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Reflective practice

This document discusses reflective practice for nurses. Reflective practice involves regularly reflecting on experiences to improve nursing care and cope with job demands. It describes two scenarios where nurses should have reflected: when a gauze was left in a patient after delivery and when a distressed mother complained about unanswered call bells. Theories of reflective practice emphasize developing problem awareness, observing carefully, testing conclusions, and creating action plans for improvement. Regular reflection helps nurses develop skills like empathy, self-awareness, and influencing change.

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Reflective Practice Prepared by: Merlin Thomas CNO Thumbay Hospital, Dubai
Introduction Reflection on practice is a key skill that nurses should possess. Engaging in regular reflection enables nurses to manage and cope with the personal and professional impact of meeting their patients’ fundamental health and wellbeing needs on a daily basis.
What is reflection for a nurse?? • You have a problem while taking care of a patient • You have to solve it as it affects: The quality of patient care Personal emotions  Total outcome of the care Patient satisfaction Self satisfaction
Scenario 1. A 28 year old Mrs. C came for normal vaginal delivery, who was a booked case. She got admitted through ER. Delivered a healthy baby and got discharged on the 2nd day. She came back to the hospital after 5 days saying that, she found some gauze pieces in the vagina on that day. On investigation, it was found that the treating physician, forgot to take the gauze out and never informed the patient on this matter. Nurse told that, nurses do not do PV and doctor have not informed her that the pack is inserted.
Reflection by the nurse What happened: Recollection. • The unit was busy, I had to attend to 3 patients • The physician never informed me that the gauze pack is inserted • Physician have not documented it
Scenario: Reflection by the nurse What should have been done: • If unit was busy, I should have asked for help • I have assisted the procedure by giving the instruments, equipment’s and disposables (including gauze pack) • I am responsible for counting them before and after the procedure • If I have done it, I have to document.
Scenario 2. Mother of a paediatric patient is very upset and complained to the nursing supervisors that the nurses do not attend the call bells on time. The assigned nurse was called along with the incharge and was advised to look into the matter and prevent such issues.
Scenario: Reflection by the nurse What happened: Recollection. • I got a handover that the mother is upset and irritated • Whenever she rang the bell, it was with a small need like, switching off the light or AC (which I feel, she can do by herself) • The patients condition was not better even after all the treatments and care • I was upset about the baby’s condition, as a mother with a kid and tried to avoid interactions as possible
Scenario: Reflection by the nurse What should have been done: • When I got the handover, I should have planned how to face the mother • I had to be more empathetic, when she calls for small reasons and understand that she is tired or even her baby do not allow her to do that. • Patients condition was making her irritated. I would have consoled and convinced her by talking, spending some time with her, making the physician to explain more about the slow progress and so on.
Scenario: Reflection by the nurse • As a mother instead of being upset and avoid the situation, I am the best person to understand and change the situation to a pleasant one.
Theory of reflective practice • In hospitals or any other services, nurses have important roles in addressing the basic human needs related to the physical and mental wellbeing of patients and related others. Working reflectively in these settings is important for nurses for a variety of reasons, as follows: • There is an emotional cost to nurses in caring for others who are at different levels of need. This is as a result of nurses being confronted with human needs, which are scientifically planned and implemented, and anxieties and worries with empathy on a daily basis
Theories… • Nursing requires multitasking ability, to coordinate the care of a patient from the multidisciplinary team • Interpersonal skills, self-awareness and the ability to influence others towards positive change are, therefore, key skills for nurses. Reflective practice facilitates the development of these skills by fostering an understanding of practice events and how one’s own approach, personality and personal history contributed to the way situations arose and how they were dealt with (Oelofsen, 2012; Somerville and Keeling, 2004).
Theories… According to Dewey, reflection consists of: • Developing a sense of the problem at hand; • Enriching that sense with observations of the relevant conditions; • Elaborating a conclusion; • Testing that conclusion in practice. Developing a sense of the problem at hand and with careful observation, answers the questions that were raised by a difficult or unmanageable situation.
Theories…. • Gibbs (1988) proposed a reflective cycle that starts with describing a practice event and then cycling through the following stages: • Identifying your feelings • Evaluating the experience • Analyzing the experience • Drawing conclusions, including alternative actions, that you could have taken • Drawing up an action plan for the future.
Theories…
A framework for practice • Step 1: Receive • This step is of perception and understanding. It arises from the ability to observe, and accept that the situations and experiences would have been better, if dealt in a different way.
Frame work… • Step 2: Recollection • It is the retrospective collection of what has happened. Recollection captures the events logically and in steps, to have a clear picture of the series of those practices. • The retrospective data is collected by asking questions to self and by assuming certain areas.
Frame work… • Step 3: Rearrange. • Rearrangement is the process of arranging the retrospectively collected data into useful steps. • This is the important step as it decides the standard and practice. • The sequences becomes clear for a better service by eliminating the improper practices
Frame work… • Step 4: Reconcile • Reconciliation is meeting the two opposite ends together. In other words, it is the drawing of conclusions based on the previous steps. • It combines the findings that are recollected and rearranged, which gives a process to be followed as modified practice guideline.
Types • Reflection-on-action • It is the most common form of reflection. It involves re-running of events in the mind. This helps to understand your strengths and to develop more effective ways of acting in the future.
Types… • Reflection-in-action • This can be done only by an experienced person. It means examining your own behavior and that of others while in a situation itself. • Mostly if a connection can be drawn from a previous experience of a similar event, it can be dealt effectively.
Importance of reflective practices • Nurses are responsible for providing care to the best of their ability to patients and their families who comes to the healthcare settings. • They have to refresh their knowledge, skills and behavior to ensure that they are able to meet the demands made on them by the profession as well as the organization. • Reflective practice has to be a part of their practice, for nurses, to provide quality care. • Nurses deals with the multidisciplinary team in healthcare, and hence requires interpersonal communication skills and team building skills. Reflective practices helps in looking into oneself for improvement of practices.
Conclusion Identify and understand your own strengths Be a dreamer…… a realist…….. and a critic of “yourself”
Thank You