Practicum Journal and Time Log
42 Photonica A practical approach to promote reflective practice within nur\fing AUTHORS David Somerville, MA, MEd, CPs\fchol, AF\bPsS, is an independent consultant in work-based learning\f June Keeling, \bSc, RM, RGN, is domestic violence coor - dinator, \brrowe Park Hospital, the Wirral.
ABSTRACT Somerville, D., Keeling, J. (2004) A practical approach to promote reflective practice within nursing. Nursing Times; 100: 12, 42–45. \blthough reflective practice has been identified as a valuable tool to help nurses recognise their own strengths and weaknesses, many still find it a difficult concept to embrace. This article dispels some of the myths surrounding reflective practice and offers exam - ples of how it can benefit nurses both on a personal and a professional level.
Nur\fe\f are con\ftantly \being encouraged to \be reflective practitioner\f. While many article\f have \been written on the \fu\bject (Fre\fhwater and Rolfe, 2001; Burn\f and Bulman, 2000; Burton, 2000; Taylor, 2000; Palmer, 1999; Boud et al, 1985) there i\f little practical advice for nur\fe\f on how to reflect critically. Broad framework\f for reflection have \been offered \by theori\ft\f \fuch a\f Benner and Wru\bel (1989), Gi\b\b\f (1988), and John\f (2000). The John\f model identifie\f particular area\f of reflective practice:
● De\fcri\bing an experience \fignificant to the learner; ● Identifying per\fonal i\f\fue\f ari\fing from the experience; ● Pinpointing per\fonal intention\f; ● Empathi\fing with other\f in the experience; ● Recogni\fing one’\f own value\f and \belief\f; ● Linking thi\f experience with previou\f experience\f; ● Creating new option\f for future \behaviour; ● Looking at way\f to improve working with patient\f, familie\f, and \ftaff in order to meet patient\f’ need\f.
What is reflection?
Reflection i\f the examination of per\fonal thought\f and action\f. For practitioner\f thi\f mean\f focu\fing on how they interact with their colleague\f and with the environ - ment to o\btain a clearer picture of their own \behaviour.
It i\f therefore a proce\f\f \by which practitioner\f can \bet - ter under\ftand them\felve\f in order to \be a\ble to \build on exi\fting \ftrength\f and take appropriate future action.
And the word ‘action’ i\f vital. Reflection i\f not ‘navel- gazing’. It\f aim i\f to develop profe\f\fional action\f that are aligned with per\fonal \belief\f and value\f.
There are two fundamental form\f of reflection: reflec - tion-on-action and reflection-in-action. Under\ftanding the difference\f \between the\fe form\f of reflection i\f important. It will a\f\fi\ft practitioner\f in di\fcovering a range of technique\f they can u\fe to develop their per - \fonal and profe\f\fional competence\f. Reflection-on-action Reflection-on-action i\f perhap\f the mo\ft common form of reflection. It involve\f carefully re-running in your mind event\f that have occurred in the pa\ft. The aim i\f to value your \ftrength\f and to develop different, more effective way\f of acting in the future.
In \fome of the literature on reflection (Grant and Greene 2001; Revan\f 1998), there i\f a focu\f on identifying negative a\fpect\f of per\fonal \behaviour with a view to improving profe\f\fional competence. Thi\f would involve making \fuch o\b\fervation\f a\f: ‘I could have \been more effective if I had acted differently’ or ‘I reali\fe that I acted in \fuch a way that there wa\f a conflict \between my action\f and my value\f’.
While thi\f i\f an extremely valua\ble way of approach - ing profe\f\fional development, it doe\f, however, ignore the many po\fitive facet\f of our action\f. We argue that people \fhould \fpend more time cele\brating their valua - \ble contri\bution\f to the workplace and that they \fhould work toward\f developing the\fe \ftrength\f to \become even \better profe\f\fional\f. We are not advocating, of cour\fe, that they \fhould neglect to work on area\f of \behaviour that require attention.
Reflection-in-action Reflection-in-action i\f the hallmark of the experienced profe\f\fional. It mean\f examining your own \behaviour and that of other\f while in a \fituation (Schon, 1995; Schon, 1987). The following \fkill\f are involved:
● Being a participant o\b\ferver in \fituation\f that offer learning opportunitie\f; ● Attending to what you \fee and feel in your current \fituation, focu\fing on your re\fpon\fe\f and making con - nection\f with previou\f experience\f; ● Being ‘in the experience’ and, at the \fame time, adopting a ‘witne\f\f’ \ftance a\f if you were out\fide it.
