Through the looking glass: the rabbit hole of reflective practice
Reflective practice is a common feature of nurse education. Indeed, the development of nursing practice is associated with being a ‘reflective practitioner’. However, how we see ourselves or interpret past events is often influenced by our own unconscious biases. While it is reasonable to hold favourable views of one's ability, biased or lack of self-insight might mean that one is actually unskilled and unaware of it. In the ambiguous clinical context where an act or omission can have potentially devastating consequences, the implications of this are significant. The questions of whether and how reflection addresses unconscious biases are relatively unexplored in the nursing literature. Given that accurate self-assessment is integral to reflective practice, this article attempts to explore the potential impact of unconscious bias on reflection. The authors conclude that while biases may limit our ability to learn from reflection, this is not a reason to dispense with reflective practice, but rather, is even more reason to critically engage with the process. Nurses of all levels must be encouraged to reflect on both their practice, and their reflection.
Reflection on, and in, practice is an integral part of nursing, with professional organisations and accrediting bodies calling for the inclusion of reflection at all levels of undergraduate, postgraduate and continuing nurse education (Aronson, 2011; Coward, 2011; Nursing and Midwifery Board of Ireland, 2015; Nursing and Midwifery Council (NMC), 2018; Donohoe, 2019). Proponents of reflective practice advocate strongly for its inclusion in curricula, arguing that reflection is intrinsically aligned to intended modular and programmatic outcomes with the potential to enhance learning by enabling students to reflect on, reconcile and reconceptualise their practical experiences with theoretical instruction (Price, 2005; Grealish et al, 2018). In addition to the coalescence of theory and practice, it is claimed that structured reflection enables the exploration of one's beliefs, emotions, and theories; thus, informing plans for future learning (Aronson, 2011) and moving practitioners from a position of unconscious incompetence (novice) towards a position of unconscious competence (expert) (Benner, 1984).
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