Paul Vaughan, Regional Director RCN West Midlands

Transcription

1 THE IMPORTANCE OF REFLECTION WITH IMPROVING CARE AND IMPROVING STANDARDS AND THE 6CS Paul Vaughan, Regional Director RCN West Midlands

2 CHALLENGING THE SO WHAT? FACTOR Sheila Marriott, Regional Director, RCN East Midlands (2013) What are the underlying blockers and enablers Where do the power relationships lay in your place of work Who do you need to influence and work differently with? What are you going to take away and do differently?

3 Changing population People admitted to hospital at weekend increase risk of death Length of stay: over 75/10 days, under 60/4 days Last 10 years hospital admission up by 35%, bed numbers down by 10% 30% of all admissions to hospital frail elderly

4 PUBLIC INQUIRY 2013 We need a patient centred culture, no tolerance of non compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership and caring, compassionate nursing, and useful and accurate information about services Robert Francis (2013)

5 Hospital patients routinely treated in storerooms Nearly two-thirds of nurses in poll say patients treated in areas not designed for clinical care, from cupboards to kitchen. Guardian, Tuesday 9 March 2010

6 SOMETIMES IT FEELS LIKE THIS

7 Care Delivering high quality care is what we do. People receiving care expect it to be right for them consistently throughout every stage of their life. COMPASSION Compassion is how care is given, through relationships based on empathy, kindness, respect and dignity. Competence Competence means we have the knowledge and skills to do the job and the capability to deliver the highest standards of care based on research and evidence. Communication Good communication involves better listening and shared decision making no decision about without me COURAGE Courage enables us to do the right thing for the people we care for, be bold when we have good ideas, and to speak up when things are wrong. Commitment Commitment will make our vision for the person receiving care, our professions and our teams happen. We commit to take action to achieve this.

8 6CS AREAS FOR ACTION Helping people to stay independent, maximising wellbeing and improving health Working with people to provide a positive experience of care Delivering high quality care Measuring its impact Building and strengthening leadership Ensuring we have the right staff, with the right skills in the right place

9 REFLECTION Refection is a type of thinking associated with deep thought, aimed at achieving better understanding

10 REFLECTION: WHAT OTHERS HAVE SAID Reflection is an important human activity in which people recapture their experience, think about it, mull over and evaluate it. It is this working with experience that is important in learning. Boud, D., Keogh, R. & Walker, D. (1985) p 43 Reflection: Turning Experience into Learning. London: Kogan Page. We learn through critical reflection by putting ourselves into the experience and exploring personal and theoretical knowledge to understand it and view it in different ways. Tate, S. & Sills, M. (eds) (2004) p 126 The Development of Critical Reflection in the Health Professions. London; Higher Education Authority.

11 LIFELONG LEARNING Vaughan 2009 Life-long learning is an essential part of your personal and professional development. In order to assist with your development, it is important to develop your practice by using self insight and self awareness with the process of reflection. To develop the ability to integrate reflection into your everyday practice is of vital importance. Reflecting on your practice and learning from your experience will enable you to carry out high standards of care to your patients/clients.

12 Informal Reflection Formal Reflection Involves self - questioning Develops our awareness of our own assumptions Draws on research and theory Provides guidance and frameworks for practice.

13 BARRIERS TO REFLECTION Time Professional arrogance Fear of judgement/criticism Defensiveness the need to be right Do not see the value Apathy

14 REFLECTION ENABLES US TO: Be conscious of our potential for bias and discrimination Make the best use of the knowledge available Challenge and develop the existing professional knowledge base Avoid past mistakes Maximise opportunities for learning

15 UNLESS WE MAKE CONSCIOUS EFFORTS TO CRITIQUE OUR OWN PRACTICE: We will be unaware of how and when we are being discriminatory Our skills will stagnate rather then develop We will continue to repeat the same mistakes; we will build on best practice and have the confidence to demonstrate best practice

16 GIBBS MODEL OF REFLECTION Gibbs identified a series of 6 steps to aid reflective practice, these elements make up a cycle that can be applied over and over. Unlike many other models, Gibbs takes in to account the realm of feelings and emotions which played a part in a particular event. Gibbs model incorporates all the core skills of reflection. Arguably it is focused on reflection on action, but with practice it could be used to focus on reflection in and before action.

17 GIBBS REFLECTIVE CYCLE (1988 ADAPTATION OF KOLB)

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19 RESPONSIBILITY Maintain standards Right skill mix YOUR ROLE Right resources Seek advice as required

20 SPEAKING UP FOR PATIENTS AND NURSING Poor Care Someone handling patients roughly Education and training Changing to e-learning model is not fit for purpose Resources Lack of moving and handling equipment or poorly maintained equipment Staffing levels Changes in staffing levels will not allow for call bells to be answered promptly or monitoring of patients effectively

21 HUMAN FACTORS: SILENCE KILLS Poor/no understanding of accountability Failure to connect ethical conscience to professional practice Lack of psychological safety Stress, burn out, depression leading to detachment Poor team relations collection of individuals versus team Culture gender issues Ineffective or poor leadership Disempowerment/fear Someone else s job Hierarchies within and across professional groups

22 STEP BY STEP APPROACH What have I done to try and address the situation within my own resources? Are there any other options open to me? Is there anything more that I can do before I involve my manager?