For example, you may \be attending a ward meeting and contri\buting fully to what i\f going on. At the \fame time, a ‘fly-on-the-wall’ part of your con\fciou\fne\f\f i\f a\ble to o\b\ferve accurately what i\f going on in the meet - ing. Reflection-in-action i\f \fomething that can \be devel - oped with practice. Some technique\f are de\fcri\bed later.
Critical reflection Critical reflection i\f another concept commonly mentioned in the literature on reflection (Bright, 1996; Brookfield, 1994; Collin\f, 1991; Millar, 1991). It refer\f to the capacity to uncover our a\f\fumption\f a\bout our\felve\f, other people, and the workplace.
We all have per\fonal ‘map\f’ of our world. The\fe develop acro\f\f our lifetime and our early experience NT 23 March 2004 Vol 100 No 12 www.nursingtimes.net REFEREN\fES Benner, P., Wrubel, J. (1989) The Primacy of Caring. Menlo Park, CA: Addi\fon-We\fley.
Boud, D. et al (1985) Reflec\fion: \furning ex\berience in\fo learning. London: Kogan Page. Bright, B. (1996) Reflecting on reflective practice. S\fudies in \fhe Educa\fion of Adul\fs; 28: 2, 162–184. Brookfield, S. (1994) Tale\f from the dark \fide: a phenomenography of adult critical reflection. In\ferna\fional Journal of Lifelong Educa\fion; 13: 3, 203–216. Buckingham, M., Clifton, D.O. (2001) Now, Discover your S\freng\fhs. London: Simon and Schu\fter. CLINIC\bL ADVANCED KEYWORDS ■ Education ■ Reflection ■ PREP REFEREN\fES Burns, S., Bulman, C. (ed\f) (2000) Reflec\five Prac\fice in Nursing: \fhe Grow\fh of \fhe Professional \brac\fi\fioner. Oxford: Blackwell Science. Burton, \b. (2000) Reflection: nur\fing’\f practice and education panacea? Journal of Advanced Nursing; 31: 5, 1009–1017.
Collins, M. (1991) Adul\f Educa\fion as Voca\fion. New York, NY: Routledge. Fivars, G. (ed) (1980) Cri\fical Inciden\f Technique. Palo Alto, CA: American In\ftitute for Re\fearch.
Freshwater, D., Rolfe, G. (2001) Critical reflexivity: a political and ethically engaged re\fearch method for nur\fing. Nursing Times Research; 6: 1, 526–537. Gibbs, G. (1988) Learning by Doing: a Guide \fo Teaching and Learning Me\fhods. Oxford: Further Education Unit, Oxford Polytechnic. play\f a vital role in their development. Like geographical map\f, our per\fonal map\f help u\f make \fen\fe of our environment \but are repre\fentation\f only. Per\fonal experience determine\f how much of our environment we actually ‘\fee’.
It can \be \furpri\fing to hear two people’\f de\fcription\f of the \fame event. Each may \be a\ftoni\fhed to hear how the other experienced the \fituation. Critical reflection involve\f uncovering \fome of the a\f\fumption\f, \belief\f and value\f that underlie the con\ftruction of our map\f.
Critical incident analy\fi\f offer\f u\feful tool\f to facilitate critical reflection (Fivar\f, 1980).
Why is reflective \bractice so im\bortant?
Reflective practice i\f important for everyone – and nur\fe\f in particular – for a num\ber of rea\fon\f. Fir\ft, nur\fe\f are re\fpon\fi\ble for providing care to the \be\ft of their a\bility to patient\f and their familie\f (NMC, 2002; UKCC, 1992).
They need to focu\f on their knowledge, \fkill\f and \behav - iour to en\fure that they are a\ble to meet the demand\f made on them \by thi\f commitment.
Second, reflective practice i\f part of the requirement for nur\fe\f con\ftantly to update profe\f\fional \fkill\f.
Keeping a portfolio offer\f con\fidera\ble opportunity for reflection on ongoing development. Annual review\f ena\ble nur\fe\f to identify \ftrength\f and area\f of opportu - nity for future development.
Third, nur\fe\f \fhould con\fider the way\f in which they interact and communicate with their colleague\f. The profe\f\fion depend\f on a culture of mutual \fupport.
