{"id":1205,"date":"2016-12-01T08:02:50","date_gmt":"2016-12-01T13:02:50","guid":{"rendered":"http:\/\/alanbatt.net\/?p=1205"},"modified":"2024-08-07T16:07:09","modified_gmt":"2024-08-07T20:07:09","slug":"an-introduction-to-reflective-practice-for-paramedics","status":"publish","type":"post","link":"http:\/\/alanbatt.net\/?p=1205","title":{"rendered":"An introduction to reflective practice for paramedics"},"content":{"rendered":"<p>Reflective practice is an important tool in practice-based professional learning settings where individuals learning from their own professional experiences, rather than from formal teaching or knowledge transfer. It is an important process in continuous professional competency and development.\u00a0Reflection is nothing to be scared of \u2013 we all reflect every day in different forms and about different things.<\/p>\n<p>Learning to be a reflective practitioner includes not only acquiring knowledge and skills, but also the ability to establish a link between theory and practice, providing a rationale for actions. Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). It can be used by both students and qualified paramedics to\u00a0reflect on their strengths, weaknesses and areas for development.<\/p>\n<p>Reflective practice has many definitions<\/p>\n<ul>\n<li>A process of learning and\u00a0developing through examining our own practice, opening our practice to scrutiny by others, and studying texts from the wider sphere. It is a focusing closer and closer. (Bolton, 2010)<\/li>\n<li>An approach to learning and practice development which is patient-centred and which acknowledges the untidiness and confusion of the practice environment (Burns &amp; Bulman 2000).<\/li>\n<li>An active process that enables health care professionals gain a deeper understanding of their experiences (Conway, 1996)<\/li>\n<li>Re\ufb02ection is being mindful of self, either within or after experience, as if a window through which the practitioner can view and focus self within the context of a\u00a0particular experience, in order to confront, understand and move toward resolving\u00a0contradiction between one\u2019s vision and actual practice (Johns, 2004)<\/li>\n<\/ul>\n<p>Reflective practice remains a relatively unknown concept in paramedic practice compared to other healthcare professions such as nursing, where it has been embraced as an essential foundation of professional practice and continuous development.<\/p>\n<p>Paramedic associations and regulatory bodies worldwide suggest that all paramedics maintain a personal CPC portfolio, and a reflective journal or diary is an essential part of this portfolio.<\/p>\n<p>How many of us discuss calls and patient outcomes with other practitioners back at base or in the ambulance (<em>aka a call \u201cpost-mortem\u201d<\/em>)?<\/p>\n<p><em>Hands up!<\/em><\/p>\n<p>Quite a few? As I thought \u2013 so reflection on practice is not a new concept to Paramedics, but the formal application of it as part of professional development may be.<\/p>\n<p>Putting these reflections down on paper and in a logical, structured manner is what proves difficult to many practitioners. The Gibbs Reflective Cycle is commonly used in nursing, and we also recommend this as an introductory process to paramedics and prehospital care providers, as it allows for a logical pathway for constructing reflective diary entries.<\/p>\n<p>Reflective journals should not be seen as a laborious task required for CPC, and rather for an opportunity to critically reflect upon and develop one\u2019s practice, as well as developing one\u2019s critical thinking skills (Brookfield, 1987). Students in other health disciplines such as medicine, nursing, pharmacy and allied health professionals find reflective journals a useful tool in the reflective process (Constantinou &amp; Kuys, 2013; Koh et al., 2014; Asselin &amp; Fain, 2013)<\/p>\n<h3>Gibbs Reflective Cycle<\/h3>\n<p>Gibbs reflective cycle is seen as one of the easiest to follow and implement, and is therefore a good starting point for those beginning with reflective practice. Once you are comfortable with the reflective process, you may decide to use another reflective cycle such as those by Kolbs, Johns, Brookfield, Rolfe or Ganshirt. Remember, reflection is a personal activity, and one model will not fill all \u2013 feel free to adapt cycles or processes to suit your individual needs. Sometimes, writing down the reflection is helpful in giving structure to your thoughts (Price, 2004).