Reflective Practice in Nursing Communication

This assignment looks at the study of theoretical reflection in conjunction with how effective communication skills can be developed to expand our knowledge. To achieve this I will explain what reflection practice is using models of reflection; evaluate theories of personal development – what they are and how they are used. Discuss how reflective practice benefits communication skills and in turn influence our knowledge of nursing care.

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What is reflection?

In scientific terms reflection is seen as light, heat or sound striking a surface to give off a reflection (Darlene 2006). Reflection is also seen as philosophical understanding of how one can gain knowledge through experience and use different approaches to the same scenario (ref). Reflection can be described as; meditation, deep thinking and or giving careful considerations to possibilities and opinions of a given situation (Mcferran and Martin 2008).

The novel idea of reflection rose from a theorist John Dewey (1859-1952); his proposed view on reflection is described as persistent, active thinking and taking into consideration the supporting evidence that forms knowledge to the given situation. This theorist suggests that the person uses their mind and emotions to facilitate reflection (Bulman and Schutz 2008). This suggests that John Dewey describes reflective individuals has being open-minded, responsible and wholehearted (Vaugn and Leblanc 2011).

Dewey’s perception of reflection was a platform for many authors to elaborate on in terms of understanding reflective practice. Johns and Freshwater (2005) propose that health professionals should find the meaning of reflection through description rather than definition because to define reflection is to suggest the author has authority over its meaning. This in turn allows reflections models and frameworks to be used intuitively giving a more holistic approach, it can be subjective and purpose driven (Johns and Freshwater 2005).

Mann et al (2007) describes Schon’s (1983) view that reflection can happen in two ways: reflecting upon activities whilst they are happening called reflection in action (present reflection) and reflecting upon activities once they have happened (reflecting on the past). Reflection can also be seen as the engine that facilitates superficial learning into finding a deeper understanding that enables the practitioner to transform what is known to knowledge in action (Boud et al 1985 cited in Rolfe et al 2011).

Reflection (Broad overview)

Describe some of the different theories and models of reflection that are available and how they are used. Explain how reflection can aid personal development.

Schon, reflection on and in action – Models of reflection, Driscoll’s, Atkins and Murphy, Gibbs, Johns, Kolb.

Reflection Model and frameworks

There are many different models of reflection which seem to have similar philosophical theories attached to each approach. Rolfe et al (2011) asserts models are methodologies and frameworks are methods used to understand and give guidance on how use the chosen reflective model and models therefore are ontological this mean they have formal specifications for representing ideas and concepts that aim to improve personal growth and development.

Model’s of reflection developed by Schon and Argyris (1992) involves three elements: (1) knowing-in-action (2) reflection-in-action and (3) reflection-on-practice (Ghaye and Lillyman 2010). Ghaye and Lillyman (2010) have extrapolated Schon’s work to include knowing-in-action; they propose that practitioners ‘customise’ and ‘tailor’ their own knowledge or theories to the situation presented. Knowing in action is described further by Carper (1978) who identifies five approaches to knowing in action; empirical, personal, ethical and aesthetic knowing ( Newton and McKenna 2009).

Empirical knowing is the formation of knowledge organised into general laws and theories for the describing and predicting phenomena pertaining to nursing practice (Averill and Clements 2007). Empirical means of knowledge tends to seek out theoretical explanation which can be replicated and be publicly verifiable (Newton and McKenna 2009). Newton and McKenna (2009) further suggest that empirical knowledge can only be effective when it is interpreted within the context of given clinical situation and how it is assimilated into practitioners personal knowledge.

Personal knowing described by Carper (1978) is about finding out how much we know about ourselves when faced with clinical challenges and that health care professionals may not necessarily know about the self but do strive to know about the self. Newton and McKenna (2009) state that Caper (1978) does reiterate that it is difficult to master however it is an essential in understanding nursing care. Newton and McKenna (2009) suggest that personal knowing demands a deeper level of understanding and awareness to communicate and interact with ourselves and others. This type of knowing requires the nurse to be empathic, nurse attempt to do this by developing a personal yet professional relationship between the patients as opposed to viewing a patient as an object (Newton and McKenna 2009). Moral actions and ethical choices are intertwined with personal knowing to which Carper (1978) suggests presupposes personal maturity and freedom.

