Applying a Gibbs’ reflective cycle framework

Applying a framework

Structured reflection, which applies Gibbs’ reflective cycle to the example above, shows how it can prompt positive action: The dental nurse thinks about, or reflects on, what had happened and that she had felt ineffective, overwhelmed and lacked the confidence to act. In trying to make sense of the situation (analysing), she realises that not practising CPR techniques regularly may have been the problem. She concludes that practising these skills more than once per year might have increased her knowledge and confidence. She decides to take action and access some extra training with her local Deanery as soon as possible. She also speaks to the practice manager and asks if regular team practice and updates in CPR can be arranged in lunch-time learning sessions. She includes practising and accessing more frequent CPR training in her Professional Development Plan (PDP), giving her an achievable and realistic target, to benefit her professional practice, patients and colleagues. This example illustrates how a reflective cycle has encouraged the dental nurse to take proactive action to resolve the immediate issue, but also to think beyond this to prevent the situation recurring, and to direct her future learning. She is in the process of becoming a reflective practitioner.

Limitations of frameworks

Rigid dependence on a framework or model can reduce the reflective process to little more than a tick-box exercise (Ghaye and Lillyman, 2010). As you become more comfortable with the process, you can avoid this, by perhaps choosing elements of different models and combining them to create your own synthesised version. You do not need to reflect in a prescribed way; but as a dental professional, you do need to learn to reflect (Rughani et al. 2003).

Self-awareness and personal responsibility

Reflective practise is inward-looking and personal to each individual and his or her work. Regular reflection can lead to greater self-awareness, which is considered essential for effective reflective practise (Johns, 2009). Becoming self-aware can show the links between our values, attitudes and beliefs and our actions (Ghaye and Lillyman, 2010), which may have a positive or negative effect on the behaviour of others (Johns, 2009).

Involving others

Reflection is not about blaming others, because blame will not contribute to your development. However, reflection can benefit when others are involved (Ghaye and Lillyman, 2010). While your reflective practise is about you, your learning and development, adding other perspectives can enhance the process (Moon, 1999). Discussing an issue or incident with colleagues, friends and family, or even reading around the subject, can help you to recognise that there are always different ways of looking at the same thing. In the following example, a senior dental nurse, whose training occurred long before stringent precautions to prevent the spread of infection were introduced, believes that infection prevention and control (IPC) in dentistry is a pointless waste of time, because there were never any problems in the past. In response to an increase in the number of needle-stick injuries in practice, the dental nurse reflects on the possible causes. Her first thought is to blame her colleagues; it is their responsibility to follow the guidance and policies. However, she discusses the issue with both junior and senior colleagues, and reads around the subjects of influence and motivating others. These other perspectives and theories lead her to realise that her value for, and attitude towards, IPC policies is apparent in her actions. As a senior dental nurse, many of her colleagues look to her for guidance. What she discovers is that, despite receiving regular training in avoiding needle-stick injuries, her colleagues’ behaviour and actions are being shaped mostly by her attitude. Trainee staff are adopting her attitude, thinking that it must be right; other colleagues are relaxing their own, otherwise rigorous standards, because the senior dental nurse sets the tone in the practice. The reflection might go on to suggest that there are a number of things that she could do differently, including changing her actions and behaviour, and ensuring that she follows guidance fully. This would make it much easier to encourage her colleagues to do the same. She could also discuss her out-of-date attitude with her colleagues and ask them to feedback their own knowledge and views, encouraging them to guide her. Hopefully this example shows that by avoiding blame, and involving other perspectives, this senior dental nurse has the opportunity to learn and grow as a professional.

When to reflect

In the previous examples, the reflective process occurred after critical incidents, or significant events. Reflective practise should not be limited to critical incidents. Keeping a reflective diary is an effective way of programming reflection into your activities. It is possible to reflect on any aspect of your work, and this is a good way to ensure that you remain self-aware.

Reflective diary exercise

• ? Spend 10 minutes reflecting on any recent conversation at work, with either a patient, senior or junior colleague. What was the conversation about, e.g. payment for treatment, an appointment, work rotas or responsibilities? Was the outcome good or bad? Were you, the patient or colleague satisfied or dissatisfied? Discuss the conversation with colleagues, friends or family (being careful to maintain patient confidentiality), to gain other perspectives
• ? How do you feel about it now, and how do you think you contributed to the outcome? Did you do, or say something that made it go well, or not so well? Might the other person have reacted well, or badly, because of something you did or said? Why did you do or say those things—habit, attitude, feelings? If the outcome was good, can you identify why and could you build on that? If the outcome was not so good, could you have done something differently, and might that have made a difference?
• ? What would you do differently next time? Would you benefit from asking for, or accessing, further training to help in the future, either to reinforce the good, or prevent the bad? What is your action plan now?

This exercise shows how a reflective diary and self-awareness can contribute to your professional development plan. This is a good way to direct your future learning to fit your needs. Another way is to reflect on CPD activities.

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