Reflective Practice in Nursing Educational Strategy - Essay Example

Reflection and Reflective Learning Reflective Practice as an Educational Strategy Introduction I am a person interested in the healing arts that is why I considered a career in nursing. In my 5 years of nursing practice, it was evident that reflective practice has been widely adopted for the growth of the professional practitioner. I worked as a staff nurse and my main role involves mentoring and teaching in clinical settings with the newly qualified registered nurses. Nurses have stepped out from behind the shadow of physician as members of the health care team. As my role has expanded and I have assumed increased responsibility, I became more visible and accountable to the consuming public I served. Change is inevitable. Without change, there is no growth, no excitement and no challenge. With too much change, there is fear, confusion and failure. Nursing is facing new challenges and developments in health care, and this requires continuous education in order to cope and meet the demands of such changes. The United Kingdom Central Council (1991), now Nursing Midwifery Council (NMC), in fact have announced that for any professionals, there is a need to maintain skills, and reinforce a critical attitude to one's work and keep up-to-date with the developments and research. Their recommendations included that of a personal professional profile to be maintained by all nurses to evidence their learning in order to support their application for re-registration. Teekman (2000) states that reflective practice is becoming an essential element of nurse education. Reflective practice in nursing has the potential to help nurses develop and learn from their practice. It is for this reason. I chose the topic on reflective practice as an educational strategy. This assignment will examine more closely the meaning of reflection and reflective learning and I will discuss the reflective practice as an educational strategy in Nursing. Reflection and Reflective Learning The word `Reflection' originates from the latin word `Reflectere', which means bend or turn backwards. The term is used broadly with a common meaning that does not seem to have changed much over time (Fairbrother and Hibbert, 1996). Reflection is today on everybody’s lips, it is a natural process used spontaneously by many people and as such is not a new concept. It’s an ordinary word where mind wander away from the action. It is synonymous to `meditation' and `introspection'. It is a mental process by which a person looks forward or, more often, goes down memory lane.(Fairbrother and Hibbert, 1996). There are many definitions in the literature of reflection. And people are in agreement that reflection is done actively and consciously. Savin-Baden (2000) points out reflection as a process wherein individuals evaluate critically the knowledge and values, which they have previously learned. It is conflicated but people do it deliberately so that they can learn from experiences which are very beneficial to them (Atkins and Murphy 1993). According to Boud et al (1985), “Through reflection, people’s experiences are recaptured for the purpose of self-analysis, examination and evaluation. People learn from experience, but they can learn more if they reflect on their experience. By looking back on things that happened, new knowledge are being discovered”. Moore (1998) acknowledged that for knowledge to expand and develop, nurses need to systematically record what they learn from their own experience, suggesting that if learning is to occur from practice, then reflection is vital. It should help learners do interpretation and apply gained knowledge in an actual situation and understand better the actuation of an individual if placed in a certain situation. The experience of an individual is carried as he grows older. And if in the future he faces a similar situation, the knowledge he gained from the previous experience will help him make a better decision (Walters et al, 2002). In Aristotle's concept of deliberation, the idea of reflection in learning was already mentioned (Fairbrother and Hibbert, 1996). Reflective learning is intensely personal where feelings and thinking are closely linked. Personal views, biases and prejudices are clarified and changed when an individual conduct self examination and exploration of a concern brought about by a certain experience (Mueller, 2005). Mezirow (1981) viewed reflection as a complex task necessitating the use of higher order mental processes such as making inferences, generalizations, analogies, discriminations and evaluations, as well as feeling, remembering and problem solving. To be able to engage in reflection, it is necessary for the person to have certain skills. Boud et al (1985) suggests that a prerequisite for reflection is to be open-minded and motivated. Atkins and Murphy states that, “The skills required for a reflection are knowledge of oneself, critical analysis, synthesis and evaluation”. Critical reflection is the ability to reflect critically on one's experience, integrate knowledge gained from experience and take actions on insight. Knowledge learned from experience combined with theoretical and technical learning lead into the acquisition of new knowledge, new behaviors and perspectives. The three stages of critical reflection are: 1. Dispositional reflection are individual’s values, preferences and characteristics that influence an action; 2. Contextual reflection can be race, gender, expertise and other cultural forces that shape an experience; 3. Experiential reflection – recalling what happened, including the