Team Reflection Research Articles

Intersections Between Hope and Vulnerability in Couples’ Experiences of the Reflecting Team Process

Couple therapists have asserted that hope and vulnerability are active forces in the therapeutic process. However, no research has been published that examines clients’ experiences of hope and vulnerability when participating in couple therapy. To address this gap in the literature, the authors conducted in-depth interpersonal process recall interviews with six clients (three couples). Interviews focused on their underlying experiences of hope and vulnerability during the reflecting team process. The authors present clients’ descriptions of where these experiences overlap. Using the information provided by clients, they make suggestions regarding attending to hope and vulnerably during the reflecting team process.

Reflective team – a clinical intervention for sustainable care improvement

The aim of this study is to illustrate conditions for the successful implementation of a work model for sustainable care improvement, called Reflecting Team (RT). For this study team leaders were trained in a caring science education programme to lead the reflective processes, and RTs were introduced into two caring contexts. Within the study professional caregivers involved in the implementation of RT were interviewed, and their statements were interpreted according to a life world hermeneutic approach. Dialectic themes emerged that established four prerequisites for successful implementation of RT. A comprehensive understanding suggests that the lowest common denominator for the four prerequisites is mutual interaction. Thus, an atmosphere of sharing was found to be necessary. The challenge of creating such an atmosphere in a caring unit is the focus of the discussion section.

Making Meaning

The reflecting team (RT) process was once a common practice in couple and family therapy training programs. This qualitative case study utilized the interview process to gain understanding about a couple’s perspective of the RT process. Categories constructed included (a) characteristics of the RT and (b) reactions to reflections. These findings underscore the need for additional research that specifically addresses these themes and aims to help counselor educators and counselors in training better understand and serve their clients. While this study supports many of the previous research findings, it adds the elements of encouraging listening, fostering hope, and facilitating engagement in the reflective process.

A public health approach to promoting advance care planning to Aboriginal people in regional communities

To explore perceptions of Noongar community members towards advance care planning (ACP), while developing culturally appropriate information resources for use in community and hospital settings. Qualitative research methods, combining active health promotion with interviews and group discussions for participant feedback. Six rural communities across the Great Southern region of Western Australia. Eighteen Noongar community members consented to participate in interviews or group discussions. Community members received information about ACP at community events or home visits, from an Aboriginal health worker and palliative care researcher. Semi-structured interviews and group discussions were thematically analysed using a descriptive, exploratory approach. Research team reflections on community events also constituted data. Key themes impacting on perceptions of ACP included cultural approaches to dying, importance of family and kin, and appropriate communication. Participants were satisfied with the information resource and method of community engagement. Culturally appropriate methods of engaging Aboriginal people in ACP discussions should include Aboriginal health workers and take a whole of community approach to awareness raising.

Prerequisites for sustainable care improvement using the reflective team as a work model

Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

Engineering students' perceptions of team conflict and high-performance teams

Our study investigates the role of team conflict in the context of student design project work. We are interested in how students experience conflicts in a team environment and how these conflicts relate to other aspects of teamwork such as communication, division of work, shared goals, and leadership. We are using a mixed-method approach to data collection through peer-review data, team observations, and reflective memos. This paper reports results from a study implemented in a required first-year engineering design course. The majority of participants recognise the benefits that task and procedural conflicts have on team performance. Specifically, teamwork aspects such as communication, open-mindedness, and working towards a common goal were connected to cognitive conflict. The peer-review data illustrates that some class sections showed statistically significant improvements in goal commitment, idea communication during conflicts, conflict engagement and attentive listening over time. The results of the post-hoc tests further suggest that students in teams with a predominantly male composition (three males and one female) reported a statistically significant decrease in goal commitment and attentive listening during the ten-week evaluation period. Finally, methodologically we found that the reflective memos and team observations were better instruments for capturing team conflict, more so than peer-review surveys.

