SELF-AWARENESS 1:

EXPLORING REFLECTION
Week 4
Achieving self-awareness
through reflection
 Objectives for today
At the completion of this lecture you should be able to:
• define reflection
• list types of reflection
• explain the importance of reflection in the
everyday practice of healthcare
professionals
• describe various models of reflection
• suggest when and how to reflect
• list possible requirements that facilitate
effective reflection.
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WHAT IS REFLECTION?
Brainstorm:
• What does it mean to reflect?
Does it mean to simply describe or recount events?
• What should a healthcare
professional reflect about?
• Suggest reasons why a healthcare
professional should reflect.

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 What is reflection
• It means taking time to think about event,
emotions and reactions. Your own
reactions and those of others around you.
It does not mean to simply recount or
describe an event.
 Reflection
• Reflection is the circular process that uses
experience, knowledge and theory to
guide and inform thoughts, action and
practice.
• Reflection facilitates the transformation of
the individual and thus transform the
thoughts and actions to achieve positive
result during practice.
 Reflection?

Some things are clear

at the time and others
become clearer with
Reflection.

FIGURE 6.1 Some things become clearer when

reflecting and others fade.

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 The “what” of reflection1
• Reflection occurs when individuals examine their
attitudes and reactions to an interactive
experience.
• It reveals causes of negative emotional
responses, which facilitates understanding of
these reactions.
• It allows of resolution and later change in
thought and behaviour in preparation for more
positive responses in future interactions.
 The “what” of reflection 2
• Reflection is the basis of self- knowledge.
• It provides knowledge of strengths and areas for
improvement.
• Sometimes, you may need to reflect with a
colleague.
• For HCP, reflection is a careful, deliberate and
critical consideration of events and their causes
that occur during communicative interactions.
 TYPES OF REFLECTION

• What is retrospective reflection?

• What might ‘in the present

reflection’ mean?

• What is prospective reflection?

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 WHY SHOULD HEALTH
PROFESSIONALS REFLECT?

• What does reflection achieve?

• Achieve awareness and understanding of self and others
around us, in the healthcare profession: the person/s

• How might it assist a healthcare

professional?
• Can promote learning and understanding about self and about
the person as well as increasing self control in difficult situation

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 For Health care professional
• Reflection contributes to self maintenance
essentials
• Continuing professional development
• Producing the development of skills and
effectiveness when communicating within
practice.
 Commonly used responses to
negative emotions or events
Possible Description
outcomes
Denial Person refuses to accept the truth
Projection Unacceptable feelings, thoughts and inadequacies, unwanted
characteristics and inappropriate desires are attributed to
another person.
Fantasy The person ignore the real world creating an imaginary world
that fulfills their needs and not reality
Displacement Strong feelings about one person are unhealthy redirected
onto another
Repression Unconscious removal of painful or anxious
Reaction Conscious thoughts and emotions are the opposite of the
formation actual unconscious wishes and emotions
Commonly used responses to negative emotions
or events 2
Possible Description
outcomes
Isolation of Excessive use of conscious thought to deny
affect uncomfortable emotions or events.
Sublimation Strong unacceptable desires and emotions are
rechanneled into personality and socially
acceptable channels
Suppression The person makes a semiconscious decision to
ignore a thought, idea or wish momentarily.
Humour The subtle and elegant defence occurs when
least expected and permits the expression of
emotions without discomfort
 Discuss this possible
DEFINITION
• Reflection is a process facilitating learning
about yourself, Person/s and healthcare
by considering emotions and examining
reactions during interactions and events –
sometimes using a model of reflection to
guide your thinking.
• Do you agree? Why or why not?

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 “ The “how” of reflection
• The purpose of reflection is to provide
information that empowers the health
professional to react appropriately: thus
----to avoid regret and guilt
---understand, accept and forgive rather
than feeling hurts, resentful.
• A model is used sometimes to assist in
reflection
 POSSIBLE MODELS OF
REFLECTION
 Kolb (1984)
 Boud, Keogh & Walker (1985)
 Fish, Twinn & Purr (1991)
 Gibbs (1988)
 Johns (1995)
 O’Toole (2020)

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KOLB (1984): A learning cycle (simplified)
DO: Act/Behave

PLAN
REFLECT

PROCESS
&
Principles
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 KOLB (1984): A learning cycle
• Do: Consider something you did or something
someone else did.
• Reflect: Think about how you did it and why you
did it and how everyone felt.
• Process and principles: Develop an
understanding of the event by seeking more
information and developing new ideas to guide
future actions.
• Plan/try: Actively test the plan in the future – did
it achieve the desired results?

