Physiotherapy Reflective Essay Example


Original Editor - Michelle Lee Top Contributors - Michelle Lee, Tony Lowe and Tarina van der Stockt

Introduction

Originating from the work of Donald Schon[1] the concept of reflective practice is recognised as a key component of developing and maintaining professional best practice in many disciplines. This practice in the healthcare context is termed clinical reflection and is a set of skills commonly developed from university level. With the ever growing pressures for service development and self progression this is now an essential skill that should be put into practice regularly by every health care professional. [2]

So this page is going to run through:
  • What is reflection and why we use it
  • The reflective journey 
  • Different methods of reflection

What is Reflection / Reflective Practice?

Reflection and reflective practice is advocated by many professional bodies to promote high quality service delivery, but what is reflection and reflective practice? Here are some definitions: 

  • "Reflection is a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice" [3]
  • “Reflective practice is something more than thoughtful practice. It is that form of practice that seeks to problematise many situations of professional performance so that they can become potential learning situations and so the practitioners can continue to learn, grow and' 'develop in and through practice” [4]
  • "a window through which the practitioner can view and focus self within the context of his/her own lived experience in ways that enable him/her to confront, understand and work towards resolving the contradictions within his/her practice between what is desirable and actual practice” [5]

Clinical reflection is a tool which enables the individual to learn from their experiences and actions, this is not only applicable in the health care setting but through day to day life. It enables the individual to learn from mistakes and poor choices they take and acknowledge when things have gone well so this can be repeated; but to clinically reflect and utilise this skill in the health care setting needs some practice, as this requires critical thinking. [6]

Watch this video on reflective learning to find out more.

The Reflective Journey

It has been acknowledged that critical reflection in clinical practice is essential for clinical effectiveness and continuing professional development. There is evidence to suggest that critical reflection is difficult without expert guidance, therefore educational institutions are now incorporating this into their programmes to establish this skills early in the individual's professional career. Reflection and critical analysis is a skill which needs to be practised in order to be developed. [7][8]

Quite often student health care professionals will start of their reflective development journeys by being given the task of keeping a reflective journal or diary of their day on clinical placements. This journal will involve certain thought provoking questions to facilitate and direct the reflection such as: 

  • What happened
  • Why did you choose that method
  • Is there any research to support your decisions
  • What went well
  • What could have gone better
  • Action points for implementation next time [9]

It is encouraged that reflections are initially written; this will help to cement the different stages of reflection, but once this skill is developed health care professionals can do this regularly (internally) throughout the day. They then may only reflect formally (written) upon an event or activity that was particularly significant for them.[10]

Watch this small lecture from the London deanery on reflection and learning in the workplace. This is aimed at trainee doctors but the principles can be translated into any health care profession.

Methods of Reflection

There are many forms of formal reflection, all differing slightly. There is no right or wrong method of reflection as long as it is:

  • A record which is useful to you
  • A cue to memory
  • Honestly written
  • Enjoyable to complete
  • Involve thinking which is objective, critical and deep

There are many different frameworks offered for structuring reflection. Here is a powerpoint presentation that runs through a number of examples.

Below are descriptions of some of the most common reflective frameworks and models that can be used. A recommended approach to find the best model to use is to practice with several different frameworks and choose the model or models which you feel are most effective for you in particular situations. Reflection is a very personal activity and so this choice should also be personal to ensure the greatest benefit to you. 

Gibbs Reflective Cycle (1988)

Gibbs reflective cycle is a formal structure which can be used for academic pieces of work but also in clinical practice which can be used to evidence continuing professional development. [11]

Description

The section in the reflective cycle is describing the event that is being reflected upon. Is only needs to be short and precise to give background information on the event.

Feelings

This section focuses on thoughts and feelings at the time of the event and after. 

Evaluation 

The evaluation is reflecting upon the experience, such as;

  • How you reacted to the situation,
  • How did you react after,
  • How did other people react
  • If it was a problem solving situation - was the issue resolved. 

If there are pieces of evidence for the event you are reflecting upon you can include these here.

