“Difficult, but important”
Reflection is an important yet ethereal skill that all Occupational Therapists need to master.
Part of completing a reflection is an inner sense of discomfort (in fact the first stage of reflection as described by Boyd & Fales 1983) so it’s no wonder many people put it off and may even try to get by without it, perhaps carrying out token reflections just to comply with CPD or course requirements. To begin with, reflecting on your actions is something that requires conscious effort after the event but eventually, according to Johns (2000), it will become an automatic thought process even when you’re in the middle of experiencing the event. When deciding which model to use, it can helpful to find out what learning style you are according to Honey & Mumford. You can relate these to the knowledge types shown in Carper/Johns’ reflective models.
Below is a rough guide to the different models of reflection out there, and which situations they’re best geared towards. They are ordered (in my opinion) from the easier ones for the beginner who is trying to break down and evaluate a situation, to the more complex ones that build on the basics and hope to elicit a change in your personal beliefs and challenge your assumptions. Gillie Bolton suggests exercises for creative ways to reflect in her book Reflective Practice: Writing and Professional Development (chapter 4).
Like Inception, you’ll naturally find yourself going deeper with your analysis of an event the more experience you gain with reflective models. Enjoy the ride!
Gibbs reflective cycle (1988)
Good for: Good old Gibbs. Basic, good starting point, six distinctive stages. Makes you aware of all the stages you go through when experiencing an event.
Criticisms are: superficial reflection- no referral to critical thinking/analysis/assumptions or viewing it from a different perspective (Atkins & Murphy 1993). Does not have the number or depth of probing questions as other models.
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I can’t use any old piece of evidence which has an abstract and a few relevant keywords to base my clinical actions on.
It could be biased (such as being funded by someone with an interest in the study’s outcome), not statistically significant, methodically flawed or irrelevant to the precise patient problem I am investigating. I could be challenged by a well-informed ‘expert patient’ who has free and easy access to information themselves via the internet, so I need to make sure I can back my decisions up.
Instead I’ll need to identify the patient’s problem, find relevant studies, critically evaluate them, and then apply them to the problem taking into account the patient’s individual needs.
Research + Clinical Expertise + Patient Preference = EBP
The process of EBP has five steps, although Melnyk (2010) later added two additional ones shown in italics below. It should also be noted that sometimes ‘Health Service Restrictions’ are included in the above formula (DiCenso et al 1998), meaning that limitations due to resource cost/access are taken into account as part of pragmatic reasoning.
0. CULTIVATE SPIRIT OF INQUIRY essential starting point
1. ASK questions that are answerable!
2. ACQUIRE search for the best evidence from the research available
3. APPRAISE critically appraise/evaluate the evidence – is it relevant, valid, reliable, applicable to you clinical question?
4. APPLY integrate the evidence with clinical expertise and patient’s preferences and values, and then implement it
5. ASSESS evaluate and reflect on the outcomes of your decision
6. DISSEMINATE EBP RESULTS share good practice and support other healthcare professionals Read more