Reflective Practice

Amanda Deaves

Clinical Tutor

Objectives

To increase knowledge of reflective practice

To review models of reflection To understand the role of critical

reflection on clinical placement To understand the role of reflection

within physiotherapy practice To prepare for assignment ?

Definitions

‘A process of reviewing an experience of practice in order to describe, analyses, evaluate and so inform learning about practice’ (Reid 1993 in Schutz 2007)

‘A process of internally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self and results in a changed conceptual perspective’ (Boyd and Fayles 1983 in Schutz 2007)

Why Reflect?

Hallmark of professional practice To improve complex decision-making

and clinical reasoning skills To achieve experiential learning Critical to the learning process Central to the process of self-appraisal CSP expectation that physiotherapists

should be reflective practitioners

CSP

The Chartered Society of Physiotherapy expects its qualified members, student members and associate members to maintain and develop their skills, knowledge and competence in order to practise safely and effectively through continuing professional development (CPD). There is a strong link between evaluation, learning and the enhancement of patient care and quality of service. (Policy Statement CPD Sept 2007)

Developing Expertise

Novice – follows rules – performance often halted and mediocre

Expert – knowledge is a by-product of experience and reflection, ability to unpick a complex (new) situation and find effective interventions, able to ‘go beyond’ rules, confident in own expertise

Reflection is key in novice to expert journey (Poulter 2004)

Gap analysis

Learning plan

Learning activities

Review & evaluation

Competencies

Gibb’s Reflective Cycle (1988)

Description of the event

Feelings

Evaluation

Analysis

Conclusion

Action plan

The Task

Choose one of your examples from your observation week

Think back and expand your thoughts and reflective skills by completing the proforma

Describe a recent experience in your professional life

ContextWhat happened?Who was involved?What was the context for the event?Why is the event important to you?

What did you do..

ContextThoughts / feelings What happenedHow did you respond to the event?

And why?

Thoughts / feelings Analysis What were you thinking at the time? (during/after)What was most demanding / rewarding

What went well…

How did you respond to the event?What were you thinking at the time? (during/after)What was most demanding / rewardingWhat helped?

And what could have been better?

AnalysisEvaluation good / badWhat hindered?What assumptions, beliefs, values, intuitions underpinned the response/reaction?

Continued next slide

What would you now do differently, faced with a similar situation?

ConclusionWhat else could be doneAlternative actions or approachesWhat is the significance of what happened? What else do I need to consider to understand better what happened and why?What sense can I make of the event/situation?

Describe what you have learnt from this experience?

In what ways was the sequence of events connected?How did it influence or change: me, my learning, my practice?What action would I take in a similar situation?What do you need to learn?How might you learn this?

Five quick tips to start reflection

Initial write as if you are talking to a confident – imagine their probing questions?

Talk – share your reflections with peers Use a model to frame your reflections Go beyond describing – follow up with the

question – so what? Write quickly / naturally at first then add

layers, answer questions, develop themes

Critical Thinking

Achieved by recognizing and analyzing multiple perspectives and is essential to problem solving

Meta-cognition Systematic critical enquiry will lead to a

better understanding of practice Questioning and challenging existing

beliefs, values, customs and rituals

Goodman’s levels of reflection

There are several frameworks which can be used to facilitate the process of reflection and reflective writing. One of the simplest was developed by Goodman (1984) who suggested that there are 3 levels of reflection that a practitioner can achieve.

Level 1 Reflection to reach given objectives.

These usually relate to efficiency, effectiveness and accountability of own actions.– Mainly descriptive in nature– Identify key features– Recording of basic facts– Indication of some awareness of what has

happened– Some learning indicated

Level 2 Reflection on the relationship between

principles and practice This involves assessment of the

consequences of actions and beliefs as well as the underlying rational for practice

Shows awareness of personal and professional values

Identifies the reasoning and evidence base of actions taken

It will trigger the need to know more and search out more information

Level 3

Reflection which incorporates level 1 & 2 plus ethical and political dimensions

Looks at the immediate event, it’s implications for practice and then broader social structures and forces.

It acknowledges the wider influences of ethical and political decisions with regard to care delivery and practice.

Goodman’s Example

Work through the example and add bullet points to indicate how the example could be expanded to achieve Level 2 and then Level 3 reflection

Facilitation of Reflection

Identifying ‘critical incident’ Awareness of feelings / attributes /

strengths / weaknesses Awareness of own learning Making connections with prior

knowledge / experience Recognition of / planning of next stage

Tools to help reflection

SWOT analysis SWOB analysis Johari’s window Reflective log Pebble pad CSP

eJournal

PHTY 223 Assignment

Reflect on one key learning incidents which occurred during the placement

Word limit: 1,000 words Different topics you may wish to consider

for your reflection You must demonstrate evidence of your

own Personal Development Guidelines for reflective writing

Summarise - Reflection is……

Applied to any activities / situations Beyond the descriptive Intellectual: analytical, draws in evidence and

literature Personal: about your experience

– May include feelings– May include wider perspectives

Intended to enhance learning and performance

References

Jasper M (2003) Beginning Reflective Practice, Nelson Thornes Kember et al (2001) Reflective Teaching & learning in the

Health Professions, Blackwell Science Plack M, Santasier A (2004) Reflective Practice: A Model for

Facilitating Critical Thinking Skills within an Integrative Case Study Classroom Experience, Journal of Physical Therapy Education, 18,1,4-12

Poulter (2004) Time to Reflect. Nursing Standard, 18, 21 Schutz S (2007) Reflection and Reflective Practice, Community

Practitioner, 80,9,26-29