Reflective Practice - Essay Example

Reflective Practice Reflective practice can be defined as "a set of abilities and skills, to indicate the taking of a critical stance, an orientation to problem solving or state of mind" (Moon, 1999: 63). We all know that a reflection in a mirror is an exact replica of what is in front of it. Similarly, we can say that reflection in terms of professional practice also gives back or shows the real self. That is on reflection we are clearly able to see what exactly has happened and how and why it has happened. Thus it makes it possible for the person to improve or change what he/she does not like in his reflection. Thus it becomes a very useful tool for professionals to pause, ponder and finally decide what they would like to do about similar things in future. Reflective practice can hence be described as an approach that promotes learning in such a way that it develops students' understanding and critical thinking skills. Many techniques are used to assess reflective approach. These are, but not limited to, self and peer assessment, problem-based learning, personal development planning and group work. Reflective Practice is not a new concept and it can be traced back to the work of Socrates and a form of learning through questioning and feedback and more recently it has been developed by educationists such as Dewey and Lewin. Schn and Kolb has used and applied a basic principle of reflecting on experience to improve professional practice. Basically the adult learners who are engaged in some kind of professional activity which they can use to reflect on their strengths, weaknesses and areas for development are called reflective practitioners. Thus, reflective practice has become a very important aspect of professional training programmes and its use is encouraged by the teachers and mentors for self analysis and development. Reflection is an active, live and an ongoing process which is usually initiated when the professional encounters some problems in his practice which he is unable to fully comprehend. As per Schn (1987) there are two types of reflection, these are reflection-in-action -- thinking on your feet and reflection-on-action --retrospective thinking. Clamp (1980) said that the attitudes of the nurses is mainly responsible for the care to be administered to their client and usually the reasons for the improper care are ignorance and wrong attitudes. Therefore the process of reflection can help the individual in gaining the required knowledge and help in improving the quality of the care that person can give to his patients. As is clear from the above discussion that the most useful result or outcome of reflective practice is Learning (Mezirow ,1981) I for most part of my career has been primarily utilizing the retrospective thinking. See appendix 1 for my reflections. In all disciplines, the use of reflection in action (while doing something) and on action (after you have done it) has become an important feature of professional training programmes. Usually all mentors or teachers encourage their wards or staff to use reflective practices in their professions. It has been said that "the "real" reflective practice needs another person as mentor or professional supervisor, who can ask appropriate questions to ensure that the reflection goes somewhere, and does not get bogged down in self-justification, self-indulgence or self-pity!" (Atherton, 2005) Infact, many educationists have described Reflections as one of the most important tool for self analysis and self improvement. Dewey (1933) who was an educationist conceptualized his version of reflective practice through experiential learning theories and defined reflection as: "An active persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it tends." As a part of my Portfolio of Learning Achievement (PLA), I have tried to use reflective practice as a tool for self assessment and improvement. Schon recommended that reflective practice can be used by the beginners in any discipline so that they are able to recognize the differences or compare their own individual practices with those of successful practitioners. There are many ways in which the process of reflection can be practiced. It has been interesting to record events and experiences in written form, particularly through the use of reflective diaries and journals (Zubbrizarreta 1999 and Tryssenaar 1995). As shown in appendix 1, I too have used Gibbs' model of reflection to write my own personal reflections. Gibbs model is simple in the sense that it provides the practitioner with easy questions to guide him through the process. This basically involves finding answers to questions like feelings, the good or the bad of the experience, analysis of the situation and prods the user to develop an action plan. Since this cycle of Gibbs' model can be used even after the action has been implemented, it is particularly useful for contributing to a change in practice if the first or the initial experience did not provide the desired results. I have tried to effectively utilize the current relevant literature on reflective models and learning theories. By using and applying The Honey and Mumford learning theory, I was able to recognize my own learning style and I was thus able to effectively use this knowledge to gauge further learning opportunities. Basically, the need for self improvement in my case started with the uncomfortable shadowing experience I had during my training period. An awareness of uncomfortable feelings and thoughts