Reflection Assignment: Theories for Nursing Practice Essay Reflection Assignment: Theories for Nursing Practice Essay This essay aims to discuss the principle theories and models of reflection and reflective practice in nursing. The theories of John Dewey and Donald Schön will be deliberated; Dewey regarded reflection as learning by experience through active participation and experimentation, in contrast Schön believed it was both an active and retrospective process. Two models of reflection will also be examined; Graham Gibbs and Christopher Johns. Gibbs (1988) believes there are six stages of reflection, from description of the incident to action plan. John (1995) however has a?five-stage model, each stage has some cue questions that acts as a checklist. Reflection is when you experience a situation, you examine what happened to see if you could have done anything differently or repeat what was successful. Howatson -Jones (2013:6) defines reflection as ?a way of examining your experience in order to look for the possibility of other explanations and alternative approaches to doing things. It can also be described as ?a window through which the practitioner can view and focus self within the context of her own lived experience ? (Johns, 2010:35). Reflective practice in nursing is looking at the positives and negatives of past decision, learning from this to create a positive outcome in future situations (Japer, 2013). Reflection Assignment: Theories for Nursing Practice Essay ORDER INSTRUCTION-COMPLIANT PAPERS HERE Theories of reflection can be described as different questions which helps to clarify your knowledge. Models of reflective practice are questions that allows peoples experience to be evaluated by applying previous knowledge to your work. It can be argued that, the history of reflection in Nursing is not a recent phenomenon One of the first reflective theorists is an American psychologist Dewey (1938). He believed much of our learning is derived from our experiences and experimenting with ideas. Dewey (1938, cited in Rolfe, Jasper and Freshwater 2011:34) ?we learn by doing and realising what came of what we did. Deweys created the?model of reflective learning, this consists of three stages. First, we experience the situation, secondly, we observe and reflect on it, thus we gain a better understanding of the event. Thirdly, the deep comprehension turns into knowledge. (see figure 1) Dewey defined reflection as (1933:9 cited in Bulman and Schutz 2013:2) ?Active, persistent and careful consideration of any beliefs or supposed form of knowledge? He viewed reflection as a scientific process of thinking for a purpose, it requires focus on knowledge adjusting and experimenting with idea accordingly (Bulman and Schutz 2013:2). Schön (1988) is another influential figure, in the history of reflection. His work was developed from Deweys idea, from this he created a two-stage theory: reflection- in- action and reflection- on -action.? Reflection-in-action means thinking about the action whist performing the task or procedure and actively amending ones action accordingly. Schön emphasises that thinking on your feet, was key to producing the expert practitioner.? Schön (1983:163, cited in Johns 2017:7) ?he shapes it and makes himself part of it. Reflection-on- action is concerned with examining the experience in greater detail after it has happened, finding alternative ways to do something to achieve the best possible outcome (Jasper, 2013). A criticism of this model is that it is very vague, it does not offer any checklist questions to guide reflection. It relies on the individuals interpretation only, it can be argued that it is difficult to measure the effectiveness. Reflection Assignment: Theories for Nursing Practice Essay. This section will compare 2 models of reflective practice in greater depth. Gibbs (1988) six stage?Reflective cycle, is based on Deweys (1938) model. The first stage is the experience, this is where you recall the critical incident and analyse your reaction of the event. The second stage deals with the feeling, you discuss your emotions, in terms of what you were thinking and how you felt at the time. Next you analyse, by exploring what went well and what did not go as planned. Then you discover areas of improvement in your Skills, which the enables further learning. This leads on to the conclusion phase where you make a judgement with the information you have gathered on this exercise. These could be both success or failure from this, you develop an action plan, which is the last phase in this model.? (see figure 2). Gibbs believes that feelings and emotions significantly influence actions, therefore understanding self is key to reflective practice. The key strength of this model is that it is clear, concise and straight forward to use. It is suitable for both the novice and the experienced professional. One criticism of this model is that there are some nuances, between the evaluation and analysis steps. This is exemplified in the question, what was good or bad and what else can you make of this experience. This is essentially asking the same question, in different ways which could lead to confusion. Johns developed Model of Structured reflection (MSR, 1995) based on Barbara Carpers (1978)?fundamental patterns