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'I don't like how formalised reflection has become'

  • Comments (14)

You will hear it every day, you will be told how important it is, and you will have so many different models thrown at you that you wont know what to do with them. Yes, I’m talking about reflection.

Reflection is important, I’m not denying that. In fact, the NMC (2010) competencies for entry to the register state both that nurses ‘must evaluate their care to improve’ and that nurses ‘must be self-aware’ and ‘maintain their own personal and professional development, learning through reflection’. 

To me it seems like a strangely clinical way to examine my thoughts and feelings

So yes, it is important.

However, I disagree with how formalised reflection in nurse education has become. It seems like everyday I have to write a new reflective journal entry, or incorporate reflection into an essay. I have to consider whether to use Gibb’s or John’s. To me it seems like a strangely clinical way to examine my thoughts and feelings. While I do learn from my mistakes, and from the things I actually did really well, I find it quite a chore to assign a time and space and try to write about it. (Ironic for a blogger, I know.)

And then I realised. I reflect all the time.

On the train home from placement I can’t help but think about what I’ve done that day. When I phone my mum after a particularly horrible day (she’s an old-school nurse who is completely unshockable, very reassuring after a bad day), or even when something funny happens to me and my friends have a good laugh at my expense.

These innocuous interactions are perfect examples of reflection in real life. And it is this form of reflection that I find helps me the most. I’m not focussing on my spelling and grammar, on the word count, or even on if I’m making sense. I can take my time and work through my thoughts at my own pace. I can back track and talk gibberish and actually interact with other people and get their opinions.

So yes, I do understand the importance of reflection. And I really do appreciate the value of it. But I think that following a particular model isn’t the right thing for me. And it may not be the right thing for you! I think we should be allowed to find what works best for us. In the mean time, I’m going to suck it up and go and reflect on my communication skills.

Also good luck to all you September intake student nurses heading back this week! And especially to the freshers – it’s scary and exciting and you will probably love it.

Also follow me on twitter @Sarah_ABN

  • Comments (14)

Readers' comments (14)

  • Anonymous

    I thought exactly the same when I was a student nurse! Since then, I have done courses requiring reflection using references, reflection without references, reflections to be shared as part of a portfolio and reflections to remain private. Having used John's model once and finding it took me hours to complete all the stages, I am firmly a 'Gibb's' fan!

    You're right, we all reflect informally. Some more than others. It's a strange beast, the formal nursing reflective piece. But it does have its place. I hope that it helps the people with less self-reflective ability to be able to examine their feelings and their practice more easily. I know a few people outside of work who could do with it!
    And it is quite gratifying now to do courses with other professionals who need slides on reflection, its importance and the various models because they don't do it as a formal process that regularly, and NOT have to spend the time learning about it, because it is so engrained as a learning process! Go forth and reflect...!

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  • We've been talking about this in our seminars, a lot of my colleagues say they hate reflection. But you're right, it's something we do naturally & not just in nursing but in all areas of our lives.

    However I am a massive a geek and love a good model/theory, I think it makes it a lot easier to set out in an essay as my reflective thoughts tend to be all over the place & difficult to set out clearly.

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  • Adam Roxby

    Hello Sarah.

    Really good article. I tried to keep a reflective diary form my time in practice but it's really hard to get out of the habit of just being descriptive. Hopefully I am getting there.

    Looking forward to your next one.

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  • Michelle Parker

    I agree wholeheartedly with what you are saying Sarah, I informally reflect every day and often scribble small reflections in a private journal, but as soon as I have to use a reflective model it becomes a less personal reflection and more of a chore. I do understand the need for it, but I personally find the models to restrictive.

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  • I have to agree. I have just qualified and the thing I hated the most was the formal reflection. I even argued with one tutor that a reflection should be about what I was thinking and feeling, and shouldn't be about whether a lot of people I have never met agree with me or not. Therefore I argued it shouldn't need references. He disagreed.

    I also agree that it is hard to keep up a reflective diary while on practice, because you just don't have the time. What I did find helpful was keeping a diary and writing down in it what I had done each shift. Whether I was nurse in charge or on the clozaril clinic, and whose assessment, review or referrals I had done (not using full names of course). I also kept a record of work I had done (photocopies with names, etc removed). When I look at these now, they recall memories of the experience in vivid detail.

    You have little choice about how you reflect for coursework, but how you choose to reflect for yourself is absolutely your choice, so find what works best for you.

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  • Thank you everybody! It's really encouraging reading all your comments, and it's interesting how many of us seem to dislike something that's such a core part of our curriculum. Personally, we don't do a lot of reflection as part of seminar/group work, and I would love to do more.

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  • Anonymous

    reflecting for too long can seriously get in the way of decision making, even to the extent of lost opportunities.

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  • Yes But

    Reflection is not listing a lot of evidence/opinion.

    It is the process of looking at such things, formulating one or more questions, and perhaps coming up with answers to those questions (ideally you want the answers, but working out the right questions is also part of reflection).

    Listing what others have written, with no critique, is definitely not reflection, and neither is writing down what you yourself have done - that is mere description, and reflection is almost always more than a mere statement of opinion.

    To quote Sarah-

    And then I realised. I reflect all the time.

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  • michael stone

    Reflection on how nurses are taught to reflect – I like it !

    I’ll pose this one, in case anybody wishes to reflect on it: evidence-based behaviour, but ‘ran backwards’. Is there a mistake somewhere in there ?

    What does ‘evidence-based behaviour’, mean ? It can’t just mean ‘we take evidence into account’, because that much is obvious. It must actually mean this:

    ‘We have identified the best treatment for any particular presentation, and we intend to always provide that best treatment for every identical presentation’.

    Now, how do you test whether ‘evidence-based behaviour’ is being applied in practice ? This is, of course, a test of whether all similarly qualified clinicians, provide the same best treatment (ignore the fact that several treatments could be equally effective – assume only one ‘best treatment’ exists, to run this particular piece of ‘reflection/analysis’) when presented with identical presentations. And clearly you can only have definitely identical presentations, if instead of comparing behaviour when presented with real-world patients, we restrict ourselves to cases that are described on paper (or on film, etc). Basically, an exam question (actually, any question).

    So what does it tell you, if you ask 100 similarly qualified clinicians ‘what should you do if ….’ and you do not get 100 identical answers ?

    It tells you that one of the following is true:

    A) If there is a provable ‘best answer’ (so ‘evidence-based behaviour’ requires that to be the answer) then some clinicians are not providing ‘best practice’ behaviour;

    B) It might tell us, that nobody has identified the ‘best answer’, which means that in a fundamental sense current practice is not ‘evidence-based’.

    My own particular interest, is in the application of this analysis to questions where law comes into play: in those cases A) becomes ‘some clinicians must be acting illegally’, and B) becomes ‘we can’t say who is doing something illegal, because we have not worked out what isn’t legal’.

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  • Yes But

    DH Agent - as if ! | 3-Oct-2012 10:04 am

    I can't find a mistake in it.

    And this is an interrsting 'game' - so I'll throw in

    'It is important to understand the fundamental difference between something which cannot be known, and something which happens to be unknown'.

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