Using Rolfe’s Reflective Model to Improve Clinical Decision-Making

Introduction

Clinical decision-making is a vital skill for healthcare professionals, particularly for nursing, medical, and allied health students. In a clinical setting, the ability to make informed, effective, and timely decisions can significantly impact patient outcomes. However, clinical decision-making is not only about applying theoretical knowledge but also about critical thinking, reflection, and continuous improvement.

One of the most effective tools for enhancing reflective practice in clinical decision-making is Rolfe’s Reflective Model. This simple yet powerful framework helps healthcare students and professionals reflect on their clinical experiences, improve their decision-making process, and enhance their practice in real-world settings. Whether you are a nursing student working on your clinical placement or a medical student preparing for your assessments, this model offers an accessible and structured approach to reflecting on your clinical decisions.

In this article, we will explore how Rolfe’s Reflective Model can be applied in the context of clinical decision-making, offering practical examples and actionable insights.

🔍 What Is Rolfe’s Reflective Model?

Rolfe’s Reflective Model, developed by Gary Rolfe and colleagues in 2001, is widely used in healthcare education for its simplicity and effectiveness. The model revolves around three key reflective questions:

1. What?

2. So What?

3. Now What?

These questions allow students and practitioners to break down their clinical experiences into manageable components, offering clarity on how to reflect, learn, and improve. By using these prompts, healthcare students can examine their decision-making processes, identify areas for improvement, and plan actions for future situations.

🎯 Why Clinical Decision-Making Matters for Healthcare Students

Clinical decision-making is central to providing high-quality patient care. As a healthcare student, whether you are in nursing, physiotherapy, medicine, or any other allied health field, making decisions in clinical settings is an everyday part of your role. These decisions can range from assessing a patient’s condition to determining the most appropriate treatment plan.

Key aspects of clinical decision-making include:

• Critical Thinking: The ability to assess and evaluate information effectively.

• Clinical Judgment: Making informed decisions based on the available evidence, patient preferences, and professional guidelines.

• Ethical Considerations: Balancing clinical decisions with ethical and patient-centered care principles.

• Patient Outcomes: Ultimately, your decisions affect the well-being of patients, which is why reflective practice is essential.

Rolfe’s Reflective Model allows you to take a step back, look at your clinical practice critically, and evaluate your decisions to ensure better outcomes in future cases.

🧠 Using Rolfe’s Reflective Model to Enhance Clinical Decision-Making

Let’s walk through the application of Rolfe’s Reflective Model in clinical decision-making, breaking down each of its three stages.

✅ Step 1: “What?” – Describe the Clinical Decision-Making Situation

The first step in the model is to describe the situation objectively. This stage involves simply recounting the clinical scenario where you made a decision. The focus here is on the facts, free from any evaluation or analysis.

Example:

During my clinical placement in a busy hospital ward, I was assigned to assess a patient with chronic obstructive pulmonary disease (COPD) who was experiencing shortness of breath. After conducting an assessment, I noted that the patient’s oxygen saturation levels were low, and I was unsure whether to adjust the oxygen flow rate or call for a senior nurse’s opinion.

Key Points to Include:

• The context of the situation (e.g., patient diagnosis, setting).

• Your role in the situation (e.g., nurse, medical student, healthcare assistant).

• The action or decision made (e.g., assessing oxygen levels, communicating with colleagues).

• Any immediate outcomes or reactions (e.g., patient response, team discussion).

✅ Step 2: “So What?” – Analyze the Situation

Once you have described the situation, it’s time to reflect on its significance. The “So What?” stage is about analyzing the decision you made and the factors that influenced it. Here, you will examine your thought processes, emotions, and any underlying knowledge or theories that came into play.

Example:

Upon reflection, I realised that I felt uncertain and hesitant due to a lack of experience in managing patients with COPD. I recognised that I had not thoroughly reviewed the patient’s medical history, which could have provided critical insights into the patient’s condition. This links to clinical decision-making theories, such as the Evidence-Based Practice model, which emphasises the importance of using patient history and clinical guidelines to inform decisions. I also felt a sense of responsibility for the patient’s safety, which caused me to hesitate in taking action.

Key Aspects to Reflect On:

• Knowledge Gaps: Were there any aspects of the patient’s history or condition that you didn’t consider?

• Emotional Responses: How did you feel during the situation? Did fear, uncertainty, or confidence influence your decision?

• Theories and Guidelines: Was the decision based on evidence-based practice, clinical guidelines, or your academic training?

• Professional Judgement: How did you assess risk, and did you consult other healthcare professionals as part of your decision-making process?

✅ Step 3: “Now What?” – Plan for Future Action

The final stage of Rolfe’s Reflective Model focuses on planning future actions based on what you have learned. This is the most important phase as it leads to personal and professional development. Here, you will decide how to improve your clinical decision-making in similar situations in the future.

Example:

In future cases, I will ensure that I carefully review the patient’s medical history before making any decisions. I will also consult with a senior nurse or doctor if I feel uncertain about a decision, especially in high-stakes situations like managing oxygen therapy. I will attend additional training on managing respiratory conditions, including COPD, to build my confidence and expertise. Additionally, I will incorporate clinical decision support tools into my practice, ensuring that I have access to up-to-date guidelines when managing complex conditions.

Actionable Steps for Improvement:

• Build Knowledge: Continuously learn about clinical conditions and interventions.

• Consult Colleagues: Don’t hesitate to ask for a second opinion when in doubt.

• Use Evidence-Based Tools: Familiarise yourself with decision-making frameworks and clinical support tools.

• Reflect Regularly: Make reflection a habit after each clinical decision to reinforce learning and identify patterns.

📚 Benefits of Using Rolfe’s Reflective Model in Clinical Practice

• Enhanced Critical Thinking: The model encourages you to critically assess your decisions and actions.

• Improved Patient Care: Reflecting on past decisions helps you make more informed and confident choices in future patient care scenarios.

• Personal and Professional Growth: By regularly engaging in reflective practice, you will develop stronger clinical judgment, self-awareness, and emotional resilience.

• Evidence-Based Decision-Making: Rolfe’s model prompts you to use available evidence and guidelines when making clinical decisions, improving patient outcomes.

• Adaptability in Practice: Reflecting on different situations helps you adapt your approach based on past experiences, preparing you for varied clinical environments.

🚀 Final Thoughts

Clinical decision-making is a complex process that requires a blend of knowledge, experience, and critical thinking. By using Rolfe’s Reflective Model, healthcare students can break down their experiences, identify areas for improvement, and enhance their decision-making skills. Reflection is not a one-off exercise; it is a continuous process of learning and growing.

For UK university students in nursing, medicine, and allied health courses, Rolfe’s Reflective Model is an invaluable tool to integrate into your clinical placements and assessments. By reflecting on your clinical decisions, you can ensure that you make informed, patient-centred choices and ultimately provide better care.