Reflective Practice

A Tool for Professional & Personal Growth

What is Reflective Practice?

Key skill for healthcare

professionals

1

Manage impact of caring

2

Process of making sense:

events, situations, actions

3

Individually, facilitated

groups, both

4

“transform a situation in which there is obscurity, doubt, conflict and disturbance of some sort into a

situation that is clear, coherent, settled and harmonious” (Dewey, 1986)

Reflection PracticeTheory

Skills

Experience

Reflective Practice

https://hhs.hud.ac.uk/lqsu/Sessionsforall/supp/Sch%C3%B6n%20reflection-in%20and%20-on%20action.pdf

Theory

Skills

Experience

Reflection Practice

Thinking on your feet!

http://infed.org/mobi/donald-schon-learning-reflection-change/

Reflection PracticeTheory

Skills

Experience

Theory

Skills

Experience

Reflection Practice

http://infed.org/mobi/donald-schon-learning-reflection-change/

Why Reflective Practice?

Emotional cost to caring for the vulnerable

Confronted with deep-seated human needs and anxiety

Change agents in the lives of people

Healthcare providers must have

Interpersonal skills

Self-awareness

Ability to influence others towards positive change

Reflective practice facilitates the development of these skills!

Natius Oelofson, updated 2015Image by H. Aguiar

Benefits of Reflective Practice

Redefining understanding of professional knowledge

Expanding personal knowledge or self-awareness

Evaluating appropriateness of actions

►Personal & Professional Growth

IpAC Unit, Australia, ECU (not dated)

A Reflective Practitioner

Reflects on feedback and integrates changes in practice

Reflects on how own perceptions, attitudes and beliefs impact practice

Identifies knowledge deficits and seeks clarification

Ensures procedures for safety and quality assurance are implemented

Models of Reflective Practice

Reflective Thought Consists Of…

Developing a sense of the problem at handDeveloping

Enriching that sense with observations of the relevant conditionsEnriching

Elaborating a conclusionElaborating

Testing that conclusion in practiceTesting

Natius Oelofson, updated 2015

Kolb’s Learning Cycle (1984)

Concrete Experience

(doing / having an experience)

Reflective Observation

(reviewing / reflecting on the

experience)

Abstract Conceptualization (concluding / learning from the experience)

Active Experimentation (planning / trying out

what you have learned)

Saul McLeod (updated 2013)

Gibbs’ Model of Reflection (1988)

Description Feelings Evaluation Analysis Conclusions Action Plan

Rodrigo (2016)

Simple, Practical Framework - Oelofson

Step 1: Curiosity•What exactly happened?

•Why did we deal with the situation in that way?

•What else could be happening?

•What was it like from the patient’s perspective?

•What are my feelings about the situation?

•How did it affect me?

•What was the impact on us as a team when that happened?

Step 2: Looking

closer

“Zoom in” on reflections from

step 1. Use different angles/

perpsectives.

Step 3:

Transformation

Turn sense-making into

action. Finding ways to

articulate content and

process that allows positive

changes to be made

Natius Oelofson, updated 2015

Reflective Practice & Burn-Out

Self-Reflection = Caring for self

Normal Olsen, 2014; Lautebach & Becher, 1996; Palmer, 2007

Purposeful reflection is a tool to help gain

self-knowledge and insight.

Practicalities

Journal Writing

Journal writing – more than just experiences

• Revisit feelings

• Re-evaluate experience

Journal can create footprints

•Easier to remember what we have learned

•Identify progress made in personal growth

Framework can be

beneficial

Example - Description

15 year-old female, colloid cyst

Younger brother has cystic fibrosis will need lung transplant

Brain dead

Organ donor – all organs perfect and transplanted

Liver recipient, teacher, post-suicide attempt through OD

Example Feelings

• Emotional – young person, brother’s illness• Family present• School friends present• Healthcare team• Course of events

• Accepting death• Personal beliefs• Brain death new to me• Testing helped to accept and understand

• Needed to see the heart stop• Why? Cultural• OR felt cold

• Liver recipient• Did they deserve the liver?• Is it fair in relation to others in need?• Why am I struggling with this?• What if it was an emotional decision?• What if saving their life will change many

others?• Maybe even save other lives?• Who would deserve the liver?• What would happen if we could

determine who gets the organs?• Where is the line?• Do I have all the facts to truly know?

Example - Evaluation

Allowing family to observe brain death testing was most effective

Patient was well managed, all organs pristine

Family care was great

OR was very clinical

Lack of staff debrief, left to make assumptions

Not clear what type of family support provided in follow-up

Example – Analysis

Review every step

Admission course

Referral for donation

Family and friends’ care

Brain death testing and declaration

Donation conversation

Preparation for OR

Organ recovery process

Aftercare

Staff

Family

Example - Conclusions

Involving family in brain death testing – yes or no

OR process to create reverence of moment

Debrief for healthcare team

Better outcome information

Information about post-family care

Example – Action Plan

Create process flow for cases

Normalize the healthcare professional’s experience

Provide regular, intermittent huddles for debriefing along the way

Create moment of silence for OR

Create a post-case debrief process

Request outcome follow-up

Clinical Supervision

Clinical supervision is “a formal process of professional support and learning which enables

individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and

safety of care in complex clinical situations.”

UK Department of Health, 1993

Clinical Supervision

Uses reflective practice and share experience for professional development

Varies by organization

Policies in place to frame and set expectations

Quality improvement

Risk management and performance management

Systems of accountability and responsibility

Royal College of Nursing, 2003

Clinical Supervision

Aims to:

Motivate while being client-centered and focused on safeguarding care

Benefits:

Improved service delivery through use of evaluation systems

New learning opportunities

Improved staff recruitment and retention

Improved efficiency and effectiveness

It is NOT:

Management tool to assess performance

Disciplinary process

Royal College of Nursing, 2003

Variety of Models

Educative (formative)

Supportive (restorative)

Managerial (normative)

Structured meeting

Meet with other specialties

Meet with other organizations

One-to-one

Peer group

Group supervision with leader

Clinical Supervision

Carefully structured

Clear aims and objectives

Template for structure:

A process

An evaluation system

Outcomes to measure success

Define ground rules and responsibilities / contract of commitment

Confidentiality

Open and honest, active listening

Seeking research for evidence-based practice

Facilitating new learning opportunities, etc.

Thank You!