Guide to Refective Practice Written by Tricia Bryant Edited by Ren Lawor Contributors Caro Stonham, Laura Rush, Ren Lawor, Say King and Steve Homes 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 Modified: February 2017 Resource Reference Number: PCRS-UK/GRP/AUG2015/V1
Introduction The governing bodies of most heathcare professiona groups require heathcare professionas to record continuing professiona deveopment (CPD) and be abe to provide detaied records to submit as part of the revaidation/accreditation process for the reevant profession. Many of the governing bodies incude the need to demonstrate different types of deveopment and earning incuding refective practice. Each governing body describes refective practice differenty but the principes of refection are the same; for heathcare professionas to be sefaware and criticay evauate their own responses to practice situations. The aim is to criticay review one s own responses to the way things are done and the care that is deivered in order to gain new understanding and so improve future practice. This is part of the process of ifeong earning. The Nursing and Midwifery Counci (NMC) 1, the Genera Pharmaceutica Counci (GPC) 2, the Heathcare Professionas Counci (HCPC) 3,4,5 the Genera Medica Counci (GMC) 6 and Roya Coege of Genera Practitioners (RCGP) 7 have a reeased guidance on how continuing professiona deveopment portfoios and revaidation shoud be undertaken. Each profession provides genera information on refective practice and how this might be achieved and the NMC provides specific guidance on its revaidation requirements in respect of refective accounts. The RCGP provides detaied information on its requirements for revaidation in its document, RCGP Guide to supporting information for appraisa and revaidation (2016) 7,8 and aso provides further information from the WPBA Standards Group on what is considered acceptabe/not acceptabe in terms of refection in its document on the Hamarks of Good Practice in Information Recording in the eportfoio. 9 Whist this information is designed for doctors in training it provides usefu advice for a GPs who are preparing refective feedback see Appendix 1. The NMC provides detaied guidance and specific requirements for refection with regard to revaidation see Appendix 2 and 3 for detaied information on the number of refective accounts required and the format of refective accounts. 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 different ways of responding in future. The process can aow you to improve your critica thinking, chaenge 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. Some heathcare professionas 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. 2 Guide to Refective Practice
Figure 1 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? 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 heathcare professionas on how to undertake critica refection. The foowing information offers some simpe tips on how to undertake critica refection in practice, giving suggested areas for refection and specific exampes of refective practice you can undertake. Exampe 1 - Refection on the patient experience Look back at the ist of patients that were seen by you today. 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? Guide to Refective Practice 3
Exampe 2 - Refection on patient feedback of a 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? 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? Exampe 3 - 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, Spirometry Assessment Certification and Registration document, NICE Quaity Standard for asthma or COPD. Deveop a short structured feedback form and ask your coeagues to provide structured feedback on your training session. Refect on the above using the questions beow: How did you fee about doing the training? 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 have you earned about your own training stye and knowedge of the respiratory fied as a resut of 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? 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? 4 Guide to Refective Practice
Exampe 4 - Refection on earning and sharing knowedge with your team With the support of your practice attend/participate in a reevant educationa event e.g. Primary Care Respiratory Society UK nationa conference Refect on the above using the questions beow: What did you think about attending the event (before you attended)? What was your experience of the event? 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 event? Give some specific exampes of changes you wi impement as a resut of attending the event? How do you fee about the event (after you have attended, was it vauabe)? How can you extend your earning and professiona deveopment beyond the earning from the event? References 1. Revaidation: How to revaidate with the NMC. Nursing and Midwifery Counci. Pubished December 2015. Avaiabe at http://revaidation.nmc.org.uk/downoad-resources/guidance-and-information. Last accessed 13/09/2016 2. Pan and Record. Genera Pharmaceutica Counci. Revised December 2015. Avaiabe at http://www.pharmacyreguation.org/sites/defaut/fies/gphc_pan_and_record_dec_2015_0.pdf Last accessed 13/09/2016 3. Your Guide to our standards for continuing professiona deveopment. Heath and Care Professions Counci. Avaiabe at http://www.hpc-uk.org/assets/documents/10003b70yourguidetoourstandardsofcontinuingprofessionadeveopment.pdf Last accessed 13/09/2016 4. Standards of Proficiency Paramedics. Heath and Care Professions Counci. Avaiabe at http://www.hcpc-uk.co.uk/assets/ documents/1000051cstandards_of_proficiency_paramedics.pdf Last accessed 13/09/2016 5. Standards of Proficiency Physiotherapists. Heath and Care Professions Counci. Avaiabe at http://www.hpc-uk.org/assets/ documents/10000dbcstandards_of_proficiency_physiotherapists.pdf Last accessed 13/09/2016 6. Leadership and Management for a doctors (Refecting on your practice paragraphs 22-23). Genera Medica Counci http://www.gmc-uk.org/leadership_and_management_for_a_doctors Engish_1015.pdf_48903400.pdf. Last accessed 13/09/2016 7. Introduction to the new RCGP Guide to supporting information for appraisa and revaidation. Roya Coege of Genera Practitioners. http://www.rcgp.org.uk/-/media/fies/revaidation-and-cpd/2016/rcgp-introduction-to-rcgp-guide-to-supporting-informationfor-appraisa-and-revaidation-2016.ashx?a=en Last accessed 10/03/2017 8. RCGP Guide to supporting information for appraisa and revaidation 2017 http://www.rcgp.org.uk/revaidation/~/media/fies/ Revaidation-and-CPD/2016/RCGP-Guide-to-Supporting-Information-2016.ashx Last accessed 10/03/2017 9. Hamarks of good practice in information recording in the eportfoio. RCGP WPBA Standards Group. Avaiabe at http://www.rcgp.org.uk/training-exams/mrcgp-workpace-based-assessment-wpba/~/media/fies/gp-training-andexams/wpba/rcgp-hamarks-of-good-practice-information-recording-eportfoio.ashx. Last accessed 13/09/2016 10. Nursing and Midwifery Counci (NMC). The Code Professiona standards of practice and behaviour for nurses and midwives. 