future of digital health

WEEK 12
Critical reflection

Introduction
The future of digital health centres around advancing technology, the further
embedding and embracing of technology in the management of person’s health
and health informatics. As healthcare professionals’ nurses need to be aware of
the future innovations that are occurring and to open their mind to embracing
new approaches to care and technology. Health informatics, the use of data to
manage health is a growing field that brings many opportunities for improved
patient outcomes, and has implications for professional practice and leadership.
Essential to the process of shaping practice in response our changing context,
Registered Nurses are expected to reflect critically on their practice and to invite
and explore emerging challenges. In this topic you will refresh your
understanding of critical reflection. Your knowledge and understanding of this
concept will be used to coalesce your learning in this unit of study, and to assist
you to prepare for your final assessment.
This module addresses the following unit outcome:
3.Critically consider communication (including advocacy), health informatics and
technology in relation to future leadership roles in practice and professional
contexts
Learning outcomes:
By the end of this module you will be better able to:
o Explain the meaning of critical reflection;
o Critique two models of critical reflection with reference to
critical/practice dimensions;
o Analyse reflective writing in relation to the three levels of reflection;
o Reflect critically on practice implications of unit content;
o Develop a plan for your final assessment task.
Critical reflection

Introduction
The future of digital health centres around advancing technology, the further
embedding and embracing of technology in the management of person’s health
and health informatics. As healthcare professionals’ nurses need to be aware of
the future innovations that are occurring and to open their mind to embracing
new approaches to care and technology. Health informatics, the use of data to
manage health is a growing field that brings many opportunities for improved
patient outcomes, and has implications for professional practice and leadership.
Essential to the process of shaping practice in response our changing context,
Registered Nurses are expected to reflect critically on their practice and to invite
and explore emerging challenges. In this topic you will refresh your
understanding of critical reflection. Your knowledge and understanding of this
concept will be used to coalesce your learning in this unit of study, and to assist
you to prepare for your final assessment.
This module addresses the following unit outcome:
3.Critically consider communication (including advocacy), health informatics and
technology in relation to future leadership roles in practice and professional
contexts
Learning outcomes:
By the end of this module you will be better able to:
o Explain the meaning of critical reflection;
o Critique two models of critical reflection with reference to
critical/practice dimensions;
o Analyse reflective writing in relation to the three levels of reflection;
o Reflect critically on practice implications of unit content;
o Develop a plan for your final assessment task.
Introduction
Why critically reflect?
What is critical reflection?
Sometimes we hear people say ‘I reflect all the time’. Thinking about what we are doing,
pondering on the consequences and what we could be do better next time is a fairly routine
behaviour that most of us engage in during the routines of daily life. However, critical
reflection as a deliberate and structured act enables us in our professional practice, to gain
the greatest learning potential from our experiences.
Some of the key tenets of critical reflection are structure, purpose, and enquiry (Cottrell,
2017, p. 188;
Nicoll & Dosser, 2016, p. 35). Cottrell (2017, p. 188) presents a more detailed
explanation of the characteristics of critical reflection:
These key characteristics of critical reflection, are common to many models of critical
reflection and can be grouped under selection and description of an experience, an
expression of individual responses to the experience, interpretation, analysis, planning for
future practice and re analysis. A cyclical representation in most theories gives emphasis to
the ongoing process of reflection on the experience, in the light of new knowledge or other
experiences. A reflective ‘spiral’ of learning and understanding is perhaps a more useful
analogy.
Note that
o the key to critical reflection is the use of theory and literature as ‘lenses’ with which
to interpret the experience;
o learning from the reflective activity does not stop with development of the plan for
future practice. The subject of the reflection can be explored more deeply over time
and in relation to the emergence of new experiences and research etc.
Activity: Assessment 3
Your final assessment task requires you to develop a critically reflective essay. Be sure to
reflect on the extent to which your written reflections address these characteristics.
The following reading explains in detail how theory can be related to the process of critical
reflection.

