This series has explored reflective practice as it relates to dental nursing. This final article examines how you can transfer your reflection skills from dental nursing to your everyday life. It also provides a summary of the previous five articles on reflection in this series

Reflection is a relatively familiar term within all areas of general nursing as well as dental nursing. We might not practice it particularly well, but we do talk about reflective practice and acknowledge the importance of it. If you have been following this series, then hopefully you will have begun to appreciate how you can incorporate reflection into your daily dental nursing practice in a useful and meaningful way. But does reflection have to stop when you go home? If reflection on our nursing practice can help us review, develop and improve what we do at work, then why not apply those principles to other aspects of our lives outside of our professional working day?

I have had three conversations over the last two days with very different types of people, all interested in using and applying the principles of reflection into their work and lives. The first was a professor of management studies, who had introduced a module on reflection into the MBA (Masters of Business Administration) degree at his university. The second was a vicar who was trying to get his congregation to reflect on the way God has worked in their lives. The third was someone who was trying to work out why a friend of many years appears to have fallen out with her. The skills that aid reflection on our clinical practice are far too important to leave at the dental surgery when we finish work, they can be applied to all aspects of our lives.

Think about the social groups you are involved with. For me, they are: wife and (relatively grown up) children; work colleagues; people I play squash with; a band I play in; the people at the church I go to; a couple of voluntary groups I help with; friends I socialise with; and people I occasionally bump into. Each of these groups has at its core, social interaction, and social interaction as we all know can be both positive and, at times, negative.

To what extent do you use your skills of reflection outside of professional work to review both positive and negative outcomes of your social interactions? Spend a few minutes thinking about areas in your life where you could usefully use your reflective skills. Now consider Joan's dilemmas below.

Joan's dilemmas

Joan has three good friends; once or twice a week they would all go out in the evening, either to the cinema or the pub. Joan was the only one with a car so she tended to pick people up and drop them off at the end of the evening. Initially, Joan did not mind this as she enjoyed driving and was proud of her car. Recently, however, she began to feel quite annoyed with her friends as they did not offer any petrol money or show general gratitude. She felt a bit used. How could Joan's skills of reflection help her deal with this situation? First, she stepped back and viewed what was happening in an objective manner and did not let her feelings of annoyance influence her actions. She reflected upon some ‘what’ questions. What is causing her to be annoyed? Is it a lack of petrol money, being taken for granted, or something else? Then she reflected upon the ‘why’ questions. Why does it feel worse than it did a few weeks ago? Finally, she reflected upon the ‘way forward’ question. Does she confront the friends? Does she drop hints? Does she have an honest conversation with all of them or one of them? The options are many; some would be quite positive options and others rather negative. Joan reflected upon what is right and achievable for her. After this reflection she acted upon her thoughts, implemented her actions and then reflected on and evaluated the outcomes. The friendships were not only maintained, but strengthened. If Jayne did not take this reflective approach, she may have continued to feel abused and one day would probably ‘snap’, causing a breakdown in a valued friendship group.

Reflection in life

The example of Joan may seem a little clinical and calculating, and you may think that real life is not that simple. That is true, the social interactions that form part of our ordinary lives are very complicated, but that is all the more reason to take this ‘step back’ approach and reflect upon how we interact with others. It is all too easy to let our emotions and prejudices dominate our spontaneous actions. We can develop cycles of making the same mistakes with different groups of people including the ones we really care about. So if the skills and techniques of reflection are good for our relationships with patients and colleagues, why shouldn't we use them for ourselves and our friends and families? Take a step back from your life, sit down and have a cup of tea or glass of wine, turn the TV off and reflect a little on what is happening in your life at this moment in time. Ask yourself the simple questions: ‘what’; ‘why’; and ‘the way forward’ and most of all, try to be honest with yourself.

Series summary

Over the last five issues of Dental Nursing, I have been exploring reflection, and its importance, implications and relevance for the dental nurse. If you have not managed to read all of the series, then this is a short summary of areas covered.

Part 1: the importance of reflection

There are a number of generally accepted concept that are used in the health care professions that we are generally familiar with but if asked to describe what they mean, how they work, or why they are important, we may find ourselves struggling. I am sure that most dental nurses are familiar with terms such as evidence-based practice, patient-centred care, holistic care and reflective practice, but to what extent do these ideas really underpin daily practice?

Reflective practice is often complicated by complex models; but like most skills it is learnt by use and practice. The article started by identifying how many times in a day we use a mirror to adjust what we are doing, from combing our hair to driving a car. If we try to live without using the reflection of mirrors, then life would be quite difficult. The work of Schon (1983) identified two types of reflection: ‘reflection on action’—when we look back on an event and think about what happened in the past and ‘reflection in action’—the ability of a skilled practitioner to reflect upon what is happening while this is happening and adjust their actions accordingly (Fowler, 2015a).

