Professional Development
Reflection: from staff nurse to nurse consultant
Part 2: What is reflection? John Fowler
232
expert practitioner and happens while the practitioner is performing their work. The practitioner is aware of the feedback they are receiving; they process the feedback and adjust their actions accordingly. Take the simple example of admitting a patient. A novice or beginner will routinely go through the admission procedure and fill in the assessment form. All their intellectual and emotional energies will be used in assessing what the form requires and completing the patient’s details as required. A practitioner who is working at a more advanced level will have developed the ability to reflect in action, as they perform the admission procedure. They will be picking up on body language and other nonverbal cues; they will be noting physiological measures they are recording and internally reflecting and processing them. As a result of this reflection, they may adjust the admission routine and respond to something that is unusual—maybe a physiological measure of breathing or the patient’s anxiety. They are reflecting in, and during, their action. Reflection on action happens after the event and is usually fairly structured. It can be a formal process, such as a critical incident analysis; it can be semi-structured, as might occur in a discussion with a manager; or it can be quite unstructured, as might occur in a discussion over coffee with a colleague. On each of these occasions, the reflection will be deepened if the person is helped to think about what happened, what the predisposing factors were, what action was taken, what feelings were evoked, what the alternative actions might have been, and what lessons could be learnt for the future. Reflection on action usually, but not always, involves reflection with another person. Reflection in action happens during the event and is far less structured. It usually only involves the individual practitioner and involves being aware of a variety of forms of feedback, processing the information and adjusting actions accordingly. Reflection in action is a bit
like driving a car: you are performing a skilled but relatively routine behaviour, but constantly monitoring the surroundings and adjusting your driving accordingly, almost without being aware of what you are doing. Reflection on and in action are important skills for any practitioner. Developing the quality and awareness of both forms of reflection will increase the individual’s clinical skills and also develop the professional care of the patient. Reflection on action can be developed and increased by regular use, by means of a simple but structured approach, as described above. A skilled manager or clinical supervisor will use reflection on action to develop their staff. Reflection in action can be developed by increasing your awareness of the effects of your actions on yourself and others. Ask yourself questions such as: what is different here? Is this a normal response, or is something unusual happening? Why are my actions causing this? Trying to develop reflection in action is difficult. It requires honesty and self-awareness. But once you begin to recognise it, you will soon realise how valuable a tool it is in helping you develop some amazing clinical skills. The next article in this series will explore some simple techniques to aid the development BJN of your reflective skills. Schön D (1983) The Reflective Practitioner. Jossey-Bass, San Francisco 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
© 2014 MA Healthcare Ltd
T
his new series in the ‘From staff nurse to nurse consultant’ column will explore what reflection is and how it can be applied to your clinical practice. It will examine some of the techniques that you can use to aid reflection and will look at portfolios, reflective learning and helping others to reflect. I’m not a particularly vain person, but today I’ve looked in a mirror four or five times while cleaning my teeth, combing my hair, trimming my beard, checking a spot on my face and reviewing in a full-length mirror my general appearance. Sometimes it was a detailed ‘look’, other times it was more of a glance to check that everything was as I thought it was. In the car, I used mirrors to check what was happening behind me, whether it was safe to move out and to see what was overtaking me. We use mirrors to get feedback on our appearance and what is happening in places that are not in our direct line of vision. If we try to live without using the reflection of mirrors, then life would be quite difficult. Reflecting on our actions, feelings and behaviour is quite similar to our everyday use of mirrors. We spend quite a bit of time reflecting on our actions without being particularly aware of doing it, only becoming aware when something unusual occurs. In clinical nursing, we have become quite good at reflecting ‘on action’ (Schön, 1983). This often occurs after there has been some sort of unusual incident—maybe a cardiac arrest— when a patient dies, or when a relative complains. This is often referred to as ‘critical incident analysis’. The team normally takes time out to reflect on what happened, what led up to it, how we responded, what we can learn from it, and what action needs to be taken. This is reflection on an event after it has happened and is usually a very constructive and useful way of developing clinical practice and enhancing patient care. There is another form of reflection that Schön (1983) identified as reflection ‘in action’. Reflection in action is a mark of a skilled or
British Journal of Nursing, 2014, Vol 23, No 4
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 25, 2015. For personal use only. No other uses without permission. . All rights reserved.
