Reflection in The Nursing Practice

Going back through previous experiences and tracing back the footsteps we have made allows us to reminisce about the good things that have happened in our lives. Somehow the undesirable memories would also seep in as they are part and parcel of our existence that we cannot do away with. This process gives us an opportunity to encounter past events that can necessarily aid us in the future. In the Nursing practice, reflection is a retrospective approach that evaluates historical processing of experiences that takes place in a structured form and is deemed highly essential (Eliis, Kenworthy and Gates, 2003, 156).

In the clinical practice, this retrospective activity facilitates in the promotion of quality care. The art of reflection however in the nursing practice focus on self rather than on the situation as the care provider (Quinn, 2000, 252). The process is a reflective practice that is a cognitive act by which we are allowed to make sense of our thoughts and memories (Taylor, 2000, 43).

This method therefore allows a practitioner to generate a complementary or alternative form of knowledge and a set of choices in the evaluation of the best course of action. It is a “deep learning” experience that reflects on our knowledge and theories and go beyond merely thinking about what we do but involves recalling what had occurred and analyzing the situation by interpreting important information recalled (Taylor, 2000, 4).

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In Nursing, the reflective process is aimed about our own practice (Taylor, 20000, 3); that nursing education and research cannot do without as a common practice in the learning mechanism in which we all engage in a regular basis (Slevin and Basford, 2000, 483). With a main purpose of enabling the practitioner to learn from experiences and increase clinical effectiveness, reflection is highly essential to the nursing practice.

For this process to be effective, Johns has provided a guided reflection which employs different models of self-inquiry to enable a practitioner to realize desirable and effective practice (2002:3). Considering that this involves a cognitive and emotional component that is expressed through analysis, different models would aid us feel comfortable about the activity. John’s model can be used in preparation for or during clinical supervision and applicable to specific incidents rather than more general day to day issues and particularly applicable to those who prefer a structure approach (Ellis, Kenworthy and Gates, 155).

Gibbs Model use term description rather than “a return to the entire experience” as a form of reflection is considered as a simpler method but one where a mentor or facilitator is likely needed(Davies, Bullman and Finlay, 2000, 84). Both models however in supervision practice can be used to facilitate clinical governance through the promotion of quality care where an exchange between two professionals employing this technique seeks to improve their practice (Watkins, Edwards and Gastrell, 2003, 266).

To maximize the potential benefits of clinical supervision, nurses have to learn to be comfortable with this retrospective activity with the aid of Gibbs or John’s models depending on where one feels most comfortable working with (Ellis, Kenworthy and Gates, 156).

Gibbs Model for reflection

As a simple and easily attainable method, Gibbs model uses term description rather than a return to a previous experience (Davies, Bullman and Finlay, 84). In psychology and teaching, reflection facilitates as purposeful change and competencies such as psychological-mindedness and self-regulation (Clutterback and Lane, 2004, 196). Usually this process involves a mentor, teacher or supervisor working with a student at different stage while allowing for individuality.

Although less specific than re-evaluating an experience; Gibbs in his cycle or reflection makes the action planning a more overt component of reflection (Davies, Bullman and Finlay, 84). Gibbs provides that in one’s own practice, an essential aspect of working as an autonomous practitioner involves a critical analysis of one’s role and responsibilities from a personal perspective (Gibbs, 1998,13). It is a process that requires others to become involved that encourages feedback and constructive comment to recognize your role and value in a health team (Humphris and Masterson, 2000, 77).

John’s Model for reflection

John’s model uses the concept of guided reflection to describe a structure supportive approach that helps the practitioner learn from their reflections and experiences (Quinn, 2000, 572). The approach involves the use of a model of structure reflection, one-on-one group supervision and the keeping of a reflective diary (Quinn, 572). The practice would aid the practitioner in learning from a reflection of their experiences. John’s model is more detailed as it provides a checklist of specific points necessary for reflection (Davies, Bullman and Finlay, 85).

The only problem cited with John’s model if it imposes on a framework that is external to the practitioner leaving little scope for inclusion as cite by other theories. John’s model can be used in preparation and during clinical supervision consisting of 6 steps that is applicable t specific incidents rather than more generalized day to day issues facing the supervisee (Ellis, Kenworthy and Gates, 155). This model is highly attractive to those who prefer a structured approach but others may find this type more restricting (Ellis, Kenworthy and Gates, 156).

Criticisms against the reflective process

Reflection involves cognitive and emotional components that are expressed through analysis and to maximize the potential benefits of the clinical supervisor nurses have to learn to feel comfortable with this retrospective activity both during and in preparation for supervision sessions (Ellis, Kenworth and Gates, 157). This could be deemed time–consuming in an institution where time is often an important element in the delivery of care. A time for reflection can be done positively only when a situation or a need arises. This is probably why reflection method is considered a radical approach to nursing education and practice given the ample time training can afford (Slevin and Basford, 483).

