Reflection on a Brain Injury Clinic

Throughout personal professional development reflection is essential, allowing health care professionals to self-develop by revisiting events and analysing areas in which improvements and learning would ensure a positive impact on their future practice. The Nursing and Midwifery Council, (NMC, 2010) notes that all health care practitioners must be self-aware in their own values and principles which could affect their practice. Ensuring they maintain personal and professional development while learning through supervision, feedback and reflection.

Critical reflection is vital to develop evidence based practice for safe and quality approaches to professional nursing practice. Nursing professionals should critically reflect on events to identify what health professionals might do to improve their practice and reduce the risk of a similar error. Reflective practice can help to learn from their mistakes, be empowered and most importantly to deliver best possible care to patient as nurses must work closely with their patients to develop a therapeutic relationship. Critical reflection is a valuable skill to ensure patient centred care. This practice promotes personal development by enhancing students’ self-awareness, their sense of community, and their sense of their own capacities for

Burns, S. Bulman, C. Palmer, A. (1997) Reflective Practice in Nursing - The growth of the professional practitioner. London: Blackwell Science.

What is reflection? Reflection is defined by Wilkinson (1996) as an active process whereby the professional gains an understanding of how historical, social, cultural, cognitive and personal experiences have contributed to professional knowledge and practice.

Reflection is a process of exploring and examining ourselves, our perspectives, attributes, experiences and actions / interactions. It helps us gain insight and see how to move forward (Nursing Times 2018). I believe reflection is particularly important when it comes to Nursing, as medicine is constantly changing/ improving and us ourselves medical professionals must adapt with the changes in medicine. I find that reflection is extremely useful in doing this as we can look over procedures or experiences that we have had, how that made us feel, whether we would change anything, then in the future we can see the changes that may have been made, whether this has changed our feelings and opinions on medical practice.

Reflective practice in nursing is the process where we examine our nursing ability’s and practice in order to critically think and analyze the way we work and think about the views of others in our practice, what we could have done and we could have achieved a greater result by doing this also allows us as nurses to include best practice and use our own judgment in patient care to show the factors that either aid and hinder nurse to patient relationship. (Lowenstein, Bradshaw and Fuszard, 2001) described reflecting in nursing practice “the nurse must first come to understand what he or she defines as ideal practice”.

Unfortunately, TBI and inmates is not a well-established area of study. According to the Centers for Disease Control and Prevention (2007), mild TBI is found within 25% to 87% of inmates. One such that looked at prevalence was done by Diamond, Harzke, Magaletta, Cummins, and Frankowski (2007) where the researchers looked at Minnesota male state prisoners and assessed them using the Traumatic Brain Injury Questionnaire. What the authors found

Reflection is described as a way of reviewing experiences from practice so that it can be described and analysed and used to change future practice (Bulman and Schutz, 2004).

Gustaffson and Fagerberg point out that reflective practice has relevance for clinical practice as by understanding the contents of nurses’ reflections, it is also possible to understand the advantages of reflective practice and how and when such measures should be used by the nurses for further professional development.

Reflective practice is often defined as when practitioners engage in a continuous cycle of self observation and self evaluation in order to understand their own actions and reactions they prompt in themselves and in learners (Brookfield, 1995; Thiel, 1999). The goal is not necessarily to address a specific problem or question defined at the outset, as in practitioner research but to observe and refine practice in general on an ongoing basis. (Cunningham 2001). Reflection on practice is a key skill for nurses. Engaging in regular reflection allows practitioners to manage the personal and professional impact of addressing their patients’ fundamental health and wellbeing needs daily (Oelofsen, 2012)

Reflective practice in nursing is considered an important aspect to nursing. Durgahee ( 1997) defines reflective practice as a process of learning and teaching professional maturity through the critical analysis of experience, whilst John ( 2009) up to date explanation of reflection is learning through our everyday experience towards realising one vision of desirable practice as a lived reality.

In recent years, reflection and reflective practice have become well-known term with in the health care arena. They are words that have been debated and discussed with in the health care setting (Tony and Sue 2006). Reflective practice is essential for nurses, as nurses are responsible for providing care to the best of their ability to patients and their families (NMC, 2008). Reid (1993) states reflection is a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice. Johns (1995) notes that reflection enables practitioners to assess, understand and learn through their experience. Reflective practice, therefore, offers nurses an opportunity to review their decisions and

Lily had only recently began dialysis treatment, and her unwillingness to proceed with treatment would have resulted in her care becoming palliative, something the healthcare professional did not think was suitable at this point in her illness trajectory. Tait (2012) points out that a critically ill patient experiences not only physiological trauma, but also psychological trauma. This psychological trauma that can be experienced after critical care has been addressed by the National Outreach Forum (2003) who suggested that services should be developed to address the implications of critical illness. Samuelson (2011) suggests that any negative emotions associated with critical care can be counterbalanced with memories that reinforce safety, control and trust. This is a useful point to consider in Lily case, who fortunately had the time to talk through her worries concerning continual dialysis treatment with the staff on the ward, who were able to convince her she was in the safest possible hands and that continuing her dialysis treatment would be the best option.

Schon (1987) identified two types of reflection that could be applied in the nursing practice. He described “refection-on-action” that involves assessing and analyzing an action while performing the action and “reflection-in-action” which involves going back to previous actions and situations and analyzing them to gain new insights and to improve the nursing practice (Schon 1987). Schon further argued that for reflection to take place there should be a commitment to action as there is to results. Coined in 1970, Borton’s theory on the other hand, proposes the use of three stem questions in the reflective practice (Borton, 1970). These questions were originally proposed by John Driscoll who described the experiential learning cycle (Driscoll, 1994) where practitioners are able to learn from their experiences to improve their practice. According to Driscoll (1970) these trigger questions could be used to complete the experiential learning cycle leading to a practitioner gaining new information and insights on how to improve their practice (Driscoll, 1994). The importance of Driscoll’s three stem questions in improving practice reflection among nurses cannot be underestimated. By answering these stem questions, nurses develop a better insight into the situation regarding how and why it occurred and identifies the next courses of action in case the situation recurs.

Patients who suffer from a mild TBI often require little rehabilitation and function normally over the course of a week or so (León-Carrión et al., 2005). Patients with a moderate TBI often suffer psychological and physical stressors, but they have an 80% chance of being high-functioning after a certain amount of time (León-Carrión et al., 2005). However, patients with moderate to severe TBI often suffer long-term physical and cognitive problems as a result of their injury.