reflective essay on health and safety

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Reflection On Health And Safety

Health and safety are paramount in every aspect of life, whether in the workplace, at home, or in the community. Reflecting on the importance of health and safety measures is crucial to ensure the well-being of individuals and the overall functioning of society. This essay delves into the significance of prioritizing health and safety, the challenges faced in maintaining them, and the strategies to promote a culture of safety.

First and foremost, prioritizing health and safety is essential because it directly impacts the quality of life and productivity of individuals. In the workplace, adherence to safety protocols reduces the risk of accidents and injuries, thereby safeguarding employees' physical and mental well-being. Moreover, a safe working environment fosters a sense of security and trust among workers, leading to increased job satisfaction and morale. Similarly, in daily life, practicing safety measures such as wearing seat belts, following traffic rules, and maintaining hygiene habits significantly reduce the occurrence of accidents and illnesses, contributing to overall health and longevity.

However, despite the awareness of the importance of health and safety, numerous challenges hinder their effective implementation. One such challenge is complacency, where individuals become lax in adhering to safety protocols due to familiarity or a perceived sense of invincibility. Additionally, financial constraints may limit organizations' ability to invest in robust safety infrastructure or training programs, leaving employees vulnerable to hazards. Moreover, cultural attitudes and societal norms may influence people to prioritize convenience over safety, further exacerbating risks.

To promote a culture of safety, proactive measures and strategies are imperative. Organizations can prioritize safety by integrating it into their core values and establishing clear policies and procedures. This includes regular safety training for employees, conducting risk assessments, and implementing measures to mitigate identified hazards. Furthermore, fostering open communication channels where employees can voice safety concerns without fear of reprisal encourages a collective responsibility towards safety.

In conclusion, reflecting on health and safety underscores their fundamental importance in preserving life and well-being. By acknowledging the challenges and implementing proactive measures, individuals and organizations can create environments that prioritize safety, ultimately contributing to a healthier and safer society for all.

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The United States Occupational Safety and Health Act (OSHA) is a landmark piece of legislation aimed at ensuring safe and healthy working conditions for employees across various industries. Enacted in 1970, OSHA was a response to the alarming rates of workplace injuries, illnesses, and fatalities that were prevalent at the time. The primary objective of OSHA is to prevent workplace hazards by setting and enforcing standards, providing training, outreach, education, and assistance to both employers and employees. One of the key provisions of OSHA is the requirement for employers to provide a workplace free from recognized hazards that are causing or are likely to cause death or serious physical harm to employees. This includes ensuring that machinery and equipment are properly maintained, providing personal protective equipment (PPE) where necessary, and implementing safety protocols and procedures. By holding employers accountable for maintaining safe working environments, OSHA has played a crucial role in reducing workplace accidents and fatalities over the years. In addition to setting and enforcing safety standards, OSHA also provides training and educational resources to both employers and employees. This includes programs such as the OSHA Training Institute (OTI) Education Centers, which offer courses on various occupational safety and health topics. By empowering employers and employees with the knowledge and skills to identify and mitigate workplace hazards, OSHA helps to prevent accidents and injuries before they occur. Furthermore, OSHA promotes workplace safety through outreach and assistance programs designed to raise awareness and provide support to employers and employees. These programs include partnerships with industry associations, trade unions, and other organizations to develop best practices and promote a culture of safety in the workplace. By collaborating with stakeholders and fostering a collective commitment to safety, OSHA has been able to make significant strides in reducing workplace injuries and fatalities. In conclusion, the United States Occupational Safety and Health Act (OSHA) plays a vital role in protecting the health and safety of workers across the country. Through its comprehensive approach to preventing workplace hazards, enforcing safety standards, and providing training and support, OSHA has contributed to significant improvements in workplace safety over the past decades. However, ongoing efforts are needed to ensure that OSHA continues to adapt to emerging risks and challenges in the modern workplace....

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During my recent clinical experience in a mental health setting, I had the opportunity to witness firsthand the complexities and challenges faced by individuals struggling with various mental health conditions. One particular encounter that left a lasting impact on me was with a patient diagnosed with severe anxiety disorder. The patient, a young woman in her mid-20s, exhibited classic symptoms of anxiety, including restlessness, rapid heartbeat, and difficulty concentrating. As I observed her interactions with the healthcare team, it became clear to me the importance of empathy and understanding in providing effective care for individuals with mental health issues. In my role as a student observer, I was able to witness the collaborative efforts of the healthcare professionals in managing the patient's anxiety symptoms. The interdisciplinary team, consisting of psychiatrists, psychologists, nurses, and social workers, worked together to develop a comprehensive treatment plan tailored to the patient's specific needs. I learned the significance of a holistic approach to mental health care, where medication management, therapy sessions, and social support all play crucial roles in promoting recovery and well-being. Moreover, the clinical experience shed light on the stigma surrounding mental health disorders and the impact it has on patients' lives. Despite the advancements in mental health awareness, there is still a significant level of misunderstanding and discrimination towards individuals with psychiatric conditions. This experience reinforced the importance of destigmatizing mental health issues and promoting open discussions to create a more supportive and inclusive environment for those in need of help. In conclusion, my mental health clinical reflection has been a profound learning experience that has deepened my understanding of the complexities of mental health care. It has highlighted the importance of empathy, interdisciplinary collaboration, and destigmatization in providing effective support and treatment for individuals facing mental health challenges. Moving forward, I am committed to advocating for mental health awareness and working towards creating a more compassionate and understanding society for all individuals, especially those struggling with mental health issues....

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1.2 Explain The Main Point Of Health And Safety Policies And Procedures

Health and safety at work regulations are put in place to ensure the well-being of employees in the workplace. These regulations are designed to prevent accidents, injuries, and illnesses that may occur while on the job. Employers have a legal responsibility to provide a safe working environment for their employees and must comply with these regulations to avoid potential fines and legal consequences. One of the key aspects of health and safety at work regulations is the requirement for employers to conduct risk assessments. Risk assessments involve identifying potential hazards in the workplace and taking steps to eliminate or minimize them. This may include providing appropriate safety equipment, implementing safety procedures, and providing training to employees on how to safely perform their job duties. By conducting regular risk assessments, employers can proactively address potential safety issues before they result in accidents or injuries. Another important aspect of health and safety at work regulations is the requirement for employers to provide adequate training to employees. Training should cover topics such as how to use safety equipment, how to identify hazards, and what to do in case of an emergency. By ensuring that employees are properly trained, employers can help prevent accidents and injuries in the workplace. Additionally, training can empower employees to take an active role in maintaining a safe work environment and reporting any safety concerns to their employer. In conclusion, health and safety at work regulations play a crucial role in protecting the well-being of employees in the workplace. Employers must comply with these regulations to ensure that their employees are safe while on the job. By conducting risk assessments, providing adequate training, and implementing safety procedures, employers can create a safe work environment that reduces the risk of accidents and injuries. Ultimately, prioritizing health and safety at work benefits both employees and employers by promoting a culture of safety and well-being in the workplace....

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Reflective Account On Health And Social Care

Health and social care play pivotal roles in ensuring the well-being and quality of life for individuals within a community. Reflecting on my experiences within this field, I have come to appreciate the multifaceted nature of these services and the profound impact they have on individuals, families, and society as a whole. One aspect that stands out in my reflection is the importance of effective communication in health and social care settings. Clear and empathetic communication is essential for building trust and understanding between healthcare professionals, service users, and their families. Through my interactions with patients and their loved ones, I have learned the significance of active listening, non-verbal cues, and adapting communication styles to meet the diverse needs of individuals. Furthermore, my experiences have highlighted the critical role of collaboration and teamwork in delivering comprehensive care. In health and social care settings, interdisciplinary teams often work together to address the complex needs of patients, incorporating medical, psychological, and social interventions. Through collaborative efforts, professionals can leverage their unique expertise to provide holistic support and promote positive outcomes for service users. Another aspect of my reflection centers on the ethical considerations inherent in health and social care practice. As professionals, we are entrusted with the well-being and dignity of those under our care, and it is imperative to uphold ethical principles such as autonomy, beneficence, and justice. Reflecting on challenging situations, I have grappled with dilemmas related to informed consent, confidentiality, and resource allocation, underscoring the need for ethical decision-making frameworks and ongoing ethical reflection. Moreover, my experiences have deepened my understanding of the broader social determinants of health and their impact on individual health outcomes. Factors such as socioeconomic status, access to education, and cultural background significantly influence an individual's health and well-being. Recognizing these determinants underscores the importance of adopting a holistic and person-centered approach to care, addressing not only immediate health concerns but also underlying social and environmental factors. In conclusion, reflecting on my experiences in health and social care has reinforced my appreciation for the complexity and significance of this field. Effective communication, collaboration, ethical practice, and consideration of social determinants are essential components of providing high-quality care and promoting positive outcomes for individuals and communities. By continually reflecting on our practice and learning from experiences, we can strive to enhance the delivery of health and social care services, ultimately contributing to the well-being of society as a whole....

Reflection Paper On Health

Health is a multifaceted concept that encompasses physical, mental, and social well-being. It is not merely the absence of disease but rather a state of complete physical, mental, and social wellness. Throughout my life, my understanding of health has evolved, shaped by personal experiences, education, and societal influences. From a young age, I viewed health primarily in terms of physical fitness and absence of illness. I believed that as long as I didn't get sick, I was healthy. However, as I matured and gained more knowledge about health, I realized that it extends beyond the absence of disease. It involves nourishing the body with nutritious food, engaging in regular physical activity, and prioritizing mental well-being. I began to understand the importance of holistic health and how each aspect intertwines to contribute to overall wellness. As I navigated through various stages of life, I encountered challenges that tested my understanding of health. During times of stress and adversity, I learned the significance of mental resilience and coping mechanisms. I discovered the power of mindfulness practices, such as meditation and deep breathing, in managing stress and promoting mental clarity. These experiences reinforced the idea that health is not solely determined by physical factors but also by emotional and psychological resilience. Moreover, my interactions with diverse communities and exposure to different cultural perspectives broadened my understanding of health. I came to appreciate the role of social determinants, such as access to healthcare, socioeconomic status, and environmental factors, in shaping health outcomes. I recognized the importance of addressing systemic inequalities and advocating for policies that promote health equity for all individuals, regardless of their background or circumstances. In conclusion, reflecting on my journey with health, I have come to realize that it is a dynamic and interconnected aspect of life. It encompasses physical, mental, and social well-being, and is influenced by personal experiences, education, and societal factors. Embracing a holistic approach to health has empowered me to make informed choices, prioritize self-care, and advocate for health equity within my community. As I continue to evolve and learn, I am committed to nurturing my health and inspiring others to embark on their own journey towards holistic wellness....

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Reflective Practice in Health Care Essay

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Introduction

The description/ event, evaluation and analysis, recommendation and action plan.

Reflection refers to an approach used to comprehend the personal practice process nature, which results in escalated knowledge as well as proper application in healthcare work, which eradicates the chances for medical errors (Walker, 1996). Reflection allows a person to think about an action and through this way, engage in a continuous learning process (Hendricks, Mooney and Berry, 1996: 100). Therefore, reflective practice is the most key source of personal improvement and professional development. As a result, the concept has become popular globally (Price, 2004: 470).

An evidence-based tool of practice applies the best care a patient can afford. The principal goal of evidence-based practice is clinical expert opinion or expertise, caregiver/ patient/ client perspectives (Pattinson, 2011). For the purpose of this assignment, the Gibbs reflective model is vital. A summarized model will offer reflection guidance as structured in the six stages. The stages are; event or description, feeling or thoughts, evaluation, analysis, conclusion, and the action plan. This paper presents a case scenario where the practitioners involved in the care of the patient did not have effective communication, which impacted negatively on the patient. It also emphasizes the need for proper communication in health care.

Several years ago, as a senior anesthesia technician was just about to release an ODA for the lunch break, a boy who was approximately 5 years old and a pediatric cardiac patient was undergoing a dental clearance. After the dentist was thorough, the inhalation agent got terminated so as to allow the patient to recover prior to the removal of the endotracheal tube. The long extension set for intravenous use had already been closed as the short procedure was taking place. The boy began breathing again and tried to open his eyes. The reverse drugs were about to be given when the anesthetist requested the ODA to flush the intravenous line using 5ml of normal saline. However, the patient stopped breathing suddenly because of the boule that forced the residual muscle relaxant back into the patient. Consequently, the anesthetist began ventilating the patient, and it took approximately thirty minutes for the patient to recover. The patient did not experience considerable harm.

The shock was one of the feelings that overcame me first. The anesthetist was impatient in treating the patient and seemed to be in a hurry (Boud et al, 1985). He ought to have waited before flushing the intravenous line so as to avoid the formation of a boule, which forced the residual muscle relaxant back into the patient. Maybe he wanted to have finished all his duties before releasing the ODA for lunch. Moreover, there seemed to be miscommunication between the ODA and the anesthetist. Both of them should have deep knowledge of the process and, therefore, there should be no errors as was the case (Rolfe, Freshwater and Jasper, 2001). It was extremely sad to see the suffering young boy lying down. I was torn between many negative emotions; sorrow, pity, empathy, and blame on the healthcare professionals (Davies, 2012).

As mandated by healthcare policies and standards, I strongly feel that healthcare professionals should adhere to them to prevent adverse effects on patients (Pattinson, 2011). Professionals ought to realize that there are countless areas where there can be a resultant detrimental impact on the well-being of the patient if there is miscommunication or inadequate communication between providers (Walker, 1996).

In the mentioned occasion, the patient should have taken the residual muscle relaxant out first before flushing the intravenous vein with normal saline (Molyneux, 2001). The anesthetist seemed not to be patient enough. Moreover, the anesthetist went beyond his obligation’s limit by authorizing the ODP to flush without thinking of the repercussions (Schon, 1991). In essence, the anesthetist failed to adhere to the protocol expected during patient management (Mac Suibhne, 2009: 434). Regardless of how long healthcare professionals have been in practice, they should always realize that they are dealing with human life and, therefore, be extremely keen (Mann and Gordon, 2009: 617).

