Subject guides: Postgraduate Health Guide: Reflective Practice

What is reflective practice?

"Reflective practice occurs when you explore an experience you have had to identify what happened, and what your role in the experience was – including your behaviour and thinking, and related emotions. This, allows you to look at changes to your approach for similar future events. If reflective practice is performed comprehensively and honestly, it will inevitably lead to improved performances" (La Trobe University, 2015).

"Reviewing experience from practice so that it may be described, analysed, evaluated and consequently used to inform and change future practice. Importantly, reflection also involves opening up one's practice for others to examine, and consequently requires courage and open-mindedness as well as a willingness to take on board and act on criticism" (Bulman, 2008, p. 2).

Models of reflection

Gibbs' reflective cycle involves 6 steps:

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Oxford: Further Education Unit, Oxford Brookes University.

Description

Describe in detail the event you are reflecting on.
What happened; where were you; who else was there; why were you there; what were you doing; what were other people doing; what was your part in the event; what parts did other people play in the event; what was the result?

Feelings

What were you thinking and feeling?
Try to recall and explore the things that were going on inside your head.
How were you feeling when the event started; what were you thinking about at the time; how did the event make you feel; how did other people make you feel; how did you feel about the outcome of the event; what do you feel/think about the event now?

Evaluation

What was good and bad about the experience?
Evaluate and make a judgment about what has happened.
What was good about the experience/event; what was bad about the experience/event; what didn't go so well; what did you and other people do to contribute to the situation (positively or negatively)?

Analysis

What sense can you make of the situation?
Break the event down into its components.
Explore the various components.
Look back and ask more questions about previous answers like: What went well; what did you do well; what did others do well; what went wrong; what didn't turn out the way it was supposed to; who and what contributed to how things turned out?

Conclusion

What else could you have done?
Having worked through the different stages you now have more information to base your judgment on.
What insights have you gained by working through the cycle; what have you learnt from the experience; what could you have done differently; what skills do you need to develop, so that you can handle this type of situation better; how could this have been a more positive experience for everyone involved?

Action plan

If it arose again, what would you do?
What would you do; would you do things differently; would you do things the same way; what actions do you need to take?

(MindTools, 2016)

Johns' model of reflection uses 5 cues to help the practitioner reflect on an event/experience, to make sense of it and to learn through it:

There are various questions that can be asked for each section.

Description

Describe the experience.
What are the key issues that I need to pay attention to?
What were the significant factors?

Reflection

What was I trying to achieve?
What were the consequences of my actions?
- For the patient and family
- For myself
- For the people I work with
How did I feel about this experience when it was happening?
How did the patient feel when it was happening?

Influencing factors

What internal/external factors influenced my decision-making and my actions?
What knowledge influenced my decision-making and my actions?

Could I have dealt with it better

What sources of knowledge should have influenced my decision-making and my actions?
How could I have dealt better with the situation?
What other choices did I have?
What would have been the consequences of these alternate choices?

Learning

What will change because of this experience?
How can I make sense of this experience in light of past experience and future practice?
How has this experience changed my ways of knowing (scientific knowledge, moral knowledge, self awareness, my own experience and what I do)?
How do I now feel about this experience?
Have I taken effective action to support myself and other as a result of this experience?

Johns, C. (1994). Nuances of reflection. Journal Of Clinical Nursing, 3(2), 71-74 4p. 10.1111/j.1365-2702.1994.tb00364.x

Rolfe's framework of reflective practice is based on Borton's (1970) model. It consists of three key questions:

What ...? - Descriptive level of reflection

... is the problem/difficulty/reason for an event?
... is the reason for feeling bad?
... is the reason why something happened?
... was my role in the situation?
… was I trying to achieve?
… actions did I take?
… was the response of others?
… were the consequences for the patient, for myself, for others?
… feelings did it evoke in the patient, in myself, in others?
… was good/bad about the experience?

