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Reflective practice guide

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Reflective Practice – what is it and why are student nurses required to do it?

Pre-registration nursing programmes are required by the Nursing and Midwifery Council (NMC) to support the following outcomes relating to reflective practice:

1.2 Prioritise the wellbeing of people promoting critical self-reflection and safe practice in accordance with The Code

3.2 Students are empowered and supported to become resilient, caring, reflective and lifelong learners who are capable of working in inter-professional and inter-agency teams.

3.14 (students) are provided with the learning and pastoral support necessary to empower them to prepare for independent, reflective professional practice

5.13 students’ self-reflections contribute to, and are evidenced in, assessments

Evidence of reflective practice is also required by the NMC as part of your three yearly revalidation once you are a qualified nurse so it’s good to get in the habit of reflecting while you are still a student.

A number of definitions have been used to describe what reflection or reflective practice is within the field of nursing but it can be described as the process that an individual deliberately undertakes to gain insight into an experience with the intention of assisting their development and improvement as a practitioner (Grech, 2020).  Research has identified success criteria for meaningful reflective practice including “open-mindedness, courage and a willingness to accept, and act on criticism” (Caldwell 2013 citing Bulmam, Lathlean and Gobbi 2012) Several models and theories have been developed which expand on the rationale for reflective practice and provide models that can be used to undertake reflective activity of which Gibbs (1998) is probably the best known and is the model taught in the second year of BSc Nursing at the University of Brighton on the NI521 module.  Many simpler models are available including the ERA cycle (Jasper, 2013) which asks us to think about our Experience, to Reflect on this and then to take Action in response to our reflection.  Or Driscoll’s 2007  ‘What‘ model which simply prompts us to think “what happened; so what; now what?”.  The trick is to consider a few models and find one that works for you.

Some universities require students to keep a diary or log of their reflective practice but the University of Brighton doesn’t do this.  Some studies have found that it is important for students to have flexibility and privacy around how they capture their reflections but that they should be supported by educators and peers to get the most benefit.

Barriers to reflection

If you’re finding it difficult to reflect then you’re not alone.  The main barriers to reflection have been found to include:

  • a lack of time
  • an organisational culture that doesn’t support, encourage or value reflective practice
  • a lack of confidence that you have the skills and/or knowledge to know-how to reflect
  • finding the right space for your reflection; it could be while traveling to and from placement; in the shower; while having a coffee or a beer with a friend – try different things to find what works for you.
  • a lack of motivation – we are ‘given’ 5.5 hours by the university for our reflection time each week but it’s often hard to find a time to prioritise time spent thinking about how things are going and following this up, particularly if your reflection has focussed on a difficult experience
  • a lack of confidence that you’re reflecting in the ‘right’ way; or that the time spent reflecting is worthwhile.  If you’re feeling this way, try reflecting with a friend or  having a break and approaching it differently next time.

The trick is to find an approach that works for you, changing and adapting that as necessary.

Some tools and tips for reflecting

Many resources are available online and in the University to help you decide how to reflect on your experiences in placement.  These include:

  • A guide produced by the Health and Care Professions Council on different approaches to reflective practice in different healthcare professions.  This includes a short (2m 51s) video of healthcare professional describing how they use reflection in their daily practice with practical examples.
  • An excellent University of Cambridge Reflective Practice Toolkit that includes two pathways – one for beginners who are just starting to use reflective practice and another for intermediate practitioners who have more experience and confidence about their use of reflective practice.
  • The NMC guide for registered nurses on how to carry out reflective practice to support their revalidation process every three years after qualifying.
  • A guide to WIN – an easy mnemonic to guide self-reflection and evaluation among nursing students that includes the following three steps:
    1. What went well today (e.g., personal growths, interdisciplinary teamwork, or processes)?
    2. What improvements needed (e.g., personal, team, or environmental)?
    3. What new knowledge has been gained?
  • A Nursing Times article that describes a model of reflection to use in critical practice:
    • R – RECALL the events (stage 1) – Give a brief overview of the situation upon which you are reflecting. This should consist of the facts – a description of what happened
    • E – EXAMINE your responses (stage 2) – Discuss your thoughts and actions at the time of the incident upon which you are reflecting
    • F – Acknowledge FEELINGS (stage 3) – Highlight any feelings you experienced at the time of the situation upon which you are reflecting
    • L – LEARN from the experience (stage 4) Highlight what you have learned from the situation
    • E – EXPLORE options (stage 5) – Discuss options for the future if you were to encounter a similar situation
    • C – CREATE a plan of action (stage 6) – Create a plan for the future – this can be for future theoretical learning or action
    • T – Set TIMESCALE (stage 7) – Set a time by which the plan outlined in stage 6 will be complete
  • If you want to take action to brush up your skills and knowledge after reflecting on experiences in placement, don’t forget to log in to clinicalskills.net where you can refresh and test your knowledge and record your reflections or Safe Medicate where you can build your medicines management skills.

Further Reading

Guide to Journaling

Final – reflective placement account and outcomes (1)

Self-reflection_ Foundation for meaningful nursing practice (1)

Reflective-practice-2-improving-nurses-mental-health-and-wellbeing-

‘Reflection is an often-misunderstood term within nursing’ _ Nursing Times

‘Learning to celebrate small successes as a student’ _ Nursing Times (2)

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