<\/p>\n<p>Once you are comfortable with reflective practice, you will begin to focus on the evaluation, analysis and planning phases in more detail. Your reflections will become more insightful, probing and detailed as opposed to a generalised narrative description commonly seen when beginning reflective diaries. Some authors refer to achievement of this level as critical reflection.<\/p>\n<div class=\"slate-resizable-image-embed slate-image-embed__resize-full-width\" data-imgsrc=\"https:\/\/media.licdn.com\/mpr\/mpr\/AAEAAQAAAAAAAAhjAAAAJDcxODhhODUyLWRlZDgtNGQzNC1iOGM5LTVjY2NkZmI4NjEzNA.png\"><img decoding=\"async\" src=\"https:\/\/media.licdn.com\/mpr\/mpr\/AAEAAQAAAAAAAAhjAAAAJDcxODhhODUyLWRlZDgtNGQzNC1iOGM5LTVjY2NkZmI4NjEzNA.png\" alt=\"\" \/><\/div>\n<p><em>Gibbs (1988)<\/em><\/p>\n<h3>Description<\/h3>\n<p>A description of the call or incident, with relevant details. Remember to maintain patient confidentiality. Don\u2019t make any judgement yet or try to draw conclusions; simply describe the events and the key players. Set the scene! It might be useful to ask yourself the following questions<\/p>\n<ul>\n<li>What happened?<\/li>\n<li>When did it happen?<\/li>\n<li>Where were you?<\/li>\n<li>Who was involved?<\/li>\n<li>What were you doing?<\/li>\n<li>What role did you play?<\/li>\n<li>What roles did others play?<\/li>\n<li>What was the result?<\/li>\n<\/ul>\n<h3>Feelings<\/h3>\n<p>Don\u2019t move on to analysing these yet, simply describe them.<\/p>\n<ul>\n<li>How were you feeling at the beginning?<\/li>\n<li>What were you thinking at the time?<\/li>\n<li>How did the event make you feel?<\/li>\n<li>What did the words or actions of others make you think?<\/li>\n<li>How did this make you feel?<\/li>\n<li>How did you feel about the final outcome?<\/li>\n<li>What is the most important emotion or feeling you have about the incident?<\/li>\n<li>Why is this the most important feeling?<\/li>\n<\/ul>\n<h3>Evaluation<\/h3>\n<ul>\n<li>What was good about the event?<\/li>\n<li>What was bad?<\/li>\n<li>What was easy?<\/li>\n<li>What was difficult?<\/li>\n<li>What went well?<\/li>\n<li>What did you do well?<\/li>\n<li>What did others do well?<\/li>\n<li>Did you expect a different outcome?\u00a0If so, why?<\/li>\n<li>What went wrong, or not as expected? Why?<\/li>\n<li>How did you contribute?<\/li>\n<\/ul>\n<h3>Analysis<\/h3>\n<ul>\n<li>What can you apply to this situation from your previous knowledge, studies or research?<\/li>\n<li>What recent evidence is in the literature surrounding this situation, if any?<\/li>\n<li>Which theories or bodies of knowledge are relevant to the situation\u00a0\u2013 and in what ways?<\/li>\n<li>What broader issues arise from this event?<\/li>\n<li>What sense can you make of the situation?<\/li>\n<li>What was really going on?<\/li>\n<li>Were other people\u2019s experiences similar or different in important ways?<\/li>\n<li>What is the impact of different perspectives eg. personal \/ patients \/ colleagues\u2019 perspectives?<\/li>\n<\/ul>\n<h3>Conclusion<\/h3>\n<ul>\n<li>How could you have made the situation better?<\/li>\n<li>How could others have made the situation better?<\/li>\n<li>What could you have done differently?<\/li>\n<li>What have you learned from this event?<\/li>\n<\/ul>\n<h3>Action Plan<\/h3>\n<ul>\n<li>What do you think overall about this situation?<\/li>\n<li>What conclusions can you draw? How do you justify these?<\/li>\n<li>With hindsight, would you do something differently next time and why?<\/li>\n<li>How can you use the lessons learned from this event in future?<\/li>\n<li>Can you apply these learnings to other events?<\/li>\n<li>What has this taught you about professional practice? about yourself?<\/li>\n<li>How will you use this experience to further improve your practice in the future?<\/li>\n<\/ul>\n<h3><\/h3>\n<h3>Kolb\u2019s learning\/reflective cycle<\/h3>\n<p>Kolb\u2019s learning\/reflection cycle is a reflection of the learning styles that Kolb defines (Kolb &amp; Fry,\u00a01975). It consists of 4 stages \u2013 planning, doing, reflecting and linking. The key elements of\u00a0the cycle are:<\/p>\n<ol>\n<li>Plan\/Test \u2013 here the learner\u2019s interest is captured, and the learning subject or material is\u00a0established and learning objectives are identified.<\/li>\n<li>Do\/Experience \u2013 the student constructs knowledge on the subject by exploring through active\u00a0learning methods such as questioning, observation and interacting.