of knowing. Which contained?4 phases: empiric (measurable actions), personal(self-awareness), ethical (moral knowledge) and aesthetics (whole picture).?Johns MSR has five phases, with some cue questions together with the influence grid to enable greater analysis of each phase (see figure 3&4). He has since revised the MSR (2010 and 2015) in each occasion adding more clarity to the steps. The first phase is the preparatory, which he refers to as ?bring the mind home this basically mean focus on the significant experience. Secondly, the focus then leads on to the descriptive phase, where you describe the experience and what issues were significant. Thirdly, the reflective phase asks you to consider the internal feeling and external influencing factor of the decisions, this considers your own and other peoples feelings. This is primarily trying to ascertain if your actions were influenced by others and if you acted differently because of this. The fourth phase is the anticipatory, which ask you to speculate how you would have changed the situation, if there was any constraint stopping you and how this might have affected the outcome. It also prompts you to evaluate the incidence retrospectively, the fifth phase is the insight, which concerned with what knowledge has been achieved as a result. Johns believes when reflecting on our performances, it is necessary to consider internal and external influencing factors (Jasper, 2013). And without this individual cannot transition to reflective practice. The strengths of this model are that the questions are very specific, this is exemplified in the question what you were trying to achieve, this can assist your reflection. Another positive is that it has been modified severally, which show the model is truly reflective. The main weakness with this model is that there too many questions to consider in each stage, this might lead to confusion, especially for the newly qualified practitioner, who might not have enough insight into own knowledge in order to analyse it extensively. The influence grid might also be distracting from real thoughts, therefore influencing your answers. Reflection Assignment: Theories for Nursing Practice Essay. There are several similarities between Gibbs and Johns reflective models, the first is the learning outcome of the experience which is the analysis, the second point is what you will approach differently next time, known as the action plan. There are some important differences between Gibbs and Johns models. Johns MSR uses cue questions and an influence grid to prompt the Practitioner to include, external factors such as other peoples feelings, which might have influenced their decisions. Gibbs model in contrast uses an individualised approach, the focus is on the practitioners thoughts only, it is not concerned about other peoples influences. Another difference is that Gibbs ask you to evaluate your approach to work, however Johns is only concerned with what you have learnt from the experience or will change in future. Reflective models can be applied in practice by utilising the strategies to support some of the key challenges facing nurses. For example, the rise in physical assault on nurses from service users. A recent report on (BBC, 2017) violence in the work place, identified that there were nearly 200 attacks on health care workers daily in England. Gibbs model can be used in this scenario, the professional will be able to spot the triggers in advance. He would communicate effectively with the patient to de-escalate and resolve the issues. Another problem in nursing is drug errors, a study by Westbrook et al (2010, cited in?Nursing standard, 2018 vol33:59) identified that 25% of all medicines administration by nurses had one clinical error. The Nursing and Midwifery council (2007) nine rights of medicine Administration, together with Schöns reflection -in -action- theory could be applied to this scenario (Schön, 1983, cited in Martin 2013) by having an action plan and clear strategies. The professional would actively double check the medication and any errors would be identified, rectified before administering to patient. NMC (2018), states that all nurses, must uphold professional standards know as ?The code: prioritise people, practise effectively, preserve safety, promote professionalism and trust. Johns MSR model (2015) can be utilised here to identify gaps in knowledge, generate an action plan to address these issues.? Reflective practice thus supports key principle of the National Health Service (NHS 2012), code of conduct known as the 6Cs: care, compassion, competence communication, courage and commitment. Reflection Assignment: Theories for Nursing Practice Essay Having emphasised the relationship between reflective theories and models been an essential tool to establish reflective practice. I am now going to reflect in this section on a critical incidence, applying the Gibbs model. I was waiting patiently in an open-air carpark queue. I had been waiting for just over twenty minutes, when I reached the front of the queue. I was feeling quite pleased that at last the wait would be over as I saw a shopper leaving a parking space. suddenly a car about few spaces behind the queue reversed, drove through a no entry route and manoeuvred into the