The new revalidation process, which comes into force from 31 December 2015, puts an emphasis on reflection, requiring nurses to document what they have learned and how it has changed their practice, as a way to demonstrate their understanding and adherence to the newly updated NMC Code.
While reflective practice is a well-established means of improving professional behaviour and maintaining patient safety, many nurses are unclear how to do it. If you’re unsure, here are three ways to take a more structured approach.
Keep a reflection diary
Some of the most valuable lessons you will learn as a nurse happen on the ward. Whether learning an advanced procedure from a colleague or adapting your practice following a patient outcome, experience brings with it a wealth of knowledge. We all reflect on stressful and challenging events, but how many of us document our thoughts? Keeping a reflection diary is a good way to make sense of upsetting experiences as well as informing your decision-making process when a similar situation occurs again.
Some nurses ask themselves ‘What have I learnt today?’ and make a note, detailing any changes they propose to make as a result. Alternatively, you may like to write a brief description of the best and worst things that happened during the day, giving you a record of your highs and lows over time.
Some nurses split a journal page into three columns: what happened, how I felt about it, and what I am going to do differently in future. If you have a big day coming up, you can also use a journal to describe how you would like the day to go (which could be a procedure or interaction between colleagues) and then reflect on how the day actually went.
As well as noting negative aspects of your behaviour with a view to improving professional competence – “I could have been more effective if I had done x differently” – be sure to document your strengths and positive contributions and look for ways to develop them further.
Many learning events highlight the need for further research and training. If that’s the case, make a note of when and how you intend to do this, along with any resources or assistance from colleagues required.
In addition to keeping a record of events, some nurses find it helpful to periodically work through a list of stimulus questions. For example:
– What challenging or unpleasant situations do I find myself in most frequently? – What am I committed to doing (and not doing) in the coming months? – What is the most important thing I can do to improve my nursing practice right now? – What do I value most and least about my working relationship with colleagues? – Which of my achievements has made me most proud?
Don’t worry about being orderly in your thoughts and don’t censor your feelings. It can be revealing to record your answers immediately after a stressful situation and then reflect on it again a week or so later. Looking back over answers is also a good way to spot patterns in your attitudes and behaviour.
Ask for feedback
Asking colleagues for feedback can be a useful part of reflective practice. Even the most self-aware nurses can sometimes view themselves and their performance differently to how others see them.
When asking for feedback, it’s important to approach someone whose opinion you value and who you trust to give an honest answer. Ideally, they will be a more experienced or senior colleague who can challenge your perceptions in a supportive way.
Choose an appropriate place and time, and make sure your request is specific. Rather than just ask for feedback, say: “Could you give me some feedback on how I answered that patient’s question?”
It can be useful to ask for feedback from a number of different people. You might be surprised at the differing perspectives you receive from people who witnessed the same event. As feedback is subjective by nature, you shouldn’t necessarily accept the comments as ‘truth’ but do give them your consideration, especially if you see a pattern emerging.
A cyclical process
Finally, reflective practice works best when used as a cyclical process, rather than a tick-box exercise. Whether you keep a diary, use stimulus questions or ask for feedback, be sure to keep a note of any improvements you set out to make. Reflect on whether the changes you made were successful (this could be evidenced using feedback from patients or colleagues) or whether they still require work.
Taking a structured approach doesn’t just help with your evidence gathering at revalidation time, it will help make you a better nurse too.
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