Reflective practice as evidence for decision making

Within this blog post, the topics reflective practice and evidence-based practice will be discussed. The importance of reflective practice and where it is typically seen being used, along with helpful models of reflection will be highlighted. Secondly, similar to reflective practice, consideration around concepts within evidence-based practice and the importance of it in a practical environment, also incorporating popular models constructing effective evidence-based practice. Finally, a comparison between the two, indication of overlaps between the practices and why it is significant for Bioveterinary scientists to use both reflective practice and evidence-based practice to enhance their professional practice.

The ability to reflect on professional experiences is seen as a key skill to advance professional practice. Husebø et al., (2015) describes reflective practice (RP) as a process of learning from experiences. The ability to compare, engage and think critically can develop an individual professionally through the assessment of experiences and evaluating how these have an impact on learning and gaining knowledge for the future (Sweet et al., 2018). RP can be seen being used within a variety of professions. Oelofsen, (2012) addresses the importance of reflective practice for nurses. It is stated that regular engagement in RP allows nurses to assess the personal and professional impact that they have on their patients, by evaluating their practice through different experiences. Sellars, (2017) also highlights the significance of RP within teaching. They state that within the active practice of teaching there is no right or wrong answer or text book to consult for every given situation. Critical reflection allows teachers to debrief said situations and make informed decisions through reflection. Reflective frameworks are more than often used to consider options and determine possible action. There are a variety of tools, in the form of models of RP, that have been established to support individuals wanting to self-reflect. A commonly used model of reflection is Gibbs Reflective Cycle Model (1988) (‘Graham Gibbs Reflective Cycle Model 1988,’ 2016) Although Gibbs is still a popular reflective model, it has been argued by Barksby et al., (2015) that it is not always easy to recall in a practice setting, and some of the stages are quite unclear. Taking this into account, the authors have developed Gibbs further and comprised a new reflective framework – The REFLECT model. Although designed for nurses and other health care practitioners, the framework could still be applied to develop professional practice for Bioveterinary scientists.

Gibbs cycle
Figure 1 – The sages of Gibbs reflective cycle. (Sheffield, 2018)
reflect.png
Figure 2 –  The seven stages of The REFLECT model. (Barksby et al., 2015)

Evidence based practice (EBP) was best described by Sackett et al., (1996) as they famously quoted “Evidence based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.” This statement is developed further by Giuffrida, (2017) who explains that EBP is a combination of; contemporary knowledge, clinical experience and client preference. EBP has evolved from solely relying on published scientific literature for best evidence. There is no guarantee that existing knowledge will have a widespread benefit. Although a concept or treatment may have been tested and published does not mean that it will necessarily work across the board for everyone (Biglan and Ogden, 2008). Client/patient preferences has now been seen to be incorporated into EBP within professional environments. Siminoff, (2013) explains the personal impact that a patience/client can have on an intervention or treatment. Social and cultural differences, along with any previous treatments or experiences, could have a significant impact on the clinical decision. Stakeholders are extremely influential factors that should always be taken into consideration when acquiring best evidence. A beneficial and structural way to asses whether evidence is appropriate to use would be to use an EBP guide.

five_steps_of_ebp
Figure 3- 5 structural stages for assesing evidence (Turner, 2018)

Although discussed as two separate subjects, similarities can be drawn between RP and EBP. Bannigan and Moores (2016) states that by integrating the two when making decisions, a practitioner can associate their previous experiences with current, valid and relevant evidence. Looking at the stages of The REFLECT model, a comparison can be drawn between stage 5 and EBP. Stage 5 describes the process of exploring options for the future for if the individual found themselves in the same situation as what they are reflecting on. Exploring options indicates comparing different forms of available evidence to assess which is most relevant and appropriate to use to improve the outcome of the situation if it should happen again. Similarly, it could be argued that the process of reflection could be used as evidence in the future to improve clinical judgment (Mamede et al., 2008). By using the REFLECT model the user is actively indicating what they have learnt through the process of reflection. Renedo et al., (2018) explains how the relationship between experience and evidence creates a hybrid form of knowledge. Learning from experience can be used as future evidence as a practitioner can refer to the knowledge they have gained in the past and compile it with existing evidence. Past experiences could also be used to assess what is deemed as “best evidence.” For example, the available best evidence may indicate a use of a treatment that may not work on an individual for a variety of reason. The practitioner may have encountered a situation similar to this in the past and could argue why the treatment may not best to use through the knowledge they have gained through past experience. This highlights the importance of RP with the interaction between stakeholders.

The integration between RP and EBP is extremely beneficial for improving professional practice. This form of advanced learning is important for Bioveterinary scientists as it integrates a from of active learning along with the assessment of what would be the best evidence to use for different situations. Understanding the importance of learning through personal actions and experiences and then linking this with the assessment of available evidence will allow for a Bioveterinary scientist to critically determine the best course of action when being faced with challenging scenarios.

 

 

Bibliography

Bannigan, K. and Moores, A. (2016) © CAOT PUBLICATIONS ACE Key words Clinical decision making Evidence-based occupational therapy practice Reflection Curriculum development Thinking.

Barksby, J., Butcher, N. and Whyshall, A. (2015) ‘A new model of reflection for clinical practice.’ The Nursing Times.

Biglan, A. and Ogden, T. (2008) ‘The Evolution of Evidence-based Practices.’ European journal of behavior analysis, 9(1) pp. 81–95.

Giuffrida, M. A. (2017) ‘Practical Application of Evidence-Based Practice.’ Veterinary Clinics of North America: Exotic Animal Practice. (Evidence-Based Clinical Practice in Exotic Animal Medicine), 20(3) pp. 737–748.

‘Graham Gibbs Reflective Cycle Model 1988’ (2016) ELN Resources. 7th December. [Online] [Accessed on 10th November 2018] https://resources.eln.io/gibbs-reflective-cycle-model-1988/.

Husebø, S. E., O’Regan, S. and Nestel, D. (2015) ‘Reflective Practice and Its Role in Simulation.’ Clinical Simulation in Nursing. (Theory for Simulation), 11(8) pp. 368–375.

Mamede, S., Schmidt, H. G. and Penaforte, J. C. (2008) ‘Effects of reflective practice on the accuracy of medical diagnoses.’ Medical Education, 42(5) pp. 468–475.

Oelofsen, N. (2012) ‘Using reflective practice in frontline nursing.’ Nursing Times, 108(24) pp. 22–24.

Renedo, A., Komporozos-Athanasiou, A. and Marston, C. (2018) ‘Experience as Evidence: The Dialogic Construction of Health Professional Knowledge through Patient Involvement.’ Sociology, 52(4) pp. 778–795.

Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B. and Richardson, W. S. (1996) ‘Evidence based medicine: what it is and what it isn’t.’ BMJ : British Medical Journal, 312(7023) pp. 71–72.

Sellars, M. (2017) Reflective Practice for Teachers. SAGE.

Siminoff, L. A. (2013) ‘Incorporating patient and family preferences into evidence-based medicine.’ BMC Medical Informatics and Decision Making, 13(Suppl 3) p. S6.

Sweet, L., Bass, J., Sidebotham, M., Fenwick, J. and Graham, K. (2018) ‘Developing reflective capacities in midwifery students: Enhancing learning through reflective writing.’ Women and Birth, June.

Turner, M. (n.d.) UC Library Guides: Evidence-Based Practice in Health: Introduction. [Online] [Accessed on 14th November 2018] https://canberra.libguides.com/c.php?g=599346&p=4149211.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s