CONTINUING PROFESSIONAL CPD DEVELOPMENT Understanding reflective practice

NS842 Nicol JS, Dosser I (2016) Understanding reflective practice. Nursing Standard. 30, 36, 34-40. Date of submission: September 28 2015; date of acceptance: January 9 2016.

Abstract Aims and intended learning outcomes This article aims to increase the nurse’s The Nursing and Midwifery Council (NMC) requires that nurses and knowledge and understanding of reflective midwives use feedback as an opportunity for reflection and learning, practice and assist them to develop a portfolio to improve practice. The NMC revalidation process stipulates that of evidence for revalidation (Nursing and practitioners provide examples of how they have achieved this. To reflect Midwifery Council (NMC) 2015a). After in a meaningful way, it is important to understand what is meant by reading this article and completing the time out reflection, the skills required, and how reflection can be undertaken activities you should be able to: successfully. Traditionally, reflection occurs after an event encountered in  Define reflection and explain its role in practice. The authors challenge this perception, suggesting that reflection professional practice. should be undertaken before, during and after an event. This article  Describe two different models of provides practical guidance to help practitioners use reflective models to reflection. write reflective accounts. It also outlines how the reflective process can  Discuss how self-awareness is integral be used as a valuable learning tool in preparation for revalidation. to reflection.  Discuss how reflection can be used as a Authors learning tool. Jacqueline Sian Nicol Lecturer, Edinburgh Napier University, Edinburgh,  Prepare several examples of reflection Scotland. to support the NMC revalidation process. Isabel Dosser Lecturer, Edinburgh Napier University, Edinburgh, Scotland. Correspondence to: [email protected] Introduction Keywords An integral part of continual, evolving nursing practice is the need to evaluate and improve critical thinking, portfolio, professional development, reflection, care in a constantly changing healthcare reflection models, reflective account, reflective practice, revalidation, environment (Bulman and Schutz 2004). self-awareness Such evaluation of practice, however, requires the ability to reflect in a critical and Review focused way. For reflection to be valuable in All articles are subject to external double-blind peer review and checked professional practice, a questioning approach for plagiarism using automated software. is required. Reflection is a method of using experiential Revalidation knowledge to enable professional and personal development while reinforcing Prepare for revalidation: read this CPD article, answer the questionnaire continuous learning (Gustafsson and and write a reflective account. www.rcni.com/revalidation Fagerberg 2004). The Code. Professional Standards of Practice and Behaviour for Online Nurses and Midwives (NMC 2015b) states For related articles visit the archive and search using the keywords above. that to fulfil all registration requirements, To write a CPD article: please email [email protected] nurses and midwives must ensure their Guidelines on writing for publication are available at: knowledge and skills are up to date. This journals.rcni.com/r/author-guidelines. may be achieved by participating in continuing professional development (CPD) activities to maintain competencies and improve practice. Complete time out activity 1

