In Africa, and enhance these healthcare practices.

In Health and Social care reflection is a mental
process in which requires you to question your values, actions and
decisions in regards to your professional practice. Reflection is
when you look over previous practice to give serious thought as to
how you can improve future practice, whether this be self reflection
or as a group. This could be problematic issues or events that occur
at work. By analysing, reviewing and evaluating prior experiences we
can make changes to practices and make better future experiences in
care. In this essay we will look at the importance of reflection in
health and social care settings. This will be done by analysing five
different resources; two recent academic texts, two recent academic
journals and one appropriate website.

first source in which has been used is Curationis, which is an
official journal of The Democratic Nursing Organisation of South
Africa. It aims to teach good healthcare practices in South Africa,
and enhance these healthcare practices. This text covers the practice
of reflection and states that ‘Critical care nurses should be allowed
time to reflect on their practice and be supported by peers as well
as a facilitator in a non-intimidating way to promote emancipatory
practice development’. This means that reflecting as a group, as well
as alone, can have a high impact on the care of the service user.
This text shows great scope as it is a main source of education
within South Africa, however there are limited practices in South
Africa and so may be limited in its knowledge. This text was chosen
as it is a credible source, backed by the University of Pretoria,
that reads well for its target audience, which is nurse and midwives.
It is also current as it was only published in 2015.

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I also researched an article by Oakland University
School of Nursing that is directed purely on reflection. This journal
looks at quantitative studies on how effective and useful reflective
practice is. Being a University published article I find that it has
good scope to it and is written well for its intended audience, which
is nurses and healthcare professionals. I chose this journal as it is
a credible source being that it is from a School of Nursing. I also
like that it has studies showing the benefits of reflective practice.
Having been published in 2013 this journal is fairly current.

Flying Start NHS is an NHS website in which health
practitioners can learn and revise practices for healthcare in
Scotland. This has a entire section on just reflection and aims for
confidence in reflective practices and also shows you examples of
reflective practices. As this is an NHS text it is a highly credible
source in which is easily read, for its wide target audience. This
would be health and social care workers in Scotland. I chose this
source as it is the most current being this year, 2018. I also chose
it as the NHS is the largest single-payer healthcare system in the
world and so making it highly credible.

‘Critical Reflection in Health and social Care’ is
an educational book that has frameworks for understanding critical
reflection, specifically in health and social care. This book was
written by authors, Sue White, Jan Fook and Fiona Gardener. This text
is aimed health and social care professionals and perhaps even
business professionals. Therefore has possibility to help reflective
practices. Though this text has important information it is not
current as it was written in 2006, so updating could be vital. I
chose this text as I questioned its credibility and so believe this
could make an interesting comparison.

The University of Leeds is a leading UK University
that has courses that cater to the health and social care setting.
The aim of this text is to raise awareness of the importance of
reflection. It is

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written well for its target audience of nursing
students, however I believe that the scope is not big enough to see
drastic change. It also does not have a published date on it so we
cannot know how current this text is. I chose this text however as it
is a credible source from the university of Leeds.

In this section, using the above sources, we will
look at the role and importance of critical reflection in health and
social care to establish and share good practice. To do this, we will
analyse; the role of critical reflection, good practice of reflection
in health and social care, issues that may hinder reflection, methods
and models of reflection, and why it is important to share good
practice. Critical reflection is making meaning of an experience, in
order to improve it, and to engage in a process of continuous
learning. Critical means to express analysis, and reflection means
serious thought or consideration. So, critical reflection must be
descriptive, analytical and critical. Critical reflection is an
extension of ‘critical thinking’. This is a process of understanding
and expressing our selves in order to grow in our personal and
professional lives. The benefits of critical thinking are evidenced
in several health and social care fields including, medicine,
pharmacy and nursing.

The origins of reflection can be traced back to
John Dewey, a philosopher of education, who explained reflection as
‘an international active progression of learning’ (Nelson 2012).
Though some say that this goes all the way back to Greek philosopher
Socrates (died 399 BC), as he once said that ‘unexamined life is not
worth living’. Which holds some truth, and in order to reflect fully
we must understand the historically contingent nature of ideas.
Critical reflection can be used in many professions, as well as in
your personal life. In the health and social care sector studies have
shown that practitioners who take the time to critically reflect
provide enhanced care for their service users. To reflect in care is
to be a part of an learning cycle in order to assist practitioners to
make sense of an experience and to seek alternatives and improve
actions in practice. Reflection is an essential attribute to
practitioners and so it is important to outline and make sense of
what critical reflection is so that we not become undiscerning or
thoughtless in our practice.

Task based approaches for reflection are being
focused on by organisers and educators. This is because when
practitioners or students of health and social care recognise their
achievements, they become more comfortable in their role, and so it
allows them to provide much better practice. Brookefield (1995)
argues that reflection is important in the daily business of life but
that critical reflection is vital if we are to make crucially
relevant changes in the way we work. When using reflection the person
becomes more aware, realistic, open, confident and they may even have
a deeper appreciation of their role. It helps us to become more
empathetic and understand our service user and so allows them to
receive person centred care. Exploring these feelings and
realisations helps to develop more emotionally intelligent
practitioners. Emotional intelligence is recognising other peoples
emotions, as well as your own. Reflective practice should be embedded
in our everyday practice. We must think; how professional was I?, Did
I think outside of the box?, Do I seek regular feedback?.