31 March 2015. www.nmc-uk.org/code. Last accessed 13/09/2016 Further reading 1. Finay, L. Refecting On 'Refective Practice'. 1st ed. The Open University, 2008. Web. 5 Apr. 2015. 2. "What Is Refective Practice And How Do I Do It? The Chartered Society Of Physiotherapy". http://www.csp.org.uk. Web. Last accessed 20/02/2017 3. Kinsea, E. A. (2010), Professiona knowedge and the epistemoogy of refective practice. Nursing Phiosophy, 11: 3 14. doi:10.1111/j.1466-769x.2009.00428.x 4. Finayson A. Refective practice: has it reay changed over time? Refective Practice Vo. 16, Iss. 6,2015 Guide to Refective Practice 5
Appendix 1 Refection - Hamarks of good practice in information recording in the eportfoio (courtesy of the RCGP WPBA Standards Group) A og entry shoud ideay show: Some evidence of critica thinking and anaysis, describing the trainee s own thought processes Some sef-awareness demonstrating openness and honesty about performance and some consideration of feeings generated Some evidence of earning, appropriatey describing what needs to be earned, why and how appropriate inkage to the curricuum Demonstration of behaviour that aows inkage to one or more competence areas. The entry shoud be anonymous and shoud not refer to specific identifiabe peope and shoud be written in a way which respects professiona behaviour. Information Provided Where possibe the information provided shoud use a range of sources to carify thoughts and feeings. It shoud demonstrate we deveoped anaysis and critica thinking e.g. using the evidence base to justify or change behaviour. Critica Anaysis The critica anaysis shoud show insight, demonstrating performance in reation to what might be expected of genera practitioners. Sef-awareness There shoud be evidence of sef-awareness with consideration of the thoughts and feeings of others as we as him/hersef. Evidence of Learning There shoud be good evidence of earning, with critica assessment, prioritisation and panning of earning. 6 Guide to Refective Practice
Appendix 2 Specific Information for Nurses foowing NMC guidance on refection The NMC has recenty revised the Code 10 by which nurses and midwives are expected to work in accordance to. Pubished in 2015, the new Code pus together 4 primary themes that overarch the responsibiity of nurses to provide pubic protection (figure 2). Figure 2 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 3) designed to evidence that they are keeping up to date and are activey maintaining their fitness to practise. Figure 3 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 Guide to Refective Practice 7
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. Keeping a record As part of a your revaidation you must provide evidence that not ony have you refected on your practice reguary but that you have aso discussed these refective accounts 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. The NMC provides a tempate for nurses to record refective accounts see Appendix 3. Refective accounts requirements for NMC revaidation You must have prepared five written refective accounts in the three year period since your registration was ast renewed or you joined the register. Each refective account must be recorded on the approved form and must refer to:- An instance of your CPD and/or A piece of practice-reated feedback you have received and/or An event or experience in your own professiona practice and how this reates to the code Practice reated feedback The refective account. 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. Description: Describe the incident, situation, feedback or piece of work undertaken Outcomes: How did the incident, situation, feedback or resuts of the work affect you and/or the practice? Anaysis and evauation: What sense can be made of the situation/feedback, how do the figures stack up, what ese coud you have done? Action pan: 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? 8 Guide to Refective Practice
Appendix 3 NMC Tempate for Refective accounts avaiabe at https://www.nmc.org.uk/gobaassets/sitedocuments/revaidation/refectiveaccounts-form.doc You must use this form to record five written refective accounts on your CPD and/or practice-reated feedback and/or an event or experience in your practice and how this reates to the Code. Pease fi in a page for each of your refective accounts, making sure you do not incude any information that might identify a specific patient, service user or coeague. Pease refer to our guidance on preserving anonymity in Guidance sheet 1 in How to revaidate with the NMC. Refective account: REFLECTIVE ACCOUNTS FORM What was the nature of the CPD activity and/or practice-reated feedback and/or event or experience in your practice? What did you earn from the CPD activity and/or feedback and/or event or experience in your practice? How did you change or improve your practice as a resut? How is this reevant to the Code? Seect one or more themes: Prioritise peope Practise effectivey Preserve safety Promote professionaism and trust Guide to Refective Practice 9
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 UK (PCRS-UK) is a registered charity (Charity Number 1098117) and a company registered in Engand and imited by guarantee (Company Number 4298947). VAT registration number 866 1543 09. Registered Offices and Address for Correspondence: PCRS-UK, Unit 2, Warwick House, Kingsbury Road, Curdworth, Warwickshire, B76 9EE Teephone: +44 (0)1675 477600 Facsimie: +44 (0)121 336 1914 Emai: info@pcrs-uk.org The Primary Care Respiratory Society UK is gratefu to its corporate supporters incuding AstraZeneca UK Ltd, Boehringer Ingehiem Ltd, Chiesi Ltd, Napp Pharmaceuticas, Novartis UK, Pfizer Ltd. and TEVA UK Limited for their financia support which supports the core activities of the Charity and aows the PCRS-UK to make its services either freey avaiabe or at greaty reduced rates to its members. See http://www.pcrs-uk.org/sites/pcrs-uk.org/fies/fies/pi_funding.pdf for PCRS-UK statement on pharmaceutica funding.