What are the professional requirements for nurses in relation to reflecting on their practice

Description Describe in detail the event you are reflecting on. Include e.g. where were you; who else was there; why were you there; what were you doing; what were other people doing; what was the context of the event; what happened; what was your part in this; what parts did the other people play; what was the result.

Feelings At this stage try to recall and explore the things that were going on inside your head, i.e. why does this event stick in your mind? Include e.g. how you were feeling when the event started; what you were thinking about at the time; how did it make you feel; how did other people make you feel; how did you feel about the outcome of the event; what do you think about it now.

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 didn’t go so well

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 e.g. what went well; what did you do well; what did others do well; what went wrong or did not turn out how it should have done; in what way did you or others contribute to this.

Conclusion This differs from the evaluation stage in that now you have explored the issue from different angles and have a lot of information on which to base your judgment. It is here that you are likely to develop insight into you own and other people’s behaviour in terms of how they contributed to the outcome of the event. Remember the purpose of reflection is to learn from an experience. Without 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 and therefore valuable opportunities for learning can be missed. During this stage you should ask yourself what you could have done differently.

Action Plan During this stage you should think yourself forward into encountering the event again and to plan what you would do – would you act differently or would you be likely to do the same? What can you do in the interim to improve your practice/ ability to respond effectively in like situations? Here the cycle is tentatively completed and suggests that should the event occur again it will be the focus of another reflective cycle.

Cycle originally appears in Gibbs, G. (1988). Learning by doing: a guide to teaching and learning methods. London: Further Education Unit.

Text from Jasper, M. (2003). Beginning Reflective Practice – Foundations in Nursing and Health Care. Cheltenham: Nelson Thornes.

08 June, 2012

Reflective practice can be used to help nurses to make sense of work situations and, ultimately, to improve care. A simple, three-stage model is proposed. Abstract Reflection on practice is a key skill for nurses. Engaging in regular reflection enables practitioners to manage the personal and professional impact of addressing their patientsâ€™ fundamental health and wellbeing needs on a daily basis.Â This article briefly reviews the theoretical background underpinning the idea of reflective practice. A simple, three-step model for practical reflection is presented, which is based on theory and grounded in practice. The three-stage cycle is illustrated with a fictional clinical example to show how this reflective method can make a difference in busy practice settings. Citation:Â Oelofsen NÂ (2012) Using reflective practice in frontline nursing.Â Nursing Times; 108: 24, 22-24. Author:Â Natius Oelofsen is consultant clinical psychologist, learning disabilities service, Norfolk and Suffolk Foundation Trust and director of Reflective Learning, a consultancy dedicated to advancing reflective practices in health and social care settings. This article has been double-blind peer reviewed Scroll down to read the article or download a print-friendly PDF including any tables and figures

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Reflection is an essential attribute for the development of autonomous, critical, and advanced practitioners (Mantzoukas & Jasper, 2004). According to Chong (2009), “Reflective practice should be a continuous cycle in which experience and reflection on experiences are inter-related” (p. 112). Studies have shown that nurses who take the time to reflect on their daily experiences provide enhanced nursing care, have a better understanding of theiractions, which in return develops their professional skills (Hansebo & Kihlgren, 2001). Reflective practice is the ability to examine ones actions and experiences with the outcome of developing their practice and enhancing clinicalknowledge. Reflective practice affects all levels of nursing, from students, to advanced practice nursing students, aswell as practicing nurses. Reflective practice is an important component of the nursing curriculum. Research has shown the relationship between student nurses and their mentors is vital. In order for reflection to be effective open-mindedness, courage, and a willingness to accept, and act on, criticism must be present (Bulmam, Lathlean, & Gobbi, 2012). This paper will explore the current literature and implications related to reflective practice in nursing.

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aBrighton and Sussex University Hospital

Find articles by Kiron Koshy

cUCL Medical School, University College London, London

Find articles by Buket Gundogan

dRoyal Devon and Exeter Hospital, UK

Find articles by Katharine Whitehurst

cUCL Medical School, University College London, London

Find articles by Daniyal J. Jafree

Received 2017 Mar 31; Accepted 2017 Apr 1.

Reflective practice is a paper requirement of your career progression in health care. However, if done properly, it can greatly improve your skills as a health care provider. This article provides some structure to reflective practice to allow a health care provider to engage more with reflective practice and get more out of the experience.

Keywords: Reflection, Reflective practice, Portfolio, Career progression, Learning

Reflective practice is something most people first formally encounter at university. This may be reflecting on a patient case, or an elective, or other experience. However, what you may not have considered is that you have been subconsciously reflecting your whole life: thinking about and learning from past experiences to avoid things that did not work and to repeat things that did. For example after tasting a food you do not like, you remember that experience, think about it, and when you next see that same food you know to avoid it. In medicine it is one of the best approaches to convert theoretical knowledge into practice.

As you progress through medical school and into foundation years as a doctor it becomes even more common. It is now expected to provide evidence of your reflections through your training on the ePortfolio and then throughout the rest of your professional life in revalidation. Hence, it is a good idea to get it right from the beginning.

First and foremost the biggest mistake you can make when reflecting is to treat it as a tick box exercise and a waste of time. With a bit of thought reflections can be a very useful tool in learning. Would you remember a generic case from a book? Would hanging all of those facts on a patient you have met make it more memorable? It allows you to recognize your own strengths and weakness, and use this to guide on-going learning. By reflection you will develop your skills in self-directed learning, improve motivation, and improve the quality of care you are able to provide.

This can be anything.

