Discuss about the Reflective Skills in Nursing.
Reflection is an essential human activity whereby people examine their actions and practice, think about it and then develop these practices to enhance knowledge in any given field. Many times, reflection is connected to the concept of learning from experience whereby a person critically thinks about what happened and why it happened and from the lessons learnt, one can prevent the same thing happening again. According to Jacobs (2016), reflection is a skill that can be acquired and practiced effectively with time and this is good news especially in nursing practice. Fowler (2015) suggests that reflection is an ongoing process that can be developed and in which experience and reflection are inter-linked. In nursing practices, reflection is a vital component which affects all levels including student nurses as well as professional nurses.
Research shows that nurses who commit themselves to learn reflection skills are in a better position to understand their actions and improve their nursing practices. Researchers also suggest that reflection practices assist in applying theoretical concepts in real life situations in a more structured way (Sharples, 2011). This means that using own ideas learnt in class, one use reflection to find solutions in their lives and of those who are close to them. In nursing, reflective practice is an essential tool because it helps nurses to make sense of work and ultimately, to improve the healthcare sector. This paper will therefore critically analyze how nurses can adapt reflective skill, the models of the practice, practical application, and its significance in the nursing field.
For the last 20 years in nursing and healthcare sector, there has been much debate about the importance of teaching reflective skills to student nurses. From these discussions, there is evidence that those nurses who are willing to learn these skills find them helpful and supportive in the long run. Research shows that for reflective skills to be developed successfully, the relationship between students and their mentors is very crucial (Ekebergh, 2014). Additionally, developing these skills depends with the learner’s attitude, mindset, and willingness to learn. In relation to this, the following models/frameworks will significantly assist student nurses to reflect on their experiences and actions and in return, improve their professional skills.
Gibbs (1988) model of reflection is a framework that is commonly used in nursing and other departments in healthcare sector. The model guides us through a cycle of six stages whereby Gibbs prompts learners to look at their actions and experiences and then formulate a plan of action so that they develop their practices in future.
Stage 1: description
This section requires the learners to think what they are going to reflect about and why they need to reflect. What event, idea, or incidence triggered the thought of reflecting in the first place? A learner can start by writing down what they are going to reflect about or else share it with a friend or a family member. At this stage, it is advisable to keep the incidence private and not share it with another person until a decision is made about exactly need to be reflected. After that, the learner can decide on whether they want to share the incident or continue with the refection without telling it to another person (Garrity, 2013). During this stage, there are several questions that one can ask to decide what should and should not be included in the reflection and they include and not limited to;
It is essential to keep the information provided clear and to the point avoiding information that is not necessary.
Stage 2: Feelings
At this stage, try to recall thought and feelings. Discuss the things that made you feel happy or dissatisfied. During this stage, the learner may find it a bit difficult to share with others and decide to keep the incident to themselves. However, regardless of things may be, always try to be honest to avoid complicating the whole process (O’Reilly & Milner, 2014). Some of the questions that can be considered here are;
Stage 3: Evaluation
By evaluation, it means that thinking about what happened by asking about if it is good or bad about how things went (Price, 2013). What is important at this stage is looking deeply at what happened and making a judgment. Therefore, the kind of questions appropriate to ask here are;
What was good about the experience?
What was the bad thing that happened?
Why/why not
Was there a solution afterward?
Stage 4: Analysis
This stage involves looking at the event in a more detailed manner to understand what triggered or hindered the event in the first place (Price, 2013). At this stage, the learner can also compare the experience with theoretical ideas that they have. Some of the questions that can be asked here are;
Stage 5: conclusion
Here, the learner has more information after exploring the experience from different angles. It is here that the learner is supposed to make judgments and acknowledge what was learnt from the experience. Talk about what could have been done differently and if the experience or the incident was a positive one, talk about if you can do it again to achieve the same results. Do not forget to talk about change if the experience was negative because the purpose of reflecting is to learn from experience. Explain what could have been avoided and plans to make sure the same thing is not repeated under the same circumstances (Anderson, 2013).