feelings and thoughts that go with it. It is going back to the experience. Several authors perceive a gap between theory and practice in nursing (Lauder 1994). They have the opinion that the gap can be remedied by reflective practice, but their claims are not backed by any evidence. “Espoused Theory” and “Theory in Use” coined by Argyris and Schon (1974) and Schon (1983 and 1987), are the basis of reflective practice in strengthening the relationship between theory and practice. Espoused theory stated, formally or informally, to represent practice. What actually occurs in practice is called “theory in use”. These theories may be consonant or dissonant and if there is a theory/practice gap, they are said to be dissonant. In tradition, ‘espoused theories’ produce more legitimate sources of guidance for health care than ‘theory in use’. However, Ford and Walsh (1994) have shown that the complexity and uniqueness of the circumstances surrounding the nursing practice rendered the espoused theory invalid or inapplicable. Reflective practice has a useful contribution to make to develop a body of knowledge to inform nursing practice. Theory that is developed while doing reflection on experiences has ridiculed the espoused theory which cannot be applied to real life nursing care due to its diversity and complexity. Reflection can synthesize theory and practice by critical analysis of theory and practice-generated research questions. Newell (1994) reminds that reflective practice lacks the precision of empirical science. A course in physiology maybe vital to nursing but it may not lend itself to reflective practice Despite this limitation it seems it’s already a reductionism to suggest that reflection cannot be applied to empirically-derived espoused theory. Benner (1984) illustrated this by using narratives in her research. While acknowledging the contribution that reflective practice can make to learning and enhanced patient care, Greenwood (1993) argued that this must be supplemented by nurse educators who tackle the complexities of practice with their students in real practice settings. This seems a sound recommendation given the current influence of reflective practice in nurse education curricula. Reflection is viewed as the equivalent of qualitative research, with theoretical nursing as the equivalent of quantitative research. As such, there is a need for integration of both in order for the nurses to learn. Schon (1987) identifies two types of reflection: 1) reflection-in-action which means thinking on your feet; and 2) reflection-on-action which is thinking retrospectively. In this earlier work, Schon (1983) described reflection-in-action as the concept of thinking while the action is on going. Ewan and White (1996) added that reflection-in-action is a process in which a practitioner needs a background knowledge and wealth of previous experiences to utilize previous experience by applying theoretical knowledge that has been learnt and better alternatives may be formulated to contribute to future practice. As a nurse undertaking reflection within education in an academic environment is an example of reflection-on-action. Moreover, Charalambous (2003) shared some concept on reflection-on-action as Schon (1987), which he noted as reflecting you do after an event. Thinking through and often discussing the incident with a colleague or supervisor, whether formally at work informally over coffee or beer. This is the essence of reflective practice. Atkins and Murphy (1993) provided a stage model for the reflective process (Appendix 1). Reflection is not simply thinking about practice, it is a complex process that requires the learner to critically analyze situations and it is argued that without critical analysis being achieved, reflection will not take place (Scalon and Chermonas, cited in Burton 2000). Learning results in reflection (Mezirow 1981). A Nurse Reflection The use of reflection in education and professional growth is heralded as the method par excellence for students to learn from the complexities of professional practice. Reflection in the context of learning is a general term for those intelligent and affective studies where individuals analyze, examine and evaluate their experiences to discover new things (Gilbert 2001)This technique of determining what is known, what remains to be discovered and how awareness is established in the affective, cognitive and psychomotor domains of learning has been used in many creative endeavours throughout history. Studies conducted by Schon and Kolb on reflective practice have maintained its relevance in recent years. Application of the basic principle of reflection resulted into improved action and professionalized practice. However, the idea was pioneered by education psychologists such as Dewey and Lewin. It can also be seen in the work of Socrates and a learning strategy through question and answer. It leads us to ask what we know and how did we know it. Claxton (1999) stated that, “learning is knowing when, how and what to do, when you don’t know what to do”. There have been many attempts to define reflective practice, but Atkins and Murphy (1993) and Goff (1995) argued that the concept is poorly defined. Wilkinson's (1996) definition is favoured here: `Reflective practice is an active process whereby the professional can gain an understanding of how historical, social, cultural, cognitive and personal experiences have contributed to professional knowledge acquisition and practice. An examination of such factors yields an opportunity to identify new potentials within practice, thus challenging the constraints of habituated thoughts