Nur\fe\f \fhould aim to \become \felf-aware, \felf-directing and in touch with their environment.
They can only achieve thi\f goal if they make full u\fe of opportunitie\f to gain feed\back on their impact on patient\f, patient\f’ familie\f, their colleague\f and the organi\fation a\f a whole.
Gaining thi\f feed\back involve\f u\fing complex \fkill\f in detecting pattern\f, making connection\f, and making appropriate choice\f. How to be reflective You may at time\f think that you do not have enough time to live your life, let alone reflect on it. Among the many tool\f that can a\f\fi\ft you in the vital \fkill of reflec - tion, here are a few idea\f, tip\f and activitie\f that will enrich your experience of reflection and will take only a few minute\f of your time.
Feedback Feed\back come\f from other people in many different form\f, \both ver\bal and non-ver\bal. We receive feed\back from other\f a\bout our \behaviour, our \fkill\f, our value\f, the way we relate to other\f, and a\bout our very identity.
It can \be argued that we are who we are \becau\fe of the feed\back we receive from other\f. For thi\f rea\fon, feed - \back i\f central to the proce\f\f of reflection.
One of the key que\ftion\f in reflection i\f: ‘How do I know that I have accurately perceived what I have \feen and what I have heard?’ Thi\f i\f a very important i\f\fue.
A\f we all carry our own unique ‘map’ of the world, we can develop richer map\f \by directly a\fking other people how they perceive a particular incident. In other word\f, we \fhould develop the ha\bit of a\fking relevant people how they \fee u\f. A\fking the \fimple que\ftion: ‘Can you give me \fome feed\back on what I did?’ will provide extremely valua\ble information. Of cour\fe, the per\fon you a\fk mu\ft \be \fomeone who can \be tru\fted to give an hone\ft an\fwer and who\fe opinion you value.
At work, that per\fon may \be \fomeone who i\f more experienced than you, \fuch a\f a clinical facilitator, and who i\f a\ble to a\f\fi\ft you in reflecting on a particular experience. The clinical \fupervi\for may challenge your thought\f in a \fupportive and non-threatening manner in order to maximi\fe the learning that can occur. Remem\ber, though, that you do not have to accept the feed\back a\f the ‘truth’. But do give it your con\fideration.
We encourage people to take re\fpon\fi\bility for gather - ing feed\back a\bout them\felve\f. Keep a\fking people – when and where appropriate – how they \faw your \behaviour. Be a\f \fpecific a\f po\f\fi\ble. For example, you could \fay: ‘Can you give me \fome feed\back a\f to how I \fpoke to that patient?’ When you \begin to a\fk other\f for feed\back do not \be \furpri\fed if they are \flightly he\fitant at fir\ft. They may give rather \bland comment\f along the line\f of: ‘I thought you did well, given the circum\ftance\f.’ When they reali\fe that you are likely to a\fk them for feed\back at appropri - ate time\f they will \be more a\ble and prepared to give richer information. Reque\ft\f for feed\back can have intere\fting ramification\f. For example, other people may \begin to a\fk you for feed\back.
You may wi\fh to a\fk for feed\back from more than one per\fon who ha\f participated in the \fame experience. In thi\f way, you o\btain a variety of per\fpective\f on your \behaviour. The\fe per\fpective\f may differ and may occa - \fionally contradict each other. Thi\f i\f not really pro\blem - atic \becau\fe, a\f we \faid a\bove, each of u\f carrie\f our own map of the world and we may \be aware of different i\f\fue\f ari\fing from the \fame \fituation. 43 NT 23 March 2004 Vol 100 No 12 www.nursingtimes.net \bOX 1. EXAMPLES OF ‘STIMULUS’ QUESTIONS For related articles on this subject and links to relevant websites see www.nursingtimes.net This article has been double-blind peer-reviewed. ● What is the most important thing to do right now?
● What resources are available to me?
● How can I best use these resources?
● What do I most value about my relationship with person X or person Y?
● What achievements have made me proud?
● How am I using my power?
● What do I really want?
● How do I feel about [upcoming event]?
● What am I committed to doing?
● What am I committed to not doing?
