Importance of Reflection and Learning From Past Incidents

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To practice competently, reflection is important because it allows one to critically think about past or present events, evaluate situations and then use the knowledge obtained to act accordingly in future situations. All of which improves patient care and helps minimise bad practice in the work place. Reflection is a skill that separates average practitioners from competent practitioners.

The act of looking back on events and being able to understand how and why things occurred as well as being able to use that knowledge for future situations is very useful. This essay should explore what reflection involves and a critical incident that was experienced on the three-week placement. Looking at reflection through a model makes the concept of reflection easier to understand and evaluation of the model will take place in this assignment. Analysis and evaluation of the critical incident is important for effective reflection and this essay aims to accomplish that. The critical incident should cover certain topics like consent, respect and communication all of which are important factors to consider when learning from past incidents. Links between theories and practical work will be shown throughout this assignment.

A more holistic definition would attempt to cover all aspects of reflection and attempt to give more depth about what it truly involves. Another point is that it's difficult to see how this definition provides guidance for when reflection can be done, regarding when the critical incident occurs. Other definitions give more detail about when and where reflection needs to be done and this ensures that there is full effectiveness of the process and actions that are created from reflection can be meaningful and useful. So, bearing that in mind Taylors definition can appear quite limited.

Another definition of reflection states that’s reflection can be split into three parts, reflection before action, in action and on action. This definition was constructed by Schon 1983 and Rolf et al 2010 and is consensually identified as the main definition of reflection according to a source. This is a more robust definition because it clearly states what reflection is and in what context it should be used. 

Reflection is needed so that negative incidents in the past can be evaluated and analysed to prevent the same or similar incidents happening in the future. It's also needed so that positive incidents from the past can also be analysed and evaluated so that they can be replicated in the future. Reflection also provides the opportunity to really understand what is going on by using several models to break down events, make sense of them and interpret if needed.

A model can be described as framework that should enables a person to simply understand a concept in a better way. There are many models by many different people who have expressed their take on reflection. Each has their strengths and weaknesses and a balance between both is needed to decide which model is the most useful. The model chosen to explain the critical incident is Gibbs Reflective model. It was chosen because it appears to have more strengths than weaknesses. The model is simple to understand and can be applied in most healthcare situations. The model seems to focus on learning from the experience which is paramount.

This is useful for recalling feelings from past incidents. Being self-aware is also useful for recalling feelings from past incidents. Good communications skills are needed so that thoughts and ideas that are helpful to others can be shared in the right way to enhance the learning of others. Lack of communication or inadequate communication can slow down the transfer of useful knowledge and the process of effective reflection. [add evidence to support claims]. Some other skills that are needed for effective reflection include openness, active listening, observational skills as well as the ability to critically analyse and evaluate (Atkins and Murphy 1993).

It is easy to assume that all nurses have these skills which enable them to critically reflect but the reality is that there are some that do not. The process and timescale for acquiring such skills can be complicated and long but, it's expected that at certain points in life and maturing, these skills can be acquired. A lot of these skills are obtained through experiences and life events so if a person hasn’t experienced much in life certain skills can be hard to possess. The impact of not having certain skills can be seen in situation where care has been poor and poor consistently for a long time. An example of this is where in the year of (add case study here)….. This kept on happening due to many factors, but one was the inability of healthcare professionals to reflect due to no having the skills to reflect.

According to Mesirow there are levels of reflection which are Non- reflectors, reflectors and critical reflectors. It's important to aim to be a critical reflector as it’s the best. This comes with practice in the healthcare setting and experience. There is evidence for reflection improving the quality of care being given to patients as it allows health care practitioners to formulate effective plans of action which would ultimately improve care.

Evidence outlined in the case study of a study shows the value of reflective practice. The situation of 73-year-old Betty is assessed and reflected upon at several points so that an action plan could be made. Reflection was conducted before, in action and on action which is in line with the definition by Schon 1983 and Rolf et al 2010.

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Evaluation of this study is that it appears to have been done more than 10 years ago where guidelines may have been different to the guidelines that are used today so the information could lack temporal validity. There is no indication that the source was peer reviewed so the accuracy of the account may not be 100 percent. 

Although the study may lack temporal validity the information is relevant as it is based in the United Kingdom and not somewhere else where guidelines are different again. Taking all these points into account, the main concepts and ideas seem coherent and have been justified in the case study to the best of the student’s ability. The abstract has been published so one can assume at the very least there have been some checks done on the case study that enable it to be used.

Gibbs reflective model illustrates 6 steps to reflection. Firstly, identification of incident occurs then, feelings are noted down, evaluation and analysis are made and then a conclusion followed by an action plan are formulated. Within identification of the incident a detailed description of the incident is given so that most insight can be obtained.

A strength of this model is that it is very detailed and gives a lot of guidance for areas to consider when a health care professional is reflecting. The model uses necessary questions to persuade the professional to evaluate an experience in the most straight forward way possible. It also persuades professionals to give clear descriptions of an experience or incident and to think systematically about the steps in the reflective cycle.

Using the model to understand my critical incident can be done. Identification of the incident was....feelings felt were ..... evaluation and analysis if the incident was.....a conclusion to the incident was and an action plan for the incident would be.... The feelings I felt throughout the placement ranged from expectance to surprise and this is because my perspective of what an acute ward would be like was quite different. Surface level research was done prior to starting the placement but I was still surprised to find how different it was.

Whilst on placement the fact that many factors affect mental health becomes a reality when one listens to life stories of the patients. Treatment of the patients also can stir opinions because one could assume that medication is given since it’s easier than fixing situational, financial or other factors that are proven to be contributing to a person’s deteriorating mental health.(may delete or reword)

Activities I did on placement involve doing a medication round whilst being supervised where I was able to use my knowledge and skills from safe medicate to calculate dose when dispensing tablets and liquid medication.

I witnessed many handover sessions which were mainly verbal and saw how communication skills are useful when relaying information to staff that are working in the day. I made several cups of tea for patients and staff. I also witnessed many interviews if the patients where a doctor, junior doctor and registered mental health nurse would assess and update patients about information about their treatment.

I conducted my own research on the ward and inquired from the healthcare professionals whether they actively reflected and what are the outcomes of this reflection. What I found was that realistically staff reflect daily without even knowing it at times. I found that through reflection staff were able to clearly identify positive aspects of the care they were giving and we’re able to rectify the negative aspects of care which may have been given.

As a student nurse on placement it can be difficult to know what to do since we have the knowledge but not necessarily the confidence or experience to do certain tasks. When coming into a health care team it may be nerve racking trying to find a place to fit in as a student nurse but with a considerate team of professionals this experience is made more comfortable and enjoyable. (may delete)

Over the days of placement skills learnt in lectures have been applied in real life situations where necessary. Knowledge about laws and guidelines also learnt in lectures, was seen in effect on placement. This knowledge has helped the process of understanding procedures when a person is admitted on to a ward.

Overall, Reflection is necessary for growth and improvement of all healthcare professionals. There are different ways of reflecting and the best way is a model where there is a balance between the positives and negatives in a way where the positives outweigh the negatives. Lessons I have learnt from my three-week placement is to never underestimate just how much paperwork is needed for any type of action or decision in the ward. I also learnt to approach new situations more confidently because it assures the patients and other staff. Asking more knowledgeable people for information when needed is always useful instead of making mistakes which may be more difficult to solve than to prevent happening in the first place.

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