Final Reflective Journal: Developing Ethical Awareness and Critical Thinking in Health and Social Care

(Radu Constantin Sofronescu)

Introduction

Over the course of this module, I have engaged in a process of self-inquiry, using reflection and peer feedback to deepen my understanding of health and social care practice. Each scenario I encountered—whether drawn from personal experience or constructed case studies—highlighted the importance of ethics, safeguarding, and critical thinking in navigating complex, often ambiguous, professional environments.

This journal brings together my reflections from the past ten weeks, structured around a central narrative: the development of ethical awareness and critical thinking as essential components of responsible practice. Using frameworks such as Kolb’s Experiential Learning Cycle (1984), the principles of biomedical ethics (Beauchamp and Childress, 2013), and critical reflection models (Thompson, 2020), I examine how I have grown in my understanding of vulnerability, professional decision-making, and safeguarding dilemmas.

Peer feedback played a critical role in this process. Engaging with others’ reflections and receiving comments on my own encouraged me to consider alternative perspectives and critically evaluate my assumptions. This collaborative learning environment reinforced the value of reflective supervision, interdisciplinary dialogue, and lifelong learning—all key components of effective health and social care practice.

1. Encountering Vulnerability: A Personal Experience Through Kolb’s Cycle

Concrete Experience

A defining moment in my journey occurred during my time as a taxi driver. One afternoon, I was asked to take an elderly woman to a local medical centre. She was accompanied to the car by a neighbour who quickly provided the destination and left. As we drove, the woman became increasingly anxious, repeatedly asking where we were going and who I was. She seemed confused, and at times distressed. I did my best to remain calm and polite, offering gentle reassurance. However, I was uncertain about what else I could do, and simply focused on getting her safely to the address.

Reflective Observation

After the journey, I found myself thinking more deeply about her behaviour. At the time, I didn’t have the language or knowledge to label it, but I now recognise that the signs—confusion, memory lapses, repetitive questions—were consistent with early symptoms of dementia. I realised that, while I had remained composed and respectful, I had missed an opportunity to do more to support her. For example, I could have asked follow-up questions or contacted a family member or care worker to ensure she was safe once the journey ended.

Some of my peers reflected that I showed patience and compassion, which affirmed that empathy is one of my natural strengths. However, they also encouraged me to think about how to transform empathy into action—a challenge that prompted me to reflect more critically on my responsibilities in moments of informal care.

Abstract Conceptualisation

Applying a health and social care lens, I now understand the importance of person-centred care, particularly for individuals with cognitive impairments such as dementia. According to McCormack and McCance (2017), person-centred practice involves tailoring communication and support to the individual’s needs, ensuring dignity, autonomy, and emotional wellbeing. Similarly, the NHS (2024) highlights disorientation, short-term memory issues, and difficulty with familiar tasks as key signs of dementia.

As a driver, I wasn’t acting in a formal care role, but I was still in a position of trust. Skills for Care (2022) outlines professional values—such as compassion, dignity, and safeguarding—that apply across both regulated and unregulated roles. Reflecting on this has helped me see that everyone who interacts with vulnerable people has a duty of awareness and care, whether formally trained or not.

Active Experimentation

If I were in a similar situation again, I would respond more confidently. I would simplify my language, avoid repeating questions, and focus on being as clear and reassuring as possible. If the individual appeared very distressed, I would not hesitate to contact a relative or neighbour, provided it was in line with safeguarding guidance. Importantly, this experience prompted me to begin basic dementia awareness training through Dementia UK and the Open University, which will better equip me to recognise vulnerability and act appropriately.

Reflection

This personal experience marked the beginning of my journey into ethical and reflective practice. It helped me realise that real-life encounters often lack clarity, and that being present, observant, and proactive can make a critical difference in someone’s safety and wellbeing. The feedback from peers reinforced that small actions—such as attentive listening—can have a powerful impact, but must be accompanied by appropriate knowledge and ethical judgement.

2. Critical Thinking in Action: Discharge Planning and System Pressures

Scenario Summary

Later in the module, I engaged with a scenario involving an elderly hospital patient, Mr L, who was recovering from pneumonia but living with dementia and limited support at home. Nursing staff were under pressure to free up beds during winter and were advocating for a rapid discharge. A junior care plan suggested Mr L return home with minimal support. However, an occupational therapist raised concerns about Mr L’s disorientation and risk of harm at home.

Analysis

This scenario illustrated the ethical tension between systemic efficiency and individual safety. Through structured critical thinking, the care team re-evaluated the discharge plan. They consulted allied professionals, reviewed case notes, and discovered that Mr L had previously refused support, lived without smoke alarms, and was prone to leaving appliances on—factors that significantly increased his risk.

