Reflective Practice Sessions Research Articles

A qualitative evaluation of weekly reflective practice sessions for the intensive care unit pharmacy team during the COVID-19 pandemic

Despite well-being initially being high on the agenda for UK health organisations, the COVID-19 pandemic has highlighted significant gaps around provision for well-being of pharmacists in the UK. The COVID-19...

The C-CAP Process: A Comprehensive Approach to Community Resource Mapping.

Place-based systems change approaches are gaining popularity to address the complex problems associated with locational disadvantage. An important stage of place-based systems change involves understanding the context that surrounds (re)produces a target problem. Community resource mapping can be used to establish the context and identify the strengths of a community that might be leveraged through systems change efforts. Approaches to community resource mapping draw on a range of philosophical assumptions and methodological frameworks. However, comprehensive, practical guidance for researchers and practitioners to conduct community resource mapping is scarce. Drawing on the learnings from a literature review, scoping workshops, and reflective practice sessions, we developed a flexible, methodologically robust process called the Contextualize, Collect, Analyze, and Present (C-CAP) process: a four-phase approach to preparing for, conducting, and reporting on community resource mapping. The C-CAP process was co-developed by researchers and practitioners and was tested and refined in two different communities. The C-CAP process provides robust guidance for conducting and reporting on a community resource mapping project. The C-CAP process can be applied by public health practitioners and researchers and adapted for use across different communities, problems, and target groups. We encourage others guided by differing theoretical perspectives to apply C-CAP and share the learnings. Application of the C-CAP process has the potential to improve the comparability and comprehensiveness of findings from community resource mapping projects and avoids duplication of effort by reducing the need to design new processes for each new community resource mapping activity.

Working with a reflective system within the SECURE STAIRS framework for integrated care: An evaluation of reflective practice sessions within the children & young people secure estate

The SECURE STAIRS Framework for Integrated Care (NHS England, 2016; Anna Freud National Centre for Children and Families, 2022) was developed by NHS England to promote a trauma-informed, evidence-based and whole system approach to children and young people accommodated in the Secure Estate. These settings accommodate children and young people presenting with high risk, high harm and high vulnerability presentations that cannot be kept safe in the community. Reflective practice sessions were facilitated over a twelve-month period for residential staff, physical health staff and management working within a Secure Children’s Home in the North of England. A pre and post questionnaire evaluation method was utilised to analyse the results. The evaluation indicated significant improvements in participant’s confidence in their practice and communication with colleagues and children and young people; ability to be reflective with others both during and after an interaction; levels of stress when interacting with children and young people; and uncertainty within their practice. However, decreases were observed in participants ability to appraise their practice and desire for improvement within their practice. The authors critically review the results of the evaluation and highlight the ongoing need for reflective spaces for staff caring for children and young people with complex needs within the Secure Estate.

Work-life balance for aspiring clinical psychologists: Topics from reflective practice sessions

Work-life balance is vital in clinical psychology, especially in early career stages. In reflective practice sessions, ten aspiring clinical psychologists raised topics of financial constraints, employment insecurities, time commitment, industry competitiveness, guilt, risk of burnout, and lack of self-care.

Acceptability and feasibility of using avatar-based virtual world software as an adjunct to clinical interventions, training, and reflective practice in a medium secure setting: A qualitative interview study.

Relationships are at the core of recovery, particularly in secure services where patients have usually had difficulties with authority figures and can have mentalisation deficits. Early indications are that avatar-based virtual world software may help facilitate communication and emotional expression. To establish the feasibility of using avatar-based virtual world software in a medium secure hospital, adjunctive to standard staff-patient interactions during clinical interventions and staff activities including reflective practice and training; to explore patient, staff participant and facilitator experiences using it. Use of the software was offered across an 89-bedded unit as an optional adjunct to clinical interventions, reflective practice and training sessions. Qualitative data were collected using semi-structured interviews and analysed using thematic analysis. Volunteer sampling was used. Five patients volunteered and were matched with an equal number of staff facilitators and participants. Eighty four sessions were completed using the avatar software with between 1 and 11 participant(s) per session, totalling 347 participant sessions. No adverse events occurred relatable to the sessions. An overarching theme of 'adding value' emerged, encompassing subthemes such as 'concrete visual presence and imagery', 'mentalisation processes' and 'enhanced focus, depth and problem solving'. Experiences of added value were affected by moderators which were 'power and relationship dynamics', the 'ability to use software', 'practical processes' and 'literacy'. Avatar software is feasible to implement, acceptable to patients and staff and may offer an opportunity to aid mentalisation and reflection. By definition, everyone engaging in this study was a volunteer, even an enthusiast, so it would now be useful to extend evaluation to those who need some encouragement to use avatar software. Research to quantify benefits and establish the cost impact is now indicated, as our findings show it may offer a novel way of connecting with hard-to-reach patient groups.

