Fundamentals of Nursing and Midwifery 2e

Unit III Thoughtful practice and the process of care

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R E S E A R C H I N P R A C T I C E

Reflection in practice

• Uncover our knowledge and thinking • Apply new ideas and, hopefully, • Learn from the experience of reflective practice itself. The following section on reflective cues provides some basic questions that will enable you to reflect on the way you are currently working in clinical practice situations. By using these cues you will be able to develop a clearer under- standing of yourself and of the way in which you develop person-centred relationships. Reflective cues Cues are the pieces of data that the clinician collects through observation, reading records and talking to patients and others in order to solve a problem, as explained further in Chapter 14. Reflective cues are the pieces of data, or cues, that evolve from the act of reflection and help us to think and act in response to the patient’s individual needs in a person-centred way. Throughout this text, wherever you have encountered the reflective cue icon you have undertaken a reflective exercise using the cues, or questions, asked regarding the scenario described. These cues have prompted you to examine each situation in order to become more self-aware, to consider all the issues and to learn to work in a person- centred manner. In this way, the cues given in the scenarios you have encountered so far have been helping you to develop your self-awareness and reflection abilities as funda- mental parts of your thinking. Developed in this way, the process of reflection becomes a part of how you think and act, rather than being questions you consciously ask yourself in order to care for a particular patient. This, of course, takes time. The kinds of cues that can help you to develop this ability are shown in Box 13-6. Note that the questions listed focus on the person (the patient) as well as on self (you). In this study, a qualitative, explorative, descriptive and contextual research approach was used to explore the theoretical and practical experiences of critical care nursing students through guided reflection. The researchers facilitated reflection-on-action (retrospec- tively) on one nursing care incident chosen by each of the participants. Johns’ model for reflection was used as As previously noted, reflection is seen as an essential nursing skill by many registering authorities. Related research De Swardt, H.C., du Toit, H.S. & Botha, A. (2012). Guided reflection as a tool to deal with the theory– practice gap in critical care nursing students. Health SA Gesondheid , 17(1), 1–9.

These kinds of questions help you to pause and think about your own values and beliefs, and then to reflect on how these might affect your relationship with the person. Paying atten- tion to this process will enable you to become more self-aware. Self-awareness means you can make decisions, and then act, at a conscious level rather than simply doing things without thinking. In our everyday life we often undertake tasks without thinking through what we are doing or why we are doing it—we just do it. We have a ‘formula’ for under- taking certain tasks, and we follow this without question. For example, consider the task of taking a person’s blood pressure. When we first learnt to do this, we were very aware of every step in the process: how to prepare the person, where and how to place the cuff, how to position the arm and the stethoscope, how to inflate and then slowly deflate the cuff, how to measure the pressure and record it on the chart, and then of course how to use our knowledge of blood pressure levels to decide whether to report the find- ings to another nurse or to a doctor. Each of these steps was interwoven with our knowledge and understanding of the process, of the physiology of the body, of the person’s con- dition and so on, and when we first learnt to undertake blood pressure monitoring we were very conscious of all of these things. However, a few weeks or months later, we are able to measure a person’s blood pressure without thinking about each distinct step. With practice, it has become routine. Much of what we do in practice can become routine in this way. However, we must always remain alert so we can iden- tify those situations that fall outside the usual routine. Often it is only when something deviates from the normal pattern (e.g. if the person’s blood pressure has been steadily increas- ing over the past two hours and they are now mildly hypertensive) that we once again become aware at a con- scious level and prepare ourselves to act on such findings a basis to design an instrument for guided reflection. The main themes that emerged were a description of the incidents experienced, and a critical analysis of knowledge, feelings and the changed perspective expe- rienced. The data showed the participants went through a series of cognitive and affective processes that trans- formed understanding of theory and practice. Guided reflection offered the participants the opportunity to deal with complicated experiences, which resulted in a changed perspective on the theory–practice interface. Relevance to practice The findings of this study support the use of reflec- tion in professional practice, by providing evidence that through reflection, nurses are considering and improving their practice.