Clinical Reflection in Practice Learning from challenging - PDF document

01/05/2020 Clinical Reflection in Practice Learning from challenging situations Arabella Gaunt MSc MOst BSc(Hons) PgACE UCO Clinical Teaching Fellow arabella.gaunt@uco.ac.uk 1 Key Learning Points Participants should be able to:- • Recall models of reflective practice • Justify the importance of using such models in clinical practice • Demonstrate your ability to confidently write in a reflective manner • Reflect on a clinical experience and build a relevant action plan to inform future learning 2 1

01/05/2020 3 A space to Evaluate your Prevent think deeply practice stagnation Creativity and Strive for Improve self Excellence knowledge awareness 4 2

01/05/2020 ‘Whatever you are, be a good one.’ William Makepeace Thackeray, Novelist (1811-1863) 5 GOsC Osteopathic Practice Standards 2019 6 3

01/05/2020 7 ‘Reflective practice is impactful by highlighting entrenched routines in relation to best practice. The process of reflective practice encourages deep consideration to occur within the reflecting individual. Consultation with supervisors, peers and the existing literature, intensifies the process by providing insights that maybe invisible to the practitioner, and presents new ideas. ’ (McIntyre et al, 2019) 8 4

01/05/2020 REFLECTIVE WRITING • IS … • IS NOT … • 1 ST person • 3 rd person • Critical/analytical • Critical by focusing on – ve • Spontaneous • Descriptive • Free flowing • Calculated • Candid • Untruthful • Engages with feelings • A way of avoiding engaging with feelings • Subjective • A waste of time! 9 Reflective Questions I ask myself in clinic everyday to start a reflective process… ‘If I were the 1 st patient I ‘If I were the last patient I saw in practice today would saw in practice today would I have been happy with the I have been happy with the quality of care I received?’ quality of care I received?’ (Readiness to practice) (Enduring quality of care) 10 5

01/05/2020 Reflective Questions I ask myself in clinic everyday to start a reflective process… ‘If any of the people I saw ‘Why did I miss that? in practice today were my What did I not ask or see? ‘What could I have done Grandma or Grandad What do I to improve my handling would I have been happy see/understand on of that difficult with the quality of care, second viewing of the case/complex situation?’ manner and language I case?’ (Identifying weaknesses & used when seeing them?’ (Unpacking clinical building a strategy for (Giving reflection uncertainty & Improving improvement) personal context, Visibility) meaning & value) 11 12 6

01/05/2020 Critical Incidents I have reflected on since qualifying… • Having an episode of acute back pain myself • Missing multiple myeloma in an elderly patient in my first year of practice • Being asked by my principal for my opinion for the first time for a patient with a shingles type rash • Not screening/referring a family member who rang me for advice after developing chest pain and mid back pain • Considering my communication skills after a patient told me ‘I came in with back pain and I’m leaving with ear ache!’ 13 FT1 & PT1 Reflection 19/20 14 7

01/05/2020 15 Gibbs’ Model of Reflection(1988) Give the experience a Title Describe Action Plan what happened? If the situation arose again, what would you do? What were you thinking and Conclude feeling ? What else could you have done ? Evaluate What was good Analyse and bad about the What sense can you experience? make out of the situation? 16 8

01/05/2020 Driscoll’s Model of Reflection (2007) So Now What? What? What? 17 Trigger Questions What? So What? Now What? • How did I feel at the • What are the implications • What is the for myself and others time? purpose of based on what I have • Were those feelings any returning to the described and analysed? different from other • What difference does it event? people who were also make if I do nothing? involved? • What happened? • Where can I get • Did I feel troubled? If so, • What did I see? information to face a in what way? similar situation again? • What was my • What were the effects of • How can I modify my reaction to it? what I did or did not do? practice if a similar • What have I noticed situation were to happen • What did other about my behavior by again? people do who taking a measured look • Which aspects of practice were involved? at it? should I tackle first? • What is the main learning I • What positive aspects now emerge from this take from reflecting on this event? event? 18 9

01/05/2020 The REFLECT Model (Barksby, 2015) R C E L F E T CREATE EXAMINE LEARN RECALL Acknowledge EXPLORE a plan Set your from the the FEELINGS options of TIMESCALE responses experience events action 19 How to use the REFLECT model Discuss Give a brief your Create a Set a time overview of Highlight thoughts Discuss the situation any feelings plan for by which and Highlight options for upon which you the future the plan actions at what you the future you are experienced – this can outlined in the time of have if you were reflecting. at the time be for the This should the of the learned to future previous consist of situation incident from the encounter theoretical stage will the facts – a upon which upon situation a similar learning or be description you are which you situation of what reflecting action complete are happened reflecting 20 10

01/05/2020 21 Helpful phrases I can see clearly that ……….. What I can’t make sense of is …………… What went well/ badly was …………. I think / felt/ discovered/ wondered/ was aware that … From the feedback I received, ……………….. This was because …………… Next time I shall ………………. In order to …………………., I shall ……………… This will enable me to ………………………….. I need to ……………… I am planning to …………………… 22 11

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01/05/2020 Put yourself in the (imaginary) readers shoes… The reader should never be thinking the following:- ‘WHY?’ ‘This could be more accurately/succinctly expressed’ ‘This is unclear -needs to be more clearly thought out.’ ‘What exactly?’ ‘How specifically?/ Be more specific.’ ‘Related to what?’ ‘So what?’ ‘What now?’ 27 CPD Follow Up Task Write a reflective account based on the following:- ‘Consider how your approach to practice has changed during the Covid -19 pandemic’ • Use one of the previously discussed models of reflection in order to write this reflective account • Don’t forget to have an action plan and to identify key texts/articles/podcasts/videos that can help you to address the areas for development you have highlighted 28 14

01/05/2020 Reference List • Barksby J et al (2015) A new model of reflection for clinical practice. Nursing Times; 111: 34/35, 21-23. • Gibbs, G. (1988). The reflective cycle. Kitchen S (1999) An appraisal of methods of reflection and clinical supervision. Br J Theatre Nurs , 9 (7), 313-7. • Driscoll, J. (Ed.). (2006). Practising clinical supervision: A reflective approach for healthcare professionals . Elsevier Health Sciences. • Spaddacini, J. FT1 BaO Reflective Practice: The Why. PowerPoint Presentation. • Spaddacini, J. FT1 BaO Reflective Practice: The How. PowerPoint Presentation. • McIntyre, C., Lathlean, J., & Esteves, J. E. (2019). Reflective practice enhances osteopathic clinical reasoning. International Journal of Osteopathic Medicine , 33 , 8-15. 29 Questions? 30 15