Self_Reflecction

Putting Self-reflection in Clinical Practice 1 Learning Outcomes By the end of workshop, you should be able to: 1. State what is self-reflection (SR). 2. Explain why SR is important in clinical learning. 3. Practice SR guided by the John’s Structured Reflection Model in the coming summer clinical block 4. Understand the 4 levels of self-reflection 5. Write self-reflective diaries. Self-Reflection: a process to inform learning from practice (Reid,1993) Review of a specific clinical situation Describe, analyze & evaluate New understanding / appreciation Reflection is • a ‘cognitive’ exploration of one-self or another’s experience, a comprehensive and in-depth review – making sense of it regarding personal, social, cultural, psychological, and organizational issues, in order to achieve more effective & satisfying work Values of Self-reflection • Enabling nurses to become open, curious, and self-aware about context of practice – Why do I do this' • Monitoring performance over time and provide new insight with future practice – How else could I do that' • Understand the nature and boundaries of each others’ roles • Understand the conditions (context), barriers, and potential (alternative) of practice • Value self; relive painful experiences and work through them. • Achieve more effective & satisfying work. A reflective learner needs 1. To be self-aware/conscious of your character. 2. To develop the quality and power of description. 3. To practice taking different ways of looking at the situation, 4. To understand & respect the values of others. The reflective cycle Description: What happened' Action plan: If it arose again what would you do' Conclusion: What else could you have done' Thinking & Feelings: What were you thinking & feeling' Evaluation: What was good & bad about the experience' Analysis: What sense could you make of the situation' (personal, social, cultural, psychological, organizational) (Gibbs, 1988) How can you practice SR in clinical block' 1. Find a clinical situations that – You made a real difference to patient (s) – It went unusually well – It did not go as planned – It was very ordinary and typical of your professional practice – It captures the essence of what your professional practice is about 2. Using checklist or guiding questions to help you e.g The John’s Structured Reflection Model How can you practice SR in clinical block' (cont’d) 3. Writing out practice experience (Richardson, 1995) • Process the experience at the earliest possible • Use different ways to remind the details: writing diary, peer reminding, checklist, etc. 4. With a facilitated group • peer supervision (i.e. peers show desirable mutual empathy) (Graham, 1995) • group discussion with respected confidentiality (Wilkinson & Wilkinson, 1996) • support for open expression Features of a good description Where and when the situation occurred What you did at the time of the situation Why the care provided / not provided How you felt about the situation at the time • Who was involved in the situation' What were their actions and attitudes' • How you coped after the situation • What you thought and felt about the situation at a later time. • • • • The John’s Structured Reflection Model (JSRM) (Johns, 2000) • What was I trying to achieve' • Why did I intervene as I did' • What were the consequences of my actions for – The patient' – Myself' – The people I work with' • How did I feel about this experience when it was happening' • How did I know how the patient felt about it' • What are the factors influencing my decision making and actions: – What internal factors' – What external factors' – What source of knowledge did or should have influenced my actions' The John’s Structured Reflection Model (JSRM) (Johns, 2000) Any alternative strategies – Could I have dealt better with the situation' – What other choices did I have' – What would have been the consequence of these other choices' • Learning obtained – How can I now make sense of this experience in light of past experience and future practice' – How do I now feel about this experience' – Have I taken effective action to support others and myself as a result of this experience' – Has this experience changed my ways of knowing' • Empirics, Aesthetics, Ethics & Personal • Sharing Session Self-Reflection Is there any level' Levels of reflection (Kember et al., 2000) 1. Non-reflection – Just report / repeat what happens – No serious thinking / trying to interpret 2. Understanding – Student becomes aware of a specific perception, meaning (of a concept/topic) or behavior of her own and she is able to verbalize her new experiences and perceptions. – Confined to theory (e.g textbook), which is not related to personal experience/ practical situations Levels of reflection (cont’d) (Kember et al., 2000) 3. Reflection – Personal insights go beyond book theory. Student is able to assess how to make decision/action, evaluate the action, and make value judgement to the practical situation, in relation to what has been taught. 4. Critical Reflection Student can assess the adequacy of concepts or theory she used and changes in perspective over her belief and understanding of a key phenomenon or practical situation Levels of Reflection How does it integrated into JSRM ' 1. What was I trying to achieve' 1. I would like to perform a wound dressing for Joanne. 2. This would provide Joan with effective and sterile dressing, with optimum psychological and physical care. 3. This can motivate myself to provide creative, autonomous nursing practice, with minimal support from supervisor. 4. I need to know more about wound dressing. This experience may be useful to know more from it. 2. Why did I intervene as I did' 1. I did the preparation by self as I have done it before. 2. The practice that I did was based on ritual rather than current research. I felt ‘too’ confident about doing this simple procedure. 3. I think the checking of the correct lotion is important for Joan whose recovery depends on our nursing actions. 4. It was essential for me & other staff to see the need to question practice that may not concur with evidence on wound care 3. The consequences for my actions • To the patient: 1. Joan might not know what we were doing for her. 2. She might have less trust in me and other staff and made her more anxious about the future care. 3. Joan could be aware that we were willing to be an advocate for her needs. 