The University of Texas Decision Making as Professional Nursing Reflection Paper Evaluate the value of reflective practice in decision-making as a professi

The University of Texas Decision Making as Professional Nursing Reflection Paper Evaluate the value of reflective practice in decision-making as a professional in nursing leadership and administrationInstructionsReflection, application with exemplar and minimum of 2 resources, one in addition to texts. Page 1 of 31
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Foreword
The presidential call for the 2003-2005 biennium was “Create the Future Through
Renewal.” One of several outcomes I identified for the 2003-2005 biennium was the
creation of a resource paper on reflective practice in nursing. These past two years I
challenged members to consider the most meaningful activities that support personal and
professional renewal. Personally and professionally I believe reflection is a means of
renewal. My logic goes something like this: as self is renewed, commitments to service
come forward more easily. Renewed commitments to service require attention to
mindfulness and reflective practice. Mindful reflective practice begets questions that
support inquiry. Such inquiry guides knowledge work and evidence-based care giving.
Care giving supports society as knowledge, values, and service intersect. Knowledgeable
people and especially knowledgeable nurses provide care that society needs. Creating a
caring society is the spirit work of nursing. Creating a caring society starts nurses caring
for themselves and becoming, through reflection, more conscious and intentional in their
being, thinking, feeling, doing, and acting. Reflection is a form of “inner work” that
results in the energy for engaging in “outer service.” Reflection in-and-on action
supports meaning-making and purpose management in one’s professional life.
The nursing scholars who have participated in the development of this resource paper
are to be commended. They have devoted many long hours to the creation of this
document. They have role modeled for all of us the creation and development of a
learning community dedicated to enhancing knowledge, learning, and service. They
created a global transcendent team and have demonstrated the value and benefits of
global cooperation around a very important professional developmental concept and
practice for nurses. I admire and appreciate the work and effort this team has put forth
and am pleased to introduce their work to the members of the honor society and nurses
throughout the world.
I think there are many stimulating and provocative ideas in this resource paper. If
reflective practice is new to you, I hope that the ideas and resources you discover will
stimulate your curiosity and enable you to see your work in nursing through new ways. If
reflective practice is already familiar to you, I hope that you support and encourage
others to experiment with the notions, information, and resources gathered together in
this paper. As we collectively reflect on the professional purpose of nursing, I am certain
the spirit of nursing will be renewed. As members of the Honor Society of Nursing, Sigma
Theta Tau International, each of us has a responsibility to enact the virtues of love,
honor, and courage that are part of our heritage. As we develop our capacity and
commitment for reflection, we will affirm that spirit of nursing and make nursing-caredifferences in the lives of people for whom we care.
Daniel J. Pesut, PhD, APRN, BC, FAAN
President, the Honor Society of Nursing,
Sigma Theta Tau International (2003-2005)
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Acknowledgements
The development of the Position Paper on the Scholarship of Reflective Practice was itself a
process of reflection. Through telecommunications, the task force members were called upon to
reflect on their own philosophies surrounding reflective practice and to identify strategies and
experiences of their own. As key informants for the paper, task force members explored the
worldwide body of nursing literature to gain a global perspective towards reflective practice. In
the process, members confronted their own naiveté, biases and assumptions towards reflective
applications in advancing nursing knowledge, learning and service.
Using email, fax, and telephone communication, the task force was called upon to shape a new
way of accomplishing strategic direction. Members engaged in telephone dialogue of questions
posed on their list serve in advance in spite of 18 hour time zone differences, some getting up
quite early in Australia and others staying up late (England and Denmark). This paper truly then
helps our society in becoming a global organization. Deep gratitude is expressed to Beverly
Taylor (Australia), Dawn Freshwater (England), Sara Horton Deutch (USA), Nancy Strijbol
(Denmark), and Alyce Shultz (USA). The staff support from Linda Finke, Kathy Wodicka, and
Tonna Thomas was a key element in maintaining our organization and focus. We are all indebted
to this creative group.
