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Why bother to reflect?
A number of commentators over the years (Brett, 1987; Hunt, 1984; Lacey, 1994; Walsh & Ford, 1989) have described nursing as being bound by routines, of continuing practices which have little basis in research or theory and which could be ineffective at best or even harmful to the client / patient. A little careful thought might help us to become more effective. In addition, nursing is a demanding profession during which there is considerable potential for involvement in others’ unhappiness and distress. That unhappiness and distress may be forced upon us in the form of demands for help (reasonable or unreasonable), aggression (physical or verbal) or rejection of our attempts to help.
We may sometimes feel overwhelmed, demoralised, and unable to see that our efforts are worthwhile, effective or skilful. We may feel that, with the benefit of hindsight, we could have handled a situation better. Reflection is not just about negative experiences, though. Very often we have many reasons to celebrate our successes, to become aware of our skills, why we were successful and how we might build more success into our practice.
Reflection in nursing therefore has a potential for the following:
• Improving nursing practice
• Problem-solving, resolving dilemmas
• Being aware of one’s strengths and weaknesses
• Professional development
• Delivery of more effective care
• Celebrating success, feeling proud, successful etc.
• Helping us to come to placements with, and resolve uncomfortable feelings
Some acknowledged authorities on reflection (e.g. Boud, and Schon) have indicated that reflection is triggered by uncomfortable feelings or thoughts (often relating to a ‘critical incident’) and have implied that such reflection has a focus on negative thoughts and feelings. However, it may be argued that there is at least as much value in reflection upon positive situations, feelings and thoughts.
Reflective practice has an evaluative component which might contain both positive and negative sides and, just as one would evaluate care plans, we might evaluate our practice in placements of:
• What has gone well, what can we learn from this, and how might we increase the likelihood of such positive events happening in the future?
• What didn’t go so well, what can we learn from this, and how might we decrease the likelihood of such negative events happening in the future?
What should we reflect about?
Donabedian (1980) suggests three possible ways of looking at what nursing practice is about, and that reflective practice might therefore concern itself with:
• The structures for care: (the systems for nursing care delivery), the nursing process, allocation of work, team work, professional communication, skill mix, and so on.
• The outcomes of care: (what happens as a result of nursing care), is the client better or worse off? Were care objectives achieved? How effective was the care?
• The process of care: (what happens during care), the nurse-client and nurse-relative relationships, communication, empowerment, and so on.
Clearly, we could therefore reflect about almost anything in our nursing practice and we therefore need to be selective about those events and situations upon which we choose to spend time and effort in reflection. Criteria which might be used in selection could include:
• Events which are a particularly good example of our practice, about which we feel particularly proud and about which (overcoming our natural modesty) we would like others to know about.
• Events which you feel are particularly meaningful, perhaps in placements of representing a watershed, a ‘fork in the road’, a key decision or dilemma etc.
• Events which have not gone well and in spite of your best efforts your planned outcome (or that of the client) was not reached.
• Events in which you feel blocked or frustrated by a lack of knowledge or skill, lack of resources, by the organisation, etc.
• Events about which you feel unhappy or distressed and which need to be resolved if they are not to add to a mounting collection of emotional ‘baggage’ which you carry around with you. These might involve ethical or moral dilemmas.
How should we reflect?
Although there are many possible models of reflective practice, the reflective accounts as a part of students’ assessment need to be written according to a single model in order that their work can be judged against a single standard.
Assignment Guidance:
Content
Produce a 1,500 (+/- 10%) word reflection on how you initiated compassionate person centred care in your placement learning opportunity.
Using Gibbs reflective cycle, consider an episode of care you have initiated in your practice learning opportunity. The headings you should use are the ones discussed in the Introduction to the module and also outlined on the marking grid.
Consider the marking grid and the module learning outcomes, demonstrating how you have achieved these.
Please use the headings to help you in your work. You can leave the headings in your submitted work.
Follow the confidentiality policy.
Structure
As this is a reflective piece you are advised to use the first person. This is still an academic piece of work so do not use colloquialisms e.g. don’t , can’t , OK etc.
Use Verdana 11 or 12
Double line spaced
Left aligned
Student number on each page.
Pages should be numbered
Include the word count.
Harvard referencing system must be used. Reference list should be single line spaced.
Ensure you proof read your work.
Preparation
In preparation you should read around reflective practice and writing.
Read around critical analysis and how you can demonstrate this in your writing. Very important in level 5 work.
Make sure you understand what synthesis, evaluation and application are so you can demonstrate in your writing.
Look at the introduction to the module.
Look at the marking grid and level 5 grading criteria. These are the tools your Personal Academic Tutor will use to Grade your assignment. You can use these to assess your work.
Revisit the Harvard referencing system via the library website.
Ensure you understand how you can provide evidence for any statements you make.
Consider if you feel confident in using NELSON. If not seek support from the academic librarians.
Consider what you have learned in the module with regard to initiating compassionate person-centred care.
Ensure you understand how you can provide evidence for any statements you make.
Undertake further reading around the subjects.
If you are unsure seek support from your personal tutor and /or module lead. Your personal academic tutor will be marking this work. You can send 10% of your work to your PAT for feedback prior to submission.
