Revalidation: Reflective Practice
Models of Reflection
In order to meet the requirements for revalidation all registered nurses will need to prepare a minimum of five written reflective accounts. These reflections could be on their learning’s from CPD, practice-related feedback they have received or from an experience or event that has taken place in their daily practice.
What is reflective practice?
Reflective practice is associated with learning from experience and is viewed as an important strategy for nurses who embrace life-long learning. Reflection is an important human activity in which people recapture their experience, think about it, mull over and evaluate it. It is this working with experience that is important in learning. Boud et al (1985)
The act of reflection is seen as a way of promoting the development of autonomous, qualified and self-directed professionals. Engaging in reflective practice is associated with the improvement in the quality of care, stimulating personal and professional growth, and closing the gap between theory and practice.
Life-long learning is an essential part of your personal and professional development. In order to assist with your development, it is important to develop your practice by using self insight and self awareness with the process of reflection. To develop the ability to integrate reflection into your everyday practice is of vital importance. Reflecting on your practice and learning from your experience will enable you to carry out high standards to the people in our care. Vaughan (2009)
Models of Reflection
There are a number of reflective models which could be usedhowever in the healthcare environment John’s,Gibbs and Rolfereflective models are threeof which are most commonly used.
Here is a description and guidance on how to these models.
John’s Model for Structured Reflection (2000) - can be used as a guide for analysis of a critical incident or general reflection on experience. John supports the need for the learner to work with a supervisor throughout the experience. He recommends that the student uses a structured diary. He advises to ‘look in on the situation’, which would include focusing on yourself and paying attention to your thoughts and emotions. He then advises to ‘look out of the situation’ and write a description of the situation around your thoughts and feelings, what you are trying to achieve, why you responded in the way you did, how others were feeling, did you act in the best way, ethical concepts etc. He also considers the use of internal factors, such as expectations from others, time factors, normal practice, anxiety of the situation etc. The model highlights the importance of experienced knowledge and the ability of a practitioner to access, understand and put into practice information that has been acquired through empirical means. In order for this to be achieved reflection occurs though ‘looking in’ on ones thoughts and emotions and ‘looking out’ at the situation experienced.
John’s model of reflection
Ways of knowing / Cues / Write your thoughts hereAesthetics – the art of what we do, our own experiences /
- What was I trying to achieve?
- Why did I respond as I did?
- What were the consequences of that for the patient? Others? Myself?
- How was this person (people) feeling?
- How did I Know this?
Personal – self awareness /
- How did I feel in this situation?
- What internal factors were influencing me?
Ethics – moral knowledge /
- How did my actions match my beliefs?
- What factors made me act in an incongruent way?
Empirics – scientific /
- What knowledge did or should have informed me?
Gibbs identified a series of 6 steps to aid reflective practice, these elements make up a cycle that can be applied over and over. Unlike many other models, Gibbs takes in to account the realm of feelings and emotions which played a part in a particular event. Gibbs model incorporates all the core skills of reflection. Arguably it is focused on reflection on action, but with practice it could be used to focus on reflection in and beforeaction (Gibbs 1988).
Gibbs model of reflection
Trigger questions / Write your thoughts hereDescription / What happened?
Feelings / What were your reactions?
Evaluation / What was good or bad about the experience?
Analysis / What sense can you make of the situation?
Conclusions / What else could you have done?
Personal action plan / If it occurs again what would you do?
Rolfe’s reflective model is a simplistic cycle composed of 3 questions which asks the practitioner, What, So What and Now What. Trough this analysis a description of the situation is given which then leads into the scrutiny of the situation and the construction of knowledge that has been learnt through the experience. Subsequent to this, ways in which to personally improve and the consequence of one’s response to the experience are reflected on.
Rolfe’s Model of reflection
Cues / Write your thoughts hereWhat? / Analysis of the situation
So what? / Scrutiny of the situation
Now what? / Construction of knowledge
With the NMC requiring practitioners to improve on their reflection, it is timely that we consider how nurses across Bupa can be supported to achieve the NMC’s requirements. Examples of these models are presented to help you to record your reflections of your clinical practice activities.Completed copies should be retained in your portfolio in preparation for revalidation. Remember when preparing your reflective accounts for revalidation you will need to use the NMC’s reflective account template.This template can be found on the revalidation pages on the NMC website.
References
NMC (2014)
Schon D. (1983) The Reflective Practitioner, How Professionals Think In Action, Basic Books.
Johns, C (1995). Framing learning through reflection within Carper's fundamental ways of knowing in nursing. Journal of advanced nursing22 (2): 226–34
Johns, C. (2000) Becoming a Reflective Practitioner: a reflective and holistic approach to clinical nursing, practice development and clinical supervision. Oxford: Blackwell Science
Gibbs G. Learning by Doing: A Guide to Teaching and Learning Methods. Oxford Further Education Unit, Oxford Polytechnic;1988.
Boud, D., Keogh, R. & Walker, D. (1985) p 43 Reflection: Turning Experience into Learning. London: Kogan Page
Rolfe, G., Freshwater, D., Jasper, M. (2001) (eds.) Critical Reflection for Nursing and the Helping Professions. Basingstoke, U.K: Palgrave. ISBN 0-333-77795-6. pp. 26 et seq., p. 35