In my reflection, I realized that there are numerous issues that are preventable if there is proper and effective communication within the settings (Schon, 1991). These include drug reactions and interactions, increased care cost and hospitalization time, untimely medications and procedures, and inappropriate treatment. All these can be prevented if professionals adhere to the protocols of effective communication (Asper, 2003: 45). If the anesthetist and ODP were communicating effectively and were aware of the proper guidelines to follow, the patient would have recovered normally from the procedure done.

It is imperative for the anesthetist to be aware of his vital role in the patient’s life. Hence, he should have adhered to the set protocol, guidelines, and standards, and ensured effective and timely communication between himself and the ODP. Flushing the IV after muscle relaxation ensures the patient recovers normally (Mann and Gordon, 2009: 617). Healthcare research indicates that approximately eighty percent of all grave medical errors are a result of miscommunication (Price, 2004: 47). It has been noted that when handing over patients to other professionals for specialized procedures, there is always incomplete information handover (Schön, 1991). Moreover, healthcare professionals lack adequate time to discuss the patients’ issues in detail, which results in negative impacts on the patient (Brown et al, 2003: 40).

In my opinion, the anesthetist was not sufficiently accountable and responsible. A medical practitioner who is responsible and accountable enough has a keen interest in a patient’s outcome. In this case, the anesthetist was impatient, which almost led to detrimental effects on the patient. He ought to have been accountable and waited for the muscles to relax before administering the drug. On the same note, the anesthetist and ODP ought to have ensured that proper medication is given to the patient. Price (2004: 40) asserts that this is because giving a patient the wrong medication is unethical and can result in detrimental patient effects.

It is worth noting that ineffective communication goes with other human factors. For instance, there might be differences among the various departments (Molyneux, 2001: 30). When professionals from these departments meet for a procedure, grudges they hold against each other may result in the patient suffering. This is ethically unacceptable and contrary to the patient’s rights (Bolton, 2010). Moreover, it is imperative that professionals go through the guidelines of the procedures they are to perform. This reduces the chances of errors. According to Schön (1991), another ethical measure is to seek the client’s consent.

It is worth noting that many patients suffer as a result of the failure of healthcare professionals to adhere to effective communication. Mostly, healthcare professionals do not dedicate adequate and quality time to patients (Larrivee, 2000: 293). They perform most of the procedures in a hurry, which affects patients negatively (Mann & Gordon, 2009: 620). If the anesthetist was not in a hurry and dedicated to the patient’s result, he would have allowed adequate time before flushing the IV. This would have ensured that the patient responded successfully after the procedure.

Ineffective and inadequate communication has been reported to be the vital contributing factor to inadvertent patient harm and medical errors (Welsh Assembly Government, 2008). It does not only result in emotional and physical inconveniences to all those concerned but also adverse happenings, which are extremely costly. For instance, the resulting cost from medical errors in Victoria’s hospitals is approximately a billion dollars every year (Boud, Keogh & Walker, 1985: 34). It is worth noting that today, healthcare is extremely diverse and complex, and improving communication amidst professionals in healthcare would considerably support safe patient care delivery (Asper, 2003). It is extremely vital that managements in hospitals stimulate action and discussion, as well as raise awareness in regard to the units, divisions, and organizations where more teamwork and improved communication is essential (Brown et al, 2003). Mostly, ineffective communication is particularly the known cause that leads to sentinel events. Ineffective communication which is ambiguous, incomplete, inaccurate, untimely, and where the recipient does not comprehend clearly, increases the results and errors, for poor patient safety (Welsh Assembly Government, 2008).

There exists immense evidence linking poor and ineffective communication between teams in healthcare (Mac Suibhne, 2009: 430). The stated results are extremely negative patient impacts (Brown et al, 2003: 96). For instance, according to America’s Joint Commission, the key cause of more than seventy percent of sentinel occurrences is a communication failure. Moreover, America’s Veterans Affairs Department National Centre for Patient Safety acknowledges that failed communication in healthcare is the chief root foundation of seventy-five percent negative patient impacts (Leitch and Day, 2000: 157).

When the patient sees too many patients, miscommunication may result (Brown et al, 2003: 103). Usually, patients make efforts to ensure the best treatment choices (Larrivee, 2000: 293). However, the treating doctor may be unconcerned about other experts caring for the patient. In most cases, physicians are usually unaware that their patients are being treated for disease complications (Hendricks, Mooney & Berry, 1996: 100). The spectrum of poor communication included services and medication being duplicated, the patient being given more medication than is necessary, and wrong surgery sites (Asper, 2003).

The negative drug interaction is another potential danger. This is mostly because the patient is ignorant of the medication being given and may not identify cases of over medication. Such a situation threatens life and should be prevented at all costs (Boud, Keogh & Walker, 1985: 91). Patients also have a role to play in their health care. They have the right to ask questions and confirm procedures (Davies, 2012: 7).

In order to ensure such a case never repeats among ODPs and anesthetists, the case will be reported to the head of the department. Discussing it will ensure that all professionals handle their patients with extra keenness and that they follow procedures and guidelines well (Ministry of Justice, 2006). Consequently, it will be discussed during the monthly meeting of the department. During the meeting, all health care professionals will be present, including the ODP and anesthetist in mention. Both will be requested to elaborate on what and why it happened. This will be aimed at reviewing their role in every procedure (Leitch and Day, 2000: 154). Moreover, the anesthetist will have to apologize to the family and elaborate on the issue to them. This will ensure accountability. These grave measures will be geared towards ensuring that all patients receive adequate, timely, and proper treatment (McSherry, Pearce and Tingle, 2011).

According to Davies (2012, 10), the main reason for writing and addressing the incident in detail is to prevent and avoid such an occurrence again. It is vital that the ODA enquires and double checks every detail with the anesthetist. Moreover, all drugs and syringes should be labeled to avoid using the wrong ones on the patient. The anesthetist should be the only one who handles them to avoid confusion.

An incident like this happens often in the UK. According to the Health and Care Professions Council (HCPC), such a case happens 109 times annually (Brown et al, 2003: 96). There is, therefore, a need to address issues surrounding it so as to reduce its incidence and prevalence.

In my opinion, failure to dedicate adequate time for patient care and miscommunication are the key causes of this incident. Following the HPC guidelines would have prevented the incident from occurring (Ministry of Justice, 2006). In the mentioned case, an efficient leader who could adhere to the use of a checklist and the structured plan was absent. This would guarantee patient safety before conducting the anesthesia as recommended by WHO.

In the light of this discussion, health care professionals should be trained adequately to ensure their effective communication and accountable participation (McSherry, Pearce and Tingle, 2011). I recommend that a structured documentation checklist, good teamwork, effective communication be made the key targets for a quality improvement plan which ensures patient safety in all departments (Asper, 2003). The majority of hospitals’ managements are unaware of the miscommunication pervasiveness that exists (Davies, 2012: 11). Moreover, miscommunication goes unnoticed in many healthcare settings. Factors that affect the quality of communication are usually ignored, which results in detrimental health impacts on patients (Schön, 1983).

In order to ensure effective communication between healthcare teams, there is the need to consider intercultural communication between staff, the circumstances and content of communication, various discourse modes, presence of resources and opportunities for creating a common body of understanding, and linguistic and cultural distances (Welsh Assembly Government, 2008). The management should ensure strategies where all these are incorporated towards effective communication (Asper, 2003: 34).

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Brown, G et al, eds., 2003, Becoming an Advanced Health Practitioner, Butterworth Heinemann, Edinburgh.

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Reflections on safety

Recently, Safety Solutions magazine asked readers the question: "What do you think is the most important issue in workplace safety today?"- We received a huge number of responses - following are some of the editor's picks for the most useful answer to the question.

1 / Peter Goss

Safety in the workplace is all about identifying risks, and then managing those risks to avoid accidents and incidents. Workplaces that have high safety records do not necessarily have low risks in operations, and vice versa. High risk industries tend to appreciate the risks as the penalty for failure is often serious, or fatal.

The common thread that holds workplaces that have excellent safety performance records together is a management commitment to the safety system. Without management commitment, any safety system will be doomed to failure.

The trend in workplaces is that the workers in the workplace are becoming more casual and the use of labour hire firms is increasing. The crew of workers on site this month may not be the same as next month.

An induction program introduces workers to hazards and risks specific to the workplace and how the workplace manages those risks (eg, site rules and procedures). It sets the standard to which people are expected to work. With the ongoing casualisation of the work-force, management must understand that workers may work at several workplaces and that, if not inducted properly and managed and supervised properly, they may make incorrect assumptions and open themselves up to increased risk.

While it is easy to overlook subcontractor safety, casuals and subcontractors are stake-holders in the safety management system which must be managed and controlled properly. The most important issue in workplace safety is ensuring that as workplaces become more casualised, all stakeholders properly understand the risks of the industry and the site and that their understanding is continually verified.

2 / Bruce Fraser

I believe the most important issue in workplace safety today is simply the role each individual plays in whatever work/ob that is being carried out at the time.

Let me explain myself more clearly:

While we can institute legal and financial responsibilities on each individual for their actions during their work function, this still does not guarantee a safe work environment.

All workplaces are faced with similar safety considerations, the main difference being the methods used to complete the task at hand.

The only way to guarantee the highest level of safe operation at work is through the roles of each individual, backed up with a large helping of trust in a person's skills and abilities. Ultimately this means everyone being responsible for their own actions with the emphasis being on the completion of the task at hand safely and effectively.

Easy to say, you may think, however, also easy to do, with a bit of planning, education, and a solid set of standards and values, which are instituted and repeated regularly for all situations. It would be unfair to ask anyone to carry out a task effectively and safely if that person did not have all the tools to complete said task, and by tools I don't just mean spanners etc.

So, is it not fair then to expect a safe work ethic if proper preparation is undertaken?

There are so many clichés, adages, and proverbs about this situation that some of these thoughts must be true, however mundane and simple they sound. After all, they were written based on other peoples' actual experiences.

A simple solution to a largely complex problem?

3 / Jon Hilder

In my opinion the most important issue in workplace safety today is the behaviour or attitude of employees. This can range from good, bad or indifferent behaviour caused by a number of factors and not limited to such things as the working environment, the home environment and the people themselves. There is more and more pressure placed on employees to produce more and compete to the highest level that this can potentially cause stress and fatigue in some people.

They may have problems in their home environment and be experiencing trauma from marriage breakdown, custody issues or loss of loved ones.

Others may see safety as someone else's responsibility and will not participate unless there is "something in it for them".

Employees need to be motivated to change and the culture of risk-taking behaviour is influenced by the pressure of performance and an "it will never happen to me" attitude.

With all that has been said and done about attitude and behaviour, if the employee does not want to change his/her behaviour, as soon as they are out of site they will revert back to their old ways. It has been recorded where employees working long hours or nights have not intentionally done something outside of their normal behaviour but, without thinking, have placed themselves in a position where they have been injured.

To overcome these inherent risk-taking behaviours, management need to promote safety leadership by example, promote safety training and competencies of all employees and actively seek participation by employees in safety management of their workplaces.

Once these issues have been addressed and only then will employees embrace a safety culture and instinctively perform their tasks with a safety attitude.

4 / Mike Carter

An organisation can have in place all the appropriate regulatory measures, provide the appropriate tools and equipment for workplace safety, but at the end of the day these safety practices and management tools are part of everyone's job description.

To get through to the employee that it is their own personal responsibility to identify and correct hazards, wear the correct protective equipment, and that the safety committee is to be respected is probably the biggest hurdle today. The culture that can exist among employees of "I'm bulletproof" or "She'll be right" needs to be dissuaded by rewarding them for identifying potential or existing hazards and coming up with the appropriate preventative and corrective actions, whilst on the other hand enforcing the rules when the rules are ignored. At the end of the day, when unsafe work practices take place or hazard identification is ignored it's not just themselves that may have put at risk but others also and the consequences may have many ongoing effects on business and personal fronts for weeks, months, even years to come. "Effective safety starts between your ears, and not with your hands."

5 / Geoff Field

In my opinion, the most important issue in workplace safety today is a combination of awareness and responsibility. Most incidents are due to someone not doing the right thing, and this is often because they're (a) not aware that what they're doing is wrong, or (b) not taking responsibility for what they're doing. Everyone needs to switch their brains on and take charge of their lives.

6 / Jason Zealley

The most important issue in the workplace today would be working at heights, it affects almost every industry whether it's loading trucks at Safeway or working on housing.

There is a huge cost for all industries, I myself am a safety coordinator for a large construction company with over 300 employees and many sites to control and the biggest issue is trying to teach the old new ways.

Where the new can't see the risks and the consequences of falling more than 2 metres and turn a blind eye against their own personal safety and importantly other co-workers.

There is no tool out to teach personnel from these dangers, there are regulations but try to explain that in ways your personnel on-site understand, it's hard where they sign your work procedures in which they help to format - I just make it sound with the use of safety terms.

When these new regulations came about last year everyone could see they were necessary in some industries but what weren't thought about were what the effects would be and what was practicable and what was not. Anyway this is one of many concerns I have and I see in our everyday working environment.

7 / David Callander

As an Occupational Health and Safety co-ordinator for a workforce of 122 employees, being made up of both permanent and casual staff, that cover an area approximately 22,000 sq kilometres, I believe that one of the most important issues affecting OH&S is education.

Council workers are called upon to provide a large and varied range of tasks and through proper and effective education programs, the tasks are performed efficiently and safely.

