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Reflective Practice

Superficial

Superficial (= descriptive reflection)  non-reflectors

Reflection at this level is very basic – some would say it is not reflection at all, as it is largely descriptive! However the description should not just be of what happened but should include a description of why those things happened. Reflection at a superficial level makes reference to an existing knowledge base, including differing theories but does not make any comment or critique of them.

Example - Superficial reflection

Today I spent time with James (client) and his family on the ward. The family had a lot of questions about the rehabilitation process and wanted to know what was going to happen for James.

I wanted to reassure them that things were OK because I knew this was what they needed to know. I said that while it was difficult for anyone to know the rate of James’ improvement I could be sure that he would improve and that it was important for the family to keep hopeful about his future.

James’ father became angry and after raising his voice at me, telling me I was a “patronising little fool”, he stormed out of the room. James mother sat weeping beside his bed and I felt I had really stuffed things up for this family. I need to get some advice about how to handle angry families.

Medium

Medium (= dialogic reflection) reflectors
At this level of reflection, the person takes a step back from what has happened and starts to explore thoughts, feelings, assumptions and gaps in knowledge as part of the problem solving process. The reflector makes sense of what has been learnt from the experience and what future action might need to take place.

Example - Medium reflection

Today I spent time with James (client) and his family on the ward. The family had a lot of questions about the rehabilitation process and wanted to know what was going to happen for James. I wanted to reassure them that things were OK because I remembered from a uni lecture by a carer that carers needed reassurance, information and hope for the future of the person they cared for. I said that while it was difficult for anyone to know the rate of James’ improvement I could be sure that he would improve and that it was important for the family to keep hopeful about his future.

James’ father became angry and after raising his voice at me, telling me I was a “patronising little fool”, he stormed out of the room. James mother sat weeping beside his bed. I felt confused and like I had done the wrong thing. I remembered from the same lecture about the emotional rollercoaster of caring for someone after a brain injury and how families could experience a range of emotional responses as they adjusted to their new reality.

I started thinking about what was happening in this family and how James’ parents were both clearly distressed and may have been having difficulty supporting each other due to their own distress. James’ father’s abuse of me was possibly not a fair reflection on me but said a lot about how he was feeling.

I decided to ask James’ mother how things were going for the family and she started to open up about how she felt. She revealed that James’ accident had opened up longstanding conflict between her and her husband, and that she didn’t feel hopeful about anything. It seemed like a useful conversation.

Deep

Deep (= critical reflection) critical reflectors

This level of reflection has the most depth. This level of reflection shows that the experience has created a change in the person – his/her views of self, relationships, community of practice, society and so on. To do so, the writer needs to be aware of the relevance of multiple perspectives from contexts beyond the chosen incident – and how the learning from the chosen incident will impact on other situations.

For some critical reflective writing tasks it is expected that your writing will incorporate references to the literature - see Example - Deep reflection incorporating the literature below. Note that these are short excerpts from longer documents previously submitted for assessments (Permission granted by author).

Example - Deep reflection

Today I spent time with James (client) and his family on the ward. The family had a lot of questions about the rehabilitation process and wanted to know what was going to happen for James. I wanted to reassure them that things were OK because I remembered from a uni lecture by a carer that carers needed reassurance, information and hope for the future of the person they cared for. I said that while it was difficult for anyone to know the rate of James’ improvement I could be sure that he would improve and that it was important for the family to keep hopeful about his future.

James’ father became angry and after raising his voice at me, telling me I was a “patronising little fool”, he stormed out of the room. James mother sat weeping beside his bed. I felt confused and like I had done the wrong thing. I remembered from the same lecture about the emotional rollercoaster of caring for someone after a brain injury and how families could experience a range of emotional responses as they adjusted to their new reality.

I started thinking about what was happening in this family and how James’ parents were both clearly distressed and may have been having difficulty supporting each other due to their own distress. James’ father’s abuse of me was possibly not a fair reflection on me but said a lot about how he was feeling. I wondered about his parent’s differing emotional responses and tried to put myself “in their shoes” to consider what it must be like for them. I could see that their questions and behaviours were driven by their extreme emotional states. They both needed an outlet for their emotions.