Stage 6: Action plan
The last stage of development cycle whereby the student is supposed to think of the way forward and think of what needs to be done differently if they encounter the same event in life. The main question at this point would be what you would do differently or are you likely to do the same again? Gibbs ends the cycle by suggesting that the next time an event occurs, it will be the start of another cycle altogether (Ekebergh, 2007).
Atkins and Murphy is another model that is recommended for nursing students who would wish to develop reflective skills. Murphy and Atkins (2014) developed a reflective model for nursing which explains five stages of developing reflective skills. This model assists nursing students in reflecting situations in clinical work that they feel is useful in their practice and future career in nursing. This model helps students to identify what is learnt from experience and then relate it to theoretical literature learnt in class or researched.
Self-awareness
According to Finch (2016), self-awareness is the ability to be conscious of whom we include our thought, strengths and weaknesses, believes and surrounding. Self-awareness also involves how one sees themselves through other, culture education, background, and the society. Typically, self-awareness involves how one relates to the inner self, other people and the surrounding environment. Booles (2016) states that self-awareness includes how one sees themselves from the inside (inner self) and how they see themselves from other people’s side (outer self). It consists of all manner of behaviors such as appearance and communicating whether it is using verbal or non-verbal skills. Many scholars describe self-awareness as the foundation of reflective practice because it underpins the whole process of learning. Research also shows that it is the ability to have personal knowledge that distinguishes reflection from other skills such as creative thinking and critical thinking. Therefore self-awareness is critical in developing reflective skills in nursing because it assists students to analyze their beliefs and feelings and then applies them to theoretical ideas learnt in class (Lomax & Jones, 2014).
Having an understanding of self-believes as a professional nurse assists in creating interpersonal relationships with patients and helping them in the healing process. It is of the essence to acknowledge that some people develop this skill naturally while others have to learn about it in their adult lives maybe for professional purposes (Ekebergh, 2007). For learners, therefore, honesty, confidence, and willingness to learn is vital because the passion for looking at oneself positively must come from within and extended to other people. In this case, nursing students ought to sacrifice more of their time and be close to their mentors to develop this skill which is needed so that they can relate well to their patients. However, it is important to understand that regardless of how one feels about themselves it is good to release the feelings whether they are positive or negative as long as it is done at the right time and place. Balancing both situations is essential as too much negativity undermines oneself (Taylor, 2010).
Description
Description means stating the appearance or characteristics of a person, object, event, or an idea without being judgmental. A description can be done through writing, word of mouth, painting, and drawing. (Jasper, Rosser & Mooney, 2013) In nursing, the ability to describe a sickness or healthy practices is crucial because a person who is good in describing does not exaggerate the situation or give judgments. In fact, it enables nurses to relate to the patient’s condition and try to look for solutions on how to help their patients. It also assists nurses to explain to their colleagues about a particular condition verbally without omitting or adding anything. Additionally, it assists nurses to write clear and comprehensive notes about a situation or an event. In other words, it is all about trying to make someone who was not there when an event occurred from your perceptive through painting a vivid picture which then enables you and others to think about the situation. Some people are naturally good at description while others find it hard to express themselves (Jasper, Rosser & Mooney, 2013). Often people lack the right words to talk about what had happened with their colleagues in which case they end up using terminologies which are not well understood by the listeners. Regardless of whether one is naturally good at describing or is learning to develop the skill, it is of the essence to use a carefully selected word to bring out the best picture of a situation or an event (Cox, 2009).