A good education program not only enforces the importance of safety at the work sites, it also gives the workers the knowledge of their rights, ownership of theirs and their fellow workers' safety, security in the knowledge that the employer knows the benefits of providing a safe work environment, both for the employer and the employee.

Through regular updates and in-service education programs, the workers are also kept informed of current best practise and any changes in the industry.

Employees who understand and practise good risk management, are receptive to new ideas, change from the old habits to best practise, are keen to continue learning, make the life of an OH&S Coordinator a little easier. Education is the only way. Waiting to learn from mistakes is not an option.

8 / Craig Brogan

In my opinion we need to combat the area of complacency. It can be found in all areas of work no matter what the industry. You will find that where people regularly do the same task they will have less of an attention span to the task at hand, they assume that because they have been doing the same job for a period of time they know all of the dangers involved and as such are blind to the probability of the unforeseen circumstance arising.

Also when they train others in the same task they do not take a look at the whole picture and will invariably leave out important safety factors.

Example of complacency - a boilermaker or fitter will use safety glasses to grind a piece of steel in preparation for work, they then remove their safety glasses to have a closer inspection of the job and they find a small area that requires touching up with the grinder, they then use the grinder without safety glasses thinking "It's only a small area and shouldn't take long." Result - foreign body in eye.

We have a program at work where the employees sign a toolbox meeting sheet every morning, we regularly move the names around so that they have to look for their names prior to signing, thus showing them that things can change without their knowledge.

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A complete guide to writing a reflective essay

(Last updated: 3 June 2024)

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We have helped 10,000s of undergraduate, Masters and PhD students to maximise their grades in essays, dissertations, model-exam answers, applications and other materials. If you would like a free chat about your project with one of our UK staff, then please just reach out on one of the methods below.

“The overwhelming burden of writing my first ever reflective essay loomed over me as I sat as still as a statue, as my fingers nervously poised over the intimidating buttons on my laptop keyboard. Where would I begin? Where would I end? Nerve wracking thoughts filled my mind as I fretted over the seemingly impossible journey on which I was about to embark.”

Reflective essays may seem simple on the surface, but they can be a real stumbling block if you're not quite sure how to go about them. In simple terms, reflective essays constitute a critical examination of a life experience and, with the right guidance, they're not too challenging to put together. A reflective essay is similar to other essays in that it needs to be easily understood and well structured, but the content is more akin to something personal like a diary entry.

In this guide, we explore in detail how to write a great reflective essay , including what makes a good structure and some advice on the writing process. We’ve even thrown in an example reflective essay to inspire you too, making this the ultimate guide for anyone needing reflective essay help.

Types of Reflection Papers

There are several types of reflective papers, each serving a unique purpose. Educational reflection papers focus on your learning experiences, such as a course or a lecture, and how they have impacted your understanding. Professional reflection papers often relate to work experiences, discussing what you have learned in a professional setting and how it has shaped your skills and perspectives. Personal reflection papers delve into personal experiences and their influence on your personal growth and development.

Each of these requires a slightly different approach, but all aim to provide insight into your thoughts and experiences, demonstrating your ability to analyse and learn from them. Understanding the specific requirements of each type can help you tailor your writing to effectively convey your reflections.

Reflective Essay Format

In a reflective essay, a writer primarily examines his or her life experiences, hence the term ‘reflective’. The purpose of writing a reflective essay is to provide a platform for the author to not only recount a particular life experience, but to also explore how he or she has changed or learned from those experiences. Reflective writing can be presented in various formats, but you’ll most often see it in a learning log format or diary entry. Diary entries in particular are used to convey how the author’s thoughts have developed and evolved over the course of a particular period.

The format of a reflective essay may change depending on the target audience. Reflective essays can be academic, or may feature more broadly as a part of a general piece of writing for a magazine, for instance. For class assignments, while the presentation format can vary, the purpose generally remains the same: tutors aim to inspire students to think deeply and critically about a particular learning experience or set of experiences. Here are some typical examples of reflective essay formats that you may have to write:

A focus on personal growth:

A type of reflective essay often used by tutors as a strategy for helping students to learn how to analyse their personal life experiences to promote emotional growth and development. The essay gives the student a better understanding of both themselves and their behaviours.

A focus on the literature:

This kind of essay requires students to provide a summary of the literature, after which it is applied to the student’s own life experiences.

Pre-Writing Tips: How to Start Writing the Reflection Essay?

As you go about deciding on the content of your essay, you need to keep in mind that a reflective essay is highly personal and aimed at engaging the reader or target audience. And there’s much more to a reflective essay than just recounting a story. You need to be able to reflect (more on this later) on your experience by showing how it influenced your subsequent behaviours and how your life has been particularly changed as a result.

As a starting point, you might want to think about some important experiences in your life that have really impacted you, either positively, negatively, or both. Some typical reflection essay topics include: a real-life experience, an imagined experience, a special object or place, a person who had an influence on you, or something you have watched or read. If you are writing a reflective essay as part of an academic exercise, chances are your tutor will ask you to focus on a particular episode – such as a time when you had to make an important decision – and reflect on what the outcomes were. Note also, that the aftermath of the experience is especially important in a reflective essay; miss this out and you will simply be storytelling.

What Do You Mean By Reflection Essay?

It sounds obvious, but the reflective process forms the core of writing this type of essay, so it’s important you get it right from the outset. You need to really think about how the personal experience you have chosen to focus on impacted or changed you. Use your memories and feelings of the experience to determine the implications for you on a personal level.

Once you’ve chosen the topic of your essay, it’s really important you study it thoroughly and spend a lot of time trying to think about it vividly. Write down everything you can remember about it, describing it as clearly and fully as you can. Keep your five senses in mind as you do this, and be sure to use adjectives to describe your experience. At this stage, you can simply make notes using short phrases, but you need to ensure that you’re recording your responses, perceptions, and your experience of the event(s).

Once you’ve successfully emptied the contents of your memory, you need to start reflecting. A great way to do this is to pick out some reflection questions which will help you think deeper about the impact and lasting effects of your experience. Here are some useful questions that you can consider:

• What have you learned about yourself as a result of the experience?
• Have you developed because of it? How?
• Did it have any positive or negative bearing on your life?
• Looking back, what would you have done differently?
• Why do you think you made the particular choices that you did? Do you think these were the right choices?
• What are your thoughts on the experience in general? Was it a useful learning experience? What specific skills or perspectives did you acquire as a result?

These signpost questions should help kick-start your reflective process. Remember, asking yourself lots of questions is key to ensuring that you think deeply and critically about your experiences – a skill that is at the heart of writing a great reflective essay.

Consider using models of reflection (like the Gibbs or Kolb cycles) before, during, and after the learning process to ensure that you maintain a high standard of analysis. For example, before you really get stuck into the process, consider questions such as: what might happen (regarding the experience)? Are there any possible challenges to keep in mind? What knowledge is needed to be best prepared to approach the experience? Then, as you’re planning and writing, these questions may be useful: what is happening within the learning process? Is the process working out as expected? Am I dealing with the accompanying challenges successfully? Is there anything that needs to be done additionally to ensure that the learning process is successful? What am I learning from this? By adopting such a framework, you’ll be ensuring that you are keeping tabs on the reflective process that should underpin your work.

How to Strategically Plan Out the Reflective Essay Structure?

Here’s a very useful tip: although you may feel well prepared with all that time spent reflecting in your arsenal, do not, start writing your essay until you have worked out a comprehensive, well-rounded plan . Your writing will be so much more coherent, your ideas conveyed with structure and clarity, and your essay will likely achieve higher marks.

This is an especially important step when you’re tackling a reflective essay – there can be a tendency for people to get a little ‘lost’ or disorganised as they recount their life experiences in an erratic and often unsystematic manner as it is a topic so close to their hearts. But if you develop a thorough outline (this is the same as a ‘plan’) and ensure you stick to it like Christopher Columbus to a map, you should do just fine as you embark on the ultimate step of writing your essay. If you need further convincing on how important planning is, we’ve summarised the key benefits of creating a detailed essay outline below:

An outline allows you to establish the basic details that you plan to incorporate into your paper – this is great for helping you pick out any superfluous information, which can be removed entirely to make your essay succinct and to the point.

Think of the outline as a map – you plan in advance the points you wish to navigate through and discuss in your writing. Your work will more likely have a clear through line of thought, making it easier for the reader to understand. It’ll also help you avoid missing out any key information, and having to go back at the end and try to fit it in.

It’s a real time-saver! Because the outline essentially serves as the essay’s ‘skeleton’, you’ll save a tremendous amount of time when writing as you’ll be really familiar with what you want to say. As such, you’ll be able to allocate more time to editing the paper and ensuring it’s of a high standard.

Now you’re familiar with the benefits of using an outline for your reflective essay, it is essential that you know how to craft one. It can be considerably different from other typical essay outlines, mostly because of the varying subjects. But what remains the same, is that you need to start your outline by drafting the introduction, body and conclusion. More on this below.

Introduction

As is the case with all essays, your reflective essay must begin within an introduction that contains both a hook and a thesis statement. The point of having a ‘hook’ is to grab the attention of your audience or reader from the very beginning. You must portray the exciting aspects of your story in the initial paragraph so that you stand the best chances of holding your reader’s interest. Refer back to the opening quote of this article – did it grab your attention and encourage you to read more? The thesis statement is a brief summary of the focus of the essay, which in this case is a particular experience that influenced you significantly. Remember to give a quick overview of your experience – don’t give too much information away or you risk your reader becoming disinterested.

Next up is planning the body of your essay. This can be the hardest part of the entire paper; it’s easy to waffle and repeat yourself both in the plan and in the actual writing. Have you ever tried recounting a story to a friend only for them to tell you to ‘cut the long story short’? They key here is to put plenty of time and effort into planning the body, and you can draw on the following tips to help you do this well:

Try adopting a chronological approach. This means working through everything you want to touch upon as it happened in time. This kind of approach will ensure that your work is systematic and coherent. Keep in mind that a reflective essay doesn’t necessarily have to be linear, but working chronologically will prevent you from providing a haphazard recollection of your experience. Lay out the important elements of your experience in a timeline – this will then help you clearly see how to piece your narrative together.

Ensure the body of your reflective essay is well focused and contains appropriate critique and reflection. The body should not only summarise your experience, it should explore the impact that the experience has had on your life, as well as the lessons that you have learned as a result. The emphasis should generally be on reflection as opposed to summation. A reflective posture will not only provide readers with insight on your experience, it’ll highlight your personality and your ability to deal with or adapt to particular situations.

In the conclusion of your reflective essay, you should focus on bringing your piece together by providing a summary of both the points made throughout, and what you have learned as a result. Try to include a few points on why and how your attitudes and behaviours have been changed. Consider also how your character and skills have been affected, for example: what conclusions can be drawn about your problem-solving skills? What can be concluded about your approach to specific situations? What might you do differently in similar situations in the future? What steps have you taken to consolidate everything that you have learned from your experience? Keep in mind that your tutor will be looking out for evidence of reflection at a very high standard.

Congratulations – you now have the tools to create a thorough and accurate plan which should put you in good stead for the ultimate phase indeed of any essay, the writing process.

Step-by-Step Guide to Writing Your Reflective Essay

As with all written assignments, sitting down to put pen to paper (or more likely fingers to keyboard) can be daunting. But if you have put in the time and effort fleshing out a thorough plan, you should be well prepared, which will make the writing process as smooth as possible. The following points should also help ease the writing process:

• To get a feel for the tone and format in which your writing should be, read other typically reflective pieces in magazines and newspapers, for instance.
• Don’t think too much about how to start your first sentence or paragraph; just start writing and you can always come back later to edit anything you’re not keen on. Your first draft won’t necessarily be your best essay writing work but it’s important to remember that the earlier you start writing, the more time you will have to keep reworking your paper until it’s perfect. Don’t shy away from using a free-flow method, writing and recording your thoughts and feelings on your experiences as and when they come to mind. But make sure you stick to your plan. Your plan is your roadmap which will ensure your writing doesn’t meander too far off course.
• For every point you make about an experience or event, support it by describing how you were directly impacted, using specific as opposed to vague words to convey exactly how you felt.
• Write using the first-person narrative, ensuring that the tone of your essay is very personal and reflective of your character.
• If you need to, refer back to our notes earlier on creating an outline. As you work through your essay, present your thoughts systematically, remembering to focus on your key learning outcomes.
• Consider starting your introduction with a short anecdote or quote to grasp your readers’ attention, or other engaging techniques such as flashbacks.
• Choose your vocabulary carefully to properly convey your feelings and emotions. Remember that reflective writing has a descriptive component and so must have a wide range of adjectives to draw from. Avoid vague adjectives such as ‘okay’ or ‘nice’ as they don’t really offer much insight into your feelings and personality. Be more specific – this will make your writing more engaging.
• Be honest with your feelings and opinions. Remember that this is a reflective task, and is the one place you can freely admit – without any repercussions – that you failed at a particular task. When assessing your essay, your tutor will expect a deep level of reflection, not a simple review of your experiences and emotion. Showing deep reflection requires you to move beyond the descriptive. Be extremely critical about your experience and your response to it. In your evaluation and analysis, ensure that you make value judgements, incorporating ideas from outside the experience you had to guide your analysis. Remember that you can be honest about your feelings without writing in a direct way. Use words that work for you and are aligned with your personality.
• Once you’ve finished learning about and reflecting on your experience, consider asking yourself these questions: what did I particularly value from the experience and why? Looking back, how successful has the process been? Think about your opinions immediately after the experience and how they differ now, so that you can evaluate the difference between your immediate and current perceptions. Asking yourself such questions will help you achieve reflective writing effectively and efficiently.
• Don’t shy away from using a variety of punctuation. It helps keeps your writing dynamic! Doesn’t it?
• If you really want to awaken your reader’s imagination, you can use imagery to create a vivid picture of your experiences.
• Ensure that you highlight your turning point, or what we like to call your “Aha!” moment. Without this moment, your resulting feelings and thoughts aren’t as valid and your argument not as strong.
• Don’t forget to keep reiterating the lessons you have learned from your experience.

