What is reflection?

Learning through reflection is a powerful way of learning. It is a means by which you learn by thinking about things that have happened to you. As a consequence of reflection you may see things in a different way, which in turn enables you to take some kind of action (Jasper 2003). The aim of reflection is to encourage you to examine and explore your behaviour, thoughts, feelings and attitudes.

Please read the following example of reflection by a first year nursing student.

1st year nursing student Joe O’Shea is with his preceptor engaged in reflection on his first experience of caring for a patient who was dying. Through the process of reflection he learns that in such a situation he finds it incredibly difficult to know what to say, feeling a large degree of unease, anxiousness and indeed vulnerability. Reflecting on the experience, he identified that much of his time with the patient was simply spent being present and remaining silent. He discovered that his unease lay in his silence, believing that he should have been distracting the patient from the enormity of their situation, offering condolences and sympathy, ‘doing something’.

In critically thinking about his experience with his preceptor in light of empirical evidence, theoretical opinion, and her experiential knowledge, he identified that the simple act of ‘being present’ with the patient was a powerful means of providing comfort and support in and of itself.

Nurses, he learned, have a potential to alleviate existential and spiritual suffering through ‘consoling presence’ (Tornøe et al, 2014). Hospice nurses revealed that sharing silence with patients can have a powerful consoling effect and that embracing the silence demands a mental shift from focusing on “doing something for the patient” to focusing on “being with the patient”. This, he learns, demands enormous personal courage. Not having a “professional mask or task” to hide behind can make a nurse feel open and vulnerable.

This was a revelation, giving voice to Joe’s initial feelings of vulnerability. He learned that what initially felt like inaction on his part was in fact a powerful means of caring for a dying patient. His need to ‘do something’ though powerful, was resisted, demonstrating personal courage on his behalf. Thinking back on it, Joe identified that it was an unconscious act, one engaged in by accident, rather than design. Equipped now with this new understanding and learning, Joe plans to actively incorporate ‘consoling presence’ and ‘sharing silence’ as part of his plan of care for those he has the privilege of caring for in their final days.

This example demonstrates Joe critically examining his experience in order to look for the possibility of other explanations and alternative approaches to doing things. He has learned from it. This is evidenced by a change in the following;
Behaviour: Will now actively engage in the skill/practice of ‘consoling presence’.
Knowledge: Of the concept of ‘consoling presence’, its impact, its pre-requisite (courage).
Attitude: Self-confidence – ‘can do’ when faced with similar situations.

Guidance notes used by School of Nursing and Midwifery UCC students to aid their reflective process while on Clinical Placement 

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Why do I need to reflect on my practice?

There are many reasons why you need to reflect on your practice and your learning. Reflection helps you to acknowledge your thoughts and feelings, thereby enabling you to scrutinise and learn from what you do. Reflection may prompt you to embrace new ideas and better ways of doing things, it enhances your learning and provides a mechanism and structure from which you can develop consistent methods of improving your practice. Reflection helps you to evaluate and improve your skills and make clearer links between theory and practice. Reflection assists you to identify your own learning needs and develop your practice further by creating a learning plan to fulfil those learning needs. Reflecting on practice will identify for you your own core decision making skills, help you to problem-solve and assist you in developing your critical thinking and self-evaluation skills.

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What should I reflect on?

You can reflect on anything that occurs in
(a) your formal learning environment, i.e. in classroom-based tutorials, in workshops, in laboratory practicals etc. 
(b) your non-formal learning environments, for example learning during your clinical placement. Learning in everyday life may be referred to as informal or impromptu learning, for example learning from an occurrence in your weekend work, on the choice of cough medicine that you got from the pharmacist etc.

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How can I reflect?

•  Your course coordinator may suggest a particular framework to guide your reflection. Examples include Gibb’s Cycle (1988), Kolb’s learning cycle, the IIoP (Irish Institute of Pharmacy) or COD (Continuing Professional Development Cycle) 
•  Use the chosen framework to structure your reflection.
•  Keep a personal diary to help capture and record your thoughts and feelings as they occur. This will be an invaluable reminder when you complete subsequent reflections. 
•  Start writing as early as possible, in your own words. You may find it helpful to refer to the literature for examples of how to write reflectively e.g. Burns & Bulman (2000). While there is no right or wrong style of writing up your reflections, these guidelines may make it easier for you. 
•  You should make reference to local policies, procedures and literature that have relevance to your reflective notes, particularly in the analysis section.
•  You need to make time to write up your reflections.
•  A good tip when writing reflections is to write something, leave it, return to it later and then try to question yourself on different aspects of this experience.
•  When reflecting on clinical or community placement experiences remember to maintain confidentiality and anonymity of the individual, staff and placement area.
•  Your placement tutor, preceptors, link lecturer, and/or other students may advise you on structuring your reflective notes. It may help you to get started by talking through an experience with someone in your support network. 
•  Remember that reflection is a skill that you can develop, so the more you practice the better you will become.

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What is considered a good reflection?

To be effective and constructive, reflective writing needs to go beyond description of events and your own associated feelings into analysis and  proposed purposeful or intentional action (Girot, 2001)

Depending on your level of study, you may need to:

• Step back, explore and critically analyse your role in the experience.
• Consider the different perspectives of others involved.
• Make connections with relevant research, theoretical and experiential knowledge supporting your ideas with reference to literature and research.
• Show awareness of wider issue or factors that may have impacted on the experience e.g. historical, social, economic, political, cultural etc.
• Demonstrate what you have learned and what you intend to do as a consequence of that learning.

Please view this sample CPD reflection guide for more insight.

THIS IS AN EXCELLENT YOUTUBE video ON REFLECTIVE WRITING https://youtu.be/QoI67VeE3ds   prepared by Hull University

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What is meant by the reflection process?

The reflective process means the stages of thoughtful activity that you go through when you consciously decide to explore an experience (Jasper 2003). There are many ways or approaches employed to facilitate the reflective process. These are known as modes of reflection e.g.

• Reflective writing (journal/diary keeping, e-portfolio development)
• Self- reflection
• One to one reflection with a ‘critical friend’ (Taylor 2000)
• Group reflective practice sessions
• Clinical supervision- individual, group, peer

It is suggested that most reflection will be done on your own (Jasper 2003) using the medium of reflective writing. However, no matter what approach you take whether or not you are engaged with a ‘critical friend’, writing up a learning log or an ePortfolio entry, a framework through which the process is structured is critical in order that your experience is examined in a critical and systematic way.
Numerous frameworks or cycles have been developed to guide the process of reflection e.g. Gibbs, Johns, Schon, Kolb cycles.
http://www.bradford.ac.uk/wimba-files/skill-space/Reflective_Writing_HTML/page_04.htm

All frameworks broadly encompass 3 fundamental questions to ask yourself about your experience:
1. What happened?
2. So what am I to make of this?
3. Now what can I do to make the situation better?
(Borton 1970 cited in Rolfe et al. 2001)

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How do I know my reflection is complete/enough?

The success of writing reflectively is in completing the reflective cycle. It is often not the subject nor the content of what you reflect on that is necessarily important but its analysis in terms of what can be drawn out in understanding and learning (Role et al., 2001). Your chosen cycle will facilitate you to achieve a ‘good reflection’ as outlined above, because its stages/cues will prompt you to examine your experience in a critical way.  

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