Clinical supervision and reflections on practice - Essay Example

?Bernhard Bierlich, Ph.D. 03.07.11 Completed: 23:59 CLINICAL SUPERVISION AND REFLECTIONS ON PRACTICE CONTENTS Introduction Reflections and Supervision: Caring for the sick and elderly Conclusion References Introduction Reflective strategies are used to enhance professional observation of the work experience with others and it enhances clinical supervision. Reflection is a process of generating meaning from experiences by considering actions taken with the aim of improving upon future decision-making (Jasper, 2003). Reflective strategies help in identifying gaps in knowledge, skills and learning needs. Reflective strategies also help in analysing communication and relationships with colleagues. Reflective strategies examine decisions taken and are essential in order to identify errors made during decision-making and steps to be avoided when making future decisions. One strategy which the author has used herself for reflection in her work place is clinical supervision. In the future, she would like to consider the use a reflective diary as well. The following discussion will be contextualized both in terms of relevant literature and postings in the MOODLE Discussion Forum by this author and various contributors commenting on the usefulness of a “reflective diary” and the value of “management and supervision” of the nursing practice. As the MOODLE postings show, practice may be perceived as benefiting from reflection and supervision. Not everyone agrees, however. Nevertheless, postings on this and the issue of supervision are a very useful way of entering on a discussion of their benefits. Reflections and Supervision: Caring for the sick and elderly “Reflective practice is associated with learning from experience and is viewed as an important strategy for health professionals who embrace life-long learning” (NHS Guidelines, 2006). Reflecting upon one’s work or practise as a nurse is thus essential (Nursing Standard, 2011; Jasper, 2003). When finding oneself in a difficult situation, one may benefit from stopping and taking time to reflect on what just transpired with the goal to learn from a past mistake in order to make amendments and adjustments to be able to do things differently next time (Johns, 1995). Reflecting upon one’s own position in a certain work process that typically involves a team that has to interact to produce a beneficial outcome, scrutinizing one’s own emotions and the way one often “balances” between the demands of biology and medicine and the needs of the sick one cares for as a nurse is fundamental to ensure “best practices” (Bowling, 2009). Keeping a “reflective journal” or a “reflective diary” are effective reflective techniques (Heath, 1998, pp. 592-598). Other useful reflective strategies include mentoring, clinical supervision, appraisals, handovers, meetings, group supervision. These means imply an evaluation of skills and enhance learning. The author of this essay has herself benefited from reflecting on her practice and various factual events when she was a student nurse, recording her private experiences, emotions, thoughts and views in a “reflective diary”. Once a qualified nurse, she abandoned the use of this important tool but has again come to realize its great benefit for nurses in always attending to the above-mentioned distinction and the uniqueness and humanity of each patient. “I have overlooked the reflective diary in my experience as a qualified nurse at junior level, even as a unit manager. I felt limited by it, and if one loses the diary all the data are lost. After doing the APEL module, my focus is totally different. From the 1st of Feb 20011 till my retirement I am determined to reflect on my practise, use a reflective diary and make a secure electronic copy of it” (“Reflective Diary”, this author, MOODLE Discussion Forum, 24 January 2011). There is wide agreement on the Forum on the usefulness of the diary (cf. Rolfe et al., 2001). One contributor notes that she qualified as a nurse a long while ago and not until taking this module did she begin to see the great value of reflecting upon her work. She notices that “I have been a nurse for along time! My past experience of reflection very basically involved a reflective diary. Personally I found it limiting, without a guide or mentor to discuss my reflections, I cannot say it motivated me to change practice. I believe I was subjective. Since doing this course it has prompted me to review my approach, and as we mature our ability to reflect develops as well. In my current position, I myself and other site specific cancer nurses are (in the next week) part of a new group to begin undertaking clinical supervision. I am looking forward to this especially as our Facilitator is a clinical psychologist, reading the literature your relationship with the facilitator is important. It will be interesting to see what impact not having a nurse faciiltate has! (“Reflective diaries/Clinical supervision”, Sharon Leahy, MOODLE Discussion Forum, 19 January 2011). Reflections, and the regular evaluations of practice they imply, enhance the performance as a nurse . A reflective diary is linked with learning from experiences and is considered an important strategy for nurses, clinical supervisors and health professionals in the context of life-long learning. The use of a reflective diary also enhances the quality of care, motivating personal and professional development, and minimizes the gap between theory and practice (Johns, 1995, p. 233). In my case, the diary provides a record of certain of my actions and thus functions to recall these and monitor all the activities and responsibilities that come under my job description. At the same time, these actions also concern relationships with patients and colleagues that are thus also recalled and evaluated, with the goal of improving upon actions and relationships. I consider the writing of a reflective dairy a very suitable and significant tool in my personal as well as professional career development. The MOODLE Forum also reflects on the role of supervision of nurses, training them in the standards of care and evidence regarding disease (an element that is as indispensable as reflections). The author herself notes “I work in a nursing home where the clinical supervision of staff was not compulsory. The general manager did only clinical supervision to a select number. Therefore, we faced many problems as an institution and nearly failed the Care Quality Commission (CQC) on the spot inspection …As nurses we need support (guidance, supervision) in the development of our practice, and one way of providing this support is through clinical supervision (Department of Health, 1993). We felt this aspect had been neglected by the management and demanded an immediate “crisis meeting” where we presented our concerns, that lacking clinical supervision of all staff had greatly contributed to the low standards of care in our nursing home…The management admitted its omissions, and each employee receives now 6 clinical supervisions a year. A recent CQC inspection was nearly 100%” (The author, MOODLE Discussion Forum, 24 January 2011). Conclusion This brief essay demonstrates that nursing practise stands to gain from both reflections and supervision. The conclusion must therefore be that both aspects are needed and shape nursing; they are interconnected in ensuring high quality care. Emphasis must therefore be placed on both supervision and the use of a reflective diary. The nurse has both to be knowledgeable and understand disease and its demands on the sick, as well as to be able to consider the humanistic demands of her profession and thus critically evaluate the “disease” perspective which is often detached from the person and his/her functioning as a human being. Words: 1,204 References Author“Reflective Diary”, MOODLE Discussion Forum, 24 January 2011. _____ “Clinical Supervision”, MOODLE Discussion Forum, 24 January 2011. Bowling, A 2009. Research methods in health. Investigating health and health Service, 3rd edition, Berkshire, Open University Press. Department of Health, 1993 A Vision for the Future: Report of the Chief Nursing Officer. Heath, H 1998 ‘Keeping a Reflective Practice Diary: A Practical Guide’. Nurse Education Today, vol. 18, no. 7, pp. 592-598. Jasper, M 2003 Beginning Reflective Practice Nelson Thornes, Cheltenham. Johns, C1995 ‘Framing learning through reflection within Carper’s fundamental ways of knowing in nursing’. Journal of Advanced Nursing, vol. 22, no. 2, pp. 226-34. Leahy, S ‘Reflective diaries/Clinical supervision’, MOODLE Discussion Forum, 19 January 2011. NHS 2006 Guidelines: http://www.wipp.nhs.uk/tools_gpn/toolu4_eg_reflective.php. Accessed on 10.07.11. Nursing Standard 2011 ‘Reflection in action’, http://nursingstandard.rcnpublishing.co.uk/students/reflective-practice/reflection-in-action. RCN (Royal College of Nursing) Publishing Company. Accessed on 10.07.11. Rolfe, G., Freshwater, D and Jasper, M 2001 Critical Reflection for Nursing and the helping Professions, Palgrave Bainsingsoke Read More