Cycles of Reflection in Nursing

Introduction

Oelofsen (2012) defines reflective practice as the process in which an individual makes sense of situations, events and actions that occur in the workplace (Natius, 2012). In the light of nursing practice, the concept of reflection plays a critical role by enabling practitioners (nurses) to, competently manage the impactful and precarious nature of care giving (Natius, 2012). According to Keeling and Somerville (2004), reflective practice facilitates the understanding and development of self-awareness, inter-personal skills and also the ability to influence positive change in others (David & June, 2004). These skills are key to nurses in mapping out the most appropriate action plans to take in any given situation.

Comparative examination of four models of reflection as applied in the context of nursing

Model of reflection	Key features
Gibbs model of reflection 1988	It is fairly straightforward (Marshall et al., 2006) gives a clear description of the situation, analysis of feelings, evaluation of the experience and subsequent analysis of the experience to make sense of it (Marshall et al., 2006) Repeats the same loop of action several times (Marshall et al., 2006) creates room for an alternative course of action It reflects on the current experience with the view to developing appropriate action plans should a similar situation arises again.
Johns model of reflection 1994	A structured model with steps that have questions, prompts and activities that aid in reflection (Davey, 2011). The concern of questions lies in describing the experience and its main issues, reflection on what the practitioner was trying to achieve and why he acted in a certain way. It also looks at the consequences of the action to the self (practitioner) and to the client (patient), the feelings that the action evoked and academic sources of knowledge that possibly influenced the decisions made. This model explores the different angles to how the situation could be handled differently and also what would be done in the future should the situation recur
Kolb’s model of reflection 1980	Based on experiential learning cycle and covers four phases. The stages are: Concrete Experience (CE)-Learning by experiencing. In this phase, the learner (Nursing student) learns from specific experience, relates to people (patients) and becomes sensitive to their feelings (Martin, 2006). Reflective Observation (RO)-Learning by reflecting. This stage entails making careful observation before judging, viewing issues and situations in different perspectives and looking for meaning in the situations. Abstract Conceptualization (AC)- Learning by thinking. It is a critical stage where a learner logically analyses ideas, plans systematically and acts on the situation from an intellectual understanding. Active Experimentation (AE)- Learning by applying / doing. This is the last phase where the learner shows the ability to get things done, takes risks and influences people and events through action.
Goodman model of reflection 1984	This approach is premised on three levels of reflection: Level 1: Reflection to attain given objectives. In this level, the criteria for reflection are limited to technocratic issues of effectiveness, efficiency and accountability. Students, for example, are expected to give an account of an occurrence and demonstrate some degree of learning (Robotham & Frost, 2006). Level 2: Reflection is on the basis of the relationship between principles and practice. Assessment of the consequences and implications of beliefs and actions, as well as the rationale employed in practice, is done. At this level, students begin to link theoretical perspectives to practice and also apply their experiences in similar circumstances. Level 3: reflection that integrates ethical and political concerns. At this level, there is deliberation of emancipation and justice over the value of professional objectives and practice. The practitioner links the everyday practice to the broader social structure and forces such as economics, health, and resources.

Gibbs model of reflection is commonly employed in the Health profession because of its clarity and precision (Brock, 2014). It allows for easy description, analysis and evaluation of experiences and thus helps the reflective practitioner (nurse) to, clearly make sense of her experiences as well as examine her nursing practice (Holland & Roberts, 2013).

Unlike the Gibbs model, the other models, for example, Kolb’s model 1980 and Goodman model 1984 are relatively complex. These models require, to a greater extent, some degree of experience (McKee & Eraut, 2012). The Kolb’s reflective model, for instance, is basically hinged on experiential learning that covers four stages (McKee & Eraut, 2012). And since experienced nurses have enough experience, they can easily relate to the model and apply it in practice.

Model that is best suited for nursing practice

John’s model of reflection 1994 is best suited as a tool for the nursing profession. Its structured nature serves as a good platform for a complete assessment of the nursing practice (Rideout, 2001). The questions are excellent cues in prompting particular actions (Driscoll, 2007). This approach is also wholesome in the sense that it explores all the areas of the nursing practice. It examines the practitioner’s experiences, her reflection on the experiences, actions taken by the practitioner and impact of the actions on self (practitioner) and the patient (Mohanna et al., 2011). It also looks at the aspect of the academic sources that may have influenced the decisions made as well as the possible angles to how the situation could have been dealt with differently and how it can be handled in the future (Moon, 2013).

Importance of the choice of framework of reflection in encouraging and supporting reflection

A desirable framework of reflection is helpful to nurses as it provides a structured process that guides the act of reflecting (Jasper, 2003). The choice of a particular framework of reflection is important because students face different experiences, and so is the need for an appropriate framework to offer the necessary support and encouragement throughout their learning process (Schon, 2008).

Critical analysis of all the four models with respect to what is good and bad about them

The four models of reflection examined above, all have their strengths and weakness in their application. Below is a table summarizing their strengths and weaknesses.

Model of reflection	Strength(s)	Weakness(es)
Gibbs model 1988	Challenges assumptions (Devinder Rana, 2013). This attribute is important in validating data and drawing appropriate conclusions. Explores different approaches to thinking and acting and as such encourages creativity. Links practice and theory. It helps a learner to apply knowledge gained in practice.	It is not necessarily introspective (Watson & West, 2006). Reflection requires both introspective and retrospective perspectives.
Johns model of reflection 1994	Its structured nature allows for wholesome analysis of learning. Simple in nature thus easy to apply	Its simplicity may not necessarily capture all the critical components of reflection
Kolb’s model 1980	Its four stages of experiential learning i.e. Concrete experience, Reflective observation, Abstract conceptualization and Active experimentation provide a favourable framework for in-depth learning and application.	Mostly applies to experienced practitioners hence cut off less experienced ones.
Goodman model 1984	This model is crucial in developing professional skills in learners as well as empowering them to be economically, socially and politically competent individuals.	Significantly cuts off young learners. Such learners are yet to fully understand the applicability of the tenets of this model.

Reflective practice and its use to medical education

The ability to reflect plays a critical role in medical education. Reflective practice enables learners in the medical field to clearly understand and develop self-awareness, interpersonal skills and analytical skills (Jack Mezirow, 2011). These skills will come in handy in practice as medical students will be able to handle people (patients) in frontline settings such as a hospital scenario.

The importance of students developing a habit of assessing their own learning needs

Through self-assessment with regard to learning needs, students are able to constantly identify areas of weakness and improve on them (Earl, 2004). The fact that students are actively engaged in the process serves as a motivation for them and subsequently translates to better outcomes (Bonnie Beyer, 2014).

References

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