•
Uncover our knowledge and thinking
•
Apply new ideas and, hopefully,
•
Learn from the experience of reflective practice itself.
The following section on reflective cues provides some
basic questions that will enable you to reflect on the way
you are currently working in clinical practice situations. By
using these cues you will be able to develop a clearer under-
standing of yourself and of the way in which you develop
person-centred relationships.
Reflective cues
Cues
are the pieces of data that the clinician collects through
observation, reading records and talking to patients and others
in order to solve a problem, as explained further in Chapter 14.
Reflective cues
are the pieces of data, or cues, that evolve
from the act of reflection and help us to think and act in
response to the patient’s individual needs in a person-centred
way. Throughout this text, wherever you have encountered
the
reflective cue icon
you have undertaken a reflective
exercise using the cues, or questions, asked regarding the
scenario described. These cues have prompted you to
examine each situation in order to become more self-aware,
to consider all the issues and to learn to work in a person-
centred manner. In this way, the cues given in the scenarios
you have encountered so far have been helping you to
develop your self-awareness and reflection abilities as funda-
mental parts of your thinking. Developed in this way, the
process of reflection becomes a part of how you think and act,
rather than being questions you consciously ask yourself in
order to care for a particular patient. This, of course, takes
time. The kinds of cues that can help you to develop this
ability are shown in Box 13-6. Note that the questions listed
focus on the person (the patient) as well as on self (you).
Unit III Thoughtful practice and the process of care
250
These kinds of questions help you to pause and think about
your own values and beliefs, and then to reflect on how these
might affect your relationship with the person. Paying atten-
tion to this process will enable you to become more self-aware.
Self-awareness means you can make decisions, and then
act, at a conscious level rather than simply doing things
without thinking. In our everyday life we often undertake
tasks without thinking through what we are doing or why we
are doing it—we just do it. We have a ‘formula’ for under-
taking certain tasks, and we follow this without question.
For example, consider the task of taking a person’s blood
pressure. When we first learnt to do this, we were very
aware of every step in the process: how to prepare the
person, where and how to place the cuff, how to position the
arm and the stethoscope, how to inflate and then slowly
deflate the cuff, how to measure the pressure and record it
on the chart, and then of course how to use our knowledge
of blood pressure levels to decide whether to report the find-
ings to another nurse or to a doctor. Each of these steps was
interwoven with our knowledge and understanding of the
process, of the physiology of the body, of the person’s con-
dition and so on, and when we first learnt to undertake blood
pressure monitoring we were very conscious of all of these
things. However, a few weeks or months later, we are able
to measure a person’s blood pressure without thinking about
each distinct step. With practice, it has become routine.
Much of what we do in practice can become routine in this
way. However, we must always remain alert so we can iden-
tify those situations that fall outside the usual routine. Often
it is only when something deviates from the normal pattern
(e.g. if the person’s blood pressure has been steadily increas-
ing over the past two hours and they are now mildly
hypertensive) that we once again become aware at a con-
scious level and prepare ourselves to act on such findings
As previously noted, reflection is seen as an essential
nursing skill by many registering authorities.
Related research
De Swardt, H.C., du Toit, H.S. & Botha, A. (2012).
Guided reflection as a tool to deal with the theory–
practice gap in critical care nursing students.
Health SA
Gesondheid
, 17(1), 1–9.
In this study, a qualitative, explorative, descriptive
and contextual research approach was used to explore
the theoretical and practical experiences of critical
care nursing students through guided reflection. The
researchers facilitated reflection-on-action (retrospec-
tively) on one nursing care incident chosen by each of
the participants. Johns’ model for reflection was used as
a basis to design an instrument for guided reflection.
The main themes that emerged were a description of
the incidents experienced, and a critical analysis of
knowledge, feelings and the changed perspective expe-
rienced. The data showed the participants went through
a series of cognitive and affective processes that trans-
formed understanding of theory and practice. Guided
reflection offered the participants the opportunity to
deal with complicated experiences, which resulted in a
changed perspective on the theory–practice interface.
Relevance to practice
The findings of this study support the use of reflec-
tion in professional practice, by providing evidence
that through reflection, nurses are considering and
improving their practice.
Reflection in practice
R E S E A R C H I N P R A C T I C E
