Reflection on practice

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