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23rd October 2016

Person-Centred Care and Reflective Practice

Person-Centred Care and Reflective Practice

Achieving truly person-centred care and support is a central objective of the Social Services and Well-being (Wales) Act, 2014. Conversely, this means moving away from practice which is less flexible, based on institutional and/or historical patterns of service provision, or dictated solely by custom and practice.

But how to ensure that employees practice is moving in the right direction? Structured reflection is one possible route. Whilst owing its origins to a philosophical and contemplative tradition, reflection is essentially a practical means by which care staff can assimilate theoretical or course based knowledge, with the challenges of everyday care and support. In another upcoming article, I will consider some strategies for encouraging reflective practice. In this article I would like to establish the nature and rationale of 'reflective practice'.

Reflection as a Means of Learning

The practice of reflecting upon past experiences and interrogating how they influence behaviours has a long intellectual history from the ancient teachings of Buddhism and the Meditations of Marcus Aurelius through to educational reformer John Dewey’s influential Education and Experience published in 1938. Donald Schön’s 1983 book The Reflective Practitioner supplemented this tradition by proposing the idea that professionals often improvise to meet an objective, and that this improvisation is informed largely by 'processing' past experience against their understanding of relevant theory, standards and regulations.

Reflective theory may best be summarized as the synthesis between theoretical and experiential knowledge. This can be conceptualized as a cyclical process whereby theoretical knowledge informs practice and the lessons learned from practice inform the theory on which you will act upon in the future.

Reflection and Improving Practice

Schön suggests the implicit learning that happens automatically when one experiences something, is not sufficient to significantly improve future behaviour. Rather, critical reflection whereby the practitioner retraces their steps and evaluates whether at each step of the process their inputs returned the results which had been hoped for. For example, when working with a client towards behaviour change, through a strategy of encouragement and positive reinforcement, it may become apparent from reflecting on practice that standard record keeping does not provide sufficient data from which to tailor interventions.

Schön’s 1991 book The Reflective Turn differentiates between the practice of reflection during an event and reflection after the event. Reflection in action involves a kind of mindfulness in which the practitioner is constantly consciously engaging with the practice and ensuring that they are acting in a way which they think is in line with best practice, rather than acting in a manner simply because this is how they have always done it. Reflection on action however, involves reflecting on an experience that has already happened. The challenge here being that reflectors engage in honest, critical self-reflection rather than simply conjure up a convenient justification for actions.

In essence, Schön’s reflective approach places the practitioner in a position to analyse their practice in regards to relevant standards and objectives.

Schön, D. (1983) The Reflective Practitioner. London: Temple Smith
Schön, D. (1991) The Reflective Turn: Case studies in and on educational practice. New York: Teachers College (Columbia)

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Nic Bowler

Welsh Care and Social Services Inspectorate Specialist

Dr Nicholas Bowler is a researcher and consultant to government-level [Welsh Government Review of Secure Services, 2009] – specialising in QA/compliance focused projects. He has interests in clinically relevant training, service development and research. He enjoys working with clients to support them in identifying problems and initiating projects to improve practice.

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