Postgraduate Health Guide: Reflective Practice

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)

(http://www.open.edu/openlearn/education/learning-teach-becoming-reflective-practitioner/content-section-6.3)

Atkins, S., & Murphy, K. (1994). Reflective practice. Nursing Standard, 8(39), 49-56.

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. doi: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?
• So what?
• Now what?

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?

(www3.hants.gov.uk/reflection-2.doc)