In this article, we are going to be examining in detail the Atkins & Murphy Model of Reflection, a reflective practice theory that was published in 1994, following a 1993 literature review by the same authors of existing theory (see references).
It was developed primarily for the nursing profession to provide a structured method for learning from experience and focuses on the importance of making the conscious decision to think through situations at work (including your thoughts and feelings) to identify areas that may be improved should a similar situation arise in the future. As Atkins and Murphy explain:
You may, however, have worked with people who never seem to learn from experience, and despite years of practising, frequently seem to make the same mistakes. We suggest that this may stem from a failure to analyse an experience and see what can be learned from it.
Table of Contents
About Atkins & Murphy
Sue Atkins MSc, RGN, RM, DipN, DipNEd, and Kathy Murphy MSc, RGN, BA, Dip N, Dip NEd, were Senior Lecturers, School of Health Care Studies, Oxford Brookes University, Oxford.
In 1993, they published a literature review of existing studies, research, models and theories related to reflective practice. They found several patterns in the works of different authors that indicated that their processes were very similar, with the primary difference being simply the terminology that they used.
A year later (1994) they published an article about reflective practice in Nursing Standard that summarised some of the existing literature, provided a generalised framework for reflective practice and identified the skills needed to reflect successfully.
Atkins & Murphy’s Model of Reflection
The Atkins and Murphy model was not intended as a model in its own right, but rather as a framework for the reflective practice process, which built on the work of pre-existing literature by exploring the similarities between them. As they write themselves:
Despite the differences in terminology and detail within these authors’ accounts of reflective processes, key stages can be identified from their writings. Although the stages are, in reality, integrated, it is useful to disentangle them and represent them in a cyclical way.
These common stages are summarised as follows:
Stage 1: Self-awareness
The first stage is to be aware of something that is not quite right. We may have feelings of dissatisfaction, uncertainty or discomfort about actions we took or decisions we made in a particular situation. Or we may feel proud and happy with an area of achievement (we can reflect on the positive as well) and want to discover how we might reproduce similar results. This propels us to find out more by examining the situation in more detail and kickstarting the reflective practice process.
Stage 2: Critical analysis
The next stage is to critically analyse the situation, including “…an examination of both feelings and knowledge of how the situation has affected the individual and how the individual has affected the situation.” Negative feelings should be addressed and managed (as these may influence objectivity). The process should be wholly constructive and should focus on the knowledge that was used and how it linked in with the practice. New knowledge may also be considered in this stage. This can include knowledge or insights gained from reflection, additional theory and consultation with others.
Stage 3: New perspectives
The third stage is where we learn. This could be a change in perspective, belief or behaviour about a situation based on new or existing knowledge and insights.
Stage 4: Action
Many reviews of the Atkins & Murphy model omit the final stage, which is to make a commitment to action either now or in the future. If your reflection identified areas where your practice could improve, you may commit to undertaking additional training in this area. If you have identified a better action to take, you should commit to taking this action should a similar situation arise in the future. As Atkins and Murphy state “For reflection to make a real difference to practice, it is important that the outcome includes a commitment to action.“.
From these underlying tenets, Atkins & Murphy developed the Framework for Reflection as shown in the diagram below:
It is a cyclical process that begins with being aware that there may be room for improvement or a better way of doing things.
Next, we generate a factual and comprehensive description of an experience that includes our thoughts, feelings, and pertinent background information.
We then critically analyse all the information, including our description of the experience, awareness of ourselves, current and new knowledge and alternative solutions. We try to find relationships between these aspects, which can be used to develop new insights and ideas.
In the next step, we evaluate the relevance of the knowledge and insights we have gained and assess how it may support our future practice.
It is then useful to summarise any learning that has occurred and commit to using this new knowledge in our practice going forward.
Following practical use of the knowledge, it is helpful to begin the process again and reflect on whether the changes we made improved our practice or not.
Key skills needed for reflective practice
Atkins and Murphy also identify five key skills that are necessary for the successful use of reflective practice in our personal and professional lives. They are:
1. Self-awareness
The starting point for all self-reflection is having self-awareness of our own personality, characteristics, beliefs, values, strengths and weaknesses. We should be honest with ourselves and consider our deeper ‘inner-self’, as opposed to our ‘outer-self’, which is what we show to others.
This enables us to recognise and analyse our own emotions and behaviours and how they may affect ourselves and others. It can also uncover prejudices that may influence our actions and decisions. Self-awareness also helps us to ‘notice’ any dissatisfaction or discomfort in our personal and professional lives, which encourages the initiation of the reflective process to try to find solutions going forward.
Some key questions include:
- What are my strengths and abilities?