usually precedes the start of reflection. (Boud, Keogh and Walker 1985). Thus what started as the quest to find out why that experience failed, eventually made me recognize the importance of reflective practice in my profession. And since it is a fact that after recognition, there should be an overwhelming need to correct things, I moved on to acquire new skills for my growth and improvement. As Gillings (2000) pointed out that "a commitment to self-enquiry and a readiness to change practice are important if the individual is to get the most out of the process." Therefore, the need of self awareness is an important prerequisite to the process of reflective practice. Unless the person understands his own value system and style, a person cannot successfully implement the reflective practices. (Atkins in Burns and Bulman 2000). The self analysis that I underwent was not an easy thing at all. Acknowledging one's own faults is a difficult thing to do but no growth is possible without taking this painful first step. The initial assessment also starts off always with a negative experience. (Johns, 1994) The recognition of the fact that I was actually lacking in communication skills has spurred me to take action in this regard. As a part of my 10 week long training programme, I will be focusing on this particular area and try to use new techniques such as Johari window communication model for interacting with others. I hope to move to a reasonable point of improvement wherein I am able to not only interact with my co workers, staff and patients in a more appropriate and desirable manner. The idea is that I should be now able to voice my opinion if I feel that something is not right. Since I have more than 20 years experience, I should able to help other nurses and staff by being more open and honest in my dealings. This exercise of reflection has helped me to look critically at my own practice . I was able to identify my own personal learning needs and style and have taken steps to fill the gaps between experience and knowledge by enrolling for my degree. (Clarke et al, 1996; Stewart et al, 2000; Griffin, 2003). Although there is a growing debate on whether the reflective practice is actually that useful as it has been touted as - for me the benefits have already begun. The first few steps have already been taken by me and I am keen to further use whatever I have learnt about myself through this practice. As stated earlier, I have started to develop and use the skills required for reflective practice. Using reflective practices , I have been able to develop skills of enquiry, analysis and problem solving which has helped to be more competent and reflective practitioner. I think I had earlier become complacent and given my experience did not feel the need for further improvement. The shadowing experience made me realize how wrong I was and this helped me gain useful insight into my psyche and my perceptions. Using my individual pragmatic style of learning, I have been able to clearly see through my shortcomings and started to move out of them. I started a community placement, which focussed on Management and Leadership Skills. The total amount of time spent during this practical placement was a total of 4 months. However, in between this 4-month period I attended another block at university to attend lectures and seminars on Utilising Evidence Based Practice/Care. I then returned to the community placement to complete the remaining weeks in practice. After completing this assignment, I feel very confident about my communication skills and I feel that now I will be able to speak out or verbalize my thoughts more coherently and to the benefit of others as well. I also spent 2 days with the community midwife as often management and leadership in Adult Nursing can relate to expectant mothers with other conditions that may not necessarily require the midwife. Due to my lack of experience within palliative care, I also organized a 2-day placement in a local Hospice. This was a good learning opportunity, especially regarding pain control with patients with a terminal illness. (an area I have identified as a need to develop more skills, and knowledge as it is such a sensitive and delicate care, not only for the patient but also for the family). The main aspect or training experience that helped me to develop and recognize my areas of weakness was the time spent shadowing the sister. Thus I would like to correct those mistakes and behave in a more professional manner if I were to become a mentor. I would try to establish a friendly rapport with the student so that we both are able to benefit from the experience. In all disciplines, the role of a mentor is an important role. The mentor is not only responsible for assessing skills and progress, but also. Guide and take responsibility. They should act as a facilitator and create learning opportunities for the students.