Joy Hall – Head of Department Public & Community Health

Birmingham City University

Outcomes:

• Define and describe the terms: reflection,

reflection-on action, reflection – in action &

critical reflection.

• Identify how these 3 methods of reflection

can be used to improve patient care,

especially in relation to patient safety.

Reflective cycle

Description :

What Happened

Feelings:

What were you thinking

and/or feeling?

Evaluation What was

good and bad about the

experience?Analysis:

What sense can you make of the situation?

Conclusion:

What else could you

have done?

Action plan:

If it arose again what would you

do?

All familiar with a reflective

cycle?

[Gibbs, 1988]

Two questions

What exactly do we mean by reflection in

professional practice

How does it improve patient safety

Reflection is the examination of personal thoughts and

actions. For practitioners this means focusing on :

• interactions with their colleagues and

• interactions with the environment to obtain a clearer

picture of their own behaviour.

It is therefore a process through which practitioners can:

• understand themselves and their actions/behaviour

better

• build on existing strengths and

• plan appropriate future action.

Note the word ‘action’ is very important

Reflection

Developing professional practice by requiring the

practitioner to :

• explore different/new ideas and approaches

towards doing or thinking about things

• promote self-improvement

(by identifying strengths and weaknesses and

taking action to address them)

• link practice and theory

(by combining doing or observing with

thinking or applying knowledge)

•Reflection-on-action

•Reflection-in-action

•Critical reflection

•The most frequently used form of

reflection. It involves carefully thinking

and re-thinking about professional actions

that have already occurred.

•The aim is to identify strengths and to

consider how professional actions can be

more effective in the future.

Questions to ask:• Is this good practice? If so, what is good? If not what is

bad?

• What are the risks for the patient?

• How could you decrease the risks in each example?

• What is does the evidence say about this practice?

This is harder to do and takes experience. It

means:

examining your own professional actions

and behaviour and

Examining the professional actions of others

while the clinical situation continues.

Skills needed:

ability to be a participant observer in clinical settings which means

For your own clinical practice

ability to carry out and evaluate your own actions and make links with previous clinical experience

For practice of other professionals

ability to carry own role and function while at the same time ‘watching’ activities and recording actions of others

ability to evaluate the practice of others

Questions to ask• Is the equipment well organised? Could it be organised

differently/better? If so, how?

• Are the nurses working well together?

• Are there any ways patent safety is at risk? If so, how

could these be reduced?

Critical reflection refers to the capacity to recognise our

assumptions about ourselves, other people, and the

workplace.

Personal experience determines how much of our

environment we actually ‘see’.

Two descriptions of the same event will be different.

Involves uncovering some of the assumptions, beliefs and

values that are part of our society so Vietnamese

reflections will vary from UK or elsewhere

Critical incident analysis offers useful tools to facilitate

critical reflection

What do you see?

Reflect on how the mother feels

How do you as a nurse feel

What are the patient risks?

What could be done better?

What does the evidence say?

How can you get to the example below?

Reflective cycle

Description :

Diabetic with wound infection-

excessive exudate, pyrexia

Feelings:

Concerned

Worried

How did this happen?

Reaction – seek medical advise –antibiotics given, clean & monitor wound & blood

glucose

Evaluation:

Badly? = wound infection

eventually resolved, blood

glucose returned to normal range

Analysis:

Patient remained pyrexial for prolonged

period

Wound with heavy exudate for long period

Hyperglycaemia for prolonged period

Conclusion:

Insulin infusion?

More frequent monitoring?

Different dressings?

Different cleaning agent?

Monitored vital signs

Action plan:

Update knowledge of:

Wound dressings & wound healing

Care of wound care related to

diabetes

What is the most important thing to do right now?

What resources are available to me?

How can I best use these resources?

What do I most value about nursing role?

What practice activities have made me proud to be a nurse?

How am I using my skills?

What do I really need to do?

How confident am I about my professional role ?

What did I find difficult?

Courage to note gaps in

knowledge

Willingness to seek training

from experts or from

colleagues in other settings

Willingness to explore the evidence and research to guide practice

Courage to challenge and change practice ( own & others)

Reflect on extent to which care

provided fits patient

expectations and how this affects

safety

Reflect on how individual

differences can be respected

without reducing safety

Reflect on the significance of

illness to

the patient?

the family

community?

ReferencesGibbs G (1988) Learning by Doing: A guide to teaching and learning

methods. Further Education Unit, Oxford Brookes University, Oxford.

Boud, D., Keogh, R. & Walker, D. (1985) Reflection: Turning Experience into

Learning. London: Kogan Page.

Ghaye,T & Lillyman, S (2010) Reflection Principles Practice for Healthcare

Professionals.London. Quay Books

Johns, C. (2000) Becoming a Reflective Practitioner. Oxford: Blackwell Science.

Mann,K, Gordon,J & MacLeod,A (2009) Reflection and reflective practice in

health professions education: a systematic review .Advances in Health Sciences

education. Volume 14 ( 4) pp 595-621

Tate, S. & Sills, M. (eds) (2004) p 126 The Development of Critical Reflection

in the Health Professions. London; Higher Education Authority

Xin Cam un