A realist synthesis of the effect of social accountability interventions on health service providers’ and policymakers’ responsiveness

BackgroundAccountability has center stage in the current post-Millennium Development Goals (MDG) debate. One of the effective strategies for building equitable health systems and providing quality health services is the strengthening of citizen-driven or social accountability processes. The monitoring of actions and decisions of policymakers and providers by citizens is regarded as a right in itself but also as an alternative to weak administrative accountability mechanisms, in particular in settings with poor governance. The effects of social accountability interventions are often based on assumptions and are difficult to evaluate because of their complex nature and context sensitivity. This study aims to review and assess the available evidence for the effect of social accountability interventions on policymakers’ and providers’ responsiveness in countries with medium to low levels of governance capacity and quality. For policymakers and practitioners engaged in health system strengthening, social accountability initiatives and rights-based approaches to health, the findings of this review may help when reflecting on the assumptions and theories of change behind their policies and interventions.Methods/DesignLittle is known about social accountability interventions, their outcomes and the circumstances under which they produce outcomes for particular groups or issues. In this study, social accountability interventions are conceptualized as complex social interventions for which a realist synthesis is considered the most appropriate method of systematic review. The synthesis is based on a preliminary program theory of social accountability that will be tested through an iterative process of primary study searches, data extraction, analysis and synthesis. Published and non-published (grey) quantitative and qualitative studies in English, French and Spanish will be included. Quality and validity will be enhanced by continuous peer review and team reflection among the reviewers.DiscussionThe authors believe the advantages of a realist synthesis for social accountability lie in the possibility of overcoming disciplinary or paradigmatic boundaries often found in public health and development. In addition, they argue that this approach fills the knowledge gap left by conventional synthesis or evaluation exercises of participatory programs. Finally, the authors describe the practical strategies adopted to address methodological challenges and validity.

Re‐Validating the Observational Teamwork Assessment for Surgery Tool (OTAS‐D): Cultural Adaptation, Refinement, and Psychometric Evaluation

The nontechnical and team skills of surgical teams are critical for safety and efficiency in the operating room. Assessment of nontechnical and team skills can facilitate improvement by encouraging both self-reflection and team reflection, identifying training needs, and informing operating room (OR) team training approaches. The observational teamwork assessment for surgery (OTAS) tool is a well-validated and robust tool for capturing teamwork in the operating room. The aims of the present study were to systematically adapt and refine the OTAS for German-speaking OR staff and to test the adapted assessment tool (OTAS-D) for psychometric properties and metric equivalence. The study was carried out in three stages: at stage 1, OTAS was translated into German. At stage 2, experienced German OR experts (surgeons, OR nurses, anesthetists) were interviewed. At stage 3, two blinded assessors observed 11 general surgical operations (general surgical and vascular procedures) and interrater reliability was tested for refined OTAS-D behavioral exemplars and scorings. The German OR experts confirmed the applicability and content validity of the vast majority of translated behavioral exemplars. After their evaluation, 32 items were changed slightly, six were changed substantially, and one item was added. During observations, perfect and substantial interobserver agreement was found for 77 behavioral exemplars (67.1 % of the items, kappa coefficient >0.60). Rating at all OTAS behaviors showed acceptable levels of reliability (intraclass correlation coefficients >0.72). The OTAS-D is a tool for valid and reliable assessment of nontechnical skills that contribute to safe and effective surgical performance in ORs staffed by German-speaking professionals. Furthermore, our study serves as an example for systematically adapting and customizing well-established observational tools across different healthcare environments.

Collaborative Informal Social Support Initiative as Perceived by the Nursing Students

Few studies have explored the experiences of nursing students participating in a collaborative informal socialsupport initiative. This study describes and explores how nursing students perceived their experiences ofparticipating in a pilot collaborative social support initiative program. The collaborative program initiated by thefaculty member, planned to facilitate the collaboration between the academic and clinical staffs in order tomanage the stress experienced by the mothers of cancer children, and to develop the nursing students knowledgeand skills.Mixed method approach was used. Convenience sample of nursing students practiced to fulfill the requirementof advanced nursing course objectives - a required last-semester nursing program course participating in the pilotsocial support program. Qualitative data were collected using team and individual reflection. Self report reactionindex was used to collect quantitative data. SWOT analysis framework to analyze the internal and externalstrengths, weaknesses, opportunities, and threats that impact the program was utilized. Nursing studentsparticipating in the initiative program were highly positive about their experiences.

