Nursing and Midwifery are changing at an ever-faster pace.
Both learners and practitioners alike need to make an effort to keep up to date with new developments. Reflective practice done well, is an easy and effective way to do this.
It’s a concept that, as Jootun and Mcgarry (2014) notes, has been well documented as a strategy for personal and professional growth since the 1980s, and it’s here to stay.
In its simplest form, reflective practice is the ability to reflect on your actions and engage in a process of continuous learning. For nurses and midwives, it’s also a necessary activity to fulfil the requirements of periodic re-validation.
Reflective practice is a core component of professional development for all health professionals. Without it, learning and self-growth become harder, and job satisfaction can suffer. It could be argued that at its best, reflection on what’s gone well or badly in the day, is a natural yet unstructured aspect of a nurse’s role. It’s part of being a good practitioner.
For many nurses and midwives however, it’s often perceived as a burden. Just another chore and tick-box exercise that has to be completed, and one more strain to manage.
Yet, done well, in a supportive working environment, reflective practice has a huge amount to offer. The key to this is to make sharing your reflections and learning from them, an integral part of your practice.
The Art of Self-Scrutiny
Olsen (2014) compares the act of self-reflection with a ‘spiritual act’ by taking time out to connect the inner-self with the outer-world. A view, he suggests, that parallels Florence Nightingale’s thoughts that providing nursing care to others can be a spiritual act. More importantly, he highlights how reflection is essential to avoid burnout by helping nurses to stay connected with their passion for their profession.
Yet, the reality for many nurses and midwives is that their working day can be full of emotional extremes, coupled with physical exhaustion. As Knight (2015) points out, working in highly pressurised clinical environments isn’t naturally conducive to the idea of pausing, engaging with feelings or staying with uncertainty.
Without some structured support, the focus on self-reflection can be viewed with suspicion and cynicism.
Reflection-on-Action v Reflection-in-Action
Reflection-on-action is the most common form of reflection. It involves mentally re-viewing events that have occurred in the past. The aim is to value your strengths and to develop different, more effective ways of acting in the future.
Reflection-in-action, on the other hand, requires a higher level of self-awareness and the ability to reflect on your actions or those of others, in the moment, as the activity is actually taking place.
‘What Have I Learnt Today?’
In its simplest form, reflection-on-action involves asking, ‘what have I learnt today?’
If recalling incidents with strong emotional content blocks you from consciously reflecting on your day, try viewing it from a detached, dissociated point of view. For example, seeing the incident play out in your mind’s eye as if on a movie screen.
At the end of a long and stressful day, this can be a good way to consider what you would like to change about the situation. This form of reflection can also be a useful stress management tool, as feelings that might otherwise have been suppressed can be reflected on consciously, deliberately and openly.
Models of Reflection
Using a model to write your reflective statements can be a useful way to focus your thoughts and draw out the greatest learning from an event.
One of the most popular and traditional models used by nurses comes from Gibbs (1988). Although well known, a common criticism of the Gibbs model is that it’s difficult to recall in a practice setting. An additional difficulty is that several of the stages, such as ‘evaluate the experience’ and ‘analyse the experience,’ seem to overlap, adding to the confusion of what exactly should be written in a reflective statement.
There are in fact many models to choose from and the one you work with is really down to your own personal preference.
Another model, preferred by many nurses for its clarity and simplicity is the REFLECT model devised by Butcher and Whysall, and described by Barksby (2015). Although reflection by definition involves looking back through time to past events, it can be argued that for it to be of practical value, it must also contain an element of looking forward. The REFLECT model caters for this by setting any agreed action steps into time.
Guided by the mnemonic REFLECT, the seven steps of reflection are:
- R – RECALL the event.
- E – EXAMINE your responses
- F – Acknowledge FEELINGS
- L – LEARN from the experience
- E – EXPLORE options
- C – CREATE a plan of action
- T – Set TIMESCALE
The simplicity of this model makes it a useful tool for both personal and professional growth. It’s easy enough to remember without recourse to a textbook and can be adapted to the needs of reflective writing, reviewing a critical incident in a group setting, or preparing for revalidation.
