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Slide 1: Reflective practice Title what does it mean? Prepared for Bachelor of Nursing year three Bronwyn Hegarty, Educational Development Centre, 2009 licensed under a Creative Commons Attribution 3.0
Slide 2: Overview of the session • Coffee metaphor for reflection • What is reflection and reflective practice? • Five requirements for reflective practice • Examples of reflective writing • Critical incident definition • Three-Step Reflective framework (RF) • Terminology and three types of reflection for nursing • Activities using the RF 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 such as organic, fair trade coffee? I think so. 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. - Thinking more broadly about cultural, socioeconomic, political or historical perspectives is termed Critical reflection. licensed under a Creative Commons Attribution 3.0
Slide 5: What is reflection? Reflection involves thinking about our thinking. It occurs at different levels and in different situations. Often an issue or an unusual event will stimulate thinking about what happened. It helps you to solve problems. Reflection helps you learn from your best and worst decisions. Reflection-in-action – “on the job”. Reflection-on-action – after the event. There are lots of definitions! licensed under a Creative Commons Attribution 3.0
Slide 6: How do you reflect? Diary, journal, blog, exemplars Friends and family Mentor Talking to yourself? Recordings – audio, video? licensed under a Creative Commons Attribution 3.0
Slide 7: 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.) licensed under a Creative Commons Attribution 3.0
Slide 8: Reflective practice in nursing Reflection provides a way for nurses to communicate and justify the importance of practice and practice knowledge (p7). And helps them initiate change and develop new knowledge. Skills for reflective practice include: self-awareness, description, critical analysis, synthesis and evaluation (p25). (Bulman & Schutz, 2008.) licensed under a Creative Commons Attribution 3.0
Slide 9: 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 10: 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 11: 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 12: Student nurse journal It was an awful afternoon shift last night. I was so busy that I realised when I got to bed 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 that he was being treated for pneumonia and was on a new drug. I gave him Ampicillin by mistake so he missed a dose of the stronger drug. It was pretty serious because he might now 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 13: 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. (Duke, 2003.)Commons Attribution 3.0 this later….. More about licensed under a Creative
Slide 14: Reflecting on a critical incident A critical incident is 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 15: Three- step Reflective Framework licensed under a Creative Commons Attribution 3.0
Slide 16: Activity • • Swap stories with your neighbour about a critical incident . Write down a description of the incident in Step One of the template provided (Three-step Reflective Framework). Analyse what happened and write in Step Two using the prompting questions. • licensed under a Creative Commons Attribution 3.0
Slide 17: More 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). Critical reflection - when we think about something from a cultural, social, political or historical perspective, power relationships. licensed under a Creative Commons Attribution 3.0
Slide 18: 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 19: licensed under a Creative Commons Attribution 3.0
Slide 20: Activity • Reading from Sue Duke’s (2003) exemplar from Bulman & Schutz, 2008). • Try and identify the technical, practical and emancipatory elements of reflection in the piece. • Does she demonstrate critical thinking and reflection? licensed under a Creative Commons Attribution 3.0
Slide 21: Activity • Finish writing about the critical incident using Step 3 of the template. • Talk to your neighbour and give an overview about what you wrote in Step 3. • Have you met any of the five requirements for reflective practice? – Which ones? • Self-awareness, description, critical analysis, synthesis, evaluation. • Discuss this with people around you. licensed under a Creative Commons Attribution 3.0
Slide 22: Five requirements Self-awareness – know yourself– beliefs, values, qualities, strengths, limitations within a social context. Description - writing and dialogue – ones-self, peer, group, mentor. 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. Evaluation – judge your performance – look back on your practice Commons Attribution 3.0 changes for the future. licensed under a Creative and make
Slide 23: Summary Reflective practice is possible and essential if you are to be a safe practitioner. It is okay to make mistakes if you learn from them and change your practice. However someone who is not reflective and continues to believe that only their way of doing things is right is not a safe or effective practitioner (Hegarty, 2009). licensed under a Creative Commons Attribution 3.0
Slide 24: 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), 4044. Schutz, S. Reflection and reflective practice. Community Practitioner; 80(9), 26-29. Taylor, B. (2006). Reflective practice. A guide for nurses and midwives. (2nd edn). Berkshire, England: Open University Press. licensed under a Creative Commons Attribution 3.0
Slide 25: THE END licensed under a Creative Commons Attribution 3.0