Mark My Words! Service User and Carer Involvement in Social Work Academic Assessment

This paper discusses the involvement of service users in academic assessment as part of a second year module for social work undergraduate students at Canterbury Christ Church University in the UK. The three main tasks undertaken in partnership are detailed: designing an assessment form, assessment of student group presentations and assessment of a written reflective essay. The paper starts by identifying key questions raised by the assessor team before providing a critical commentary on the process, and identifying challenges and learning points. The experience emphasises the need for a more critical and searching approach towards service user involvement in social work education in academic assessment. Moreover, the team's experience suggests that such work is best achieved in the context of collaborative working relationships based on trust, with opportunities for team reflection and supported by training in academic assessment.

The development of media-driven clinical skills through using the ‘e-skills portfolio’

Background: The‘e-skills portfolio’ has been developed to give students the opportunity to engage in a creative approach to learning the distinctive core skills of: electrotherapy, manual therapy and therapeutic exercise. This paper aims to review the development and implementation of this e-skills portfolio within a pre-registration MSc physiotherapy programme. Content: Students work in small groups, and capture (through film or images) practice of clinical skills through simulation in the university setting. The analysis of the e-skills portfolio involved a pluralistic approach to: analysing data collected from two student discussion groups (n=21); reviewing submitted portfolio content; and teaching team reflections. Findings were then coded, and the emergent themes identified. Emergent themes from the data included assessment of skills and feedback, reflective practice, employment, continuing professional development through peer and self-coaching, and resource access. Conclusions: Engagement in compiling the e-skills portfolio appears to promote students' continuing professional development through a critical process of peer- and self-coaching and deliberate practice. This practice of using the e-skills portfolio is based within an adapted action research model, and appropriate learning support, particularly in IT, is a crucial element in this process.

Reflekterande team — En arbetsmodell for evidensbaserad vård

A reflective team (RT) is working to solve current health care problems in a professional team led by a reflection leader. The goal is that through reflection about the team members’ own caring exp ...

Reflective Team Supervision After a Frightening Event on a Psychiatric Crisis Service

The authors demonstrate the value of reflective team supervision as part of the informal curriculum in an emergency psychiatry setting after a potentially traumatizing adverse event. The article gives a case presentation of a violent adolescent who eloped from his hospital Emergency Department and provides a description of team supervision sessions that facilitated informal learning for residents and medical students after this event. Reflective team supervision sessions after this event resulted both in improved resident well-being and learning opportunities, as well as hospital quality improvement designed to prevent future elopements. Reflective team supervision can be an essential component of trainee education to enhance residents' well-being and to promote both systems-based practice and practice-based learning. This can be an excellent forum to explore themes of humility, self-reflection, and professional growth.

Attributes of Interdisciplinary Research Teams: A Comprehensive Review of the Literature

To solve large complex health-related problems, there has been a progressive movement towards interdisciplinary research teams; however, there has been minimal investigation into the attributes of successful teams. The purpose of this literature review was to examine the attributes that are important for the effective functioning of these teams. Literature from medicine, nursing and psychology databases, published between 1990 and 2010, was reviewed. Thematic organization of the findings identified seven attributes important to effective interdisciplinary research teams: team purpose, goals, leadership, communication, cohesion, mutual respect and reflection. These attributes are described in depth. Identification of these attributes could form the basis of a new measure to monitor interdisciplinary research team effectiveness, identify weaknesses and promote team development.

COLLECTIVE LEADERSHIP: A Case Study of the All Blacks

This case study evaluates the development of a formal collective leadership approach by the All Blacks (New Zealand’s national men’s rugby team) management. The All Blacks have an astonishing 75% winning record in test matches over a hundred year period. This winning ethos is part of their organizational culture, which has been developed, nurtured and sustained since the inception of the first national team in 1903 (Palenski, 2003; Tobin, 2005). In this qualitative research study, p rimary data was obtained through the analysis of semi-structured, in-depth interviews with past and present All Black captains and coaches (over a period of 60 years from 1950-2010). Stories which are narratives based on true events provide a rich description, which enhances the credibility and transferability of the findings. A key finding is the strong senior collective leadership that has been ever present. Originally led by senior players informally from ‘the back seat of the bus’ this internal leadership has been formalised by the most recent coaching team and has proved to be very effective with regards to maintaining a winning culture in an ever-changing organizational and socio-cultural environment. The learning culture and learning leadership demonstrated within the All Blacks collective leadership model instils a commitment to total honesty in self and team evaluation and reflection. It is anticipated that these findings will be transferable to other business and team sport contexts and assist in organizational development.