Analysis
Analyzing involves looking at a situation from different angles and asking questions that will help a student to understand what exactly triggered an event to occur fully. It involves dividing the situation into smaller constituents to get a clear meaning and see how these components are related to each other. In reflecting analyzing includes a critical analysis which means that judgment can be done by weighing the strengths and weaknesses of a situation (Willsher, 2014). Critical analysis means looking at both sides of a situation equally and if used on a daily basis, can lead to negative results because it is about finding faults. However, regardless of the judgment after critical analysis, the process is important for a nursing student because it helps identify strengths and weaknesses of a situation which then assists in finding a solution to eliminate the positives while working with the strengths (Willsher, 2014). For example, nurses can use the positives to evaluate the needs of individual patients as well as making contributions to the whole healthcare service. Additionally, weaknesses can be used as opportunities for changing things and moving on from what has already happened. Research shows that critical analysis can be used to solve problems by acknowledging beliefs and values. In the nursing profession, nurses find themselves in unique and compromising situations which require them to use personal knowledge and experiences to find a solution. In this case, the outcome of the situation will depend on the person’s believes and behaviors (Lomax & Jones, 2014).
Evaluation
Evaluation is defined as a process of looking at a situation as a whole and looking at what was good or bad about what has already happened. It means bringing ideas together and trying to thick why something happened and what was the outcome. In short, it can be described as the opposite of analysis (Jacobs, 2016). Generally, evaluation is all about being creative in the midst of a problematic situation and coming up with a most appropriate solution. In nursing practice, evaluation is a critical component when it comes to developing a patient plan because it needs students to look at different sources and then bring all the ideas together to come up with something positive. Different patients require specialized and unique plans depending on their medical history and condition at that moment. A good medical plan is flexible and dynamic depending on the patient’s needs (Regan & Onello, 2013). Evaluation is necessary when reflecting because it includes coming up with new ideas which are then inter-linked with personal feelings and believes in developing insights that did not exist before so that you and other can learn from it. To achieve effective results from reflection, evaluation is, therefore, a must. In an assessment, deciding whether to introduce change or work with old ideas is of the essence because whichever the decision, one must critically think about it depending on the scope of what is available at that particular moment. At this point, the idea of listening to what others have to say about the situation is of importance because the idea of synthesizing a situation alone is a difficult one. Asking for opinions is helpful in this case because it gives one different choice to think about (Taylor, 2010).
Identify learning
After everything has been done and said, is there anything learnt from the reflection process? This process involves making a final judgment about the value of reflecting on a situation. It includes determining whether the goals of reflecting have been achieved or not. In nursing, this concept can be used to access if there is any progress in the healing process of a patient (Cox, 2009). Identifying learning is a critical component in reflective practice because it is about facing the facts. The idea of identifying learning sometimes make students feel uncomfortable because they are unsure of what others are going to say about the results and it is natural and acceptable if someone wants to avoid the process altogether. As it is reflection is a personal exercise which requires one to make a judgment on personal feelings, values, and believes even though they received opinions or observations from other people. At the end of it all, it is all about being who you are and what you believe in or what you feel. What can be learnt is that reflection is not supposed to be a self-torture; instead, it is supposed to be an opportunity to change things in future (Pai, 2016)
It is evident therefore from this reflective model that most of the skills learnt here are meant for nurses who are beginners in the reflective journey (Regan & Onello, 2013).
For a student to fully reap the benefits of developing reflective skills, it is important to acknowledge the existence of barriers in the learning process (Cronin & Rawlings, 2014). By doing this, the learner will be able to make necessary changes to achieve positive outcomes in future. There are many challenges to practicing reflection for a nursing student but more importantly, one should strive to overcome these barriers no matter the cost so that they can effectively reflect their experiences when delivering in the nursing practice. Time is one of the constraints that prevent learners from fully developing reflective skills. Sometimes, it is challenging to complete reflection within fixed deadlines and this means that time should be considered before embarking on reflection journey (Pai, 2016). It is therefore necessary to realize that effort and enough time is required to develop reflective skills in nursing effectively. The other challenge faced by leaners in developing reflective skills is lack of self-motivation.
