How to get the most out of reflective discussion
Reflection is more than a revalidation must-have – it can help you face challenges
Reflection is more than a revalidation must-have – it can help you face challenges
With nurses working longer shifts and under increasing pressures, finding time for reflection can be challenging – but revalidation has given it added emphasis.
‘It almost fell out of vogue for a while, but now there’s a renewed focus on its value to practice,’ says Alison Finch, assistant chief nurse at University College London Hospitals (UCLH) NHS Foundation Trust.
Many of the traditional points in the day, such as shared lunchtimes and breaks, when nurses may once have had the chance to reflect together, have been lost, Ms Finch says, especially with 12-hour shifts now commonplace. ‘It doesn’t happen in the way it used to,’ she says. ‘Operationally, it’s so busy in many clinical settings, and we work much more in silos. The natural times when people would get peer support and reflect with one another almost have to be recreated.’
The value of reflective discussion
What is reflection?
Reflection invites you to describe a significant work event and:
- Think about how it made you feel
- Evaluate and analyse it
- Explore how things could have been done differently and what you might do in the future
To read more from the RCN’s advice on reflection click here
Yet when she carried out a formal evaluation of the experience of revalidation for nursing and midwifery staff at the trust, it showed that of all the elements, they most appreciated the reflective discussion.
This was introduced three years ago as a requirement of the new revalidation process. ‘It surprised me,’ says Ms Finch. ‘I’m often told by nurses that they’ve taken a really difficult situation to a reflective discussion and found it helpful.’
In its guidance on revalidation, the Nursing and Midwifery Council (NMC) says reflective discussions should take place face-to-face with another NMC registrant, centring on the person’s five written reflective accounts – another requirement of revalidation – and linking them to the Code.
Accounts should be based on an example of professional development, a piece of practice-related feedback, an event or experience in their own professional practice or any combination of these.
Discussions can be used in many ways, including sharing ideas, information and experiences, debriefing after an incident, gaining another’s perspective on a situation, and thinking about professional development objectives. Discussion partners may help someone reach a conclusion or develop an action plan, the NMC says.
‘It’s important to draw on where there have been difficulties – that’s probably where the greatest opportunity to grow is derived’
Alison Finch, assistant chief nurse, UCLH NHS Foundation Trust
At UCLH, these reflective discussions take place outside appraisals. ‘In some areas, it’s part of it. But we felt to do it well, it needed dedicated time,’ explains Ms Finch. She recommends registrants choose a partner who takes a genuine interest in both them and their professional growth.
Identify a challenge
‘The emphasis is on development, as much as having a reflective conversation,’ she says. ‘If someone identifies something that is learning or a challenge, and they want to put together an action plan, it’s useful to have a partner who is an enabler and can help make that happen.’
For those reflecting as part of their revalidation, there can be a tendency to concentrate on what’s gone well, says Ms Finch. ‘And that can increase your confidence, your strengths and awareness of situations where you flourish,’ she says.
‘But it’s also important to draw on where there have been difficulties. That’s probably where the greatest opportunity to grow is derived. We can overplay our strengths sometimes to avoid encountering situations we find more challenging. Reflection can help bring that to the fore.’
Finding opportunities to reflect as an individual is important, says Ms Finch, who suggests using the commute to and from work as one option. ‘Today’s climate is so demanding and there can be a tendency to take things home with us, so we ruminate,’ she says. ‘Rather than mulling things over indefinitely, if you can reflect in a structured way, it can be healthy from a work-life balance perspective, helping you to draw a line under something and move on.’
Tap into your feelings
While feelings are not directly mentioned in the NMC’s forms, including them as part of your reflection is important, says RCN professional lead for education Gill Coverdale. ‘Ask yourself how something made you think and feel,’ she advises. ‘It may be a physical reaction, feeling scared, anxious or challenged.’
Taking this approach can be cathartic, she says. ‘It allows you to live through the experience again. By writing it down or talking about it, you’re not keeping it in. Nurses hold a lot of stressful events, and reflection allows you to move those feelings and anxieties from your internal space.’
