Guide to Reflective Practice

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1 Guide to Refective Practice Written by Tricia Bryant Edited by Ren Gimartin Input supported by a Task & Finish Group comprising Caro Stonham, Debbie Roots, Say Harris and Ren Gimartin PRIMARY CARE R E S P I R AT O R Y S O C I E T Y U K Date produced: August 2015 Resource Reference Number: PCRS-UK/GRP/AUG2015/V1

2 Introduction The Nursing and Midwifery Counci (NMC) has recenty revised the Code by which nurses and midwives are expected to work in accordance to. Pubished in March this year the new Code pus together 4 primary themes that overarch the responsibiity of nurses to provide pubic protection (figure 1). Figure 1 Together they signify good nursing and midwifery practice Prioritise peope Practise effectivey Preserve safety Promote professionaism and trust Pubic protection One of the aims of the Code is to acknowedge and reguate the changing, and wider roe, of nurses within the UK. The NMC has a responsibiity to ensure that those working as registered nurses are up to date and practising safey within their scope of competence within each of the 4 areas highighted. This responsibiity has ed to the deveopment of a revaidation process for a registered nurses every 3 years. Nurses wi be expected to meet a range of requirements (figure 2) designed to evidence that they are keeping up to date and are activey maintaining their fitness to practise. Figure 2 Third party confirmation Confirmer must meet requirements of NMC (oversee the practise of the registrant and be a UK registered nurse) If above not possibe, 2 individuas can perform the roe Refecting on feedback Minimum of five refective accounts per three year period Evidence that nurse has refected on feedback, not evidence of feedback itsef CPD 40 hours of CPD over three years At east 20 hours to be participatory (i.e. earning with others) Practice hours 450 practice hours over three years 2 Guide to Refective Practice

3 The overa aims of revaidation are mutifactoria but there is a significant active encouragement for nurses to utiise the method of written refection to evidence earning and improvement in practise. However, many nurses are unfamiiar with the forma process of refection. This short guide aims to demystify refective practice and provide some simpe tips on how you can undertake refective practice. What is refective practice? Refection is a way of considering and examining your own thoughts, actions and reactions, and sometimes those of others, to a given situation or event in order to gain a better understanding of yoursef and to identify more effective ways of responding in future. The process can aow you to improve your critica thinking, change your approaches to patient care, promote sef-awareness and improve your communication skis. However, to be an effective refector one must be prepared to uncover one s own perceptions and to be objective about how these perceptions and subsequent judgements may have affected one s chosen actions. Many nurses find this eve of persona insight unnerving but refection shoud be ooked at in a positive way, as a process by which we can earn about ourseves, our coeagues and our environments in such a way that the resut is an improvement in future care. And remember, refection is not just used to anayse when something went wrong. It is equay important to refect on things that went we. Keeping a record As part of your revaidation you must provide evidence that not ony have you refected on your practice reguary but that you have aso discussed these refections with another NMC registered nurse and received feedback. To hep you do this it is wise to keep an ongoing persona record. It doesn t have to be anything fancy and can simpy be a record of what refections you have undertaken during a period of time and why. Record what questions you asked yoursef and what outcomes you considered (figure 3). Some peope find it hepfu to spend just a few minutes at the end of the day writing down their thoughts on what went we, what didn t go we and any questions that you think you need to ask yoursef. This wi hep you to put together the documented evidence that you need for your feedback and revaidation. Figure 3 Description Describe the incident, situation, feedback or piece of work undertaken Outcomes Anaysis and evauation Action pan How did the incident situation, feedback or resuts of the work affect you and/or the practice What sense can be made of the situation/feedback, how do the figures stack up, what ese coud you have done? What action(s) need to be taken to address the situation/issue raised/identified? Concusion What are your concusions, what woud you do differenty next time? Guide to Refective Practice 3

4 Suggested refective work There are many theorists and modes on refective practice and a quick Googe search wi provide both simpe toos and more compex ones. However, there is itte information and practica advice avaiabe for nurses on how to undertake critica refection. The foowing information offers some simpe tips on how to undertake critica refection in practice. Refection on the patient experience Look back at today s ist of patients that you saw. Think about the first consutation of the day. How were you feeing at the start of the cinic? Did your state of mind have any effect on the consutations with the patients? Did you give adequate time to the first patient you saw? If you were the first patient seen, woud you have been happy with the consutation, how woud you have fet it went? Do you think the computer was a barrier as far as the patient was concerned? Were you facing the computer or the patient? Was there anything that you coud have done differenty to improve the patient experience? Given the same situation, what actions woud you have done that coud have improved the patient experience or aowed the consutation to be more efficient/effective. Refection on the cinic environment Why not consider deveoping a questionnaire for a specific cinic that you run and ask a the patients attending the cinic to provide anonymous feedback? Before reviewing the feedback consider each consutation and think about your thoughts and actions. Think aso about the cinic as a whoe, is it effective and efficient, is it run at the right time for the patients, how coud it be improved? Review the feedback from the patients and see if there are any common themes, what do the patients ike about the cinic, what don t they ike about the cinic, is there anything that you can do within your power to change and improve things? Are there any organisationa changes that coud hep improve the efficiency of the cinic? Did you support your coeagues in the cinic, did you fee supported by your coeagues? Are there appropriate mechanisms in pace for you to be empowered to run/manage the cinic? 4 Guide to Refective Practice