Reflection: from staff nurse to nurse consultant
Part 2: What is reflection? John Fowler
232
expert practitioner and happens while the practitioner is performing their work. The practitioner is aware of the feedback they are receiving; they process the feedback and adjust their actions accordingly. Take the simple example of admitting a patient. A novice or beginner will routinely go through the admission procedure and fill in the assessment form. All their intellectual and emotional energies will be used in assessing what the form requires and completing the patient’s details as required. A practitioner who is working at a more advanced level will have developed the ability to reflect in action, as they perform the admission procedure. They will be picking up on body language and other nonverbal cues; they will be noting physiological measures they are recording and internally reflecting and processing them. As a result of this reflection, they may adjust the admission routine and respond to something that is unusual—maybe a physiological measure of breathing or the patient’s anxiety. They are reflecting in, and during, their action. Reflection on action happens after the event and is usually fairly structured. It can be a formal process, such as a critical incident analysis; it can be semi-structured, as might occur in a discussion with a manager; or it can be quite unstructured, as might occur in a discussion over coffee with a colleague. On each of these occasions, the reflection will be deepened if the person is helped to think about what happened, what the predisposing factors were, what action was taken, what feelings were evoked, what the alternative actions might have been, and what lessons could be learnt for the future. Reflection on action usually, but not always, involves reflection with another person. Reflection in action happens during the event and is far less structured. It usually only involves the individual practitioner and involves being aware of a variety of forms of feedback, processing the information and adjusting actions accordingly. Reflection in action is a bit
like driving a car: you are performing a skilled but relatively routine behaviour, but constantly monitoring the surroundings and adjusting your driving accordingly, almost without being aware of what you are doing. Reflection on and in action are important skills for any practitioner. Developing the quality and awareness of both forms of reflection will increase the individual’s clinical skills and also develop the professional care of the patient. Reflection on action can be developed and increased by regular use, by means of a simple but structured approach, as described above. A skilled manager or clinical supervisor will use reflection on action to develop their staff. Reflection in action can be developed by increasing your awareness of the effects of your actions on yourself and others. Ask yourself questions such as: what is different here? Is this a normal response, or is something unusual happening? Why are my actions causing this? Trying to develop reflection in action is difficult. It requires honesty and self-awareness. But once you begin to recognise it, you will soon realise how valuable a tool it is in helping you develop some amazing clinical skills. The next article in this series will explore some simple techniques to aid the development BJN of your reflective skills. Schön D (1983) The Reflective Practitioner. Jossey-Bass, San Francisco 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
© 2014 MA Healthcare Ltd
T
his new series in the ‘From staff nurse to nurse consultant’ column will explore what reflection is and how it can be applied to your clinical practice. It will examine some of the techniques that you can use to aid reflection and will look at portfolios, reflective learning and helping others to reflect. I’m not a particularly vain person, but today I’ve looked in a mirror four or five times while cleaning my teeth, combing my hair, trimming my beard, checking a spot on my face and reviewing in a full-length mirror my general appearance. Sometimes it was a detailed ‘look’, other times it was more of a glance to check that everything was as I thought it was. In the car, I used mirrors to check what was happening behind me, whether it was safe to move out and to see what was overtaking me. We use mirrors to get feedback on our appearance and what is happening in places that are not in our direct line of vision. If we try to live without using the reflection of mirrors, then life would be quite difficult. Reflecting on our actions, feelings and behaviour is quite similar to our everyday use of mirrors. We spend quite a bit of time reflecting on our actions without being particularly aware of doing it, only becoming aware when something unusual occurs. In clinical nursing, we have become quite good at reflecting ‘on action’ (Schön, 1983). This often occurs after there has been some sort of unusual incident—maybe a cardiac arrest— when a patient dies, or when a relative complains. This is often referred to as ‘critical incident analysis’. The team normally takes time out to reflect on what happened, what led up to it, how we responded, what we can learn from it, and what action needs to be taken. This is reflection on an event after it has happened and is usually a very constructive and useful way of developing clinical practice and enhancing patient care. There is another form of reflection that Schön (1983) identified as reflection ‘in action’. Reflection in action is a mark of a skilled or
British Journal of Nursing, 2014, Vol 23, No 4
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 25, 2015. For personal use only. No other uses without permission. . All rights reserved.
