constant searching of oneself in order to make the unknown
known. An awareness of all of these facets of self is very
helpful in interpersonal communication and assists in the
development of the relationships that are fundamental in
person-centred care (Jack & Smith, 2007).
Reflection
Reflection is a normal human activity. We frequently think
about what has just happened and how it has affected us.
However, clinicians may think superficially about their
practice and about what is happening around them without
engaging in the type of reflection referred to in this
chapter. Reflection as explored here is a much more pur-
poseful activity dependent on motivation and moral
agency that leads to action, improvement of practice and
better patient outcomes. Learning from reflection is not
automatic and requires a deeper understanding of how and
why reflection contributes to the repertoire of the effective
nurse or midwife.
Reflection can be part of your everyday practice, and can
deepen your understanding of self as described above.
Reflection
is a means of self-examination that requires the
individual to look over what has happened in practice in an
effort to evaluate and improve it, to seek other possible
explanations and alternatives, as well as to encourage pro-
fessional growth and development (Howatson-Jones,
2010). The key to reflection is learning how to examine
experience rather than just live it. Developing your ability
to be curious about your own experiences and actions
enables you to open up the possibility of ‘purposeful learn-
ing’—learning not from books or experts but from your
own work and life.
History of reflection
Reflection is an ancient practice. Socrates remarked that an
unexamined life is one not worth living (Ahbel-Rappe &
Kamtekar, 2006). During the Enlightenment of the 17th and
18th centuries, philosophers such as Locke and Rousseau
argued that individuals should be free to think and question
the norms imposed by the prevailing authorities. Dewey
(1933) reintroduced the idea of reflection in the early 1930s,
relating reflection to critical thinking as a means of giving
serious consideration to a particular subject. He believed
that reflection involved the whole person and included both
rational and intellectual thinking and emotions. He suggested
that being open-minded, responsible and wholehearted were
the characteristics of a reflective person. Habermas (1971)
added to this by highlighting that reflection also has a social
and psychological basis, and Freire (1972) exposed the crit-
ical empowering and political aspects of reflection. Building
on these theories, Schön (1983, 1990) has argued that pro-
fessionals face unique and complex situations in their
everyday practice that they are unable to resolve by using
technical or rational approaches alone. It is therefore impor-
tant, he argues, to incorporate reflection as a means of
resolving complex issues as well as to facilitate learning.
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Chapter 13 Thoughtful practice: Self-awareness and reflection
Reflective experiences
Certain kinds of experiences create particularly powerful
opportunities for learning through reflection. Situations that
involve complex clinical problems, dilemmas or uncertainty all
provide opportunities for critical reflection. You can use reflec-
tion to enhance the delivery of a person-centred approach to
care for the individual as well as the team you work in.
Hammond and Collins (1991) describe such an approach to
practice as being underpinned by a certain set of beliefs and
values concerning professional development. These include:
•
Promoting self-awareness, social awareness and social
action
•
Supporting the principles of lifelong learning
•
Stimulating self-expression and peer expression or
dialogue
•
Improving self-expression, learning and cooperation
•
Linking theory and practice.
Schön (1990) has highlighted three types of reflection—
reflection-in-action, reflection-on-action and reflection-for-
action:
•
Reflection-in-action
happens in the here and now of the
activity, and is also known as ‘thinking on your feet’.
This type of reflection is conscious but is often hard to
articulate. It is critical in nature and gives rise to
spontaneous action.
•
Reflection-on-action
occurs after the fact and involves
thinking through a situation that has occurred in the
past. It is used as a means of evaluating the experience
and deciding what could have been done differently.
•
Reflection-for-action
is the desired outcome of the first
two types of reflection, and helps the individual to think
about how future actions might change as a result of the
reflection. Reflection-for-action is used when a clinician
prepares for a future encounter by drawing on past
experiences of similar situations, and by critically
analysing the current situation with a view to making a
critical decision about the action to be taken. According
to Teekman (2000), reflection-for-action helps us to focus
on the nature of situations in order to be able to call on a
range of strategies to use in a given situation. For that
reason this type of reflection has an ‘anticipatory’ nature.
These three types of reflection not only focus on the
actions taken and the technical aspects of the situation, but
also enable individuals to reflect on their role in the situa-
tion, on any conflict or contradiction that occurred for them,
and on any emotions that may have had an effect on the sit-
uation. As Johns (2009, p. 4) highlights, reflection is:
Learning through our everyday experiences towards real-
ising one’s vision as a lived reality. It is a critical and
reflexive process of self-inquiry and transformation of
being and becoming the practitioner you desire to be.
Of particular importance is the difference between how we
act in a given situation and how we would like to have acted.