Gwen Sherwood, RN, PhD, FAAN
Chair, Scholarship of Reflective Practice International Task Force
University of North Carolina at Chapel Hill School of Nursing
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The Honor Society of Nursing, Sigma Theta Tau International
Title of resource paper: The Scholarship of Reflective Practice
Issue being addressed: This resource paper describes definitions of reflection and reflective
practice, and their historical context, methods, processes, applications, benefits, and limitations.
Recommendations are made regarding policy and research agenda items for reflective practice
worldwide. In the spirit of inquiry and reflection, questions for exercising thought are included
throughout this document. Recommendations are made to promote reflective practice in nursing
worldwide.
Policy or position developed, recommended, adopted: The task force makes the following
recommendations for reflective processes in nursing globally in relation to practice and practice
development, clinical supervision, education, research, and leadership:
Recommendation 1
Nursing education incorporate reflective models, theories, processes, and methods when
preparing nurses so that they will be able to utilize and integrate reflective practice in their
practice and practice development, clinical supervision, research, education, and leadership.
Recommendation 2
Adoption of reflective processes in clinical supervision in nursing to enable nurses to become
self reflective in their work, in order to enhance their professional knowledge, skills, and
humanity when relating to people in their care, families, communities, other members of the
health care team, and themselves.
Recommendation 3
Nursing practice and practice development be augmented by systematic reflective processes
that create ongoing improvements in the provision of care and the development of nursing as
a professional practice.
Recommendation 4
Reflective models, theories, processes, and methods be used as research approaches, and/or in
combination with other research approaches, in order to encourage deeper levels of analysis
and interpretation of nursing issues relating to practice and practice development, clinical
supervision, education, and leadership.
Recommendation 5
Reflective models, theories, processes, and methods be used to guide and enhance the
education, practice, and development of self-reflective nursing leaders, who can act as
stabilizers and change agents in the dynamic contexts of nursing and health.
Background: This resource paper is the product of the Scholarship of Reflective Practice Task
Force, which was established by President Daniel J. Pesut during the 2003-2005 biennium. He
established the task force to support his presidential call, “Create the Future Through Renewal.”
Specifically, the task force was charged to examine the issue of the scholarship of reflective
practice and to create principles, practices, and resources that advance reflective practice in
nursing. Additional expected outcomes associated with the charge were recommendations and
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guidelines related to reflective practice useful to individual clinicians, health care organizations,
institutions, educators, and health care consumers. Descriptions of models or methods that
represent excellence in the actualization of the scholarship of reflective practice were encouraged
along with a set of principles and practices that support the development of scholarship of
reflective practice. The original vision associated with the development of the resource paper
included a comprehensive bibliography of resources on the scholarship of reflective practice that
provides people with references and tools that they could investigate. Finally, the task force was
charged with development of recommendations regarding policy and research agenda items for
reflective practice in nursing.
Task force members:
Gwen Sherwood (Chair), RN, PhD, FAAN
Dawn Freshwater, PhD, RN, FRCN, BA (Hons)
Sara Horton-Deutsch, DNSc, RN
Alyce Schultz, (Board liaison)RN, PhD
Nancy Strijbol, BSN, MSSc
Bev Taylor, PhD, Med, RN, RM
Staff:
Linda Finke, PhD, RN
Kathy Wodicka, RN, BSN
Tonna Thomas, BA
Authors of the resource paper:
Dawn Freshwater, PhD, RN, FRCN, BA (Hons)
Professor of Mental Health and Lead for Centre of Excellence in Applied Research
IHCS, Bournemouth University, UK
Sara Horton-Deutsch, DNSc, RN
Associate Professor of Nursing at Indiana University
Director of the Adult Psychiatric Clinical Nurse Specialist Program in the Department of
Environments for Health
Bloomington, Indiana, USA
Gwen Sherwood, RN, PhD, FAAN
Executive Associate Dean
The University of Texas Health Science Center at Houston
School of Nursing
Houston, Texas, USA
Bev Taylor, PhD, Med, RN, RM
Foundation Chair in Nursing and Research Director
Nursing and Health Care Practices, Southern Cross University, Australia
The resource paper on The Scholarship of Reflective Practice was submitted it to the Sigma Theta
Tau International board of directors for approval.
