Bachelor of Midwifery (BM) students' experiences of reflective practice: A grounded theory study

There is a strong focus on the promotion of reflective practice and the development of critical thinking skills within nursing and midwifery practice, both within the profession and throughout university education (Nursing and Midwifery Board of Australia [NMBA], 2008; Nursing and Midwifery Board of Australia [NMBA], 2006). The Australian Catholic University’s (ACU) Bachelor of Midwifery (BM) course into which I teach incorporates, teaches and supports reflective practice and acknowledges reflective practice as a defining characteristic of a professional midwife. The focus on the promotion of reflective practice throughout the ACU BM course aims to build a framework for reflection as the student moves from novice to practitioner through the duration of study and beyond. In order to facilitate reflective practice, midwifery students are encouraged to keep a reflective journal as part of the development of a professional portfolio and as a way to review and evaluate their clinical practice experiences. The process of reflection is supported by midwifery governing bodies such as the Nursing and Midwifery Board of Australia [NMBA] and the Australian College of Midwives [ACM] (2008). The NMBA National Competency Standards for the Midwife (2006) describe reflective practice as integral to the midwife’s understanding and ability to identify the impact of their own culture, values and beliefs on the provision of care while recognising the power relations that exist within the community and the health system (p.2). Anecdotal evidence, however, suggests that BM students’ experience of engaging in contemporary reflective practice as required by the curriculum is viewed by many as a burden. The midwifery students report that there is no time for the type of written reflection required, while also acknowledging that reflection is beneficial. This study was initiated to explore if and how BM students understand and participate in reflection, along with factors that may act as barriers to and enablers of this process. The aim of this grounded theory study was to explore 2nd year ACU Bachelor of Midwifery (Melbourne) students’ experience of reflective practice. Eight students agreed to participate in semi-structured interviews; analysis of the data identified that the students’ first impressions of reflective practice and subsequent ongoing support to participate in reflective activities had a significant impact on when and how they undertook reflective practice. The study identified the core category of “becoming a reflective midwife”, which incorporated the major categories of ‘learning’, ‘practising’, ‘valuing’ and ‘adapting’. Overall, the study concluded that contrary to anecdotal reports that reflective practice was a tiresome chore or a burden; all midwifery student participants appreciated the value of reflective practice, undertook reflective practice activities in one way or another, and voiced their intentions to continue to become reflective practitioners. This insight prompts consideration of how reflective practice is taught at university and the timing of its introduction and ongoing inclusion throughout the course. Additionally, strategies to promote and facilitate ongoing reflective practice activities within the general population of midwifery students could be reviewed and implemented.