Cottrell, S. (2017) Critical thinking skills. Chapter 12 critical reflection. Relating theory and
practice p. 194.
As you view the following videos that explain three different models of reflection, you should
aim to understand the cycle or spiral of reflective learning, and where in the models the
experience is
critically examined in relation to theory and new knowledge such as academic
research. These presentations vary in terms of their emphasis on these characteristics.
The first presentation is of Gibbs reflective cycle with which you are no doubt familiar.
Please review with the above characteristics in mind.
EPM (2019, May 3)
Gibbs reflective cycle [Video].You Tube. https://youtu.be/-gbczr0lRf4
We now view Kolb’s model that contains similar features to Gibbs. Note that the phase of
‘active experimentation’ foregrounds ongoing analysis of the experience.
Preceptor Education Program (2015, September 9)
M5 Kolb’s experiential learning cycle
[Video]. You Tube. https://youtu.be/Rp-gaV-uSIo
Reflection often involves challenging our core assumptions and behaviours. This can be a
daunting experience especially if it makes us question deeply held beliefs or perceive
weaknesses in previous practice. In the following short video, Mezirow’s theory of
transformative learning focuses our attention on this process. While it is beyond the scope of
this module to explore Mezirow to any depth, it’s important to be aware of the
‘disorienting dilemmas’ that we encounter, that serve as important rigger points for
reflection. These events can be quite powerful.
Jarvis, C. (2015, August 11).
Introducing transformative learning theory. [Video]. YouTube.
https://youtu.be/liU1zsi3X8w

As a final recap, the following reading is recommended. You may find it useful to download
the chapter, as we refer to it in later sections. The reading also includes a range of engaging
activities that you may find useful.
Cottrell, S. (2017) Critical thinking skills. Chapter 12 critical reflection. pp. 188-189.
Critical reflection
Critical writing
Why critically reflect?
Critical reflection enables us to use our own experiences as an essential resource for
learning. It is a process that invites an openness to challenges to our assumptions, from
theoretical, experiential and other sources, so that we can learn and grow in our professional
work (Cottrell, 2017). Reflection takes some practice, however the depth of understanding
and personal and professional growth that can emerge from critical reflection can be
surprising, illuminating and transformative.
Note the purpose of the reflective task you are required to undertake in
Assessment 3
“This assessment task presents an opportunity for you to extend and integrate your
understanding of communication, health informatics and technology through critical
reflection on the learning experiences that you have encountered during the semester. Your
analysis also establishes a basis for considering professional practice implications.”
The task is both analytical and forward looking, with professional practice implications a key
outcome.
1.Knowledge and reflection
In this unit, learning is presented as an active process that seeks to establish relationships
between your existing understanding of communication, health informatics and technology
and the new knowledge that forms the unit content. Knowledge development is a complex
process, and time does not permit us to deal with that here. It’s sufficient to say that
knowledge can sometimes be tacit, that is, some of our knowledge is hidden away, for
example the knowledge that enables us to respond or make judgements while we are
interacting with a patient, – or driving a car. Some knowledge is formed from the learning
that occurs alongside formal instruction (Eraut, 2004) i.e. through studying course readings
and material, preparing assignments, which can then be personalised by thinking about your
work and applying it to practice. By making this ‘personalised’ knowledge explicit, we

extend the operating knowledge that we have to work with moving forward, including being
able to share it with others, build and deliberate on its meaning (Eraut, 2000).
Critical reflection, and writing, is one way that we can enable the transformation of tacit
knowledge to explicit knowledge. It is recommended that you record your reflections
throughout the semester, to aid your learning and to establish a basis for the development of
Assessment 3.
2.Competency Standards
Critical reflection is also a key dimension of the Nursing and Midwifery Board of Australia
(2016). National Competency Standards for the Registered Nurse (p. 3).
As you can see from Figure 1, Standard 1 ‘Thinks critically and analyses nursing practice’ as
a key Standard is clarified:
“RNs use a variety of thinking strategies and the best available evidence in making decisions
and providing safe quality nursing practice within person-centered and evidence- based
frameworks”
Note that this standard is related to Standards 2 and 3, and is common to the remaining
dimensions 4,5,6,&7. Critical practice is therefore clearly embedded in all areas of the
nursing standards, and is therefore expected in the conduct of professional nursing practice.
Criterion 1.2 is more specific to reflection:
1.2 develops practice through reflection on experiences, knowledge, actions, feelings and
beliefs to identify how these shape practice.
There are other reasons why critical reflection offers a valuable foundation for professional
practice, as the following reading explains.
Cottrell, S. (2017) Critical thinking skills. Chapter 12 critical reflection. p. 190
Why critically reflect?
Bringing it all together