Introduction
A. Definitions of Reflection and Reflective Practice
Reflection is a way in which professionals bridge the theory-practice gap. Reflection enables one
to uncover knowledge in and on action (Schön, 1983). Practitioners develop practical knowledge
and working intelligence as they make sense of their work in theoretical ways (Schon, 1983).
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Through reflection, tacit knowledge (or knowing-in-action) can be made explicit. Reflection
raises awareness that enlivens and changes practice (Schön, 1987). Schön noted differences
between reflection-on-action happening after practice and reflection-in-action happening in the
moment of practice.
Reflective learning is the process of internally examining and exploring an issue of concern,
triggered by an experience, which reacts and clarifies meaning in terms of self and which results
in a changed conceptual perspective (Boyd & Fales, 1983). In the context of learning, reflection is
a generic term for intellectual and affective activities, in which individuals engage their
experience to create and clarify meaning in terms of self, and which results in a changed
conceptual perspective (Boud et al., 1985).
Jarvis (1992, p. 180) distinguishes reflective practice from thoughtful practice and suggests a
reflective practitioner is one who is able to “problematise many situations of professional
performance so they can become potential learning.” Pierson (1998) considered reflection to be
thoughtful, innovative, and critical practice, and similarly, Kuiper and Pesut (2004) defined
reflection as a metacognitive process that supports thinking about one’s own thinking related to
an experience within a conceptual framework.
Taylor (2000, p. 3) defined reflection as “the throwing back of thoughts and memories, in
cognitive acts such as thinking, contemplation, meditation and any other form of attentive
consideration, in order to make sense of them, and to make contextually appropriate changes if
they are required”. This definition allows for a wide variety of thinking as the basis for reflection,
and it is similar to many other explanations (Mezirow, 1981; Boyd & Fales, 1983; Boud et al.,
1985; Street, 1992) by suggesting that reflective thinking is a rational and intuitive process, which
potentiates positive change.
Freshwater (2001) examined the lack of consensus in defining reflective practice and reflexivity,
especially as applications have been developed in all fields of nursing. Reflexivity is a “turning
back on itself” as a “kind of meta-reflection” (p. 529) and emphasises its critical nature of
unsettling previously held assumptions to gain new awareness.
Reflective exercise
What is your definition of reflection?
To what degree do you think about your being, thinking, feeling, and acting in intentional ways?
How has reflection affected your life and work?
How have you used reflection to support personal and professional renewal?
Discuss with a colleague the potential for reflection to raise awareness and change.
B. The Historical Context of Reflection in Nursing
Reflection is an essential skill implicit in professional nursing practice. For example, the work of
Benner (1984) has provided a foundation for reflecting on nursing practice worldwide, in terms of
the developing expertise of nurses in action. The ability to make clinical judgments and intervene
in nursing care contexts requires reflection. Effective nursing practice, education, research, and
leadership are grounded in the complexity of human relationships and therefore require
systematic and careful thinking in order to achieve successful outcomes. Reflection has been
linked to the cognitive behavioral skills of self-monitoring, self-evaluating, and self-reinforcing
goal-oriented behaviors that are aspects of metacognition. Metacognition is reflective thinking or
a level of consciousness that exists through executive cognitive control and self-communication
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experiences (Flavel, 1979; Mezirow, 1981; Kuiper & Pesut, 2004). Critical thinking pre-supposes
a reflective stance (Facione & Facione, 1996).
Reflective practice is more widely applied as a scholarly approach in Australia, New Zealand, and
the United Kingdom. It transcends mere “doing” and is often emphasised with a concentration on
“being.” Scholarship in reflective practice in the southern hemisphere originated with the
discipline of education at Deakin University, Australia, using the work of Donald Schön.
Influential scholars who influenced the spread to nursing in 1988 include Stephen Kemmis, John
Smyth, and Annette Street. Now, reflective practice is fundamental to Australian clinical nursing
practice. Given the relatively long life of Australian reflective practice in nursing, the current
challenge relates to maintaining enthusiasm and depth of engagement in reflective processes so
that it is not just assumed.
In the United Kingdom (UK), reflection is a tool for learning that integrates theory and practice; a
means to both develop and research practice that is essential to effective learning and caring.