34 mDownloadeday 4 :: vol 30from no RCNi.com 36 :: 2016 by ${individualUser.displayName} on Aug 17, 2017. For personal use only. NoNURSING other uses without STANDARD permission. Copyright © 2017 RCN Publishing Company Ltd Defining reflection If reflection is to be practised to best effect, the Reflection, in a professional sense, should be supporting model should have personal appeal purposeful, focused and questioning. Many as well as being clear and coherent. Reflection nurses believe that they reflect regularly; is a personal matter as well as a statutory however, for this to be purposeful they are requirement. Professional reflection requires a required to ask what happened or what might focused and strategic approach in contrast to happen, what they are doing or did, and how reflection on personal and social circumstances. that relates to their objectives. In reality, nurses Two commonly used models of reflection that rarely scrutinise when situations have gone have been advocated by educationalists are well, or investigate why or how something went shown in Figure 1 (Borton 1970, Gibbs 1988). well or went wrong. By adopting a structured Driscoll (2007) developed Borton’s (1970) and strategic approach, practitioners can link model by including prompt questions for experience to intentions of what was, or is, each stem question to complete the process of being attempted. reflection (Figure 1). Borton’s (1970) model has Several authors have attempted to also been adapted by Rolfe et al (2010). Other define reflection, the consensus being that reflective models used in academic study can be reflection has three components (Schön 1983, applied to nursing practice, for example Johns’ Rolfe et al 2010): (2013) model. Although Johns’ (2013) model is  Reflection before action – involves thinking complex, with more than ten steps, it can be a 1 Consider what about what you aim to achieve and useful aid when learning how to reflect. you think reflection understanding the means by which this will Different reflective models may be appropriate on your professional be accomplished by drawing on previous for different practitioners and situations. Some practice entails. Does it experience. favour a structured model, such as that developed involve your emotions,  Reflection in action – relates to your conduct by Gibbs (1988) (Figure 1), to prompt the questioning what you while undertaking the task and allows you process of reflection. Gibbs’ (1988) model is a did, or what you thought to modify what you are doing while you step-by-step process that encourages the user to suitable or right? Does it are doing it. This is commonly described as consider how an event made them feel. This is involve reviewing choices ‘thinking on your feet’. important when considering self-awareness and as part of an episode of  Reflectionon action – involves looking emotional intelligence, and can often be missed care or reviewing your retrospectively at how practice was executed in the absence of prompts. Thinking about how knowledge? and analysing the information gathered an event makes you feel can be challenging and in terms of knowledge, new learning and can easily be overlooked in favour of focusing 2 Look at your professional development. on evaluation and analysis of the situation. In answers to time out The majority of nurses are very familiar with the evaluation stage of Gibbs’ (1988) model, activity 1 and decide reflection on action. However, many nurses the reflector explores the main issues associated how your ideas about also reflect before action and in action without with the situation and determines which aspect reflection are modified being consciously aware of this. Nurses may requires additional analysis. The analysis depending on whether believe that they reflect on practice on a stage prompts the reflector to search and you reflect before, regular basis. However, for reflection to be read the literature to increase their knowledge during or after an event. meaningful conclusions must be reached and and understanding to make sense of the Does reflection at a an action plan agreed to inform future practice. situation, arrive at a conclusion and, ultimately, specific point require Reflection may result in a positive outcome; reach the action plan stage to formulate more effort or offer conversely, reflection can identify areas that new learning. greater possibilities? require improvement or a change in approach Gibbs’ (1988) model is most often used or attitude. retrospectively (reflection on action); however, 3 Select a reflective Although reflection is often associated it can be used when reflecting on an anticipated model to evaluate a with situations that did not go well, it is also event (reflection before action) and considering situation you have a valuable learning tool to understand why how to approach a particular situation. encountered in practice things did go well. Some may feel that Gibbs’ (1988) model is with a mentor or Complete time out activity 2 unnecessarily complex. Borton’s (1970) model colleague. Begin with has three steps (Figure 1), is simple to use and reflection on action. easy to remember. However, in contrast to Gibbs’ What seemed easy or Models of reflection (1988) model, the questions do not automatically difficult when using Different models of reflection are recommended remind us to consider our emotions. The second your selected model to assist thinking; having a range of models question: ‘So what?’ requires attention to the to prepare notes on to choose from enables their use by a broad individual, their perceptions and feelings, but what happened? community who might learn in different ways. might result in overlooking important insights.

