Johns Reflective Model Essay English

Reflection Assignment 2 Following Johns Model Of Structured Reflection

Reflection Assignment 2

Following Johns Model of Structured Reflection

For this placement I was on an elderly male medical ward. As I have had no previous experience of care in a healthcare setting their where numerous thing with which I had to a customise myself with.

Johns Model of Structured Reflection (Johns 1998)

1.Write a description of the experience. Ask yourself:

*'What are the significant issues I need to pay attention to?'

On my first day on the ward it was decided that I should shadow one of the staff nurses to acustomise myself with the ward. During this induction we had to assist an elderly gentleman with sever diarrhoea the gentleman in question was quit large and almost completely immobile. On inspection of the patient he was incontinent of both urine and faeces the staff nurse then talked with the patient explaining to him what had happened and that we needed to clean him and change his bedding. It was very difficult to understand what he said in reply because as I found out later he was also suffering from sever oral thrush making it painful for him to open or move his mouth. We began by removing the top sheet and counterpane and it was decided that because the patient was lying slightly to the left we would role him towards the staff nurse leaving me to do the majority of the cleaning. As I had never encountered anything like this before I was getting more and more flustered as to what to do and whether I was doing it correctly and each time the patient moaned in pain I felt worse. the staff nurse with me was helpful but as she would have done this kind of thing hundreds of times she was not very instructive as it probably seemed perfectly obvious what to do and how to do it. Each time I did something I was thinking what now, how do I do this and slowly convinced myself that I was hopeless and incapable of even changing a bed. Whilst rolling the patient over towards me to remove the old sheet I started to feel hot and dizzy the nurse working with me noticed this almost straight away called for some help to take my place and took me to the visitors' room to sit down and recover.

2.Explore the experience using the reflective cues:

*Aesthetic: Ask yourself:

a)-'What was I trying to achieve?'

b)-'Why did I respond as I did?'

c)-'What were the consequences of that for:

*The patient?

*Others?

*Myself?'

d)-'How was the person(s) feeling?'

a) We where trying to clean and change the patient to make him more comfortable with minimum pain and distress.

b) I think I responded as I did because of several factors. firstly I...

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Guidance on Reflection

‘Medical education has traditionally focussed on the assimilation of vast amounts of knowledge and on clinical apprenticeship as the ‘hallmark’ of good training, and has undervalued reflection in learning.  Today, however, medical and dental education needs to prepare students for lifelong learning.  It must foster professionals who take a deep approach to learning and equip students to determine their own learning needs, set their own learning goals and monitor the occurrence of continuing progress.  To achieve this, a more reflective approach is called for’ (Pee et al, 2000).

It is important that students develop a habit of assessing their own learning needs, developing strategies to meet them and reflecting on their own learning and personal development.  

‘Reflection - the conscious weighing and integrating of views from different perspectives – is a necessary prerequisite for the development of a balanced professional identity … acquiring knowledge and practical skills alone are not enough to become a medical professional.  Reflecting on education and clinical experiences in medical practice, including one’s own behaviour, becomes crucial’ (Boenink et al, 2004). 

Reflective Practice

Introduced as a concept for many professions in the 1980s

Means that we learn by thinking about things that have happened to us and seeing them in a different way.

There are three components

  • Experiences – that happen to a person
  • Reflective process – that enables a person to learn from their experience
  • Action – resulting from the new perspective taken as a result of the reflection

Reflection as a learning activity comes from educational theory, Kolb (1984) describes a cycle of stages that are gone though in learning from experience:

                                                      OBSERVATION                

ACTION                                                                                                                      REFLECTION           

                                     CONCEPT DEVELOPMENT and THEORISING

Levels of Reflection

Goodman (1984) describes three levels of reflection:

  • Level 1:  Reflection to reach given objectives – criteria for reflection are limited to technocratic issues of efficiency, effectiveness and accountability i.e. students gives an account of an incident and demonstrates some learning
  • Level 2: Reflection on the relationship between principles and practice – there is an assessment of the implications and consequences of actions and beliefs as well as the underlying rationale for practice i.e. students begin to link theory to practice and to extrapolate their experiences to other similar situations
  • Level 3: Reflection which besides the above incorporates ethical and political concerns – issues of justice and emancipation enter the deliberations over the value of professional goals and practice and the practitioner makes links between the setting of everyday practice and broader social structure and forces e.g. health economics and resources.