5 Do you have appropriate equipment, training and experience in order to run the cinic? What actions coud you impement to improve the patient experience at this cinic? What pans coud you put in pace to improve the efficiency and effectiveness of the cinic in future? Refect on an area of practice Downoad the practice improvement worksheet Post-acute care bunde in COPD ( and read through the document and review the resources provided as inks in the document. Seek the support of the practice team to identify any patient attending for an unschedued COPD visit. Arrange to review the patient within 48 hours of being seen as an unschedued attendance for COPD. Foow the guidance in the worksheet and assess the patient as described. Refect on the above using the questions beow: How did you fee / what were your thoughts about providing a care bunde for the patient? Did you earn anything new from the worksheet or its associated resources? What did you discover when you reviewed the patient? Were the outcomes of the visit as you woud expect or did you discover anything new about your own knowedge, the process for reviewing peope with COPD, any organisation of care issues or anything new about the patient s own knowedge and management of their condition? What have you earned by impementing this care bunde? How wi what you have earned infuence your practice in future? Refect on peer feedback Provide an update to your practice team on an area of new respiratory guidance aunched for respiratory care e.g. BTS/SIGN Guideine update, NICE Guideine update, NICE Quaity Standard for asthma or COPD. Deveop a short structured feedback form and ask you coeagues to provide structured feedback on your training session. Guide to Refective Practice 5

6 Refect on the above using the questions beow: How did you fee about doing the training? Did the preparation of the training hep improve your own knowedge, what can you earn from doing training sessions with other coeagues? In your own opinion, how did the training session go, what went we, what was not so good? What was the feedback from your coeagues? Are there any common themes? What did you do we? What coud you have done better? What have you earned about your own training stye and knowedge of the respiratory fied as a resut of doing the training? How can you put the training you have undertaken for the team to good use, is there anyone ese you can share the knowedge with, disseminate more widey? If you are asked to repeat the training what can you do to make it more effective? Refection on earning and sharing knowedge with your team With the support of your practice see if you can attend the PCRS-UK nationa conference Refect on the above using the questions beow: What did you think about attending the conference (before you attended)? What was your experience of the conference? What did you earn? How can you share the knowedge you have earned with the practice team? How wi your patients benefit as a resut of your attendance at the conference? Give some specific exampes of changes you wi impement as a resut of attending the conference? How do you fee about the conference (after you have attended, was it vauabe)? How can you extend your earning and professiona deveopment beyond the earning from the conference? 6 Guide to Refective Practice

7 References Nursing and Midwifery Counci (NMC). The Code Professiona standards of practice and behaviour for nurses and midwives. 31 March Last accessed 1 June 2015 Further reading Using refection on reading for revaidation. Nursing Times June 2015 Reaising the benefits of refective practice. Nursing Times June 2015 Using refective practice in frontine nursing. Nursing Times June 2012 Is it possibe to refect on your practice on a daiy basis? Nursing Times June 2014 Do nurses have time for refective practice? Nursing Times June 2012 Refective practice in Nursing. Nursing Times February 2014 Somervie D, Keeing J. A practica approach to promote refective practice in nursing. March Nursing Times 2004;100(12):42 Vaughan P. Refective practice and the 6cs of nursing data/assets/pdf_fie/0007/586654/refectivepractice.pdf RCNi Refective Practice Atkins, S & Murphy, K (1994) Refective Practice Nursing Standard 8(39):49-54 Borton, T (1970) Reach, Teach and Touch. Mc Graw Hi, London. Boud D, Keogh R & Waker D (1985): Promoting refection in earning: A mode. INRefection: Turing Experience into Learning (Eds: Boud D, Keogh R & Waker D). Kogan Page, London. Boyd E & Faes A (1983): Refective Learning: the key to earning from experience. Journa of Humanistic Psychoogy 23(2): Carper B (1978) Fundamenta ways of knowing in nursing. Advances in Nursing Science 1(1):13-23 Gibbs G (1988) Learning by doing: A guide to teaching and earning methods. Oxford Further Education Unit, Oxford. Fitzgerad M (1994): Theories of Refection for earning IN Refective Practice in nursing, A Pamer and S Burns (eds). Backwe Scientific, Oxford. Kim HS (1999): Critica Refective inquiry for Knowedge Deveopment of nursing practice. Journa of Advanced Nursing 29(5): Greenwood J (1993): Refective practice a critique of the work of Argyris & Schon. Journa of Advanced Nursing 19: Johns C (1995) Framing earning through refection within Carper s fundamenta ways of knowing in nursing. Journa of Advanced Nursing 22; Schon DA (1983): The Refective Practitioner. Basic Books, New York. Smyth J (1989): Deveoping and sustaining critica refection in teacher education. Journa of Teacher Education 40(2):2-9 Guide to Refective Practice 7

8 PRIMARY CARE R E S P I R AT O R Y S O C I E T Y U K The Primary Care Respiratory Society is a registered charity (Charity No: ) and a company imited by guarantee registered in Engand (Company No: ) VAT Registration Number: Registered Offices: PCRS-UK, Unit 2, Warwick House, Kingsbury Road, Curdworth, Warwickshire, B76 9EE Teephone: +44 (0) Facsimie: +44 (0) Emai: The Primary Care Respiratory Society UK is gratefu to its corporate supporters incuding AstraZeneca UK Ltd, Boehringer Ingeheim Ltd, Chiesi Ltd, GaxoSmithKine, Napp Pharmaceuticas, Novartis UK, Pfizer Ltd and TEVA UK Ltd for their financia support which supports the core activities of the Charity and aows PCRS-UK to make its services either freey avaiabe or at greaty reduced rates to its members. See for PCRS-UK statement on pharmaceutica funding.

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