A model for structured reflection
Introduction
The development of reflective review offers the practitioner a useful way to take responsibility for his or her clinical effectiveness. Johns (1993) states that the methods for managing quality in care need to be devolved to the point of delivery and that this is an essential aspect of everyday practice. Reflection is used as a means of exploring approaches to clinical supervision, clinical effectiveness and clinical governance, as well as reflecting on the participant’s skills.
The definition developed by Johns underpins the philosophy of the RCN Accreditation Unit:
‘…a window for practitioners to look inside and know who they are as they strive towards understanding and realising the meaning of desirable work in their everyday practices. The practitioner must expose, confront and understand the contradictions within their practice between what is practised and what is desirable. It is the conflict of contradiction and the commitment to achieve desirable work that enables the practitioner to become empowered to take action to appropriately resolve these contradictions’
The following is an adaptation of a model described by Johns (1993) to facilitate reflection. It is based on a series of questions, which could be used within an assessment relating to practice.
1. Description of experience
- What is the ‘here and now’ experience?
- What essential factors contributed to this experience?
- What were the significant background factors to this experience?
- Reflection
- What was I trying to achieve?
- Why did I act the way I did? What influenced my action?
- What were the consequences of my actions for: myself, clients/patients, colleagues?
- How did I feel about this experience when it was happening?
- Why did I feel that way?
- How did the clients/patients, colleagues feel about it?
- Why did I think they felt that way?
- How did I know this?
- Alternative actions
- What other choices did I have?
- What would have been the consequences of those other choices?
4.
Learning
- How do I now feel about this experience?
- How could I have been more effective?
- What would I do now, faced with a similar situation?
- What have I learned from the experience?
Adapted from: Johns, C (1993) Achieving effective work as a professional activity in Towards Advanced Nursing Practice (Ch11) Eds: Schober, JE., and Hinchliff SM., (1995) Arnold.
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