Implementing reflective practice

Although nurses understand the need to reflect on their practice, reflection does not occur simply as a result of knowing about it. The author of this literature review seeks to clarify 'reflection' and suggests ways to implement reflective practice.     

Reflections on the role of the nursing development facilitator in clinical supervision and reflective practice

The notions of clinical supervision and reflective practice are attracting considerable interest across the spectrum of nursing. This paper focuses upon how the two were linked together and, with the support of an independent survey, were used to evaluate the nursing development facilitator role. It is argued that reflective practice, as a model of clinical supervision, may provide a forum for nurses to explore the value of their actions. Linked to this, the personal knowledge that is revealed may mirror reality and as a result it is argued that there is benefit in evaluating practice through reflection.     

Educating for reflective practice

This paper describes the reflective practice approach adopted at the University of Westminster School of Integrated Health and shows how critical reflection can be incorporated into the complementary therapies undergraduate curriculum.     

Redescribing reflective practice and evidence-based practice discourses

This paper provides an analysis on the discourses of reflective practice and evidence-based practice. It commences by examining the role of discourse in describing and defining our beliefs and attitudes. Consequently, it argues that each discourse is based on a certain epistemology, which in effect are language constructs that create realities and like all language constructs, the epistemology of each discourse is open to the possibility of being restructured. Sequentially, any discourse can (re)describe a different type of reality by providing a set of different words, values and beliefs. Eventually, by exposing the language play and the engineered binary of the reflective practice and the evidence-based practice discourses it is concluded that these discourses are not mutually exclusive as they have been portrayed by most of the literature, but complementary ones. Finally, reflective practice and evidence-based practice are re-described as supplementary discourses and practitioners can simultaneously utilize both through the process of critical reflexivity.     

How reflective practice improves nurses' critical thinking ability.

Purposeful reflection is consistent with adult learning theory. It is known to lead to a deeper understanding of issues and to develop judgment and skill. Required by law to ensure members' competence in their professional practice, the College of Nurses of Ontario recommends and has developed a tool for evaluating reflective practice. The tool focuses on key attributes said to be demonstrated by competent practitioners, including critical thinking (CT) and job knowledge. This study aimed to determine whether nurses engage in reflective practice and whether they perceive that it enhances their CT ability. Surveys were sent to 60 gastroenterology nurses at a large teaching hospital; 34 surveys were anonymously returned. All respondents engaged in reflective practice, and 24 reported using the college's tool. Nineteen respondents strongly agreed that their nursing practice had improved as a result. Critical thinking is difficult to assess because of a lack of clear-cut performance criteria. Improvement of CT was difficult to evaluate from the responses, even though all respondents participated in reflective practice. Both CT and reflective practice need to be better defined in order to examine and explain their relationship.     

Planting seeds of reflective practice

COVID-19 has forced educators to redesign courses for different delivery modalities. While this originally caused chaos for many faculty members, the continued need for flexibility has provided an opportunity to rethink how courses could best support students both during the pandemic and moving forward. A pre-licensure first semester fundamentals of nursing course changed from fully in-person to hybrid delivery. Adaptations were made with a focus on concepts of growth mindset and creating a supportive environment to foster early acquisition of reflection skills. Many of these adaptations can continue to be incorporated into a fundamental of nursing courses beyond the COVID-19 crisis.     

Web journaling. Using informational technology to teach reflective practice

Reflection is a process by which we think about experiences and relieve them. Web journaling is a tool that gives students opportunities to use reflection when they are away from the immediate clinical environment. Through such reflection the student's personal knowledge that informs their practice is revealed. The revelation of personal knowledge is key to structuring subsequent faculty guidance. The web journal is a vehicle for student/faculty dialogue aimed at expanding both the faculty's responses to students' learning needs and the students' responses to persons in their care. Questions formulated in the dialogue direct the student's web-based search for new information. Faculty guidance subsequently focuses on the student's decisions regarding the use of information to direct clinical practice. Web journaling done over several nursing courses reinforces a model of learning, which is increasingly more deliberative and intentional. Web journaling may contribute to the development of practice throughout a nursing career because it becomes a way for self-directed learning.     

Using reflective practice in frontline nursing

Reflection on practice is a key skill for nurses. Engaging in regular reflection enables practitioners to manage the personal and professional impact of addressing their patients' fundamental health and wellbeing needs on a daily basis. This article briefly reviews the theoretical background underpinning the idea of reflective practice. A simple, three-step model for practical reflection is presented, which is based on theory and grounded in practice. The three-stage cycle is illustrated with a fictional clinical example to show how this reflective method can make a difference in busy practice settings.     

Using action learning in reflective practice

Action learning encourages individuals to use reflective processes such as group support and self-directed learning. A staff development programme for nurses in a neurology unit adopted this approach. Action learning groups were used by staff nurses for six months and were evaluated through interviews and questionnaires. Nurses had positive experiences as they developed their practice through the support of others.     

Exploring reflective thinking in nursing practice

While it is claimed in the nursing literature that reflective thinking is the approach par excellence for learning and advancing the art and practice of nursing, few empirical studies have been undertaken in this area to date. Sense-Making, a qualitative research method, was utilized to obtain and analyse data from interviews with 10 registered nurses in order to study reflective thinking in actual nursing practice. Ten non-routine nursing situations were analysed for the presence of reflective thinking. Time-line interviews of the events resulted in a total of 59 micro-moments, each of which was explored in terms of the thinking processes utilized to make sense of the situation as well as the focus of their thought. 'Pre-perceptions' played an important part in how the respondents perceived their situation. Reflective thinking was extensively manifest, especially in moments of doubt and perplexity, and consisted of such cognitive activities as comparing and contrasting phenomena, recognizing patterns, categorizing perceptions, framing, and self-questioning in order to create meaning and understanding. Self-questioning was identified as a significant process within reflective thinking. By exploring and analysing the type of questions respondents were asking themselves, the study uncovered three hierarchical levels of reflective thinking. Respondents most often engaged in reflective thinking-for-action which centred on the here and now in order to act. Reflective thinking-for-evaluation focused on creating wholeness and contributed to the realization of multiple perceptions and multiple responses. Reflective thinking-for-critical-inquiry could not be demonstrated in the study sample. The findings of this study resulted in the development of a model of reflective thinking, which is discussed in terms of the implications for learning in nursing practice.     

The value of reflective practice for nursing

• ? This paper notes the dawning of reflective practice on the horizon of nursing practice and sets out to explore its value for nursing.
• ? Central to this value is the potential of reflective practice to enable practitioners to develop clinical expertise towards achieving desirable and effective practice and, through collaborative research, the development of a valid disciplinary knowledge grounded in practitioners' personal knowledge.

     

Promoting reflective practice through structured clinical supervision

This paper outlines some early issues from a research project that is part of a North West Regional Health Authority pilot study on clinical supervision. The aims of the study and the research methodology utilized are discussed. The experiences of both a sister from a busy accident and emergency department and a practice nurse in the community are examined consecutively as supervisor and supervisee.