( Wilkes 2006: 42 ) I would also try to maintain evidence-based practice as mentioned by the Nursing and Midwifery Council. For providing better quality care to patients , it is necessary that we use practices which are consistent with the best evidence. Evidence Based Nursing is the process by which nurses make clinical decisions using the best available research evidence and. their clinical expertise. This basically involves a continuous and systematic approach for researching and applying latest research findings into clinical practice. The main aim is to improving patient care through continous learning and research. I would like to use my training period to work on this aspect of my professional practice as well. I would also like to pursue effective practice based on evidence in a multi-disciplinary environment, by promoting interprofessional working and understanding, co-operation and communication for team working. Since I have been a sort of odd person out in team conditions, I am also working on this aspect of fostering team coordination and development. As a teamleader, my effort would be to establish a conducive working environment where the staff can share their positive and negative experiences and make it a learning experience for all by organizing group discussions and inviting each member to speak up on the issues. Appendix 1 Personal Reflections For writing my portfolio of practice I am expected to include a piece of personal reflection which should relate to situations in my clinical work where I feel I have learnt something which is valuable to me in my current and future career. This could be a positive or a negative experience. There are many models of reflection which I can use to write my own personal reflections such as Johns Model for structured Reflection (2000), Rolfe et al - Framework for reflexive practice (2001) and Gibbs' model of reflection (1988). Here I will be using the Gibbs' model. Gibbs (1988) reflective cycle encourages a clear description of the situation, analysis of feelings, evaluation of the experience, analysis to make sense of the experience, conclusion where other options are considered and reflection upon experience to examine what I would do if the situation arose again. Description: I am a Registered Nursing holding a Certificate in Adult Nursing. I qualified as a Registered Nurse in 1981. In 1986 I qualified as a Community Nurse, then last year I completed an Accelerated Learning Module to access the Degree in Adult Nursing. The course started approximately one year ago and is due to finish in 4 months. I am completing the course on a part time basis due to home commitments. Before starting the Degree in Adult Nursing, I worked as a qualified Community Nurse for over 20 years. Prior to starting the Degree I worked within a large community nursing team of 10 Registered Nurses and 2 Health Care Assistants, both mature in years and very well experience within their role. Although I have worked with this team for approximately 5 years, I am still considered to be one of the newest members to join the team. Approximately 6-7 of the staff has worked and remained within the same team for over 20 years. Interprofessional Working and Conflict has often been an issue especially with the members who have worked at the base for such a long time. Since I am a working mother, I had limited time at my disposal to attend to my needs of further education and improvement. Now I have been working for over 20 years and sometimes I still feel the need to understand and contribute to the needs of the healthcare staff that I am in contact with on a day to-day basis in a more constructive and useful manner. One of my practical placements consisted of a Community Placement, where I was placed as a Student for 16 weeks. During this period, I worked with the Community Nursing Sister by undertaking a shadowing experience for the duration of the placement. The Community Nursing Sister, who was also my mentor, recognized that I was already trained not only as a registered nurse but also as a Community Nurse but still persisted with the shadowing work. I was unimpressed with the experience of shadowing and did not feel it was appropriate due to previously spending so many years working within the community. Feelings: Although I am an experienced registered nurse I think that certain aspects of my nursing practice are unable to support or justify my actions and decisions. I have had a bad shadowing experience and my inability to do anything about it has left me frustrated and makes me very vulnerable to criticism. Due to my lack of assertiveness I found it difficult to be honest with the Community Nursing Sister (Mentor) that I did not seek any benefit from the shadowing experience. I questioned if the problem was with her mentoring skills or with my lack of assertiveness. I feel that the problem was a combination of a lack of inexperience on her part, and a lack of honesty and assertiveness on mine. Thus I am interested in accessing a variety of learning opportunities to assist in making my transition more successful. i.e I want to consolidate education and competence in practice after having previously trained over 20 years ago, to almost qualifying/going through transition after studying to obtain a degree in Adult Nursing. Analysis: Utilizing the principles of reflective practice, I have been doing a lot of introspection and self-analysis. As I thought more about the shadowing experience I felt that due to her inexperience and a combination of feeling like she is the 'new girl' plus the fact athat I was a lot older than the others in the team, we reached a point of no return. My obvious lack of assertiveness or the shyness in me created a break down in communication. This however was not a issue in my previous nursing base, but one that I had experience before when taken away from my normal place of work. Based on my ponderings, I feel that my style of learning was different from my mentor's and this created another gap between us. It is interesting to find out about your own particular way of learning and it also helps to know that everyone does not learn the way you do i.e