Reflective Practice on Nursing

A great deal has been documented on reflective practice over the years, and it has been heralded by some as a radical new methodology to extend education and practice. According to Basford and Slevin (2012, p. 483), reflective practice dates back to Socrates, who encouraged his pupils to find solutions to philosophical problems from within themselves. In modern times, its use can be traced back to John Dewey (1938) who asserted that ‘people learn by doing and realizing what came of what they did’ (Leonard 2011, p. 56). In the nursing context, reflective practice is used to refer to the ‘application of this reflective tool to an exploration of feelings, thoughts, and beliefs relating to our own practice’ (Alder 2012, p. 98). From this definition, reflective practice comes out as a cognitive act, by which one makes sense of memories and thoughts, implying that it has clear implications for learning, more so ‘deep learning’ (Kolb 2015, p. 67; Quay and Seaman 2011, p. 69).

Reflective practice in itself is a type of ‘deep learning’ from which practice is shaped, it is viewed as retrospective contemplation of practice carried out for the purposes of unearthing the knowledge used in a specific situation through the analysis and interpretation of the recalled information. This paper is a reflective practice on one serious health issue in Hong Kong, which is the lifestyle of alcohol drinking. In order to prompt this reflection, John Dewey’s reflective learning model and David Kolb’s experiential learning theory model will be used.

Reflective Learning Model of John Dewey

According to Basford and Slevin (2012, p. 229), reflection journals are excellent approaches to incorporating conversation with oneself into the leaning process, as it links learning, experience, and writing. In Cossart and Fish’s (2014, p. 95) opinion, reflection is active involvement in the learning process that helps learners deal with ill-structured problems in society. Reflection in itself is a process involving a review of an experience that permits to describe, analyze, evaluate, and inform the learner’s learning and practice (Miettinen 2010, p. 60). In essence, it is the ability to make unequivocal to oneself or uncover what a person has observed, planned, or realized in practice. From the perspective of Basford and Slevin (2012, p. 484), reflection takes place in the cycle of action, reflection, and action where it assists learners in gaining a deeper understanding of the content, acknowledge and grapple with bias and assumptions.

Reflective learning, as put forth by Dewey, focuses on experiences, which implies observation and reflection on it through raising critical questions (Miettinen 2010, p. 63). According to Leonard (2011, p. 57), reflections though questioning the experience will result in new knowledge and learning, bringing together the knower and the knowledge. To Dewey’s mind, experience-reflection-knowledge is a continuous process and not a one-off event. Evidently, reflection has provided a linkage between facts, observations, and ideas. This connection enables people to achieve their life goal by helping them to connect the present with what they have experienced and known. According to Alder (2012, p. 99), this goal may be as fundamental as efforts to make more informed decisions about whether and how to best offer services to communities in the future. Reflection, as a matter of fact, goes beyond experience, and to truly understand an experience, it is imperative that one understands how he/she is connected to or affected by it. According to Cossart and Fish (2014, p. 95), it is vital for one to place him/herself in the middle of the process of reflecting upon service-learning experiences. He/she should also connect the current situation with past knowledge and experiences as a means of realizing the desired goal.

Basford and Slevin (2012, p. 484) presume that the reflective learning model looks into reflection and studies how it takes place by providing skills with the help of which knowledge or processes towards a purpose can be manipulated. In this context, reflection is allied with thinking, where it is described as a kind of thinking that entails turning a subject over in the mind and giving it a serious thought. This approach views reflection as a chain of linked ideas that aim at making a conclusion, which is more than a stream of consciousness (Quay and Seaman 2011, p. 72). In this reflective model, the desired or anticipated outcome could be said to coincide with the purpose of reflection. According to Pawar and Anscombe (2011, p. 46), this model is guided by four key principles:

i. Learning by doing

ii. Bringing together the knower and the knowledge

iii. Constructing knowledge by reflecting on past and current experiences

iv. The continuous process of reflective learning

This model focuses on reflecting on challenging experiences, enquiring or questioning learning, the building of knowledge, wholehearted open-mindedness, and awareness of self-belief (Oermann, 2012, p. 23). The limitation of this model is that it is only limited to learning and thinking, it has no focus on practice/action, and it has no focus on positive experiences (Miettinen 2010, p. 67).

Experiential Learning Theory Model of David Kolb

Moon (2013, p. 56) claims that experiential learning entails a direct encounter with the phenomena being studied as opposed to merely thinking about the encounter or only considering the possibility of doing something about it. Kolb (2015, p. 69) defines experiential learning in terms of an instructional model, which starts with the learner engaging in direct experience followed by a reflection discussion analysis and evaluation of the experience. It has also been defined as a process that helps the learner create meaning from direct experiences. Leonard claims (2011, p. 67) that experiential learning takes place when: (1) a person is involved in an activity, (2) he/ she looks back at the activity and evaluates it, (3) he/she determines what was useful or important to remember, and (4) he/she utilizes this information to perform another activity.