Bonus Tip - Using Wider Sources

Although a reflective piece of writing is focused on personal experience, it’s important you draw on other sources to demonstrate your understanding of your experience from a theoretical perspective. It’ll show a level of analysis – and a standard of reliability in what you’re claiming – if you’re also able to validate your work against other perspectives that you find. Think about possible sources, like newspapers, surveys, books and even journal articles. Generally, the additional sources you decide to include in your work are highly dependent on your field of study. Analysing a wide range of sources, will show that you have read widely on your subject area, that you have nuanced insight into the available literature on the subject of your essay, and that you have considered the broader implications of the literature for your essay. The incorporation of other sources into your essay also helps to show that you are aware of the multi-dimensional nature of both the learning and problem-solving process.

Reflective Essay Example

If you want some inspiration for writing, take a look at our example of a short reflective essay , which can serve as a useful starting point for you when you set out to write your own.

Some Final Notes to Remember

To recap, the key to writing a reflective essay is demonstrating what lessons you have taken away from your experiences, and why and how you have been shaped by these lessons.

The reflective thinking process begins with you – you must consciously make an effort to identify and examine your own thoughts in relation to a particular experience. Don’t hesitate to explore any prior knowledge or experience of the topic, which will help you identify why you have formed certain opinions on the subject. Remember that central to reflective essay writing is the examination of your attitudes, assumptions and values, so be upfront about how you feel. Reflective writing can be quite therapeutic, helping you identify and clarify your strengths and weaknesses, particularly in terms of any knowledge gaps that you may have. It’s a pretty good way of improving your critical thinking skills, too. It enables you to adopt an introspective posture in analysing your experiences and how you learn/make sense of them.

If you are still having difficulties with starting the writing process, why not try mind-mapping which will help you to structure your thinking and ideas, enabling you to produce a coherent piece. Creating a mind map will ensure that your argument is written in a very systematic way that will be easy for your tutor to follow. Here’s a recap of the contents of this article, which also serves as a way to create a mind map:

1. Identify the topic you will be writing on.

2. Note down any ideas that are related to the topic and if you want to, try drawing a diagram to link together any topics, theories, and ideas.

3. Allow your ideas to flow freely, knowing that you will always have time to edit your reflective essay .

4. Consider how your ideas are connected to each other, then begin the writing process.

And finally, keep in mind that although there are descriptive elements in a reflective essay, we can’t emphasise enough how crucial it is that your work is critical, analytical, and adopts a reflective posture in terms of your experience and the lessons you have learned from it.

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Students’ reflections on the relationships between safe learning environments, learning challenge and positive experiences of learning in a simulated GP clinic

• Published: 08 May 2015
• Volume 21 , pages 63–77, ( 2016 )

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• J. E. Young 1 ,
• M. I. Williamson 1 &
• T. G. Egan 2  

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Learning environments are a significant determinant of student behaviour, achievement and satisfaction. In this article we use students’ reflective essays to identify key features of the learning environment that contributed to positive and transformative learning experiences. We explore the relationships between these features, the students’ sense of safety in the learning environment (LE), the resulting learning challenge with which they could cope and their positive reports of the experience itself. Our students worked in a unique simulation of General Practice, the Safe and Effective Clinical Outcomes clinic, where they consistently reported positive experiences of learning. We analysed 77 essays from 2011 and 2012 using an immersion/crystallisation framework. Half of the students referred to the safety of the learning environment spontaneously. Students described deep learning experiences in their simulated consultations. Students valued features of the LE which contributed to a psychologically safe environment. Together with the provision of constructive support and immediate, individualised feedback this feeling of safety assisted students to find their own way through clinical dilemmas. These factors combine to make students feel relaxed and able to take on challenges that otherwise would have been overwhelming. Errors became learning opportunities and students could practice purposefully. We draw on literature from medical education, educational psychology and sociology to interpret our findings. Our results demonstrate relationships between safe learning environments, learning challenge and powerful learning experiences, justifying close attention to the construction of learning environments to promote student learning, confidence and motivation.

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Reflecting on what? The difficulty of noticing formative experiences in the moment

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Acknowledgements

We are grateful for a University of Otago, Committee for the Advancement of Learning and Teaching Grant in 2012. We wish to thank the students for their insights and permitting us to use their essays, SECO teachers Jim Ross, Kristin Kenrick, Peter Radue, Tom Swire and administrator Frances Dawson for their work in running the SECO clinic. Thank you to Associate Professor Chrystal Jaye and Jim Ross for their advice in the early stages of the project. We are grateful to the reviewers for their comments on an earlier version of this paper.

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Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand

J. E. Young & M. I. Williamson

Faculty of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

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Correspondence to J. E. Young .

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Young, J.E., Williamson, M.I. & Egan, T.G. Students’ reflections on the relationships between safe learning environments, learning challenge and positive experiences of learning in a simulated GP clinic. Adv in Health Sci Educ 21 , 63–77 (2016). https://doi.org/10.1007/s10459-015-9611-3

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Received : 02 July 2014

Accepted : 23 April 2015

Published : 08 May 2015

Issue Date : March 2016

DOI : https://doi.org/10.1007/s10459-015-9611-3

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Reflecting on Safety

Assessing safety programs then and now.

By Gary A. Higbee, EMBA, CSP

How good is your safety program? Twenty years ago, I set out to answer that question by identifying five stages an organization passes through on its way to world class safety performance. I’ve seen a lot in 20 years and I’ve since refined my answer. Here’s what I said back then.

Evaluating Safety Performance

Determining the quality of your safety program is a lot trickier than it might appear. Some people think it’s a numbers game. They think if there aren’t a lot of injuries and illnesses, then the program must be good. If there are a lot of injuries and illnesses, then the program must be bad.

If only things were that simple! Equating the number of accidents and illnesses with the quality of the safety program is confusing cause and effect. It also overlooks the role of luck—good and bad—in workplace safety.

The journey to attaining world class safety performance starts with a clear understanding of:

• Where you have been
• Where you are today, and
• Where you are going if nothing changes.

When you understand these things, you can determine the changes you need to make and the path to take to achieve your goal.

Then—Five Stages of a ‘Good’ Safety Program

Where is your program right now? There are five stages that organizations pass through. (Some organizations go through a combination of two at the same time):

Stage 1: Realization

This stage is marked by high injury rates and workers’ compensation costs. Employees are at high risk of injury and the company at high risk of liability. The direct costs of lost time injuries eat away at profitability. All of these factors exert pressure on management to “do something.” Audits are conducted to identify areas most in need of improvement.

Stage 2: Traditional

In this stage, companies make it a priority to develop policies and procedures. This is also when the education process begins. As yet, the organization has had no success in changing behaviors. Employees and management continue to do what’s convenient without regard for safety. Steps taken to identify and address hazardous conditions have resulted in higher production and overhead costs. Machine maintenance and repair, shielding and guarding derive from a reactive—“we’ll fix it when it’s broken”—approach by management. Employees are still at high risk of injury but the company’s liability risks have probably been reduced since obvious compliance problems have likely been addressed and workers’ comp precludes employees from suing the company for their injuries.

Stage 3: Observation

During this stage, management initiates an observationbased safety program in addition to the traditional program. Management is driving the improvement process with little to no employee involvement. Managers spend more time on the production floor or the worksite “observing” for hazards. Compliance is at the forefront of their minds and better documentation and recordkeeping are a priority.

Stage 4: Empowerment

Management and employees now share responsibility for assessing risks and preventing injuries. There’s joint accountability in the education process. Employees have gained confidence in the management group and believe that safety is a core value of the organization. Employees drive improvement and are committed to company goals. Injuries fall. Employee observations have increased awareness of risk factors resulting in the development of ‘habit strength’ for effective safe behaviors. The gains made in safety are improving the company’s financial performance. The company has gained a competitive advantage because the decline in lost time injuries has freed up resources for allocation to other parts of the business. Consequently, productivity and quality improve.

Stage 5: Utopia

The company’s safety culture is self-sustaining and developing. Employees are looking out for each other and peer-to-peer safety interventions are a normal part of the operation. The company is progressive in its approach to safety and has become a benchmark by which other companies in the industry measure their own safety performance.

Now—The Weak Link of a Safety Program

Back to the present. As I noted above, I wrote this essay about 20 years ago. I’ve learned a lot since then. While I still believe in the five stages of progression, I now realize that my analysis wasn’t complete. I’ll explain what that missing aspect was when I present my “mature” view of how to access a safety program.

The refinements I mention relate principally to the fourth stage: Empowerment. As you recall, that’s the stage when management and employees share responsibility for risk assessment and injury prevention. This is also the point at which employees have become aware of risk factors and developed “habit strength” for effective safe behaviors.

When I first described this stage, I made a misjudgment about “habit strength.” More precisely, I made an assumption that I now realize is flawed. Under normal situations, habit strength does result in safe behaviors. But what I failed to recognize is that this isn’t always true and that safe habits break down when individuals are under stress.

A Moment of Revelation

This bit of wisdom first struck me when I was performing an audit at a manufacturing facility. I was observing a forklift operator who I knew was particularly good at his craft. He always wore his seatbelt and never set a load at the production line without clearing the employees. When he entered a trailer at the loading dock he always inspected the trailer and assured the wheels were caulked. He just did everything right.

In the afternoon, I noticed some extra activity on the production line. The line was going down because of a missing part that was stored outside in a trailer that was stuck in the snow. The assembly line employees were incentive workers and they didn’t want the line to go down because it would cost them money.

Just 30 seconds before the line was to go down, the truck was freed from the snow and backed to the dock. The same forklift driver that I had admired for his impeccable work and safety habits jumped onto his forklift, drove into the trailer and got the load. He placed the load on the line and everyone cheered.

The problem was he didn’t fasten his seatbelt, the trailer was not caulked and if the truck driver had pulled forward to reset the trailer, who knows what might have happened. The forklift operator’s habit strength was lost in an instant.

My Revised Viewpoint—From 5 Stages to 3 Attributes

This incident gave me pause and caused me to rethink. The many safety programs I have observed over the years have had the same effect. The product of this is a more mature and simplified theory.

My theory has morphed from five stages to three attributes. In other words, there are three attributes that all world-class safety programs have. Now, I judge the effectiveness of a safety program by determining if it has those attributes:

1. Traditional Safety Program

Yes, I still believe you must have a strong traditional safety program. This includes written programs, policies and procedures and ensuring that these policies and procedures are followed. You can assess your own traditional safety program by auditing them to set standards. You can do this internally or use an outside auditor. It’s a simple way to look at what you say you’re doing and see if you are actually doing it. Most of us have a lot of work to do just to get our traditional programs up to snuff.

2. Observation Programs

This is a combination of the observation and empowerment stages from the five stages theory. Companies with first-rate safety programs have an observation process to watch for at-risk behaviors. It’s not an audit program, but a behavioral observation process that involves both employees and management. There needs to be teamwork.

Workers on the floor are encouraged to perform safety observations on a peer-to-peer basis. They’re also encouraged to accompany the supervisor and safety director on their rounds. What are they looking for? Three things:

• Whether workers know how to do their jobs
• Whether workers have the tools necessary to perform their tasks safely
• Whether there are any gaps in the system.

Workers observed committing at-risk behaviors are not disciplined, but engaged in discussion whose purpose is to correct the observed at-risk behavior.

With an observation program, you’re reinforcing safe behaviors and intervening when at-risk behaviors are observed. This process develops ‘habit strength.’

3. Advanced Training

We wouldn’t expect a person who’s never played golf before to read a golf rulebook and suddenly become a pro. We understand that the person would have to be taught about the game and shown how to play it.

It’s the same with employees. Employees need advanced safety skills and safety awareness training. In order for the traditional and observation programs to be successful, employees must be taught the skills that will keep them safe when the system breaks down. They need practical, relevant and easy-to-understand skills to manage themselves effectively. Without this, the system will continue to fail under stress, because some will lose the habit strength.

This recognition is what was missing from my original five stages theory.

After 20 years, I still believe that world-class safety performance is not just the dream of some wide-eyed college graduate or recently appointed safety manager. It is a very attainable goal. But it takes a commitment to have a strong traditional safety program, an ongoing observation program to catch gaps and advanced safety skills and safety awareness training for all employees.

Gary A. Higbee is a Certified Safety Professional and has an MBA from the University of Iowa. He worked for over 32 years for John Deere & Company where he held assignments in safety, environmental, production and engineering. He has earned numerous awards, including the 2010 Distinguished Service to Safety Award and the Gary Hawk Safety Award. With over 45 years of experience, Gary has become an internationally recognized speaker on safety, health, environmental and business issues.

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Reflective Essay Examples

50 best reflective essay examples (+topic samples).

If you have ever read reflective essay examples, you would know that these types of written works examine the writer’s life experiences . When you write a reflective paper example, you write about your own experiences and explore how you’ve changed, grown or developed because of those experiences. There’s no standard format for this essay as it may vary depending on the target audience.

Table of Contents

• 1 Reflective Essay Examples
• 2 What is a reflective essay?
• 3 Reflective Paper Examples
• 4 Format of reflective essay
• 5 Creating the outline of reflective essay examples
• 6 Reflective Paper Samples
• 7 Tips for writing reflective essay
• 8 Reflective Essay Samples

What is a reflective essay?

A reflective essay is a type of written work which reflects your own self. Since it’s about yourself, you already have a topic to write about. For reflective essay examples, readers expect you to evaluate a specific part of your life. To do this, you may reflect on emotions, memories, and feelings you’ve experienced at that time.

