Download - 2.joy hall e
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Joy Hall – Head of Department Public & Community Health
Birmingham City University
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Outcomes:
• Define and describe the terms: reflection,
reflection-on action, reflection – in action &
critical reflection.
• Identify how these 3 methods of reflection
can be used to improve patient care,
especially in relation to patient safety.
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Reflective cycle
Description :
What Happened
Feelings:
What were you thinking
and/or feeling?
Evaluation What was
good and bad about the
experience?Analysis:
What sense can you make of the situation?
Conclusion:
What else could you
have done?
Action plan:
If it arose again what would you
do?
All familiar with a reflective
cycle?
[Gibbs, 1988]
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Two questions
What exactly do we mean by reflection in
professional practice
How does it improve patient safety
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Reflection is the examination of personal thoughts and
actions. For practitioners this means focusing on :
• interactions with their colleagues and
• interactions with the environment to obtain a clearer
picture of their own behaviour.
It is therefore a process through which practitioners can:
• understand themselves and their actions/behaviour
better
• build on existing strengths and
• plan appropriate future action.
Note the word ‘action’ is very important
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Reflection
Developing professional practice by requiring the
practitioner to :
• explore different/new ideas and approaches
towards doing or thinking about things
• promote self-improvement
(by identifying strengths and weaknesses and
taking action to address them)
• link practice and theory
(by combining doing or observing with
thinking or applying knowledge)
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•Reflection-on-action
•Reflection-in-action
•Critical reflection
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•The most frequently used form of
reflection. It involves carefully thinking
and re-thinking about professional actions
that have already occurred.
•The aim is to identify strengths and to
consider how professional actions can be
more effective in the future.
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Questions to ask:• Is this good practice? If so, what is good? If not what is
bad?
• What are the risks for the patient?
• How could you decrease the risks in each example?
• What is does the evidence say about this practice?
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This is harder to do and takes experience. It
means:
examining your own professional actions
and behaviour and
Examining the professional actions of others
while the clinical situation continues.
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Skills needed:
ability to be a participant observer in clinical settings which means
For your own clinical practice
ability to carry out and evaluate your own actions and make links with previous clinical experience
For practice of other professionals
ability to carry own role and function while at the same time ‘watching’ activities and recording actions of others
ability to evaluate the practice of others
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Questions to ask• Is the equipment well organised? Could it be organised
differently/better? If so, how?
• Are the nurses working well together?
• Are there any ways patent safety is at risk? If so, how
could these be reduced?
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Critical reflection refers to the capacity to recognise our
assumptions about ourselves, other people, and the
workplace.
Personal experience determines how much of our
environment we actually ‘see’.
Two descriptions of the same event will be different.
Involves uncovering some of the assumptions, beliefs and
values that are part of our society so Vietnamese
reflections will vary from UK or elsewhere
Critical incident analysis offers useful tools to facilitate
critical reflection
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What do you see?
Reflect on how the mother feels
How do you as a nurse feel
What are the patient risks?
What could be done better?
What does the evidence say?
How can you get to the example below?
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Reflective cycle
Description :
Diabetic with wound infection-
excessive exudate, pyrexia
Feelings:
Concerned
Worried
How did this happen?
Reaction – seek medical advise –antibiotics given, clean & monitor wound & blood
glucose
Evaluation:
Badly? = wound infection
eventually resolved, blood
glucose returned to normal range
Analysis:
Patient remained pyrexial for prolonged
period
Wound with heavy exudate for long period
Hyperglycaemia for prolonged period
Conclusion:
Insulin infusion?
More frequent monitoring?
Different dressings?
Different cleaning agent?
Monitored vital signs
Action plan:
Update knowledge of:
Wound dressings & wound healing
Care of wound care related to
diabetes
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What is the most important thing to do right now?
What resources are available to me?
How can I best use these resources?
What do I most value about nursing role?
What practice activities have made me proud to be a nurse?
How am I using my skills?
What do I really need to do?
How confident am I about my professional role ?
What did I find difficult?
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Courage to note gaps in
knowledge
Willingness to seek training
from experts or from
colleagues in other settings
Willingness to explore the evidence and research to guide practice
Courage to challenge and change practice ( own & others)
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Reflect on extent to which care
provided fits patient
expectations and how this affects
safety
Reflect on how individual
differences can be respected
without reducing safety
Reflect on the significance of
illness to
the patient?
the family
community?
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ReferencesGibbs G (1988) Learning by Doing: A guide to teaching and learning
methods. Further Education Unit, Oxford Brookes University, Oxford.
Boud, D., Keogh, R. & Walker, D. (1985) Reflection: Turning Experience into
Learning. London: Kogan Page.
Ghaye,T & Lillyman, S (2010) Reflection Principles Practice for Healthcare
Professionals.London. Quay Books
Johns, C. (2000) Becoming a Reflective Practitioner. Oxford: Blackwell Science.
Mann,K, Gordon,J & MacLeod,A (2009) Reflection and reflective practice in
health professions education: a systematic review .Advances in Health Sciences
education. Volume 14 ( 4) pp 595-621
Tate, S. & Sills, M. (eds) (2004) p 126 The Development of Critical Reflection
in the Health Professions. London; Higher Education Authority