As earlier mention, reflection is a process of looking back at things that have already happened and trying to learn from the experiences surrounding the event. Sometimes, it becomes challenging to get something positive from experience especially if the experience had affected the learner negatively. In this case, a learner may feel discouraged to relate such an experience with ideas and a situation, especially in professional practices. In other words, failure to move on from what had happened in the past is a barrier in the reflective process. The other challenge in reflective practice is fear to be judged or criticized by other people if they share about an incidence they want to reflect about. People feel comfortable and shy off from reflecting on personal experiences because they fear about how people are going to react or say about them (Hannigan, 2011).
However, the good news is that these barriers can be overcome if one takes the process positively and tries to see the good side of it and taking the negatives as an opportunity to change things for future benefits. The issue of time as a barrier can be overcome if students and their mentors try to honor the process by allocating enough time for the exercise. Since the practice is a complex task that needs a lot of time and dedication, a learner can find a quiet place where there is minimal disturbance during the evening or early morning to do the exercise (Tashiro et al. 2012). Additionally, time constraint can be overcome by being dedicated and committed to achieving nothing but the best from the development process. The issue of motivation and can be handled by accepting that not all students have the strength to ponder on something that happened to them and most probably did hurt them whether positively or negatively. Students can beat this challenge by looking for someone they trust and then share the idea with them so that they can get the energy to start the reflection process (Taylor, 2013). In developing reflective skills, mentors and tutors should acknowledge the existence of personal differences amongst students. Some students are comfortable when working alone while others thrive when working as a group. In this careful, it is crucial to give learners an opportunity to choose the system they are comfortable working with. Last but not the least; it is advisable to see reflection as a continuous process and arena for personal and professional growth. Learners in nursing need to realize that it is for their personal and professional benefit that they are learning these skills so that they can be motivated. In relation to this, dedication, commitment and working closely with mentors is essential (Asselin & Cullen, 2014).
Today nurses are working under pressure arising from the ever-increasing needs of the aging population, public expectations, and hard economic times. Nurses are always in the forefront in the provision of emotional and psychological support to patients to assist them in the healing process. To deal with these pressures which seem to be endless, nurses are encouraged to develop skills that will help them develop new insights so that they can understand themselves better (Lindsay, 2016). By doing this, they will be in a position to take care of themselves, their careers, and their patients. In connection to this, having the ability to reflect on personal experiences and relating them in nursing helps nurses to relate to their patients. The fact that nurses work in an environment filled with human vulnerability, trauma, stress, and injuries stresses the need for nurses to acquire these skills. After all, have been said about reflective skills in nursing, the following are some of the attributes of reflection to a nurse student or professional nurse (Souter, 2013).
Learning through mistakes
The primary purpose of reflecting is to learn from past mistakes. For nursing professionals who would wish to develop personally and professionally, reflection is essential in that through evaluating failures and accomplishments; one can gain knowledge about a current situation and use the experience to find a solution. Learning from experience means taking time and profoundly thinking how an incident came to occur and what could have been done differently. By doing this, a nurse can be prepared to face a similar incident should it happen again because he/she is ready to face the result whether they are positive or negative (Balla et al., 2009).
Confidence
For a nurse student who has to apply theoretical literature in practical nursing, having reflective skills is an added advantage. It is natural to panic if a mistake happens or worse still if plan goes opposite of what is expected. However, in such a situation, reflection can be applied whereby a nurse can reassess the procedure and make improvements confidently. Reflecting on a similar situation which was successful and relating gives nurse confidence to go on with the procedure. Similarly, practicing nurses who use reflective skills seem to be more confident when faced with a challenging situation whereby they can challenge themselves and others using an experience (Willsher, 2014).
Different approaches
Reflection helps improve traditional approaches to nursing by coming up with new and modernized practices and procedures. Stadter (2015) suggests that through reflection a nurse can identify a solution and come up with different ideas and better methods of getting a solution. Students can use the Gibbs model to come up with new approaches in nursing practices through reflecting on a procedure. Additionally, nurses can be able to detect an error before it occurs and then analyze the situation to see how it can be solved. Through reflection, a nurse can make sense out of a challenging situation and can use it as a reminder that learning is a continuous process and there is no end to it whatsoever (Regan, 2010).