Instead of following the initial plan, the team advocated for a temporary residential placement to allow further assessment. Although this delayed discharge and potentially strained the system, it prioritised Mr L’s right to safe, person-centred care, in line with the Care Act 2014 (DHSC, 2014).

Critical Reflection

This scenario helped me understand that critical thinking is not just about following procedures, but about challenging them when needed. Thompson (2020) defines critical reflection as the process of questioning assumptions, analysing context, and evaluating outcomes. In this case, the team had to balance professional judgement, ethical values, and legal frameworks to safeguard the patient.

Peer feedback highlighted how important it was that team members voiced concerns even when it went against the dominant narrative (i.e. discharging to free beds). This resonated with me, as I recognised the importance of professional curiosity and the courage to speak up. Schön’s (1983) idea of the “reflective practitioner” became especially relevant here—someone who can reflect in action, not just after the fact.

Learning

This case affirmed that in real-world practice, decisions are rarely black and white. Health and social care professionals often operate in complex environments where they must weigh multiple factors—such as risk of harm, system pressures, professional responsibilities, and individual rights—before making a decision. I learned that safeguarding is not always about immediate protection in the moment; it often requires anticipating potential risks, considering long-term outcomes, and taking steps that may initially seem inconvenient or disruptive but are ultimately in the person’s best interest.

In this scenario, advocating for a delay in discharge went against the ward’s immediate need for bed space, but it reflected a deeper understanding of Mr L’s vulnerability and the dangers of rushing decisions. I realised that safeguarding can sometimes mean challenging established processes, requesting further assessments, and standing firm when a care plan does not feel safe or appropriate. It requires confidence, collaboration, and a willingness to speak up—even when others may not immediately agree.

This experience helped me see how safeguarding is not just a checklist—it’s a continuous, thoughtful process that involves critical reflection, risk analysis, and ethical judgment. It reinforced my belief that effective safeguarding often lies in the ability to pause, reflect, and ask: “Is this really safe for this person?” even when time and resources are limited.

3. Consent, Confidentiality, and Adolescent Safeguarding

Scenario Summary

In a school-based drop-in session, a 15-year-old girl, Sasha, disclosed that she had been struggling with anxiety and sometimes stayed overnight at a 21-year-old friend’s flat. She insisted that nothing inappropriate was happening and begged the practitioner not to share this with her parents or the school. This raised a safeguarding dilemma: should confidentiality be respected, or should concerns be escalated?

Ethical Analysis

This case presented a complex conflict between respecting Sasha’s autonomy and the duty to protect her from harm. Confidentiality is central to building trust, particularly with adolescents. However, according to Working Together to Safeguard Children (HM Government, 2018), practitioners must share information if there is a risk of significant harm.

The concept of Gillick competence (Department of Health, 2009) became central to this case. While Sasha may be competent to make some decisions, that does not negate the practitioner’s legal responsibility to act if risks—such as exploitation or emotional neglect—are present.

Applying Beauchamp and Childress’ (2013) ethical principles helped me understand the dilemma more clearly:

• Autonomy: Respecting Sasha’s wishes and her right to confidentiality.

• Beneficence: Acting in her best interests to prevent potential harm.

• Non-maleficence: Ensuring no further harm comes through action or inaction.

• Justice: Ensuring she receives the same protections as any other at-risk child.

Reflection

This scenario challenged me emotionally. It raised questions about trust, transparency, and the limits of confidentiality. Reflecting on feedback from peers, I realised how essential it is to communicate the boundaries of confidentiality from the outset. If Sasha had known that certain disclosures might trigger safeguarding actions, she might have been more prepared for that outcome.

It also highlighted the value of trauma-informed practice, where young people are included in decisions and not treated as passive recipients of intervention (Wilkins and Whittaker, 2018). In this case, the practitioner could help Sasha feel heard while also making a referral, maintaining the relationship as far as possible.

Learning and Application

This case taught me that safeguarding is not about making assumptions—it is about gathering context, asking the right questions, and acting responsibly. It reminded me that ethical decisions in health and social care often involve navigating grey areas where no solution feels perfect.

One of the most significant lessons I learned is the importance of professional curiosity. At first glance, Sasha’s situation might not have triggered immediate safeguarding intervention—after all, she appeared calm, denied abuse, and asserted that nothing inappropriate was occurring. However, critical safeguarding practice involves looking beyond surface-level disclosures and understanding the wider risks that may be hidden or minimised by the young person. In this case, the practitioner had to recognise that Sasha’s decision to stay overnight at a 21-year-old’s flat—regardless of her stated intentions—could indicate vulnerability to grooming, emotional distress, or unsafe conditions.

