Reflection- in-action for clinicians involves recognizing a new problem and thinking about it while still carrying out the clinical duties. It helps the clinicians to identify their strengths and weaknesses and make improvements through the reflective process. Reflection in action is a trait for all experienced clinicians where they examine their behavior and that of others while in a particular situation. Some of the skills involved by clinicians include participating in observing situations that offer learning opportunities, attending to one’s feelings and observations in the current situation, focusing on the responses and connecting with the previous experiences, and finally being ‘in the experience’ as well as a witness if one was outside the experience (Somerville & Keeling, 2004).
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Reflection- in -action for clinicians
During reflection-in action, the clinician allows himself to experience surprise, or confusion when he finds himself in a uncertain or unique situation. He then reflects on the phenomenon before him and the prior understandings which have been inherent in his behavior. He then carries out an experiment which assists in generating both a new understanding of the phenomenon and a change in the situation. It is therefore a very important aspect of professional creativity (Stockhausen, 2006).
In acquiring the reflection in action skills, one needs to build his or her own framework and have a list of questions that which one can ask him/herself that will focus the reflection to a particular situation. Eventually the nurse will be able to incorporate the reflections into his/her own actions as will as the ethical, legal and broader social issues that one will have developed for that particular experience.
Chris John’s Model of Structured Reflection offers a framework for those in the healthcare field to help in their reflection skills. This is a detailed model compared to other models and is essential especially for nurses since nursing literature requires that nurses should be taught how to reflect with a comprehensive model (Bertero, 2010). John’s model arose from his work in Burford Nursing Development Unit. The focus for his model was to uncover and make explicit the knowledge used for clinical practice. John’s framework involves use of five cue questions which are sub-divided into more focus areas to ensure detailed reflection.teh cue questions include:
Description if the experience
This involves describing the phenomenon which is the current experience, then the casual, which describers the essential factors which contributed to that particular experience, then the context which involves the significant background factors related to the experience and finally clarifying the main processes for reflection for that experience.
This involves questions such as what one is trying to achieve, why he intervened as he did, the consequences of the action to the self, the patients/family and the work mates. Other questions are how one felt when the experience was happening, how the patient felt about it and how one can know how the patient felt about it.
Here one asks about the internal and the external factors that influenced his decision making and the sources of knowledge that could have influenced the decision making.
Evaluation: Could I have dealt with the situation better?
Here one asks about the other choices that he had and what could have been the consequences of those choices.
Here one asks himself of how he is feeling about that experience and how he has made sense of that experience in respect to the past experiences and future practice. The other question include how the experience has changed one’s ways of knowing empirics (scientific), ethics (moral knowledge), personal (self awareness) and aesthetics (the art of what we do).
Suggestions for Clinicians’ Reflection in Action
These questions offer a comprehensive reflection list that is essential for operating room nurses. They are also in line with the above model by Chris John. The questions lead the reflection process through various stages of reflection. For example the first six questions such as “am I reasonably sure of my thinking here, being too rigid or loose, asking all the questions…..” among others can assist in analyzing the situation and one’s actions on that situation. The other questions lead one to considering any available options. For example “am I closing my mind off to any possibilities? Am I forgetting any important rules here?” At this step one is able to consider other options relevant to the situation. The last questions help one to make a reflection before the final action. For example am I missing anything? Am I making conclusions based on solid data? Am i able to predict where this is going? Therefore one is able to end the process systematically and covering all the important details.
These questions are very essential especially for the operating room nurses who have various critical duties for the patient and the operating surgeon. The operating room nurse’s greatest role is to ensure sterility of the entire operation process by taking care of the operating room, the surgeon and the patient. It is therefore important for the nurse to go through the reflection process while carrying out these duties.
Reflection-in-action is a very important process especially due to the critical nature of the clinical work. Every clinician should make the habit of always reflecting on every situation they are faced with. It also helps in promote professionalism which is a very important aspect for every clinical work. It should therefore be encouraged at every level.
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