Since you’re writing reflection essay samples about yourself, make sure that they’re interesting and exciting. This is very important so that your readers don’t get bored with what you’ve written. Reflective essays are very personal thus, they’re a special type of essay. As you write one, you need to reflect, think, and explain.

In the essay, you should demonstrate and describe different feelings or emotions which you’ve felt in the past. These statements breathe life into your essay as your readers start picturing what you’ve written in their minds. Reflective essays are very honest, personal, and emotional, especially those which describe painful experiences.

Reflective Paper Examples

Format of reflective essay

As aforementioned, reflective essay examples don’t have a standard format. They seem easy enough to write but once you’ve sat down to start writing, you may suddenly find the task very challenging! Besides the format, you must think about the life experience you want to write about and remember everything about it.

A reflective paper example is a lot like a personal journal or diary. Of course, the difference is that other people will read your essay. Therefore, you must write it with good structure and coherence. In this regard, reflective essays are a lot like the other types of essays too.

When writing a reflective essay, you will have to examine your own life experiences. The purpose of writing such an essay is to provide yourself with a platform to share your most meaningful life experiences with other people. You can also use it as a way to explore how your experiences have changed you as a person.

You can present reflective writing in different formats. Most of the time though, people use a learning log or a diary entry format. You can use these formats and others. Just make sure that your essay has a good flow and that it’s easy for other readers to understand.

The format to use for your reflection essay samples would depend on your target audience. You can make an academic reflective essay or you can make it as a general and informal piece of writing. If you need to write the essay for a class assignment, follow the format given to you by your teacher.

No matter what format you choose, you may write an essay which:

• Focuses on your personal growth Such an essay helps you learn how to evaluate and analyze the experiences you have had in your personal life. This helps promote emotional development and growth. It also helps you understand yourself and your behaviors better.
• Focuses on literature For this type of essay, you may have to include references to literature and apply these to your own life experiences. Such essays are commonly given as assignments to students in school.

Creating the outline of reflective essay examples

Before you write your reflective essay examples, you must create an outline for them. Although you’d write about your own life, creating an outline gives structure to your essay to serve as a guide for what you want to write about.

Whether you need to write an essay for school, for a magazine or for any other reason, creating an outline is the very first step. With a good outline, you have a better idea of how your essay will flow from one paragraph to the next all the way to the conclusion.

When creating the outline of your reflective paper example, keep it organized. Develop the outline gradually and put a lot of thought into it. In doing this, you make the writing process much easier. Here is a rundown of the steps involved in the essay-writing process:

• Choose a topic (a significant life experience you want to write about)
• Gather information
• Create an outline
• Write a draft
• Finalize your essay

Reflective Paper Samples

Tips for writing reflective essay

As you think about the content of your reflection essay samples, remember that the important thing is that such an essay must be highly personal but also engaging to readers. There’s so much more to reflective essays than just writing your story. You must also reflect on your experiences to engage your audiences.

For your starting point, think about the most significant experiences you had in your life. Those which had either a negative or a positive impact on you as a person. If the reflective essay is a school assignment, your professor would probably specify what you must write about. Here are some tips for you for writing your reflective paper example:

• Reflection The most important part of writing your reflective essay is the reflective process. Think about the personal experience you want to write about. Focus on what happened, how this experience made you feel, and how it affected your life. Explore your memories and emotions for this part of the process. As you’re recalling and reflecting on your life experience, take a lot of notes . Write down all the details you remember and try to be as clear and as detailed as you possibly can. Take as much time as you need for reflection. You can even close your eyes as you try to remember those experiences vividly. When you’re confident that you have recalled all of the details of your life experience, it’s time to write your essay. To make it more meaningful, try to answer some important questions about your life experience including: Did you learn anything new about yourself because of this experience? Have you grown or developed because of this experience? If so, in what way? Did this experience impact your life positively or negatively? If you had the chance to experience this all over again, would you do anything differently? Why did you behave in such a way at the time of this experience? Did you make the right choices? What are your general thoughts and feelings about this experience? Can you say that you learned from this experience? Did you gain any new perspectives or skills because of this experience? These are “signpost questions” which can help you write a more meaningful essay. These are just some examples, you can also think of your own questions to ask yourself. The point of these questions is to make sure that you think critically and deeply about the experience you’re writing about.
• Planning After you’ve reflected on your life experience, it’s time to start planning your essay. When it’s time to start, you might feel as if you’re not adequately prepared even though you’ve done a lot of reflection. This is a normal feeling, especially if you want to create a written piece which people will love reading. To ease your anxiety and doubt, come up with a well-rounded and comprehensive plan. The best way to do this is through an outline. With an outline to guide your writing process, you can come up with an essay that’s more coherent and which has a clear structure. An outline or plan is important for reflective essays. Since you’re writing about an emotionally-charged topic, you might find yourself getting “lost” along the way. This is especially true if you’re writing about a painful experience which still affects you until now. The outline serves as a map for you to keep your thoughts organized. In your outline, make sure to establish all of the fundamental details you wish to include in your essay. This helps you pick out and remove any superfluous information to make it easier to read and understand. Planning the points you want to write about makes it easier for you to stay on point. As such, your writing becomes a lot clearer and your readers can follow your line of thought. An outline also prevents you from missing out any relevant information. It’s very difficult and frustrating to go back after you’ve written the whole essay just to fit in this information! Planning your essay also saves you a lot of time. Coming up with the structure makes you more familiar with your essay even before you start writing it. Thus, you can spend more time writing, revising, and proofreading your essay to make it the best version possible.

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Using Gibbs: Example of reflective writing in a healthcare assignment

• Description In a placement during my second year when I was working on a surgical ward, I was working under the supervision of my mentor, caring for a seventy-two year old gentleman, Mr Khan (pseudonym), who had undergone abdominal surgery. I had been asked to remove his wound dressing so that the doctor could assess it on the ward round. I removed the dressing under my mentor's supervision, using a non-touch procedure, and cleaned the wound, as requested by the doctor. My mentor was called to another patient at this point, so at her request I stayed with Mr Khan while we waited for the doctor to come to see him. The doctor had been with another patient, examining their wound, and I noticed that she came straight to Mr Khan to examine his wound, without either washing her hands or using alcohol gel first. I also noticed that she was wearing a long-sleeved shirt, and I was concerned that the cuffs could be contaminated. I thought for a moment about what to do or say, but by the time I had summoned enough courage to say something, I thought it was too late as she was already examining Mr Khan. Feelings I was alarmed by this, as I had expected the doctor to wash her hands or use alcohol gel before examining Mr Khan. However, I felt intimidated because I felt that the doctor was more experienced than me as a second year nursing student; and I didn't want to embarrass her. Also, I didn't want to make Mr Khan concerned by confronting the doctor in front of him. Later, I spoke to my mentor about the incident. She suggested that we speak to the doctor together about it. My mentor took the doctor aside, and asked her whether she had washed her hands before examining Mr Khan. She looked quite shocked. She said that she had been very busy and hadn't thought about it. My mentor discussed the importance of hand hygiene with her, and the doctor assured her that she would wash her hands before examining every patient in the future. Evaluation The incident was extremely challenging for me. I regret that I did not act to challenge the doctor's practice before she examined Mr Khan. However, I am pleased that the doctor responded so positively to the feedback of my mentor, and I have observed that she has now changed her practice as a result of this incident. I too have learned

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Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature

Jessica dawson.

1 School of Psychology, University of Adelaide, Adelaide, SA 5000, Australia

2 Poche SA+NT, Flinders University, Bedford Park, SA 5042, Australia

Keera Laccos-Barrett

3 College of Nursing & Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; [email protected]

Courtney Hammond

4 School of Public Health, University of Adelaide, Adelaide, SA 5000, Australia; [email protected]

5 Wardliparingga Aboriginal Health Equity Unit, SAHMRI, Adelaide, SA 5000, Australia

Alice Rumbold

6 Women and Kids Theme, SAHMRI, Adelaide, SA 5000, Australia; [email protected]

7 Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia

Associated Data

All data are publicly available as this is a review article. Data are summarised in Table 1 (Summary of key characteristics of the educational interventions included).

Cultural safety is increasingly being taught in tertiary programmes of study for health professionals. Reflexivity is a key skill required to engage in culturally safe practice, however, there is currently limited literature examining how reflexivity is taught or assessed within cultural safety curricula. A systematic review of the literature up until November 2021 was conducted, examining educational interventions which aimed to produce culturally safe learners. Studies were limited to those with a focus on Indigenous health and delivered in Australia, Aotearoa New Zealand, Canada, and the United States. A total of 46 documents describing 43 different educational interventions were identified. We found that definitions and conceptualisations of reflexivity varied considerably, resulting in a lack of conceptual clarity. Reflexive catalysts were the primary pedagogical approaches used, where objects, people, or Indigenous pedagogies provided a counterpoint to learners’ knowledges and experiences. Information regarding assessment methods was limited but indicates that the focus of existing programmes has been on changes in learner knowledge and attitudes rather than the ability to engage in reflexivity. The results demonstrate a need for greater conceptual clarity regarding reflexivity as it relates to cultural safety, and to develop methods of assessment that focus on process rather than outcomes.

1. Introduction

The beliefs, attitudes, and biases that healthcare professionals hold can substantially influence the way they interact with and provide care to people. This is particularly relevant to the health and well-being of Aboriginal and Torres Strait Islander Australians, where healthcare professional attitudes are seen as a major factor in whether care is considered safe, adequate, and acceptable [ 1 , 2 , 3 ]. Dismissive, rude, and outright racist behaviours have been reported by Aboriginal and Torres Strait Islander people in their encounters with non-Indigenous healthcare professionals. These experiences can result in inadequate or negligent care provision and deter recipients of care from further engaging with a healthcare system that is perceived as culturally unsafe [ 4 , 5 , 6 ]. In turn, this can have significant flow-on effects for healthcare access and outcomes and contributes to the health inequities experienced by Aboriginal and Torres Strait Islander people. Parallels can be seen in Aotearoa New Zealand, Canada, and the United States, where racial discrimination and culturally unsafe care contribute to inequities in healthcare access and outcomes for Indigenous peoples [ 7 , 8 , 9 ].

Cultural safety is recognised as an approach to healthcare with the potential to improve the experience of care for Indigenous peoples in Australia, Aotearoa New Zealand, Canada, and the United States. The concept of cultural safety was originally developed in Aotearoa New Zealand by Māori nurses and midwives, to address the racism experienced by Māori patients being cared for by a largely non-Indigenous health workforce [ 10 , 11 ]. Cultural safety in healthcare delivery recognises the centrality of culture to health and well-being and seeks to ensure that healthcare is respectful and non-discriminatory. To provide culturally safe care, healthcare professionals need to engage in critical reflexivity, whereby they examine their own cultural identity, positioning and power, the values, attitudes, and biases they carry, and the potential consequences of these for the people they provide care to [ 12 , 13 , 14 , 15 ].

The importance of cultural safety as an approach to healthcare provision is now well established, with a substantial body of literature exploring the application of cultural safety across a range of health professions, including nursing and midwifery [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ], medicine [ 24 , 25 , 26 , 27 , 28 ], psychology [ 29 ], physiotherapy [ 30 ], occupational therapy [ 31 , 32 ], and nutrition [ 33 ]. As such it is increasingly being included in health sciences curricula at the tertiary level in Australia, Aotearoa New Zealand, Canada, and the United States [ 34 ] and developed as short continuing professional education courses (for example, [ 35 , 36 , 37 ]). While there is a growing body of literature exploring best practice approaches to the development and delivery of cultural safety education, this predominantly focuses on overall curriculum structure and content (for example [ 20 , 31 , 38 ]). Currently, however, there is little guidance on the most appropriate pedagogical approaches to teach students how to be reflexive, or on how educators should assess student learning outcomes concerning reflexivity. Given the centrality of reflexivity to culturally safe practice, we argue that there is a need to develop best practice approaches to the teaching and assessment of reflexivity within cultural safety education.

Reflexivity and Cultural Safety

The way reflexivity is defined, conceptualised, and operationalised varies both across and within fields and disciplines, depending on the purpose to which it is being put [ 39 , 40 ]. At its core, reflexivity involves an awareness and examination of the ontological and epistemological foundations that inform our existence and shape our thoughts and behaviours [ 39 , 41 ]. Notably, reflexivity is concerned with the self in relation to others; that is, how our ways of knowing, being, and doing shape our interpretation of and behaviour towards people [ 40 , 42 ]. Despite its centrality to culturally safe practice, reflexivity has not been specifically defined or conceptualised in this context. In her account of reflexive, culturally safe research, Wilson draws on the broader research literature to define reflexivity as a tool “to gain greater understanding of the self/other positionalities and the experience of research” [ 42 ] (p. 219). How this might be adapted into healthcare contexts and included in cultural safety education is yet to be determined.

In the context of cultural safety, reflexivity serves several purposes, and each presents challenges for educators and students alike. Perhaps the most cited purpose of reflexivity is the examination of own cultural worldviews and values and how these might influence delivery of care to people from different cultural backgrounds [ 43 , 44 ]. Notably, there is an acknowledgement that ‘culture’ is a complex intersection of factors such as race, ethnicity, gender, age, socioeconomic status, disability status, geographical location, and sexual orientation, among others [ 34 , 43 , 44 ]. Arguably, this complexity presents students with a significant challenge of understanding their own intersectional nature. Given the tendency of cultural safety education to focus on Indigenous health, there is a risk that this type of curricula reinforces a false dichotomy of Indigenous and non-Indigenous identity, resulting in a curriculum more akin to cultural competency training [ 13 , 45 ]. It also risks diminishing the complexity of Indigenous identity, which encompasses more than ethnicity on its own [ 46 , 47 ]. Further, as Lumsden [ 39 ] (p. 3) notes, there is an inherent risk that reflexivity can easily become entangled in notions of individual identity, “while failing to recognize the wider disciplinary, institutional, and political context(s) in which reflexivity…takes place, and in which knowledge is constructed, situated, and (re)negotiated”. In cultural safety education, and specifically in the context of Indigenous health, considerations of these broader contexts and the sites and methods of knowledge (re)production are essential.