space. I was feeling angry, shocked and annoyed that this woman can just jump the queue. I went over and told her calmly, that there was a queue system and that the space was mine. She pretended she could not understand what I was saying at first, then she claimed to have been approached by the previous driver to park there and did not see the queue. She refused to move, parked up and paid for her ticket. The negative part of this incidence was that I had to wait an additional ten minutes to find a space, another negative was that I kept seeing her round every shop I went into that afternoon. This ruined my shopping experience, because for majority of the time I felt uncomfortable even though I had been in the right. I had to accept that I could not change other peoples behaviour, I could only change mine. I can conclude from this experience that it was pointless trying to explain the situation as it did not achieve my main goal. My action plan would be, to avoid confrontation in the future but instead wait for another parking space or find another carpark. This essay has examined the reflective theories of Dewey and Schon and the models of Gibbs and Johns. When comparing the theories and models it became obvious that each situation might determine the choice of reflection. For example, Schöns theory might be suitable for the experienced nurse whilst Deweys could be appropriate for the novice. Johns model might be best for deeper analysis on the other hand Gibbs favours a straightforward approach. It remains clear that theories and models are useful, in the transition to professional behaviour in nursing practice. By identifying strengths and weakness and creating an action plan it can enable personal growth and competence in skills. It can Improve patient safety by preventing errors, promote person centred care, as self-awareness is a key element of reflection.?Reflective practice also supports the 6Cs (NHS, 2012) and (NMC 2018) ?the code. It can be applied in different situation however it is relevant to remember to use them wisely and apply common sense. John (2017:36) reminds us that ?models are not a prescription for reflection.? Reflection Assignment: Theories for Nursing Practice Essay References BBC (2017) NHS Health check??most staff have been attacked;?doctor says available at https://www.bbc.co.uk/news/health-38917156 accessed?19 December 2018. Bulman, C .and Schutz, S. (2013) Reflective Practice in Nursing?edn:2 Oxford: Willey-Blackwell. Howatson-Jones, L. (2013)?Reflective practice in Nursing?edn:2 London: Learning Matters. Jasper, M. (2013)?Beginning reflectively practitioner?edn:2 Andover: Cengage learning. Johns, C. (2010)?Guided reflection?edn:2 Chichester: Wiley-Blackwell. Reflection Assignment: Theories for Nursing Practice Essay Johns, C. (2017)?Becoming a reflective practitioner?edn:5 Chichester: Wiley-Blackwell. Johns, C. (2017)?MSR?fig3,?influence grid?fig.4, p.37-38.?Becoming a reflective practitioner?edn:5 Chichester: Wiley-Blackwell. Martin, P. (2018)?Coping and thriving in nursing London:?Sage publication. National Health Service (2012) ?The 6Cs available at www.england.nhs.uk/leadingchange/6cs. Nursing and Midwifery Council (2007)?Standards for Medicine Management: London. Available at?https://www.nmc.org.uk/standards-for-medicine-management?Accessed 24 December 2018. Nursing and Midwifery Council (2018) ?The code: professional standards of practice and behaviour for nurses, midwives and nursing associates: London available at https: www.nmc.org.uk/standards/ code. Accessed 24 December 2018. Nursing standards?Understanding the Human and System Factors involved in Medication errors?vol (33) pp.59-61 September 2018. Rolfe, G. Jasper. Freshwater, D. (2011)?Critical reflection in practice?edn:2 Basingstoke: Palgrave Macmillan. Rolfe, G. Jasper. Freshwater, D. (2011) ?Deweys model of reflective learning (1938)???Critical reflection in practice?edn:2 p.34 Basingstoke: Palgrave Macmillan. Rolfe, G. Jasper. Freshwater, D. (2011) ?Gibbs reflective framework (1988)???Critical reflection in practice?edn:2 p.35 Basingstoke: Palgrave Macmillan. Siviter, B. (2013) The student nurse handbookedn:3 London: Elsevier. Sourcefig.1: Rolfe, Jasper& Freshwater. 2011:33 ORDER INSTRUCTION-COMPLIANT PAPERS HERE Appendices Appendices Figure 1: Deweys model of reflective learning (1938) Source: fig.2 Rolfe, Jasper & Freshwater 2011:34 Figure 3: Johns model for structured reflection (MSR) edition 17th. Figure 2: Gibbs reflective framework Reflective cue Appendix 3 The Source: Johns, 2017 Bring the mind home Write a description of an experience What in particular seems significant to pay attention to? Why did I respond as I did? Was I effective in terms of consequences for others and myself? What factors influenced my response (see figure 4) Given the situation again, what are my options for responding more effectively? Reflection Assignment: Theories for Nursing Practice Essay What are the potential consequences of responding differently? How do those influencing factors need to shift so I can respond differently? What tentative insight do I draw? How does extant theory/ idea inform and deepen my insights? How does exploring with guides and peers challenge my insight? Reflection Assignment: Theories for Nursing Practice Essay Order Now