Analysis 

This section is where you can really demonstrate your reflection on the experience. Pick out points that you think have hindered or enhanced the experience. What went well, and what has not gone so well. Similarly to the evaluation section where references may have been incorporated, the analysis section is where you can link your experience to what the literature is reporting. This is where you will improve your grades if this is an academic piece of work, but also useful for using it as a piece of evidence in a portfolio for continued education purposes.

Conclusion

This section is about summarising the outcome of the event being reflected upon.

  • Would you do the same again
  • What would you change
  • Identify what you could do to stop the same things from happening in future
  • or how can you make sure the same happens again to ensure the same positive outcome

Action Plan

This section is essential to any reflection, this is about what you are going to do next. How are you going to implement the changes you have identified to achieve the desired outcome next time, be it performance improvement or maintaining the standard achieved. 

John's Model for Structured Reflection (2000) 

John's Structured Reflective model is exactly that. It is a set of questions that are asked to direct the reflector through the process. This may be attractive to some people, but potentially could be a little restrictive for others. [12]

Description

  • Phenomenon - -describe the here and now experience
  • Causal - what essential factors contributed to this experience?
  • Context – what are the significant background factors to this experience?
  • Clarifying – what are the key processes (for reflection) in this experience?
Reflection
  • What was I trying to achieve?
  • Why did I intervene as I did?
  • What were the consequences of my actions for:
  • Myself?
  • The patient/family
  • The people I work with?
  • How did I feel about this experience when it was happening?
  • How did the patient feel about it?
  • How do I know how the patient felt about it?
Influencing Factors 
  • What internal factors influenced my decision making?
  • What external factors influenced my decision making?
  • What sources of knowledge did/should have influenced my decision making?
Evaluation
  • What choices did I have?
  • What would be the consequences of these choices?
Learning
  • How do I feel now about this experience?
  • How have I made sense of this experience in light of past experiences and future practice?
  • How has this experience changed my ways of knowing
  • Empiric
  • Aesthetics
  • Ethics
  • Personal

Borton's/Driscoll's Development Framework

Borton's three Whats questions[13] were mapped on to an experiential learning cycle by John Driscoll[14] to form a simple a framework for supporting reflection. This framework is easy to remember and implement, and is therefore a popular option used by many health care professionals and advocated by professional bodies. 

There are only 3 steps in this framework: [15]

What?

These questions prompt the reflector to describe what has happened by: 

  • What were the roles of the people involved?
  • What was my role?
  • What were the problems
  • What happened 
  • What did I do?

So What?

This is the analysis of the reflection.:

  • What was the outcome?
  • What did you learn?
  • What was important?

What Now?

This is one of the most important sections of a reflection. This section focuses on what will you do next /  what does your learning experience mean for future practice?

  • What do you need to do now?
  • What were the consequences?
  • How do you resolve the situation / improve the outcome?
  • How will what have you learnt from this experience change your future practice?                                         [16]

Conclusion

Now you have learnt about 3 of the main learning frameworks / reflective structures to use in clinical practice. It is important to understand that reflection is a skill that is developed through repeated practice. When selecting a model to use it is essential, as discussed previously, to try different structures and frameworks for different situations to learn which suit you and a particular context best. Day to day reflections (e.g. for CPD events) may be better suited to the Borton's framework, whereas for an academic piece of work or a significant incident at work, a more detailed framework such as Gibbs may be more appropriate. It is also important to review relevant literature as well as your own experience and anecdotal evidence and include this within your reflections to develop an evidence based practice approach in your reflective practice. 