Experiential learning, which is learning by doing or learning through experience, was created by Kolb with Roger Fry (1975) (Kolb 2015, p. 72). This theory comprises four elements: concrete experience, observation of and reflection on that experience, formation of abstract concepts based on the reflection (abstract conceptualization), and testing of the new concepts (active experimentation) (Oermann, 2012, p. 20). These four elements, as described in figure 1 below, form the basis of the learning cycle that can begin with any of the four elements, but it typically starts with the concrete experience.

Source: Adapted from David Kolb, Experiential Learning: Experience as the Source of Learning and Development (Englewood Cliffs, Prentice Hall, 1984) (Livermore 2011, p. 197).

The first phase of this process is concrete experiences, which may be as significant as the trauma of losing a loved one, or as life-transforming as the adventure of travelling to another part of the world, or even as jarring as an interchange with someone from a different generation over a lunch-break (Livermore 2011, p. 197). The second phase in Kolb’s learning cycle is a reflection, where the individual steps back to think about and observe what has taken place in the concrete experience stage. According to Leonard (2011, p. 77), at this stage, awareness, to a large extent, comes into play. Additionally, internal awareness enhances effective reflection in the midst of the experience, creating time and space after the experience to reflect on it. From here, the person moves into the third stage of abstract conceptualization, where he/she starts to come up with themes and ideas related to what was observed.

In the words of Kolb (2015, p. 73), where the learner draws on things like logic sets and category width to help him/her conceptualize the nature of what has taken place in the initial experience. The learner asks how the experience fits with his/her existing categories, does it or does it not fit. If it does not fit, how does it affect the way in which he/she views the experience? Does it need a new category? Which assumptions require deconstruction? And so forth. In Alder’s (2012, p. 99) opinion, the asking of these kinds of questions and starting to hypothesize responses to them form part of the beginning of abstract conceptualization. Finally, the initial concrete experience is formed into active experimentation through future, ongoing involvements, and happenstances. Consequently, this enables the individual to draw on theories generated in the reflective mode as he/ she reengages in action.

According to Pawar and Anscombe (2011, p. 46), this model of reflection is guided by four principles: experiential learning stages, reflecting on experiences, conceptualizing and testing, and the continuous process. This model focuses on reflections on experiences, knowing/concept/theory, integration of doing and knowing, testing, and creation of knowledge (Quay and Seaman 2011, p. 73). The limitations of this reflection model show that it is more focused on individual learning and management, it decontextualizes the learning process, and it does not include other factors influencing learning (Oermann 2012, p. 24). According to Taras (2012, p. 203), real experiences often help the individual learn advanced abstract concepts. These experiences may result in paths, which allow the individual to actively gather information, learn, and become a member of the community. Additionally, reflection and critical thinking may refine ideas or lead the individual to consider alternate possibilities. Each phase of this model potentially leads to another and builds upon the former.

Dialogue on the Current Social and Political Health Issue

This dialogue concerns the “lifestyle of alcohol drinking” as a social health problem. The statistics from the Health Factor of Hong Kong (2015) survey have revealed that the prevalence of alcohol drinking stands at about 3.3% in Hong Kong. In 2007 and 2008, alcohol was a controversial topic in the country, but with the government consistently waiving taxes on alcoholic beverages, its strength diminished by less than 30% (Woo 2014, p. 173). The history of alcohol in the Chinese history dates back to over 5,000 years ago, where it was used as a health product rather than a social beverage, in contrast to this generation (Mathews & Lui 2013, p. 125). In traditional China, alcohol played an important and special role in daily living, not only when there were health issues. In important business gatherings, alcohol was present and accepting it was viewed as a sign of politeness. Still, in this historical context, alcohol was consumed in little quantities and its consumption was regarded as the way to heal the sick, keep people healthy, make them happy and braver, drive away from the madness. Additionally, its consumption was a sign of adulthood and its relationship with socio-economic activities was close.

Presently, in Hong Kong, alcoholic beverages are easily accessible in supermarkets, stores, or food outlets (Department of Health 2015, p. 2). Thus, many people are not aware of the harm that alcohol does to their health. Even though it is widely held that a small amount of alcohol is good for the heart in certain countries, and some evidence exists to support this assumption, there is greater evidence that suggests the contrary. Little evidence suggests that suitable amounts of alcohol intake can prevent coronary heart diseases and ischaemic stroke (Woo 2014, p. 176; Kim, Wong, Goggins, Lau & Griffiths 2013, p. 1220; Huang, Ho, Lo, Lai & Lam 2013, p. 880). On the contrary, the key to the prevention of heart diseases does not imply consuming alcohol, but rather pursuing a healthy lifestyle that includes healthy eating, exercise, and no smoking habits. Alcohol abuse has both short-term and long-term consequences and risks.