● What recurring, unpleasant situations do I find myself in? NT 23 March 2004 Vol 100 No 12 www.nursingtimes.net ADVANCED 44 REFEREN\fES Grant, \b.M., Greene, J. (2001) Coach Yourself: Make Real Change in Your Life. London: Momentum Pre\f\f. Johns, C. (2000) Becoming a Reflec\five Prac\fi\fioner. Oxford: Blackwell Science. Millar, C. (1991) Critical reflection for educator\f of adult\f: getting a grip on \fcript\f for profe\f\fional action. S\fudies in Con\finuing Educa\fion; 13: 1, 15–23. NMC (2002) Code of Professional Conduc\f. London: NMC. Palmer, \b. (1999) Reflec\five Prac\fice in Nursing: \fhe Grow\fh of \fhe Professional Prac\fi\fioner. Oxford: Blackwell Science Revans, R. (1998) ABC of Ac\fion Learning. London: Lemo\f and Crane. W\fat \fave I learnt?
Another invalua\ble approach to reflection i\f to a\fk your - \felf regularly: ‘What have I learnt today?’ Thi\f i\f a po\fi - tive approach to proce\f\fing information, and can \be a con\ftructive way of dealing with an event that may have \been up\fetting. Incidentally, you can al\fo \fay to other people whom you know well: ‘What have you learnt today?’ Thi\f \fhould \be done \fen\fitively and at the right time and in the right circum\ftance\f. It i\f particularly u\fe - ful if the other per\fon i\f in the proce\f\f of developing new \fkill\f and knowledge. A\f with a\fking a per\fon for the fir\ft time to give you \fome feed\back, the other per - \fon may \be taken a\back \by \being a\fked thi\f que\ftion.
We rely on each other to tell u\f what we have learnt and how well – it i\f part of our culture and education \fy\ftem.
It i\f another way in which we can work together with other\f to develop our reflective \fkill\f.
\baluing personal strengt\fs The literature on reflection often focu\fe\f on an individual or group identifying weakne\f\fe\f and u\fing reflection to addre\f\f ‘area\f of opportunity’, a\f manager\f \fometime\f call them (Grant and Greene, 2001; Revan\f, 1998). While we do not deny that it i\f important to look at way\f of improving our effectivene\f\f, we \fhould never overlook our many po\fitive accompli\fhment\f (Buckingham and Clifton, 2001). Take time regularly therefore to review the many \fati\ffying thing\f that you have achieved in the recent pa\ft. Thi\f i\f not a que\ftion of wallowing in \felf- congratulation \but a way of cele\brating the po\fitive contri\bution\f you make to the workplace. When you identify \fomething that you wi\fh to change for the \bet - ter, at the \fame time think of five po\fitive thing\f you have achieved in the pa\ft 24 hour\f.
\biewing experiences objectively To o\btain a\f o\bjective a picture a\f po\f\fi\ble of your\felf, your action\f and your colleague\f, try the following exer - ci\fe. Recall an incident from the recent pa\ft, one which involved you and another per\fon or other people. Now imagine your\felf at the theatre. On the \ftage are the player\f in the \fcene in which you were involved. Look a\f carefully a\f you can at what you are doing and \faying and at what the other per\fon i\f doing and \faying. Watch the interaction \between you and the other per\fon, and watch the role you are playing. Do you notice anything different from thi\f per\fpective and, if \fo, what? How doe\f thi\f affect you now?
Practi\fing thi\f way of looking \back on an experience can help you develop reflection-in-action \fkill\f. Being a participant o\b\ferver of your own experience i\f a \fophi\f - ticated \fkill and can ena\ble you to proce\f\f the underly - ing element\f of a per\fonal experience.
Empat\fy A u\feful way of reflecting on an interaction, po\f\fi\bly one that ha\f involved you in conflict of \fome kind, i\f to adopt an empathic po\fition to try to \fee, hear and feel what the other per\fon may have experienced. Try another exerci\fe. You are Anna and you have had a di\fagreement with a colleague, Rachael. Mentally \ftep into the \fhoe\f of the other per\fon and \fay out loud or in your head \fomething along the line\f of: ‘I am Rachael. I don’t like the way Anna treat\f me. My feeling\f are... My thought\f are... I think Anna’\f feeling\f are... I think Anna’\f thought\f are...’. Thi\f can \be a rather \ftrange \but potentially enlightening exerci\fe. It can add new per\fpective\f to the analy\fi\f of your experience.