According to Flying Start the qualities in which
those who practice critical reflection are; a willingness to learn
from what happens, being open to share practice with others, being
motivated to replay aspects of clinical practices, a belief that
change is possible, being honest in describing clinical practice to
others, being aware of conditions necessary for reflection to occur,
ability to describe in detail before analysing practice problems, not
being defensive, being courageous, and holding the belief that there
is no end point to learning. These are all great attributes in which

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stakeholders in health and social care should hold.
Stakeholders in health and social include; Doctors, nurses,
podiatrists, speech therapists, behavioural therapists, pharmacists,
family carers, health care assistants, dietitians, dentists, dental
nurses, theatre staff, physiotherapists, occupational therapists,
mental health nurses, social workers, as well as other roles you may
not necessarily think of such as, security, gardeners, cleaners,
volunteer staff and cooks.

Though reflection is a positive practice, there are
still issues in which may occur when critically reflecting. Such as,
different usage of meanings can be confusing. When studying up on
reflection some terms are said with different meanings, so who is to
understand which version is meant. Also if is difficult to design
models and apply approaches that that go across different disciplines
and professionals. The relationship between professionals of
different professions may not be excellent, and so this can get in
the way of reflecting their care practice as the service users needs
may not be fully met if they do not share information with one
another. Ip Et Al (2012) found that students desire to reflect was
highly related to their perception of the value of perception,
meaning that those with a negative attitude are less likely to
reflect totally. Another issue that could occur is the fact that
people do like negative feedback and may react negative to it or may
not react at all. In which would mean that no progress in their
practice is being achieved. If the organisation does not offer time
and space for reflection then this can leave very little time for
practitioners to officially reflect, and so this may reflect in their
care. If the critical reflection facilitator does not have a good
relationship with the practitioner then this could cause a negative
effect on their practice. Boomer and Plowright (2010) state that
reflection is a learned skill that requires development and so if not
taught or learnt correctly then this can hinder reflective practice.
It is the responsibility of of both the educator and the learner.

In health and social care good practice means
following a set of values and morals. These are as follows; agencies
working together in multi-agency practice, being respectful to other
professionals as well as service users, maintaining good professional
relationships, protecting data and maintaining confidentiality where
possible, promoting dignity for service users, ensuring equality
rights are upheld under law, safe guarding staff and service users,
and always aiming for person centred care. These are things we must
look at and critically reflect on when applying theory to practice.
It is important to share good practice amongst healthcare
professionals as they can share and try different methods of
clinical reflection, as well as reassure one another that they are
doing good practice. Or if good practice is not being followed then
they can be advised on how to do so. It also helps to share practice
as it can dispense the emotional load. Health and social care can be
an emotionally heavy profession and so this is important. It is also
highly important to continually practice empathy when in a healthcare

In order to share good practice there are many
models and designs for critical reflection. Some people prefer to
reflect vocally, whilst others prefer to write stuff down. There are
simple methods such as; focus group discussions, confidence building,
clinical audits, online discussions, or risk assessments. Burnard
(2002) believes that self awareness is a highly important practice as
it is crucial for developing good interpersonal skills and ‘ if we
are blind to ourselves, we are also blind to our choices’. Oakland
University believe that written assignments or reflective journaling
are the most effective practices to critically reflect. Flying start
shows an example of the ‘being available template’ (Johns 2004) in
which has a template set out to record important information on
practice previously done. He states that ‘looking in and looking out’
is a way of challenging our natural tendency to judge ourselves too
harshly. This model is shown below;

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Model for Structured Reflection – adapted
from Johns (2000)

Looking in:

Find a
space to focus on self
attention to your thoughts and emotions
down these thoughts and emotions

Looking out:

Write a
description of the situation
issues seem significant

was I trying to achieve?
did I respond as I did?
were the consequences for myself and others?
were others feeling?
did I know this?


did I feel the way I did within this situation?


Did I
act for the best?

factors were influencing me?
knowledge did or could have informed me?

does this situation relate to previous experiences?
could I have handled this better?
would have been the consequences of alternative actions?
How do
I feel now about the experience?
can I support myself and others better in the future?


Yeung Et Al (1999) devised a model that has three types
of reflectors; non reflectors (involving habitual action, thoughtful
action, and introspection), reflectors (involving content, and the
process of reflection), and critical reflectors (involving premise
reflection). Students at the University of Leeds found this a highly
useable and useful method. There are a few similar concepts in which
share the common idea that it is possible to differentiate lower and
higher levels of reflection. Such as King and Kitcheners (1994)
concept in which has seven levels, or Hatten and Smiths (1995)
concept in which has five stages.

In conclusion Critical reflection is vital if good
practice is going to upheld in a health and social care environment.
If we do not practice critical reflection when using theory in our
practices then this can mean that care will not be fully patient
centred as the patients needs may not be fully understood. There are
many methods and models in place to practice critical reflection that
can be easily followed and achieved and so we can practice patient
centred care to our fullest extent.

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