1. REFLECTIVE PRACTICE MAY 2016

2. BupaPrivate and Confidential Learning Outcomes By attending this session you will; Understand what reflective writing is and why it is important to reflect on your daily practice Understand what types of situations you could reflect on during your practice Understand what the NMC’s requirement is for reflective practice Understand what you can include in your reflective accounts Have an understanding of the skills required for reflecting Understand how to write a reflective account Have an understanding of the models of reflection available to use 2

3. BupaPrivate and Confidential Agenda Item 1. Introduction 2. What is reflective writing? 3. What can you reflect on? 4. Why is reflection important? 5. The NMC’s requirement for written reflections 6. Skills for reflection 7. What to include in your written reflective accounts? 8. Tips for reflecting 9. Models of Reflection 10. Further Reading 3

4. BupaPrivate and Confidential What is Reflective Writing? 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). Reflective writing involves: Describing an experience and your actions Reflecting on what went well and what did not Discussing what you learned and what you would do differently next time Reflective writing is about documenting the reflections you are already doing. 4

5. BupaPrivate and Confidential What can you reflect on? Positive / negative experiences in your professional practice Eventful / unusual incidents Routine activities Feedback you have received on your practice What you have learnt from CPD Information discussed in a clinical supervision session or team meeting 5

6. BupaPrivate and Confidential Why is reflecting important? 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) It can help us challenge practice Provides us with the opportunity to review the care we deliver and consider what we do well and how we need to develop Enables us to learn from our experiences Helps us to understand the effects our practice can have on the people we care for and work with Helps us to continually develop Overall it helps us to keep on improving and challenging practice 6

7. BupaPrivate and Confidential The NMC’s requirement for written reflections Five written reflective accounts They must link back to the Code You must not identify any personal information You must use the NMC reflective account form You must have a reflective discussion with another NMC registered nurse about your five written reflective accounts 7

8. BupaPrivate and Confidential Skills for Reflection Self Awareness – analyse feelings, involving an honest examination of how a situation affects an individual and how an individual affects the situation Description – ability to recognise and recollect accurately significant events and key features of an experience. Give an account of the situation Critical Analysis – examining each part of the situation, identifying existing knowledge, challenging any assumptions and exploring alternatives Synthesis – Integration of new knowledge with previous knowledge. Used to solve problems and to predict likely consequences of actions Evaluation – enables a judgement to be made about the value of something. It is crucial to evaluate in order to develop a new perspective. 8

9. BupaPrivate and Confidential What to include in your reflective accounts? What happened? Description of what happened – at this stage don’t make any judgements or any conclusions. For example, where was I? Who else was there? Why was I there? What was I doing? What happened? What were your feelings and how did you react? Keep focused on your emotions – don’t be tempted to analyse yet For example, how was I feeling? What did other people’s actions make me think/feel? How did I feel about the outcome? What was good and bad about the experience? Evaluate your initial feelings and reactions – by doing this, you will be able to identify the key issue (s) which will allow you to move on to critical analysis What sense did you make of the experience? Analyse what was going on. Were your experiences different or similar to that of others? Are there any themes emerging from your analysis? How does this experience compare with your previous experiences? Can you challenge any assumptions 9

10. BupaPrivate and Confidential What to include in your reflective accounts? What have you learnt from reflecting on this experience? What have you learnt about yourself, your self awareness or your practice? What have you learnt that you would recommend for practice in general (i.e. social, political, cultural or ethical issues)? What would you do differently? What would you do if this type of situation happened again? What skills/knowledge could I develop? How am I addressing this? What goals have I set for myself? How will you decide if your practice has been improved? How is it relevant to the Code? Think about what theme(s) of the Code your reflection links to. 10

11. BupaPrivate and Confidential Tips for Reflecting Always have a pen and paper to hand Write down ideas in note form as they come to you Seek feedback from others Pair up with someone and have a conversation about your reflections See reflective practice as an essential part of your practice Analyse your assumptions and practices 11

12. BupaPrivate and Confidential Models of Reflection There are a number of reflective models which could be used however in the healthcare environment John’s, Gibbs and Rolfe reflective models are three of which are most commonly used. 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. 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. 12 Ways of knowingCuesWrite your thoughts here Aesthetics – 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?

13. BupaPrivate and Confidential Models of Reflection 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 1988). 13 Trigger questionsWrite your thoughts here DescriptionWhat happened? FeelingsWhat were your reactions? Evaluation What was good or bad about the experience? Analysis What sense can you make of the situation? ConclusionsWhat else could you have done? Personal action plan If it occurs again what would you do?

14. BupaPrivate and Confidential Models of Reflection Rolfe’s reflective model is a simplistic cycle composed of 3 questions which asks the practitioner, What, So What and Now What. Through 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. 14 CuesWrite your thoughts here What?Analysis of the situation So what?Scrutiny of the situation Now what?Construction of knowledge

15. BupaPrivate and Confidential Further Reading Available 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 nursing 22 (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 15