<\/li>\n<li>Reflect \u2013 learners provide their explanation of the material that was covered.<\/li>\n<li>Link\/Conceptualise \u2013 applying the knowledge gained to various\u00a0different situations and problems.<\/li>\n<\/ol>\n<div class=\"slate-resizable-image-embed slate-image-embed__resize-full-width\" data-imgsrc=\"https:\/\/media.licdn.com\/mpr\/mpr\/AAEAAQAAAAAAAAkXAAAAJDc4NGFkMTgyLTIxMGMtNDk5NC04Y2NiLTdiOWExOGQyMzQ5YQ.png\"><img decoding=\"async\" src=\"https:\/\/media.licdn.com\/mpr\/mpr\/AAEAAQAAAAAAAAkXAAAAJDc4NGFkMTgyLTIxMGMtNDk5NC04Y2NiLTdiOWExOGQyMzQ5YQ.png\" alt=\"\" \/><\/div>\n<p><em>Kolb &amp; Fry (1975)<\/em><\/p>\n<p>Practitioners using Kolb\u2019s cycle self analyse\u00a0if learning objectives were met \u2013 this starts the cycle again at the plan phase. The\u00a0cycle can however begin at any stage.\u00a0The learner reviews the learning content, plans\u00a0study and learning objectives. The learner then studies the material, reflects on what they have learned, and\u00a0see if they can apply it practically to a number of exercises and problems. If not, then they must reevaluate\u00a0and start the cycle again. This can also occurred based on a discontinuity \u2013 the learner may\u00a0discover something they do not know, and therefore the cycle\u00a0begins at the reflection phase. (Boyatzis, 2002)<\/p>\n<h3>Ok&#8230;I\u2019ve reflected! What next?<\/h3>\n<p>Reflection should be a never-ending process. Done regularly, reflective practice will enable you to pay attention to the details of your clinical practice, and your ability to bridge the gap between theory and practice. Bearing this in mind, you will be able to anticipate upcoming situations as being new learning experiences, and in doing so, become a more informed, safer and more skillful practitioner.<\/p>\n<h3>Further reading<\/h3>\n<p><a href=\"http:\/\/www.nursingtimes.net\/Journals\/2012\/11\/30\/v\/l\/x\/040323A-practical-approach-to-promote-reflective-practice-within-nursing.pdf\" target=\"_blank\" rel=\"nofollow noopener\">A practical approach to promote reflective practice within nursing<\/a><\/p>\n<p><a href=\"http:\/\/www.heacademy.ac.uk\/resources\/detail\/subjects\/medev\/Focus-_Becoming_a_reflective_practitioner\" target=\"_blank\" rel=\"nofollow noopener\">Becoming a reflective practitioner<\/a><\/p>\n<p>Johns, C., Freshwater, D. (2005) (eds.)\u00a0Transforming Nursing\u00a0Through Re\ufb02ective Practice. (2nd Ed.)\u00a0Oxford, Blackwell Science.<\/p>\n<h3>References<\/h3>\n<p>Asselin ME1, Fain JA.\u00a0<a href=\"http:\/\/qxmd.com\/r\/23703269\" target=\"_blank\" rel=\"nofollow noopener\">Effect of reflective practice education on self-reflection, insight, and reflective thinking among experienced nurses: a pilot study.<\/a>\u00a0J Nurses Prof Dev. 2013 May-Jun;29(3):111-9. PMID:\u00a0<a href=\"http:\/\/qxmd.com\/r\/23703269\" target=\"_blank\" rel=\"nofollow noopener\">23703269<\/a>.<\/p>\n<p>Bolton, G (2010) Reflective Practice, Writing and Professional Development (3rd edition),\u00a0California,\u00a0SAGE publications.<\/p>\n<p>Boyatzis, R.E. (2002). Unleashing the power of self-directed learning; in R. Sims\u00a0(ed.) Changing the Way We Manage Change: The Consultants Speak. New York,\u00a0Quorum Books<\/p>\n<p>Brookfield, S. (1987). Developing Critical Thinkers: Challenging Adults To Explore Alternative Ways of Thinking and Acting. Milton Keynes, Open University Press.<\/p>\n<p>Burns, S., Bulman, C. (2000). Reflective Practice in Nursing: The Growth of the Professional Practitioner. (2nd Ed.). Oxford, Blackwell Science.<\/p>\n<p>Constantinou M1, Kuys SS.\u00a0<a href=\"http:\/\/qxmd.com\/r\/23219653\" target=\"_blank\" rel=\"nofollow noopener\">Physiotherapy students find guided journals useful to develop reflective thinking and practice during their first clinical placement: a qualitative study.<\/a>\u00a0Physiotherapy. 2013 Mar;99(1):49-55. PMID:\u00a0<a href=\"http:\/\/qxmd.com\/r\/23219653\" target=\"_blank\" rel=\"nofollow noopener\">23219653<\/a>.<\/p>\n<p>Conway, J. (1996) Nursing Expertise and Advanced Practice.\u00a0\u00a0London,\u00a0Quay Books.<\/p>\n<p>Gibbs, G., (1988). Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Educational Unit, Oxford Polytechnic.<\/p>\n<p>Johns, C. (2004) Becoming a Re\ufb02ective Practitioner, 2nd edn.\u00a0Oxford, Blackwell Science.<\/p>\n<p>Koh YH1, Wong ML, Lee JJ.