model is comprehensive and allows for reflection that touches on many important elements. Adult education scholar Stephen Brookfield proposed that critically reflective practitioners constantly research their assumptions by seeing practice through four complementary lenses: the lens of their autobiography as learners of reflective practice, the lens of other learners' eyes, the lens of colleagues' experiences, and the lens of theoretical, philosophical and research literature. It also helps us detect hegemonic assumptions—assumptions that we think are in our own best interests, but actually work against us in the long run.

Reflective practice has been described as an unstructured or semi-structured approach directing learning, and a self-regulated process commonly used in health and teaching professions, though applicable to all professions. Professional associations such as the American Association of Nurse Practitioners are recognizing the importance of reflective practice and require practitioners to prepare reflective portfolios as a requirement to be licensed, and for yearly quality assurance purposes. The concept of reflective practice has found wide application in the field of education, for learners, teachers and those who teach teachers teacher educators. Microreflection gives meaning to or informs day-to-day practice, and macroreflection gives meaning to or informs practice over time".

Students can benefit from engaging in reflective practice as it can foster the critical thinking and decision making necessary for continuous learning and improvement. When teachers teach metacognitive skills, it promotes student self-monitoring and self-regulation that can lead to intellectual growth, increase academic achievement, and support transfer of skills so that students are able to use any strategy at any time and for any purpose. Students who have acquired metacognitive skills are better able to compensate for both low ability and insufficient information.

The concept of reflective practice is now widely employed in the field of teacher education and teacher professional development and many programs of initial teacher education claim to espouse it. Reflecting on different approaches to teaching, and reshaping the understanding of past and current experiences, can lead to improvement in teaching practices. As professor of education Barbara Larrivee argues, reflective practice moves teachers from their knowledge base of distinct skills to a stage in their careers where they are able to modify their skills to suit specific contexts and situations, and eventually to invent new strategies. This does not happen in stages, but is a continuum of reflection, leading to change Without reflection, teachers are not able to look objectively at their actions or take into account the emotions, experience, or consequences of actions to improve their practice.

It is argued that, through the process of reflection, teachers are held accountable to the standards of practice for teaching, such as those in Ontario : commitment to students and student learning, professional knowledge, professional practice, leadership in learning communities, and ongoing professional learning. For students to acquire necessary skills in reflection, their teachers need to be able to teach and model reflective practice see above ; similarly, teachers themselves need to have been taught reflective practice during their initial teacher education, and to continue to develop their reflective skills throughout their career.

However, Mary Ryan has noted that students are often asked to "reflect" without being taught how to do so, [43] or without being taught that different types of reflection are possible; they may not even receive a clear definition or rationale for reflective practice. Some writers have advocated that reflective practice needs to be taught explicitly to student teachers because it is not an intuitive act; [45] [43] it is not enough for teacher educators to provide student teachers with "opportunities" to reflect: they must explicitly "teach reflection and types of reflection" and "need explicitly to facilitate the process of reflection and make transparent the metacognitive process it entails".

Rod Lane and colleagues listed strategies by which teacher educators can promote a habit of reflective practice in pre-service teacher education , such as discussions of a teaching situation, reflective interviews or essays about one's teaching experiences, action research , or journaling or blogging. Neville Hatton and David Smith, in a brief literature review, concluded that teacher education programs do use a wide range of strategies with the aim of encouraging students teachers to reflect e. The implication of all this is that teacher educators must also be highly skilled in reflective practice. Andrea Gelfuso and Danielle Dennis, in a report on a formative experiment with student teachers, suggested that teaching how to reflect requires teacher educators to possess and deploy specific competences.

Many writers advocate for teacher educators themselves to act as models of reflective practice. Tom Russell, in a reflective article looking back on 35 years as teacher educator, concurred that teacher educators rarely model reflective practice, fail to link reflection clearly and directly to professional learning, and rarely explain what they mean by reflection, with the result that student teachers may complete their initial teacher education with "a muddled and negative view of what reflection is and how it might contribute to their professional learning". Reflective practice "is a term that carries diverse meaning" [42] and about which there is not complete consensus. Professor Tim Fletcher of Brock University argues forward-thinking is a professional habit, but we must reflect on the past to inform how it translates into the present and future.