Critical writing
Presentations in the previous section summarise the meaning and purpose of reflection. In
the following section we will explore how to record your reflections in a manner that is
useful for you, and to aid your preparation of
Assessment 3.
As you are aware there are many models of reflection. Gibb’s (1988) model offers the
following structure:
o Describe the situation
o What were you thinking and feeling?
o Initial evaluation: What was good and bad about the situation?
o Analysis of the situation: What sense can you make of the situation?
o Conclusion what else could you have done?
o Action plan: If it happened again what would you do? (and once you have enacted
your plan you can return to ‘describe the situation’.
Which ever model you use, or if you choose to develop your own, I suggest that you refer to
the ‘characteristics of critical reflection’ presented in an earlier section to ensure your choice
of structure addresses these elements.
Where to record your reflections
Choose a place to record your critical reflections. You may choose a diary or journal in hard
copy or an online space. Your journal can include drawings, photographs, diagrams and need
not be confined to writing. The practice of writing your reflections has the following
benefits:
o Writing can be therapeutic;
o Writing can help to analyse or ‘unpack’ the experience, even before you have
engaged in the structured process a of analysis;
o By writing your reflections, you have a record that you can use for ongoing reflection
on the experience, including reflection on earlier reflections, which gives insights
into how your thinking has changed.
(Nicoll & Dossier, 2016)
Do you recall the ‘pensive’ in the Harry Potter series? In this magical story it was possible to
store memories in glass bottles, for later viewing and consideration, as well as for sharing
with others, through the ‘pensive’. Unfortunately we are confined to the less sophisticated
paper journal, but the point of reflection and analysis on experience and sharing it with

others is poignant in this short extract from Harry Potter and the Half Blood Prince. You
need only watch the first 30- 40 seconds.
Stefan Dajiba (2009, June 26) Harry Potter and the half blood prince: pensive scene.


YouTubehttps://youtu.be/dumUElmlVJA
Critically reflective writing
The following video presents an excellent framework for writing critically. The examples of
critical writing, while drawn from outside of the nursing field, exemplify the type of analysis
that needs to be reflected in your critically reflective writing, with implications for your
preparation of
Assessment 3.
Academic skills The University of Melbourne (June 2 2017) Reflective writing,


YouTube https://youtu.be/SntBj0FIApw
The following extract from Cottrell (2017) presents further examples of critically reflective
writing in relation to the core phases of reflection.
Cottrell, S. (2017) Critical thinking skills. Chapter 12: Critical reflection, pp. 198-200

Critical writing
References
Bringing it all together: Using reflection to integrate your learning in HEA536
The future of digital health centres around advancing technology, the further embedding and
embracing of technology in the management of person’s health and health informatics. As
healthcare professionals nurses need to be aware of the future innovations that are
occurring and to open their mind to embracing new approaches to care and technology.
Health informatics, the use of data to manage health is a growing field that brings many
opportunities for improved patient outcomes.
In this topic, reflective activities are presented to support your integrated engagement with
these knowledge areas, to provoke critical thinking, challenge of existing assumptions and to
facilitate the transformation of tacit knowledge to a more explicit form that can be used for
analysis and sharing (Eraut, 2004). These reflective activities present further opportunities
for you to identify themes to work with in
Assessment 3.
Keep in mind the following key objectives as you work through these activities.
1. The future of Australia’s digital health and progress achieved to date
2. Actions taken by government, industry and healthcare providers to advance digital
health
3. The opportunities created by advances in digital health for professional nursing
practice
Activity 1
Return to the unit modules and reflect on or revise your responses to the unit reflective
activities. Do you agree with your initial responses? Draw on the prompts in Activity 3 to
reflect on any changes.
Activity 2
Review your learning across the semester, noting that the emphasis on communication. The
following summary may assist with this task.
4. In Module 1 you studied the nature of communication in healthcare, including
person centred care, clinical handover, nursing communication and fostering
effective therapeutic relationships and communication, interpersonal and teambased communication.
5. In Module 2 you studied communication for safety and person- centered
communication in relation to culture, with Aboriginal and Torres Strait Islander
peoples, and people with language barriers.

