Reflection for practice improvement

Reflective practice has been developed in nursing as a method of accessing and building the experiential knowledge. Bulman & Schutz (2008) stated that reflection is a reviewing experience from practice which is described, analyzed, evaluated and then used to inform and change future practice. According to Dewey (1933), reflection involves opening up one’s practice for others to examine, and consequently requires courage and open-mindness as well as a willingness to take on board and act on criticism (as cited in Bulman & Schutz, 2008). Therefore, reflection involves more than intellectual thinking since it is intermingled with practitioners’ feelings and emotion and acknowledges an interrelationship with action.

Thinking is fundamental to human life and inquiry, and reflection is thinking through rational and intrusive process which can lead to implement change and improve clinical practice. Effective reflection on practice leads to more conscious, deliberative and intentional interventions. Reflection on beliefs, values and norms offer the opportunity to examine, articulate and generate local philosophies and theories of care, as well as assessing the contribution of the individual to health care delivery (Freshwater, Taylor, & Sherwood, 2008).

With true reality, reflection provides us a vehicle through which we can communicate and justify the importance practical knowledge. After all, reflective practice can only be developed by becoming immersed in actually doing and practicing.

It is important for nurses to be able to analyse and respond to new and different challenges in a proactive way. Reflection, critical reflection and reflexivity have distinguishing features. Reflection is a focused way of thinking about practice with the aim of achieving deeper awareness and understanding of that practice. Critical reflection is thinking about how we are thinking, while simultaneously thinking about our practice. Bowden (2003) summarized that critical reflection involves taking a fresh look on practice, viewing practice through a different lens and questioning previously accepted, taken-for-granted values, belief systems and routines. Reflexivity is having awareness of contextual influences on our thinking and practice bringing it to bear through reflective processes. Freshwater, Taylor, & Sherwood (2008) described that reflexivity alludes to the methods and processes the nurse researcher uses, in order to attain higher levels of knowledge and change strategies in relation to the area of interest.

Development of reflective practice has certain underlying skills which are self-awareness, description, critical analysis, synthesis and evaluation. Self-awareness is to be conscious of one’s character, including beliefs, values, qualities, strengths and limitations encompassing social-self of culture, education and socialisation (Bulman & Schutz, 2008).  In professional practice, good descriptive abilities are necessary when communicating verbally with colleagues about patients and for writing a clear and comprehensive account of a situation.

Critical analysis, a key skill for reflective practice involves analysing one’s own knowledge and feeling, actively seeking out ideas, theories and research of others. To examine one’s own knowledge, Carper (1978) identified four fundamental patterns of knowing: empirical, the science of nursing; aesthetic, the art of nursing; personal knowing in nursing; and ethical, the component of moral knowing in nursing (as cited in Chinn & Krammer, 2008). They reordered the Carper’s pattern of knowing as emancipatory, followed by ethics, personal, aesthetic, and ended with empiric knowing.  Emancipatory knowing is capacity to critically examine the social, cultural and political status quo to identify the conditions which is limiting human potentials and is required to change. The process of emancipatory knowing, praxis, calls for looking beyond personal experience to reflect on the broader social and cultural implications (Chinn & Krammer, 2008).

The next important synthesis skill is the ability to integrate new knowledge, feelings or attitude with the existing. For example, new evidence-based knowledge about use of dialyzer for heparin free haemodialysis is integrated with the existing knowledge that dialyzer with low thrombogenecity should be used for heparin free haemodialysis. Then, decision can be made for the choice of dialyser usage, weighting on the cost and benefits. Evaluation skill is the ability to make judgement with reference to predefined criteria and standards.

Nurse educators and practitioners should be encouraged and supported to develop these

key skills underlying reflective practice. Reflection models provide the practitioners with

guidance and systematic application of reflection to practice. Bowden (2003) suggested that

using a framework to reflect is helpful for incorporating not only reflections on own actions,

but ethical, political and broader social issues that develop for a given experience.

Developing critical thinking and reflective skills assist nurses to meet the challenges of providing care in a context of rapid change and to become a critically reflective practitioner. Some attributes and characteristics of reflective practitioner are outlined in Bulman & Schutz (2008) which include; demonstrating artistic practice, possessing a repertoire of experience, being able to frame problems and experiment in practice, having ability to articulate reflective practice, having a transitional and constructivist relationship with practice and possessing tacit knowledge.

Principally, these attributes of reflective practitioners have developed and supported within

advanced education. Praxis is in need of nursing because it emphasizes the requirement to

make a positive difference to client and strives to develop responsive, purposeful and

understanding practice. Current thinking in nursing advocates nurses to be educated in

ways that develop their autonomy, critical thinking, ability to be sensitive to others and

open-mindness (Bulman & Schutz, 2008). Thinking beyond personal to broader social

environment in nursing and health care will gain a heightened awareness of the variety of

factors that shape our practice, and as such awareness is a driving force to create

substantial change and transform nursing and health care.             


References:

Bowden, S. D. (2003). Enhancing your professional nursing practice through critical reflection.  Abu Dhabi Nurse. Retrieved 4 April 2012 from http://www.abudhabicme.com/main/doc/nurs01c28_31.pdf.

Bulman, C. & Schutz, S. (2008). Reflective practice in nursing. (4^th ed.). United Kingdom, Oxford: Blackwell publishing.

Chinn, P. L., & Kramer, M. K. (2008). Integrated Theory and Knowledge  Development in Nursing.(7^th ed.). Missouri, U.S.A, Mosby: Elsevier.

Freshwater, D.,Taylor, B. J., & Sherwood, G. (Eds.). (2008). International Textbook of reflective Practice in Nursing. United Kingdom, Oxford: Blackwell publishing, Honor Society of Nursing.