Yet reflection is valuable if done in partnership with someone else which led Davies et al to believe that the approach is quasi-therapeutic (Davies, Bullman and Finlay, 86). The principles have been transferred directly from client-centered psychotherapy and may trigger more powerful responses such as guilt and anxiety. Practitioners are therefore evaluated before they are given a chance to try this one out according to conservative studies. However with practice, it is assumed that a reflective process may not hold as much negative impact for the learned practitioner in an answer to the demands for a continuous review of a practice in a critical and analytical manner that support the reflective concept.

The Value of Reflection for the Student Nurse

As an essential component of scholarly practice, reflection, reflection is a method for generating a complementary alternative form of knowledge and theory (Humphris and Masterson, 2000:78).  Regardless of any negative criticism a reflective method may elicit from critics, I consider this to be a valuable tool. For the student, this is a process were one internally examines and explores an issue of concern triggered by an experience that clarifies the meaning of perspectives (Canham and Bennett, 2001, 185). The nursing practice has been surrounded by a world of silence and reflection is a way for nurses to reflect that is enhanced and introduced in the nursing curriculum (Guzzetta, 1998, 102).

Often in the professional practice, nurses have encouraged silence among themselves in their health environment and setting while usually developing a shared professional voice with her team. Oftentimes, her relationship with the rest of the health team and other professionals faced difficult efforts because of the autonomy. The process of reflection allows one to air out her sentiments and ideas within her group or to a mentor or a supervisor during moments of reflection that could be produced as a shared voice for the team.

Developing a habit of reflection is therefore a must for nursing education in order to uncover dimensions of experiences such as hidden and explicit meanings of behavior that can aid a student nurse in identifying her own perspective of the nursing practice that is highly useful in her entry to the profession (Guzzetta, 1998, 103).

For a student in nursing, one must therefore develop a habit of reflection in order to uncover experiences and the meaning of behavior, values and thoughts that could readily prepare one for professional practice. It should be noted that the reflective process can helpfully aid in teamwork where one has the chance to relay sentiments after reflection of her past experience.Nursing education must therefore develop and evaluate innovative strategies to prepare nurses to meet the challenges of the rapidly changing health care system and for lifelong learning (Johns and Freshwater, 1998, 149).

Reflection and reflective practice are currently receiving attention as a strategy yet little is known about the process of becoming a reflective thinker, how to teach skills needed for reflection, or the barriers and facilitators to becoming a reflective practitioner (Clutterback and Lane, 2004, 198). However a reflection process is worthy of study and practice that should initially be started and adapted as a core training for everyone wishing to professionally practice nursing as a positive way to analyze the development of reflective practice abilities.

Bibliography

1. Canham, Judith and Bennett, JoAnne, 2001, Mentoring in Community Nursing: Challenges and Opportunities, Blackwell, London, 2001.
2. Clutterback, David and Lane,Gill, 2004, The Situational Mentor: An International Review of Competencies and Capabilities in Mentoring, GowerHouse, London.
3. Davies, Celia, Bullman, Anne and Finlay, Linda, 2000, Changing Practice in Health and Social Care, Sage, London.
4. Ellis, Roger, Kenworthy, Neil and Gates, Bob, 2003, Interpersonal Communication in Nursing: Theory and Practice, Elsevier Sciences, Orlando.
5. Gibbs, Graham, 1998, Learning by Doing: A Guide to Teaching and Learning Methods, Oxford, London.
6. Guzzetta, Cathie, 1998,Essential Readings in Holistic Nursing, Jones Bartlett, Maryland.
7. Humphris, Debra and Masterson, Abigail Masterson, 2000, Developing New Clinical Roles: A Guide for Health Professionals, Elsevier, Florida.
8. Johns, Christopher, 2002, Guided Reflection: Research in Practice, Blackwell Publishing, Perth.
9. Johns, Christopher and Freshwater, Dawn, 1998, Transforming Nursing Through Reflective Practice. Blackwell, Perth.
10. Quinn,   Francis M. 2000, The Principles and Practice of Nurse Education, 4rth ed., Nelson Thorne, London.
11. Slevin, Oliver and Basford, Lynn, 2003, Theory and Practice of Nursing: An Integrated Approach to Caring Practice, Nelson Thomas, London.
12. Taylor Beverly, 2000, Reflective Practice: A guide for Nurses and Midwives, Allen and Unwin, St. Leonard.
13. Watkins, Dianne, Edwards, Judy and Gastrell,Pam, 2003, Community Health Nursing: Frameworks for Practice, Elsevier Sciences, Orlando.

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