The introduction of regular group reflective practice sessions for junior doctors in a critical care setting during the second wave of COVID-19 pandemic – a Pilot

AimsReflective practice is a core component of undergraduate as well as post graduate training. Reflective practice provides an opportunity for individuals to learn through their experience as well as gaining insight into themselves and their practice. If completed effectively, it has been shown to reduce stress and improve mental well-being. Our aim therefore was to provide regular group reflective practice sessions with the aim of supporting junior doctor's mental wellbeing during the second wave of the COVID-19 pandemic.MethodJunior doctors within a critical care setting were offered two-weekly group reflective practice sessions focusing on ‘difficult or challenging cases and encounters.’ The sessions were offered to all junior and middle grade doctors within a critical care department in a small district general hospital. Consultants were also able to attend. The groups were facilitated by a consultant liaison psychiatrist and an accredited balint group leader. Critical care doctors were provided a feedback questionnaire assessing the impact of the sessions and the levels of stress and burnout. The themes emerging from the sessions were also explored.ResultA total of six reflective practice sessions were offered during a three-month period. A total of four reflective practice sessions were completed; two sessions were cancelled due to high workload on the department. Each session lasted approximately 50mins. On average a total of 3-4 junior doctors attended each session. The sessions were conducted face to face in a socially distanced manner and with all participants wearing face masks. The sessions were predominately attended by foundation doctors and SHOs. There was occasional attendance by middle grades and a consultant.The predominant themes that emerged included: guilt, prolonged suffering, desensitisation, support and exhaustion. Despite the challenges associated with the pandemic and lockdown, many of the doctors also acknowledged the benefit of being at work during both waves of the pandemic. There was a sense of collectiveness and group belonging. The group found it beneficial to be able to share their experiences and challenges faced; this was most striking amongst the very junior members of the team.Questionnaires were also provided to gain additional insight into the wellbeing of the critical care doctors. Worryingly the results highlighted a significant proportion of doctors were experiencing signs of burnout including fatigue (77%), lack of energy (54%), cynicism (31%), frustration and irritability (45%) and detachment (38%). Many of the issues highlighted were in response to the demand created by the pandemic and a lack of medical staffing wth 69% of doctors requesting regular feedback on staffing issues.ConclusionBurnout and low morale were already highlighted in a significant number of junior doctors prior to the pandemic. COVID-19 has identified a clear need for NHS employers and medical leaders to provide emotional and psychological support to staff. It is vital that we create an open environment where individuals can express their feelings openly without fear that they will be judged. Group reflective practice provides an avenue to build on collectiveness created during both waves of the COVID-19 pandemic. This pilot has demonstrated that if introduced as part of a wellbeing support package, junior doctors within a critical care setting are able to utilise the sessions in an effective and productive manner.

Staff wellbeing initiatives in a multidisciplinary community learning disability service in response to the Covid-19 pandemic

In response to the pressure and potential burden on staff members in a busy London Community Learning Disability Service during the Covid-19 pandemic, several staff wellbeing initiatives emerged. These included a weekly wellbeing newsletter, wellbeing sessions, virtual lunches and reflective practice sessions. Through using a responsive approach, the initiatives were adjusted to meet demand and the need of the staff members within the service. Feedback has suggested that in particular, the wellbeing session and newsletter were the most valued and gave staff members a sense of connectedness and belonging and helped to manage anxiety. These initiatives are now ongoing. To increase the reach and potential benefits of the wellbeing initiatives across the service our learning indicates management modelling, protected time and collaboration across disciplines may be important factors.

