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Slide 1: Reflection what does it mean Title for nursing practice? Sub-title Bronwyn Hegarty, Educational Development Centre, 2009 licensed under a Creative Commons Attribution 3.0
Slide 2: Overview of the session • What is reflection and how do you reflect? • An example of when reflection is used in nursing reflective practice • Recording reflective practice and the process of reflection • Five requirements for reflective practice • Examples of reflective writing • Three-Step Reflective framework (RF) • Terminology and three types of reflection for nursing licensed under a Creative Commons Attribution 3.0
Slide 3: The story of coffee – a metaphor for reflection in everyday life Reflections in a coffee cup by Gunjan Karun licensed under a Creative Commons Attribution 3.0
Slide 4: Coffee metaphor Our flat always buys loads of cheap coffee and it tastes horrible. Is it better to buy and drink better quality coffee - organic, fair trade coffee? It would be better for us, and would support the growers so they get a fair price and have better living conditions. - We think so we can understand something. - We think so we can change things and make them better. licensed under a Creative Commons Attribution 3.0
Slide 5: What is reflection? Reflection is “thinking with a purpose”. Reflection helps you to: • raise your self-awareness • process information and experiences • learn from your best and worst decisions • solve problems • understand what and how you learn • deepen the quality of your learning - critical thinking • explore your view Attribution 3.0 world of the licensed under a Creative Commons
Slide 6: Flight of the Conchords Think About it http://www.youtube.com/watch?v=TLEK0UZH4cs licensed under a Creative Commons Attribution 3.0
Slide 7: The video is a great example of how to look at the world more critically. Critical thinking – examining your and others’ ideas, assumptions, issues, beliefs, actions. Critical reflection - when we think about something from a broader viewpoint - cultural, socioeconomic, political or historical perspectives e.g. social justice, power relationships. licensed under a Creative Commons Attribution 3.0
Slide 8: How do you reflect? Telling stories (dialogue) - friends, family, mentor, colleagues Recording the event – writing, audio, video? Talking to yourself? Mulling things over - in the bath/shower, on the bus, in bed? If you record your reflections – what do you use? - diary, journal, blog licensed under a Creative Commons Attribution 3.0
Slide 9: An example of when reflection is used in nursing 1. While you are watching a demonstration of a skill, e.g. how to give an injection or take a blood pressure You might think - that seems easy/hard, will I be able to do it? - what do I need to understand to do it well? - what do I need to remember? licensed under a Creative Commons Attribution 3.0
Slide 10: 2. When you try out the skill for yourself - what do I do and in what order? - what do I remember from the demonstration? - how is it explained in the skills manual? licensed under a Creative Commons Attribution 3.0
Slide 11: 3. After you have used the new skill - did I do that well, how could I have done it better? - what did I learn? - Is there anything or anyone I need to seek guidance from? licensed under a Creative Commons Attribution 3.0
Slide 12: 4. Before you carry out the skill the next time - which is the best way to start? - what did I do well or poorly last time? - how can I improve my skill this time? Key point: Reflection can help you to be a more competent nurse. This is an example of reflective practice. licensed under a Creative Commons Attribution 3.0
Slide 13: Recording reflective practice 1. Journals (includes blogs) - Free writing - log of events, thoughts etc. - Autobiographical – personal development - Structured writing – exercises, questions or guidance, frameworks (Hegarty Three-Step RF) 2. Portfolios – professional, a record of learning, evidence and reflections. licensed under a Creative Commons Attribution 3.0
Slide 14: Recording reflection in journals A journal can provide you with a special and permanent place to record your thoughts. For example, a journal might be: • A special book you write in • electronic - a document or blog - double-entry journal – use two columns – one for description, and the other for your reflections on the event. It helps make the process of reflection more important and concrete. You can easily return to it. licensed under a Creative Commons Attribution 3.0
Slide 15: What stimulates reflection? Often a problem or an unusual event will stimulate you to think about what happened and why. In nursing, we call this a critical incident. A real event from practice which had either a positive or negative impact on you (Bulman & Schutz, 2008). - it can be pleasant or adverse, mundane or significant. licensed under a Creative Commons Attribution 3.0
Slide 16: Terms Critical thinking occurs in complex situations and is essential for safe practice. It involves rational examination of ideas, assumptions, principles, arguments, issues, beliefs, actions – use of the nursing process, decision-making and reasoning and selfawareness are all important (Taylor, 2006). • Reflection-in-action – “on the job”. • Reflection-on-action – after the event. licensed under a Creative Commons Attribution 3.0
Slide 17: Process of reflection 1. Select - It is usually easiest to select something to reflect on. 2. Describe – this stage is relatively easy – chronological (in order), narrative (story), a list. 3. Analyse – explain the reasons for what happened. Much harder – requires self-awareness and critical thinking. 4. Action – what you learned and what you will do next (goals). licensed under a Creative Commons Attribution 3.0
Slide 18: Three- step Reflective Framework licensed under a Creative Commons Attribution 3.0
Slide 19: Watch a short video clip and identify a critical incident. • Choose one to talk and write about afterwards. Choose either - Legally Blonde http://www.youtube.com/watch?v=iOE3CUw92pE OR Grey’s Anatomy http://www.youtube.com/watch?v=LSFTaqNCJK0 licensed under a Creative Commons Attribution 3.0