and practices. A form of supervision guides the process of reflective practice. Through the exploration of individual and social behaviour and experiences, there is scope to gain insights to challenge and guide professional practice. This definition offers insights into the nature of reflection and shows the potential of reflective practice for professional nursing. According to Jarvis (1992), reflective practice is more than just thoughtful practice. It also gives the opportunity to learn and discover new things. Thoughtful practice is often mistaken for reflective practice, but the latter can only exist where practice is not taken for granted and so the outcome of practice is more learning from experience. Benner (1984) supports this concept in describing reflective practice as transforming reflective thoughts into action by way of creating a potential learning situation. Jarvis (1992) asserts that professionals ordinarily use reflective practice as they face different situations and challenges. Moon (1999 p63) synthesized the many activities involved in thinking about learning by echoing reflective practice as “skills”, to indicate a critical stance, an approach to problem solving or state of mind. According to McDrury (2002), the three tools developed for reflective practice are as follows: Storytelling – a very useful way to understand a situation from different views and obtain recommendations how to handle similar situations in the future. Journaling – having a written record of event is seen as a key strength. Drawing – the use of colors as a creative expression is another way of analyzing critical events of the various tools available. According to Stein (2000), “Journaling or keeping records in a diary is the common method of recording events and the actions taking concerning the events. It has serious limitations though, writers may suffer from selective recall of events. Reflective practice is a concept that is simply explained as an approach for learning from experience and incorporating that knowledge into practice. It actually a four step systematic review of one's own nursing practice to determine learning goals and incorporate learning to improve one's own practice. It is as simple as ABCD – a ssess your practice, b ased on standards, c ollect feedback and d evelop a learning plan. In order to assess one's level of competence in the four dimensions of nursing practice such as professional responsibility, knowledge-based practice, legal/ethical practice and collaboration, standards should be selected applicable to one's area of practice. Feedback collected from others help identify strengths and opportunities for further development. In developing a learning plan, activities are laid out to meet one's goals. Central to Johns' (1995) idea of reflective practice is the goal of accessing, understanding and learning through lived experience. It is this that enables the practitioner to take ``congruent action towards developing increased effectiveness within the context of what is understood as desirable practice.'' Reflective practice in nursing can be summarized as learning from experience. Nursing education is difficult enough without the convergence of different factors such as information and skills to deal with the rapid advances that are occurring today. In fact, the central point of nursing education has changed from teaching to learning (Glendon and Ulrich, 1997). It is the responsibility of each practicing nurse to pursue a continuing education as advocated by the Nursing Midwifery Council (NMC). Continuing education refers to formalized experiences designed to enhance the knowledge or skills of practitioners. Constant updating and growth are essential to keep abreast of scientific and technological change and changes within the nursing profession. The aim of nursing education is to develop practitioners who are competent, knowledgeable and able to respond to the changing needs in clinical practice (Lau, 2002). It is designed to meet one or more of the following needs: Keep nurses abreast of new techniques and knowledge Keep nurses attain expertise in a specialized area of practice and Provide nurses with information essential to nursing practice. Reflective practice is a graduate level in the nursing education, which has attracted a considerable interest within classrooms, conferences and journals. It is synonymous with creating a learning situation and ensuring that the learning outcome is a combination of previous experiences, specific contexts and the theories that guided practice. Johns (1995) noted reflective learning as a dimension of critical thinking, while advocated the instilling of critical skills in nurses through emancipatory education, empowering practitioners to transform some of the more contradictory aspects of their practice. One of the biggest questions facing nursing is whether education should be based on ``nursing as it is'' or ``nursing it should be'' (Harris et al 2001). With reflective practice, learners can reflect upon real situations of ``nursing as it is'' and reflect on this in comparison to ``nursing as it should be''. With the evidence-based practice, objectivity is ideal, whereas reflection allows for the study of poor practice in addition to good practice (Taylor, 2003). Rich and Parker (1995) notes that reflective education aims to help students take each client encounter as unique and constantly arrive at a new or revised interpretation of the meaning of an experience. Educators face a challenge of providing a condition where students from different areas of discipline actively participate in the classroom discussion. Teaching