Description
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MWHC
Reflective Practice
Nurse Residency Program
Medstar Washington Hospital Center
Medstar Washington Hospital Center
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Objectives
• Describe reflection and reflective practice
• Identify characteristics of reflective thinking and
practice
• Describe what facilitated reflection practice is
• Explain the role of the facilitator in reflection
• Demonstrate effective skills in using facilitated
reflection as a learning strategy
• Engage in professional growth through reflecting
and acting upon job performance feedback
Medstar Washington Hospital Center
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Rewind to Benner
• Max level of skilled performance that can be
achieved through classroom alone vs. the
context-dependent judgments and skills that can
ONLY be acquired in real situations
(Benner, 2001)
Medstar Washington Hospital Center
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Reflective Practice
• Reflective practice involves a purposeful analysis
of actions and decisions with the intent of
recognizing problems and successes
• Hypothesizing solutions to the problems
• Applying both recognized successes and new
solutions to future actions and decisions
(Davies, 2012)
Medstar Washington Hospital Center
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Why Do It?
• There is evidence that engaging in Reflective
Practice is associated with the improvement of
the quality of care, stimulating personal and
professional growth, and closing the gap
between theory and practice
(Davies, 2012)
Medstar Washington Hospital Center
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Becoming a Reflective Practitioner
• The reflective process has the potential to enable
the beginning health practitioner to learn from
their professional experiences
• Describe and understand their own feelings and
influence in clinical practice
• Link theory to practice gaps
(Johnson, 2013)
Medstar Washington Hospital Center
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Gibbs’ Reflective Cycle
6 stages
Action Plan
If it arose
again What
would you
do?
Description
What
happened?
Conclusion
What else
could you
have done?
Feelings
What were
you thinking
& feeling?
Analysis
What sense
can you
make of the
situation?
Evaluation
What was
good and
bad about
the
experience?
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Purpose of Gibbs’ Reflective Cycle
• Help one think through the phases of an experience or
activity
• 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)
• Linking practice and theory (by combining doing or
observing with thinking or applying knowledge)
8
(Gibbs, 1988)
Medstar Washington Hospital Center
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Written Process Example
Stage 1 – Description of the event – What happened?
Stage 2 – Feelings/Reactions
What were you thinking? How did you feel
about the event?
Stage 3 – Evaluation or judgment about the event
Stage 4 – Analysis
Break event down into parts and discuss
Stage 5 – Conclusion – What did you learn?
Stage 6 – Action Plan
What would you do if you encountered again?
(Mind Tools, 2015)
Medstar Washington Hospital Center
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Benefits?
➢ Increased learning from an experience or situation
➢ Promotion of deep learning
➢ Identification of personal and professional strengths and areas for improvement
➢ Identification of educational needs
➢ Acquisition of new knowledge and skills
➢ Further understanding of ones own beliefs, attitudes and values
➢ Encouragement of self-motivation and self-directed learning
➢ Could act as a source of feedback
➢ Possible improvements of personal and clinical confidence
(Somerville & Keeling, 2004)
Medstar Washington Hospital Center
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Limitations?
➢ Not all practitioners may understand the reflective process
➢ May feel uncomfortable challenging and evaluating own practice
➢ Could be time consuming
➢ May have confusion as to which situations or experiences to reflect upon
➢ May not be adequate to resolve clinical problems (this could point to a further
learning needs)
(Price, 2004)
Medstar Washington Hospital Center
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Skills Required – Personal
✓ Self-awareness
✓ Description
✓ Critical analysis
✓ Synthesis
✓ Evaluation
✓ Honesty
✓ Trust
✓ Time commitment
✓ Motivation
✓ Practice
(Atkins and Murphy, 1993)
Medstar Washington Hospital Center
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Basic Elements
• The what, why, and how of things you do:
– Keeping an open mind
– Being aware
– Questioning
– How do others do
• Generating choices, options and possibilities
• Comparing and contrasting results
• Seeking to understand underlying mechanisms and rationales
• Viewing our activities and results from various perspectives
• Asking “What if …..?”
• Seeking feedback and other people’s ideas and viewpoints
(Roth, 1989)
Medstar Washington Hospital Center
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Facilitator of Reflective Practice
• Provoke thought and professional development
• Guide discussion
• Talk with v. talk at
(Miraglia, & Asselin, 2015)
Medstar Washington Hospital Center
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Role of the Facilitator
• Facilitates group discussions and reflective practice
sessions each month, promoting professional reflection
and assisting NTP nurses in developing professional
behaviors
• Acts as a point of contact for the NTP nurses
• Assists NTP nurses in dealing with transition to practice
issues that may arise
• Acts as a guide for the EBP project
Medstar Washington Hospital Center
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Next Steps
• Each seminar will have opportunity for reflective
practice during Clinical Reflection or Unit Specific
time with your assigned Educator
• You may have a covering Educator depending on
conflicts but the practice will be the same
• Over next 11 months, will complete two reflective
practice prompts (written)
Medstar Washington Hospital Center
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References
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Atkins, S., & Murphy, K. (1993). Reflection: A review of the literature. Journal of Advanced Nursing,
18, 1188-1192.
