Reflective Approaches in Nursing Education and Clinical Practice

Abstract

Today modern society is becoming more complex and constantly information is changing along with problem solving strategies, reflective learning is an ability to look back over an experience and break it down into its significant aspects, such as any factors affecting success or failure. Due to this complex and continually changing environment, healthcare professionals could benefit from a program of reflective practice. Reflective Practice (DAVIS 2012) 1 is increasing from an experience for any situation, acquisition of new knowledge and skills, further understanding of own beliefs, attitudes and values. This practice involves encouragement of self-motivation and self-directed learning in nursing education and clinical practice.

1. Introduction

Today Modern society is becoming more complex since the Covid-19 pandemic starts the information is becoming more advanced with technology and changing more rapidly leading users to constantly rethink, moving to new direction and adopt problem solving strategies.

Reflective learning is a capacity to look back over an experience and able to analysis in significant way, any factors which affect success or failure.

Learning in reflection will aid in enhancement for own human skill development and finding a clear path between the effort in development activity and outcome of it Reflection also heap in knowing are learning experiences regarding the purpose of activity and its importance (Figure 1). Reflecting on learning enables to link professional development to practical outcomes and widens the definition of what counts as useful activity.

Figure 1.

Learning in reflection.

Being is learner in reflective practice. One always try to apply knowledge and practice in further work as learning is always connected to the action and theoretical knowledge to clinical skills.

We can always assess our learning outcome through the feedback from peer group teachers with self assessment. As we understated that reflection is the process which aid to gain meaningful look into are professional practice.

2. Reflective approaches

In nursing education reflective approaches can be used as important tool in clinical practice based where the nursing student learn from their own professional experience, classrooms lecture or mentor which is always helpful in career advancement and adopting same process is able to bring together theory and clinical practice.

As Paterson Chapman [1, 2] mentioned that reflection is vital part of learning from experience and mainly lead to develop and maintain completely across a professional’s lifetime in the area of health care. John Dewey was among the first to explain about Reflective Practice with his exploration of experience, connection between incidents as shown in Figure 2.

Figure 2.

Experience and reflective process.

Reflections helps to see and able to mark schools of thought and theory of concept within the context of our work done [3]. Important point to be noted about reflection during the practice reveals that the individual not only look back on his past activities and the action taken, but also deeply look into observation of emotions shown, previous happenings, actions taken, and its effect and thus lead to higher level of understanding [2].

The use of reflection in nursing education:

1. Enhance self awareness leader to increases understanding of the effect that past experience may have on care delivery.

2. To develop nursing students intellectual capacities to conceptualize knowledge to better assess client need.

3. Acquiring of novice knowledge and clinical practice skill.

4. Analysis of self and value, core, belief and attitude.

2.1 The various model of reflective practice

Reflective practice applied in disciplines such as teaching, nursing, social work as a way to learn from real life experience. There are many models to explain and guide personal and situational analysis and improvement. The first stage of reflection usually start with the description what has happened and the next stage of reflective practice describe about what we know the situation and what it is impact and the final stage of reflection briefs about the change and outcome of situation as explained in Figure 3 the co-relation of Reflection, learning and action. The structure and format of these modals may have difference but mostly all reflective modals have many common features.

Figure 3.

Co-relation of reflection, learning and action.

2.1.1 Gibbs’ reflective cycle or Gibbs’ model of reflection (1988)

One of the most common cyclical models of reflection which consist of following six distinct stages of exploring the experience [4].

• Description

• Feelings

• Evaluation

• Analysis

• Conclusions

• Action plan.

Gibbs reflective cycle allows to reflect upon ones experience as they happen and it helps to enhance our performance and for better improvement in future.

2.1.2 Rolfe 2001

2.2 Adaptation of the Rolfe reflective model

Rolfe’s reflective model is based on three simple questions what happened, (self awareness) and how it happened (critical analysis and evaluation), and what will be next plan (action oriented), so what and what next (As shown in Figure 4). A simplistic cycle composed of three questions which asks the practitioner, by introducing the problem that they are reflecting on before making their observation about the issue and finally concluding what they would change next time Through this analysis, a description of the situation is given which leads into the scrutiny of the situation and the construction of knowledge that has been learn through the experience. The most important advantage of Rolfe model relates to its clarity and simplicity. It often produce meaningful solutions.This models not only consider reflection after the moment but when the event is taking place so that the corrective measure can be taken.