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Borton’s (1970) three questions allow a degree reach a reasoned conclusion and form an action of flexibility and include reflection before, in and plan for future practice. on action. Complete time out activity 4 Complete time out activity 3 Rolfe et al (2010) discussed reflection as an It is important that you choose the model or activity that enables practitioners to think, feel framework that works for you; not doing so can and imagine while learning from an event. In result in suboptimal learning from experiences addition, reflection facilitates consideration of (Jasper 2013). Time is required to purposefully what might have happened if things were done reflect on situations and this is not always easy in differently and how things could be done in practice. To capture your thoughts and feelings the future. For reflection to be effective and for about a situation, there is an optimum time the nurse to understand what should be done, 4 Consider reflection frame within which to recall events accurately. focused thought combined with an exploration before action, and think The aim is to reflect as soon as feasibly possible, of related literature and up-to-date research of an example of planning preferably with a colleague who ideally observed evidence is required. Reflective thinking a nursing activity. Nurses the same event. Another person’s perspective can should prompt further enquiry and is, in turn, are often required to be supportive and challenging because they may augmented by it. Reflection changes as a result anticipate the reactions remember events differently. Reflection clarifies of new information. For example, reflection of patients and the success or failure, and facilitates procedural on helping a patient to manage their pain is outcomes of planned insights and actions that can be considered for supplemented with reading about patient activities. Using Borton’s future practice. perceptions of pain and a review of research (1970) model, draw on about the merits of various pain relief strategies. previous experiences By adopting critical thinking, you begin to plan a strategy to Critical thinking to enquire more deeply into the situation you meet your objectives, If reflection is to be considered a learning tool are reflecting on. Critical thinking can pose and record your plan to achieve meaningful understanding, it must challenges when we believe that our practice in writing. Do you think be combined with critical thinking (Price 2004). is correct. Taking time to engage in in-depth this three-step approach When analysing any situation, it is critical thinking about a situation facilitates scrutiny is valuable? thinking that provides the knowledge and of the decisions you have made and why you understanding that will ultimately help you made them. Critical thinking is undertaken at

FIGURE 1 Two models of reflection

Borton’s model Gibbs’ model

Stage 1: what? Describe the Describe the situation. situation

Action plan: if it What were you happened again, what thinking and feeling? would you do? Stage 2: so what? Explore the situation.

Initial evaluation: what Conclusion: what else was good and bad about could you have done? the situation?

Stage 3: now what? How can the new learning be translated into practice? Analysis of the situation: what sense can you make of the situation? (Borton 1970, Gibbs 1988)

36 mDownloadeday 4 :: vol 30from no RCNi.com 36 :: 2016 by ${individualUser.displayName} on Aug 17, 2017. For personal use only. NoNURSING other uses without STANDARD permission. Copyright © 2017 RCN Publishing Company Ltd the analysis stage to tease out specific issues and and feelings, we would be robotic. Therefore, it is consider the supporting information. At this not suggested these feelings and emotions should point, you will begin to deconstruct the event not exist, but that an understanding of how – examine how something developed or was situations and events can affect nurses helps them achieved, the processes used, the way in which to plan and prepare for future practice. Nursing people acted and how you responded. involves perceptions and emotions as well as It is important to understand the empirical evidence, and nurses must work in the complex evidence and how it compares with your world of feelings. For that reason, a calm and perceptions. For example, a recording of body empathic review of emotions – our own and temperature is considered empirical evidence, those perceived in others – remains valuable. but observing a patient and sensing that they are The professional duty of candour (General feverish is a perception. You add information Medical Council (GMC) and NMC 2015), the together – touching the patient, listening to development of which can be linked directly how they talk – to inform your impression of to The Mid Staffordshire NHS Foundation what is happening. Perceptions may prompt Trust Public Inquiry (Department of Health you to gather empirical evidence and review the 2013, Francis 2013), stresses the importance of evidence previously obtained. Undertaking this dealing with concerns in an open way. It states activity can lead to exploration and examination that ‘Every healthcare professional must be open of the literature, which can reveal new or and honest with patients when something goes alternative evidence-based practice. wrong with their treatment or care which causes, If writing a reflective account is a new process or has the potential to cause, harm or distress’ for you, you might begin to write in a descriptive (GMC and NMC 2015). To be self-aware should way. However, the more you write and become be considered compulsory in today’s caring familiar with reflective models and frameworks, profession, to improve nursing practice and to the more your writing will develop. maintain the standards required for effective care. Reflection, therefore, is an activity that should become commonplace in practice to Self-awareness understand why a treatment may have gone To reflect meaningfully on situations, it is wrong or why a situation had the potential to important to be honest with yourself when cause harm or distress. examining issues. This is especially important Complete time out activity 5 with regard to your attitudes and values, the how and the why of your approach to care. To Reflecting on practice and behaviours is expected that end, self-awareness is essential to reflection to take place frequently. This could involve (Howatson-Jones 2010). reflecting on a situation with a patient, relative or The desire to care for individuals and their colleague, including mentors or other members 5 Think of a practice families is integral to nursing. Therefore, the of the multidisciplinary team. situation that evoked basis of any learning is to achieve this goal. It is Complete time out activity 6 feelings in you that only by knowing more about who we are and influenced your actions. what motivates us that we can provide the best Effective working relationships rely on shared Did you realise this possible care (Burnard 1992). The importance and mutually respectful perceptions of who we at the time? Did you of self-awareness in nursing is not a new (the healthcare team) are. If the team is to provide have a strategy to deal phenomenon (Burnard 1988, Rawlinson 1990). an effective and responsive service to patients, with such an event? Burnard (1992) stated that until we are clear the team must have common purpose. This is If so, what was it? about who we are, we cannot help others. There achieved when colleagues are comfortable with are occasions in practice that this can evoke shared procedures. In the case study in Box 1, 6 Consider the case uncomfortable feelings of vulnerability, doubt, Janet used reflection to examine relationships study in Box 1 and how distrust and anxiety. Nevertheless, to become with other team members and whether they using reflection in this self-aware requires a conscious process to know understood what she was contributing to situation can be used as what makes us feel and act the way we do. the team. In this instance, that could involve a learning tool to help Jack and Smith (2007) suggested that whether the consultant understood Janet’s resolve an issue. Reflect self-aware practitioners are equipped to manage level of experience, but also a need for respect on a situation that you emotions and feelings in a controlled manner between the consultant and the nurse in the experienced in practice as opposed to being overwhelmed by them and presence of junior doctors. It is possible that that you did not address, simply reacting; they manage rather than cope. Janet was oversensitive about the consultant’s and analyse why you did Emotions and feelings make us who we are as question and remarks, but it is also possible not act. caring individuals and without these emotions that the consultant had inadvertently dismissed