Always thinking about 'what's next' rather than 'what just happened' can constrain an educator's reflective process. The concept of reflection is difficult as beginning teachers are stuck between "the conflicting values of schools and universities" and "the contradictory values at work within schools and within university faculties and with the increasing influence of factors external to school and universities such as policy makers".

It is important to acknowledge reflective practice "follows a twisting path that involves false starts and detours". Newman refers to Gilroy's assertion that "the 'knowledge' produced by reflection can only be recognized by further reflection, which in turn requires reflection to recognize it as knowledge". In turn, reflective practice cannot hold one meaning, it is contextual based on the practitioner. It is argued that the term 'reflection' shouldn't be used as there are associations to it being "more of a hindrance than a help". It is suggested the term is referred to 'critical practice' or 'practical philosophy' to "suggest an approach which practitioners can adopt in the different social context in which they find themselves".

Finally, with reflection often taking place independently, educators lack the motivation and assistance in tackling these difficult problems. It is suggested that teachers communicate with one another, or have an indicated individual to talk to, this way there is external informed feedback. Reflective practice is viewed as an important strategy for health professionals who embrace lifelong learning. Due to the ever-changing context of healthcare and the continual growth of medical knowledge, there is a high level of demand on healthcare professionals' expertise.

Due to this complex and continually changing environment, healthcare professionals could benefit from a program of reflective practice. Adrienne Price explained that there are several reasons why a healthcare practitioner would engage in reflective practice: to further understand one's motives, perceptions, attitudes, values, and feelings associated with client care; to provide a fresh outlook to practice situations and to challenge existing thoughts, feelings, and actions; and to explore how the practice situation may be approached differently. The act of reflection is seen as a way of promoting the development of autonomous, qualified and self-directed professionals, as well as a way of developing more effective healthcare teams.

Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education across a variety of health professions. They noted that the evidence to support curricular interventions and innovations promoting reflective practice remains largely theoretical. Samantha Davies identified benefits as well as limitations to reflective practice: [66]. The use of reflective practice in environmental management , combined with system monitoring , is often called adaptive management. However, the authors noted the challenges with melding the "circularity" of reflective practice theory with the "doing" of sustainability.

Reflective practice provides a development opportunity for those in leadership positions. Managing a team of people requires a delicate balance between people skills and technical expertise, and success in this type of role does not come easily. Reflective practice provides leaders with an opportunity to critically review what has been successful in the past and where improvement can be made. Reflective learning organizations have invested in coaching programs for their emerging and established leaders. Adults have acquired a body of experience throughout their life, as well as habits of mind that define their world. The goal is for leaders to maximize their professional potential, and in order to do this, there must be a process of critical reflection on current assumptions.

Reflective practice can help any individual to develop personally, and is useful for professions other than those discussed above. It allows professionals to continually update their skills and knowledge and consider new ways to interact with their colleagues. David Somerville and June Keeling suggested eight simple ways that professionals can practice more reflectively: [75]. From Wikipedia, the free encyclopedia. Ability to reflect on one's actions so as to engage in a process of continuous learning. This article possibly contains original research. Please improve it by verifying the claims made and adding inline citations.

Statements consisting only of original research should be removed. December Learn how and when to remove this template message. The reflective practitioner: how professionals think in action. New York: Basic Books. ISBN OCLC Reflective practice: writing and professional development 3rd ed. Los Angeles: Sage Publications. John January Journal of Teacher Education.

S2CID January Review of Research in Education. JSTOR Accident and Emergency Nursing. PMID Physical Therapy in Sport. How we think: a restatement of the relation of reflective thinking to the educative process. Boston: Houghton Mifflin. Academy of Management Learning and Education. CiteSeerX Educational Action Research. Reflective Practice: International and Multidisciplinary Perspectives.

Reflection, turning experience into learning. Interactive Learning Environments. Reach, touch, and teach: student concerns and process education.

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