23 STEP BY STEP APPROACH Could I prioritise things to reduce the impact on the patient? What am I concerned about specifically? What do I need to help me deal with this situation safely? What do I want from my manager?

24 NOW WHAT? Incident report forms Direct letter or Raising your concern

25 WHAT TO WRITE Be specific: Impact statements Write the impact that staff shortages have on your ability to deliver safe and effective care Increase in mistakes, infections, falls, untoward incidents Increased sickness, low morale, stress Increased number of complaints from patients or relatives. Using relatives to deliver care Identify action taken Canvassed staff for ideas Examined duty rotas (cancelled holidays, study leave, staff changing plans etc) Booked agency/bank Reported concerns verbally to line manager Reported concerns in writing to line manager Complaints from colleagues, multidisciplinary team

26 WHAT DO YOU WANT WHO TO DO? Negotiate with Influencing skills essential Improve staffing levels other department Get equipment or resources e.g. Laundry Reduce workload Tell them Give advice and support

27 SPEAKING OUT Whistle- blowing Raise with RCN Public Concern at Work Going public Regulators Check local policy Keep your local reps informed Advice Line: Media CQC Raise with manager Raise formally Information on the PIDA MP Monitor Timeframe for response Escalate concern (designated officer) Get receipt

28 When did it happen? What evidence do you have? Where did it happen? How did it happen? Who was involved? What happened?

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30 SOMETIMES IT FEELS LIKE THIS

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32 COMPASSION Compassionate action involves working with Create Similarities Be present Appreciate ourselves as much as working with others Pema Chodron Treat as you want to be treated Flip your perspective Compassion

33 TOP TIPS FOR DEVELOPING YOUR PRACTICE CPD Be heard Communication Skills Share good practice Assertiveness Skills Develop your confidence Use of Information Look after yourself 33

34 To survive and actually thrive in nursing, we will all need to pull together as a profession and begin by working together at the bedside and being great team players willing to support each other. Something magical happens when we give to others; wonderful things begin to come back to us in far greater ways than what we have originally given. Val Gokenback (2012) THE VAUGHAN CHALLENGE Paul Vaughan, Regional Director, RCN West Midlands

35 THE VAUGHAN CHALLENGE The Vaughan Challenge: When you go back to your workplace, give people permission to challenge you and ask for permission to challenge them Reflect what could you do differently? Now you have decided what you are going to do differently WHO are you going to tell? Tell people at home what you are going to do! Tell people at work what you are going to be doing differently

36 REFERENCES Gibbs G (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit, Oxford Brookes University, Oxford. Boud, D., Keogh, R. & Walker, D. (1985) Reflection: Turning Experience into Learning. London: Kogan Page. Tate, S. & Sills, M. (eds) (2004) p 126 The Development of Critical Reflection in the Health Professions. London; Higher Education Authority

37 CONTACT AND INFORMATION ON LLES Twitter: PaulRCNWM RCN Direct:

38 RCN STRATEGIC PLAN Promoting excellence in Practice Nursing development and education Use our knowledge and profile to demonstrate to the public how nursing contributes to safeguarding health and wellbeing secure the future education of nursing staff in higher education and actively promote mandatory preceptorship and clinical supervision lobby for provision to keep nurses updated, addressing post-registration pathways and education and tackle workforce planning and staffing levels that have a negative effect on patient safety. Shaping health policies Draw on the best available evidence and expertise to contribute to change in health and social care policy Share intelligence and work collaboratively within the RCN and with other organisations

39 RCN STRATEGIC PLAN Representing nurses and nursing Increase the number and visibility of our accredited representatives Improve local member engagement in decision-making Enable nursing staff to engage with the RCN Recruit and retain health practitioner members An effective, value-for money organisation Emphasise the benefits gained from our dual role as a professional organisation and trade union Actively listen to the voice of members and put them at the forefront of developing and delivering our work Support greater engagement with HCA s and students Extend our work on environmental and corporate social responsibility

40 HCA s regulation and training: Code of Conduct, Uniform, registration and common national standards for education and training Leadership: Supervisory role of ward and community nursing team leaders Paperwork and Administration: Many staff feeling that paperwork is taking precedence over providing care Safe Staffing Levels: In order to safeguard patient care, the RCN believes now is the time to set more clearly defined standards and that mandatory nurse staffing levels must be adopted by providers, regulators and commissioners of health services Principles of Nursing Practice: These eight principles tell us what everyone can expect from nursing practice, whether they are colleagues, patients, or the families or carers of patients Education: The RCN believes that the vast majority of our nursing students receive an excellent standard of education and we want to share this good practice across the UK Professional Attitudes and Behaviours: It s key that we understand and promote good practice in terms of how patients are treated