Grounded in theory and research from a variety of disciplines and sources (Dewey, 1933; Schön,
1987; Palmer et al., 1994, Burnard, 1995; Johns, 1995; Johns & Freshwater, 1998; Freshwater &
Rolfe, 2001; Freshwater, 2002; 2005) the growing wealth of literature and educational resources
around reflection and reflective practice in the early 1980s led the Department of Health (DoH) to
implement reflective practice as essential for the continuing professional development of nurses
(DoH, 1999). Reflective capacities were cited as a level of learning along with critical thinking
and problem solving for qualified nursing staff to promote informed, knowledgeable, and safe
practice. Key proponents of reflection, critical reflection, and reflexivity in the UK continue to
work hard to establish a systematic and rigorous utilization of reflective practice based on local
and contingent knowledge, highly relevant to practitioners, educators and researchers in their
everyday practice (Freshwater, 2002; Johns and Freshwater, 2005). Reflective practice is an
integral element of clinical supervision in the UK with the two concepts inextricably linked
(Fowler & Chevannes, 1998; Rolfe et al., 2001).
Reflective exercise
Reflect on nurse authors who have introduced and inspired major developments in nursing’s
heritage. In what ways have they supported reflective approaches to nursing knowledge,
learning, service, and leadership worldwide?
Methods and Processes of Reflective Practice
The methods and processes of reflective practice are varied. Discussion includes models,
frameworks, theories, the purposes of reflective practice, the processes of reflection, strategies
and processes to promote the development of reflection, and processes for reflecting-on-action
and reflecting-in-action.
A. Models, Frameworks, Theories
Explanatory models that suggest reflection are best described and defined as phases and
transitions between phases include Kolb (1984), Atkins and Murphy (1993), and Boud (1995).
Other models offer probing questions that stimulate reflection to elicit thinking, feelings,
behaviors, and theories that may implicitly guide thinking, feeling, and doing (Burrows, 1995;
Johns, 2000a). Reflection also includes various levels of dialogue and discussion of events as a
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means to develop understanding of values and beliefs and the effects on personal and professional
practice (Wong et al., 1997).
Mezirow (1990) defined three levels of reflectivity. Level one, non-reflection, is the absence of
reflective thought. Level two, lower level reflection, involves the awareness of judgments,
observations and descriptions, evaluations of planning, and assessment of decisions. Level three,
critical reflection, is the process of reflection and includes assessment of the need for further
learning, and awareness that routines are not adequate and change in perspective is needed.
Greenwood (1998) identifies the role of reflection in single-loop and double-loop learning. In
single-loop learning, the level of response is to simply change the actions intended to lead to the
same outcomes. In double-loop learning the person does not merely search for alternative actions
to achieve the same outcome, but examines the appropriateness and correctness of the chosen
end. It involves reflection on values and norms. Greenwood (1998) identifies single-loop
frameworks such as Smith and Russel (1991), Burrows (1995), and Johns (1995). Smyth’s (1992)
framework is explicitly double-loop. Greenwood asserts that the former frameworks may be most
suited for young learners with limited experience whereas the latter is recommended for advanced
reflective practice that incorporates the norms, values, and social relationships that underpin
human action.
Greenwood (1993) views Schön’s model of reflection-on-action and reflection-in-action as
flawed because it fails to recognize the importance of reflection-before-action. Reflection-beforeaction involves thinking through what one wants to do and how one intends to do it before one
actually does it. This relates closely to mindfulness where one opens oneself to the moment by
clearing out unwanted distractions and eliciting presence and openness before interacting with
others.
Teekman (2000) proposes a model of reflective thinking that reflects the different levels of
reflective thought as well as the dynamic aspects inherent in the process, presented as a spiral of
reflective thinking. Taylor (2000) offers three types of reflection that can be used separately, or in
any combination, according to the requirements of the practice or personal situation. These types
of reflection are technical, practical, and emancipatory. Technical reflection acknowledges the
influence of the scientific model on empirical knowledge in daily nursing practice, improving
clinical policies and procedures by devising reasoned approaches to work, using critical thinking
processes. Practical reflection offers a means of making sense of human interaction, offering the
potential for change based on nurses’ raised awareness of the nature of a wide range of
communicative matters pertaining to their practice. Emancipatory reflec…
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