Goodman's Levels of Reflection in Nursing Practice

Introduction to Nursing Theoretical Frameworks

There are countless theories regarding the effective manner in which nursing practice might be conducted and developed. The value of theoretical frameworks has in fact been foundational to the development of nursing practice. Many models have been developed to put into perspective the importance of the actions taken by nurses in the direct practice arena as well as in a broader community context — that is, how their work affects the individual, community, and world. Each framework is developed, discussed, and possibly adopted given the orientation of the educational institution, the facility in which the nurse works, or even the individual nurse.

Adopting a theoretical framework can in fact be one of the most foundational things a student nurse or a practicing nurse does, as it offers a guide for action and interaction that puts into perspective the role and efficacy of the nurse. Many also argue that too much of nursing theory focuses on direct patient care and the development of physical and emotional skill on the part of the nurse, but does not respond to the broader community and the nurse's role within it.

This paper, by contrast, reviews a theory that has effectively responded to this concern as well as to the practical aspects of nursing practice and patient care. The theory discussed at length here is Goodman's Theory of Reflection, often referred to as Goodman's Levels of Reflection. Goodman's work is generally reflective of other research theorists, most specifically Van Manen (1977) and Dewey (1933), but has developed into a set of three levels that respond effectively to both practical and theoretical issues surrounding nursing practice. The theory can serve as a template to help focus retrospective views on nursing practice events and help build a comprehensive set of goals to improve both the narrow and broad impacts of nursing practice. This work will first broadly define Goodman's Theory of Reflection and then address each level of the theory independently, offering critical examples of focus material that could be applied at each level.

Overview of Goodman's Theory of Reflection

Goodman expands on the ideas of Van Manen (1977) and Dewey (1933) to create a comprehensive, reverse-pyramid reflective process that addresses the broad range of nursing practice. According to Goodman (1984), there are three levels of reflection that can be achieved. These levels serve as a "broad guide" for assessing the depth and quality of reflective work. Goodman stresses that the focus of the reflection needs to be clarified, or students will likely focus in an unbalanced manner on one level over another — most often on the first level, as it is the most immediately applicable (Bulman & Schutz, 2004, p. 169).

The reason an individual might focus more on first-level reflection is that it is most applicable to the physical act of completing nursing tasks, which often demands the lion's share of attention in nursing practice. It is for precisely this reason — the fact that nurses frequently work in rapidly moving environments with many physical needs to be met in short periods of time — that Goodman's theory is most useful. It works as a framework, or as Bulman and Schutz describe it, as a "way of thinking and being" (p. 169) that forces individuals and groups to expand their thinking to a local and then global perspective, beyond the physical practice of nursing.

The first level of reflection demonstrates an individual or group reflecting on how nursing tasks work in a practical and technical sense. The second level addresses the local dimension: how particular nursing practices align or conflict with the principles of the profession. The third level is global: reflection on how nursing practice operates on a political and social scale, with regard to ethics and a broader social structure. Each of the three levels works both together and independently to help identify best practices and develop a responsive approach at the individual, local, and global levels — one that is congruent with the principles of nursing, medicine, and broader society (p. 169).

According to Bulman and Schutz, Goodman also stresses that reflection is not simply a tool for problem-solving. It has a broader purpose as a way of thinking and responding to practical and theoretical concepts encountered in nursing and education. Goodman emphasizes that the opportunity to reflect in a focused manner can offer insight and intuition that is invaluable to the process and can help foster innovation as a result (p. 170). Collaborative thinking — or even one independent practitioner reflecting systematically across all three levels — could potentially generate changes that have been long overdue but were previously never articulated or considered. The process could serve to create better physical products and procedures, as well as practices that are more in line with the principles of the local and global community.

First Level: Technical Reflection on Tasks and Objectives

The first level of reflection is defined as follows: "Reflection to reach given objectives: criteria for reflection are limited to technocratic issues of efficiency, effectiveness and accountability. The worth of objectives is taken for granted; reflection criteria are limited to accountability, efficiency and effectiveness. Students are worried about what works in maintaining the status quo." (Bulman & Schutz, 2004, p. 169)

As emphasized above, first-level thinking is most closely associated with the practical. Reflecting on how or why a certain procedure is performed, and how it worked or did not work for a particular patient, can be an essential aspect of reflection. This process can help nurses and other staff understand how mistakes occurred or how results were effective for a patient or for the system in general. The medical industry is a highly technical field, and nurses fulfill both routine and complex roles that reflect this reality. Many nurses fall into the trap of simply working as rapidly as possible to achieve the long list of tasks required during a shift.

Reflecting on these tasks could provide nurses with the information needed to streamline their work in ways that maintain the status quo but more efficiently — potentially leaving more time for secondary responsibilities, such as comforting patients or discussing care with colleagues. Some might argue that such reflection is unnecessary for experienced practitioners who work in a streamlined manner through habit and repetition. Yet reflecting on these very skills could produce a template that another person could follow, improving efficiency for those filling in or new to an area. Sharing this reflection collaboratively would also help nurses offer one another insights about techniques that have saved time and produced better physical outcomes.

This aspect of reflection could seriously assist any department in its goal of continual learning and help individuals feel empowered in a state of constant learning and teaching.

Conclusion

Clearly, integrating these three reflective focuses could make nursing and healthcare better in many functional and innovative ways. The perception that the healthcare system is rather insular has been raised by many observers and needs to be examined reflectively in order to address this reality in the profession. Such examination would make nurses and those who work alongside them far more aware of their roles — individually, locally, and globally. This "way of thinking" may greatly influence the achievement of that goal. Goodman's Theory of Reflection is clearly a productive framework that could greatly enhance the nursing profession.

References

Bulman, C., & Schutz, S. (2004). Reflective Practice in Nursing (3rd ed.). Blackwell Publishing.