Fundamentals of Nursing and Midwifery 2e

243 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.

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.