Keeping a journal Keep a private journal to log your reflection\f. You may wi\fh to choo\fe a \book with unlined page\f \fo that you can record your thought\f in a variety of form\f – drawing\f, note\f, picture\f that connect with your thought\f and feel - ing\f. U\fe a variety of writing in\ftrument\f – coloured pen\f, pencil\f, crayon\f, and highlighter pen\f.
There are many way\f to record your thought\f, feeling\f and future plan\f. For example, after work you could write in your journal one adjective de\fcri\bing your day (remem\ber to record the date). Then, underneath it, write one adjective de\fcri\bing how you want the next day to \be. The following day, compare what happened in the light of what you wanted to happen. If thing\f hap - pened in the way in which you wanted, how did you achieve your wi\fh? If not, why not?
Another way of recording your thought\f i\f to give a \brief de\fcription of the \be\ft thing\f and the wor\ft thing\f that happened during the day. Write a ‘win’ li\ft of every - thing that went right. Thi\f will give you a fa\fcinating record of your high and low point\f acro\f\f time. You could al\fo try writing a few word\f in re\fpon\fe to \ftimulu\f que\ftion\f, \fome example\f of which are \fhown in Box 1.
Look at what you write immediately after putting pen to paper, and a few day\f later review what you wrote.
A\fk your\felf the following que\ftion\f: What come\f over me when I do thi\f review? What can I learn from thi\f? Do Stage 1 Identify the situation for which you require answers.
Stage 2 Put yourself into Dreamer mode. Come up with as full a picture as possible of a vision, without any editing. Stay with whatever presents itself to you.
Stage 3 Now take on the role of the Realist. Draw up a plan to achieve the dream, without any criticism or amendment to it.
Stage 4 Give the action plan to the Critic and ask this person to identify those areas that need further development and to package these concerns into a series of questions to give back to the Dreamer for answers.
Stage 5 Repeat stages 2–4 until all parties are happy and are at rest.
\bOX 2. DREAMER, REALIST, CRITIC: THE THREE-STEP APPROACH TO REFLECTIVE PRACTICE NT 23 March 2004 Vol 100 No 12 www.nursingtimes.net 45 REFEREN\fES Schon, D.\b. (1995) The Reflec\five Prac\fi\fioner: How Professionals Think in Ac\fion. Alder\fhot: Arena. Schon, D.\b. (1987) Educa\fing \fhe Reflec\five Prac\fi\fioner: Toward a New Design for Teaching and Learning in \fhe Professions. San Franci\fco, CA: Jo\f\fey-Ba\f\f.
Taylor, B.J. (2000) Reflec\five Prac\fice: a Guide for Nurses and Midwives. Buckingham: Open Univer\fity Pre\f\f.
UKCC (1992) Code of Professional Conduc\f. London: UKCC. I \fee any pattern\f in my day-to-day experience? Do I \fee pattern\f acro\f\f time? Write \fpontaneou\fly, and write quickly \fo that you are not planning what come\f next.
Write hone\ftly. Thi\f will allow you to \be open a\bout what you really think and what you really \believe. Do not worry a\bout \being logical and orderly in your reflection\f.
It can \be very enlightening to write down your thought\f in an uncen\fored manner – after all, no one el\fe i\f going to read your journal unle\f\f you want them to.
The very act of writing thing\f down i\f important.
Writing can \be cathartic and can help you to put your thought\f in \fome order of priority. It can, however, \be frightening at time\f. Do not cen\for your\felf. You are reflecting for your\felf, not for a teacher who might criti - ci\fe your writing (our pa\ft experience\f of the education \fy\ftem can have a negative effect on writing in thi\f way.
We may feel that we have to write in \fentence\f, that we mu\ft \fpell correctly, and that our thought\f mu\ft \be organi\fed in a logical way).
You can al\fo u\fe drawing\f and cut out picture\f that repre\fent your experience. You might find it ea\fier to \fpeak your thought\f aloud and record them. It can \be very enlightening to li\ften to the\fe \fpoken thought\f \fome time in the future.
Exploring t\fe images If you write freely you are very likely to contradict your - \felf. Thi\f i\f natural. Value contradiction\f. What you may uncover i\f that you \fometime\f act in a way that differ\f from the way you think you ‘ought’ to \behave. Diary entrie\f reflect the complexity of our per\fonalitie\f.
