1. Joy Hall – Head of Department Public & Community
Health
Birmingham City University

2. Outcomes:
• Define and describe the terms: reflection,
reflection-on action, reflection – in action &
critical reflection.
• Identify how these 3 methods of reflection
can be used to improve patient care,
especially in relation to patient safety.

3. All familiar with a reflective
Description :
What
Happened
Reflective
cycle
Feelings:
What were
you thinking
and/or
feeling?
Evaluation
What was
good and bad
about the
Analysis: experience?
What sense can
you make of
the situation?
Action plan:
If it arose
again what
would you
do?
Conclusion:
What else
could you
have done?
cycle?
[Gibbs, 1988]

4. Two questions
What exactly do we mean by reflection in
professional practice
How does it improve patient safety

5.  Reflection is the examination of personal thoughts and
actions. For practitioners this means focusing on :
• interactions with their colleagues and
• interactions with the environment to obtain a clearer
picture of their own behaviour.
It is therefore a process through which practitioners can:
• understand themselves and their actions/behaviour
better
• build on existing strengths and
• plan appropriate future action.
Note the word ‘action’ is very important

6. Reflection
Developing professional practice by requiring the
practitioner to :
• explore different/new ideas and approaches
towards doing or thinking about things
• promote self-improvement
(by identifying strengths and weaknesses and
taking action to address them)
• link practice and theory
(by combining doing or observing with
thinking or applying knowledge)

7. •Reflection-on-action
•Reflection-in-action
•Critical reflection

8. •The most frequently used form of
reflection. It involves carefully thinking
and re-thinking about professional actions
that have already occurred.
•The aim is to identify strengths and to
consider how professional actions can be
more effective in the future.

9. Questions to ask:
• Is this good practice? If so, what is good? If not what is
bad?
• What are the risks for the patient?
• How could you decrease the risks in each example?
• What is does the evidence say about this practice?

10. This is harder to do and takes experience. It
means:
 examining your own professional actions
and behaviour and
Examining the professional actions of others
while the clinical situation continues.

11. Skills needed:
 ability to be a participant observer in clinical
settings which means
For your own clinical practice
 ability to carry out and evaluate your own actions
and make links with previous clinical experience
For practice of other professionals
 ability to carry own role and function while at
the same time ‘watching’ activities and
recording actions of others
 ability to evaluate the practice of others

12. Questions to ask
• Is the equipment well organised? Could it be organised
differently/better? If so, how?
• Are the nurses working well together?
• Are there any ways patent safety is at risk? If so, how
could these be reduced?

13.  Critical reflection refers to the capacity to recognise our
assumptions about ourselves, other people, and the
workplace.
 Personal experience determines how much of our
environment we actually ‘see’.
 Two descriptions of the same event will be different.
 Involves uncovering some of the assumptions, beliefs and
values that are part of our society so Vietnamese
reflections will vary from UK or elsewhere
 Critical incident analysis offers useful tools to facilitate
critical reflection

14.  What do you see?
Reflect on how the mother
feels
How do you as a nurse feel
What are the patient risks?
What could be done better?
What does the evidence say?
How can you get to the
example below?

15. Description :
Diabetic with
wound infection-excessive
exudate, pyrexia
Reflective
cycle
Feelings:
Concerned
Worried
How did this happen?
Reaction – seek
medical advise –
antibiotics given,
clean & monitor
wound & blood
glucose
Evaluation:
Badly? = wound
infection
eventually
resolved, blood
glucose returned
to normal range
Analysis:
Patient remained
pyrexial for prolonged
period
Wound with heavy
exudate for long period
Hyperglycaemia for
prolonged period
Action plan:
Update
knowledge of:
Wound dressings
& wound healing
Care of wound
care related to
diabetes
Conclusion:
Insulin infusion?
More frequent
monitoring?
Different
dressings?
Different
cleaning agent?
Monitored vital
signs

16. What is the most important thing to do right now?
What resources are available to me?
How can I best use these resources?
What do I most value about nursing role?
What practice activities have made me proud to be a nurse?
How am I using my skills?
What do I really need to do?
How confident am I about my professional role ?
What did I find difficult?

17.  Courage to note gaps in
knowledge
 Willingness to seek training
from experts or from
colleagues in other settings
Willingness to explore the
evidence and research to guide
practice
Courage to challenge and change
practice ( own & others)

18.  Reflect on extent to which care
provided fits patient
expectations and how this affects
safety
 Reflect on how individual
differences can be respected
without reducing safety
 Reflect on the significance of
illness to
 the patient?
 the family
 community?

19. References
Gibbs G (1988) Learning by Doing: A guide to teaching and learning
methods. Further Education Unit, Oxford Brookes University, Oxford.
Boud, D., Keogh, R. & Walker, D. (1985) Reflection: Turning Experience into
Learning. London: Kogan Page.
Ghaye,T & Lillyman, S (2010) Reflection Principles Practice for Healthcare
Professionals.London. Quay Books
Johns, C. (2000) Becoming a Reflective Practitioner. Oxford: Blackwell Science.
Mann,K, Gordon,J & MacLeod,A (2009) Reflection and reflective practice in
health professions education: a systematic review .Advances in Health Sciences
education. Volume 14 ( 4) pp 595-621
Tate, S. & Sills, M. (eds) (2004) p 126 The Development of Critical Reflection
in the Health Professions. London; Higher Education Authority

20. Xin Cam un