In view of its spread, drinking of alcohol is very common in Hong Kong, and it is flagrantly acceptable during social gatherings and celebration events. Despite its harmful effects on the human body, alcohol does play an important role in Hong Kong Chinese culture. It is an important beverage consumed during celebrations like wedding and birthday parties (Department of Health 2015, p. 7). Besides, Chinese people of Hong Kong often use it as a health product and a kind of medication. This embodiment of alcohol in the sociocultural context makes young people have a wrong perception of alcohol. Therefore, it leads to further increment in alcohol consumption levels. The major cause of this shift and adoration of the beer bottle has been linked with the increasing living standards and changes in values. Much of these changes in values have been brought by the western lifestyle influences, where alcohol consumption is the norm (Chung, Yip, Griffiths & Yu 2013, p. 723). Most of the Chinese in Hong Kong have imitated this culture and adopted alcohol consumption as well. In my opinion, I think the Hong Kong Government should do something in order to stop this increasing trend of alcohol consumption. If not, the burden of health care concerns related to alcohol consumption will be heavy.

Alcohol drinking leads to a number of harmful effects on individuals and on society at large. Psychologically, heavy drinking provokes acute intoxication and even death in some serious cases. It may also cause certain types of injuries to a person, emanating from risks like drowning, falling, and road accidents; more so, when people drive after consuming alcohol. Prolonged use of alcohol may result in alcohol dependency and in some instances, non-communicable diseases like cancers of the larynx, pharynx, esophagus, liver, colon, rectum, and breasts.

Psychologically, alcohol consumption may increase anxiety and depression and, consequently, lead to amnesia, memory loss, and dementia (Department of Health 2015, p. 12). Long term and excessive consumption of alcohol will influence people’s ability to cope with stress. Socially, alcohol may affect people’s relationships and create conflicts among family members. Such conflicts could result in family breakages, divorce, couple and child abuses (Department of Health 2015, p. 13). Most aggressive behaviors have their root cause in alcohol. This aggressive conduct could be verbal and physical aggression towards other people. The result of such aggression could be fought, and people may be hit due to their uncontrolled behavior after drinking. Consequently, these alcohol-related acts will increase the burden on society and the healthcare system.

Summary of Dialogue

This dialogue concerns the “lifestyle of alcohol drinking” as a social health problem. Alcohol consumption was once viewed in historical China and Hong Kong as having healing and curative abilities and a sign of social status, where its acceptance was a sign of politeness. In early 2007 to 2008, alcohol consumption was not rampant and was not a serious issue, as it is at present. The influence of reduced taxation on alcoholic beverages and western lifestyles coupled with the increased living standards have led to an increase in the consumption of alcohol. It is easily available in supermarkets, shops, and food markets. This accessibility, together with the belief that alcohol consumption treats various heart conditions, has led to a rise in the number of young people consuming alcohol. Its consumption is a health problem in Hong Kong and has further strained the social and health care concerns of the nation. If this issue is not addressed, the government will feel a substantial burden. Heavy consumption of alcohol has its negative effects that range from social issues like domestic violence to health concerns like serious cancerous diseases.

Representation

It is worth recalling that the concept of reflection follows two approaches, Dewey’s and Kolb’s. Dewey’s approach focuses reflection on challenging experiences, enquiring or questioning learning, the building of knowledge, wholehearted open-mindedness, and awareness of self-belief (Oermann 2012, p. 23). Kolb’s approach, on the one hand, focuses reflection on experiences, knowing/concept/theory, integration of doing and knowing, testing, and creation of knowledge (Oermann 2012, p. 24). Using these perspectives, it is clear that increased alcohol consumption among young people in Hong Kong is a health issue that needs to be addressed through recommendations on social changes. Increased alcohol consumption could result in alcohol dependency and addiction, which eventually suck potential and usefulness out the young. Therefore, it makes them unproductive and useless to society. In addition, there is a close link between alcohol and crime and other social evils like domestic violence and abuse (Martin, 2015 p. 56). In addition, there are a number of health complications and serious chronic conditions related to alcohol consumption and the continual intake of alcohol slowly reduces a person’s lifespan. A change in behavior is the only cure for alcohol consumption. The figure below shows the alcohol lifestyle and recommendations for social changes.

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Conclusion and Recommendation

In conclusion, the alcohol lifestyle among young people in Hong Kong can be broken with the help of social changes involving seven steps. The first step entails acknowledging the reason behind the drinking problem, whether one drinks because of anxiety, stress, or other life challenges. The second involves thinking rationally on the alcohol lifestyle problem through self-awareness of the health and social consequences of engaging in it, people are hurt because of it, and they do not deny the fact that it is a social evil. The third step suggests making use of alternative coping skills by replacing old habits with new ones like exercises and other relaxation techniques. The fourth one implies identifying the danger zones in terms of tempting situations, environments, and friends who could easily make one revert to the habit. This is followed by a changing lifestyle, like walking with a fixed amount of money, cleaning house of alcoholic beverages, and even avoiding friends with whom one drinks. The sixth step demands to be accountable and have a support network of credible people who can help to pursue the endeavor to change alcohol lifestyle. Finally, there is a stage of rewarding oneself by giving credit for the steps made towards changing the alcohol lifestyle.