- What are my limitations?
- What are my core values and beliefs?
- What are the traits and characteristics that make up my unique personality?
2. Description
After grounding oneself with self-awareness, the next key skill focuses on comprehensively describing the experience itself, along with our thoughts and feelings at the time. Any relevant background details should also be noted. Situations need to be detailed thoroughly; however, any judgments or opinions should be reserved for later.
To better describe the situation, consider these questions:
- What exactly occurred during the situation? (Remember – accuracy, objectivity and detail are important)
- When and where did the situation take place?
- What was my role/involvement?
- What was the role/involvement of others?
- What was I thinking?
- What was I feeling?
3. Critical Analysis
Critical analysis is the skill of closely examining all of the information about the situation gathered previously and analysing it at a much deeper level. This can involve considering the situation in greater detail, exploring associated feelings, challenging any assumptions that you made, reconsidering existing knowledge and exploring alternative sources of knowledge.
Existing and new sources of knowledge could come from our own personal experiences, other people (particularly other professionals in the same field) and theory, studies and research relating to your practice. In addition, thinking about our feelings during the situation and combining this with awareness about ourselves can help us to assess whether our assumptions are correct or not and can lead to further reflection, introspection, and understanding.
Keep these questions in mind when performing critical analysis.
- What clear knowledge and information did I have at the time?
- What assumptions did I make?
- Were my assumptions correct?
- What could have been done differently? (This should be a thorough exploration of possible alternatives)
- Which sources of knowledge would be useful and relevant to the reflection?
- Is there a possible outcome that could have decreased my level of discomfort?
4. Synthesis
Synthesis is the skill of combining new knowledge with old knowledge to create new perspectives and understanding. This can be used to supplement our existing knowledge and provide us with additional knowledge and insights that we can tap into when we need to solve similar problems in the future. It can also help to identify the concrete learning that has taken place during the reflective practice process.
Some questions that may be asked during synthesis include:
- What have I learned from this process?
- What new knowledge and insights have I gained?
- How might I use this information in my future practice?
5. Evaluation
This skill involves assessing the relevance of the knowledge gained from the reflective practice process.
Consider the following when evaluating the relevance of knowledge within this model:
- Will the new knowledge and insights be useful in solving future problems?
- Do I feel that I have used this knowledge as effectively as possible?
Additional Guidance & Insights from Atkins & Murphy
There are several other pieces of advice relating to reflective practice that Atkins and Murphy impart in their works. These are summarised below:
- Attitudes and qualities that support learning through reflection include motivation, commitment, open-mindedness and receptivity
- Schön’s ideas about reflection-on-action (reflection after an event) and reflection-in-action (reflection during an event) are referenced
- Atkins & Murphy reference several other works in the field of reflective practice, including those of Johns, Mezirow, Boud and Dewey
- The benefits of reflective practice include developing competence, articulation of how knowledge and practice are linked, justification of actions, creation of new knowledge, the facilitation of social change and improving practice
- Reflective practice supports continuing education and learning after formal education has ended
- It is useful to maintain a reflective journal or diary to help develop the skill of description, articulate learning and record progress
- Reflection can be used in a group setting (McGill & Beaty’s Action Learning Cycles are referenced)
- Reflective practice can be used as part of supervision and coaching/mentoring processes
Advantages & Disadvantages of the Atkins & Murphy Model of Reflection
This section will explore the pros and cons of Atkins & Murphy’s model of reflection.
Advantages
One of the benefits of Atkins and Murphy’s model is that it is underpinned by decades of work by other experts in the field. Atkins and Murphy disentangle the various theories to produce a common framework.
The framework is also very detailed and comprehensive, which can support practitioners to get the most from their reflections. It is also very flexible and, although developed for the Nursing profession, can be used across a wide range of professions as well as in our personal lives.
The focus on self-awareness in this model and the importance of being able to challenge prejudices or flawed assumptions even if it is uncomfortable to do so facilitates both personal and professional growth.
Disadvantages:
Atkins and Murphy’s framework is very detailed and therefore time must be set aside to go through the process, which may not be possible in busy work settings. However, the authors do argue that reflection should be made a part of daily activities.
The drive for efficiency and cost-effectiveness may leave little time for an individual or group of nurses to reflect on their clinical practice. Nevertheless, it is recommended that specific time and space be built into the working day.
Similarly, because the process is very thorough and deep it may not be an effective model for reflecting during experiences (reflection-in-action).
Alternatives to Atkins & Murphy’s Model
Other models of reflection that may be used as an alternative to the Atkins and Murphy model are included below.
