Reflective practice in health

The reflective process has the potential to enable the beginning health practitioner to learn from their professional experiences, to link theory and practice gaps, and to describe and understand their own feelings and influence, in clinical practice. 

Engaging in this process will help you develop skills as a reflective practitioner, perhaps become part of discussion groups and also provide an opportunity to give vent to incidents and experiences.

To guide you through the reflective process, steps are outlined under reflective writing.

What is a reflective professional?

As health professionals move from novice to expert they integrate learning attained through active reflection on their practice experiences. Doubts and frustrations in practice; the moments when you are forced to stop and think “what will I do now?”, frequently promote reflection. The health professional needs to consider the issues and possibilities for action before an action can be trialled and evaluated in an effort to resolve the doubt or frustration.

Professionals reflect both in the moment (reflection-in action) and after the event (reflection-on-action) (Schon, 1983). Both types of reflection inform what the health professional does in any particular situation, and also in situations that are similar in their future practice.

Why is reflective practice important for professionals?

• Reflective practice facilitates personal and professional growth and development, and improved outcomes for clients.
• Reflective practice is increasingly being considered as a critical dimension of professional development for health professionals.
• Professional standards and credentialing processes to demonstrate continuing competence for most health professionals now require demonstrations of reflection or reflective practice.

Kinsella (2001) argues that action without reflection leads to meaningless activism, while reflection without action means we are not bringing our awareness into the world. Her preference is for a balance of action and reflection.

Many authors recognise the need to consider the contexts in which we practice and to understand that the “good intentions” (Townsend, 1998) of health professionals can be overruled by practice contexts and resource limitations that don’t facilitate or allow optimal practice. Reflecting on these issues can be challenging as decisions need to be made about what one can and cannot tolerate. It may promote professionals to become advocates for their clients or to challenge the systems and practice contexts in which they work. Considering the consequences of challenges is an important part of reflection prior to action.

How do professionals reflect?

Reflection requires routines and habits that can be learned and practiced. Reflection can be based on any moment of practice but is frequently used when the regular flow or the expected sequence of practice is disrupted. The professional poses questions of themselves and the experience:

•    What happened?
•    Why?
•    What was my role?
•    What was the role of the client?
•    What was the role of the context?
•    What was the role of the system?
•    What was the outcome?
•    How was this similar or different to what I expected/ to my past experience/ to my theoretical understanding?
•    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.

Actions of the reflective professional

1.     Acknowledge all practice as a learning opportunity.
2.     Think about what you do and the meaning of your practice experience regularly.
3.     Create opportunities to share your practice experiences with others.
4.     Examine the assumptions behind your practice.
5.     Compare the theory of your practice to what you actually do
6.     Consider the systemic influences that impact your practice, imagine positive improvements and advocate for these through action.

(Adapted from Kinsella, 2001)

Reflective services

Services in which health professionals work can be more or less reflective. Reflective services find ways of making reflection routine and institutionalised. This might include regular supervision of all staff with a more senior colleague, that is facilitated to promote reflection and personal and professional development. Communities of practice or learning networks are growing in popularity in the health professions. These are groups of people with a common interest who regularly share practice issues with the intention of using the group to facilitate reflection. These can operate within services or may link professionals from a range of services and backgrounds allowing the cross fertilisation of ideas.

Clinical meetings and case presentations may identify particular challenges and promote team discussion and reflection on underlying causes and potential solutions or optimal ways forward. Critical incidents (practice moments when things have not gone to plan and outcomes for clients are less than optimal and could potentially be critical), provide opportunities for reflection and improvement but will be most effective if conducted in the spirit of improvement rather than blame. Reflective services acknowledge that there are limitations to what can be known and that people choose the wisest actions given their limitations (Cervero, 1992). Staff are not pushed to work beyond their capabilities or sphere of professional expertise.

• Kinsella, E. A. (2001). Reflections on reflective practice. Canadian Journal of Occupational Therapy, 68(3), 195-198.
• Schon, D. (2009). The reflective practitioner: How professionals think in action. New York: Basic.
• Cervero, R. (1992). Professional practice, learning and continuing education: An integrated perspective. International Journal of Lifelong Education, 11, 91-101.
• Townsend, E. (1998). Good intentions overruled: A critique of empowerment in the routine organization of mental health services. Toronto: University of Toronto Press.