The contribution of reflective practice to clinical nursing

The aim of this assignment is to discuss, meaning to give an account of and consider evidence for and against, the contribution of reflective practice in clinical nursing. This will be achieved by examining John’s model of reflection (1990) and Gibbs reflective cycle (1988), discussing how they are utilized in clinical practice and considering the differences and comparisons between both of the models.

The main body of the assignment will include a definition of reflection and why it is important to nursing, what impacts it can have and how it aids clinical practice and personal development. As the focus of the assignment will be on models of reflection, both John’s and Gibbs models will be summarized, discussed how they are used in clinical practice and benefits of using them within practice will be evaluated. Some of the barriers of reflection will also be discussed. The assignment will be concluded with a summary of the main body and a discussion of the implications that reflective practice has for clinical nursing.

Main Body

What is Reflection?

Reflection is characterised as learning through experience towards gaining new insights or changed perceptions of self and practice (Boud et al, 1985, Boyd and Fales 1983, Mezirow 1981)

Taylor (2000) also gave a similar definition which defined reflection as throwing back thoughts and memories, in cognitive acts such as thinking, contemplation, mediation and any other form of attentive consideration in order to make sense of them to make contextually apparent changes if they are required. Through both definitions it can be drawn that via a process of thinking and learning from experience, reflection may be beneficial to some practitioners.

Nursing has applied reflective practice ideas to many of their disciplinary areas, and for some time has used reflective practice processes to improve practice and practice development. This can be achieved by encouraging practitioners to use reflective practice efficiently. (Taylor 2000, 2000a, 2000b; Thorpe and Barsky 2001; Stickley and Freshwater 2002; Johns 2003)

Why is reflection important to nursing?

A lot of nursing literature suggests that reflective practice plays a major role within clinical nursing. Reflective practice is becoming an essential element of the nursing education as professional nursing bodies worldwide are being impressed by literature on learning by reflection. The persistent and diverse use of reflection implies that it is popular within the healthcare sector. (Teekman 2000)

Ghaye and Lillyman (2000) stated that reflection can help the practitioner make sense of practice and move thinking forward. If a practitioner fails to do this and does not move their thinking forward the needs of the patient may not be met. This implies that reflection does not just benefit the practitioner, but the patient as well.

Street (1991) stated that in nursing, reflection is seen as a way to empower nurses to become fully cognizant of their own knowledge and actions. This in turn will help them learn from experience and awareness of new experimental knowledge and different actions.

The impacts of reflection and how it aids clinical development and personal development

Reflective practice is seen to be an important aspect of all nursing practice (Johns, 2002) and is a particular component of nurse prescribing courses (Scottish Executive Health Department 2006)

According to Boyd and Fales (1983) through reflection, the practitioner may come to see the world differently and based on new insights may come to act differently as a changed person. Mezirow (1981) and Boud et al (1985) found similar things. This research implies that reflection can facilitate the practitioner to develop various skills and help them move forward within their practice.

Parker et al (1995) also states that the development of reflection assists the individual to gain self awareness, insight, ability to express emotion and problem solving skills which are all desirable to professional and personal growth.

Models of Reflection

Ghaye and Lillyman (1997) suggested that models help practitioners learn from experience because they are practitioner focused. Two of the main models used within practice are Johns model and Gibbs reflective cycle.

Johns Model

According to Johns, reflective practice requires structure and guidance in the form of challenge and support. John’s model consists of a series of reflective cues to prompt practitioner to analyze experiences in ways that will lead to understanding and insights that can be applied to new experiences. These cues are under the headings of aesthetics, personal, ethics, empirics and reflexivity. The fifth cue of reflexivity has been criticised by Rolfe, Freshwater and Jasper (2001) who state that questions asked under the reflexivity heading do not allow for the practitioner to reflect on an ongoing experience but instead only in situations that have already happened. However Rolfe, Freshwater and Jasper (2001) also stated that the first four reflective cues of Johns model, borrowed for his framework from Carper’s (1978) are well researched and already familiar to many nurses, which will help aid in the act of reflecting.

Sch�n (1987) argued that refection is not a simple process and that practitioners need coaching and require the use of reflective diaries as tools for dealing with practice problems. This is also similar to Johns approach of structured reflection, which also includes the use of a reflective diary in addition to the use of the model itself.

Gibbs Model

Gibbs (1988) reflective cycle encourages a clear, basic description of reflection arranged in a circular format. Similarly to Johns model the final stage of the cycle asks the practitioner what they would do if the situation arose again and not how to resolve the current situation, which again can be seen as a criticism of the model.

Roger, Gates and Kenworthy (2003) pointed out similarities between Johns and Gibbs models, being that they are both applicable to specific incidents as opposed to everyday life events. Some individuals may prefer these highly structured models that help guide through the experience but others may find the cues in the models restricting. (Quinn 2000)

Barriers of Reflection

Barriers of reflection can cause the practitioner to find it difficult to reflect, which may in turn refrain from them reflecting at all. Hullat (1995) pointed out that when nurses are pressurised into reflecting it may cause negative consequences.

Cotton (2001) also stated that there are potential dangers in promoting private thoughts in public spheres which could in turn stop practitioners from reflecting all together.

Taylor (2003) reports that reflective practice adopts a naive realist position and fails to acknowledged the ways in which reflective account construct the word of practice this is also shown by evidence from a longitudinal qualitative study Maben, Latter and Macleod (2007) who found that nurses who had little control over their practice and felt that due to barriers, such as time restraints led to dissatisfaction within their practice and this occasionally resulted in the practitioners leaving the nursing profession altogether.

Conclusion

Summary

The assignment has shown that reflection has many uses within clinical practice and is used as a means of helping a practitioner develop their knowledge and skills. Models of reflection can establish a successful use of reflection but do not always meet the needs of the practitioner.

Implications for Nursing

The use of well structured reflection can be used as a basis for consciousness raising and self-development which are essentially key foundations for practice. (Tones and Tilford, 2001)

Overall the implications for use of reflective practice in clinical nursing is very well supported and a lot of the research states that the utilization of it within practice has positive outcomes and can help the practitioner to continue to develop skills and knowledge throughout their career, however reflection is not always desirable to all practitioners and some barriers may affect the outcome of personal reflection.