Resources

References

  1. ↑Schön DA. The reflective practitioner: How professionals think in action. Basic books; 1983.
  2. ↑McClure P. Reflection on Practice. http://cw.routledge.com/textbooks/9780415537902/data/learning/8_Reflection%20in%20Practice.pdf [accessed on 10 June 2016]
  3. ↑Reid B. But We’re Doing it Already! - Exploring afckLRResponse to the Concept of Reflective Practice in Order to Improve its Facilitation. Nurse Education Today 1993;13:305-309
  4. ↑Jarvis P. Reflective Practice and Nursing. NursefckLREducation Today 1992;12:174-181
  5. ↑Johns C. Becoming a reflective practitioner.fckLROxford: Blackwell Science, 2000
  6. ↑Patterson B. Developing and Maintaining Reflection in Clinical Journals. Nursing Today 1995;15:211-220
  7. ↑McClure P. Reflection on Practice. http://cw.routledge.com/textbooks/9780415537902/data/learning/8_Reflection%20in%20Practice.pdf [accessed on 10 June 2016]
  8. ↑Queen Mary University of London. Guidance on Reflective Writing. http://qmplus.qmul.ac.uk/mod/book/view.php?id=257889 [accessed 15 June 2016]
  9. ↑McClure P. Reflection on Practice. http://cw.routledge.com/textbooks/9780415537902/data/learning/8_Reflection%20in%20Practice.pdf [accessed on 10 June 2016]
  10. ↑Wessel J, Larin H. Blackwell Publishing Ltd Change in reflections of physiotherapy students over time in clinical placements. Learning in Health and Social Care 2006; 5(3):119–132
  11. ↑Queen Mary University of London. Guidance on Reflective Writing. http://qmplus.qmul.ac.uk/mod/book/view.php?id=257889 [accessed 15 June 2016]
  12. ↑Queen Mary University of London. Guidance on Reflective Writing. http://qmplus.qmul.ac.uk/mod/book/view.php?id=257889 [accessed 15 June 2016]
  13. ↑Borton, T. (1970) Reach, Touch and Teach. London:Hutchinson.
  14. ↑Driscoll J. Reflective practice for practise. Senior Nurse. 1994;14(1):47.
  15. ↑White S,Fook J, Gardner F. Critical Reflection in Health and Social Care. Maidenhead: Open University Press, 2006
  16. ↑Queen Mary University of London. Guidance on Reflective Writing. http://qmplus.qmul.ac.uk/mod/book/view.php?id=257889 [accessed 15 June 2016]

A reflective essay based on an episode of patient care.

rodrigo | December 3, 2012

WritePass - Essay Writing - Dissertation Topics [TOC]

Introduction

This is a reflective essay based on an episode of care that I was directly involved in managing during a community placement. This episode of care will be analysed using up to date references, health care policies and relevant models. Issues and theories relating to leadership qualities and management styles will also be explored, taking into consideration any legal, ethical and political factors that may have impacted on patient care. Care delivery, delegation and prioritisation will be examined along with team working, risk assessment and patient safety. I will also take into consideration my role as a supervised student nurse and analyse the roles and responsibilities of those supervising me and what influence this has on my practice. These issues will be debated and questioned within the framework of leadership and management theory

In order that I could use this situation for my reflection the patient will be referred to as “Mrs A”. In this assignment confidentiality will be maintained by the use of pseudonyms, this is to maintain privacy and confidentiality in line with the NMC Code of Professional Conduct (NMC, 2008), “as a registered nurse, midwife or health visitor, you must protect confidential information”, and to “Treat information about patients and clients as confidential and use it only for the purpose for which it was given.”

Starting an extended practice placement as a third year nursing student enables the student to develop their knowledge and skills in management and leadership ready for their role as a qualified adult nurse. During my extended practice placement there were many opportunities to develop these skills and manage my own caseload of patients and arrange many complex aspects of their care.

During this placement an 88 year old patient, to be known as Mrs A, was due to be discharged from a rehab centre following recurrent falls, issues with safety at home, and self neglect, the referral had been made by a concerned General Practitioner. Mrs A had spent the last 6 weeks receiving holistic multidisciplinary care, including; intensive physiotherapy, occupational therapy and nursing care. Mrs A had made much improvement and was able to safely administer her own medication.

One of the Physiotherapists called Ken, had commented during handover, that Mrs A had seemed confused during their session together, and asked if the nurses would go in and review her.  Upon visiting Mrs A it was clearly evident that she was not herself, and seemed confused. Following discussion with my mentor I felt that Mrs A was not safe to administer her own medication. I recommended to the patient to let the rehabilitation staff administer her medication. Mrs A consented to this, thus reducing a great risk of Mrs A causing her-self harm. I delegated to the support workers to obtain a urine sample which was tested and confirmed that Mrs A had a urinary tract infection, antibiotics were prescribed by her GP. The team leader at the rehabilitation centre was informed of Mrs A’s infection and plan to handover the administration of her medication to them, she was happy with this decision and pleased that I had informed her.

