Reflective practice and self-awareness

Abstract

Gareth Morgan, Project Manager of the National Service Framework for Older People for the Welsh Assembly, suggests that self-reflection may be key to developing the public health workforce Workforce development is matter of considerable importance to ensure the effective and sustainable delivery of local and national public health policy. Given the diversity and challenges of public health roles, workforce development requires multiplicity of approaches, and reflective practice could be considered, perhaps with increasing prominence, as part of this. It has been suggested that the benefits of reflective practice are threefold.1 The first is to re-define the understanding of professional knowledge; the second to develop personal knowledge or self-awareness: and the third is to evaluate the appropriateness of actions. This piece presents summary of some of the underpinning theories of reflective practice along with examples of how these may be applied. The literature on reflective practice is extensive and includes contributions from Boud, Schon and others. A critical review of this literature has identified three key stages that appear to underpin the process of reflective practice.2 Stage 1 is triggered by an awareness of uncomfortable feelings or thoughts; stage 2 involves constructive analysis of the situation, examining feelings and knowledge; while stage 3 involves the development of new perspective on the situation. Prerequisites to reflection appear to include having an open mind and being self-aware.2 One limitation to this three-stage model might be that it does not recognize the potential for positive feelings or thoughts to be trigger for reflection. Despite this limitation, the suggested prerequisites to reflection are interesting and have been explored in other contexts. For example, in clinical medicine, lifelong learning and improving performance may not occur if mistakes are reviewed alone.3 Furthermore, it has been suggested that the achievement of expert levels of practice requires guided feedback.3 Perhaps the journey towards expert practice therefore requires an open-minded approach to learning from experience supported by guided feedback from professional mentor. Meditation can be helpful in developing self -awareness, and theoretical models may also provide useful frameworks with practical application. The Johari Window model, for example, presents domains that relate to the level of self-awareness; this includes reference to a spot.5 In nursing practice, it has been suggested that portfolios provide the opportunity to document personal and professional growth, which in turn may help to minimize the blind spots that compromise self-awareness. The Hawthorne effect is management principle that suggests that individuals tend to improve their performance when they are under observation. So perhaps another potential route to reflection is to ask colleagues to observe and provide feedback on performance. Some have questioned the Hawthorne effect,6 yet being under observation from colleagues could trigger reflection and iead to some of the benefits described previously. The potential exploitation of the Hawthorne effect might be best undertaken as complement to line manager feedback and continuing professional development opportunities. Another approach to reflection might be through the keeping of personal journal. Moon has suggested number of possible questions for prompting reflective writing and critical thinking/ Starting with pure description of an event that sets the scene, questions to facilitate reflection might include: How do you feel about the situation? How do your feelings relate to any action? If you step back from this, does it look different? Are there ethical, moral or social issues that might be explored? The 360-degree feedback of professional skills offers structured method to facilitate reflection and selfawareness, and can provide valuable information to promote reflection on range of matters including interpersonal skills and thinking styles. …