Ethical knowing is about the moral aspect of nursing that is concerned with making choices, making justifiable actions and judging outcomes (Newton and McKenna 2009). The main focus of ethical knowing is trained towards issues of obligations that would require rationalisation and deliberate reasoning (Carper 1992). Chinn and Kramer (2004) suggest that rational can be expressed through codes, moral rules and decision-making. Newton and McKenna (2009) assert that having knowledge of moral issues is not isolated to ethical codes of nursing disciplines for example the Code of Conduct written by the NMC (2010). Newton and McKenna (2009) assert that ethical knowing is only partly learnt through applying codes and moral rules but is more through experiencing situations that initiate reflection upon what is or has happened and how this affects patient care.

Gibbs( date) Driscoll(dates)and Kolb ( date)all conjured reflective models which are each similar to one another; they are all cyclical – reveals that learning through reflection about what is or what has happened is continuous cycle. Gibbs et al (1988) model please see appendix 1 (a)

Do you know of any other models that perhaps don’t take on such a cyclical approach… consider the work of Chris Johns, Mezirow, Boud et al also…. How do they compare and contrast with each other? Why might one model of reflection suit one situation or context better than another?Think about which models promote single loop or double loop learning if you can.

Reflective practice (Specific)

Give an overview of how reflection is used in nursing. Explain its relevance to nursing and how and when it is used. Explore the concepts of reflective practice and critical incident analysis.

Introduce use of reflection for personal development. CPD, self regulation. Identify the different situations where reflection can be used. Skills V critical Incidents – what is a critical incident.

Reflective practice is seen has using reflective techniques to improve, maintain change in clinical procedures and influence guidelines to encourage greater safety of patients in all areas of health organisations (Bulman and Schutz 2008).

Health care organisations in the UK have undergone and still continue to undergo changes to how it is regulated (Rolfe et al 2011). The emphasis is largely associated with increasing patient safety and risk reduction (Rolfe et al 2011). The four main bodies in the UK; Royal College of Nursing (RCN), Nursing Midwifery Council (NMC) and General Social Care Council (GSCC) and General Medical Council (GMC) which are concerned with the controlling, training and regulating of the healthcare system in UK (Rolfe et al 2011).

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Evidence-based studies have taught the NHS and regulatory bodies how to change practices and procedures to create better outcomes for patients, they have also encompassed further development for staff to promote a better use of resources through continuing professional development CPD (Ghaye and Lillyman 2010). An example of this could be the pressure sore nurses taking on the responsibility of giving guidance to non-specialist nurses to take care of patients with such conditions. This could not have been achieved if it was not for reflective thinking being part of the learning process (ref).

How do we use reflective practice within our day to day practice? Consider the approaches that mentors take when supporting students, look at the principles involved in preceptorship and clinical supervision…

Communication skills (Application)

Discuss and analyse how reflection can be utilised to improve your communication skills in practice. Explore how and when you would use it. What practical steps would you take and what resources would you utilise and why.

Link reflection in and on action to communication situations – giving information (in), breaking bad news (on), then use of journals, models, writing, peer support.

Conclusion

Sum up

You have made a solid start at this assignment so far and have introduced many ideas which are relevant to the topic. These themes now need to be explored in greater detail . You have a slight tendency to introduce theoretical concepts ( not all of which are uncomplicated) without fully explaining their meaning…. Take care to avoid this as just mentioning them does not mean that you understand them and we will be looking for evidence of understanding. You also need to pay attention to your sentence construction as there are several poorly constructed sentences noted so far…. Make sure that when you lift them from the text you have referred to , that you do adapt them to make sense in the context that you are trying to use them. I would like to have a look at this piece when it has been developed a bit more. You are definitely heading in the right direction though and overall have made an effective start.