The Gibbs’ reflective cycle (1988) encourages a clear description of the situation, analysis of feelings, evaluation of the experience and analysis to make sense of the experience. This would be followed by conclusions where other options are considered and reflection upon experience to examine what one would do if the situation arose again.
It describes a cycle of description, feelings, evaluation, analysis, conclusion and action plan. The description is questioning what happened followed by the feelings brought about through the questions—‘what were you thinking and feeling?’. The evaluation component describes what was good and not so good about the experience. The analysis should identify what sense can be made of the situation and the conclusion details of what else could have been done. The process of reflection is ended with an action plan for what could be done if the situation arose again.
For reflection to have a real effect it needs to be followed by an action committee. The authors describe a cycle of awareness, description, analysis, evaluation and learning. The reflective process begins with the awareness of uncomfortable feelings and thoughts from the action or new experience followed by a description of the situation including thoughts and feelings. This would need to include salient events and key features identified by the reflector. The reflector would need to analyze feelings and knowledge relevant to the situation—identifying knowledge, challenging assumptions, imagining and exploring alternatives.
The reflection process would also need to include evaluation and consolidating learning. Evaluate the relevance of knowledge through asking questions includes the following: ‘Does it help to explain and/or solve problems’? ‘How complete was the use of knowledge’? These steps would be followed by identifying any learning which has occurred.
The after-action review is a de-brief process in practice originally developed by the US army which aims to identify how to improve, maintain strengths and focus on the performance of specific objectives. The de-brief manual provides guidance for individuals and group reviews.14 The review would answer the following four questions: What was supposed to happen? What actually happened? Why were they different? What did we (I) learn?
Reflection enhances personal development by leading to self-awareness.16 If the focus of reflection is improvement in patient care, it helps to expand and develop clinical knowledge and skills. The process slows down activity providing time to process material of learning and link to previous ideas. It should also enable more ownership of the learning taking place. Reflection has been reckoned to promote optimum effectiveness and efficiency in an ever-evolving and complex health-care system through practitioners auditing their own practice. ‘Reflection reminds qualified practitioners that there is no endpoint to learning about their everyday practice’.
Where it exists, the practice of reflection has tended to focus on individual professionals at specific points in time and/or on specific elements of practice. This, however, can form only a part of the experience as many PH actions involve many disciplines. Often action takes place across multi-sectoral teams and involves multi-phased interventions.
Listen to these educators discussing what reflective practice means for them. How do their ideas about reflective practice compare with yours?