Part 2: Ways to aid reflection

Although the idea of a mirror is a useful analogy for reflection, it does give the impression that reflection is a quick and superficial look at what you have done. Superficial reflections have the danger of reinforcing the person's own thoughts, rather than bringing in fresh ideas and alternative solutions. Therefore, we have to use the idea of mirrors as a reflective tool with some degree of caution. Another way of looking at reflection is to see it as a microscope, a tool that allows you to view something in depth. If you combine a mirror and a microscope then you have two good reflective tools.

Reflective feedback was another tool covered in this issue. Receiving feedback is one of the most powerful tools you can use to develop your skills and move from novice to expert. You need to obtain the feedback in a way that you can use it positively. This means finding a person whose skills you respect and who will give you honest feedback. It means asking for feedback on specific areas of your practice, listening to what is said, processing it and then acting upon it (Fowler, 2015b).

Part 3: Reflective practice and reflective teaching

As a busy dental nurse, it is all too easy to become so rushed that we lose the ability to step back and think about what we are doing. The first step in becoming a reflective practitioner is making time to step back; this article gave some ideas on how you can create that time in a busy environment. The article gave ideas on how to develop and carry out a two-minute reflection in the middle of a busy shift.

If we want to enhance our practice of teaching in the clinical area then we need to make time to reflect on what we are teaching, when it is happening and what our role is. The first thing to do is to recognise when we are taking on a teaching role. This does not mean when we stand up in front of someone and start delivering a lecture. Teaching patients and staff is far more about supporting them to learn from their experiences (Fowler, 2015c).

Part 4: Reflective management and learning

Management is about assessing and planning, it is not about jumping in without thinking. So the first stage in the reflective management process occurs before you do anything. Think about what needs to be done and why. What are the key objectives and how can they be achieved. A list can help clarify issues and is a great reflective tool. Having identified what you need to do, then think through what the implications will be for the other people who will be affected by your decisions. This article also looked at learning from reflection. For learning to occur we need to combine experience with reflection. Think of it like an equation: experience + reflection = learning. Spend a few minutes thinking about that equation and see if that reflects your own experience of learning; not only your dental nursing skills, but all aspects of your life skills (Fowler, 2015d).

Part 5: Informal and formal reflection

This article looked at a number of different ways you may use reflection in your dental nursing practice. It started with examining how you could help someone use reflective skills. Helping people reflect and then learn from that reflection requires you to develop skills of encouragement, facilitation, and coordination. Instead of seeing people as empty boxes that need to be filled by tipping in numerous amounts of facts, try seeing them as people who already have a jumble of facts inside them—your role is to help them organise those facts together, join the ones that connect and helping them to fill in any gaps. Finally, this article examined how you might use more formal written reflections to build up your portfolio, which could be used when applying for a new job, promotion or a specialist university course (Fowler, 2015e).

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Conclusions

My final question for you to consider in this series on reflection is: can you swim? Not an obvious question you may think and you may be wondering what it has to do with dental nursing and reflection. Before you read the next few sentences take a few minutes to think why I might have posed that question and what has the ability to swim got to do with reflection on dental nursing practice. Any thoughts?

I am sure many of you that have managed to think about the connection (without letting your eyes fall on the next few sentences!) will begin to see some similarities between learning how to swim and reflection; they are both skills that you learn and become better at, by getting involved and having a go.

If you want to learn how to swim you have to get into the water, overcome a few fears, paddle around in a depth of water you feel safe in and then gradually extend your boundaries. When learning to swim, it helps if you learn with a friend, have some sort of instruction and make a commitment to regular attendance at the pool. It might be interesting to read a book or a series of articles on swimming, but they will do little to help you develop and perfect the skill.

Learning to be a reflective practitioner is very similar to learning how to swim. It may be interesting to read about reflection, and hopefully this series has helped you realise and understand the importance of reflection within nursing, management, education and life; but if you leave reflection there, with just a theoretical understanding, you will never become a reflective practitioner.

You need to make a commitment to practice reflection, starting in small ways where you feel safe and can get some feedback from a colleague and then develop the use of reflection into all areas of you clinical, educational, managerial and life situations. You need to ‘do it’ and ‘practice it’ if you want to become a skilled reflective practitioner.

The next topic in this career development series will be on writing for publication—my challenge for you is to start using reflection in your dental nursing practice, then if you follow the next series you will be able to write up some of your reflections for publication, which could be published in Dental Nursing. Good luck.

Author: MA Healthcare