Journal of Community Nursing - page 105

2013,Vol 27, No 4
This process should generate
positive self-motivation and the
ability to direct their own learning
amid the minutiae of everyday
practice and in the larger context
of their ongoing lifelong learning.
For example, in learning the
importance of body language when
communicating with patients, the
student can link this to the learning
objectives required by their
learning contract, module or
knowledge and skills framework
(KSF), which, for instance, might be
‘developing communication skills
in practice’.
For students to attain clinical
excellence and improve practice,
they need to establish in their own
minds how reflection facilitates
progression to expert level (Benner,
2001). This begins by students
understanding what is actually
happening when they are reflecting
or thinking through their actions,
thought processes or competencies.
In point 3, the student decides
precisely how to reflect in the given
situation and which method to
use. New situations that result in
the acquisition of fresh skills may
require students to use a reflective
model in conjunction with the
grid, whereas for consolidation
of practice, the student may only
require short analysis to evaluate a
skill or experience. In the latter case,
the student might simply write: ‘I
shall use the reflective grid.’
In point 4 of the grid, the student
describes the particular experience
in one or two sentences or bullet
points, which means there is little
opportunity to get ‘bogged down’
in detail.
A brief summary is sufficient,
for example: ‘I found that my
knowledge of non-medical
prescribing was out of date,’ or,
‘While assessing a patient I realised
there was a difference between
what she was saying to me with
her words and with her facial
expression and demeanour.’
Point 5 outlines the salient or
significant learning issue, which
is identified so that the student
can focus on it. Students are asked
to imagine a page of text and
then ‘zoom in’ to an imaginary
box, which explains in one or
When completing point 6, the
student should ask themselves
questions such as: ‘What does
the literature say?’; ’What does
the evidence say about what am I
doing in practice?’; and, ‘What are
the differences between what I am
doing and what the protocol states?’
Point 7 contains an action plan and
is designed to ascertain whether
the student’s reflection process has
highlighted the need for further
training or study, or indicated a
different approach to achieving
competency or best practice.
For example, the student may
identify the need to explore further
the range of communication skills
used by nurses to improve their
assessment skills, or alternatively,
conclude that their current
knowledge of the prescribing
framework is sufficient and further
training is not indicated.
As students explore these ideas
they are learning about themselves,
their learning needs and how to
critically evaluate their learning.
Finally, in point 8 students identify
what needs to change — or, indeed,
stay the same — as a result of
their learning process if they are to
achieve clinical excellence.
For example, they may feel that
they are already operating at a ‘best
practice level’ and that this does not
need to change. Alternatively, they
may feel that they need to be more
aware of patients’ body language,
for example.
In the author’s area, the reflective
grid has been used to support pre-
registration and post-registration
student nurses and has so far
enjoyed good evaluations. Nurses
who have struggled with critical
analysis and reflection have found
that the grid asks questions that
enable them to develop a critical
‘The student describes the
particular experience in one
or two sentences or bullet
points, which means there
is little opportunity to get
“bogged down” in detail.’
two sentences what they want to
For example, this could be the
salient moment in an assessment
when the student realised that
the patient’s body language
was conveying much more than
his or her verbal answers; or
the realisation that up-to-date
knowledge is the key to clinical
The reflective grid is designed
to facilitate the understanding
of one significant issue at a time.
However, the learner may use the
grid three times, for example, for
three different learning issues,
provided they are extrapolated from
one scenario.
The aim is to provide students
with clear, specific skills and the
ability to identify their own needs.
After students have used the
reflective grid to help them critically
identify their learning issues, these
can all be combined into one
reflective account.
In point 6, key policies, protocols or
evidence that support and critically
evaluate practice against the
literature can be documented. This
should be easily available in the
workplace or on the trust’s intranet.
It is important that students
develop a working knowledge
of the evidence and policy that
informs their practice.
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