Fundamentals of Nursing and Midwifery 2e

Unit III Thoughtful practice and the process of care

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TABLE 13-1 Critical reflection in action through critical incident analysis

Reflective practice

Reflective questions

Learning

What was my role in the incident?

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 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. 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.

Self-awareness These questions are aimed at helping Gillian to become more aware of self. Reflection These questions are aimed at helping Gillian to identify deficits in knowledge and the actions or inactions that contributed to the situation.

What did I learn about myself?

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?

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