Comments are closed. How reflective practice has been adopted within a variety of workplaces tohelp illustrate its value for OH. By LizGriffiths The concept of reflective practice has become enormously influential in theworld of professional education. The Nursing and Midwifery Council (NMC) Post-Registration Education andPractice (PREP) requirements advocate reflection on practice in order toenhance career progression and lifelong learning.1 This is further endorsed inthe Code of Professional Conduct in the maintenance of professional knowledgeand competence,2 and in the guiding principles supporting the need for clinicalsupervision, an important part of clinical governance, with the aim ofimproving standards.3 Courses designed to prepare students for specialist practice in occupationalhealth nursing may encourage reflection on critical incidents in the practiceenvironment to inform learning, and use reflective writing as part of theassessment process. The significance of reflection in nursing rests in its close relationship tolearning in professional practice settings, where learning develops fromexperience. Reflection is an important component of this experiential learningbecause it can promote the ability to engage in self-assessment, to adapt tochange and develop autonomy. However, professional practice is not always clear-cut and learningsituations are often unpredictable. Schon uses the phrase “indeterminatezones of practice” to highlight the spheres of professional action thatare characterised by uncertainty, uniqueness and possibly conflict – adescription that must seem very real in many OH settings.4 An expert professional should be able to create different possibilities asthe result of reflecting on what could be routine practice, an unexpectedoutcome or even some uncertainty. By drawing such experiences together, ameaningful pattern may emerge as a means of transforming practice. Johns seesreflection as a window through which the practitioner can view experiences,working towards the resolution of contradictions between what may be desirableand what is realistic in actual practice.5 It may be worth considering if the concept, like many fashionable ideas, hasbecome distorted with use, or has retained its relevance in practicedevelopment, particularly for occupational health nurses (OHNs). One criticism of the emphasis that is placed on reflection in courses ofstudy has been the lack of evidence exploring successful outcomes in practiceas a consequence of reflection. Although much has been written about the apparent advantages and benefits,Quinn cautions that as professional practice is demanding and stressful, it maybe unrealistic to expect practitioners to reflect systematically, unless theyare given time and support to do so effectively.6 Nevertheless, there is evidence that although reflective writing is challenging,the scope of development is more valuable and longer lasting when the activityis structured through a written account.7 Jasper’s study – exploring how nursesfrom a variety of settings were using reflective writing skills as a tool forpractice learning – concluded that nurses were able to identify personal andprofessional growth being facilitated by reflective writing. An investigation recently carried out with students undertaking a specialistpractitioner programme confirmed that links with practice could be made throughreflection to enhance professional development. Students were asked to considerwhether undertaking a piece of reflective writing prior to beginning the coursehad been of value to them. The comments relating to the application ofreflection in practice were spontaneous and unprompted. One student commented:”It was beneficial to explore how and why I practiced what I did”,and another that it “allows and enables changes”.8 By referring to several examples where the reflective process has beenadopted in a variety of workplaces, it is clear that the value for OH practicedevelopment can be identified. This is not only shown from an individualperspective, but also demonstrates the wider implications in management andorganisational matters for students and more experienced practitioners. It iscommon to focus on the negative aspects of practice in reflection, but theseexamples highlight a few of the more positive features. Return-to-work interview following maternity leave The practitioner had prepared well for the interview in terms of informationregarding organisational factors and practical issues, but the interview didnot proceed in the way she expected. The client was much more concerned withthe emotional impact of her immediate return to work rather than those issuesthat had been anticipated by the nurse. On reflection, the OHN realised that she had not considered this aspect inher preparation. She also found that identifying her thoughts and feelingsabout the experience was relatively easy. What was much more difficult wastrying to make sense of the experience through analysis. However, by using areflective cycle to structure her thinking, she found that she could develop aplan of action for future encounters of this kind, and so learn from a routinesituation. Attendance management interview One aspect of the role of OH in assisting management to manage attendanceeffectively is to ensure that any policy is applied consistently and fairly. An experienced practitioner found it helpful to reflect in a group withcolleagues, after the interview. This is particularly relevant to ensure aconsistent approach among the team and within the organisation, where concernsof policy and procedure are apparent. In this case, the employee had attendedthe department reluctantly, because the line manager had not adhered to thecompany referral procedure. The OHN’s view was that sharing experiences brings differing perspectives toincidents. This also boosts confidence by endorsing decisions made in clinicalpractice. This group approach to reflecting on learning was adopted by the teamand became a regular feature at staff meetings. An observer at pre-employment health interviews When faced with practice in a new setting, many experienced practitionersfind that keeping a reflective journal can help make sense of the transitioninto a new field. It also serves as a permanent record to reflect on for futureoccasions. Adjustments can then be made to practice, or action plans modifiedas experience develops. For an OH student in a new role, keeping a journal was not only found to beessential, but the importance of returning to the reflective writing andreviewing it with new knowledge was found to be extremely helpful. The studentnoted that previous work history seemed to be an important factor explored bypractitioners during pre-employment health interviews, but did not initiallyappreciate the significance of the questioning. As knowledge and experience increased, this was recorded and reflected upon,and the student was able to set their learning within a public health,legislative and professional framework. A case for referral This OHN had been supporting a departmental manager through a personalcrisis over a period of time. In line with custom and practice in her setting,she was seeing the client weekly at pre-arranged appointment times. However,she was beginning to feel increasingly uneasy as the visits continued. On reflection, her analysis examined several aspects that she identifiedfrom the experience. Her own professional accountability and competence, anidentification of her need for specific training, departmental proceduresregarding counselling and referral, opportunities for collaborative working,possible alternative courses of action, and the referral of the client to anappropriate agency. In addition to these factors, she reviewed the evidence onthe relevant topic area and the existing company policy. This analysis led to asatisfactory resolution both for the client and the practitioner, and aproposed change of practice for the rest of the OH team. Conclusion These examples provide evidence of using the reflective processretrospectively, to analyse critical incidents that occur frequently inpractice to inform learning. The outcome may not always be a resolution, butthe key element is the learning, both professionally and personally, that hasbeen gained from reflecting on the experience. This ability to reflect is seenas an essential part of becoming an expert practitioner.9 Although reflection should not be seen as a panacea for professionaldevelopment, the benefits should be considered by OHNs in practice and, inparticular, as a means of increasing professional competence and confidence. Liz Griffiths is a lecturer in OH nursing at Brunel University, and part ofthe community health nursing team in the Department of Health and Social Care References 1. The PREP handbook – NMC (2002) London 2. Code of professional conduct – NMC (2002) London 3. Supporting nurses and midwives through lifelong learning – NMC (2002)London 4. Educating the reflective practitioner – Schon D (1987), California:Jossey-Bass 5. Becoming a Reflective Practitioner. A reflective and holistic approach toclinical nursing practice development and clinical supervision – Johns C(2000), Oxford: Blackwell Scientific 6. Continuing Professional Development in Nursing. A guide for Practitionersand Educators – Johns C (2000), Cheltenham: StanleyThornes Ltd 7. Nurses’ perceptions of the value of written reflection – Jasper M (1999),Nurse Education Today 19 pp 452-463 8. An investigation into the student experience of APEL – Griffiths E(2003), research project. (unpublished) 9. Learning Human Skills: 4th edition – Burnard P (2002), Oxford:Butterworth Previous Article Next Article Time for reflectionOn 1 May 2004 in Clinical governance, Personnel Today Related posts:No related photos.