This episode of care was managed effectively as the underlying cause of the patients confusion was discovered and treated, a risk assessment was completed and a referral was promptly made to medicine management and a dossett box was supplied to Mrs A, to help her manage her own medications safely. All members of the multi-disciplinary team were fully committed to the team approach to care delivery and this facilitated efficient and organised care delivery. The care delivered was patient-centred and teamwork was integral to providing this care.

First will be a discussion on the importance of self awareness and how this awareness enabled a more assertive and confidant approach to be made to managing patient care.

Self awareness must be considered as the foundation for management and is a vital skill and quality needed in leadership. If you wish to provide care that is of a high standard and improve your own performance as a skilled health care professional you need to manage the cognitive, affective and behavioural self in order to engage effectively in therapeutic relationships. Self awareness is the process of understanding one’s own beliefs, thoughts, motivations, biases and limitations and recognising how they affect the care and services provided (Whetten and Cameron, 2010).

Without being self aware, recognising personal and cultural beliefs, and understanding interpersonal strengths and limitations, it is impossible to establish and maintain good relationship with co-workers and patients. Maslow’s Hierarchy of Needs Theory (1954) depicts self-actualisation at the highest level of the hierarchy of needs. This relates to the need to maximise potential and achieve a sense of personal fulfilment, competence, and accomplishment (Maslow, 1954).  It is important as a student nurse to be completely aware of strengths and weaknesses, and to be conscious of any limitations, self-awareness helps to exploit strengths and cope with weaknesses (Walshe and Smith, 2006).

When organising and planning patient care it is vital to have effective management and leadership skills, this is part of every nurse’s role, and involves planning, delivering and evaluating patient care. These management responsibilities are part of every nurse’s role (Sullivan and Garland, 2010) and to exhibit these professional behaviours demonstrates their value to the organisation (Huber, 1996). To understand nursing management it is crucial to understand what nursing management is and the theory behind it.

Managers are defined as “a member of a specific professional group who manages resources and activities and usually has clearly defined subordinates” (Gopee & Galloway, 2009).  Another definition of management is a process by which organisational goals are met through the application of skills and the use of resources (Huber, 1996).

Borkowski (2010) argues that Douglas McGregor made a significant impact on organisational behaviour and was an American social psychologist that proposed the ‘X-Y’ theory of management and motivation. McGregor (1966) describes the ‘X-Y’ concept as the theory that underpins the practices and attitudes of managers with regard to their employees. Huber (2006) states that theory ‘X’ managers assume that employees are lazy, that they dislike responsibility, would rather be directed, oppose change and desire safety. Theory ‘X’ implies that employees are rational and easily motivated (either by money or threat of punishment); therefore managers need to impose structure and control and be active managers (Huber, 2000).

Huber (2000) asserts that the opposing theory, (‘Y’) assumes that people are not lazy and unreliable by nature rather that they are self-directed and creative if well motivated in order to release their true potential. Businenessballs.com (2002) asserts that most managers are inclined towards the ‘X’ theory and usually obtain poor results whereas managers who implement the ‘Y’ theory produce better performance and results thus allowing people to grow and develop (Businessballs.com, 2002).

References

Borkowski, N. (2009) Organizational behaviour, theory, and design in health care , USA: Jones & Bartlett Publishers

Cameron, K. and Whetten, D. (2010)Developing Management Skills, USA: Prentice Hall

Gopee, N.  and Galloway, J. (2009) Leadership in Management in Heathcare, London: Sage Publishers

Huber, D. (2006) Leadership and Nursing care Management. 3rd Edn.USA: W.B Saunders Company

Maslow, A. (1954) Motivation and Personality, New York: Harper & Row

McGregor, D. (1966). The human side of enterprise. Leadership and motivation. Cambridge:

MA: The MIT Press.

Sullivan, E. And Garland, G. (2010) Practical Leadership and Management in Nursing, Essex: Pearson Education Limited

Walshe, K. And Smith, J. (2006) Healthcare Management, New York: Open University Press

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