Fundamentals of Nursing and Midwifery 2e

Unit III Thoughtful practice and the process of care

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Reflection does not just happen; it is a skill, and therefore must be learnt in order for it to provide us with continual learning opportunities. If reflection is the window through which we can focus on self within the context of our experience, we must develop an understanding of the techniques that guide our reflection at a practical and critical level. Johns (2000) has developed ‘the ten Cs of reflection’ (Box 13-2), which he sug- gests incorporate the essential elements required for reflection. The presence of each of these elements is essential for effective reflection. You may wish to use the ten Cs to guide you in reflecting about a past issue (reflection-on-action) or to prepare you for future action (reflection-for-action). By regularly using and becoming familiar with each of the ten Cs, you should find that they become part of your everyday reflective practice. Models of reflection Within this chapter we will explore three reflective models commonly used in nursing and midwifery preparation for prac- tice and in professional portfolios. These models have many commonalities but vary in complexity, from the simplicity of the Gibbs model, through Johns’ model for structured reflec- tion to the more complex Mezirow model used for critical reflection. The Gibbs and Johns models are discussed below. The Mezirow model is discussed opposite. Commitment Believing that self and practice matter, accepting responsibility for self, having the openness, curiosity and willingness to challenge normative ways of responding to situations. Contradiction Exposing and understanding the contradiction between what is desirable and actual practice. Conflict Harnessing the energy of conflict within contradiction to become empowered to take appropriate action. Challenge and support Confronting the practitioner’s normative attitudes, beliefs and actions in ways that do not threaten the practitioner. Catharsis Working through negative feelings. Creation Moving beyond self to see and understand new ways of viewing and responding to practice. Connection Connecting to new insights within the real world of practice, appreciating the temporality of experience over time. Caring Realising desirable practices as everyday reality. Congruence Reflection as a mirror for caring. Constructing personal knowing in practice Weaving personal knowing with relevant extant theory in constructing knowledge. BOX 13-2 The ten Cs of reflection

Gibbs’ reflective cycle The reflective cycle developed by Gibbs (1988) is a basic model for reflecting on clinical practice. It is easy to apply to a range of situations and asks individuals to construct their stories through the use of critical questions at each stage of the cycle. This is a good model for those who are new to using reflection as a mechanism for learning about self and practice. See Figure 13-3 for an illustration of this model. Think of a recent situation that would be useful for you to reflect on. Consider the key elements that occurred. Follow the steps of Gibbs’ cycle by asking yourself each of the questions shown. Try to answer openly and honestly, and document your answers. What did you learn about the situation, the context, the people involved, your actions and inactions, your emotions, the contradictions between desired and actual practice, and any conflict that arose for you (or others)? Have you developed any new insights about yourself or others? Have you related your present experience with past experiences and any future experiences you may have? What have you learnt about yourself and/or about your practice? Johns’ model for structured reflection The model for structured reflection (MSR) developed by Johns (Box 13-3) takes into account the need during reflec- tion for us to look in (towards self) as well as out (at the situation itself). Johns (2009) cautions, however, that although this model, and the previous models, are presented as a series of logical steps that enable a progression of thoughts, reflection is not a linear process to be imposed upon people or situations. In particular, he stresses that reflection is not a concrete technical activity in which the situation is made to fit the model; rather, it should be used creatively to enable the individuals to see themselves in the context of the situation itself.

Description What happened?

Action plan If it arose again what would you do?

Feelings What were you thinking and feeling?

Conclusion What else could you have done?

Evaluation What was good and bad about the experience?

Analysis What sense can

you make of the situation?

Figure 13-3 Gibbs’ reflective cycle (1988)

Source: Johns, 2000.