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 Boud, Keogh & Walker (1985)

• Returning to the event

EVENT • Utilising positive feelings • New perspectives
on the experience
Personal • Removing or controlling
experience: obstructing feelings • Change in
behaviour
• Behaviour • Evaluating the experience
• Readiness for
• Feelings • Examining intent and
knowledge application
• Ideas • Commitment to act

Experience/s Reflective processes Outcomes

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 Boud, Keogh & Walker (1985)

Use the reflective

process to return to the Resolve and
EVENT event, examine the overcome the
feelings, reconsider causes. Adopt a new
Consider the and evaluate the
event; note perspective that
different components of
the intent and the experience. facilitates different
how to Consider their causes thoughts, feelings
intervene and possible reasons. and actions in future.
Commit to those
actions.

Experience/s Reflective processes Outcomes

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 Fish, Twinn & Purr (1991)
Four strands that together provide a
framework for reflection
THE FACTUAL STRAND
THE RETROSPECTIVE STRAND
THE SUB-STRATUM STRAND
THE CONNECTIVE STRAND
The strands are complementary, operating
together to produce the best outcomes and most appropriate
change in thoughts, feelings and actions.
The first two are the easiest – the last two produce
deeper reflection, but may be forgotten.
There are no questions to answer.

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 Fish, Twinn & Purr (1991)
• The factual strand: Retell or recall chronological stages of
the event, use the retelling to explore and explain, identify
the critical points, feelings and intentions in the event.
• The retrospective strand: ‘Observe’ – critique the whole
event, examine critical incidents and the success or failure
of the incident, consider the perspective of all
stakeholders. Note what was learnt about self and others.
• The sub-stratum strand: Use relevant theory to explain the
event, explore your assumptions, beliefs, values and your
level of knowledge about your healthcare profession and
the health service.
• The connective strand: Connects the above three strands
to establish what has been learnt about the past and for
the future. It identifies the implications for the future.

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The Gibbs reflective cycle (1988)
Describe
Feelings &
thoughts
Action plan

Conclusion Evaluate
Analyse

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 The Gibbs reflective cycle (1988)
• Describe: Describe the events and surrounding
environmental conditions.
• Identify feelings and thoughts: Your own and the
possible thoughts and feelings of other relevant
people.
• Evaluate: Were they appropriate?
• Analyse: Examine causes and reasons.
• Conclude: Using information from the above,
draw a conclusion about the event.
• Plan: Future action.
• https://www.youtube.com/watch?v=-
gbczr0lRf4 24
 Johns: Structured reflection
10th edn (simplified)

Structured and specific types of questions

• Aesthetics = 5 questions
• Personal = 2 questions
• Ethical = 2 questions
• Empirics = 1 questions
• Reflexivity = 6 questions
(Ashby 2006, p 32)

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 Johns: Structured reflection
10th edn (simplified)
1. Describe event/situation
2. Possible causes
3. Background information
4. Aim of each action and reasons
5. Consequences – feelings as well
6. Why other actions not chosen.
Consequences of these?
7. Resultant learning for future events
(O’Toole 2020, p 78)

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A healthcare-related model to guide
reflective care (O’Toole, p. 78)
Choosing to and allocating time to Reflect
about your healthcare practice.

Choose a Challenging or
Interesting Event.
Act to Fulfil the Plans:
Reflecting upon and
Changing Healthcare as
necessary.
Describe and Explore
the Chosen Event.

Develop Strategies and/or

Future Action Plans.
Explore ALL Reactions:
Self and the Person.
Establish relevant Goals for similar
future events or interactions.