If you want to change the world you have to start with yourself: The impact of staff reflective practice within the Offender Personality Disorder pathway

The offender personality disorder (OPD) pathway was implemented in 2012 to help improve services for people with personality difficulties within the criminal justice system. The OPD pathway acknowledges the importance of supervision, training and reflective practice for staff working with this client group and such activities have therefore been embedded within this initiative. Despite the research from this pathway identifying benefits to both staff and service users, there is a gap in knowledge about the impact of reflective practice. This study aims, therefore, to increase this knowledge base by exploring staff’s experience and perception of reflective practice as part of the OPD pathway programme. Focus groups and semi-structured interviews were completed with 32 members of National Health Service and National Probation Service staff within offender management teams and approved premises in the North East of England. Thematic analysis was used to analyse the data, resulting in the emergence of four key themes relating to the utility of reflective practice sessions. The findings suggest that reflective practice is useful, however, there are some barriers to attending sessions. The findings have implications for service delivery and workforce development within the OPD pathway programme and more widely within NPS.

Conducting a consensus conference to design a psychology service model for acute mental health wards

ObjectivesThis paper outlines best practice recommendations for the clinical psychologist's role in inpatient settings and also presents a methodology for deriving evidence‐based recommendations, which may be replicated by health care professionals in other areas of service development.MethodsTwenty‐three, nationally drawn experts, deemed expert by profession and/or experience attended a one‐day conference. Participants were presented with findings from previous research and key unanswered questions in terms of how psychological services should be delivered in inpatient settings. Participants discussed the information presented within small groups and then independently responded to the questions posed. Responses to questions either involved ranking priorities or choosing the best possible option in terms of what or how aspects of the model should be delivered.ResultsWe were able to identify referral priorities for formulation, nurse‐led psychosocial interventions and psychological therapy using ranking questions. Consensus (defined as 70% agreement) was achieved within 1–3 voting rounds for all questions which involved selecting one of a range of possible options. These responses provided information about how to deliver formulation, supervision of nurse‐led psychosocial interventions, staff well‐being interventions, and one‐to‐one therapy, as well as psychologists' own training and supervisions needs.ConclusionsFindings provide recommendations relating to five different service areas for inpatient settings seeking to implement a psychological service model: formulation, nurse‐led interventions, one‐to‐one therapy, staff well‐being, and psychologist training and supervision. Additionally, we showcase a methodology for synthesizing knowledge and decision‐making that can be implemented by researchers and health care professionals seeking to design interventions or service models in other settings.Practitioner points Psychologists working on inpatient wards should endeavour to develop a team formulation for each patient, prioritizing patients with longer length of stay, repeated admissions, and who staff find challenging. Psychologists should offer 1:1 therapy with patients who have complex needs that cannot be addressed by nurse‐led interventions. Reflective practice sessions should be a key component of the psychologist's role on inpatient wards with the function of improving staff well‐being. Consensus conferences are useful methodology to synthesize knowledge and undertaking decision‐making in relation to the design of interventions or service models.

Balint-style reflective practice groups in a year 4 undergraduate general practice attachment: experience of the first two years.

Background and aimsMany undergraduate medical curricula include reflective practice sessions based on traditional Balint-groups. Those sessions can help students to acknowledge that experiencing ‘negative’ feelings in relation to patients is normal and may contain important information about the clinical encounter. They may also help to protect students from some of the emotional challenges of studying medicine. The Edinburgh University scheme provides all students in their first clinical year with two dedicated reflective practice sessions. Here we report on experience of the first two years.MethodsStudents’ attitudes to the sessions were ascertained using a questionnaire, and views of the group leaders were assessed using a questionnaire and through informal verbal and email discussions. Practical difficulties were recorded as they arose.ResultsStudents generally rated the sessions positively with regard to exploring relationships and self-reflection, and they found the sessions interesting and helpful. The sessions did not seem to affect career choice. The free-text comments suggested four positive themes and four areas for future modification.ConclusionWe have succeeded in providing all undergraduate students with an opportunity to take part in a reflective practice. We have highlighted aspects which have been successful and suggested future improvements.

