Reflecting on reflections
By Natalie Boxall on 01 August 2014
First year student midwife at De Montfort University Natalie Boxall explains how reflective writing and looking at past situations and assessing what you have learnt from them, is key when studying midwifery.
Your first year at university as a student involves locating and then reading numerous journals and drafting long essays. For student midwives (SMs), it also includes learning a whole new way of thinking – as they are required to assess their practise through reflective writing.
Reflection has emerged as a key concept in educational theory and learning in the health and social care professions (Clark, 2009). It involves looking at a past situation, assessing what you have learnt from it, what you could have done differently, realising new approaches to your care and ultimately, how you felt about the whole experience. A 2006 study found that midwives who had undertaken reflective writing during their degree had adopted the approach once qualified, which benefited their practice (Collington, 2006).
Understanding your feelings is a vital skill for reflective writing, and studying for a midwifery degree involves being in a lot of new situations – doing your first antenatal booking; helping a woman with breastfeeding support; witnessing a birth – which can bring new reactions to the surface. It’s important to comprehend what you feel, why you feel that way and to then learn from it, as failing to reflect can lead to poor insight and therefore poor performance in practice (Hays & Gay, 2011).
Writing reflectively requires a whole new approach to academic writing, and to make things easier there are three common models to follow: Van Manen, Gibbs and Durgahee (Giminez, 2011). They all involve thinking systematically about the phases of an activity, using headings including: description, feelings, evaluation, analysis, conclusion and action plan. These theoretical frameworks provide a starting point for the critical skills that all SMs need to develop by the end of their degree.
Newly qualified midwife Amy Hegarty, who studied at De Montfort University (DMU), says she approaches reflections as mini assignments and often uses situations in practice, which have made her question an aspect of care. She says: ‘I have always used the Gibb’s cycle and analysis is always where the most attention is given. It’s where you examine the literature and learn about what you’ve done and why you’ve done it – was there another way you could have done it? Who says you were right? And, are there any alternative models of care you could have considered?’
The next section involves making sense of your analysis and looking ahead to the future, as Amy explains. ‘You need to look at the findings of your analysis and decide how good the care was that you gave. This is where the action plan comes in – what would you do differently next time, how would the women perceive this, and what difference would it make? You can assess this by looking at many elements, including is it cost-effective, is it holistic or would another approach make your job less stressful and therefore give more job satisfaction?’
Midwifery requires developing self-awareness, as university placements involve adapting to new situations, which are challenging, exciting and sometimes daunting. When you’re working outside of your comfort zone, while trying to take in new information and giving quality care to an array of women, there isn’t a lot of time to think about why you’re doing what you’re doing.
SMs are given time every week during placement to reflect on their experiences, which can primarily help to take ownership of the feelings these experiences provoked. It can also give space for an SM to evaluate their actions and ultimately, help them learn from practical experiences, which ideally should help to develop future practice.
SM Sophie Anderson used the process after delivering a stillbirth. She said in an article for the BJM (BJM 2010): ‘I never wanted to think of what had happened again as it was so upsetting. My mentor suggested that I write a reflection of what happened – I was horrified at the thought... but I am grateful to my mentor for helping me through this experience and I want other students to realise the importance of reflection and what a huge help it can be.’
Most SMs will not have had to think this way before, so how do you recognise when you’re in a situation that would make for a good reflection? Amy Hegarty says her top tip is to always take notes on placement. ‘It’s often best to pick a topic randomly and start writing about it while you have time, rather than waiting for an experience to come up. The specific experience will come along at some point – hopefully not on the day before deadline – but at least if it does you only have to write the description and action plan as the main analysis will already be done.’
Once you have drafted an analysis based on an experience when you’re given a relevant assignment to use it, it’s then a case of fine-tuning it to apply to the outcomes for that module. During the first module of the first year at DMU, SM’s need to submit a formative reflection and three summative reflections, which must cover an antenatal skill, breastfeeding support, postnatal skill and a significant event. Your tutor and your placement mentor will read these.
Amy Hegarty suggests that you should not write with a specific audience in mind. ‘Whether it’s knowing your tutor will be marking it, or that your mentor will see it, you can end up stifling your real feelings because you don’t want to upset them. You should try to forget about them and do what you need to do to get through and finish your reflection.’
Writing a reflection isn’t just about learning how to write in a new way academically, it is a covert way of teaching you to assess your feelings, as Amy Hegarty explains. ‘Writing reflections during your degree can lead on to learning to evaluate your experiences in different ways – whether that is to reflect’ over a cup of tea and crying on your colleague’s shoulder, or to writing conference pieces to present to an audience – it teaches you the skills to adequately deal with the array of experiences you will encounter, throughout the rest of your career.’
References
Anderson, S. (2010) Learning through experience: a student’s reflection of a stillbirth. British Journal of Midwifery, 18 (12): 814.
Clark, P. (2009) Reflecting on reflection in interprofessional education: Implications for theory and practice. Journal of Interprofessional Care 23(3): 213-23.
Collington, V. (2006) Reflection in midwifery education and practice: an exploratory analysis. Evidence Based Midwifery 4(3): 76-82.
Giminez, J. (2011) Writing for Nursing and Midwifery Students 2nd ed. Palgrave: UK.
Hays & Gay (2011). Reflection or ‘pre-reflection’: what are we actually measuring in reflective practice? Medical Education. 45: 116–118.