approaches should motivate students to share their views with others. They should also give due recognition to the value of professional approaches to clients’ care (Ross et al 2005). Students in a reflective practice discussion group receiving instructions from a coach should be encouraged to share experiences, personal views and ideas to others. Shared experience incorporate into one experience gives a deeper understanding and interpretation of a situation (Schon 1983 & 1987). The group then associate, integrate and validate the new knowledge produced. Through advice, criticism, description, demonstration and questioning, one person helps another learn reflective practice (Fairbrother and Hibbert 1996). Reflection of individuals or groups properly applied to practice can provide new knowledge which can improve individual clinical skill. Burnard (1995) examined nurse educator's perception and reflective practice in nurse education. Results showed that most educators supported reflection as a learning strategy in facilitating effective clinical teaching. Horn and Wilburn (2005) noted that a reflective practicum could help form a bridge between the worlds of theory and practice. Reflection can assist students to learn about their own reality which would help them link theory they are learning to clinical experience (Horn and Wilburn, 2005). Reflective practice is an important area of professional practice like nursing. It is urged that educators accept the challenge of motivating nursing students to develop in themselves reflective skills (Jarvis 1992). In the United Kingdom, the drive to encourage reflective practice through clinical supervision as a means of ensuring quality of provision in nursing profession is now well-embedded in practice (McDrury, 2002). It is natural for individuals to reflect on things happened for private and personal consumption. This is different from the formalized ‘reflective practice’ which log, records in a diary, personal development portfolio, critical incident journal or other recording device the experiences, views and ideas of participants in the structured evidence-based activity. These participants maybe referred as ‘reflective practitioners’ (Schon 1983). Reflection gives sense to what was learned, why it was learned and how the learning took place. Further, the objective of reflection is to connect one area of learning to the wider learning perspective that leads to realizing the bigger picture. Reflection is an important aspect of professional practice. It provides practitioners to make an important decision in a critical situations and be professionally accountable (McDrury 2002) It also gives right amount of confidence to practitioners to handle unique and complex situation in the practice of their profession. Moreover, Charalambous (2003) advocates reflections as a potential tool to uncover the knowledge embedded in practice. In the same light, Benner (1984) and Schon (1983) talks of the wealth of untapped knowledge embedded in the practice. The desire for reflection comes our when a practitioner encounters some problems while in the conduct of his profession and try to gain knowledge from it (Walters et al 2001). Nurse can also learn from the difficulties they meet in the hospital by analyzing and evaluating practice experiences. When reflecting `in' or `on' action, if carried out effectively then the practitioner is learning. This process of learning occurs because the individual is generating new knowledge (Marks-Maran and Rose, 1997). Any learning from reflective experience is a different concept to straightforward thinking about practice ( Hull and Redfern 1996). According to Schon (1983) reflection will occur in practice setting. However, it might be for various reasons that on occasion, reflection on action occurs away from the practice setting. The practice environment can be busy and conditions prevent the realisation of reflection (Reed and Procter 1983, Glaze 2002). It can be seen then that a balance of reflection within both areas, which makes the links between practice and knowledge is more beneficial to the learner. Reflection has the potential to help nurses to develop and learn from their practice. Its potential can be realized through continuous practice. Reflection in between works can tell an individual if she is doing her job right. Schon (1983) came up with an accessible question guide to reflection on every day practice (Appendix 2). Learners are reflecting in an educational sense when they do analysis and evaluation of one or more personal experiences and try to make generalization from that thinking (Cowan 1999 p18). While reflection in a mirror shows what is in front of it, reflective professional practice shows an improvement of the original (Biggs 1996 p6). Implementing Reflection: Personal Context In my opinion, reflection is a way of rekindling, and professionally, it is synonymous with renewed commitment to better service. Because through reflection, nurses become more mindful of their words and deeds, giving rise to a more caring society. Embracing the concept of reflective practice in nursing practice equals self-reflective nurses that will, as a consequence, improve their relation to clients under their care and strongly suggests a positive change. Nurses learn through practice, hands-on profession and the desire and capacity to learn from experience is necessary for nurses to develop practice. Practitioners need time to learn the skills of reflection and the time to reflect on practice, because reflection is not an easy process. To adopt a reflective approach in nursing practice, teaching and learning