Author: Clare Hopkinson
Reflection is a key aspect of the personal and professional development that nurses are required to undertake to keep pace with the changing nature of practice. It helps ensure safe and effective evidence-based care by allowing nurses to constantly improve their skills.
This article brings a fresh perspective to Gibb’s Reflective Cycle for nurses starting out in practice and shows how critical reflection can be used as a systematic and thoughtful approach to improve and develop skills. It also explains why it is necessary to go beyond this model and includes ideas and activities for how to put this into practice by keeping a diary.
Why is Reflection important for nurses?
We all engage in the kinds of conversations in which the shortcomings of systems, organisations or other people are identified and where simple solutions for making things better are suggested. Unfortunately, the same cannot always be said in relation to ourselves: indeed, we rarely engage in conversations that identify our own shortcomings, let alone provide solutions for improving our performance as nurses. If nothing else, reflection provides an opportunity to review the effects and consequences of our behaviour and actions.
By using a structured form of reflection it can enable you to identify your role in an incident and to help you to begin to understand how the incident might have been avoided altogether. From this a plan of action can be constructed to assist you with personal and professional development.
To develop is to improve. Development occurs when things can be said to have improved. Development is intimately bound with thinking; thinking about the way things are now and thinking about the way things might be improved: and to engage in thinking about things in this way is to engage in reflection. Thus reflection is an essential feature of development, and as suggested above, most of us engage with this type of activity on an everyday basis. We might not normally call this ‘reflection’ but when we think about how things are and how they might be improved we are reflecting on what is and what might be.
Personal development is personal improvement, while professional development involves improving experiences of health and nursing care for patients. So in a professional sense, engaging with reflection (i.e., thinking about how things are and thinking about how they might be improved for patients) must be accompanied by action (i.e., actually doing something in an attempt to make things better for patients). Thus reflection is an integral part of personal and professional development.
Gibbs Model Of Reflection
The simple cyclical structure of Gibbs’ model makes it easy to use and popular among nurses. It is useful as it emphasises the link between reflection and action (and this can assist in setting a personal development plan). However, it neither encourages consideration of other people in (or affected by) the event nor does it require examination of motives, values, knowledge, or congruence between thoughts and actions. While action-based and thus relevant for professional development it may not encourage deeper reflection of self and thus may be limited in terms of personal development.
Reflective Nursing Journal
A deeper understanding of ourselves can be achieved through writing. Written reflection is a common theme in the literature as a way of reflecting on action but it is strewn with confusing language. There are learning logs, journals, portfolios, structured accounts, reflective models, reflective reviews and personal diaries. Some reflective writing is public (e.g., a portfolio for an assignment) while other writing is private (e.g., a diary). Through writing, nurses can be encouraged to reflect on critical incidents from practice (I prefer the term ‘stories of experience’). These stories are usually prompted by some emotional or ethical discomfort. Stories can focus on positive or negative experiences and allow you the chance to view events from a distance, considering:
• What happened, paying attention to the context and detail of the story.
• What you did and why you did it.
• What you felt about the experience and how this may connect with past experiences.
• What you have learned about yourself, others, your practice.
• What were the gaps in your knowledge, attitudes and skills.
• What could be done differently.
• How your practice has changed now you have read or considered a different way of working.