Rolfe’s Framework for Reflective Practice

Rolfe’s Framework for Reflective Practice
ACTIVITY: Ask one patient – ‘What can I do to improve your care today?’
Descriptive level of reflection Theory- and knowledge-building
level of reflection
Action-oriented (reflexive) level of
reflection
What... So what... Now what...
.... Was my role in the
communication activity?
....was going through my
mind as I engaged in this
communication activity?
....broader issues need to be
considered if future
communication activities are
to be successful?
My role in the communication
activity was to interact with a
patient concerning his or her
subjective perceptions
regarding my role in improving
his or her care today. As a part
of this activity, I interviewed a
client – a 30 year old woman
with depression. Prior to
proceeding with the
communication I obtained
informed consent from the
patient and assured her that all
her details will be kept secure
and that her identity will be
kept confidential. To ensure the
same I recorded the activity
details by hiding the identity of
the patient as ‘X’.
Upon asking the assigned
question, the client answered
with a low voice and without
eye contact that she would be
grateful if I could simply listen
to what she has to say.
Before I could take any action, I
was rather surprised that the
client expected something as
simple and minute as listening,
as a part of helping to improve
her care for the day. However, I
responded promptly by assuring
her of not just my consent but
also my eagerness and
enthusiasm to listen to all that
she would have to say. I then
acted upon my placing gently
my hand on her hand followed
by prompting her to proceed.
The patient then continued to
Throughout the conversation, a
key question which was initially
going on in my mind was
regarding why the patient
asked something as simple as
listening from me. However, as
the conversation proceeded, I
realised how important a simple
strategy of communication like
active listening has the power
of improving someone’s mental
as well as physical wellbeing. In
the case of the patient, I
realised that had her family and
peers actually paid heed to
listening to the patient’s
problems, she would have
experienced her present
condition. Indeed, it has been
evidenced that active and
patient listening encourages
positive rapport and self-
esteem and encourages a
person to feel that he or she is
being valued and respected
(Dalvandi
et al. 2017).
This communication also taught
me the importance of
encouraging and motivating
individuals as well as
empathising with them as
observed in how the patient
smiled when I shared with her
my experiences as well as
motivated her. Encouragement
and mutual support coupled
with empathy have been
evidenced to contribute to
positive self-esteem in
individuals (Santamaría-García
et al. 2017).
After the conversation, I felt
that I could have improved upon
my skills of recording and
documentation had I the
opportunity to integrate my
communication activity with a
mental state assessment. Even
though I shared relevant details
with my supervisor regarding
the risks observed in my client,
including a mental state
assessment could have allowed
me to document and present a
more detailed assessment of
the client’s condition to the
multidisciplinary team. Thus, for
improved future
communication, inclusion of a
mental health assessment can
be useful. It has been evidenced
that a mental health
assessment paves the way for
timely and comprehensive
identification of present
healthcare issues which paves
the way for implementation of
effective interventions (Thagard
and Larocque 2018).
Additionally, taking insights
from the communication
activity, I learned that I also
need to improve upon my skills
of my communication and
listening. Thus to ensure
improvement of the same, this
communication activity
prompted me to engage in
regular supervisor feedback as
well as consider the need to
participate in communication
workshops or training sessions
(Joung and Park 2019).
Year 1 / Reflection 2: Activity based on Rolfe, G., Jasper, M. and Freshwater, D. (2011)
Critical
Reflection in Practice – General knowledge for Care. 2nd Edn, London: Palgrave MacMillan.
Page 1

share how she was overweight
and rather outspoken as a child
which prompted some of her
classmates to bully her. While
her parents seemed to
disregard these as harmless,
the patient revealed how the
bullying experience contributed
to her feelings of low self-
esteem and self-worth as a
child. These feelings aggravated
during her work experience
when one of her colleagues
commented on how losing a
little weight could have made
her feel better. This prompted
her to attempt suicide and thus
pave the way for her admission
here.
All the while, I was listening to
her patiently without any
interruption. When the patient
paused, I asked regarding why
she wanted me to listen to her
rather than doing anything else
to improve her care. She then
shared how she felt that nobody
really listened to her since her
childhood and maybe would
have felt better had she
‘starved’ or ‘killed herself to
death.’ I was genuinely alarmed
at this response but however,
calmly proceeded to empathise
with her regarding some of my
childhood experiences and then
appreciate her strength
regarding how she was so brave
enough to share all her stories.
To my relief, I observed a slight
smile on her face. We then
talked about her hobbies, hopes
and dreams before concluding
the interaction.
I shared all the records with my
supervisor and even shared my
concern on the need to engage
a multidisciplinary team for the
patient, since she seemed to
demonstrate a risk of suicide
ideation, anorexia and self-
harm. My supervisor agreed to
my suggestions and then we
decided to share the same with
registered nurse and
practitioner assigned to the
Year 1 / Reflection 2: Activity based on Rolfe, G., Jasper, M. and Freshwater, D. (2011)
Critical
Reflection in Practice – General knowledge for Care. 2nd Edn, London: Palgrave MacMillan.
Page 2

patient.
How is this relevant to the Code?
Select a theme:
→ Prioritise People
→ Practice effectively: Standard 7
→ Preserve safety
→ Promote professionalism and trust
Write a short note about how this relates to
the code theme and standard
The communication activity can be well
related to the code since I engage in
communicating actively with the patient
regarding obtaining consent as well as
encouraging her (7.2). I even used verbal and
non-verbal communication skills of listening,
encouraging and holding the patient’s hand
as per the code (7.3). Lastly, my
communication activity can be related to the
code since I engaged in evidence based
practice by communicating to my supervisor
on the patient’s risk of suicide (6.2) as well
as by respecting the skills and expertise of
the multidisciplinary team (8.1, 8.2, 8.3, 9.1)
(Nursing and Midwifery Council 2017).
Wider Group Reflection (based on communicating the above to
the wider group):
After the session with the patient, a small group reflection
Year 1 / Reflection 2: Activity based on Rolfe, G., Jasper, M. and Freshwater, D. (2011)
Critical
Reflection in Practice – General knowledge for Care. 2nd Edn, London: Palgrave MacMillan.
Page 3