Frameworks for Reflection

There are many frameworks that can be used to encourage and support reflection; the choice of framework depends on the student’s skills and experience and may change as students become more expert in their reflections.  A range of frameworks and tools follow:

Helping students to reflect:

Consider what you did on your placement visit today…did anything that happened during the day surprise you?  Has anything that happened during the day contradicted or challenged your ideas or expectations?  Have your views changed?  For example:

If you met a patient:

How did the patient’s life experiences differ from your own?

Did you feel able to empathise with the patient?

If you were shadowing a health care professional:

Did anything about the person’s role surprise you?  Do you think the roles of all members of the MDT are valued?  How do you feel about team working with other professionals? 

Your knowledge:

Have you identified gaps in your knowledge or skills?  How might you go about addressing these?

Or you might like to use one of the following frameworks to reflect on your experience:

A Learning Experience (Pee et al, 2002)

Briefly describe what happened.

  • Describe your feelings at the time this happened.
  • Why do you consider this experience to be worthy of reflection?
  • What strengths in your clinical practice did this experience demonstrate?
  • What learning needs did this experience reveal to you?

Gibbs Reflective cycle (1988)

                                                                                                          Description

                                                                                                        (What happened)

Action Plan    Feelings

(If it arose again what                                                                                                                                                                                              (what were you

would you do?)                                                                                                                                                                                                      thinking and feeling?)

Conclusion    Evaluation

(What else could you                                                                                                                                                                                      (What was good and bad about

Have done?)                                                                                                                                                                                                      the experience?)

                                                                                                      Description

                                                                                (What sense can you make of the situation?)

Borton’s Developmental Framework (1970)

This is a simple model that is suitable for novice practitioners, at its simplest it’s three steps can be summarised as:

i.e. the What questions such as:  What happened?, What was I doing? Serve to identify the experience and describe it in detail.

The So what? Questions include questions like: So what do I need to know in order to understand this situation? So what does this tell me about me? About my relationship with the patient? With the other members of the team? I.e. the student breaks down the situation and tries to make sense of it by analysing and evaluating in order to draw conclusions. 

The Now what? Questions e.g. Now what do I need to do to make things better?  Now what might be the consequences of this action?  At this stage the student plans intervention and action according to personal theory devised.

Johns Model of Structured reflection (1994)

Core questions – What information do I need to access in order to learn through this experience?

Cue questions:

  1. Description of the experience
  • Phenomenon - -describe the here and now experience
  • Causal - what essential factors contributed to this experience?
  • Context – what are the significant background factors to this experience?
  • Clarifying – what are the key processes (for reflection) in this experience?
  1. Reflection
  • What was I trying to achieve?
  • Why did I intervene as I did?
  • What were the consequences of my actions for:
    • Myself?
    • The patient/family
    • The people I work with?
  • How did I feel about this experience when it was happening?
  • How did the patient feel about it?
  • How do I know how the patient felt about it?
  1. Influencing factors
  • What internal factors influenced my decision making?
  • What external factors influenced my decision making?
  • What sources of knowledge did/should have influenced my decision making?
  1. Could I have dealt with the situation better?
  • What choices did I have?
  • What would be the consequences of these choices?
  1. Learning
  • How do I feel now about this experience?
  • How have I made sense of this experience in light of past experiences and future practice?
  • How has this experience changed my ways of knowing
    • Empirics
    • Aesthetics
    • Ethics
    • Personal
Compiled by Maria Hayfron-Benjamin,
Lecturer in Medical Education,
Barts and the London School of Medicine and Dentistry

m.j.hayfron-benjamin@qmul.ac.uk

References

Boenink AD, Oderwald AK, deJonge P, vanTilburg W and Smal JA (2004) Assessing student reflection in Medical Practice.  Medical Education, 38, 368 – 377.

Borton, T. (1970) Reach, Touch and Teach.  :

Gibbs, G. (1988) Learning by Doing.  Polytechnic,

Goodman, J. (1984) Reflection and teacher education: a case study and theoretical analysis.  Interchanges, 15, 9 – 26

Jasper, M.  (2003) Beginning Reflective Practice.  Nelson Thornes, .

Johns, C. (2000) Becoming a Reflective Practitioner. Blackwell Science, .

Palmer, A., Burns, S.  and Bulman, C. (1994) Reflective Practice in Nursing.  Blackwell, .

Pee B, Woodman T, Fry H, and Davenport E. (2000) Practice-based learning: views on the development of a reflective learning tool.  Medical Education, 34, 754 – 761.

Pee B, Woodman T, Fry H and Davenport E. (2002) Appraising and assessing reflection in students’ writing on a structured worksheet.  Medical Education, 36, 575 – 585

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