I also thought about what James needed from his parents to optimise his participation in the rehabilitation program and how I could support them to provide that. I knew I didn’t have the skills or confidence to provide the grief counselling they probably needed but I thought I could provide them with some space to share and acknowledge their grief and to suggest options for them to get further assistance in this area. I sat by his mother and said “This is really hard for you all isn’t it”. She responded with “so hard” and cried some more. We sat without talking for a while and when she was calmer I said “a lot of families find it helpful to talk with our social workers about how they are feeling when things like this have happened”. She agreed it would be good to talk and I helped her organise an appointment for the next day.

From the experience today I have learned that families don’t need superficial reassurance and that this can be perceived as patronising. It will be more helpful if I can acknowledge their emotional distress and fears and reassure them that their response – whatever it is – is normal and expected. If I show that I can cope with their distress I can assist them to get the support they need and this will be critical in getting the best outcome for clients like James.

Example - Deep reflection incorporating the literature

NOTE: These short excerpts are from longer documents previously submitted for assessments (Permission granted by authors). Also note the format of the in-text citations reflect this.

EXAMPLE 1

I needed to understand more about what resilience actually is, and whether it is learnable or inherent in a person’s personality.  McDonald, Jackson, Wilkes, & Vickers, (2013) define resilience as the capacity to deal with “significant disruption, change or adversity” (p.134) and that in the workplace, adversity relates to the difficult or challenging aspects of the role. The authors identify traits associated with resilience such as “hardiness, hope, self-confidence, resourcefulness, optimism flexibility and emotional intelligence” (McDonald et al., p.134) and discuss how training programs have been established within the workplace to teach people these skills.

....

A plan for building resilience for my future role as a midwife would need to start now in order that positive patterns are embedded in my practice and everyday life. This would include activities discussed above as well as attempting to engage in habits of mindfulness on a day to day basis (Foureur, Besley, Burton, Yu, & Crisp, 2013).

References

Foureur, M., Besley, K., Burton, G., Yu, N., & Crisp, J. (2013). Enhancing the resilience of nurses and midwives: Pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemporary Nurse: A Journal for the Australian Nursing Profession, 45(1), 114-125.

McDonald, G., Jackson, D., Wilkes, L., & Vickers, M. (2013). Personal resilience in nurses and midwives: Effects of a work-based educational intervention. Contemporary Nurse: A Journal for the Australian Nursing Profession, 45(1), 134-143.

EXAMPLE 2

It is vital to ensure a healthy work-life balance (Pelvin, 2010). Imbalances in professional and personal life can cause burnout (Fereday & Oster, 2010). Burnout increases with the incidence of family-work conflict (Jordan et al., 2013). Non work-related interests help reduce the risk of burnout; exercising, resting, leisure-time and self-pacing all assist in managing stress (Jordan et al., 2013; Mollart et al., 2013). Self-awareness and mindfulness positively affect our personal relationships and make valuable contributions to the professional workplace (van der Riet et al., 2015). Mindfulness also enables midwives to be totally present with women and their families (White, 2013). Keeping an up-to-date family diary has assisted in planning and pacing my study, work, personal and social activities.

References

Fereday, J., & Oster, C. (2010). Managing a work–life balance: The experiences of midwives working in a group practice setting. Midwifery, 26(3), 311-318.

Jordan, K., Fenwick, J., Slavin, V., Sidebotham, M., & Gamble, J. (2013). Level of burnout in a small population of Australian midwives. Women and Birth, 26(2), 125-132.

Mollart, L., Skinner, V. M., Newing, C., & Foureur, M. (2013). Factors that may influence midwives work-related stress and burnout. Women and Birth, 26, 26-32.

Pelvin, B. (2010). Life skills for midwifery practice. In S. Pairman, S. Tracy, C. Thorogood & J. Pincombe (Eds), Midwifery: Preparation for practice (2nd ed.). (pp. 298-312). Chatswood, NSW: Elselvier Australia.

van der Riet, P., Rossiter, R., Kirby, D., Dluzewska, T., & Harmon, C. (2015). Piloting a stress management and mindfulness program for undergraduate nursing students: Student feedback and lessons learned. Nurse Education Today, 35, 44-49.

White, L. (2013). Mindfulness in nursing: An evolutionary concept analysis. Journal of Advanced Nursing, 70(2), 282-294.

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