‘We’re thinking while something’s happening, but we may not realise that what we’re doing is reflection’
Gill Coverdale, RCN professional lead for education
It’s equally important to acknowledge when something has gone well. ‘If you’ve had great feedback or been involved in some intensive nursing and the patient has survived, think about how that makes you feel,’ she says. ‘It’s good to have both sides.’
Reflection may also happen in the moment, she says. ‘Often it can be when things are not going to plan or are very intense. We’re thinking while something’s happening, but we may not realise that what we’re doing is reflection,’ says Ms Coverdale.
Where to start with reflection and revalidation
- Get to know yourself first, says Alison Finch, assistant chief nurse at University College London Hospitals NHS Foundation Trust (UCLH). ‘Do you draw your energy from yourself or others? Are you introspective or do you thrive more when you’re challenged by someone else? Once you know, you can put things in place to help yourself.’
- If you have not revalidated yet, speak to someone who has, suggests Emma Broadbent, director of registration and revalidation at the Nursing and Midwifery Council (NMC). ‘It may be feel daunting, but people tend to be very positive about the experience and can guide you.’
- Consider using a framework to help your reflection, says Gill Coverdale, the RCN's education lead. ‘It helps to order your thinking,’ she says. Among those she recommends is Borton’s development framework, which asks three simple questions: What? So what? Now what? To find out more about Borton’s model of reflection click here
- But don’t get bogged down with applying academic theories or models, advises Ms Finch. ‘They can be helpful for some, but it’s about taking forward the principles, rather than seeing it as an academic exercise,’ she says. Ms Coverdale agrees: ‘The NMC isn’t asking for a 1,000-word essay, with references and underpinned by theory. They just want you to think through what’s happened in your practice, how that relates to the Code, and be the best nurse you can be.’
- Avoid going through the motions, advises Ms Finch. ‘With revalidation, there can be a tendency to think about satisfying the NMC and the needs of the form. We need to remind ourselves it’s actually about us and our learning – we’re not doing it for someone else.’
- Give yourself time to reflect, says Ms Coverdale. ‘And if you think you’re going to forget important points when they happen, record your thoughts and feelings on your phone,’ she suggests.
- Prepare early and don’t leave things until the last minute, advises Ms Broadbent. ‘A lot of the calls we receive are from people who have reached our deadline, and then been let down by their discussion partner or confirmer,’ she says.
- Think of it as a life skill, says Ms Finch. ‘We learn from our experiences and without that reflection, no matter how informal, we don’t evolve as people,’ she says.
- Be wary of spiralling into negativity, says Ms Coverdale. ‘It’s important not to use reflection as a tool to bash yourself with,’ she says. ‘If you are in that situation, talk about it to someone who can help lift you out of those feelings.’
- Think of it as an ongoing process, rather than a one-off, says Ms Broadbent. ‘It’s not just a point-in-time assessment. Make it a habit,’ she says.
Support from employers
While reflection is an individual responsibility, employers can do much to support it. ‘As it improves your own practice, it also benefits service-users, enhancing patient care,’ she says. ‘I would see it as a cornerstone of nursing practice and I think it’s what the regulator believes too. It reminds you of why you came into the profession in the first place – and what you, as a nurse, are all about.’
So far, the reflection elements of revalidation have been warmly received by both employers and registrants, says Emma Broadbent, director of registration and revalidation at the NMC. ‘The feedback is extremely positive,’ she says. ‘Employers see the benefits of reinforcing professional development.
‘Registrants value that it makes them take time out of the day to reflect on what they’ve learned and done. We all move on, and often don’t take the opportunity to think "that was a great piece of work" or "if I did that again, what would I do differently?". Now that it’s part of revalidation, you have to make the time to do it.’
She agrees that employers have a vital role in the overall success of the process. ‘They provide registrants with support, advice and time. They are a very important part of the picture,’ she says. ‘They need to know when members of their team are approaching revalidation, so they can think about how they can help them.’ Having a managerial approach that encourages reflection, positively reinforcing learning is also key.
When reflection goes well, it undoubtedly helps to foster improvements in practice and services, she believes, nurturing a culture of continuous learning. ‘I also think it supports people in multidisciplinary team work,’ she says. ‘It allows people to reflect on those relationships and engage with their colleagues about what’s working, and what could be improved.’
Lynne Pearce is a health journalist