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Janet’s abilities in the presence of others. What the mentor judged that it was reasonable for care is clear is that Janet needs to calmly raise her to proceed, but then modified the response when concerns with the consultant. The reflection the patient became violent. A related reflection enables Janet to consider the consequences of might occur regarding how decision making not raising the matter, as well as anticipating is a constant process in response to changing why the conversation might prove difficult. A situations. Second, Alexis has to consider patient reflection on action prompts thoughts about the confidentiality and in this instance, Alexis makes next action. an appropriate decision, resisting the invitation In the case study in Box 2, Alexis has two to share private information regarding a patient complex issues to consider. First, she has to on social media. Reflection in action sometimes consider whether it is appropriate to care for involves such ‘near miss’ matters, where it a patient who is known to her socially. In this could be easy to make a wrong decision. Alexis situation, reflection is likely to be about the reflects on what encouraged her to act as she did, appropriateness and ethics of who nurses explaining her commitment to The Code (NMC should care for in practice. In this instance, 2015b) to her friend. BOX 1 By using reflection and instinct, Janet and Case study: Janet, a newly qualified nurse Alexis in both case studies (Boxes 1 and 2) were practising self-awareness. Self-awareness and Janet is a newly qualified staff nurse who has been asked to assist in the thinking critically about a situation are integral ward round. There are several junior doctors attending the ward round and to reflection (Howatson-Jones 2010, Rolfe et al the consultant leads. The consultant, without warning, asks Janet a question 2010). Nurses are frequently confronted with that would usually be asked of a doctor and, although she knows the answer, ethical dilemmas, and thus reflection in action she is slow to respond. The consultant makes a remark that insinuates that becomes particularly important. As a moral and Janet is incompetent. Although upset by the remark, Janet feels it would be unprofessional to say anything at that moment. Using her choice of reflective professional practitioner, it is important to take model, she subsequently reviews the situation. Nurses cannot escape attitudes, ownership and responsibility for your actions. but understanding our own attitudes and ensuring that they are professionally All nurses should understand fully the details defensible is part of being an ethical nurse. Janet’s reflection makes her realise and implications of The Code (NMC 2015b) she has to address what happened with the consultant in the hope that he will and the professional duty of candour (GMC realise his question and subsequent remark seemed untactful. Although ward and NMC 2015) for practice and respond rounds have a clinical function – reviewing patient progress and treatment – appropriately (Box 3). they also indicate the importance of interprofessional working relationships and Nurses often associate reflection with judging the respect required if a healthcare team is to work well. Not to express her their performance and, in the case study in Box 3, concerns to the consultant might mean that he remains unaware of what Janet Thomas faces a moral dilemma associated with viewed to be unprofessional behaviour. This takes courage, but by not accepting the behaviour of the consultant, Janet is acting professionally and hopes to his behaviour. In the interest of patient safety, he prevent similar behaviours in the future towards her or other colleagues. must tell his colleagues that the patient has drunk water before the invasive procedure. This may raise questions about his practice, including the BOX 2 failure to remove the water jug from the patient’s Case study: Alexis, a third-year nursing student bedside. For reflection to facilitate learning, Alexis is a third-year nursing student on placement in a ward that specialises in it is important to use reflection as a means of liver disease. She realises at the report handover that one of the patients is her improving practice and reviewing alternative friend’s aunt; she has been admitted for investigations for alcohol-related liver actions, as well as measuring performance. problems. Alexis is aware that the woman is estranged from her family because Thomas will be accountable for his actions but of her alcohol dependence. Alexis tells her mentor about her connection to the he needs to understand why the error occurred patient and that she is concerned it would be inappropriate for her to care for if he is to learn from the experience. Thomas the patient. Her mentor initially suggests she asks the patient how she would needs to understand the warning signs that might feel if Alexis was caring for her; however, this idea is abandoned following a alert him and his colleagues, and avoid future violent outburst from the patient and Alexis is assigned to a different area risks to others. of the ward. When Alexis goes home that evening, she notices that there is a message on a social media site from an acquaintance telling her friend that her Openness and honesty are integral to nursing, aunt was admitted to hospital. Alexis receives a message from her friend asking and are promoted by the NMC (2015b). for confirmation of the situation and an update of the aunt’s condition. Alexis Although Thomas had been partly responsible is disturbed by this and reflects on the situation and how it could affect her for the error, his openness and honesty in career. She decides to telephone her friend and explain that as a result of her alerting senior staff meant that the issue could be professional accountability in relation to confidentiality, as outlined inThe Code addressed quickly and that he and others could (Nursing and Midwifery Council 2015b), and because of her professional values, learn from the situation. Had he chosen not to she cannot disclose any information about patients. Alexis explains that she will be honest, the consequences could have been not enter into any conversation on social media about the situation. serious, for both himself and the patient, and

