So how does one reflect? It is not difficult to consider some past interactions – the more pleasant ones usually do not pose questions, just happiness and pleasure. However, the uncomfortable ones often leave an individual wondering how and why. To remove any
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What do you feel gives you value?•
What do you feel gives other people value?•
From the perspective of a health professional, consider the benefits and limitations of believing that individual value comes from achievements or external factors (e.g. social status, colour, race, sporting skill or musical skill).•
How comfortable are you with considering your emotional responses? Do you find it easy or do you prefer to avoid experiencing emotions?•
Do you think that feeling emotions is a sign of weakness? If so, why?•
Do you think your emotional responses are never important? If so, why are the feelings of others more important than your feelings?•
Do you find that your emotions dominate your actions? If so, why is this?•
Do you think you really do not have emotional responses? If so, it is important to remember that everyone feels; why do you stop yourself from feeling your emotions?•
Are the thoughts isolated through answering these questions true? For example, is it true that the feelings of others are more important than your feelings? Where do these thoughts originate?53
guilt associated with such interactions, an individual will often wish to re-experience the events for an opportunity to react differently. Alternatively, individuals may feel hurt and resentful because of the actions or words of another during an uncomfortable interaction.
The purpose of reflection is to provide information that empowers the health professional to react appropriately and thus (i) avoid regret and guilt; or (ii) understand, accept and forgive rather than feeling hurt and resentful as a result.
A model of reflection is a helpful tool when attempting to answer the question of how to reflect. A model guides an individual through a process. It explains the way to complete a process. Some may think that the process of reflection does not require direc-tions or a plan because it simply requires the individual to ask and answer quesdirec-tions (Mohan et al 2004, 2008). While this may be true, some people find it difficult to estab-lish which questions to ask and to determine the exact focus of those questions. Some-times thoughts lack clarity when uncomfortable emotions are experienced, and thus a model can bring clarity and resolution to those emotions by providing a focus for pos-sible questions. Such focus facilitates appropriate and adequate answers for any commu-nicative interaction, but is particularly useful when considering uncomfortable interactions.
The information in the following paragraphs is adapted from an article by Boud & Walker (1990).
Reflection upon an interaction requires describing the interaction by returning to it through thought, verbal expression, written expression or some combination of all three (Ellis et al 2004). Consideration should be given to the
individuals involved in the interaction and all the known information about each person (e.g. knowledge of and past experience in relating to these individuals). Exam-ining the process leading to the outcome of previous interactions can guide the health professional to under-stand this outcome. This underunder-standing, together with other information (e.g. whether they appear happy, tired, hurried, preoccupied), is something most people relate to and absorb unconsciously when beginning an interaction. The appearance of the person, their non-verbal behaviour or perhaps an environmental factor (e.g. the threat of rain can cause preoccupation) provides this information. Consciously considering such information assists when reflecting about an interaction.
Reflection should also involve consideration of the intention of each interacting person. It should establish
whether the intent of each person was clear initially and throughout the interaction, and whether everyone in the interaction had the same intention or purpose. If there were differences in the intention of each person, consideration could be given to the way in which this variation influenced the outcome of the interaction. Reflection should involve consideration of a method for clarifying intent in future interactions. Consideration of how an individual was feeling before the interaction (i.e. were there related or unrelated events causing negative emotions before the interaction that may have adversely affected their intent unconsciously?) is important and may explain differences in purpose or intention.
Reflection should consider the events occurring during the interaction, including actions, words, non-verbal behaviour and environmental factors. A person who is effective
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List the factors and skills relating to the ‘Person’ that requireconsideration when reflecting about interacting (e.g. age, knowledge, experience, emotional state). First consider the health professional, then the Person/s and then a colleague. Refer to other chapters in this book when compiling the list.
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What other factors might be included in the word all found in the opposite paragraph?COMMUNICATION: CORE INTERPERSONAL SKILLS FOR HEALTH PROFESSIONALS
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at reflecting considers the reason for each event, the outcome of each event and the overall consequence of the event or interaction. Sometimes the overall result is positive despite negative events during the interaction and – while answers to questions relating to each
‘event’ within an interaction are important – it is the overall result that must guide future interactions. However, reflection should include exploration of the necessity or suitability of each ‘event’. While negative events are sometimes necessary to produce positive out-comes, they require skilful management and experienced personnel. Discussion with significant others can result in expression of strong emotions that initially appear negative;
however, the expression of these emotions may result in positive interventions and resolu-tion of emoresolu-tions.
