Reflection: from staff nurse to nurse consultant

Part 1: the importance of reflection John Fowler

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Recently, I was marking some essays by qualified nurses undertaking a Masters course. The assignment asked them to explore an area of evidence-based practice within their specialty. For many of these qualified nurses, the technique of examining the evidence base was obviously something they were not familiar with. Although they knew the meaning of words like ‘reliability’ and ‘validity’, the application of these ideas into daily nursing practice was a little vague. The same is true of reflection and reflective practice. Most nurses have a general understanding of what is meant by it, but how many of us has the ability to do the equivalent of ‘driving’ the reflective car— or is our knowledge that of the passenger? As the saying goes, they may ‘talk the talk, but can they walk the walk’? If you have not heard that expression before, then spend a few minutes thinking about how it applies to where you work, the people you work with and your own practice. I must admit that for many years, my own knowledge and appreciation of reflection and reflective practice was that of a passenger. I viewed it as a bit of a fad, the latest craze in nursing (we have had a few); the sort of thing that those nurses who did not work in busy clinical jobs seemed to be keen on. My opinion changed when I began talking to a variety of staff who had been involved in some form of clinical supervision. One of the elements of clinical supervision is helping someone to reflect on their practice. As part of this qualitative research I listened to a number of staff who had found that reflective process and experience to be a very powerful tool. Not everyone, admittedly, but too many to be a coincidence. Although that study was about 15  years ago, I still vividly remember one ward sister who was on the verge of leaving the profession, but said that the reflective sessions she had with an experienced supervisor helped her live and work through a difficult time and emerge a much stronger nurse and

person. A health visitor also recalled to me how a reflective discussion with a small group of staff helped her develop a very simple way of helping a new mother with learning disabilities to make up her baby’s bottle to the correct formula strength. I saw first-hand evidence of nurses growing, developing and learning as a result of one specific application of reflection. The other significant point in my life that convinced me of the value and importance of reflection was a piece of work I had to do when undertaking my PhD. I had to draw together and reflect on a number of articles that I had written over the previous few years. I discovered that by thinking about and writing down my ideas, I was learning not only about the topic, but also about myself. If, like many nurses, you are a bit of a passenger when it comes to reflection, then journey with me over the next ten  issues of the British Journal of Nursing as we explore reflection: what it is and how to make it work, not only for your nursing practice but for your general life and relationships as well. The next column in this series, which will appear in the next issue of BJN, will explore BJN different sorts of mirrors. 

Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to primary care trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books

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his new series in the ‘staff nurse to nurse consultant’ column is going to explore and discuss reflection. It will examine some of the techniques that you can use to aid reflection, and how it can work in clinical practice, education and management. It will look at portfolios, reflective learning, helping others to reflect, reflection and feedback, and reflection in life. There are a number of words or concepts that are used in nursing that we are generally familiar with but if asked to describe what they mean, how they work or why they are important, we may find ourselves struggling. The ones that come to my mind are: ■■ Evidence-based practice ■■ Patient-centred care ■■ Holistic care ■■ Reflective practice. I am sure that every nurse is familiar with these terms and if you have completed your nurse education in the last 5 years, it is a safe bet that you will have written an essay on each of those topics. Those of us that trained some time ago will probably have attended study days, read articles or been part of clinical working groups exploring these topics. I have just had a conversation with my 21-year-old  son about driving lessons. Although he has never had a driving lesson in his life, he assures me that all he needs to do is a one-week course and he will be able to pass his test. Because he has been a passenger for 20  years, he thinks he knows all about driving. The same is true, to some extent, for our knowledge and understanding of evidence-based practice, patient-centred care, holistic care and reflection. These are words and ideas that have been part of nursing practice for about 20 years. Most of us use them, if not daily, then weekly, and we do know what they mean—at least in the same way that my son knows about driving. Like my son and driving, many nurses feel quite confident and knowledgeable about these topics.

British Journal of Nursing, 2014, Vol 23, No 3

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06/02/2014 15:23

Reflection: from staff nurse to nurse consultant. Part 1: the importance of reflection.

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