Reflecting team processes in family therapy: a search for research

Tom Andersen's Reflecting Team approach is widely (and creatively) employed in family therapy. Despite continuing enthusiasm for the practice, however, there are few journal articles reporting empirical research and only one (now dated) review of the literature. After defining reflecting team processes through practices that are embedded in particular approaches to knowledge construction and theoretical interpretation, we offer an overview of the empirical research found in our search of the literature. In the second half of this article we ask why there is so little existing research in this area. Various possible explanations are explored and future directions proposed. We conclude that a dialogue around the complex interweaving of practice, theory and research (that is, praxis) would be a helpful overall stance to adopt in relation to future work in this area.

Quality self assessment: a process of course team development or contrived collegiality and impression management?

Ethnographic research in an FE College (College X) between 2000 and 2005 was designed to uncover the extent to which quality self-assessment processes had effectively utilised productive motivational inputs (i.e. lecturer self-interest, intrinsic motivation, altruism and tacit knowledge) in line with New Labour’s agenda of improved skills in students for employability and its egalitarian agenda of improved provision for disadvantaged students. The conclusion of such research was that top-down management within the college had limited the utilisation of productive motivational inputs because it created the context for contrived collegiality and impression management rather than course team reflection in line with New Labour’s skills and egalitarian agenda. Research suggested that a more effective QSA process would require senior managers in College X to adopt a more distributed leadership style so that motivational inputs beyond self-interest might be utilised, and to facilitate such leadership, a more de-centralised and trusting form of governance to shift the culture of College X from one of compliance with policy diktats to one of risk-taking and experimentation.

Team Knowledge Sharing Intervention Effects on Team Shared Mental Models and Student Performance in an Undergraduate Science Course

The purpose of this study was to examine the effects of a shared mental model (SMM) based intervention on student team mental model similarity and ultimately team performance in an undergraduate meteorology course. The team knowledge sharing (TKS) intervention was designed to promote team reflection, communication, and improvement planning. Results reveal that the TKS intervention was partially effective in enhancing student team SMM and team scores on meteorology lab assignments. The TKS intervention has potential for use in science courses where a teaming approach is used. Similar interventions could likely be developed, empirically examined, and potentially employed to promote success in handling complex challenges while working in teams in the classroom and beyond.

A Fugue in Four Voices: Sounding Themes and Variations on the Reflecting Team

In this account of an on-going reflecting team, a group of 4 therapists describe how they preserve multiple perspectives, yet join their voices to create coherent, meaningful reflections. This reflecting approach emphasizes developing a theme and creating variations on this theme, in a manner resembling a musical fugue. In addition, the practicalities of creating and sustaining a reflecting team in a private practice context are described.

Systemic Hypothesising for Challenging Behaviour in Intellectual Disabilities: A Reflecting Team Approach

The treatment of challenging behaviour in intellectual disabilities has evolved dramatically since the 1950s, from a reliance on psychopharmacological restraint and operant conditioning to a multifaceted support plan that recognises the communicative intent of the client alongside their need for meaningful community participation. In recent years there has also been an increasing recognition of the critical role of family relationships in the maintenance and amelioration of challenging behaviour, as well as in attempts to integrate the fields of family therapy and applied behaviour analysis. The aim of this article is to describe a model of tertiary consultation that draws on the skills of systemic family therapy to assist clinicians who might be struggling with responding to challenging behaviour in settings characterised by complex and ‘stuck’ mediation problems. This model applies principles of reflective practice to assist such clinicians to develop a sophisticated understanding of the nature of interactions and relationships in the client's life, a critical prerequisite to the application of behavioural intervention. A detailed description of the model and a case study will be provided.