According to Cotton (2001), many proponents of reflection
advocate using a ‘guide’ (Johns, 2000), a ‘coach’ (Schön,
1983) or a ‘critical friend’ (Hatton & Smith, 1995). Johns in
particular advocates the value of guided reflection, as it is
often difficult for practitioners to see beyond the distortions
of reality created by their own view of self. The mentor or
guide can assist the clinician to see beyond these distortions
in order to truly learn and gain from the experience.
The concept of
mentoring
is an ancient one that can be
traced back to classical Greece. In this relationship, a trusted
person—usually a more experienced practitioner—acts as an
advisor to help the less-experienced clinician to grow person-
ally and professionally (Neville & Wilson, 2008). Mentoring
can be conducted either in a formally arranged manner with
an appointed person or in an informal manner with the clini-
cian seeking out a mentor. In both cases mentoring is a form
of professional relationship that is intended to provide:
•
Access to an experienced and competent role model
•
A means by which to build a supportive one-to-one
teaching and learning relationship
•
A smooth transition from learner to an accountable
practitioner.
Mentoring is traditionally a one-to-one relationship;
however, there are also models in which one person mentors
a group. The mentoring relationship is usually conducted
through face-to-face contact; however, new technologies are
Unit III Thoughtful practice and the process of care
248
now making distance mentoring possible. Regardless of
these variations, the mentor listens, coaches and advises
while challenging preconceptions and encouraging self-
awareness, motivation and moral agency through supportive
reflection and discussion.
Clinical supervision
Another method employed to increase self-awareness
through reflection is
clinical supervision
(Teasdale, Brock-
lehurst & Thom, 2001). As a student you may have
encountered this term in your clinical placement, when it
referred to your supervision and support by a clinical facili-
tator or educator. Used in this context, however, the term
refers to a process whereby an experienced practitioner
assists with the development of self-awareness in a less-
experienced practitioner through reflection and discussion
similar to that used in a mentoring relationship. Clinical
supervision may also include discussion about values,
beliefs, prejudices, concerns and attitudes, and how personal
issues, habits and behaviours can intrude on professional
encounters. This method is particularly helpful for consider-
ing cultural safety issues (discussed in Chapter 6) that may
be subtly embedded in a clinical situation. As a result of the
clinical supervision episode, the reflective practitioner
becomes aware of these and takes action to rectify any
deficits and to build on identified strengths. Severinsson
(2001) maintains that clinical supervision is beneficial as it
Self-awareness
These questions are
aimed at helping
Gillian to become
more aware of self.
What was my role in the incident?
What did I learn about myself?
I gave the drug to the wrong patient. The drug was
meant for Jenny Beatty, not Jenny Smith. I was in a rush
and did not check each of the five rights (right patient,
right drug, right time, right dose and right route).
When I am in a rush I take shortcuts.
Reflection
These questions are
aimed at helping
Gillian to identify
deficits in
knowledge and the
actions or inactions
that contributed to
the situation.
What circumstances may have
contributed to the error?
Were there any knowledge deficits
that contributed to the error? If so,
how might I overcome these?
Were there any environmental
issues that may have contributed
to the error occurring?
What did I learn from the
incident?
How might I act differently in
future?
The ward was very busy and I was already behind on
my work and trying to do three things at once. I asked
someone to check the drug with me, but I knew they
were also busy and not focused on the task at hand.
I already knew about the five rights but I did not check
them, so the deficit relates to acting on my
knowledge, rather than to a lack of knowledge.
The fact that both patients were called Jenny was not
‘red-flagged’ on their wristbands or in their notes, as
per hospital protocol.
This reinforced the importance of checking and also of
my role in safe administration of medication. Luckily
the patient did not suffer an adverse reaction, but it
did make me stop and think about my practice.
I will think about the patient first and ensure I am not
rushed during drug administration. I will ask for help.
TABLE 13-1 Critical reflection in action through critical incident analysis
Reflective practice
Reflective questions
Learning
