Learning through reflection

Three types of reflective learning have been identified; pre-reflective, whereby the learner thinks about what they are going to do before doing it, and this may be based on theoretical knowledge or previous experience (reflection before action) (Greenwood 1998); reflective cognitive, which requires reflection during the experience (reflection in action); and contemplative - thinking deeply about a concrete experience post event (reflection on action). Knowledge gained from this learning cycle results in affective change, that is, to the way the individual thinks and behaves (Kember et al., 2001; Sewchuk 2005).

Reflection has been used in nurse education for over 20 years as a way to aid learning and develop practice (Quinn and Hughes 2007). Benner (1984) asserted that nurses’ had been very poor keepers of evidence of clinical learning, believing that their knowledge base would not develop until they documented what their experiences had taught them. This documentation process however, necessitates the action of reflection in order to facilitate assimilation of the experience by the learner.

Observations & reflections of concrete experience Test new concepts/theories in practice Concrete experience

Analysis & formation of Abstract concepts &

An ethnographic study by O’Donovan (2007) set out to gauge the perceptions of a small purposive group (n= 5) of final year student nurses in Eire introduced to reflection in their final year. In-depth one to one interviews were utilised to gather data, which were subject to constant comparative analysis (Charmaz 2006). Findings demonstrated that generally the students found reflection useful. They understood the ‘deliberative thinking process’ of reflection, needed in order to make sense of it. They found the process of reflection quite challenging initially, but with guidance and support from preceptors and placement co-ordinators and the use of a reflective model, (such as Gibbs, 1988 or Kolb, 1984) they believed they were able to develop their skills of reflection.

The sample reported that the action of reflection increased their self – awareness, an aspect also identified by Bulman et al., (2012). However, the written reflections of O’Donovan’s (2007) sample tended to be superficial due to a reluctance to document deeper, more personal feelings. Students’ preferred to discuss more the significant reflections on a one to one basis with their preceptor/ placement co-ordinator. Timmins and Dunne (2009) found similarly, when they undertook an evaluation of 840 portfolios which revealed that 84% (n=402) of reflective accounts were descriptive and superficial in nature.

Students in O’Donovan’s study (2007) believed they would have benefited from more practical guidance earlier on at the start of year three. In fact they believed it would have been more beneficial to them to have reflection from first year, rather than as a distinct topic in third year. Certainly, within my HEI, and throughout nurse education in the UK, reflection is embedded within the programme from year one in the format of portfolios (NMC 2008; UWS 2011).

Whilst O’Donovan’s study was valuable in revealing students’ perceptions towards reflection and supported to some extent the benefits of reflective practice, the small sample size (n=5) and the fact that reflection was only introduced to the students in their final year, as a distinct module, render the findings representative of only that specific group (Lewis and Ritchie 2003: in Ritchie and Lewis 2003; Holloway and Wheeler 2010). The study was set in Eire, with a different professional body than the UK.

The inherent value and use of reflection within UK nursing and non-nursing education is well documented within the literature (Greenwood 1998; Moon 2004; Quinn and Hughes 2007; Silberman 2007; NMC 2008). It could be argued that the nursing programme in O’Donovan’s study (2007) is lagging behind other nursing programmes in Eire (Timmins and Dunne 2009) and the UK. It is difficult to reconcile why they would not have reflection embedded more fully into their nursing programmes when O’Donovan stated that recommendations to that effect have existed since 2000.

The quality of the reflections could also be questioned as students stated that they tended to keep documented reflections to a superficial level, suggesting that any analysis/ synthesis could be likewise. Reflection therefore may not have provided the same educational benefit to O’Donovan’s (2007) sample due to the limited period they were exposed to it.

Skills of reflection need to be developed over time in order to get beyond superficial description (Moon 2004). Bulman et al., (2012) revealed that students in their study reported that their skills of reflection developed over time. It would also have been more revealing if O’Donovan’s data had been gathered over a longer period to ascertain if reflective reasoning skills improved. Students themselves felt that reflection would have helped them more if they had been introduced to it from first year.

Timmins and Dunne (2009), undertook an exploratory study concerning the use and benefit of student nurses’ portfolios. A sample of 619 student nurses from Years one to four was recruited from a nursing programme in Eire. Students participated in an online survey, which asked for responses to 44 standardised, predetermined Likert statements related to portfolios. Results were generally positive but revealed confusion regarding what to document in the portfolio. Findings also suggested that although guidance and support were available it was not utilised. However, the response rate of 12% (n=100), rendered these findings limited to those respondents only (Polit and Beck 2008; Burns and Grove 2010).

In addition to the questionnaire, 840 portfolios (54%) were examined for structure and content. Within those, 84% of reflections were of a superficial nature. However, in fairness it should be noted that 69% (n=329) of the sample was from years one and two. Years three and four (32%: n=141) produced reflections of greater depth. It is probable that the greater percentage of junior students skewed the results (Polit and Beck 2008). However, had the sample in O’Donovan’s study (2007), who were in year three, been exposed to reflection from year one they may have developed their skills of reflection and been able to produce less superficial and descriptive reflections.

To return to Bulman et al’s, (2012) ethnographic study, aimed at understanding how reflection was perceived by a purposive sample of post-registered students (n=11) and teachers (n=9). Students in this UK based post-registered course compiled reflective learning contracts (RLC), which were reviewed as a source of data and participated in one – to – one interviews, whilst teachers were observed in teaching and learning situations. Data were thematically analysed.

Findings revealed that students valued reflection. They saw it as a way to help them make sense of experiences (Dewey 1938), using phrases like ‘getting better’ and ‘moving on’ and appreciated the importance of ‘feelings’ within the reflective process. Skills of reflection took time to develop and students saw this as valuable.

Data transcripts from the observations illustrated how the teachers facilitated the development of reflective skills. The students were post-registered nurses so perhaps they had previous experience of reflection. Bulman et al.’s, (2008) study was small so findings are limited to that context (Holloway and Wheeler 2010). However, they do support the value of reflection as an aid to learning. What was clear was that reflection, if carried out well, could be a valuable learning tool. However, robust facilitation is required from the outset to help learners develop understanding of the process. Coward (2011) opined that students often saw reflection as a laborious task and suggested this was due to poor understanding resulting from poor preparation.

Within nurse education another learning strategy linked to experiential learning and the SCE is ‘situated learning’, introduced by Lave and Wenger (1991) in the 1990s’. Lave and Wenger believed that the key to situated learning lay in the relationship between learning and the social context. This theory will now be introduced and discussed.