The development of reflexive skills and the exploration of own cultural identity most often occurs in conjunction with learning about the social determinants of Indigenous health. In colonised countries like Australia, Aotearoa New Zealand, Canada, and the United States, this includes developing an understanding of historical and ongoing processes of colonisation, and the resulting interpersonal and institutional racism, whiteness, and power differentials. Students also need to develop an understanding of how these factors intersect with other social determinants such as education, employment, housing, and food security to produce the health inequities that Indigenous people experience [ 13 , 43 , 48 ]. In part, this learning is intended to help students understand that health is the product of social, economic, political, and historical forces [ 44 ]. It is also an opportunity for students to become aware of and challenge their own internalised stereotypes, assumptions, and biases through exposure to new learning. Yet this can be a challenging process for students, one which has been consistently shown to produce feelings of discomfort for students [ 48 , 49 , 50 ]. These feelings of discomfort can range from disengagement in class to outright hostility towards content, learning, and educators. This discomfort, if carefully managed, can produce transformative learning experiences for students. Conversely, poorly managed discomfort may serve to reinforce negative attitudes towards learning, content, and Indigenous people themselves [ 48 , 49 , 50 ].

Additionally, students are expected to engage in this complex, deeply personal, and potentially uncomfortable learning process in the context of a tertiary educational institution. While educators might strive to provide genuinely transformative learning experiences, the reality for students is that they need to pass their studies. Faced with the task of engaging reflexively, there is a risk that students will simply provide the responses they think educators want. This has been acknowledged as a potential issue in the literature [ 39 , 49 , 51 , 52 , 53 ] but has not been explored in-depth regarding whether and to what extent this occurs within cultural safety education.

While there is a growing body of literature on cultural safety education, at present, there is little guidance on the best approach to teach or assess reflexivity in the context of cultural safety. Currently, most cultural safety education literature falls into three broad categories: qualitative explorations of student learning experiences [ 18 , 22 , 30 , 54 , 55 , 56 , 57 , 58 ], evaluations of student learning outcomes [ 17 , 19 , 23 , 26 , 29 , 32 , 33 , 50 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ], and descriptions of curricula development and delivery [ 16 , 20 , 21 , 25 , 28 , 31 , 38 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. In evaluations of curricula and learning outcomes, student reflective journals are a common source of data. However, these articles tend to focus on whether and how the curricula have produced transformative learning, with little information provided on the specific pedagogical approaches used to teach students reflexivity, nor how assessments are structured to capture the reflexive process.

The dearth of literature on teaching and assessment of reflexivity may be reflective of the diversity of definitions, conceptualisations, and ways of operationalising it as a concept. Lumsden [ 39 ] warns against using standardised instructions for learning how to engage in reflexivity, as this implies a ‘correct’ and ‘incorrect’ way of going about the process, and risks reducing it to a checklist approach. In the absence of such instruction, how do educators help students develop the skill of reflexivity? Further, in the tertiary education system, where educators are required to assess the learning outcomes of students in a standardised manner, how do they assess whether students have effectively demonstrated these skills? The current research aims to address these questions through a systematic synthesis and exploration of the Indigenous cultural safety literature, with a specific focus on reflexivity, and aims to address the following questions:

• How is reflexivity conceptualised within cultural safety educational interventions?
• Where and how is reflexivity included as part of learning outcomes in educational interventions?
• What types of pedagogical approaches are used in cultural safety educational interventions to help students develop reflexive skills?
• How is the development of reflexivity as a skill assessed?

2. Materials and Methods

2.1. data sources and search strategies.

An initial systematic search of the following databases was conducted: CINAHL, PubMed, Scopus, Informit, PsycINFO, and Embase. Consultation with a research librarian determined that, due to the specificity of the search parameters and the limitations this placed on using indexing terms, a simplified set of search terms was most appropriate. Therefore, all searches across the databases used the following search terms: “cultural safety” and “culturally safe”. Where the databases provided the option, searches were limited geographically to Australia, Aotearoa New Zealand, Canada, and the United States of America, and to articles in English.

Additionally, a targeted internet search was also conducted, specifically to capture data produced by Indigenous and other non-government organisations (NGOs) as well as any available information on CPE. These data sources represent an important but often overlooked source of information not captured in other literature reviews, as they are often direct accounts of the educational process and often centre Indigenous experiences, knowledges, and aspirations.

2.2. Eligibility Criteria

Data sources were included if they described an educational programme or intervention that fitted the following inclusion criteria: (1) aimed to develop culturally safe learners; (2) was delivered as either part of an undergraduate or postgraduate degree or as continuing professional education (CPE); (3) had a focus on Indigenous health outcomes; and (4) was delivered in Australia, Aotearoa New Zealand, Canada, or the United States of America. The latter criteria were employed as these countries share similar historical and ongoing colonial processes, with resulting similarities in health inequities experienced by Indigenous peoples. The inclusion criteria were designed to allow for the inclusion of all cultural safety education literature and the identification of variations in how and where reflexivity was included or excluded.

Data sources were excluded if they were published in a language other than English, described an educational approach other than cultural safety, or a full-text article was not available.

2.3. Article Review

The initial search of the databases returned a total of 2860 results, which were exported into Endnote [ 74 ]. Duplicates were removed ( n = 1125), leaving 1735 results. Initial screening of titles was carried out by the lead author (JD), and identified a further 852 for removal, due to either irrelevance (for example, most of those excluded discussed a “culture of safety” rather than cultural safety), or duplicates missed by the Endnote sorting function.

Titles and abstracts of the remaining articles ( n = 883) were reviewed by JD and CH according to the inclusion/exclusion criteria; 738 articles were excluded, leaving 145 articles for full-text review. Full-text review resulted in the identification of another two articles, bringing the total number of articles reviewed to 147. JD conducted all full-text reviews, with a 10% cross-check provided by CH. Where agreement could not be reached on an article, it was discussed with AR until a decision could be made. An additional 29 articles were identified in the grey literature. An updated search conducted in 2021 identified an additional 17 articles for inclusion.

It should be noted that the targeted internet search identified a wide range of cultural safety training modules available via organisational websites, such as Australian Indigenous Doctors’ Association (Australia) and San’yas (Canada). Most of these organisational websites contained publicly available information about the expected learning outcomes of the training module but were excluded from analysis due to insufficient information on other aspects of learning.

2.4. Data Extraction

Data in the current research are descriptive and primarily sourced from the introduction and background sections of articles where information about the educational intervention is provided as a preface to evaluation or measurement of student learning and outcomes. Data were analysed using a two-stage thematic analysis process. In the first stage, data were coded under four major themes drawn from the research questions: definition and conceptualisation of reflexivity; where and how reflexivity is included in learning outcomes; pedagogical approaches used to develop reflexivity; and assessment methods used to measure reflexivity development. The second stage of analysis used inductive thematic analysis, where learning is generated from the data itself rather than guided by existing theoretical frameworks [ 75 ]. Data in each of the major themes were iteratively analysed and coded according to the sub-themes that emerged.

Additionally, discursive analysis [ 75 ] was used to provide a more nuanced understanding of how language practices shape the definition, conceptualisation, and practice of reflexivity within cultural safety education. Analysis of how reflexivity is defined drew on constructivist theory [ 76 ] to examine how language shapes our understanding of both the nature and purpose of reflexivity. Analysis of how reflexivity is conceptualised primarily drew on existing cultural safety and reflexivity literature (for example, [ 13 , 38 , 39 , 43 ]), and analysis of the pedagogical approaches drew on the object-based learning literature [ 77 , 78 ]. Throughout the analysis, we also drew on the work of Indigenous educators who operate at the cultural interface [ 79 ] and whose writings and approach to teaching are informed by Indigenous ways of knowing, being, and doing [ 53 , 55 , 80 , 81 ].

Data and analysis were managed using NVivo12 software [ 82 ].

3.1. Summary of Educational Interventions

A total of 46 documents were analysed, describing 43 different educational interventions. The majority ( n = 35) of documents described university-based educational interventions [ 16 , 18 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 38 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 66 , 68 , 69 , 70 , 73 , 80 , 81 , 83 , 84 ], with one set of documents describing a short vocational training course [ 85 , 86 , 87 ], and the remainder ( n = 8) describing continuing professional education (CPE) courses for practicing health professionals [ 17 , 19 , 20 , 36 , 69 , 73 , 88 , 89 ]. Just over half of the documents analysed ( n = 28) were from Australia [ 17 , 18 , 20 , 22 , 23 , 24 , 27 , 28 , 29 , 30 , 33 , 36 , 38 , 54 , 55 , 56 , 57 , 62 , 64 , 66 , 67 , 73 , 81 , 84 , 85 , 86 , 87 , 90 ], with the rest from Aotearoa New Zealand ( n = 5) [ 25 , 61 , 71 , 72 , 89 ], and Canada ( n = 13) [ 16 , 19 , 21 , 26 , 31 , 32 , 59 , 60 , 64 , 70 , 73 , 85 , 86 ]; there were no documents from the United States. Table 1 provides a summary of key characteristics of the documents included for analysis.

Summary of key characteristics of the educational interventions included.

3.2. Definitions of Cultural Safety

While an exploration of cultural safety definitions was not a central aim of this study, it was notable that several definitions included did not contain any reference to reflexivity or similar processes, such as critical reflection or self-awareness. Six of the documents included for analysis made no reference to reflexivity or similar in either the definition of cultural safety or in the educational intervention [ 19 , 24 , 27 , 28 , 73 , 88 ]. One of these documents referred to practicing cultural safety skills learned in a previous topic via structured simulation workshops [ 28 ], but the cultural safety skills are not outlined so it is unclear whether this includes reflexivity. An additional eight documents included in the analysis did not include reflexivity in the definition or conceptualisation of cultural safety but did include reflexivity as part of the educational intervention described [ 23 , 32 , 33 , 56 , 57 , 64 , 67 , 68 ].

3.3. Definition of Reflexivity

Inductive thematic analysis of the data found a lack of consistency in the terminology used to name and describe the reflexive process within cultural safety educational interventions. Of the 46 documents analysed, 40 described some form of reflexive process. Ten documents specifically referred to a process of ‘reflexivity’, either as part of the cultural safety definition [ 17 , 18 , 25 , 26 , 29 , 30 , 31 , 84 ] or as part of the educational intervention [ 23 , 38 ]. The remaining 30 documents used variations of the following terms: (self) awareness [ 20 , 54 , 57 , 58 , 59 , 63 , 64 , 69 , 80 , 91 ]; (critical and/or self) reflection [ 21 , 22 , 32 , 33 , 36 , 55 , 56 , 57 , 58 , 63 , 64 , 66 , 67 , 68 , 73 , 80 , 81 , 83 , 84 , 85 , 86 , 87 , 91 ]; (self) examination [ 16 , 61 , 65 , 71 , 72 , 75 ]. None of the documents analysed used the term reflexivity as a standalone concept; the ten documents that used the term reflexivity did so interchangeably with the other terms listed above.

Where documents described the process of reflexivity, a variety of terms was used. The most common descriptors included ‘reflect on’ [ 21 , 22 , 23 , 27 , 30 , 31 , 32 , 33 , 36 , 56 , 64 , 66 , 67 , 68 , 73 , 80 , 90 ]; ‘examine’ [ 16 , 17 , 25 , 61 , 71 , 72 ]; ‘become aware of’ [ 17 , 18 , 36 , 63 , 68 , 75 , 88 ]; ‘explore’ [ 17 , 18 , 36 , 63 , 68 , 75 , 88 ]; ‘consider’ [ 29 , 56 , 67 , 68 ]; ‘understanding’ [ 36 , 58 , 87 ]; and ‘identify’ [ 21 , 64 , 67 , 72 , 89 ]. What is notable about these descriptors is that most—including all the most commonly used—describe a passive process of identification, observation, and awareness. In contrast, some descriptors contain a call to action, for example, the requirement to use this new knowledge and understanding of self to enact attitude change [ 23 , 36 , 56 , 71 , 72 ], and to contest and deconstruct previous understandings [ 29 , 73 ].

3.4. Conceptualisations of Reflexivity

Four sub-themes emerged relating to how the purpose and focus of reflexivity was conceptualised. These sub-themes included self-identity; held beliefs; relationality; and context, with each sub-theme encompassing a suite of factors that learners were expected to reflect on. These factors are outlined in Table 2 , below, although it should be noted that conceptualisations of reflexivity varied considerably across the data and inclusion of a sub-theme did not guarantee inclusion of all factors. All documents included for analysis conceptualised reflexivity using at least one sub-theme, but usually two or more sub-themes were present.

How the purpose and focus of reflexivity is conceptualised: sub-themes identified in the data.

