3rd Reflective Entry around using reflection and critical thinking to address health and social care dilemmas and solve problems

<Alina Soare>

Health and social care professionals often face ethical, emotional, and practical dilemmas. Practitioners use the skills of reflection and critical thinking in these situations to ensure the decision they make is informed, compassionate and effective. For the purposes of this submission, I will explore the extent to which these skills support the resolution of dilemmas in a care context, using a personal experience and a theoretical perspective.

The Role of Reflection in Health and Social Care

Reflection is used by practitioners to analyse their actions, emotions and outcomes, which foster ongoing development. As mentioned by Williams (2022), working in care can involve people’s lives and personal well-being being put at risk, so reflective practice helps the practitioner:

●      Recognise any biases or assumptions that might colour a care decision.

●      Learn from mistakes to protect against similar mistakes and harm in the future.

●      Develop the ability to empathise by seeing a patient’s or family’s situation from their perspective.

Recognizing Critical Thinking in Ethical Dilemmas

Critical thinking offers a systematic approach to examining care dilemmas (Hayes, Chatterjee and Schwartzstein, 2017). Suppose, for instance, a patient is considering refusing life-saving treatment due to cultural beliefs. A critical thinking approach may involve the following:

●      Identify and gather information- consider the medical, ethical, and cultural issues.

●      Evaluate ethical principles- autonomy (the patient's right to choose) vs beneficence (acting in the patient's best interests).

●      Make a reasoned judgment decision- consider the legal and ethical aspects, and the patient's emotional impact/needs.

As a result, without a critical thinking approach, professionals may impose their biases and/or simply act out of time-pressured emotions and therefore risk their established connection and patient is wellbeing.

Personal Experience

During a placement in a dementia care facility, I confronted a dilemma involving an elderly resident, Mrs. A, who was insistent on walking unassisted even though she had experienced a series of falls. The staff's discussions centred on limiting Mrs. A is ability to walk independently. I utilised Gibbs’ Reflective Cycle to critically analyse my experience:

Description- During staff intervention, Mrs. A displayed agitation, while we were equally concerned that her falls could cause some form of injury.

Feelings- I felt conflicted with concern for Mrs. A is safety, yet seeing restrictions in her autonomy was equally distressing.

Evaluation- Reducing Mrs. A is independent movement would reduce falls, but increase stress and agitation; allowing Mrs. A is autonomy maintained her dignity.

Analysis- Being severely restricted or limited in dementia care can either increase the risk of depression, or decline faster; so there had to be a way to accommodate both safety and autonomy.

Conclusion- Instead of restraining Mrs. A and limiting her essentially to a sedentary position in a chair, my team and I provided her with walking aids, while also monitoring her closely and engaging her in balance exercises with supervision.

Action Plan- I would work to advocate for a complete risk assessment with options other than restraint for patients who are ambulant.

Overcoming Obstacles in Ethical Care Dilemmas

●      Emotions that cause stress– many of us experience care dilemmas with personal attachment, while others may be emotionally dysregulated.

●      Time pressures– as mentioned, the professional may have to make decisions quickly and to act on those decisions without considerable reflection.

●      Conflicts of values – when professionals disagree with each other, patients, or families.

Potential strategies to address the aforementioned include:

●      Interprofessional collaboration– careful consideration of dilemmas engaged with colleagues offers collaborative practice and a variety of perspectives (Scott and Manning, 2022).

●      Ethical frameworks- models such as the Four Principles Approach contribute a balanced approach to given ethical dilemmas (Page, 2012).

●      Debriefing- regularly scheduled structured reflection sessions allow the team to reflect together and learn as a team.

References:

• Alzheimer’s Society (2020) Falls in people with dementia. [Online] Available at: https://www.alzheimers.org.uk/ [Accessed 28th Jul 2025].

• Bensley, D.A. and Murtagh, M.P. (2012) Cognitive Foundations of Critical Thinking. Boston: Pearson.

• Bolton, G. (2014) Reflective Practice: Writing and Professional Development. 4th ed. London: Sage.

• Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Oxford Polytechnic.

• Manley, K., Martin, A., Jackson, C. and Wright, T. (2021) Using critical reflection and dialogue to build person-centred practices. Journal of Clinical Nursing, 30(13-14), pp.1956–1967.

3rd Reflective Entry