Reflective Practice Templates for Revalidation
In the UK, all nurses and midwives must record five reflective statements every three years to qualify for re-validation. To help make this as easy as possible, the Nursing and Midwifery Council (2017) provides templates along with some examples to follow. A quick online search will also bring up a selection of easy to follow books, both on reflective essay writing and reflective practice.
Reflection as a Dynamic Tool for Improving Care
Recent studies (Wilshaw & Trodden 2015) suggest guided reflective practice raises the quality of nursing and helps provide and sustain compassionate care. Yet, whilst reflective practice remains a relatively solitary activity, its use is limited as a tool for change.
Middleton (2016) reports that 3.5 million reflective accounts will be collected in the first three years of revalidation. She goes on to ask the question, what should be done with those reflections and how can they best be used to improve the profession and the care nurses offer?
Collectively, these reflections on practice represent a huge opportunity to improve standards of care. However, Wilshaw & Trodden (2015) warn us that much of this valuable learning could be lost without wider cultural changes.
Collating, managing and implementing the learning that can arise from an entire profession reflecting on its practice, not only requires supportive colleagues but also a strengthening of clinical nurse leadership. The end goal being to create a culture that is more supportive and conducive to growth.
If that can change, nurses and midwives may begin to feel more empowered and willing to share their learning, allowing reflection to become integral to everyday culture and practice.
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- Barksby, J, Butcher, N & Whysall, A 2015, ‘A new model of reflection for clinical practice’, Nursing Times, vol. 111, no. 34-35, pp. 21-23, viewed 13 December 2017, https://www.ncbi.nlm.nih.gov/pubmed/26492666
- Gibbs, G 1988, Learning by Doing: A Guide to Teaching and Learning Methods, Further Education Unit, Oxford Polytechnic: Oxford.
- Jootun, D, Mcgarry, W 2014, ‘Reflection in Nurse Education’, Journal of Nursing Care, vol. 3, no. 2, p. 148, viewed 13 December 2017, https://www.omicsonline.org/open-access/reflection-in-nurse-education-2167-1168.1000148.pdf
- Knight, S 2015, ‘Realising the benefits of reflective practice’, in Nursing Times, 1 June, viewed 13 December 2017, https://www.nursingtimes.net/realising-the-benefits-of-reflective-practice/5085419.article
- Middleton, J 2016, ‘Reflecting on care is a great way to improve it’, in Nursing Times, 21 March, viewed 13 December 2017, https://www.nursingtimes.net/opinion/editors-comment/reflecting-on-care-is-a-great-way-to-improve-it/7003448.article
- Nursing and Midwifery Council 2017, Revalidation: Written Reflective Accounts, NMC, viewed 13 December 2017, http://revalidation.nmc.org.uk/what-you-need-to-do/written-reflective-accounts/
- Olsen, NC 2014, ‘Self-reflection: Foundation for meaningful nursing practice’, in Reflections of Nursing Leadership, 2 March, viewed 13 December 2017, http://www.reflectionsonnursingleadership.org/features/more-features/Vol39_2_self-reflection-foundation-for-meaningful-nursing-practice
- Wilshaw, G & Trodden, I 2015, ‘How do nurses experience reflective practice?’ in Nursing Times, 12 October, viewed 13 December 2017, https://www.nursingtimes.net/how-do-nurses-experience-reflective-practice/5091016.article
Anne is a freelance lecturer and medical writer at Mind Body Ink. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Her background includes working as a hospital midwife, Critical Care nurse, lecturer in Neonatal Intensive Care, and as a Clinical Nurse Specialist for a company making life support equipment. Anne has also studied many forms of complementary medicine and has extensive experience in the field of clinical hypnosis. She has a special interest in integrating complementary medicine into conventional healthcare settings and is currently an Associate Tutor, lecturing in Health Coaching and Medical Hypnosis at Exeter University in the UK. As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. Her recent publications include The Health Factor, Coach Yourself To Better Health and Positive Thinking For Kids. You can read more about her work at www.MindBodyInk.com.