Reflection is a conscious, dynamic process of thinking about, analysing, and learning from an experience that gives you insights into yourself and your practice. These insights in turn, help you respond to similar clinical situations with a changed and improved perspective . Practice reflection is a valuable part of your professional practice and can improve your critical thinking, change your approach to patient care, promote self-awareness, and improve your communication skills.
To be effective, reflection must be deliberate: just thinking about something that’s happened won’t necessarily help you gain insights that improve practice. And reflection isn’t griping about a bad day either. Complaining and venting may feel good momentarily, but they don’t help you change the situation or your emotional response to it in a positive way.
When you engage in reflection, you’re working toward a goal, to thoughtfully consider the situation and determine problems that need to be addressed, skills that need to be strengthened, and perspectives that need to be changed. The most valuable technique for achieving this goal is a written narrative that lets you analyse the situation more clearly and with more depth than you’d achieve by simply talking about it.
But you don’t have to go it alone. Nursing Matters have develop a guide to help you start the reflection process and reach a depth that you might not have achieved alone. And to help you along the way we are also publishing reflections so that you can help other nurses develop and we learn from each other. Why not earn whilst you learn and submit your stories to us and get paid if we publish your reflection.
Why do we need to reflect?
As nurses we encounter many situations that trigger emotional reactions, including ethical dilemmas, conflicts with a patient’s family, or rudeness from a colleague. Most of us can recall a time when we’ve wondered what we would do if we could rewind an episode and manage it differently.
“Reflection is a window through which the practitioner can view and focus self within the context of her own lived experience in ways that enable her to confront, understand and work towards resolving the contradictions within her practice between what is desirable and actual practice. Through the conflict of contradiction, the commitment to realise desirable work and understanding why things are as they are, the practitioner is empowered to take more appropriate action in future situations” (Johns 2000:34).
Our step by step guide to reflection
Firstly ask yourself if you’re truly willing to explore issues in depth. This does involve making a commitment to increased self-awareness and may involve recalling uncomfortable situations or painful memories. To get started, consider making your first reflection about a positive experience-perhaps the first time you knew you made a difference as a nurse, or how you helped a patient get better. Whatever you choose, Nursing Matters would like to hear your story and share it with other nurses to help them reflect and improve their practice. To thank you for your positive reflection, we would like to offer a £20 reward for any published reflective practices. Whatever you choose, be certain that your subject is something you want to explore. Remember, reflection can help you dissect both positive and negative clinical situations.
Second, engage in a dialogue with your guide, the template on the website or someone who’s willing to participate in your reflection. This “primes the pump,” helping to get your memories in focus and preparing you to put words to the feelings or images in your mind. This step won’t be as helpful if you engage in reflection by yourself. Another person can make sure you stay on topic and don’t get stuck in one place, getting hung up about a single element of an incident.
Once you’ve prepared yourself, your third step is to begin journaling. Just let your ideas flow freely as you become comfortable with the act of writing. Don’t edit, censor, or criticise yourself. Simply let your hand write what your mind says while you enjoy the process.
Fourth, if you haven’t yet done so, identify a second person that can be your guide. This guide, who may be the person with whom you engaged in oral reflection, should be someone who’s familiar with written reflection and can provide you with structure. Make sure you’re comfortable with this person, even if she or he asks difficult and probing questions. At this point, you may choose to have the guide read your written narrative reflection or you may use it to frame a conversation with your guide about the situation.
Your guide should help you deal with any anxiety related to reflection, encourage you to explore the meanings of events, challenge you to uncover any discrepancies -between ideal and actual nursing practice, and serve as a sounding board.
Using a three-phase approach
You can use a format for reflective journaling. By engaging in a three-phase approach, nurses can best analyse a clinical situation. These three phases are the descriptive phase, the reflective phase, and the critical phase.
Phase One – Descriptive
In the descriptive phase, you create a written narrative of the situation, paying special attention not only to your actions, but also to your thoughts and feelings. Your guide can play an important role in ensuring that the narrative is as truthful as possible and that you deal honestly with issues that cause discomfort or distress.
Phase Two – Reflective
During the reflective phase, examine your narrative on three different levels. First, consider your practice against standards of high-quality nursing. Second, reflect or consider how specific features of the situation influenced your practice. Finally, examine the intentions that motivated your actions; in doing this, think about aspects that influence decision-making. Some questions you might ask yourself include these:
At the time, what did I believe guided my actions (or inactions)?
Looking back now, what do I think guided my actions?
What values or ethical standards guided my actions?
Were my intentions consistent with the patient’s goals?
Why did I carry out the actions as I did?
Phase Three – Critical
Finally, in the critical phase, you’re ready to gain insight into ways to improve future practice. By examining any gaps in your competencies or knowledge and by identifying any need for changes in your nursing practice or in your attitudes, you begin to see the incident as a learning tool. You can now identify the gaps between ideal and actual nursing practice.
Now ask yourself some further questions:
Were my actions in this situation the best, most appropriate, and most successful ones possible?
Did I use my knowledge appropriately?
What were the critical factors that got in the way of doing a better job, and why?
How could I change my practice in the future?
Ask yourself the tough questions
To help you get started, try asking yourself these questions:
What situation made me feel uncomfortable or triggered my emotions somehow?
Did a clinical situation seem significant to me in some way?
Did I ask myself, “Did I miss something?
What could I have done differently?
Would I like a deeper understanding of a situation that I found interesting?
The reflective process should not be an end in itself but rather a means by which we can consider the experiences of others and learn from that process in order to improve and develop both the quality of care we provide (Burnard 2002). Through engaging and embedding reflective practice in our everyday practice we also improve and develop ourselves.