Achieving change through reflective practice: closing the loop

This paper draws on a small scale, exploratory study which was conducted in the clinical area in the early 1990s (Page 1992). The study drew on the principles of reflective practice in order to enable practitioners to identify learning needs in relation to cardiopulmonary resuscitation (CPR) procedures. Whilst considerable benefit from the reflective sessions was noted, one unanticipated and unpalatable outcome was what might be termed professional apathy. This was manifest in several ways, most importantly in that issues 'for action', identified through reflection, were not prioritised or acted upon. Whilst partial responsibility for this may lie with the somewhat naive way in which the reflective process was facilitated, some responsibility also rests with the nurses in question. One possible explanation is that, for changes in practice to occur, the planning and management of change should form an integral part of the reflective cycle. This point has been largely absent in the reflection literature to date. Such concerns are reviewed here in the context of nurse education's ongoing involvement with the notion of reflective practice and the role of the educationalist in the clinical area. The current political backdrop of 'quality initiatives' to create and demonstrate high standards of clinical care may be useful in advancing the debate.