Impact of narrative medicine program on improving reflective capacity and empathy of medical students in Iran.

PurposeNarrative medicine consists of the expression of medical experiences and the reflection on narratives to foster empathic communication with patients. Reflecting on narratives increases self-awareness and recognition of the feelings of the narrator or the story’s main character, which in turn affects the audience. This study was conducted to examine the impact of a narrative medicine program on the reflective capacity and empathy of medical students.MethodsA quasi-experimental study was performed during the 2018–2019 academic year at Isfahan University of Medical Sciences in Iran involving 135 medical interns in 2 groups (control [n=66] and experimental [n=69]). Interns in the experimental group took part in seven 2-hour reflective practice sessions, while those in the control group underwent no educational intervention. Pre-test and post-test assessments were conducted for both groups using 2 valid and reliable tools for the assessment of reflective capacity and empathy. Mean reflection and empathy scores were compared within groups (between pre- and post-test values) and between groups (using the paired-t test and the t-test; P≤0.05).ResultsThe mean reflection and empathy scores of the experimental group significantly increased from pre-test to post-test, but those of the control group did not. Moreover, the mean post-test scores were significantly different between the 2 groups (P<0.001).ConclusionNarrative medicine is an effective teaching method that can improve reflective capacity and empathy, thereby ultimately promoting professionalism as a core competency in medicine. Consideration of learning conditions and interdisciplinary teaching are necessary for implementing a narrative medicine program.

Occupational Therapy Enhanced Practice Education Approach: Student Perspectives

It has been suggested that to provide occupational therapy students with the best opportunities to learn while on a placement, it is important that they enter a supportive and welcoming environment that fosters quality learning experiences. To achieve a quality practice education experience, the occupational therapy team at Barwon Health developed and implemented the Barwon Health Occupational Therapy Enhanced Practice Education Approach (BHOTEPEA). The aim of this research was to ascertain occupational therapy students’ perceptions of the impact of the implementation of three core components of the BHOTEPEA: the student orientation process, facilitated practicums and reflective practice sessions. The method utilised by this study was an on-line survey to collect quantitative and qualitative data from occupational therapy students who had undertaken placements at Barwon Health between December 2014 and December 2015. Thirty-six out of 125 occupational therapy students responded to the survey (response rate of 29.8%). Students indicated that the approach assisted them to feel welcomed and prepared for placement, develop their practice skills and abilities, and develop their reflective practice skills. In conclusion, it appears that the BHOTEPEA supports the key elements of a quality practice education experience for occupational therapy students identified in the literature, including a welcoming learning environment, detailed orientation, clear expectations and a graded program of learning experiences. The findings from this research suggest other placement sites may be able to enhance the quality of their student placement experiences by adopting the three core components of the BHOTEPEA.

Reflective practice applied in a clinical oncology research setting

As a previous systematic review highlighted a wide variety of approaches and a lack of published evidence on the use of specific models for reflective practice in health care, a scoping review of existing literature describing reflective practice models preceded piloting the programme with the research team. The Mindful Attention Awareness Scale (MAAS) was used to assess the benefit for participants. Scores from the first and last session were analysed using a paired-sample t-test. Feedback from questionnaires was analysed using descriptive statistics (for Likert scales) and direct quotes from free text exemplified the experience. Seven people participated. Six were female, all were research nurses except for one research allied health professional. The median age was 37 (range: 23-40 years). The average time since graduation was 10 years (range: 1.5-18 years). All researchers worked in a tertiary oncology setting. Although a total of 21 reflective practice sessions were facilitated, the median number of sessions attended was 9 (range: 2-21). The mean MAAS score improved from 57.83 to 62.83 (p=0.0146). The participants rated the experience and impact as positive. The results of the MAAS score indicate that mindfulness was enhanced by the sessions. The feedback from the participants highlighted the impact on their professional development. This is encouraging to support developing similar facilitated reflective practice programmes in different settings.