3.4.1. Sub-Theme 1: Self-Identity

The sub-theme of self-identity was primarily concerned with students reflecting on their own identity, culture, worldviews, and values, and was seen in 30 of the documents analysed [ 16 , 17 , 18 , 20 , 21 , 22 , 23 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 36 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 66 , 67 , 69 , 70 , 71 , 73 , 83 , 87 ]. The primary purpose of reflecting on self-identity was broadly described as developing an understanding that identity, culture, worldviews, and values are not universal, exemplified in the following extracts:

“Participants were therefore encouraged to…explore their own culture, values, and beliefs [and] acknowledge difference” [ 17 ] (p. 248)

“[Cultural safety] requires registered nurses to reflect on their own cultural identity and practice in a way that affirms the culture of clients and co-workers” [ 21 ] (p. 3)

Further, learners were required to develop an understanding that their own self-identity shapes and influences understanding, attitudes, and behaviours, as demonstrated in the following extracts:

“This includes understanding your own worldview and how your values and beliefs influence the way you perceive other people” [ 57 ] (p. 88)

“[Students will] reflect on their own cultural background and their life experiences including the development of values and attitudes that have shaped their thinking and behaviours” [ 23 ] (p. 120)

3.4.2. Sub-Theme 2: Held Beliefs

Thirty-five of the documents analysed described the sub-theme of held beliefs, where learners were required to identify and articulate their current knowledge, attitudes, biases, power, and privilege specifically in relation to Indigenous peoples [ 16 , 17 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 29 , 30 , 31 , 33 , 36 , 38 , 54 , 55 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 66 , 67 , 69 , 70 , 73 , 80 , 81 , 83 , 87 , 90 , 91 ]. In most of these educational interventions, learners were required to reflect on both self-identity and held beliefs, and these were conceptualised as related. However, eight of the educational interventions only included a requirement to identify, reflect on, and in some cases actively critique held beliefs [ 19 , 25 , 55 , 56 , 68 , 86 , 88 , 89 ].

A closer examination of the language used to describe the sub-theme of held beliefs found that the process and focus of reflexivity was often couched in neutral terms that glossed over the inherent racism underpinning beliefs and attitudes, as seen in the following extracts:

“…highlighted the importance of health providers reflecting on and questioning their own assumptions about Aboriginal people that can impact on the care they provide”. [ 90 ] (p. 3, emphasis added)

“…learners were encouraged to reflect on their own cultural values or emotional responses to diverse histories, cultures, worldviews, values, and contemporary events related to Indigenous people” [ 32 ] (p. e2, emphasis added)

Notably, across the educational interventions, there was minimal expectation that learners would reflect on their future or current professional culture, and the norms, beliefs, and values that would inform their practice. Three exceptions to this are Demers et al. [ 31 ], Kelly et al. [ 20 ], and Ramsden [ 70 ]. Demers et al., note that cultural safety “requires exploration of cultures and identities, on both a personal and professional level” [ 31 ] (p. 184). Similarly, Kelly et al., argue that culturally safe nurses are “aware of their own culture and that of the hospital” [ 20 ] (p. 110), and Ramsden states that nurses and midwives must become aware of “the cultural boundaries which surround [the] traditional nursing and midwifery role” [ 70 ] (p. 23).

3.4.3. Sub-Theme 3: Relationality

Half of the educational interventions ( n = 23) described the sub-theme of relationality [ 16 , 17 , 18 , 20 , 21 , 22 , 25 , 29 , 31 , 36 , 54 , 57 , 58 , 59 , 60 , 64 , 66 , 67 , 69 , 70 , 73 , 87 , 91 ]. In this sub-theme, learners were required to reflect on how self-identity and held beliefs impact on engagement with and care for others, and how this contributes to poor health and social outcomes, as exemplified by the following extracts:

“…students reflected on their own place-based identity (i.e., who they were, where they came from) and recognized how their own personal biases were unintentionally but significantly brought into practice and how those biases influenced their work and social interactions” [ 31 ] (p. 187)

“…notice our own cultural practices and individual behaviours and the impact these may have on Aboriginal and Torres Strait Islander people” [ 87 ] (p. 23)

3.4.4. Sub-Theme 4: Context

The fourth sub-theme identified in the data was context and was included in 10 of the educational interventions analysed [ 16 , 22 , 23 , 29 , 31 , 55 , 59 , 60 , 67 , 75 ]. Context was described as a process of reflecting on how self-identity, held beliefs, and relationality have been shaped by historical, social, political, and economic forces. Like relationality, reflection on context takes the process of reflexivity beyond introspection and allows a more critical analysis of the self as socially located. In some cases, this was a passive analysis, as in the following extract:

“Become aware of their own social conditioning, their (often privileged) status, and how their conditioning and status can affect their interactions with clients” [ 59 ] (p.179)

In contrast, other conceptualisations of reflexivity recognised the opportunity to actively challenge and deconstruct [ 29 ] this social conditioning, a process that Sjoberg and McDermott refer to as “disassembling planks of belief” [ 73 ] (p. 30).

All educational interventions included content on contextual factors such as colonisation, racism, and sociopolitical processes, and their impact on the health and wellbeing of Indigenous peoples. It is notable that while there is ubiquitous recognition of how colonialism and racism have impacted on Indigenous health and well-being, there is comparatively less recognition of how these factors have shaped non-Indigenous self-identity, held beliefs, and relationality.

The varying conceptualisations of reflexivity can be seen as existing on a spectrum, ranging from basic reflection on self-identity at one end, to more critical reflection on self-beliefs and relationality in the middle, and reflexive analysis of the self as contextually situated at the other end. This can be seen in Figure 1 , below:

Spectrum of reflexive practice.

3.5. Where and How Reflexivity Is Included as a Learning Outcome

None of the educational interventions included learning outcomes that explicitly required students to develop knowledge of or ability to engage in reflexivity. Instead, reflexivity was operationalised as a method for achieving other learning outcomes, such as developing awareness and knowledge of self-identity, held beliefs, relationality, and/or context. Of the documents included for analysis, only 15 explicitly stated the learning outcomes of the educational intervention, and of these, 10 included learning outcomes relating to reflexivity [ 17 , 29 , 54 , 55 , 56 , 59 , 64 , 70 , 85 , 91 ]. An example of this can be seen in the following extract, which outlines two of the learning aims of a one-day workshop for Australian postgraduate health sciences students:

Specific aims of the day were to facilitate students in: “Recognising and acknowledging their own views and frames of reference in relation to Indigenous Australians”; “Critically reflecting on the impact of ongoing colonisation and its pervasive discourse on the health and well-being of Indigenous Australians”. [ 55 ] (p. 106)

In most of the other documents included for analysis ( n = 31), expected learning outcomes could be inferred from the description of the educational intervention. For example, the extract below describes the intended learning outcomes of a community placement for master of physical therapy students in Canada:

“Our goal was to study whether expanding the clinic beyond the classroom and into a Métis community would make the students more aware of their own identity and worldviews, how they may be different from those in that community, and how they shape their stereotypes and misperceptions of peoples from other cultures”. [ 58 ] (p. 147)

The conceptualisation of reflexivity as an approach to learning can be traced back to Ramsden’s early work on cultural safety education. The learning objectives outlined by Ramsden specifically require students to “examine their own reality and…attitudes”, “be open minded and flexible in their attitudes toward people”, and to become “self-aware” [ 70 ] (p. 22), learning requirements that are reflected throughout the cultural safety education literature. While there were a range of pedagogical approaches used to facilitate reflexivity, there is no mention of whether students were explicitly taught about the concept and purpose of reflexivity, or how to go about being reflexive. It may be that some of the facilitated activities included instruction on the concept and process, but this is not outlined in any of the literature included for analysis.

3.6. Pedagogical Approaches to Facilitate Reflexivity

The analysis revealed that reflexivity was facilitated through a range of pedagogical approaches, all of which involved some type of reflexive catalyst [ 78 ]. These catalysts were used as a counterpoint to the learner’s own lived experiences and worldviews, with the intention that exposure to difference would result in some level of reflexivity. Pedagogical approaches can be seen as grouped into three broad categories, depending on the type of catalyst used: objects, people, and Indigenous pedagogical practices.

3.6.1. Objects

Object catalysts were described in 27 of the educational interventions analysed, and included things like readings, case studies, stories, visual art, and films [ 17 , 20 , 23 , 24 , 29 , 30 , 31 , 32 , 33 , 36 , 38 , 56 , 59 , 62 , 63 , 64 , 66 , 67 , 68 , 69 , 71 , 73 , 84 , 85 , 87 , 90 , 91 ]. Reflexive engagement with object catalysts was most often depicted as small or large group discussions, where new knowledge and understanding was co-produced through the sharing of beliefs, experiences, and interpretations. Examples of this can be seen in the following extracts:

“… the session includes a semi-formal lecture in a quieter space of the gallery … student literature reviews, gallery exploration, and a group reflective discussion”. [ 30 ] (p. 37)

“The tutorial format was tightly structured and included the viewing of a vodcast (prepared specifically for the unit and featuring Aboriginal speakers), discussion of issues arising, case studies, and periodic presentations by students. … Guidelines [were] developed by students [to facilitate classroom discussions, to ensure] that consideration be given to experiences and background that may influence attitudes expressed”. [ 23 ] (pp. 115–116)

3.6.2. People

Twenty-six educational interventions analysed included people as a reflexive catalyst [ 16 , 17 , 18 , 19 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 31 , 36 , 38 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 62 , 63 , 69 , 80 , 81 , 83 , 84 ]. Immersive, community-based placements or field trips were the most common ( n = 16), where predominantly non-Indigenous students visited (and sometimes stayed in) Indigenous communities or health services [ 16 , 18 , 22 , 24 , 25 , 26 , 27 , 31 , 54 , 57 , 58 , 59 , 60 , 63 , 81 , 83 ]. The educational interventions that took this approach shared similar theoretical underpinnings, where exposure to difference was described as an opportunity for reflection and growth. The extract below is exemplary of this theory:

“Cultural immersion is an experiential approach to learning about culture and social situations. In medical education this type of approach is beginning to be recognized for its potential to raise consciousness among students; expose tacit inappropriate biases, including racism; help students learn about themselves and other cultures; and assist students in their preparation for work in culturally diverse settings”. [ 26 ] (p. 3)

In 13 of the educational interventions analysed, Indigenous educators were positioned as the reflexive catalysts, either as core teaching staff [ 17 , 36 , 56 , 57 , 68 , 71 , 90 ] or in ad hoc roles such as guest speakers [ 19 , 21 , 60 , 64 ] or patient simulation actors [ 28 , 63 , 86 ]. Indigenous educators were frequently described as providing learners with an opportunity to challenge their own stereotypes and beliefs about Indigenous peoples, as exemplified in the following extract:

“Having the opportunity to be taught by and interact with an Indigenous academic is thought to have a major role in reducing stereotypes and negative attitudes about Indigenous Australians … Our objective was to present an Indigenous informed perspective filling in the gaps of knowledge that have resulted from silencing Indigenous peoples, their stories and experiences. We wanted to provide students with some positive and affirming images of the strength and resilience of Australian Indigenous peoples”. [ 55 ] (pp. 105–107)

Simulated patient scenarios involving Indigenous people as ‘patients’ were all described as an opportunity for learners to practice and refine communication skills and develop their cultural safety skills. This was seen as providing a safe, controlled environment for both learners and ‘patients’ where feedback could be provided to facilitate learner reflection [ 28 , 63 , 86 ].

3.6.3. Indigenous Pedagogical Practices

Eighteen of the educational interventions analysed described the inclusion of Indigenous pedagogies as a method of facilitating learner reflexivity [ 16 , 17 , 18 , 19 , 27 , 30 , 32 , 38 , 54 , 56 , 60 , 64 , 68 , 71 , 73 , 81 , 83 , 84 ]. In some educational interventions this was an integral aspect of immersive community placements, where learners engaged in a variety of cultural and community events [ 16 , 18 , 27 , 55 , 61 , 85 ]. In other educational interventions, this was described as a process of engaging with Indigenous ways of knowing, being, and doing through activities such as talking (or yarning) circles [ 17 , 57 , 70 , 73 ], storytelling [ 19 , 30 , 32 , 68 , 90 ], and ‘Indigenised spaces’ [ 30 , 65 , 87 ]. In these educational interventions, Indigenous pedagogies were described as providing a counterpoint to deficit-based understandings that may be held by learners, or to legitimate Indigenous knowledges, as demonstrated in the following extracts:

“field experiences can provide students with a first-hand account of the ‘ways of knowing, being, and doing’ …that is, communicating with and listening to Aboriginal Elders, practitioners and community members provides a deeper analysis of social work practice through assessing the cultural context, yarning and storying” [ 54 ] (p. 199)

“A yarning circle approach was used to privilege First Peoples’ culture and voice. First Peoples have recognised yarning as a method of sharing stories, information and knowledge for generations”. [ 17 ] (pp. 247–248)

3.7. Assessment of Reflexivity

Of the 46 educational interventions analysed, only 22 provided information on the assessment of reflexivity, and in most instances only a brief description of the assessment task(s) was provided [ 18 , 22 , 23 , 24 , 26 , 27 , 29 , 33 , 38 , 54 , 55 , 56 , 58 , 59 , 63 , 66 , 69 , 73 , 81 , 84 , 85 , 91 ]. The most common forms of assessment were written reflections in the form of journals [ 23 , 24 , 29 , 57 , 60 , 87 ], essays [ 22 , 59 , 67 , 68 , 75 ], and portfolios [ 26 , 27 , 33 ]. Other forms of assessment included structured reflective questions [ 54 , 85 ], oral presentations [ 18 ], and arts-based reflection activities [ 59 , 63 ].

A common theme throughout assessments is the requirement for students to reflect on their learning, and how this applies to them personally and professionally, as demonstrated by the following extracts:

“Students subsequently submitted a critical self-reflection exploring their personal learnings, including reflections on assumptions, discomfort and realisations” . [ 38 ] (p. 6)

“The idea that students would be given a ‘real world’ experience, be required to reflect on what they had observed and what they had learnt, with supporting literature, was vital to identifying elements of changing attitudes and effectiveness of learning. Furthermore, students then had to plan how they would use their new knowledge in future practice contexts”. [ 54 ] (p. 201)

The above extracts demonstrate the two different ways that learners were required to reflect on their learning. In the first extract [ 38 ], the purpose of the assessment is described as assessing what students have learned about themselves, demonstrating an inward focus on self-identity and held beliefs. In the second extract [ 54 ], assessment is described as having a more applied focus; students must reflect on what they have learned and consider the implications for practice.

