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 pr inciples of reflective practice in order to enable practitioners to identif y learning needs in relation to cardiopulmonary resuscitation (CPR) procedu res. Whilst considerable benefit from the reflective sessions was noted, on e unanticipated and unpalatable outcome was what might be termed profession al apathy. This was manifest in several ways, most importantly in that issu es 'for action', identified through reflection, were not prioritised or act ed upon. Whilst partial responsibility for this may lie with the somewhat n aive way in which the reflective process was facilitated, some responsibili ty also rests with the nurses in question. One possible explanation is that , for changes in practice to occur, the planning and management of change s hould form an integral part of the reflective cycle. This point has been la rgely 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 edu cationalist in the clinical area. The current political backdrop of 'qualit y initiatives' to create and demonstrate high standards of clinical care ma y be useful in advancing the debate. (C) 2000 Harcourt Publishers Ltd.