38 mDownloadeday 4 :: vol 30from no RCNi.com 36 :: 2016 by ${individualUser.displayName} on Aug 17, 2017. For personal use only. NoNURSING other uses without STANDARD permission. Copyright © 2017 RCN Publishing Company Ltd would have resulted in non-adherence to The themes that emerge, for example how you react Code (NMC 2015b). in particular situations. Reflecting on your entries Complete time out activity 7 over time helps you to understand how you have developed your self-awareness and possibly helped your colleagues to reflect on their practice. Ways of reflecting You can choose specific situations from your diary The most common form of reflection is done that you feel are suitable for revalidation and silently and in personal thoughts by recalling inclusion in your portfolio, using the mandatory what happened. Sometimes these thoughts may template, when requested by the NMC (2015a). be discussed with a colleague, however neither of these practices captures the full account and some of the facts may be lost from our memory Revalidation process over time. One way to capture the details, NMC (2015a) revalidation aims to improve particularly when considering feelings, is to public protection and professional standards write them in a reflective diary (Jasper 2013). by encouraging a culture of reflection This can be any notebook or folder that is for and improvement while strengthening your personal viewing. It is crucial to write in it professionalism through ongoing reflection. regularly and as soon as possible after an event To evidence this, a minimum of five written or shift while events are clear in your mind. You reflective accounts in the three-year period could put an example of your chosen reflective since the renewal of registration are required model at the beginning to guide your thinking (NMC 2015a). These must refer to an instance of when writing. If using a folder, you could have a CPD and/or a piece of practice-related feedback template with the main stages, and complete the and/or an event in your professional practice, as various sections. Alternatively, you might choose well as relating to The Code (NMC 2015b). to record notes on an electronic tablet. It is important for those who are yet to register, The benefits of such documented records are and those who are registrants, to demonstrate numerous. It can be therapeutic to write about they can provide evidence of how reflection what happened and how it made you feel, as well ensures their skills and knowledge are up to date 7 Read the guidance as promoting honesty if you were responsible. It for practice to be safe and effective. Purposeful on the duty of candour can help you think about how you could rectify reflection can result in meaningful approaches (GMC and NMC 2015) a situation, if that has not already been done. to practice as well as contributing to CPD. A and using social media Not everyone enjoys writing and you revalidation requirement includes some response responsibly (NMC might prefer to use a digital recorder, such as a to patient feedback, and reflection has the 2015c), as well as local Dictaphone, to recall events and work through potential to demonstrate that. Reflection can be policy for the hospitals the reflective model. This can be done when used to demonstrate CPD and produce evidence in your region. Discuss alone and then listened to as a way of critiquing for revalidation. CPD has many forms; for this information with your involvement in the situation. Others might example, study days, completing CPD articles your colleagues and express their feelings in artistic ways, such as or attending mandatory training sessions. think about how producing a collage, although these would still Up-to-date information on the revalidation you might apply this to require a written explanation if they are to be process is available on the NMC website your practice. included in the personal development portfolio to (www.nmc.org.uk). demonstrate CPD. Using an inappropriate style of reflection for you often means you delay or ignore BOX 3 the process (Jasper 2013). Having insufficient Case study: Thomas, a third-year nursing student time to write is a common barrier to documenting Thomas is a third-year nursing student in his final placement on a busy medical thoughts. You should begin the reflective process receiving unit that is short staffed. The staffing levels have resulted in Thomas by recording brief notes using these headings: finding it difficult to spend time with his mentor. He has been asked to prepare  What happened? a patient who will be undergoing an invasive procedure as a matter of urgency.  How did I feel? The procedure, and its necessity, is explained to the patient. Thomas is preparing  What are the main points? to take the patient to the radiology department when he realises that the  What do I need to explore further? patient, who had been fasting as part of the preparation, had a drink of water.  What are my initial thoughts were this to The patient had been told not to eat or drink, but had forgotten he was told happen again? this. Thomas realised that he had not removed the water jug from the patient’s You then have a record on which to reflect bedside locker, the patient was thirsty and had a drink. Thomas felt panicked purposefully when you have time to explore the and irresponsible, but quickly realised that he needed to take responsibility and inform his mentor and the nurse in charge of his error since he was aware this situation using critical thinking. When reading might affect the procedure. over your records you could note common