Benner, P.E. (2001). From Novice to Expert. Upper Saddle River, NJ: Prentice Hall Health.
Davies, S. (2012). Embracing reflective practice. Education for Primary Care, 23, 9-12.
Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods, Oxford Centre for
Staff and Learning Development, Oxford Polytechnic. London: Further Education Unit.
Roth, R. (1989). Preparing the reflective practitioner: Transforming the apprenticeship through the
dialectic. Journal of Teacher Education, 44(3), 31-35.
Somerville, D., & Keeling, J. (2004) A practical approach to promote reflective practice within
nursing. Nursing Times, 100(12), 42-45.
Price, A. (2004). Encouraging reflection and critical thinking in practice. Nursing Standard, 18(47),
46-54.
Johnson, J. A. (2013, January/February). Reflective learning, reflective practice, and metacognition.
Journal for Nurses in Professional Development, 29(1), 46-48.
Mind Tools. (2015). Gibbs’ reflective cycle. Retrieved from
https://www.mindtools.com/pages/article/reflective-cycle.htm
Miraglia, R., & Asselin, M. E. (2015 March/April). Reflection as an educational strategy in nursing
professional development. Journal for Nurses in Professional Development, 31(2), 62-72.
Medstar Washington Hospital Center
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Thank you
Medstar Washington Hospital Center
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Questions?
Medstar Washington Hospital Center
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Name:________________________
Unit:________ Date:____________
NEW TO PRACTICE NURSE RESIDENCY PROGRAM
Writing Reflective Narrative: Reflection on Practice Template
Reflective Practice is the “Deliberate process of critically thinking about a clinical experience, which
leads to development of insights for potential practice change.”
Why is reflective practice important?
•
•
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It challenges your assumptions.
It supports you in exploring different/new ideas and approaches toward doing or thinking about
things. What can I learn? What can I do to improve my practice? What can I share with others?
It promotes self-improvement (by identifying strengths and weaknesses of your practice,
knowledge and/or skill gaps, and taking action to address them).
It links practice and theory (by combining doing and observing with thinking or applying
knowledge).
It aides in exploring the thoughts and feelings you experienced during a practice situation and
patient care encounter.
Directions:
Choose an event. Some examples of events that you can choose are:
•
•
Clinical situations that occurred on the unit (examples rapid response, patient with uncontrolled pain,
change in patient condition).
Inter-professional: communication with other team members, delegation to support associates, patient
advocate.
Using Gibbs Reflective Model (1988) follow the stages below and reflect on an event, and write about it. The
questions in each box will guide you. You will not need to answer all of them, just those that are relevant to your
event. Use first person when completing the narrative, be specific and concise. When completed, give to you [Nurse
Educator/Residency Coordinator/Residency Facilitator].
Stage 1: Description of the Event – What Happened?
Name:________________________
Unit:________ Date:____________
Stage 2: Feelings/Reaction – What were you thinking? How did you feel about the event/situation?
Stage 3: Evaluation – Evaluate or make a judgment about the event/situation
Stage 4: Analysis – Break the event down into its component parts and explore separately
Stage 5: Conclusion –Focus on learning from the event/situation
Stage 6: Action Plan – Think about encountering the event again and plan what you would do
Name:________________________
Unit:________ Date:____________
Asselin, M.E. & Fain, J.A. (2013). Effect of reflective practice education on self-reflection, insight, and
reflective thinking among experienced nurses. Journal for Nurses in Professional Development, 29(3),
111-119.
Asselin, M.E. & Schwartz-Barcott, D. (2015, May/June). Exploring problems encountered among
experienced nurses using critical reflective inquiry. Journal for Nurses in Professional Development,
31(3), 138-144.
Johnson, J.A. (2013, January/February). Reflective learning, reflective practice, and metacognition.
Journal for Nurses in Professional Development, 29(1), 46 – 48.
Mind Tools. (2015). Gibbs’ Reflective Cycle. Retrieved from
https://www.mindtools.com/pages/article/reflective-cycle.htm
Miraglia, R. & Asselin, M.E. (2015 March/April). Reflection as an educational strategy in nursing
professional development. Journal for Nurses in Professional Development, 31(2), 62-72.
Thompson, N. & Pascal, J. (2012). Developing critically reflective practice. Reflective Practice, 13(2), 311325.
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