4. Her length of stay might be shortened if evidencebased practice was made. 3. The consequences for my actions • To myself: 1. I could avoid in making any mistake. Thanks God! 2. I felt disappointed about self for not attempting to apply wound care theory to practice as a 2nd year student. 3. Challenging current practice might help to change knowledge and attitudes towards wound care practice on the ward. 3. The consequences for my actions • To people who work with me: 1. On the good side, it is a happy ending to all. 2. I realised that some practices need to be questioned. The ward staff were pleased as I questioned practices. 4. How did I feel about this situation when it was happening' 2. I felt ashamed in front of Joan that the procedure was delayed. 3.I felt annoyed as I did not check the dressing trolley set up with my supervisor before starting the procedure. I was disappointed that I only followed a ward routine without question. 4. I was at first reluctant to challenge the practice but I know it is not only an RN’s duty but also my duty and responsibility to do so. 4. As a second year student, I felt inadequate as I did not think carefully before using any medication. Why using Hibitane lotion with calcium alginate dressing' I should search about the related literature and understand the specific wound dressing. 5. How did the patient felt about it' How did I know how the patient felt about it' 1. Joan did not complain about the treatment, I perceived that she was satisfied with it. Joan did not complain about the delay of procedure, but she appeared concerned about the consequences of previous (incorrect) way of carrying out her dressing. 2. 3. I should follow up this incident and understand more about Joan’s feeling and concerns. Errors in nursing procedure may cause negative consequences physically and psychologically to patient. 6. Has this experience changed my ways of knowing' Empirics • I realised that staff and students should be knowledgeable in recent evidence of nursing practice, otherwise, … • Nursing students should not act like a technician, but should be a thinking profession – make sure what is update knowledge on the topic! 6. Has this experience changed my ways of knowing' Aesthetics • Appreciation of the need to work tactfully with colleagues and clients has been highlighted. • For the role as a student, my duty would be less value if I cannot demonstrate that caring and critical thinking is central to nursing knowledge and practice. 6. Has this experience changed my ways of knowing' Ethics • Joan’s treatment is best given and I should not blindly follow ward practice. Personal • This reflective experience given me more insight into the way I think about practice. • Update knowledge is essential to make ethical and effective choices in patient care, rather than merely carrying out procedures taught by other. References Barnett, M. (2005). Caring for a patient with COPD: A reflective account. Nursing Standard, 19 (36), 41-46. Bulman, C., & Schutz, S. (Eds.) (2004). Reflective practice in nursing (3rd ed.). Oxford: Blackwell Publishing. Burns S, Bulman Chris. (2000). Reflective practice in nursing: The growth of the professional practitioner (2nd Ed). Oxford: Blackwell Science Hannigan, B. (2001). A discussion of the strengths and weakness of reflection in nursing practice and education. Journal of Clinical Nursing, 10, 278-283. Health, H. (1998). Keeping a reflective practice diary: A practical guide. Nurse Education Today, 18, 592-598. Johns, C. (1995a). The value of reflective practice for nursing. Journal of Clinical Nursing, 4 (1), 23-30. Johns, C. (1995b). Achieving effective work as a professional activity. In J. E. Schober, & S. M. Hinchliff (eds.), Towards advanced practice: Key concepts for health care (pp. 252-280). London: Arnold. Johns, C. (2000). Becoming a reflective practitioner: A reflective and holistic approach to clinical nursing, practical development and clinical supervision. Oxford: Blackwell Science. References (cont’d) Kennison, M. M., & Misselwitz, S. (2002). Evaluating reflective writing for appropriateness, fairness and consistency. Nursing Education Perspectives, 23 (5), 238-242. Lau, A. K. L., Chuk, K. C., & So, W. K. W. (2002). Reflective practice in clinical teaching. Nursing and Health Sciences, 4, 201-208. Lau, P. Y., & Chan, C. W. H. (2005). SARS (severe acute respiratory syndrome): Reflective practice of nurse manager. Journal of Clinical Nursing, 14, 28-34. Liimatainen, L., Poskiparta, M., Karhila, P., & Sjogren, A. (2001). The development of reflective learning in the context of health counseling and health promotion during nurse education. Journal of Advanced Nursing, 34 (5), 648-658. McSherry, R., Simmons, M., & Abbott, P. (Eds.) (2002). Evidenceinformed nursing: A guide for clinical nurses. London: Routledge. O’Callaghan, N. (2005). The use expert practice to explore reflection. Nursing Standard, 19 (39), 41-47. O’Regan, H., & Fawcett, T. (2006). Learning to nurse: Reflections on bathing a patient. Nursing Standard, 20, 60-64. References (cont’d) Palmer, A., Burns, S., & Bulman, C. (1994). Reflective practice in nursing: The growth of the professional practitioner. Oxford: Blackwell Scientific Publications. Platzer, H., Blakek D., & Ashford, D. (2000). Barriers to learning from reflection: A study of the use of groupwork with post-registration nurses. Journal of Advanced Nursing, 31 (5), 1001-1008. Poskiparta, M., Karhila, P., & Sjogren, A. (2001). The development of reflective learning in the context of health counseling and health promotion during nurse education. Journal of Advanced Nursing, 34 (5), 648-658. Richardson, G., & Maltby, H. (1995). Reflection-on-practice: Enhancing student learning. Journal of Advanced Nursing, 22 (2), 234-242. Smith, A. (1998). Learning about reflection. Journal of Advanced Nursing, 28 (4), 891-898. Smith, A., & Jack, K. (2005). Reflective practice: A meaningful task for students. Nursing Standard, 19 (26), 33-37 Wilkinson, J. (1999). Implementing reflective practice. Nursing Standard, 13 (21), 10-16. Thank you for your attention!