every individual has a different or unique style of learning and we should respect that. Burns (1995, p99) 'conceives of learning as a relatively permanent change in behaviour with behaviour including both observable activity and internal processes such as thinking, attitudes and emotions.' Then came Laird (1985) with his traditional sensory stimulation theory and Skinner with his Reinforcement Theory. But the most famous one is that of Kolb who proposed a four-stage learning process. Based on Kolb's theory , Honey and Mumford (1986) identified four learning styles: Activist (enjoys the experience itself), Reflector (spends a great deal of time and effort reflecting), Theorist (good at making connections and abstracting ideas from experience) and Pragmatist (enjoys the planning stage) Each of the four mentioned styles have their own strengths and weaknesses. According to them learning is better if we are able to recognize our own unique learning style. This will help us in improving our strengths and work towards reducing the weaknesses to improve the quality of learning. These H&M stages are represented as north, east, south and west on a circle or four-stage cyclical flow diagram. The Activists (stage 1) are the ones who seek challenge and immediate experience and are the ones who enjoy the experience itself. The Reflectors (stage 2) are the ones who gather data, ponder and analyse, and are very thoughtful. The Theorists (stage 3) think about the problems through in logical steps, Pragmatists (stage 4) are the ones who seek and try out new ideas. They are practical and enjoy problem solving and decision-making quickly. Based on this theory I have identified myself as the Pragmatist who enjoys problem solving and is ready to try out new ideas. I also had a close look at the Johari Window since it is similar to the above theory in the sense that it also works on four stages or windows. Moreover this is basically a communications model and I felt that since my lack of assertiveness is a communication problem, it would be worthwhile it have a look at it. The Johari Window (Luft and Ingham,1955), is a useful model which describes the process of human interaction. It consists of four quadrants : open, hidden, blind, and unknown. According to them two people communicate via the open quadrants. At the first or initial level, difficulties may arise due to a lack of clarity in the interaction. As a result the other person is unable to understand you correctly and is able to criticize you. This model is a useful tool for improving self-awareness, and mutual understanding within a group or between individuals. As per my analysis using Johari model, I feel that not talking openly about my dissatisfaction of shadowing, I unwittingly allowed my interaction with my mentor to move in " hidden" area. This resulted in both of us hiding our true feelings about the work as well as each other. Evaluation: I think, there have been both positive and negative aspects to my experience. The good thing was that I was able to recognize my need for improvement in the communication area. I now understand that I should be able to speak my mind and not allow my non assertiveness to come in my proper handling of my duties according to the Nursing standards. The Bad thing was that it took me much more time to realize that I wasn't gaining anything from the experience. I lost an education opportunity by keeping quiet. I could have utilized that time in doing or learning something more useful which would have helped me provide better care to the patients. Conclusion: To conclude, If I had been any wiser, I would have requested my mentor to change my shadowing experience to something else - which would have been probably more useful to my current and future practice. By being more honest, I would probably have been better accepted in the group. This would have definitely helped me to learn and acquire friends and mentors to enhance my personal development. Action Plan: Now that I have identified my key areas of improvements, I will utilize my current training period to enhance my communication skills and develop my core competencies to further my personal growth and career. The shadowing experience has identified specific learning that I would like to take into my future practice. 1. I am now aware of why student ask certain question by experiencing for myself how different the training is compared to years ago (when I first qualified) 2. As a mentor I would ensure I supported the student and listened effectively by taking on board any suggestion that would benefit us both. 3. Ensure I maintain my professional accountability by researching/maintained evidence based practice as stated by the Nursing and Midwifery Council ; an area which opened my eyes to a more effective way of learning making full use of the resources available. References: 1. Atherton J S (2005) Learning and Teaching: Reflection and Reflective Practice [On-line] UK: Available: www.learningandteaching.info/learning/reflecti.htm 2. Atkins, S. and Murphy, K. (1994) Reflective Practice. Nursing Standard 8(39) 49-56. 3. Boud D, Cohen R and Walker D (1985) Reflection: turning experience into learning (London: Kogan Page) 4. 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(2000) Reflection and its place in the curriculum: Should it be assessed Assessment and Evaluation in Higher Education, 25 (4), 370-380. 30.Wilkes, Z (2006) 'The student mentor relationship: a review of the literature', Nursing Standard, May 24/vol 20/no37, 42-47 . Read More