Reflective Practice and its Application in the Imaging Department - Coursework Example

Reflective Practice and its Application in the Imaging Department Introduction The process of thinking and analyzing past experiences with the goal of learning from them is formally called ‘reflective practice’. Popular in the field of teaching and education, reflective practice also finds wide acceptance in the field of health care particularly in the clinical setting as it is perceived to provide benefits not only to the practitioner but to all stakeholders. In principle, reflecting enables people to fully appreciate and comprehend the effects of their action and use this learning as a basis for future activities. Reflective practice had already been applied in podiatry, physiotherapy, pharmacy, midwifery and mental health nursing with their effects on the practitioner and the people served determined and analyzed. This paper seeks to expand this further by examining the application of reflective practice in the imaging department specifically in its management and service functions. The goal is to determine opportunities for application and development. To achieve this, the nature of reflective practice is discussed and elaborated. Examples of the application of reflective practice in the management and service delivery of health care is drawn and used to identify application and effects to the imaging department. The meaning of Reflective practice A standard dictionary search on the meaning of reflection would yield interesting results. In the field of physical science, reflection refers to the symmetrical transformation in which a figure is reversed along an axis so that the new figure produced is a mirror image of the original one. In the field of social sciences, reflection takes a deeper definition as it is the process of meaning-making that guides a learner from one experience to the next resulting in a deeper understanding of the relationship between the experiences. This definition basically states that reflection is the act of developing that mirror image. Scholars in the health care sciences adopt the experiential learning approach as they seek to determine the nature of reflective practice. Boud, Keogh and Walker (1985) considers it to be a thinking practice where the individual remembers and analyze his or her experiences leading to new conceptual perspectives and understanding. Jarvis (1992, p. 180) considers reflective practice as something more than thoughtful practice as it ‘problematise many situations of professional performance so that they can become potential learning situations and so the practitioners can continue to learn, grow and develop in and through practice’. Atkins and Murphy considered the practice as a method integrating theory and practice as it bridges the gap between what is learned in the classroom and what is done in the field. Doyle & Young (2000, p. 18) considered reflective practice as ‘a process of disengaging from or stepping back from an experience and taking time to deliberately and carefully review it, think about it and construct meaning from it’. There are several more definitions and identifying them all would be exhaustive. A better course of action is to identify common themes. The defining attributes of reflective practice present throughout literature includes: a) examination of practice, b) reflexivity, c) active and deliberate constructive process and d) process of transformation. A discussion on each of this attributes is found in the following passages. Examination of Practice Literature on reflective practice agrees that a defining characteristic is the examination of practice particularly that of the profession one belongs to and is currently engaged in. Lau and Chan (2005), for example, identified reflection as a method of examining practice issues in nursing and a constructive guidance tool offering the opportunity to learn and develop not only technical knowledge and skills but also ethical and personal domains. Mantzoukas and Jasper (2004) also found that reflective practice enables practitioners to monitor and analyze their daily job activities and problems encountered. Several other researches provide further evidence that reflective practice is a valuable educational approach in developing critical thinking and acquisition of practical knowledge to address problems from practice. (Boud and Feletd, 1997; Williams, 2001; Saylor, 1990; Brockbank and McGill, 1998). Reflexivity Oftentimes, professionals become single-minded individuals capable of seeing and understanding the situation in an isolated manner. Reflective practice is characterized in literature to provide reflexivity which is otherwise known as ‘holistic knowing’. Johns (1995) points out the fact that reflective practice provides an impact analysis of past experience on present and future actions. It is a practice of understanding experiences not only in an isolated moment but in a continuous flow of spatial and temporal conditions. Change can also be evaluated over time and space by comparison and analysis of the reflections made. Johns (1995) provides a list of critical questions showing how reflections can provide holistic knowing: Table 1. Extract from Johns' (1995) structured model of reflection 1. How does this connect with previous experience? 2. Could I handle this better in similar situations? 3. What would be the consequences of alternative action for the patient, others or me? 4. How do I feel about the experience? 5. Can I support others and myself better as a consequence? 