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Reflective practice has been defined as "Involving self, a process that is undertaken in response to a positive or negative event that may be initiate consciously or subconsciously, that requires to provide an answer" (Chapman, Dempsey et al. 2009). It has also been defined as "Paying critical attention to the practical values and theories which inform every day actions, by examining practice reflectively and reflexively, this leads to developmental insight" (Clouston, Westcott 2005). Reflective practice is a process to which a person dissects their internal reactions to certain situations, and how they dealt with the cause and effect. It is only through this reflection that an individual can comprehensively understand and learn from their previous decision making mechanisms. Reflective practice gives the opportunity for a health professional to look back at their clinical skills used in given situations, and assess how these skills could be amended to better their professional practice. It is a method of learning from experiences, using experiences to analyze why problems occurred, and then to find a solution to these problems (Taylor 2010).
Reflection has been defined by Dewey (1933) as "active persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it tends" cited by (Mann, Gordon et al. 2009). Boud (1978) reinforces Dewey's assessment of reflection, however, he aligns himself with an overtly emotional assessment of personal experience. Boud defines reflection as "a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to a new understanding and appreciation" cited by (Mann, Gordon et al. 2009).
There is a gap between academia and good professional practice. Although a student may have a very good understanding of theory, this does not necessarily teach them about good professional practice (Baird 2008). Knowledge is something that is to be challenged and reinforced. Gaining knowledge through clinical experience and reflection is key to being a reflective practitioner (Clouston, Westcott 2005). This can be obtained at university level within Radiography through clinical placement, positioning classes and a personal development system (PDS) (Baird 2008). These classes give the student an opportunity to challenge, discuss, but more importantly reflect on the theory which they have learned. It is through problem solving that a student can reach below the purely scientific understanding of processes and procedures, and can delve into the deeper, and one could argue, the more complexities of clinical practice. Through these teaching methods a student can learn that the theory of practice is not always going to work in given situations, and through reflection they can amend their knowledge to give the result of better clinical skills and professional practice (Baird 2008). It would be nieve to assume that every patient, every ailment, should reprieve a standard set method of treatment. The PDS is an online resource which provides a student with a key initial starting block to which they can build a more successful, productive, and ultimately professional methodology to explore key skill and developmental needs (Rowland 2006).
A study of students found that reflective exercises proved successful, and that they thought it could be a valuable part of their professional careers within the health service. Students realised that reflective practice can help to deal with any similar issues arising (Cronin, Connolly 2007). Another study found that student nurses gained confidence in decision making through journal writing also stating that they believed more, that writing could be used to learn (Epp 2008). Both studies show that reflective practice is a beneficial tool that can be used to enhance professional practice. However the first study is seemingly over crediting the usefulness of reflective practice on a 'one size fits all' basis. Students must not become fully dependant on the benefits which reflective practice may bring, and must leave room for ingenuity, and adapt these procedures to specific circumstances. The second study reinforces the benefits which reflective practice can bring to a student's confidence in their own professional expertise.
The introduction of key performance indicators (KPI) into healthcare departments increased awareness among staff and gave an obligation to staff to fulfil certain tasks (Abujudeh, Kaewlai et al. 2010). Through KPI's in individual can highlight areas of strengths and weaknesses, however more importantly can develop a systematic and detailed plan to improve their continual personal development. There are methods incorporated into KPI'S to encourage reflective practice, Continual Professional Development (CPD) and life long learning (LLL) (Chapman, Dempsey et al. 2009). Within radiography these two strategies are used to develop reflective practice. LLL was implemented with the intention for individuals to continually re-educate themselves on advances within their field of work. CPD is a resource which is discussed in detail with, the relevant line manager. If CPD is used properly reflective thinking is encouraged in the practitioner (Chapman, Dempsey et al. 2009). This reinforces the relationship which exists between CPD and the development of reflective practice. The society of radiographers has invested in an exclusive CPD tool which gives advice to members on how to reflect and learn. The CPD plan outlines that reflective practice can be carried out in a number of ways. Firstly by writing a reflective journal about personal experiences in the workplace or secondly in an educational environment through health professionals attending courses, to learn better ways of becoming a good reflective practitioner (Kelly 2005). It is only through implementation of all of these methods that a continual and productive mode of reflective practice can be achieved through the CPD plan. Writing a reflective journal helps a health professional keep a record of their practice, remind themselves of good and bad practice, why it happened and how they overcame or will overcome the problem (Clouston, Westcott 2005). A study found when a group of radiation therapists gathered to write journals together that their motivation, confidence, professional knowledge, critical thinking and professional practice all increased ensuring the CPD of staff (Milinkovic, Field et al. 2008).
It is vital for reflective practice to be a success, all individuals within an organisation must be wholly committed to the belief that reflective practice is a worthwhile and productive tool. Things which hinder reflective practice occur in workplaces where there is no emphasis put on it by line management.. The pressures placed on professionals in the clinical environment mean that the health professional may feel that time spent on reflective practice may seem wasted (Mann, Gordon et al. 2009). It is a well known fact that as the health professional spends more time in the profession, it is found that less of their time is spent reflecting. It has been said that barriers to reflective practice include lack of time and space, negative preconceptions, organisational culture, fear, the risk of routine and not fully understanding reflection (Clouston, Westcott 2005). A study found that the use of a facilitator within a healthcare team to guide people and help promote reflective practice was very beneficial to the team. The time spent on reflection was said to have enhanced critical thinking, professionalism, making decisions and being able to challenge things they were not in full agreement with (Mann, Gordon et al. 2009). The use of a reflective practice facilitator provides a systematic and constant reminder to practitioners of the importance and benefits which this tool can give in work life. The facilitator provides an outlet for relevant and knowledgeable advice in what a practitioner may perceive as being a difficult circumstance. This study suggests that reflective practice has a positive impact on clinical skills and professional practice. Another study found that within the format of a meeting environment consisting of health professionals, reflective practice was influenced by five factors. The first factor which influenced reflective practice was that too much structure in a meeting lowered the ability to reflect. Secondly the level of interest a professional has in reflection, the more interested being better reflectors. Meetings in which people have certain roles and consist of tasks do not provide ideal for reflection. A pressurised environment where a professional is obliged to complete tasks, was shown to prevent reflective capabilities also (Heel, Sparrow et al. 2006). It would be nieve and absurd to remove structure from this mode of reflection, as the KPI targets reinforce good reflection methods. .
Reflective practice has been proven to be an important tool in developing clinical skills and professional development. All studies had a similar agreement that reflective practice is good but the method of reflecting varied. Reflective practice has to be carried out from student to professional level. Reflection was said to increase confidence, decision making, motivation and professionalism (Clouston, Westcott 2005). There were no studies found that measured the effectiveness of reflective practice, perhaps this is an area where more research is needed. Another area that no research was located on was bad experiences of reflective practice. Further study into these areas could give more insight into how beneficial reflection is.