Kolb’s Reflective Learning Cycle (1984)
Kolb was one of the pioneers in the field of reflective practice and many subsequent models and theories are based on his initial ideas.
This model is much more simplistic than the Atkins & Murphy model and may therefore be more useful in situations where we would want to perform a quick self-reflection (for example, whilst undertaking a work activity or because time is limited).
Gibbs’ Reflective Cycle (1988)
Similarly, Gibbs’ model provides a more simplistic structure for reflective practice but does include considerations of our feelings that is not present in Kolb’s cycle.
Johns’ Model of Reflection (1995)
Like Atkins and Murphy, Johns’ model of reflection was developed for use in nursing. The process is made up of five sets of questions that encourage the practitioner to consider a wide range of perspectives, including both internal and external factors.
An Example of the Atkins & Murphy Model of Reflection
To demonstrate the application of the Atkins & Murphy model of reflection, let us look at a nursing scenario and how you would apply the reflective model to it.
Step 1: Self-Awareness
Following a routine checkup with an elderly gentleman suffering from arthritis, I felt uncomfortable with the way that I responded to their query about the use of copper bracelets for pain management. One of my core beliefs as a nurse is to only recommend treatments that are backed by strong evidence.
Step 2: Describing the Experience
Mr C. came to the surgery for his annual medical checkup. I have worked with him for over 5 years and we have developed a strong working relationship. Over this time, I have also seen rheumatoid arthritis in his hands worsen to the point that he needs strong medication to manage the pain.
During this visit, I noticed a new bracelet on his wrist and asked him about it. He informed me that he had bought it from the Internet after seeing claims that it can help to reduce pain and it seemed to be working. He told me that they should be made available on the NHS.
I responded by explaining that there is no evidence that copper bracelets effectively reduce pain and that he shouldn’t be taken in by dubious claims that he finds online. I then went on a bit of a rant about how these types of alternative therapies are created by unscrupulous charlatans to get vulnerable people to hand over money under false pretences.
Throughout the rest of the appointment, Mr C became more withdrawn and was not as cheery as he was when he first arrived although he still remained polite. I felt that the atmosphere had become more awkward and uncomfortable. I attempted to lighten the mood a little but it did not seem to make much of a difference.
3. Analysing the Situation
I researched the use of copper bracelets in pain management which reinforced my understanding that there is no evidence that they reduce pain or inflammation and that there is strong evidence that they have no clinical effect whatsoever. However, even though I provided sound information, I still felt uncomfortable and attributed this to the way that I had delivered the information to Mr C. without taking into account his perspective.
I felt that I was instantly dismissive of his claim and my subsequent rant only served to embarrass him and make him feel vulnerable and victimised. I also failed to take into account that Mr C. believed that the bracelet was helping him to manage his pain and, even if it was just a placebo effect, it was making a positive contribution to his overall wellbeing. Through my research, I also discovered that although copper bracelets have no positive clinical impact, they also have no negative side effects and are relatively inexpensive, so Mr C.’s decision to wear one would not have resulted in any harm.
I described the situation to my clinical lead who explained that I was correct to provide Mr C. with professional and accurate advice following his request but it is advisable to just present the facts so that patients can make their own informed decisions without bringing my own personal opinions into the mix. Particularly in cases where I may consider a patient’s decision to be unwise but it does not have a negative impact on their overall health and wellbeing.
4. Evaluating the Relevance of Knowledge Gained
This process of reflection has helped me to identify an area of my practice that could be improved. I should take the time to consider the thoughts and feelings of my patients before I speak so that I can provide information to them in a way that is empathetic, compassionate and non-judgmental. I should also avoid letting my own personal views and opinions influence my professional communications.
This will help to improve my bedside manner and help to maintain positive working relationships with my clients.
On the positive side, my knowledge of alternative and complementary medicines, including what is and is not available on the NHS, is very good, which helps me to provide sound clinical advice to patients.
5. Final Findings & Future Action
Going forward, I will commit to being more respectful and empathetic to my patients when providing advice that may be contrary to their current beliefs. For example, in relation to the situation with Mr C. I could have simply explained that there is currently no evidence that copper bracelets are effective in pain management, which is why they are not available on the NHS but I was glad he felt that it was helping him.
I will also try to ensure that I do not let my personal views and opinions interfere with my clinical practice.
In addition, I resolve to apologise to Mr C. during our next appointment and explain how this event has made a positive contribution to my personal and professional development.
References:
- Atkins S and Murphy K (1993) Reflection: a review of the literature. Journal of Advanced Nursing 18 p1188-1192
- Atkins S and Murphy K (1994) Reflective practice. Nursing Standard 8(39) p49-54