6. Has this changed my ways of knowing? Active and Deliberate Constructive Process Cattini and Knowles (1999) identify the reflective practice as: ‘A dynamic process where an individual practitioner actively considers the various components of a given task with a view to learning from and using the lessons learnt to improve the practice’. Undertaking reflective practice entails active participation for a reflection devoid of interest would bring no meaning. The process entices the practitioner to actively pose questions on one’s self regarding uncertainties and incongruence between the ideal and the real. Osterman and Kottkanip (1993) found that actively engaging in careful thinking inspires further inquiry and attainment of new knowledge which in turn leads to the pursuit of effective strategies to address the uncertainty and incongruence. A constructive cycle of questioning and finding answers ensues and the learning and professional development of the practitioner become a successive and connected action. Mezirow (]991) point out that the bond between reflection and problem-solving is a deliberate process because when we assess our assumptions regarding the problem solving strategies we identified and find them erroneous, a dynamic and spontaneous process occurs where we try to create new ones or make changes to our old assumptions and interpretation of our experience. This is an indication that reflective practice is a conscious and deliberate strategy aimed at understanding clinical practice. Process of Personal Transformation A key feature of reflective practice is transformation. In this regards, Wallace (1996) has this to say about the nature of reflective practice: 'A dynamic, uniquely individualized process of expanding consciousness whereby individuals become critically aware of old and new self-views and choose to integrate these views into a new self-definition.' Thru the process of careful and critical analysis of previous experiences, the practitioner is made aware of the implications of his actions and directs him what to in the future. Changes in behaviour occur to be more capable in carrying out the practice. Johns (2002) agrees that the reflective journey is a process of ‘being and becoming’. In a study of reflection-practicing nurses, Mantzoukas and Jasper (2004) found that it was a powerful activity that raised consciousness on knowledge, practice and power issues in the clinical setting especially if it was promoted by the culture. Model for Reference There are several models and frameworks developed to illustrate the process involved in reflective practice such as the structured reflection of Johns (1995), iterative model by Gibbs (1988) and hierarchical approach proposed by Mezirow (1991). Nevertheless, the preferred model is the one proposed by Gibss (1988) because it captured the whole essence of reflective practice despite the simplicity of the process diagram used. It also shows the four Figure 1: A cyclical model of Reflection (Gibbs, 1988) Effects of Reflective Practice on the Imaging Department Now that the nature of reflective practice is known, its application and benefits now to the field of medical imaging will be explored particularly in the management and service delivery areas. The goal is to determine how reflective practice can provide tangible results to the development of the profession. Management Benefits The effects of reflective practice on the management of different areas of healthcare have been explored. Our own search for literature specific to the radiography department has been unfruitful. To address this problem, the course of action taken was to consider the researches on other healthcare fields as benchmarks. Common in reflective practice research concerning management such as that of Gardner & Boucher (2000) and (Greenall, 2004) is the recognition that reflective practice can improve the manager’s ability to handle the following: ● Staff issues especially with regards to the management of poor performers ● Personal issues related to job stress, difficult staff, role overload and work/life balance. ● Use of managerial power ● Authority issues involving other managers, peers and more senior staff. ● Skill development in areas such as conflict management, negotiating and running meetings. From these areas of improvement, reflective practice benefits the manager in two ways: a) how to do managerial tasks and b) learning about one’s self in the role of a manager. The first is concerned on how reflective practice enables the development of skills and attributes while the second is focused on developing self awareness (Talbot, 1997). Reflective practice enables managers to sit down and establish coherence on their stressful day-to-day activities. Writing down, for example, an encounter with a person with a strong personality enables the manager to determine ways on how to handle that person. Managers usually develop reclusive personalities to establish a sphere of authority. Hence, they cannot easily relay their thoughts and feelings to other employees. Reflective practice provides an avenue for releasing the pent-up thoughts and feelings of the manager enabling him to think clearly and consequently, manage more effectively. Service delivery Reflective practice can improve service delivery in the imaging department in two significant ways. First is by providing avenues where the practitioner can realize ‘habitual’ or ‘dysfunctional’ practices in day-to-day activities. Second is by providing valuable insights into the current situation of the practice that can be used to enhance the patient experience. Break from ‘Habitual’ and ‘Dysfunctional’ Practice How can reflective practice improve the quality of services offered by imaging departments? Applying reflective thinking can assist practitioners in creating knowledge as individuals and as a member of the community of practitioners (Burton, 2000). Reflective practice also serves as a bulwark against the ‘habitual’ and, in extreme cases, ‘dysfunctional’ practice. Consider for example the journal entry of a radiography student about his clinical learning experience (adapted from Burchell et al, 1999): “The hospital I went had a vast range of patients and poses a great threat to the spread of infection (sic)… An elderly inpatient was brought to the radiology