Improve the healthcare sector
On a broader view, nurses can use their reflection skills to improve and introduce positive changes in the healthcare. Through their personal experiences, nurses can improve patient care and the whole sector in general. To achieve these, nurses need to have a positive attitude and possess the necessary knowledge concerning the situation on the ground. Reflection gives nurses knowledge to improve themselves, their careers, patients and the quality of care. On the other hand, reflection helps nurses to share experience with others and through this; the quality of patient care is improved. Having nurses who can be able to reflect on their nursing practices is the best thing can happen in the healthcare (Morris & Stew, 2017).
Artistic practice
Possessing reflective skills comes with artistic skills for nursing practitioners. Artistic skills enable a nurse to see practical situations from different angles instead of focusing on only traditional sources. As a nurse, it is crucial to be able to bring past experiences to formulate the best approaches to handle a difficult situation. A nurse who can practice this in a difficult situation is considered to be ‘knowing in action’ (Hébert, 2015).
Eighteen years ago, I was a student nurse during my first placement. During my third week in the hospital, I was assigned to work in an acute ward where I was supposed to look after cancer patients. One of my patients who I will call Maria for confidentiality and privacy purposes was in a critical condition and it was difficult to tell how her condition would be. Mary was a strong woman in her early fifties and she always s afforded a smile regardless of how ill she was. Sometimes I would spend time with her talking about so many things and many are times I encouraged her to be positive but at times, I lacked words to tell her for her to feel motivated. The lady was regularly visited by her daughters and sons who were always curious what will come out of their mother. Every time they visited, they would look for me to keep them updated about their mother’s health.
During such moments, I would feel trapped because I would vividly remember the doctor saying that he was not sure how the treatment would turn out to be. During my practice as a student I realized that I would be able to explore my experience further in such a situation. Having been in my placement for only three weeks, I realized that I lacked enough knowledge and experience to deal with this situation. Sometimes, I would feel like running away from the whole situation because I hate it when I lack answers in such sensitive issues. When I was attending to Maria, I felt so much pressure, fear, and anxiety, lest she asked me about her condition and when she would be out of that bed. Personally, I always feel obliged to want to help people and relieve them the pain they are going through and the feeling of not having the ability to help Maria made me feel inadequate. One of the important things I realized from this experience is that there is a sharp difference between caring for people and my job. At times, we may not have all answers in all situations (Rowe, 2015).
After critically thinking about the events surrounding Maria’s condition and using the reflective skills that I have, I decided to be open and share with her children about her health. Although I could not protect them from sadness and fear of losing their mother to cancer, I realized that I could at least make them understand that I very well knew how hard it must be to lose a mother like Maria. I learnt that if I continued to hide the truth, I was not doing any good to the children because at the end of it, they would be having false hopes about their mother’s recovery. From that day, I became more confident when faced with similar situations where I did not have answers for situations which put me under pressure. Although I still feel anxious and concerned about a patient’s health where I do not have answers, I always prefer to be honest and open instead of giving people false hope. I now know that I cannot have answers to all questions but better still, I can offer necessary support where need be (Cross, 2014).
Conclusion
Reflection is an essential practice not only in nursing but also in other fields. In nursing reflective skills are vital because of the emotional nature of the work. Reflection is not only beneficial to nurses but also to patients and even the healthcare in general. From the critical analysis of reflection literature, it is evident that reflection is a continuous process which is developed through various processes such as self-awareness, description, analysis, evaluation, and identifying learning. Essentially, all frameworks of reflection encourage nursing students and professionals to practice reflection for their own sake and that of their patients. It is also clear that there are challenges that face learners when developing these skills but fortunately, these barriers can be overcome through a positive attitude and dedication of those who are involved in the process. Finally, those who take the initiative to learn about reflection benefit from it by becoming confident in the patient care, and also gaining knowledge to handle stressful situations. In future, I would like to gain more insight especially in Advanced Emergency Management in trauma and come up with new approaches that will help improve the healthcare sector.
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