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The NMC (2015a) revalidation guidance BOX 4 includes templates to record CPD and reflective Advice on completing reflective accounts accounts. The time out activities in this article provide the opportunity for participatory  Relate reflective records toThe Code (Nursing learning, which can be used as evidence for the and Midwifery Council 2015b) to demonstrate CPD log and revalidation portfolio. how you are attending to professional values. The headings in the template for reflective  Identify in your records how you enquire and accounts are (NMC 2015a): speculate; inquisitive records demonstrate an  What was the nature of the CPD activity interest in learning. and/or practice-related feedback and/or event  Consult with the person who will sign off your work to ensure that this works cogently with Write two reflective or experience in your practice? 8 role commitments and plans. To duplicate work accounts using the  What did you learn from the CPD activity is to complicate the process. headings identified by the and/or feedback and/or event or experience in NMC (2015a) that link to your practice? The Code (NMC 2015b).  How did you change or improve your practice because these are crucial to the reflective process. Select two themes from: as a result? Reflection is more than discussion of a situation; prioritise people, practise  How is this relevant to The Code? it involves consideration of how situations make effectively, preserve From reading this article you will see that the us feel, understanding what went right or wrong, safety, and promote question headings are similar to those in Borton’s and reaching a reasoned conclusion that provides professionalism and (1970) model (Figure 1). Advice on completing an action plan to inform future practice. trust. Discuss your reflective accounts is provided in Box 4. This article focused on providing practical reflective accounts with Complete time out activity 8 examples to highlight the value of the reflective an NMC registrant. process. Reflection can be both a participatory and a personal activity. Examples of how to Conclusion 9 Now that you have record reflective accounts have been outlined, completed the article, Reflection and reflective models enable nurses such as writing in a reflective diary or audio you might like to write to identify what suits their learning style and recordings. Regardless of your chosen format, a reflective account as to reflect in a purposeful manner. Reflection time is required to undertake this personal but part of your revalidation. is a valuable lifelong learning tool which can essential aspect of practice. The NMC (2015a) Guidelines to help you be used to promote personal development and has issued guidance for revalidation and this are on page 44. optimum care for patients. The importance of article will support you with this process NS self-awareness and critical thinking was explored Complete time out activity 9