department from a ward for abdominal x-rays. The ward was known to have patients with gastro. In general most of the radiographers involved in the examination used protective measures… There was however a radiographer … who found it unnecessary to apply protective barriers and follow the hospital protocol… I found the situation troublesome. I believe the situation was handled poorly by that specific radiographer and perhaps even by other radiographers involved. None of the radiographers who correctly followed the infection control protocol took it upon themselves to check everyone participating in the examination was wearing protective clothing before the patient was handled… Ultimately, I believe the level of patient care was compromised due to the failure of a radiographer to correctly follow precautionary measures”. This simple journal entry shows how reflective practice can help the radiography practitioner in being alert of dysfunctional practices. Writing down seemingly simple observations can lead to realizations about best practices or lead to a change in practical behaviour. As all educators would know, learning theory in the school cannot tell someone how to practice. This is the reason why curriculums include an on-the-job training. In the health care sciences, this is better known as clinical experience or internship. Nonetheless, these clinical experiences or on-the-job training where reflective practice is not applied do not adequately capture the essence of professional knowledge. Reflection enhances the learning experience by enabling the practitioner to fully grasp the relevance of their day-to-day practice. To better illustrate this, a clinical report from a radiography practitioner is given below (adapted from Baird, 1996): “By the end of the first week, it was clear that not all doctor’s requests were precisely correct in terms of the radiographs required. Often, much more information is relayed directly from verbal communication with the patient. One such outstanding case appeared whilst I was assisting Kathy (a radiographer with 8 years experience) on an inpatient (sic). The request form for this elderly patient had ordered for an AP and lateral projection of the hip joint (normal protocol in the hospital) as she had undergone a total hip replacement. However, the patient continually complained about her leg. After querying about where and how the pain was initiated, it was decided that a shot of the whole femur would be done. The commendable outcome was that a fracture at the tip of the pin was captured – and only seen on the AP projection (sic). If the conventional projections suggested by the doctor had been undertaken, such a fracture would have never been seen. Due to rational communication with the patient the problem was identified”. The ‘realization’ benefit of reflective practice is readily apparent above. More importantly, however, is the opportunity of learning how to adapt learned rules and theory to the particular problem at hand. According to Harris (1993), competent practical action depends on competent practical reasoning developed through ‘knowing in action’, ‘reflection in action’ and ‘reflection in action’. The ability to define a problem or make sense of a puzzling situation is important for the application of technical and scientific knowledge in which Radiography and other imaging methods are all about. Essentially, reflective practice develops the individual and makes him capable of managing and deciding on situations of uncertainty, conflict and uniqueness. While practitioners who do not practice reflection lose themselves in the midst of confusion, their peers who practice reflection are able to call upon a host of cognitive and emotional assumptions, examine them, pose new questions, construct effective judgments and consequently develop new or modified action theories (Baird & Winter, 2005). In service delivery, reflective practice helps by enabling the practitioner to discern and break out from habitual responses to their practice. To further illustrate how reflective practice enables a person to develop against professional practice, consider the following clinical learning report by a radiography student (adapted from Hackett, 2001): “The initial breakdown in communication was not helped when the attending doctor told the patient in much the way as referring to a mischievous child “you have two choices you either have the x-rays or you go out of the door!” The radiographer then proceeded to use forceful actions to move the patient … most communication was blunt” The student noted that the patient was not under the influence of alcohol or drugs but was shy to expose his body. In seeing the poor professional practice, the student made a promise to himself to be more mindful of their patients and treat them better. Valuable insights into the Professional Practice Reflective practice can provide details on how the profession is being conducted which might not be readily apparent. The examples shown in the first service delivery improves the way the individual practices his profession. In this section, the argument is that reflections regarding the imaging department’s day-to-day activities can help avert a social crisis and lead to policy formulation. Consider the following journal entry of a radiography practitioner (in Baird, 1998, p337): “I was questioned by my supervising radiographer as to what I was doing? I said that I was helping the patient change as the patient was having difficulties. Also, because we were not busy, I felt that I had time to chat to the patient. I was told not to waste my time talking to my patients. My supervisor told me if they want better service they should go to a private practice’. This journal entry was often cited by policy makers, which included the author Baird, when they were advocating a systemic change in the health system. It was used as further evidence showing that medical