The Reflective Professional
As health professionals move from novice to expert, they are constantly gaining experience and integrating new knowledge. Active reflective practice improves the integration between learning, experience and applied practice.
It is a given that society expects nurses to practice safely and to undertake what is necessary to keep up to date. Reflection helps us to self-correct where the notion of continuous improvement becomes habitual to our practice. (Usher & Byfield, 2021)
Reflective practice is increasingly considered to be a critical dimension of professional development for health professionals. It facilitates personal and professional growth and development, and improved outcomes for clients. Professional standards and credentialing processes for health professionals in Australia, especially the standards focused on continuing professional development (CPD), often require demonstrations of reflection or reflective practice.
Professionals can use reflection both in the moment (reflection-in action) and after the event (reflection-on-action) (Schon, 1992). Reflection-in-action occurs in the moment, while making decisions during practice. Reflection-on-action is used to after an event to review what has occurred and prepare for similar situations in the future. Reflective practice can also allow a practitioner to process emotions like stress, trauma and grief, and build resilience. For graduates, it can be a valuable way to process and document complex and demanding clinical situations, or difficult interpersonal relationships. Reflective practice underpins critical thinking and reasoning and can reduce occupational stress.
“Reflection will help you to recognise and set aside the emotional content and enable you to learn from otherwise negative experiences.”(Usher & Byfield, 2021)
Reflective practice can also involve consideration of the 'bigger picture' contexts and environments of clinical practice. As part of examining the patterns of healthcare practice, a reflective practitioner may identify instances when optimal practice is being hampered or overruled by the environment, for example by resource limitations or institutional norms. Reflecting on these issues can be challenging, and can lead to difficult decisions for health professionals about what they choose to tolerate. Some practitioners have reported that reflective practice led them to increase their advocacy for patients or challenge the systems in their work environment.
How do professionals reflect?
Reflective practice is a skill that can be learned, improved, and developed into an ongoing routine. It can be based on any moment of practice, but is frequently used when the regular flow or the expected sequence of practice is disrupted by a specific case or experience.
When engaging in reflection following a situation, it can be useful to pose questions about the experience:
- What happened?
- Why?
- What was my role?
- What was the role of the client?
- What was the context, and did this influence the situation?
- Were there any systemic factors that influenced the situation
- What was the outcome?
- How was this similar or different to what I expected/ to my past experience/ to my theoretical understanding?
- Did I make assumptions? Did I have evidence to support what I did?
- What have I learned and how can I use this learning in the future?
Answering these questions requires a degree of honesty and willingness to learn and grow.
Organisational Reflection
Reflective practice is most often seen as a private, individual activity; however this is not the only form it can take. Some healthcare organisations and services will make reflective practice routine and institutionalised. This may include:
- Reflective supervision: Supervision of staff by a more senior colleague who facilitates and promotes reflection and personal and professional development.
- Communities of practice or learning networks: Groups of professionals with a common interest who regularly share practice experiences with the intention of using the group to facilitate reflection. These can operate within organisations or externally, and may include professionals from a range of services and backgrounds, facilitating a sharing of ideas.
- Clinical meetings and case presentations: Reflective practice can occur during team discussions in formal or less formal ways. These discussions can review particular challenges, their underlying causes, and potential solutions or optimal ways forward.
- Discussion of critical incidents: During discussion of practice moments when things have not gone to plan and outcomes for clients are less than optimal, opportunities for reflection can arise. These are most effective when the discussion is conducted in the spirit of improvement, rather than blame.
Engaging with others can lead to new perspectives, valuable advice, and collective improvements to practice. In the absence of organisational practice, some practitioners - especially those who benefit from active or discussion-based learning styles - develop a 'critical friend' and incorporate a dialogue-based style into their reflective practice.