1. Reflection on practice

2. Learning outcomes In this presentation you will: Consider the importance of reflective practice Be introduced to the concept and process of critical reflection Explore how critical reflection relates to professional development Understand the outcomes of being critically reflective

3. Why bother with reflective practice? Own experiences condition us to how we respond to individuals, agency or managers’ decisions. Need to have awareness of how this will influence our responses and seek to minimise that. Otherwise potential to negatively effect our actions based on our views rather than the needs of the service user. About accepting and understanding that everything we do is based on assumptions and that we don’t all share the same beliefs or values that underpin those assumptions.

4. What is reflection? Ability to assess your thinking, actions and behaviour and evaluate their effectiveness and areas for improvement. Human dimension of nursing and social work will inevitably mean you are faced with ethical and value dilemmas, which will require you to reflect on your actions. “…reflection is a self-involvement process.... personal experience, feelings and cognition are intermingled in recalling past experience, resolving current difficulties, easing out uncomfortable feelings, evaluating one’s present and past performance and searching for new perspectives and new solutions.” (Yip 2006: 779)

5. Types of reflection Schon (1983) – educational theorist – associated with earliest discussions about ‘reflective practice’. – reflection-in-action – as we are practising but it does not interrupt our actions – reflection-on-action – reflecting afterwards on why we did what we did and what we learnt from it

6. Types of reflection (cont.) Technical reflection –reflecting on the technical skills used, eg. assessing and planning, and reflecting on whether your skills or behaviours need improving by looking at what done and evidence base for what to do Practical reflection –reflecting on personal assumptions underpinning practice and looks for alternative responses to enhance professional understanding and personal insight Process reflection –being aware of emotions relating to practice with service users, ie. think about “relationship dynamics” – recognising associated thoughts and feelings, emotional responses to clients and their experiences Critical reflection –“professionals engage in a process of critical self-evaluation about how their own practice and values are being shaped by external social, political and cultural contexts.” (Yip 2006: 779)

7. Reflection on practice (Webb 2009) Reflection on practice is defined as reflection that comes AFTER an experience. (By contrast reflection IN practice is exercising self awareness and observation DURING an experience). Reflection on practice helps the practitioner in skills of self awareness, assertiveness, confidence and personal/professional development. There are all sorts of methods for reflection on practice. The following slides give examples for ongoing and in-practice development.

8. Practice/Clinical supervision. Practice or clinical supervision can be an effective forms of reflection. A guided conversation with a more, or differently, experienced peer is invaluable when performed openly and without prejudice. It must not be a managerial tool however. Check your current practice. does your team have any form of practice supervision? Do you have someone you can discuss difficult, puzzling or complex cases? Do you have team or individual discussion? Is it normalised in your team or only available when you are ‘stuck’? Would you be reluctant to discuss something you think shows you up to be ‘inadequate’? Check the resource on practice and clinical supervision to check if your supervision is meeting your needs.

9. Structured reflection There are ‘models’ for reflection which help some people to structure their thoughts about a case or incident. Nurses may be familiar with Gibbs or John’s models of reflection. Social work and social care staff may be familiar with Yip or Schon. The trick is to use one you are familiar and happy with. These are perhaps most useful when we need to document our reflection, perhaps for a training portfolio for example. They are only as good as the person using them as they require a good degree of self awareness and objectivity to make best use of them without another person to pose the questions.

10. Intuitive reflection Intuitive reflection is an easily available method reliant on good self awareness and objectivity. The key here is being able to open up a dialogue with yourself to explore ideas you haven’t thought of. Socratic questioning can help: asking yourself for more explanation in order to dig deeper. –i.e. Why do you think that? What else could you do, what if that doesn’t work? Why doesn’t it work? Etc, etc.

11. Reflective and Reflexive Two terms which are often confused are reflexive and reflective: –reflexive – adopts a stance which is situated in a particular context and an understanding of one’s own influence in action –reflective – process of reflecting upon practice. Not mutually exclusive as reflective processes can be underpinned by a reflexive stance (Fook 2002: 43).