institutions and professionals who should be dedicated in treating and caring for the sick and dying were being forced into focusing on patient treatment quantity and not quality. This ‘marketization’ of the profession was highlighted in another often-cited journal entry where a reflecting practitioner was relating her co-worker’s situation (in Baird, 1998): “Sonia (another informant) found the habit of radiographers in “hurrying” patients along instead of stopping and explaining things to them, quite disconcerting. She told me that the radiographers she had worked with “get the patient against the bucky with the cassette in place before the patient has had a chance to comprehend what is going on”. In fact, Sonia found that during her time at Primrose Square Hospital the radiographers made her feel that she had been in the way. Their overriding concern was “to get the patient done and get on to the next one” (Baird, 1998). These journal entries were used by advocates such as Baird (1998) to stress their point that the protocols established by the imaging departments were designed to meet targeted revenues rather than the quality of patient care. On the Strength of Reflective Practice The way people interpret and make sense of experience is extremely influenced by personal philosophies. Hence, people may come with wrong interpretations and misjudge their experiences. In some cases, developed thoughts and program of actions can be negatively affecting the behaviour of the practitioner. In other cases, they may be writing about mundane things such as writing down the day’s comic mishap. When this happens, reflective practice tends to work against not only the individual but the profession itself (Dowling, 2007). These issues can be addressed by providing formal training to the practitioner on how to ‘properly’ reflect. Courses entitled Reflective Practice for Radiographers are now offered by universities to help health care professionals comply with the requirements of the NHS. Conclusion The nature and benefits of reflective practice in the imaging department has been explored in this paper. From the analysis conducted, it became clear that reflective practice enhances the managing capability of managers and improves the individual practitioner’s code of conduct and practical skills. The foregoing analysis point out to the fact that when people take the time to analyze their experience, something fruitful will come out. References: Atkins S. & Murphy K (1993) Reflection: a review of the literature, Journal of Advanced Nursing 18(8): 1188-92. Baird, MA (1996). The idea of a reflective practicum: overcoming the dichotomy between academia and the practice setting. Radiography 1996; 2(2):119-38. Baird M and Winter J (2005). Reflection in clinical practice. In: Rose M, Best D, eds. Transforming practice through clinical education, professional supervision and mentoring. Edinburgh: Churchill Livingstone. Boud D, Keough R, Walker D (1985). Reflection: Turning Experience into Learning. Kogan Page, London. Boud, D. and Feletti, G. (1997). The Challenge of Problem-Based Learning. 2nd edn. Kogan Page, London. Brockbank A, McGill I (1998). Facilitating Reflective Learning in Higher Education. Open University Press, Berkshire. Burchell H, Higgs T, Murray S (1999). Assessment of competence in radiography education. Assessment and Evaluation in Higher Education 24(3):315-26. Burton AJ (2000) Reflection: nursing's practice and education panacea? J Adv Nurs 31(5):1009-17. Cattini P. & Knowles, V. (1999). Core competencies for clinical nurse specialists: a usable framework. Journal of Clinical Nursing 8(5): 505-1. Dowling J (2007). Chaos rules hospitals: doctor. The Sunday Age. 23 September 2007 Gardner, I., & Boucher, C. (2000) Reflective practice: a meta-competency for Australian allied health managers, paper presented at the Seventh Annual International Conference on Advances in Management, Colorado Springs. Greenall, P. (2004) Managerial process: the reflective practitioner, International Journal of Health Care Quality Assurance, 17(4/5), viii–xii. Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods, Further Education Unit. Oxford Polytechnic: Oxford. Hackett S (2001). Educating for competency and reflective practice: fostering a conjoint approach in education and training. J Workplace Learning 13(3):103-12. Harris IB (1993). New expectations for professional competence. In: Curry L, Wergin JF, eds. Educating professionals: responding to new expectations for competence and accountability. Jossey-Bass: San Francisco. Jarvis P. (1992). Reflective Practice and nursing. Nurse Education Today 12: 174-81. Johns, C (1995). Framing learning through reflection within Carpers fundamental ways of knowing. Journal of Advanced Nursing 22: 226-234. Johns, C (2002). Guided Reflection, Advancing Practice. Blackwell Publishing, Oxford. Lau P and Chan C (2005). SARS (Severe Acute Respiratory Syndrome: Reflective practice of a nurse manager. Journal of Critical Nursing 14: 25-34. Mantzoukas S and Jasper MA (2004) Reflective practice and daily ward reality: A covert power game. Journal of Clinical Nursing 13(8): 925-33. Mezirow, J (1991) How critical reflection triggers transformative learning. In Fostering Critical reflection in Adulthood. Jossey Bass: CA, San Francisco. Osterrnan K and Kottkamp R (1993). Reflective Practice for Education: Improving Schooling through Professional Development. Corwin Press Inc: California. Saylor, CR (1990) Reflection and professional education: art, science and competency. Nurisng Education 15(2): 8-11. Talbot, C. (1997) Paradoxes of management development: trends and tensions, Career Development International, 2(3), 119–146. Wallace, D (1996). Using reflective diaries to assess students. Nursing Standards 3(10): 44-7. Williams, B (2001). Developing Critical Reflection for Professional Practice through problem-based learning. Journal of Advanced Nursing 34(1): 27-34. Read More