Date Presented 03/26/20
A grounded theory study explored reflective practice experiences of OTs from a national survey. Findings indicated reflection was triggered by challenges to knowledge, communication, safety, and ethics. Depth of reflection was associated with critical analysis, engagement in EBP activities, and actions taken to change practice. Future research needs to investigate integration of reflective practice with EBP and to examine curricular and philosophical barriers to integration.
Primary Author and Speaker: Robert Krueger
Additional Authors and Speakers: Melissa Sweetman
Contributing Authors: Malissa Martin, Thomas Cappaert
PURPOSE: Self-reflection behavior has recently been identified as a leading support to evidence-based practice (EBP) implementation in practicing occupational therapists; however, the process of how this occurs is unknown. Therefore, the purpose of this study was to explore the construct of reflective practice (Mann, Gordon, & McCloud, 2009) and self-reflection behavior in occupational therapists to better understand how reflective thinking acts as a support to EBP.
METHOD: Thirty occupational therapists were purposefully sampled from a pool of 100 participant volunteers from a phase I of a mixed-methods study. Theoretical sampling was used to select individuals based on scoring on self-reflection behavior and EBP implementation survey variables. A grounded theory approach was used to analyze data collected from a semi-structured interview. The critical reflection inquiry model was brought to the study as a theoretical framework (Kim, 1999).
RESULTS: Practice experiences that triggered reflection (i.e., iterative reflection) included challenges to knowledge, challenges to communication, challenges to safety, and challenges to ethics. Participant narratives varied in depth of reflection (i.e., vertical reflection) from descriptive accounts (shallowest), reflective analysis (intermediate), and critical analysis (deepest). Participants with high self-reflection behavior from the survey demonstrated deeper levels of reflection in the interview making more critical analysis statements critiquing practice and critiquing systems supporting practice. Deep critical reflectors engaged in steps of the EBP process (e.g., formulating questions, searching the literature, evaluating evidence, and applying evidence to practice), and were more likely to take action to correct their practice when faced with disruptive events.
CONCLUSION: Reflective practice appears to act as an important support to EBP implementation. Future models of professional thinking should integrate reflective practice when teaching and applying EBP (Bannigan & Moores, 2009). Both the concepts of EBP and reflective practice are included in occupational therapy educational programs and standards, yet tend to be separated within curricula possibly due to philosophical differences (Blair & Robertson, 2005). Future research should clarify by (1) investigating where concepts of EBP and reflective practice are taught within educational curricula, and (2) exploring philosophical differences among professional stakeholders that may act as barriers to integration of these essential concepts.
References
Mann, K., Gordon, J., & McCloud, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14, 595-621. doi:10.1007/s10459-007-9090-2
Kim, H.S. (1999). Critical reflective inquiry for knowledge development in nursing practice. Journal of Advanced Nursing, 29(5), 1205-1212. https://doi.org/10.1046/j.1365-2648.1999.01005.x
Blair, S.S.E., & Robertson, L.J. (2005). Hard complexities – soft complexities: An exploration of philosophical positions related to evidence in occupational therapy. British Journal of Occupational Therapy, 68(6), 269-2776. https://doi.org/10.1177/030802260506800605
Bannigan, K., & Moores, A. (2009). A model of professional thinking: Integrating reflective practice and evidence based practice. Canadian Journal of Occupational Therapy, 76(5), 342-350. https://doi.org/10.1177%2F000841740907600505