This reflection also helped me appreciate the role of trauma-informed communication in safeguarding. Young people often share sensitive information tentatively, and how practitioners respond in those moments can either strengthen or damage trust. Even when confidentiality must be broken for the young person’s protection, the way this is done matters. Being transparent, involving the individual in the process, and explaining what will happen next are vital to maintaining dignity and emotional safety. I have learned that safeguarding is not just a procedural act—it is also a relational and ethical one.

From a practical perspective, this case reinforced the importance of being aware of organisational safeguarding protocols, such as who to contact for advice, how to record concerns clearly, and how to access multi-agency support when needed. I now better understand the need to consult with designated safeguarding leads or supervisors when faced with uncertainty, rather than making decisions in isolation.

Finally, this scenario challenged me to think critically about the limits of consent and autonomy in safeguarding. While respecting a young person's wishes is important, it must be balanced against the duty to protect. Gillick competence, while a useful guideline, does not override the practitioner’s ethical responsibility to act when risk is evident. This balance requires constant reflection and an ability to adapt based on each individual situation.

Overall, this learning has deepened my confidence in approaching safeguarding conversations and increased my awareness of the ethical dilemmas that professionals face. It has shown me that there are rarely perfect answers—but there are always better ways to approach decisions through thoughtfulness, consultation, and ethical reasoning.

Final Reflection: Bringing it All Together

Reflecting on these three scenarios collectively, I see how my understanding of vulnerability, ethics, and reflective practice has evolved. Each situation involved:

• A person at risk (an elderly woman, Mr L, or Sasha),

• A practitioner (or myself) facing a decision with ethical complexity,

• The need for critical thinking, ethical judgement, and compassionate action.

Together, these reflections demonstrate the value of integrating personal experience with professional frameworks. Kolb’s learning cycle helped me structure my reflections, while critical theories by Thompson (2020) and Schön (1983) encouraged deeper self-inquiry.

I also saw how reflection is not a solo activity. Engaging with peer feedback pushed me to be more open-minded, and reading others’ experiences reminded me of the diversity of challenges professionals face. These exchanges deepened my commitment to ethical, person-centred care.

Conclusion

This journal represents a journey of professional growth, shaped by reflective practice, ethical reasoning, and critical thinking. Through examining real-life scenarios and applying theoretical models, I have developed a deeper awareness of the complexities involved in health and social care work. These reflections have shown me that professional learning does not happen only in formal settings—it happens through everyday interactions, difficult decisions, and moments of uncertainty that challenge our values and assumptions.

As I move forward in my career, I will continue to:

• Reflect on experience using structured models, such as Kolb’s cycle and ethical frameworks, to turn practical experiences into meaningful learning;

• Seek peer feedback and supervision to gain alternative perspectives and challenge my own biases;

• Prioritise safeguarding and person-centred care, ensuring that individuals’ needs, rights, and dignity are central to every decision;

• Question assumptions and evaluate complex situations critically, particularly when risks are not immediately visible.

Health and social care is not simply about following procedures—it is about making ethical decisions in real-world contexts, often under pressure, and always with the wellbeing of others at the centre. It requires emotional intelligence, professional judgement, and the courage to act in the face of uncertainty. This reflective journey has strengthened my belief that continuous learning, openness to feedback, and commitment to ethical practice are essential to becoming a responsible and compassionate practitioner.

References

Beauchamp, T.L. and Childress, J.F. (2013) Principles of Biomedical Ethics. 7th ed. Oxford: Oxford University Press.

Brookfield, S.D. (2017) Becoming a Critically Reflective Teacher. 2nd ed. San Francisco: Jossey-Bass.

Department of Health (2009) Reference Guide to Consent for Examination or Treatment – Second Edition. London: DH.

Department of Health and Social Care (2014) Care Act 2014: Statutory Guidance. London: DHSC.

HM Government (2018) Working Together to Safeguard Children. London: HM Government.

Kolb, D.A. (1984) Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, NJ: Prentice Hall.

McCormack, B. and McCance, T. (2017) Person-Centred Practice in Nursing and Health Care: Theory and Practice. 2nd ed. Chichester: Wiley-Blackwell.

NHS (2024) Symptoms of Dementia. [Online] Available at: https://www.nhs.uk/conditions/dementia/symptoms [Accessed 11 Jul. 2025].

Schön, D. (1983) The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books.

Skills for Care (2022) Core Skills and Values in Health and Social Care. [Online] Available at: https://www.skillsforcare.org.uk [Accessed 11 Jul. 2025].

Thompson, N. (2020) The Critically Reflective Practitioner. 3rd ed. Basingstoke: Palgrave Macmillan.

Wilkins, D. and Whittaker, C. (2018) Doing Child Protection Social Work. Bristol: Policy Press.