Most reflections are on things that go wrong. These situations stay in one’s head and force us to begin to think about whether they could have done anything differently. For example:

Postoperative complications
Missed diagnosis
A dissatisfied patient
Failed procedure

However, reflecting on things that went well can often be more rewarding and be just as useful. It can build confidence and help you to repeat it again on another occasion. For example:

A well-managed cardiac arrest
An interesting seminar or conference
A patient thank you letter
A difficult but well performed procedure

There are numerous models for reflections, but it is important to understand why you are asking each question and how that will help you to reflect1. This an integration of many concepts but the broad process is similar in all models: what happened, why does this matter and what are the next steps?2

Think about the situation in detail: What happened exactly and in what order, where were you at the time and who else was involved? What part did you have to play? What was the final outcome?

What was running through your head and how did you feel about it? Be honest with yourself: were you afraid, confused, angry or scared? If you can understand how you were feeling at the time it will help you put together why things happened as they did, and help you to recognize similar situations in the future.

Now you have thought about the situation in greater detail, and probably recognized things that would have otherwise gone unnoticed, think about why things happened as they did. How did the situation, yourself, and others interact at the time. Did the situation go well or was there room for improvement?

With the help of hindsight how would you have managed the situation differently? Think about what factors you could have influenced: is there anything you could have tried that may have improved the situation, or is there anything you did that was particularly important in the situation? It is easy to remember the things that you did not do and it is often the things that you did well that are forgotten.

This is arguably the most important stage in reflecting. You need to pull together everything you have thought of before to learn, change your own practice, and improve3. Do not only think about what you would do differently in that specific situation, but think whether you have thought of any transferable knowledge or skills you can utilize elsewhere. For example: if you reflect on a postprocedural complication do not only think of how you would manage this again but also how you would prevent it happening if you performed the procedure yourself! If you are a part of a well-led cardiac arrest do not think only of what you would do next to help, but also how you would lead an arrest in the future, or even how you would lead a team in any other situation!

Test your reflections: When comparable situations happen again, do things change as you would expect them to? This is a chance to repeat the reflective cycle to refine and develop your understanding.

As mentioned previously most people see reflective practice as a tick box exercise, but it does not have to be.

Over the next day take note of any interesting situations that arise. Later in the day try mentally reflecting, following this framework, and if you think any will be particularly useful to you write them down. If you try this for a week you will begin to see similar situations arising and how your reflective practice is positively affecting you.

Remember: you do not always have to learn only from your own experience; learn from others’ mistakes as well. Reflect on situations that you have witnessed to work out why things happened as they did, and how this can influence you.

It can be useful to take these reflections for peer or senior review: others may be able to draw light on things you have not noticed. This can allow you to recognize points for improvement and work on them. This can also be a useful learning opportunity for the other involved!

I was involved in a patient confrontation; the patient was unhappy with her hospital stay and wanted to be discharged home. Unfortunately she required a package of care and so could not be discharged. I explained this and she returned to her bed. I was happy I had explained everything to her and continued with my other jobs.

Who, what, and why

I was involved in a patient confrontation; an elderly patient was unhappy with hospital stay and wanted to be discharged home. She was under our general surgical team for a head injury and observation after a normal CT head. She had been seen on our ward round and told that she was medically fit for discharge but still awaiting social services: her house had been reviewed and deemed unsafe so she was waiting for banisters to be installed. The issue was raised with me by chance as I was doing other things on the ward. I explained this to her and although she remained annoyed I was able to make her understand what the delay was and she returned to her bedside. She did not seek further clarification that day.

How did it make you feel

At the time I felt rushed and frustrated. I had a lot of other work to be done and this was distracting from that. She had already been told she was waiting for social services in the morning. I understood why this was difficult for her but did not think I would be able to do anything to help.

Why did it happen

The morning ward round was quite rushed and so our explanation was limited to telling her we were waiting for social services. I can understand from her point of view this may have meant very little, and so my explanation of what exactly we were doing may have relieved some frustration. Having been waiting up to this point, it is no surprise she continued to be angry but may have been accepting of this plan.

Could you have done anything differently

I think my explanation was very good, and the patient seemed happy with this, although I did not give a rough idea of how long this would take. It may have been useful to have spoken to the sister in charge to ask for what progress had been made to feed back to the patient. Also I did not ask her whether she was happy with this explanation: I may have been able to satisfy her frustration further by answering a few more questions or even recognize any other issues at home that may need addressing before discharge. Although the information given in the ward round was correct, it was not understandable to the patient. If this had all been quickly clarified in the morning, the patient would have been happy throughout the day and not caused a problem later on.

What will you do differently in the future

I think that the route problem in this situation was our explanation on the morning ward round. Furthermore, I am not sure how long such issues take to be addressed. To avoid a similar situation in the future I will speak to the other health care professionals on the ward to get a round idea of how long occupational interventions such as this and other community interventions take to start. This means when future patients are medically fit I can spend a moment in the morning informing them of what needs to be done and how long it may take. Hopefully this will allow me to address patient concerns early to avoid them becoming an issue when it is too late.

Re-enforcement

I will reflect on how future situations similar to this develop, looking for an improvement in the quality of my patient care.

Following a structure helps to focus a reflection: I am sure you will agree the learning points are much clearer from a good reflection!

To summarize, the benefits of reflecting are clear: it may be difficult to do initially, but through practice you will develop your own skills and become a better learner. Many structures are available so choose one what works for you. Reflective practice is an important part of your career progression on paper, but if done well, can greatly improve your skills as a health care provider.

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 15 June 2017

1. Gibbs G. Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Educational Unit, Oxford Polytechnic; 1988. [Google Scholar]

2. Rolfe G, Freshwater D, Jasper M. Critical Reflection in Nursing and the Helping Professions: a User’s Guide. Basingstoke: Palgrave Macmillan; 2001. [Google Scholar]

3. Schön DA. The Reflective Practitioner: How Professionals Think in Action. New York, NY: Basic Books; 1983. [Google Scholar]