Nurses’ views on reflective practice sessions in a medium secure unit

Aim Reflective practice is essential in the development of autonomous, critical and advanced practitioners, and can positively affect nurses at all levels. This study aimed to evaluate nurses’ experiences of participating in reflective practice sessions in a medium secure mental health service.Method Data were gathered over four months in 2013, through semi-structured interviews with eight nurse participants.Results Analysis revealed four themes – nursing growth, unsafe terrain, unmet needs, and a sense of direction and improved practice, which comprised both positive and negative elements.Conclusion To the best of the authors’ knowledge, this study is the first of its kind and contributes to the evidence base on reflective practice. Reflective sessions, although useful, are not always used effectively because of nurses’ concerns about psychological safety in the group and because of lack of staff. Better education about the aims, objectives and nature of reflective practice might improve nurses’ engagement.

An evaluation of the appropriateness and effectiveness of structured reflection for midwifery students in Ireland

Midwifery students undertaking the undergraduate midwifery education programme in Ireland participate in facilitated reflective sessions that aim to develop their skills of reflecting on and in clinical practice. This paper presents a qualitative evaluation of the appropriateness and effectiveness of the facilitated reflection sessions for pre and post-registration midwifery students in two large Dublin maternity teaching hospitals. The aim was to evaluate structured reflective practice sessions which sought to assist midwifery students to become competent reflective practitioners. Group reflection sessions were conducted weekly in a clinical practice area at the same time each week over one academic year. After the series of structured reflective sessions, midwifery students and facilitating staff were invited to evaluate the reflective process. This evaluation consisted of a self-completion survey to identify the factors that facilitated and impeded student participation in the sessions. Respondents answered a series of questions about the reflective practice sessions and were also invited to enter qualitative data regarding their subjective experiences of the process in free text boxes. The data were then collated into themes by an independent reviewer. The results of the evaluation clearly indicate that midwifery students and facilitators welcomed the opportunity to engage in group reflection sessions as a form of peer support and as a catalyst for learning from clinical practice. Findings suggest that reflective practice can contribute to the development of skilled, self-aware and engaged practitioners.

Making practice inclusive in gender-based violence work

PurposeThe purpose of this paper is to present a case for reflective practice with an intersectional focus in supporting practitioners working with gender-based violence (GBV). It is argued that GBV increases women’s experiences of social exclusion requiring support systems that are inclusive and alert to intersecting forms of oppression. Some challenges to inclusive practice are identified and some supportive practices are suggested.Design/methodology/approachReflective practice examples are drawn from UK-based advocacy and therapeutic work involving women experiencing GBV.FindingsThree critical challenges to inclusivity are identified: poor knowledge of intersectionality, misuse of power and over-reliance on the scope of empathy.Research limitations/implicationsThese themes are drawn from case examples gained from work-based practice with services in London and the southeast of England. The findings have limited scope but could be used to stimulate further research.Practical implicationsIf health and social care services are to achieve a more inclusive response to women who experience GBV then reflective practice needs to shift the focus to a broader inquiry into women’s experiences. Whilst reflective practice cannot overturn the power invested in the health and social care sector it can help individual practitioners to respond to the inequalities they observe.Social implicationsIt is argued that providing a regular reflective space is an effective mechanism for fostering inclusive practice responses to women experiencing GBV.Originality/valueIntersectionality, power and empathy are identified as central themes for improving practitioner responses to GBV. How these themes apply to interactions between practitioners and abused women is demonstrated through examples from reflective practice sessions.

A competency-based approach to nurses' continuing education for clinical reasoning and leadership through reflective practice in a care situation

Newly graduated nurses need to demonstrate high levels of competencies when they enter the workplace. A competency-based approach to their education is recommended to ensure patients' needs are met. A continuing education intervention consistent with the competency-based approach to education was designed and implemented in eight care units in two teaching hospitals. It consists of a series of 30-min reflective practice groups on clinical events that newly graduated nurses encountered in their practice. It was evaluated using a descriptive longitudinal evaluative research design, combining individual and group interviews with stakeholders, the analysis of facilitators' journal entries, and a research assistant's field notes. The results suggest that issues associated with the implementation of the continuing education intervention revolved around leadership for managers, flexibility for nursing staff, and role shifting for the facilitators. Newly graduated nurses who participated in the study noted that the reflective practice sessions contributed to the development of both clinical reasoning and leadership. Nursing managers stated the advantages of the intervention on nurses' professional development and for the quality and safety of care. Following the end of the study, participants from two units managed to pursue the activity during their work time.

