Reflection which have been carried out. Girot, R. (1997).

Reflection has been described as thinking back to experiences which have happened or situations you may have been in before, one way to help establish tacit and intuitive knowledge (Johns and Freshwater 2005). Reflection is a process which can change individuals and their actions (Ghaye and Lillyman 2010) and as stated by John’s 2013, it is a way to realise why things have happened and how they may have happened. Tacit knowledge is described as having an understanding about something and intuitive means being aware of links between experiences which have happened before.

Howatson-Jones, L. (2010). Reflective practice in nursing. Exeter, Angl.: Learning Matters.

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Girot in 1997 defined reflection as:

‘Reflection is …  a way of thinking about what you do; in some sort of objective way . From a process of exploration, it then encourages  you to make sense of that experience and learn from it to help you in the future. The most important aspect of reflection is learning from the experience.  

(Girot, 1997, pg 39 )

Girot is suggesting that reflection is an active process which involves thinking about your actions. He says that reflection should be objective rather than subjective as this will help you to make more sense of reflection and it will also allow you to develop your knowledge further by being objective. He recognises that reflection is purposeful and is a process in which we go through consciously in our lives and careers. Girot is suggesting that we learn from the event and we explore our actions. Reflection is not a passive process, but simply a way of exploring the actions which have been taken then we have to explore those actions, make sense of them and then learn from the actions which have been carried out.

Girot, R. (1997). Reflective Skills. In: Maslin-Prothero, S. (Ed.)  pg 201-206.

Critical reflection is about weighing up and evaluating an incident which occurred in depth. It is about evaluating our actions and our own responses to practice situations in a critical way. It is about learning through experience rather than just learning from theory. Critical reflection is a very important part of reflection as it allows us to gain an insight into the self and it creates knowledge which could be useful for when you are in practice. Critical reflection is about helping us to grow in our personal life rather than just in our careers. John’s (2004) suggested that:

‘Reflection is not primarily a technology to produce better patient outcomes. Reflection is about personal growth.’

(Johns 2004, pg 44)

 

 

 

John’s said that reflection is not just about helping patient’s, but it is also for helping the healthcare professionals who are giving the care to the patient’s, helping them with their personal and professional growth. It allows them to learn about who they are, the term used to describe this is ontological. It suggests that we view reflection as a way of helping us to explore who we are as human beings and as healthcare professionals. This then allows us to develop our intellectual knowledge and use it in practice effectively.

Jasper (2013) in the book “Beginning reflective practice”, suggested that the way in which one reflects could be different to the way in which another individual reflects upon a situation or practice. It depends on what model they use. These models are more like guides to help reflect, they give cues and a style on how to breakdown experiences to reflect on them.

Jasper, M. (2013). Beginning reflective practice. Andover: Cengage Learning.

The two main theorists who have looked deeply into reflection and developed theories which support it and show how it can be carried out, they are John Dewey (1859-1952) and Donald Schon (1930-1997).

Dewey (1933) questioned the idea of commanding theoretical understanding of learning. Dewey suggested that to develop our learning/knowledge it needs context and experience. He looked at normal action and reflective action. Reflective action is guided by authority and conventional values. Reflective action is about intelligence and knowledge surrounding certain issues and situations. However, he suggested that emotions and feelings play apart while reflective action is taking place. In 1938 Dewey said:

“We learn by doing and realising what came out of what we did”.

Dewey (1938)

Dewey, J. (1933). How we Think. Boston: DC Health and Co.

Dewey, J. (1938). Experience and Education. New York: Macmillan.

Schon’s theory of reflection was based upon the idea of retrospective critical thinking. He suggested that we reassemble incidents later, this will then help practioners to develop their knowledge. In 1983 Schon suggested that professional practice is unpredictable and messy. He argued that technical rationality does not produce enough information for healthcare professionals. Schon believed that its more than just intelligence its associated with how that person is feeling and the emotions they have. Schon’s theory suggests that the knowledge healthcare practioners have can be obtained through the practice of reflection.

Schön, DA (1983). The Reflective Practitioner. New York:  Basic Books.

 

 

 

Reflective models help us to reflect and improve knowledge based upon incidents or situations practioners may have been involved in. These models will ask questions and give headings to help reflection. They are the framework to lead people through the reflective process. These models allow practioners to focus on their experiences in structured style. One model of reflection was developed by Goodman (1984).

Goodman’s level of reflection. Goodman (1984) implied that there are 3 levels to reflection for which a healthcare professional could conclude. When we begin our reflection in practice, we are only expected to be going through Goodman’s first level (Goodman 1984). The first level is based on how descriptive someone may be. It requires the basics to be written down, so the facts of what happened. It also requires you to show awareness of what is going on at the time. This is viewed as making a connection to the efficiency, effectiveness and accountability of an individual’s actions. At this level a reflective account could be discussed with a supervisor. As we progress through our professions, we then move onto the second level.

Jasper, M. (2013). Beginning reflective practice. Andover: Cengage Learning.

Goodman believed that in his second level o reflection, we begin to see our learning and then also start drawing up conclusions about the situation. This then allows us to use those conclusions if we are ever in a situation like the one that has happened. This is also where theoretical ideas come into place to help us understand and explain what has occurred in the situation. Goodman believed that at this level of reflection, it shows the perception of the meaning of professional and personal morals. Goodman’s third and final level of reflection has included acknowledgement towards other influences, which have ethical and political influences, on how care is delivered. This stage is based around relating it to the framework of care through the norms which society sets out and constraints, for example, health policies.