Slide 20: Reflective practice Reflection allows you as a practitioner the opportunity to explore and describe your experiences, analyse your feelings, interpret your responses, critically evaluate, link theory to practice, become more self-aware, transform your learning, change your practice. (Bulman & Shutz, 2008.) Reflection helps nurses to initiate change and develop new knowledge and it gives nusrse a voice (p7). Skills for reflective practice include: selfawareness, description, critical analysis, synthesis and evaluation (p25). (Bulman & Schutz, 2008.) licensed under a Creative Commons Attribution 3.0
Slide 21: Five requirements Self-awareness – know yourself– beliefs, values, qualities, strengths, limitations within a social context. Description - writing and dialogue – ones-self, peer, group, mentor, clinical supervisor. Critical analysis – pulling the thing apart – identify weaknesses and strengths in yourself and others. Synthesis – create new knowledge, change the way you think, your beliefs and look at things from other perspectives (learning). Evaluation – judge your performance – look back on your practice and make changes for the future. licensed under a Creative Commons Attribution 3.0
Slide 22: Activity - self-awareness 1. Tell a story about yourself to your neighbour 2. Write down 50 words to describe your personal beliefs, values, qualities, strengths, limitations – this will not be read by anyone else. • • Write down which is your inside story and which is your outside story. What are the differences? licensed under a Creative Commons Attribution 3.0
Slide 23: Reflective writing Bridget Jones diary Had six cups of coffee today and three desserts. Met friends for lunch and drinks after work. Saw Mr Darcy sitting in the corner at the café looking lonely and lovely. I must pluck up the courage to talk to him tomorrow. What shall I wear? Do I need to touch up my roots? Calories: 4000+ Exercise: Nil Love prospects: 1 Promises broken: Nil licensed under a Creative Commons Attribution 3.0
Slide 24: Student nurse journal It was an awful afternoon shift last night. I was so busy that I realised when I finally got to bed at 1230 am that I had given Fred the wrong antibiotics. I was so tired and it was so late that I didn’t tell anyone about it until the next day. I thought it would not matter. Bad mistake! I found out today, Fred was being treated for pneumonia and it was resistant to the usual antibiotics. Therefore he was on a new, stronger drug. I gave him Ampicillin by mistake so he missed a dose of the stronger drug. It was pretty serious! Now he might need to have IV drugs and will end up staying in hospital longer. I feel awful…. licensed under a Creative Commons Attribution 3.0
Slide 25: Nurse practitioner I was angry and disappointed with the care a medical colleague had shown a woman who was terminally ill. Kate, a 67 year old woman with a brain tumour was referred to me for symptom management and ongoing care planning. She felt dizzy when moving and often vomited. Also she was unable to use her left leg fully as it was weak. Although she really wanted to go home as soon as possible, she was really worried about being able to manage. I felt for her. I organised a meeting with the palliative consultant. During the consultant’s assessment she focussed mainly onCreative Commonssymptoms and not her worries Kate’s Attribution 3.0 licensed under a about going to the hospice… (Sue Duke, 2003.)
Slide 26: Activity Swap stories with your neighbour about a critical incident – over the summer, or the distant past – 5 min. licensed under a Creative Commons Attribution 3.0
Slide 27: Writing activity critical incident Write on Step One of the template provided – 5 min: • • • • • • Outline why you chose this incident. Comment on what you were doing, feeling, thinking, needing at the time. Comment on whether what you already knew helped you. Mention initial reactions and what you did to deal with the situation. Indicate what helped you, or not. Describe all the people involved, including their perspectives Commons Attribution 3.0 licensed under a Creative of the situation.
Slide 28: Activity Continue writing in Step Two of the template for the Three-Step Reflective framework. licensed under a Creative Commons Attribution 3.0
Slide 29: Three types of reflection In nursing three types of reflection are acknowledged: • Technical – procedures and competence – modify and improve actions in the workplace • Practical – making sense of human interaction – interpret a situation, raise awareness • Emancipatory – how you see yourself and others in social/political situations – transformative action They are not always easy to separate and are often combined. licensed under a Creative Commons Attribution 3.0
Slide 30: Summary Reflection is important for your nursing practice (reflective practice) to help you reflect on your competency, “unpack” critical incidents and learn from your experiences. Journals add permanence to your reflections – provide a record. Dialogue will need to be recorded to do this. The Three-Step Reflective Framework is one method you can use to guide your writing. Types of reflection –Technical (procedural), practical (interactions), emancipatory (transformation), critical reflection (culture, socio-economic, licensed under a historical, Creative Commons Attribution 3.0 political)
Slide 31: Three- step Reflective Framework licensed under a Creative Commons Attribution 3.0
Slide 32: References Bulman, C. & Schutz, S. (2008). Reflective practice in nursing. Oxford, UK: Blackwell Publishing. Hilliard, C. (2006). Using structured reflection on a critical incident to develop a professional portfolio. Nursing Standard, 21(2), 35-40. Lasater, K. & Nielsen, A. (2009). Reflective Journaling for Clinical Judgment Development. Journal of Nursing Education, 48(1), 40-44. Schutz, S. Reflection and reflective practice. Community Practitioner; 80(9), 26-29. (Sue Duke, 2003 exemplar.) Taylor, B. (2006). Reflective practice. A guide for nurses nd and midwives.Commons Attribution 3.0 Berkshire, England: Open edn). licensed under a Creative (2
Slide 33: THE END licensed under a Creative Commons Attribution 3.0

   
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