Two documents included for analysis focused specifically on the assessment of reflexivity in their respective educational interventions, with descriptions of how these assessments connect to learning outcomes and are supported via learning activities. Sjoberg and McDermott [ 73 ] discuss what they call the ‘deconstruction exercise’, where students are required to critically examine and ‘deconstruct’ their chosen question rather than answer it directly. The aim is to expose the racialised assumptions and stereotypes that inform the question and how this links to broader social, historical, and political contexts. By externalising this critique, Sjoberg and McDermott argue that the deconstruction exercise provides learners with an “opportunity to reflect on the everyday language in which they may be immersed, to see behind the dominant Australian lexicon to the colonial, discursive position from which it has been constructed” [ 73 ] (p. 31).

Power et al. [ 22 ] describe a reflective essay assignment in which students were required to complete three online reflections before, during, and after their 3-week placement. Students were provided with ‘trigger questions’ to prompt their online reflections, and these reflections formed the basis of their submitted reflective essay. The trigger questions step students through the reflective process, prompting them to think about their current knowledge and expectations (pre-placement), new learnings about themselves (mid-placement), and how this applies to future practice (post-placement).

What is notable about the educational interventions described by Sjoberg and McDermott [ 73 ] and Power et al. [ 22 ] is that learners are supported to complete these assessments in several ways, including clear links made to topic content, scaffolded activities to support reflexive skill development, and prompting questions to guide the reflexive process. Several other educational interventions described similar approaches to support learner reflexivity, although only limited information was provided. For example, Chiodo et al. note that learners were required to keep a reflective journal in which they “reflect upon the topics covered in class and in the set reading material … to think about what the issues/concepts/theories…meant for them both in their personal and professional lives” [ 29 ] (p. 184). Here, assessment requirements are clearly tied to learning content and instructions regarding the focus of reflexivity; this was described in eight documents analysed [ 22 , 26 , 29 , 55 , 64 , 67 , 68 , 75 ].

4. Discussion

The current study analysed a total of 46 documents, which described 43 different educational interventions. Definitions and conceptualisations of reflexivity varied; in many definitions, reflexivity was conceptualised as a passive process of observation rather than an active process of analysis, critique, and change. Four sub-themes were identified: self-identity, held beliefs, relationality, and context, with conceptualisations of reflexivity drawing on varying combinations of these sub-themes.

In all educational interventions analysed, reflexivity was considered an approach to learning rather than a learning outcome itself. Only 15 of the documents included for analysis specifically outlined syllabus learning outcomes, so it is possible that the other educational interventions include learning outcomes related to the development of reflexivity as a skill. Pedagogical approaches relied on three types of reflexive catalysts: objects, people, and Indigenous pedagogies. The use of reflexive catalysts was premised on the assumption that exposure to difference would engender understanding and respect for perspectives, beliefs, and experiences different to those of the learners. There was limited information available on the assessment of reflexivity, although most assessments focused on new knowledges and understandings gained through the educational intervention, including knowledge of self, and how these apply to students’ personal and professional lives.

It is noteworthy that 14 of the documents analysed included a definition of cultural safety that did not include reflexivity as a core aspect of culturally safe practice, with eight of those documents positioning reflexivity as additional to cultural safety, and six documents making no reference to reflexivity at all. Definitions that lack reference to reflexivity tend to align more with cultural competency models, which emphasises learning about other cultures and has been criticised as taking a more tick-box approach that risks essentialising culture and reinforcing stereotypes [ 13 , 45 ]. Cultural safety specifically moves away from this model of learning, with the emphasis placed on students learning about themselves and their own culture, and how power imbalances impact healthcare provision. Notably, there were several documents included in the analysis that used the terms ‘cultural safety’, ‘cultural awareness’, and ‘cultural competency’ interchangeably (for example, [ 21 , 23 ]) or conceptualised them as aspects or stages of the same process (for example, [ 17 , 36 , 86 ]). This potentially highlights a lack of understanding of core cultural safety concepts, and arguably, results in less effective teaching.

Variations in how cultural safety is conceptualised may provide some explanation for the variations in how reflexivity was defined and conceptualised. As noted by Lumsden [ 39 ], definitions of reflexivity differ according to context and purpose. The analysis showed that where the purpose of the educational intervention was to increase recognition and respect for diversity, reflexivity tended to be conceptualised as a process of understanding self-identity, held beliefs, and in some cases, relationality [ 16 , 17 , 18 , 19 , 20 , 22 , 23 , 25 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 36 , 38 , 54 , 55 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 66 , 67 , 69 , 70 , 73 , 80 , 81 , 83 , 87 , 90 , 91 ]. Where educational interventions were conceptualised as a way to address colonialism, privilege, and power imbalances, reflexivity was defined as a process of identifying and critiquing self-beliefs and the structural, institutional, and discursive factors that contribute to them [ 16 , 22 , 23 , 29 , 31 , 55 , 59 , 60 , 67 , 75 ].

As outlined in Figure 1 , reflexivity could be conceptualised as existing on a spectrum. At one end, reflexivity was concerned with acknowledging and exploring self-identity and held beliefs, while at the other end, reflexivity was concerned with contextualising the self as socially located. Most of the documents analysed fell into the ‘basic’ or ‘critical’ reflection portions of the spectrum, with a greater focus on identification and understanding of self-identity and held beliefs, and to a lesser extent relationality. Expectations that students will identify and critique their self-identity and held beliefs would arguably be a contributing factor to student feelings of discomfort and resistance [ 48 , 49 , 50 ]. While discomfort is a necessary part of transformative learning, this discomfort needs to be carefully managed [ 49 , 50 , 54 ]. We would argue that a greater focus on the social, historical, political, and discursive forces which inform and shape students’ self-identity and held beliefs are an important part of the reflexive process. This would provide students the opportunity to understand that these are not immutable aspects of their own identity, but rather changeable aspects that have been shaped by problematic, inequitable, and racist systems [ 73 ]. If adequately managed, students may feel empowered to change problematic beliefs and attitudes while critiquing the systems that produced them.

All educational interventions analysed included information about the social determinants of health, so it is possible that learners were assisted to reflect on the connections between their own worldviews and broader contextual factors during learning. This is common throughout the cultural safety education literature, where learning about social determinants is positioned as a method for challenging and critiquing racialised beliefs, assumptions, and stereotypes that may negatively impact on care provision [ 20 , 33 , 42 , 43 , 56 , 57 , 68 , 71 , 72 ]. However, this was not evident from the available data, where discussion of the social determinants was explicitly described as developing an understanding of their impact on health outcomes for Indigenous peoples. Arguably this works to construct social processes as unidirectional, only impacting on Indigenous peoples’ health, without acknowledgement of how learners themselves are embedded within and shaped by these processes. This potentially limits the extent to which learners can engage in reflexivity, directing greater attention to self-identity and held beliefs and how they impact on behaviours and attitudes towards others.

The pedagogical methods used to facilitate reflexivity are also worth greater examination. More than half ( n = 26) of the documents analysed used people as the catalyst for reflexivity, where exposure to people with different cultures and life experiences provided learners with a counterpoint to their own culture, beliefs, assumptions, and stereotypes. Cultural immersion theory aligns with a pedagogy of discomfort [ 49 ], in that learners are taken out of their comfort zones and confronted with new knowledges and experiences that may challenge their preconceptions. What is notable here is that, while many of the immersion-based curricula were designed and delivered by Indigenous community members, there was little consideration given to the cultural safety of this experience for the community itself. In contrast, learner needs were paramount in discussions, with a range of strategies employed to manage student discomfort and create culturally safe learning experiences. For example, Gray et al. [ 62 ] describe an Indigenous health workshop for fourth-year allied health students, in which students interviewed local Aboriginal Elders and other community members to develop culturally safe communication skills. Gray et al., note that “this process provided a ‘safe space’ for students to interact with an Indigenous Australian person” [ 62 ] (p. 3). Arguably, however, there is at least as much risk for elders and other community members in the potential exposure to the racism, dismissive attitudes, and resistance to learning that often accompanies student feelings of discomfort [ 23 , 49 , 50 ]. Gray et al. indirectly acknowledge the potential for this to occur, noting that educators are taught how to de-escalate situations, and “post-workshop debrief sessions were held for teaching staff, to allow for the ‘venting’ of concerns” [ 62 ] (p. 3).

In other immersive-based curricula, efforts were made to ensure that reciprocity was an underpinning principle, where communities received as much benefit as students did. This is exemplified by Hudson and Maar, who note that their placement experience was informed by a social accountability model, where “the obligation of medical schools is to direct education, research and service activities towards addressing priority health concerns in the community” [ 26 ] (p. 2). While laudable, it does not explicitly address the potential risks for the community members hosting students; there is an expectation that the risk to educators and other community members is worth the educational gains for students. Only two educational interventions explicitly addressed the issue of safety for Indigenous educators and community members [ 55 , 80 ], acknowledging the potential for Indigenous people to be exposed to racism. The culturally unsafe nature of the classroom for Indigenous educators is well recognised (see for example, [ 53 , 80 , 81 ]) yet there are currently limited strategies put in place to address this risk. Most educational interventions analysed had some level of Indigenous involvement in development and/or delivery (see Table 1 ), yet on its own this does not guarantee the safety of Indigenous educators or community members. There is a need for more research to develop strategies that minimise the risk for Indigenous people working in this space [ 92 ].

Finally, the lack of information on the assessment of reflexivity within cultural safety curricula highlights a significant gap in the literature. Reflexivity is a fundamental aspect of being culturally safe; presumably, then, it is important to determine whether learners have developed the necessary reflexive skills to become culturally safe. Yet assessment is often glossed over in curricula descriptions, with only brief summaries provided of what is being assessed. In all instances where information on assessments was provided, learners were expected to demonstrate reflection on learning and how this applied to them personally and professionally. There were no examples that required students to explicitly demonstrate reflexive skills; in other words, assessment was of content rather than process. Arguably there are issues with this approach; as noted previously, focusing on what students have learned about themselves is potentially problematic and could be a causative factor in student feelings of discomfort, disengagement, and resistance [ 50 , 75 , 80 ]. Additionally, the potential for students to game their reflections also calls into question the efficacy of these types of assessments. A possible solution is to shift the focus of assessment from content to process, where learners’ ability to demonstrate reflexivity is assessed, although currently there is very little research to indicate what this might look like (for example, [ 93 ]), and none within cultural safety education. Arguably then, there is a need for more research to determine how best to assess reflexive skills within cultural safety education without reducing it to either a checklist approach or a navel-gazing exercise [ 40 ].

While the results of this study are specifically concerned with reflexivity in the context of Indigenous cultural safety, cultural safety is increasingly being adopted in other discipline and population contexts. In particular, there is growing interest in how cultural safety might improve care provision and health outcomes for marginalised and disadvantaged populations, for example the LGBTIQA+ community [ 88 , 89 ], racial and cultural minority groups [ 94 , 95 ], and Indigenous populations globally [ 96 ]. In an increasingly globalized and multicultural society, the importance of cultural safety and the ability to engage reflexively is fundamental to the provision of equitable, non-discriminatory care.

Limitations

A potential limitation of the current study is the type of literature that has been included. Most articles included in the analysis were evaluations of all or part of a cultural safety curriculum, with information on the learning outcomes, pedagogical approaches, and assessment options provided in the introduction or methodology sections. Articles were included where they provided sufficient information on at least three of the four key areas of analysis. The reliance on this type of data may explain the paucity of information on assessment approaches, as this was not a key feature of curriculum evaluations, where most of the focus was on changes in learner attitudes and knowledges, or learner experiences. However, the inclusion of this literature also means that a much broader picture of cultural safety education can be gleaned, compared to only including articles that focus on curriculum description.

Another possible limitation is that literature was only sourced from Australia, Aotearoa New Zealand, Canada, and the United States. It is possible that additional insights and perspectives might have been gained from other countries, broadening our current understanding of cultural safety curricula. Given the similarities in colonial history and Indigenous experiences of health and social inequity, it was felt that the cultural safety curricula literature would be comparable across these four countries, whereas this may not be the case for other countries.

5. Conclusions

While there is a substantial body of research exploring pedagogical approaches to teaching cultural safety in the context of Indigenous health, relatively little work has been done to determine best practice approaches to teaching and assessing reflexivity as a core cultural safety skill. Indeed, the above analysis demonstrates that even within the cultural safety education literature, there is substantial variation in whether and how reflexivity is included within definitions of cultural safety, and how reflexivity itself is conceptualised. This lack of conceptual clarity presents issues for educators when trying to develop cultural safety curricula and suggests that more work is required to develop a more cohesive model of reflexivity specifically aligned with the aims of cultural safety curricula and practice. Additionally, more thought must be given to the pedagogical and assessment approaches utilised within cultural safety education. A range of strategies were utilised during learning to manage student discomfort, yet almost no attention was given to how that discomfort might manifest in the context of assessments. Likewise, while there was a substantial focus on student safety within the educational interventions, relatively few educational interventions considered the cultural safety of Indigenous educators and community members involved in the development of delivery of these programmes. Further research is required to provide greater conceptual clarity, consistency in skills development, and safety of learners and educators alike.

Acknowledgments

The authors would like to acknowledge the Kaurna people of the Adelaide Plains region, and the Peramangk People of the Adelaide Hills region on whose lands this research was conducted. We pay our respects to Elders past and present and acknowledge the ongoing connection of Aboriginal and Torres Strait Islander people to the lands, skies, and waters. This research was supported by a University of Adelaide Faculty of Health Sciences Divisional Scholarship, with continued financial support from Poche SA+NT, Flinders University.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, J.D. and A.R.; methodology, J.D.; validation, J.D., C.H. and A.R.; formal analysis, J.D.; investigation, J.D.; data curation, J.D. and C.H.; writing—original draft preparation, J.D.; writing—review and editing, J.D., A.R. and K.L.-B.; supervision, A.R.; project administration, J.D. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

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