strategies can be employed to encourage students to develop reflections skills (Moore, 1998). So influential is the concept of reflective thinking that is has now been identified as a prerequisite competency for beginning nurse practitioner (Teekman, 2000). In the same light, I support that reflection in nursing will lead to better practice and to greater competence. Since, every registered nurse has a professional obligation to be competent, it is expected of the licensed nurse to subject to a continuing competence which is the on-going acquisition and application of knowledge that results in better health and welfare of clients served. How care is administered to patients depends on the attitudes of nurses. The most common cause of low quality care is lack of knowledge and wrong attitude. Further, professional practices are witnessed by the patient and the nurse. It is imperative that the nurse must be professionally accountable (Bulman and Burns 2000). Reflection then provides an opportunity to think about practice, to identify what is satisfactory and what is in need of improvement or validation (Fairbrother and Hibbert, 1996). The process of reflection if properly put into practice can help the individual in getting enough knowledge that can lead to the improvement of in the quality of care received by patient. When carrying out activities in practice without the use of reflection then the actions become ritualistic and part of habit, with minimal thought of alternatives (Mark-Maran and Rose, 1997). This absence of reflection prevents the development of practical knowledge (Mark-Maran and Rose, 1997). The knowledge learnt through reflective practice should be used to expand the individuals practice to benefit the patients (Hull and Redfern 1996, Markham 2002). Although many positive applications of reflective practice have been highlighted and has become an accepted concept, critics have noted limitations of reflective practice in nursing pointing to its broad scope. Learning should be carried out by individual. Students use their own individual knowledge and experience. Learning is also contextual which means that nurses’ attitude affects their ability to understand. They should also realize that learning is relationship building (Boud 1995). Reflecting on negative situations can be dangerous to an individual. It can damage self-esteem, affect self-confidence and render one to become hopeless (Rich and Parker 1995). There is a clear need for research to investigate what reflective practice can achieve. James and Clarke (1994) challenged the assumptions in some of the literature that reflective practice is a panacea for many of nursing’s troubles. They identify a need for greater clarity and recommend that this will be best achieved through more debate and research into the specific claims made about reflective practice. Conclusions: Reflective practice has long been advocated within nursing as a means of improving practice and learning from practices situations (Freshwater, 2000). There appears to be a general consensus in the nursing literature that reflecting on problematic situations helps individuals understand and make sense of them by examining parts, possible connections between these parts, as well as links to previous situations. I agree with Teekman that ``the fruits of this mental activity result in an increased knowledge level that in turn will contribute to improved nursing practice.'' Nurses today must equip themselves with knowledge to become competitive in the continuous changing health care system. But nurses entering today’s healthcare field must not only be capable of coping with change, but should grow from their experiences. They need to examine themselves and learn ways how to put themselves above the rest. Clients are coming from diverse cultural backgrounds They will demand for better services, sensitivity, caring, commitment and skills which can be gained by learning new knowledge which can be obtained through reflective practices. The value of reflection has encouraged me to reflect on my day-to-day practice and therefore enhanced performance as a healthcare professional. Reflection in nursing, whether in research, teaching or clinical practice, has increasingly become a cornerstone of nursing professionalism (Charalambous, 2003). It has become as source of knowledge necessary for directing and informing practice, choosing among alternatives and making the place a conducive place for learning. Wisdom is learnt in reflection and this knowledge should be transferred to the practice setting to benefit the clients. Schon (1983) emphasized that if reflective practice is about linking knowledge learnt within the academic setting and relating this knowledge to nursing practice to provide the best practice, then the ideal setting would be the practice environment rather than the academic setting. The essay on reflection and reflective practice made me realize the benefits of reflection in our profession which has the passion of maximizing the effectiveness of care. Reflective practice changed my views and behaviors concerning people actuation in a given situation. It is hoped that it will increase the awareness of my senses, to analyze personal thoughts and feelings, continue to develop mastery, critical thinking skills and through reflection, enable me to predict consequences that may occur from my actions. As I seek to develop my own reflective practice skills, I have come to terms that it is the process of learning that is important and as I develop reflective practice, I would be able to respond to the unique challenges of my nursing practice. Read More