\u00a0<a href=\"http:\/\/qxmd.com\/r\/24350800\" target=\"_blank\" rel=\"nofollow noopener\">Medical students\u2019 reflective writing about a task-based learning experience on public health communication.<\/a>\u00a0Med Teach. 2014 Feb;36(2):121-9. PMID:\u00a0<a href=\"http:\/\/qxmd.com\/r\/24350800\" target=\"_blank\" rel=\"nofollow noopener\">24350800<\/a>.<\/p>\n<p>Kolb, D. A. and Fry, R. (1975). Toward an applied theory of experiential learning; in C.\u00a0Cooper (ed.) Theories of Group Process. London, Wiley.<\/p>\n<p>Mann K, Gordon J, MacLeod A.\u00a0<a href=\"http:\/\/qxmd.com\/r\/18034364\" target=\"_blank\" rel=\"nofollow noopener\">Reflection and reflective practice in health professions education: a systematic review.<\/a>\u00a0Adv Health Sci Educ Theory Pract. 2009 Oct;14(4):595-621. PMID:\u00a0<a href=\"http:\/\/qxmd.com\/r\/18034364\" target=\"_blank\" rel=\"nofollow noopener\">18034364<\/a>.<\/p>\n<p>Price A.\u00a0<a href=\"http:\/\/qxmd.com\/r\/15357553\" target=\"_blank\" rel=\"nofollow noopener\">Encouraging reflection and critical thinking in practice.<\/a>\u00a0Nurs Stand. 2004 Aug 4-10;18(47):46-52, quiz 53-4. PMID:\u00a0<a href=\"http:\/\/qxmd.com\/r\/15357553\" target=\"_blank\" rel=\"nofollow noopener\">15357553<\/a>.<\/p>\n<p>Tsingos C1, Bosnic-Anticevich S2, Smith L1.\u00a0<a href=\"http:\/\/qxmd.com\/r\/24558286\" target=\"_blank\" rel=\"nofollow noopener\">Reflective practice and its implications for pharmacy education.<\/a>\u00a0Am J Pharm Educ. 2014 Feb 12;78(1):18. PMID:\u00a0<a href=\"http:\/\/qxmd.com\/r\/24558286\" target=\"_blank\" rel=\"nofollow noopener\">24558286<\/a>.<\/p>\n<p>This article was originally published online at http:\/\/prehospitalresearch.eu\/?p=1550<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Reflective practice is an important tool in practice-based professional learning settings where individuals learning from their own professional experiences, rather than from formal teaching or knowledge transfer. It is an important process in continuous professional competency and development.\u00a0Reflection is nothing to be scared of \u2013 we all reflect every day in different forms and about [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1207,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"saved_in_kubio":false,"_uag_custom_page_level_css":"","footnotes":""},"categories":[76,1],"tags":[],"class_list":["post-1205","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","category-uncategorized"],"uagb_featured_image_src":{"full":["http:\/\/alanbatt.net\/wp-content\/uploads\/2016\/12\/reflect.png",600,273,false],"thumbnail":["http:\/\/alanbatt.net\/wp-content\/uploads\/2016\/12\/reflect-150x150.png",150,150,true],"medium":["http:\/\/alanbatt.net\/wp-content\/uploads\/2016\/12\/reflect-300x137.png",300,137,true],"medium_large":["http:\/\/alanbatt.net\/wp-content\/uploads\/2016\/12\/reflect.png",600,273,false],"large":["http:\/\/alanbatt.net\/wp-content\/uploads\/2016\/12\/reflect.png",600,273,false],"1536x1536":["http:\/\/alanbatt.net\/wp-content\/uploads\/2016\/12\/reflect.png",600,273,false],"2048x2048":["http:\/\/alanbatt.net\/wp-content\/uploads\/2016\/12\/reflect.png",600,273,false],"kubio-fullhd":["http:\/\/alanbatt.net\/wp-content\/uploads\/2016\/12\/reflect.png",600,273,false]},"uagb_author_info":{"display_name":"Alan","author_link":"http:\/\/alanbatt.net\/?author=1"},"uagb_comment_info":0,"uagb_excerpt":"Reflective practice is an important tool in practice-based professional learning settings where individuals learning from their own professional experiences, rather than from formal teaching or knowledge transfer. It is an important process in continuous professional competency and development.\u00a0Reflection is nothing to be scared of \u2013 we all reflect every day in different forms and about&hellip;","_links":{"self":[{"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/posts\/1205","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1205"}],"version-history":[{"count":1,"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/posts\/1205\/revisions"}],"predecessor-version":[{"id":1209,"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/posts\/1205\/revisions\/1209"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/media\/1207"}],"wp:attachment":[{"href":"http:\/\/alanbatt.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1205"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1205"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1205"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}