2000; Glaze 2001; Mantzoukas and Jasper 2004; Nicholl and Higgins 2004;
McGrath and Higgins 2006). The mental health nurse needs to be mindful of such limitations when considering reflection in the context of clinical practice and the development of reflective practice. Nonetheless, we believe that the use of reflection in practice can offer the potential for professional and per- sonal development, and learning. However, we are also aware that for learning to occur, the mental health nurse will require structure, guidance and support as well as an openness to use different strategies that foster the ongoing devel- opment of reflective skills and reflective practice.
For the purpose of this chapter, we have chosen Gibbs’s (1988) reflective model to illustrate how it can be used to reflect on a specific experience or event.
Gibbs’s model of reflection
Gibbs’s (1988) reflective model provides a simple framework for reflection. It comprises three main stages of reflection, which are cyclical and include the following description and analysis of the experience, as well as the learning acquired from reflecting on the experience. This model also identifies specific questions to facilitate the nurse’s ability to think more deeply about a specific experience or event. This in turn helps the nurse to make sense of his/her experience. The model also includes a conclusion that considers other alter- natives, along with an action plan to guide the practitioner in the event of a similar situation arising again. It can be used on its own or as a structured framework when writing your reflective journal. The following example illus- trates Louise’s, a first-year student, use of Gibbs’s model to reflect on a specific experience that occurred during her second clinical placement.
Using Gibbs’s model of reflection Description: What
happened?
Feelings: What were you thinking and feeling?
Evaluation: What was good and bad about the
experience?
It was my first day on the ward. I was excited although a little nervous. This ward was the older adult ward. I was afraid that the client would not take what I said seriously because I look so young. The staff nurse asked me to talk to Mrs Gray, a 70-year-old lady. She had just seen her doctor. I introduced myself and commented on the photos of her lovely grandchildren. She reminded me of my Nan. I felt less nervous and was talking away. I asked her about her grandchildren, their names and ages. Mrs Gray told me their names, ages and what they were doing. Her face lit up as she talked about them. She suddenly became tearful and started crying uncontrollably. She kept saying ‘I am going to forget them, I won’t know them any more.’ I did not know what to say; I wanted to give her a hug but I did not think it was the right thing to do. I just stood and held her hand. The staff nurse came into the room and gently asked Mrs Gray what was wrong. She said the doctor had just told her ‘she was losing her memory’. Using listening skills and
encouraging prompts, for example ‘tell me more’, the staff nurse encouraged Mrs Gray to talk. She talked for a long time about what she had been told, her fears and what this meant for her. I tried to listen, but I felt embarrassed for upsetting her.
I felt so stupid in front of the staff nurse.
Thoughts: I did something wrong.
The staff nurse would think I was uncaring and stupid.
Feelings: I felt upset for making Mrs Gray cry.
I think it was good that I tried to listen to Mrs Gray.
I resisted my need to hug her.
I wasn’t aware of the client’s needs and just started talking without thinking and using my
observation skills.
I wasn’t listening actively all of the time; I was distracted, worrying about what the staff nurse might think of me.
Analysis: What sense can you make of the experience?
Mrs Gray was upset after receiving this distressing news. I didn’t know this and my comments about her grandchildren triggered her feelings.
She was upset and frightened. I felt upset because the client was upset; I wanted to make it better for her. I liked this client, she reminded me of Nan. I know that I talk a lot and very quickly when I am nervous. The doctor should have told the nursing staff what he said to Mrs Gray, so we or I could have been more prepared for her response.
Conclusion: What else could you have done?
Action plan: If it arose again, what would you do?
Be more ‘tuned in’ to the client’s body language and other signs that might indicate the client’s feelings.
Ask her about her conversation with her doctor, for example ‘I noticed your doctor was talking to you for a long time. What did he have to say?’
Be aware of my own fears and pause before I say anything. Remind myself to talk less, when I am feeling nervous. Let the client speak first and lead the conversation.
To be more client-centred and follow the client’s cues rather thinking about my own needs.
To listen and allow the client to talk.
Source: Adapted from Gibbs (1988)
The above model might be best suited for nurses new to the concept of reflective practice. As with all ongoing learning, nurses should demonstrate increased self-awareness, and greater depth and breadth of critical analysis, synthesis and evaluation. We will now briefly describe a more complex reflec- tive model, which may be more appropriate for more senior learners and/or qualified staff.
Framework for reflective practice (Rolfe et al., 2001)
The What? model of reflection, by Rolfe et al. (2010), uses a questioning ap- proach to facilitate the nurse to reflect on the three stages of the reflective process. The questions What? So what? and Now what? can stimulate reflec- tion from novice to advanced levels. The model comprises three stages. Each stage has an extensive range of trigger questions, which aim to stimulate the mental health nurse’s depth of thinking about the situation. The following illustrates a modified version of the What? model of reflection.
The What? model of reflection
Descriptive level of reflection
Understanding the context Theory and knowledge level of reflection
Action and future
orientated level of reflection
What. . .↔
↑. . .is the
problem/difficulty/issue for feeling angry/not getting on /with client . . .etc.?
. . .role did I have?
. . .actions did I take?
. . .did I hope to achieve?
. . .was my reaction to it?
. . .was the response of
others?
. . .feeling did it evoke?
. . .in the patient?
. . .in myself?
. . .colleagues?
. . .was good/bad,
useful/not useful about the experience?
So what. . .↔
↑. . .does it tell me/mean
to me about my client/our therapeutic relationship/my beliefs about mental health nursing/my role/my skills, etc.?
. . .did I base my actions
on?
. . .was I thinking and
feeling when I responded?
. . .other knowledge can I
use to understand this event?
. . .could I have done
differently?
Now what. . .↔
↑. . .do I need to do
differently to improve my skills/be more confident/be more effective/
get on better. . . etc.?
. . .other issues do
I need to consider for the future?
. . .might the
consequences be if I do/don’t do?
Source: Adapted from Rolfe et al. (2001)
Practice exercise
r Think of a recent interaction that took place during your clinical placement.
r When you have chosen your interaction, use the trigger questions described in Rolfe et al.’s model to reflect on your particular experience and the three stages of the reflective process.
r We would encourage you to keep brief notes about your thoughts, feelings and learning in your reflective journal and use them to discuss with your mentor or clinical supervisor.