Figure 4.

Rolfe reflective framework.

To conclude Rolfe model describe that reflections does not remain superficial but it is comprehensive by completing the simple action plan with key pointers about what we will do and how will decide that our practice has improved.

2.2.1 Ganshirt 2007

The reflective model Christian Ganshirt 2007 was prepared on the concept of the design cycle and the Ganshirt design cycle is explained with the first step begin with any innovative thoughts and next step is using visual and audio aids through same ideas is expressed and transfer in cyclical way with the critical rethinking and the same process goes on.

To summarize these models provide a useful guide or mode to begin but reflection is a unique and innate process and nursing professional will perceive it in a different way. Everyone takes some time to try different reflective approaches until it works positive and effective.As the time passes and as a reflective practitioner that we may try to practice different methods to handle the current situation.

The main four level of reflection can be described as:-

1. Response to any situation.

2. Exploration of learner response to same situation.

3. Analysis of the response and by investigating the action taken.

4. Indentify the outcome for the future clinical practice.

2.3 Application of reflective learning for health professional

Reflective Practice is always connected with learning from previous experience, and is considered as an important strategy for nursing professionals who believes in learning process in all phases of lives and it is known fact there is always changes in context of healthcare practices leading to continuous progression in medical knowledge hence there is a always remarkable need for experts in medical and nursing education.

Reflective practices seem to be important tool for healthcare professional because of rapid changes in healthcare facilities. Price explained in 2004 [5] about the benefits of reflective practices for healthcare practitioner by understanding his or her own motive,thoughts,moral and feelings connected with client care and to promote solution to practice situations and meet challenge with existing ideas, response of action taken with positive or negative feeling and also to rethink how the practice situation can be handled in different way.

In the field of nursing profession there is always a concern that actions taken in any situation may have the risk of habitualization, thus dehumanizing client care and their needs. Reflective Practice always aids to nurses are to plan their process of nursing care and keen monitoring the action to ensure it is beneficial to the clients.

The act of reflection is seen as a way of promoting the self decision, qualified and professionals with leadership quality. Involving in Reflective Practice leads to the improvement of the quality of nursing care, enhancing personal and professional growth and reducing the gap between theory and practice. Reflective practices are now being introduced into undergraduate, postgraduate and continuing nursing education. Mann [6] expressed in her research that in nursing professional in clinical practice reflection process is multi factorial and to include different aspects. All experiences during anticipation of a difficult situation also added to reflection. Practicing professionals always have variation in their attitudes and capability to reflect. Denner [7] mentioned that reflection has meditation aspect which causes a change in brain alpha and theta wave activity and also increases the right hemisphere brain activity which is connected to our insights and leads to sudden awareness of correct answer to any verbal problem and leads to creativity. Many researchers have proved that self reflection involves the brain’s cortical midline structures (CMS) any disturbance to the CMS causes difficulty in evaluating the difficult situation and there is tendency to overestimate one’s personal abilities [8].

3. Conclusion

To prevent burnout, nursing professional need to have passion of their profession. Nursing professional at every level after this covid 19 pandemic will need to be more perseverant and passionate with excellence in clinical practice [9]. Thus reflective learning is important tool to learn and enhance skill competency over time and evaluates our learning experience towards nursing care. Self reflection enhances skills which involve motivation and temperament which are necessary for success in the health care professional.

Acknowledgments

I would like to acknowledge the extraordinary debt I owe to the editor and my special thanks to Paula Gavran, Author Service manager for her continual support. I also thanks to all my reader.

Conflict of interest

I declare no conflict of interest.

Further reading

• Dewey J. How We Think. Revised ed. Boston: D.C Heath; 1933

• Schön D. The Reflective Practitioner, How Professionals Think in Action. Basic Books; 1983

• Hartman HJ. Teaching Metacognitively. In: Metacognition in Learning and Instruction. Dordrecht: Springer; 2001

• Freshwater D, Horton-Deutsch S, Sherwood G, Taylor B. Resource Paper: The Scholarship of Reflective Practice. The Honor Society of Nursing, Sigma Theta Tau International; 2005