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1. Reflection is an activity that 7. During which stage of reflective How to use this assessment should be done: practice should critical thinking be This self-assessment questionnaire (SAQ) a) Before an event ❏ undertaken? will help you to test your knowledge. Each ❏ ❏ b) During an event a) Initial evaluation week you will find ten multiple-choice c) After an event ❏ b) Analysis ❏ questions that are broadly linked to the d) All of the above ❏ c) Action planning ❏ CPD article. Note: there is only one d) Conclusion ❏ correct answer for each question. 2. Reflection before action involves: a) T hinking about what you aim to 8. The duty of candour stipulates You could test your subject knowledge achieve and the means by which the need to: by attempting the questions before this will be accomplished ❏ a) Be vague when things go wrong ❏ reading the article, and then go back over them to see if you would answer b) E xamining what you are doing b) Offer remedy or support when any differently. and how you can change what requested only ❏ you are doing ❏ c) D ismiss the patient’s concerns ❏ You might like to read the article to c) L ooking retrospectively at your d) Deal with concerns in an open update yourself before attempting practice ❏ and honest manner ❏ the questions. d) U sing new learning to inform When you have completed your future practice ❏ 9. How many written reflective self‑assessment, add it to your professional accounts are required for portfolio. You can record the amount of 3. One of the following authors did revalidation? time it has taken. Space has been provided not develop a reflective model: a) One ❏ for comments. a) Johns ❏ b) Three ❏ b) Gibbs ❏ c) Five ❏ You might like to consider writing a c) Kolb ❏ d) Ten ❏ reflective account, see page 44. d) Borton ❏ 10. Which of the following 4. Which of the following statements statements is incorrect? Report back is incorrect? a) Nursing care should be based This activity has taken me _­____ hours to a) R eflection should be purposeful, solely on evidence and not on complete. focused and questioning ❏ perceptions and emotions ❏ Other comments: b) R eflection involves the use b) Openness and honesty are of experiential knowledge ❏ integral to nursing practice ❏ c) R eflection should be used to c) S elf-awareness is integral to consider events after they have reflection ❏ happened only ❏ d) Reflection can be used to d) F or reflection to be useful, it demonstrate evidence for should lead to an action plan revalidation ❏ Now that I have read this article and to inform future practice ❏ completed this assessment, I think This self-assessment questionnaire my knowledge is: 5. Stage 3 in Borton’s model is: was compiled by Rebecca Akkermans Excellent ❏ a) Now what? ❏ Good ❏ b) So what? ❏ The answers to this questionnaire will Satisfactory ❏ c) What? ❏ be published on May 18 Unsatisfactory ❏ d) How? ❏ Poor ❏ As a result of this I intend to: 6. As a practitioner, you should use the reflective model that: The answers to SAQ 840 on situation a) Your colleagues use ❏ awareness, which appeared in the b) Is the simplest ❏ April 20 issue, are: c) You have always used ❏ 1. d 2. b 3. b 4. d 5. c d) Works best for you ❏ 6. c 7. a 8. b 9. d 10. a

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