When the health professional is responsible for negative results of events they should reflect on the causes of these events and, if appropriate, how to avoid unnecessary events in future interactions. It is important to examine the causes and reactions of all the inter-acting individuals, including the health professional, to avoid the repetition of negative events during similar interactions.
Reflection should consider the emotional responses of all interacting individuals. These emotional responses may or may not be expressed verbally during an interaction. They may simply be non-verbal responses that require exploration and understanding to guide future interactions and, perhaps, intervention. The cause of these responses should be considered and support or suggestions provided for resolution of these responses. Some-times this support requires referral to an appropriate health professional. No health pro-fessional has all the answers for every Person/s, and this reality should guide health professionals when communicating with everyone involved in and relating to the health professions.
Edith is a 76-year-old mother of three. She has been falling regularly lately, and her last fall caused her to fracture her neck of femur. As Edith has indicated she feels unsafe living alone, a family meeting to discuss her future living arrangements is organised for today. One of her daughters has been happy to talk about Edith living with her, so the team is confident that this meeting will be positive with an agreeable outcome for all family members. The daughter who is happy to have Edith live with her arrives a little earlier to spend time with her mother, and during that time Edith experiences bowel incontinence. Because of her embarrassment, Edith has been successfully hiding this problem from her daughter. The daughter, while not showing her mother, has a strong emotional reaction to this event. A nurse cleans up the floor and Edith just in time for the meeting.
The other children arrive feeling confident because they know their sister is happy to have their mother live with her; they have no idea of the ‘accident’ before the meeting.
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Suggest the possible team members who should be present for such a meeting.•
Decide how the negative emotion of the daughter might unconsciously affect her responses in the meeting. Remember that her intent was positive but she has had no time to process the event or her emotions, nor does she have any idea of the support services available for her mother, herself and her immediate family.•
Discuss the possible effects this negative emotion might have on the events during the meeting and on the people interacting throughout the meeting. Remember that all members of the family are present, including Edith.55
Johns (1993) provides a model to assist in the process of reflection. Although similar to the Boud & Walker model (1990), Johns expresses the steps differently and includes additional factors for possible consideration:
1. Describe the experience – what actually happened?
2. Consider the possible causes of the reactions, including the abovementioned contributing factors and any others.
3. Consider the significant background information relating to the environment and each individual in the interaction, and how this may have affected the interaction.
4. Consider the aims of each action and the possible reasons for the actions.
5. Consider the consequences of the actions, including the feelings of each individual.
6. Consider why possible alternative actions were not chosen and the possible consequences of such actions.
7. Consider the resultant learning and how to change reactions in the future.
These seven points provide a sound basis for reflection about interactive experiences either while practising as a health professional or in daily life.
Reflection is a process that although challenging does not have to be tedious. It takes commitment and varying amounts of time – the time decreases with practice. Writing in a journal and sipping an enjoyable drink may assist the process of reflecting. Other people may assist if they are willing to explore honestly the reasons for any negative responses.
The benefits of reflective and reflexive practice are many for both the Person/s and the health professional.
1. When events become unsatisfactory what questions are beneficial? Consider an uncomfortable event you remember, preferably a recent one (e.g. with teachers, family members, fellow workers, or an accident, perhaps in a carpark). Use the following questions to guide your reflection about that event.
What was the purpose of the communicative interaction?
What was I feeling before the interaction?
Was I preoccupied? Was I focused?
Do I have a fundamental bias relating to this person or situation? Do I have a past negative history when communicating with the person or in similar situations? If so, why?
When did this interaction begin to deteriorate or go wrong?
Was the trigger one or more of the following?
Something that was said?
Something that happened before?
Something the person was already feeling?
Non-verbal? From who?
How do I feel in response to this event? What is the cause(s) of these emotions?
What could I have done differently?
What do I do now?
What do I need to do in relation to the other person?
What do I need to do within myself to ensure positive interactions in the future?
2. Do these questions assist you to isolate and highlight those factors that could promote a more comfortable and satisfactory interaction next time?
3. What other questions could assist you to change your patterns of thought and action to ensure positive reactions and outcomes that produce effective communication?
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