6. In Modules 3,4 and 5. You studied health information and technology, as a more
specific form of communication that has become embedded in every aspect of health
care.
7. In Module 3 you explored some of the regulatory bodies in the digital health space
such as the Australian Digital Health Strategy and the Australian Digital Health
Agency, the World Health Organisation, World Health Organisation Global Strategy
on Digital Health, National Nursing and Midwifery’s Digital Health Capacity
Framework, Registered Nurse Competencies and Standards for practice;
International Council of Nurses Code of Ethics for Nurses; National Safety and
Quality health service a standards; Aged care quality standards.
8. In Module 4 you studied health informatics specifically in relation to nursing,
including digital tools for reporting and managing incidents, electronic health
records, health informatics innovations and telehealth, student nurse experiences
with health technology, health technology and health literacy, social determinants of
e health access, digital health and inter professional communication.
9. Module 5 focuses on digital health for carers, digital health and acute care, the future
of Australia’s digital health, and health informatics.
Activity 3
As a simple task reflect on the knowledge you have gained in relation to the unit learning
outcomes:
Learning Outcomes:
1.Critically review communication models and modes and their implications for effective,
appropriate and culturally safe nursing practice for individuals, families, groups and
communities, throughout the lifespan and in all practice settings.
2.Critically review health informatics and technology in relation to effective nursing practice
and to safe, quality healthcare delivery, including in catastrophic disasters such as
pandemics
3.Critically consider communication (including advocacy), health informatics and technology
in relation to future leadership roles in practice and professional contexts.
Activity 4
Reflect on your learning in relation to the following prompts:
You might consider:
10. What do I know now that I didn’t before?
11. What surprised me or worries me about the topics I studied?
12. What behaviours or attitudes have I changed?
13. Which topics should I take particular note of, and be sure to investigate further?
14. How will I apply my new knowledge to future practice?
15. What novel connections did I make between these topics and the readings that
underpinned them?
Source: Adapted from Cottrell, S.(2013)
The study skills hand book. Palgrave.
Bringing it all together
References
Academic skills: The University of Melbourne (June 2 2017) Reflective writing,


YouTube https://youtu.be/SntBj0FIApw
Cottrell, S. (2013).
The study skills hand book. Palgrave.
Cottrell, S. (2017)
Critical thinking skills. Palgrave
EPM (May, 3, 2019) Gibbs reflective cycle You Tube video https://youtu.be/-gbczr0lRf4
Eraut, M. (2000). Non‐formal learning and tacit knowledge in professional work.
British
Journal of Educational Psychology
, 70(1), 113-136. doi:10.1348/000709900158001
Eraut, M. (2004). Informal learning in the workplace.
Studies in Continuing Education, 26(2),
247-273.
doi:10.1080/158037042000225245
Jarvis, C. August 11, 2015.Introducing transformative learning theory. [Video] YouTube

Nicol J.S., & Dosser, I. (2016). Understanding reflective practice. Nursing Standard. 30(36),
34-42. doi: https://10.7748/ns.30.36.34.s44. PMID: 27154119.
Nursing and Midwifery Board of Australia (2016). National Competency Standards for the
Registered Nurse.
Preceptor Education Program (September 9, 2015) M5 Kolb’s experiential
learning cycle[Video} You Tubehttps://youtu.be/Rp-gaV-uSIo
Stefan Dajiba (2009, June 26) Harry Potter and the half blood prince: pensive scene.


YouTubehttps://youtu.be/dumUElmlVJA

Wilson, J., Mandich, A., & Magalhães, L. (2016). Concept mapping: A dynamic, individualized
and qualitative method for eliciting meaning.
Qualitative Health Research, 26(8), 1151-1161.
doi:10.1177/1049