12. What is critical reflection? Critical reflection takes reflection further and adopts a reflexive stance. “In critical reflection, professionals engage in a process of critical self-evaluation abut how their own practice and values are being shaped by external social, political and cultural contexts.” (Yip 2006: 779) Critical reflection takes a holistic perspective that incorporates consideration of how we as individuals use power, values and knowledge in our relationships with patients or service users, and the political, cultural and social context within which we are situated.

13. Critically reflective environment A supportive environment – supportive organisational context including colleagues and supervisors providing empathic rapport; mutual support and sharing with colleagues. Professional’s readiness to self reflect – open mindedness; self motivated – readiness in terms of physical environment, social environment and psychological readiness. Individual space to do it – “inner space” to stop and think, deal with uncomfortable feelings, to analyse and resolve discrepancies. Awareness of one’s limits and breaking point – know when to seek external help and support, when to relax, when to accept inadequacies (Yip 2006).

14. Inappropriate conditions for CR Individual with poor physical or mental health An oppressive working environment where self reflection may be used against you A highly critical supervisor or colleagues Negative self image Unresolved trauma. (Yip 2006)

15. What does it involve Looking at events in your practice Describing the immediate effects on people involved Include your own feelings about the event and practice experience Draw on existing knowledge to make sense of the experience Seek new perspectives to ensure critical thinking – from challenging questioning, discussion, drawing on research evidence and theory Articulate your new understanding in terms of the learning process and the actions it may lead to in future practice (Thomas in Gould and Baldwin 2004)

16. What does it involve (cont.) “Examining the evidence in detail, from different perspectives through reflexive involvement, so that we avoid risk and open up opportunities. Contextualising the examination of evidence by placing it explicitly within the context of theoretical and value positions … that might have an impact on the judgements being made. … Developing an overview, so that we and others involved see the full implications of the situation. Presenting our judgments to an audience, such as a case conference, clients or their families, or people in the community in ways that may assist, guide or influence their own understanding and evaluation.” (Payne et al. 2002: 6)

17. Supervision and critical reflection Supervision and supervisory relationship is essential for effective critical reflection. Should provide a safe and supportive forum for reflection. Context of supervision and discussion that new ways of working created and applied and evaluated. During periods of rapid change – even more important that critical reflection and professional development is part of good supervision. (Gould 2004)

18. Skills for reflective practice Problem solving Ability to build on existing knowledge Ability to explore questions in depth Ability to be critically aware Open-mindedness Motivation Self awareness Ability to recall Ability to use theoretical perspectives appropriately Ability to gather information and critically evaluate it Ability to learn from experience Ability to create their own knowledge

19. How to develop skills for C.R. Frequent reviews of practice Supervision sessions Peer discussion Reading In-house training Developing others Service user commentary

20. Outcomes of critical reflection The outcomes (learning) of the reflection on the experience in terms of: –new awareness –new questions –new understanding –new decisions

21. Summary “Like peeling off the layers of an onion, reflection can go deeper and deeper, starting from being aware of one’s performance, to critically assessing one’s ideology and belief behind one’s thinking and feeling in the action.” (Yip 2006: 778) This is particularly important when working with people with problematic substance use. They will be expecting you to disapprove of them, be reluctant to help them and to judge them. Reflection and critical reflection practice with people with substance problems is therefore hugely important in ensuring practice remains empathic and patient/service user focussed.

22. References and further reading Fook, J. (2002) ‘New ways of knowing.’ In: J. Fook, Social Work: critical theory and practice. London: Sage Gould, N. and Baldwin, M. (2004) Social work, critical reflection and the learning organization. Aldershot: Aldgate Johns & Freshwater (2005) Transforming Nursing through Reflective Practice. Blackwell, Oxford. Payne, M., Adams, R. and Dominelli, L. (2002) ‘On Being Critical in Social Work.’ In: R. Adams et al. (eds.), Critical Practice in Social Work. Basingstoke: Palgrave Schön, D. (1983) The Reflective Practitioner. How professionals think in action, London: Temple Smith Webb, L. (2009) Personal and Professional Development In: Webb, Nursing: Communication Skills in Practice. Oxford University Press, Oxford. Yip, K-S. (2006) ‘Self-reflection in Reflective Practice: A Note of Caution.’ British Journal of Social Work, 36 (5): 777-788. doi: 10.1093/bjsw/bch323