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 A healthcare-related model to guide
reflective care (O’Toole p. 78)
1. Choosing to and allocating time to Reflect about
your healthcare practice.
2. Choose a challenging or interesting event.
3. Describe and explore the chosen event.
4. Explore ALL reactions both of Self and the Person
5. Establish relevant goals to achieve in similar
situations to ensure positive outcomes.
6. Develop strategies and action plans to ensure
achievement of these goals?
7. Act to fulfil the plans: continuing to reflect and
change your healthcare as necessary.
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 REFLECTION
So why do healthcare professionals need
to reflect?

ALL HEALTHCARE PROFESSIONALS

NEED TO INTERACT AND
COMMUNICATE ON A DAILY BASIS
Such interactions must have positive
outcomes for all interacting people.

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 REFLECTION
• Suggest ways that reflection can
achieve and enhance family/Person-
centred care.

• Remember the components of the

steps that facilitate family/Person-
centred care.

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 REFLECTION (cont.)
• When beginning to reflect, it may prove
helpful to initially use a published model of
reflection.
• Chose a model that suits your thought
processes and follow the steps or stages.
• As you develop skills in reflecting you will
find you will develop your own ‘model’ that
effectively and positively evaluates and
changes your thoughts, feelings and
behaviours.
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When to use reflection in practice
Daily – at least one event each day.
These events might relate to:
• your reactions during an interaction
• the reactions of the Person/s
• a positive event
• a negative event
• the process of choosing an intervention
• an intervention and the results or
outcomes.
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 Why use reflection in practice?
Benefits of reflection
Reflection can increase:
• Self/Person-awareness
• Awareness of areas of strength
• Awareness of areas for improvement
• Understanding and honesty
• Predictability
• Competence in communication and
practice.

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 Why use reflection in practice?
Reflection can increase:
• Self/Person-awareness
• awareness of areas of strength
• awareness of areas for improvement
• understanding and honesty
• predictability
• competence in communication and
practice.

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What do you require to reflect effectively?
 A commitment to learning and self-development
 Honesty with yourself
 Willingness to listen to feedback from others
 Realistic ideas about what needs to change
 An understanding that learning is lifelong in
professional careers. Why?
 Motivation to reach your potential as a person
and therefore as a healthcare professional.
 Valuing excellence in practice for the benefit of
the Person/s.

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Effective reflection takes time and requires:
 a commitment to reflecting
 time dedicated to reflection
 a reflective diary may assist the reflective
process
 a trusted colleague to help you reflect
 a commitment to regular reflection
 recording significant learning to identify growth
and development of skills and competence.

People who are natural reflectors BEWARE. WHY?

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 Video

• https://www.youtube.com/watch?v=eHKS
R_6aym8

• LA
?QUESTIONS?
Next lecture:
Self-awareness 2: becoming self-aware
Required Reading for next week:
Chs 5, 6, 7 and 18

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 Required reading for Wk 4
O’Toole, G., 2020. Communication: Core
interpersonal skills for healthcare
professionals, fourth edition. Elsevier,
Sydney. Chs 6, 7 and 8

Recommended reading
See reference list at the end of Chapter 6
for other references.

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 References
Ashby, C., 2006. Models for reflective practice. Practice Nurse 32,
10–12. ProQuest Nursing and Allied Health Source, p 28.
Boud, D., Keogh, R., Walker, D., 1985. Reflection: turning
experience into learning. Kogan Page, London.
Fish, D., Twinn, S., & Purr, B., 1991. Improving the supervision of
practice in health: Training notes. West London Institute of Higher
Education, West London.
Fish, D., Twinn, S., 1997. Quality clinical supervision in the health
care professions: principled approaches to practice. Butterworth
Heinemann, London.
Gibbs, G., 1988. Learning by doing: A guide to teaching and learning
methods. Further Education Unit, Oxford Polytechnic, Oxford.

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 THANK YOU
References
Johns, C., 1993. Professional supervision. Journal of
Nursing Management 1, 9–18.
Johns, C., 1995. Framing learning through reflection
within Carper’s fundamental ways of knowing in
nursing. Journal of Advanced Nursing 22, 226–234.
Kolb, D.A., 1984. Experiential learning. Prentice Hall,
Englewood Cliffs, NJ.
O’Toole, G., 2020. Communication: Core interpersonal
skills for healthcare professionals, 4th edn. Churchill
Livingstone Elsevier, Sydney.

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