Improving person-centered mobility care in nursing homes: A feasibility study

Person-centered care is often equated with quality nursing home care. At the same time, quality mobility care contributes to residents' independence and quality of life. Realist evaluation and mixed methods were employed to evaluate the feasibility of a multi-faceted training intervention focused on person-centered mobility care. Staff and ambulatory residents of a ninety bed Australian nursing home with 3 units—one dementia-specific—participated. The intervention consisted of training sessions, weekly mobility care huddles and reflective practice sessions with individual staff. This study demonstrated the feasibility of an intervention aiming to improve person-centered mobility care in nursing homes; it was practical and well accepted. Study methods and outcome measures were suitable. Outcome measures demonstrated capacity to determine the effectiveness of the intervention in a larger randomized controlled trial. Focus groups provided insights regarding the context and mechanisms of change. Future research is recommended to evaluate intervention effectiveness and sustainability.

Social Media Impact: Utility of Reflective Approach in the Practice of Surgery.

Social media is rapidly being incorporated into medical education. We created a small group, reflective practice sessions by integrating specific medical cases to improve awareness about professionalism on social media. Medical scenarios were generated for reflective practice sessions on social media professionalism. Anonymous pre/post-session surveys evaluated residents' use of social media and gathered their opinions on the session. Thirty-eight of 48 (79%) residents replied to the presession survey with 50% (19/38) reporting daily digital media use, 76% (29/38) witnessed unprofessional postings on social media, and 21% (8/38) posted unprofessional content themselves. Of the 79% (30/38) residents who attended the session, 74% (28/38) completed the post-session survey. Residents reported the session added to the longevity of their professional career 4.11, 95% CI (3.89-4.36). As a result of the session, they were more conscious of using the social media more professionally 3.47, 95% CI (2.88-3.96) and would be proactive in protecting patient privacy and confidentiality on social media sites 3.96, 95% CI (3.50-4.37). In summary, reflective practice-based sessions regarding the impact of social media on professionalism in surgery was well favored by the residents. The majority agreed that it had important implications for the longevity of their professional career. Participants reported having an increased awareness to protect patient privacy and utilize social media more professionally.

LOS SEMINARIOS DE PRÁCTICA REFLEXIVA EN EL PRÁCTICUM DE PEDAGOGÍA DE LA UNIVERSIDAD DE BARCELONA

INTRODUCTION. The Practicum of the Pedagogy degree at the University of Barcelona has three compulsory subjects that are coordinated under a logic of progressive immersion in an institution of practicums: Professionalization and Labor Opportunities, Professional Initiation Practicum and External Practicums (PEX). The innovation introduced is part of a consolidated teaching innovation project at the University of Barcelona. Specifically, we present innovations related to the compulsory subject of External Practicums that with a transdisciplinary point of view, opt on the one hand, for the immersion of students in an organization, and on the other hand, for reflective practice sessions between students and college tutors that allow the transfer of knowledge, and a process of reflection on the relationship between theoretical knowledge and experiential knowledge in professional life. Reflective practice sessions follow a thematic approach structured around competencies. METHODS. The evaluation of teaching innovation presented uses a methodology based on a research survey that uses quantitative techniques to collect and analyze information. Three questionnaires address students, the tutor from the institution offering the practicum, and the college tutor, respectively. The sample comes from students and tutors involved in the academic year 2012-2013: 143 students, 15 university teachers, and 45 tutors form the institutions offering the practicums. RESULTS. Among the results the reflective practice sessions are valued for competences development in the External Practicum of the Pedagogy degree. DISCUSSION. The assessment of competencies, especially in the Practicum, is a major challenge. Despite the good psychometric result of the proposed study, there are still some difficulties to overcome, for example regarding the sustainability the method of assessment. The results indicate the need to deepen the relationship between students´ awareness of their level of competence, and the improvement of their safety, self-esteem and their subsequent employability.