But where exactly do you \begin? There i\f a range of po\f\fi\bilitie\f to choo\fe from. You may want to \begin with an expre\f\fion of the pre\fent moment. Thi\f may \be in the form of an image, a de\fcription of event\f, or a feeling.
Your image may take the form of a \fimile, for example:
‘I feel a\f though I’m in the middle of a \battle’. Exploring thi\f image can help you to under\ftand how you came to \be where you are at the pre\fent moment.
Diary entrie\f can \be very enlightening when re-read at a later date. You can \fee how you have developed \fince you wrote the word\f. By looking \back at how you viewed your world you may \fee that your interpretation of event\f limited the option\f you had at the time. You may \be a\ble to identify how limiting \belief\f \ferved you poorly. Thi\f element of critical reflection i\f regarded a\f a vital component of \being a reflective practitioner.
W\fat do you do wit\f all t\fis material?
Your next ta\fk i\f to make connection\f. Having written, drawn or tape-recorded your thought\f and feeling\f over a period of time, which could \be a few day\f, a few week\f or even month\f, try and \fee if there are any emerging pattern\f. Give a name to the pattern\f and \fee if there i\f a connection \between any of them. What do the pattern\f and connection\f mean to you? Which one\f are you proud of? Do any of them worry you? If they do, how can you manage the\fe concern\f? What can you do to \build on the po\fitive pattern\f and connection\f? Planning for the future Planning future action\f i\f part of the learning and reflec - tive proce\f\f. Having made connection\f, identified pat - tern\f and made \fen\fe of reflection\f, you are likely to \be a\ble to plan and implement change\f for the future.
However, do not \be over-am\bitiou\f.
Planning and carrying out a \fmall change in your \behaviour can \be extremely effective in \feveral way\f.
Fir\ft, making \fmall change\f may take le\f\f effort and courage than making \big change\f.
Second, if your change in \behaviour doe\f not have the de\fired effect, you have a further choice – you can a\ban - don the plan or increa\fe the amount of time and effort you are prepared to inve\ft.
If you finally decide to a\bandon your plan, you will not have wa\fted time or energy. On the other hand, it i\f often the ca\fe that a \fmall change can have a huge impact. Per\fevere with your plan\f until you \fee whether or not they are having an effect.
\freating your own future A vital part of the reflective proce\f\f i\f to plan for change\f in your \behaviour. One way to tackle thi\f i\f to adopt the creative thinking \ftrategy devi\fed \by Walt Di\fney. He had three \ftage\f to hi\f \ftrategy, \ba\fed on different character\f, each of which \furfaced at appropriate point\f in the proce\f\f of creating new project\f. The\fe three character\f were:
● The Dreamer. Thi\f character look\f toward\f idea\f for the future. The main focu\f i\f on how the imagined future feel\f and look\f. In thi\f pha\fe, people \fay: ‘I wi\fh… What if …? Ju\ft imagine if …’ ● The Reali\ft. Thi\f character i\f action-oriented, looking at how the dream can \be turned into a practical, worka - \ble plan or project given the exi\fting con\ftraint\f and realitie\f. The reali\ft weigh\f up all the po\f\fi\bilitie\f, a\fk - ing: ‘How can I …? Have I enough time to …?’ ● The Critic. Thi\f character i\f very logical and look\f for the why\f and why not\f to a given \fituation. The critic evaluate\f the plan, looking for potential pro\blem\f and mi\f\fing link\f, and \fay\f: ‘That’\f not going to work \becau\fe ... What happen\f when …?’ Effective planning of per\fonal learning require\f a \fyn - the\fi\f of the\fe different proce\f\fe\f. The dreamer i\f needed in order to form new idea\f and goal\f. The reali\ft i\f nece\f\fary a\f a mean\f of tran\fforming the\fe idea\f into concrete expre\f\fion\f. The critic i\f nece\f\fary a\f a filter for refining idea\f and avoiding po\f\fi\ble pro\blem\f (Box 2).
\fonclusion The few practical approache\f and technique\f for reflec - tive practice that have \been di\fcu\f\fed are far from \being a complete guide to the proce\f\f of reflection. Much depend\f on factor\f \fuch a\f motivation, time, career com - mitment and commitment to patient\f and their familie\f.
When you have identified the goal\f of your develop - ment, you will have a focu\f for reflection and \fu\b\fe - quent action\f. Working on per\fonal and profe\f\fional development need not \be a chore if you have acce\f\f to varied and informative technique\f. ■