Jasper, M. (2013). Beginning reflective practice. Andover: Cengage Learning.

In contrary to Goodman’s levels of reflection, Graham Gibbs developed his model of reflection in 1988 and used Kolb’s (1984) Experimental Learning cycle to help develop each stage of his model on reflection. This model is one of the most well-known and used models by healthcare professionals. Gibbs (1988) suggested that there are 6 stages in model to allow reflection to take place. He put forward the idea that if a situation has been fully looked back upon, a full analysis could be taken regarding that situation through using precise questions at each of the stages in the model. This model focuses fully on the experience itself. Its main two focuses are the incident which has occurred and the individual’s actions during and after the situation. Below is an example what Gibb’s (1988) model of reflection looks like and the questions that should be thought about at each stage, from the Oxford Brooke’s website page:

 

 

 

The Reflective Cycle (gibbs 1988) Gibbs model of relction. (n.d.). Retrieved from https://www.brookes.ac.uk/students/upgrade/study-skills/reflective-writing-gibbs/

The Reflective Cycle (gibbs 1988) Gibbs model of relction. (n.d.). Retrieved from https://www.brookes.ac.uk/students/upgrade/study-skills/reflective-writing-gibbs/

 

 

 

 

 

 

 

 

 

 

 

 

At the start of my course, I went on a three-week placement to a GP Surgery. Below is a description of a critical incident that I witnessed. It does involve a patient, but I will be keeping the patient’s personal information private and confidential, apart from the reason for them needing an appointment. I will be using Gibb’s (1988) model of reflection to help me develop my knowledge from this experience.

During my three-week observational placement at a GP surgery in north wales, I was being mentored by a practice nurse at the surgery. A young female had made an appointment to have a smear test done. When the patient got called her name by my mentor and came into the clinical area, my mentor informed the patient of who I was and why I was sitting in the room during the consultation, she asked the patient if she was comfortable with me being in the consultation. My mentor went through the patients details and information, she also explained what the smear is done for and why she was having it done. The nurse/my mentor then explained what would happen and how the smear test would be carried out. My mentor then asked the patient if she would be comfortable with me (a student nurse) observing the smear being carried out. The patient said she was happy for me to observe. I then asked the patient if she was happy for me to observe and that I understood if she did not feel comfortable having me observe the procedure. The patient was then taken to the bed and area where she could remove any items of clothing on the lower section of her body, the curtain was then drawn to respect the patient’s dignity me and the nurse waited outside the curtain until the patient was ready for us to enter the area. Throughout the procedure, the nurse explained to both me and the patient was she was doing. I asked the patient if she was okay and comfortable and okay. Once the nurse had completed carrying out the smear test, both me and the nurse went back around the curtain to allow the patient to get changed. Once the patient was ready, the nurse explained how she would receive her results and the appointment then ended.

My feelings throughout and after observing the procedure was mixed. I feel very fortunate to have been able and allowed by both my mentor and the patient to observe a procedure such as this one, as they can be very awkward and uncomfortable for all parties involved. While the procedure was taking place, I felt a little bit embarrassed and nervous. I think this is because it was the first ever time I had witnessed a procedure which involved an intimate and personal part of the body.  However, throughout the smear being taken, I always made sure that I was aware and respected the fact that for the patient they may have been feeling embarrassed and nervous due to the nature of the smear test.

Looking back at my time observing the critical incident and how my mentor conducted herself and treated the patient. I feel as though my mentor handled it very well and professional, especially as the reason for the patient seeing the nurse for a smear test, it can be very difficult for both the patient and healthcare professional. Throughout the appointment, from when the patient entered to when the she left, my mentor respected the patients right to dignity and always made sure she received consent from the patient for anything which needed consent throughout the consultation.

One thing which could have maybe be done to help keep the patient relaxed is before the smear test took place, either me or my mentor could have looked the door to prevent anyone from entering the room or disturbing the consultation. Even though this incident did not occur, it is a concern that women having a smear test has. From doing research online, for the best practice when having to take a smear test, on Jo’s trust charity website which had been set up to support women who have been diagnosed with cervical cancer and encourage women to have smear tests done, it noted the issue of a door not being locked as a concern that women can have. It stated that:

“Many women tell us that they worry someone will come in during their smear test, so ensuring you explain to your patient that you are locking the door and why, will help them feel at ease.”

By just locking the door, it can help make the patient feel a bit more comfortable and more at ease with the situation. It will make it easier for both the patient and healthcare professional.

In-text: (Jo’s Cervical Cancer Trust, 2017)

Your Bibliography: Jo’s Cervical Cancer Trust. (2017). Best practice prior to taking a cervical screening test (smear). online Available at: https://www.jostrust.org.uk/information-healthcare-professionals/information-practice-nurses-and-gps/best-practice-prior-taking Accessed 13 Jan. 2018.

From observing this critical incident, it has defiantly enhanced my learning experience while on my observation placement at the GP surgery. It has made me think about how I would handle a procedure like this. One thing I would always remember to do throughout the test is to remember to respect the dignity of the patient and always make sure that I have gained consent off the patient. I would make sure that I would show compassion and that my communication was good when speaking to patients. This is so they are aware of the procedure they are having and, so they fully understand what they are giving their consent to. Dependent on the communication needs in which the patient required, I would tailor it to show respect and it would allow the patient to keep their dignity.

 

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