ADDITIONAL INFORMATION 

Theories for Nursing Practice

Introduction

Nursing is a profession that requires a lot of knowledge, but it’s not always easy to keep up with all the latest research. To help simplify your life, we’ve collected some of the most common theories for nursing practice and included links so you can read more about them.

Holmes and Rahe Stress Scale

The Holmes and Rahe Stress Scale is a tool that measures the cumulative impact of stressful events in your life. It was developed by Richard H. Rahe, Ph.D., and Harold G. Holmes to help people who were experiencing high levels of stress recognize when they needed to take action to reduce their level of stress.

The scale has five categories:

• Anxious-Preoccupied (A) – People who are anxious-preoccupied have worrying thoughts about how they might not be able to cope with future problems or challenges

• Depressed (D) – People with depressive symptoms are more likely than others to feel hopeless, helpless, guilty and worthless; this can lead them to avoid social situations because they feel too depressed

• Anxious and Depressed (A&D) – A&Ds have feelings of anxiety alongside depression symptoms such as fatigue or lack of energy

Uncertainty in Illness Theory

The Uncertainty in Illness Theory (UII) is based on the work of Hans Selye, who was a Canadian physiologist and emeritus professor at McGill University. Selye described three categories of stressors:

• Primary stressors – These are events that trigger changes in our body’s biochemistry and physiology, such as infection or injury. They can also include things like financial problems or changes in relationships with other people around us.

• Secondary stressors – These are events that occur after a primary stressor has occurred, but before recovery has begun; they may be related to the original cause of illness or even unrelated to it at all! For example: if your loved one gets sick while traveling abroad during their vacation because they ate contaminated food at an unfamiliar restaurant; this would constitute a secondary cause for them getting sicker than usual since their immune system wasn’t ready yet due to lack of exposure prior experience dealing with foreign foods within its own country ecosystem…etc..

General adaptation syndrome of Hans Selye

Theories of general adaptation syndrome (GAS) were developed by Hans Selye in 1926. This theory proposes that the body undergoes three stages of stress upon exposure to a new situation: alarm, resistance and exhaustion.

The first stage is known as the “alarm” phase, during which the body reacts to a stressor with an increase in heart rate and respiration, resulting in increased metabolic activity. This can be seen as an emergency response designed to protect us from immediate danger or even death if necessary. After some time has passed without further incident (the “resistance” phase), our bodies begin functioning normally again but with increased efficiency due to what we call “adaptation”—a process whereby physiological systems are able to handle more difficult situations than before while remaining efficient overall; this includes both physical changes such as hormonal release throughout all tissues involved including bones/tissues themselves! Finally comes a state called “exhaustion” where there simply isn’t enough stimulus left anymore so no longer being able anymore respond effectively because they’ve reached maximum capacity already.”

Nightingale’s Environmental Theory

• Nightingale’s Environmental Theory

• Nurses are influenced by the environment in which they work. The theory was first proposed by Florence Nightingale in the late 19th century and based on her observations of soldiers during the Crimean War. She believed that poor conditions contributed to poor health outcomes, so she developed a set of rules for hospitals to follow.

Orem’s Self-Care Model

Self-care is the ability to meet personal needs and to maintain a healthy balance between self and others. It’s an ongoing process, not something you will be able to accomplish overnight. It can be difficult at times—especially when there are conflicting demands on your time or energy—but it’s important that you take care of yourself so that you can do the best possible job for your patients.

Self-care is about learning how to manage stress effectively, identifying ways in which you might be contributing towards a situation where stress has become excessive (or if it hasn’t yet), figuring out ways in which this could change and working towards creating more positive outcomes for yourself as well as others who impact upon your work environment (e.g., coworkers).

When we look at these theories together: self-care; caring for others; our sense of belonging; identity development through relationships with others outside ourselves…we see how they all play into each other!

Roy’s Adaptation Model for Nursing

Roy’s adaptation model for nursing is a theory of nursing that focuses on how people adapt to changes in their environment. It is based on the idea that people have a need to be independent and to control their lives.

In this model, nurses can help patients by offering support and encouragement during times when they feel overwhelmed or unsure about what will happen next (e.g., after surgery). They also provide information about possible solutions when they think it would be helpful (e.g., talking with family members).

Neuman Systems Model

The Neuman Systems Model is a nursing theory that is based on the work of Carl Rogers and Abraham Maslow. It is a holistic model of human behavior, focusing on the individual’s needs, motivations, and expectations. The NSM was developed as an alternative to traditional theories such as Freudian psychoanalysis or behaviorism in order to better explain how people make decisions about their health care needs.

The NSM focuses on four key principles: self-actualization (the desire for personal growth), intrinsic motivation (the desire for success), empathie gratification (the need for social acceptance), and congruence between one’s beliefs and actions.

Johnson Behavioral System Model

The Johnson Behavioral System Model is a theory that explains behavior in terms of three systems: the cognitive system, the emotional system and the behavioral system.

The cognitive system is responsible for perception, cognition and learning. It’s also known as thought or emotion-thought-behavior linkage. This involves thinking about what you need to do with your patient. For example, if you have to give an injection to a patient and they don’t want it because they’re afraid of needles (fear), then this will influence how you feel about giving them an injection because your own fear gets involved too!

Takeaway:

• Nurses need to be aware that a patient’s health status is not just about the physical body.

• Nurses need to be aware of the importance of the mind and body connection.

• Nursing theories are important for nursing practice because they help nurses understand how their patients think, feel and behave when experiencing different health conditions or events in their lives.

Conclusion

Not all theories are created equal, and some are more applicable to your specialty than others. If you’re interested in finding out what theory fits best with your practice, it might be time to do some research!

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