So what ...? - Theory and knowledge building level of reflection

… does this tell me?
... does this teach?
... does this imply/mean about me, my patient, others?
... does this imply/mean about my patient's care?
... does this imply/mean about the model of care I'm using?
... does this imply/mean my attitudes, my patient’s attitudes, other people's attitudes?
… was going through my mind as I acted?
… did I base my actions on?
… other knowledge can I bring to the situation (experimental, personal, scientific)
… could/should I have done to make it better?
… is my new understanding of the situation?
… broader issues arise from the situation?

Now what ...? - Action-orientated (reflective) level of reflection

… do I need to do in order to make things better
... do I need to do in order to stop being stuck
... do I need to do in order to improve my patient’s care
... do I need to do in order to resolve the situation
... do I need to do in order to improve my skills/knowledge?
… broader issues need to be considered if this action is to be successful?
… might be the consequences of this action?

Rolfe, G., Freshwater, D., Jasper, M. (2001) Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

1. Awareness

In the first step of Atkins and Murphy model of reflection it is essential to gain knowledge or awareness about the triggers that have caused discomfort. This step is not yet concerned with the whole situation because this will be described in the following section. Instead, it is now essential to identify one’s thoughts and emotions that have resulted from the experience. This means that an individual must be open and express him- or herself vulnerable to identify the discomforts. According to Atkins and Murphy model of reflection, analyzing personal feelings and thoughts in this way improves developments. In addition, discomfort can also be a result out of new experiences. This could include a discomfort caused by switching job positions if a new job has to be learned.

Awareness of uncomfortable feelings and thoughts:

What happened?
What had an effect on my emotions?
What were my emotions after the situation occurred?
What was I thinking?
What am now thinking looking back at the situation?

2. Describe

Now that the personal emotions and thoughts have been analyzed, the Atkins and Murphy model of reflection states that it is time to describe the situation. In this step, an individual has to analyze the situation and key events that have occurred critically. For example, a particular environmental setting may have caused a trigger for an individual to experience discomfort, but it could be that a different environmental setting has prevented the discomfort from happening. For this reason, it is important to analyze and describe the situation. In this way, a better understanding will be realized why a discomfort occurred, and it will be easier to learn from this discomfort.

Describe the situation, including thoughts and feelings:

What was the event?
Where was the event?
When did it happen?
What was my involvement during the event?
What did other people do?
What were the key observations?

3. Analyse

In this step of Atkins and Murphy model of reflection, the individual must now analyse assumptions that he or she made, also referred to as the knowledge of the reflective practice participant. For example, before a situation occurred, the individual might have thoughts about the event. It is in step essential to determine whether the assumptions were correct or false. More importantly, Atkins and Murphy model of reflection states that the participant of reflective practice must additionally explore alternatives. This means that he or she must analyse how the behavior would have been different in a different setting.

Analyse feelings and knowledge relevant to the situation:

Imagine and explore alternatives
What did I already know about the situation?
What were my assumptions about the situation?
How did the reality reflect my assumptions?
What were the differences?
How would I react if something else happened?
In what type of scenarios would the discomfort not occur?

4. Evaluate

This step of Atkins and Murphy model of reflection may differ from one person to another. It is concerned with personally assessing how the knowledge of the previous step is relevant for improvements. The relevance of knowledge is therefore concerned with identifying if it helps to explain the problem or discomfort. It also deals with assessing how the problem could be solved. For a participant of reflective practice, it can help to analyze different scenarios and potential behaviors, but the positive effects of this way of reflection may differ per individual.

Evaluate the relevance of knowledge:

How does it help to explain the situation?
How does analyzing different scenarios influence your thoughts?
How complete was your use of knowledge??
How can your knowledge next time be useful?

5. Identify

Based on the previously described steps of Atkins and Murphy model of reflection, it is now possible to identify the learnings. By this step, the model has assessed the emotions, situations, assumptions, and knowledge of the reflective practice participant. By integrating all elements, the participant of reflective practice can easily state learnings and make use of these in future situations.

Identify any learning which has occurred: