Fundamentals of Nursing and Midwifery 2e

Unit III Thoughtful practice and the process of care

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REFLECTIVE PRACTICE The process of compiling a professional portfolio includes reviewing, reflecting and recording (Timmins, 2008). The skills involved in this active and continuous process enhance self-reflection and enable practitioners to take control of their lifelong learning. Reflective practice in the context of nursing and mid- wifery is the first component of thoughtful practice (see Figure 13-1 for how reflective practice fits within the model of thoughtful practice). Reflective practice has three ele- ments (Figure 13-1). The first two elements—self-awareness and the process of reflection—will be discussed here. You might recall that a key aspect of person-centred care, the underpinning philosophical approach taken throughout this text, is the formation of effective relationships with others. Effective relationships are sustained when they nurture those involved in the relationship (clinician and patient; clinician and colleague). Such relationships require valuing and knowing the self and others, as well as the ability to reflect on such things as values and beliefs and how these affect care delivery (McCormack & McCance, 2010). Before reading further, it is timely to stop and reflect again on what being person centred means, and how this might affect our awareness of self. Think back to Chapter 1 where person-centred care is defined, and the personal attributes for a person-centred clinician are listed in Box 1- 5. Being person centred relies on the first two attributes on this list (open-mindedness and valuing the person) in getting to know the person, their social context and the values held by the person. The third element of reflective practice—critical think- ing—is introduced in Figure 13-1 simply to acknowledge its connection with reflection, and in order to understand how many authors combine critical thinking with self-awareness and reflection as the basis for reflective practice. Tanner (2006) demonstrated the links between reflection and ‘thinking like a nurse’ in her model of clinical judgement, and Nielsen, Stragnell and Jester (2007) encourage clini- cians to reflect in an evidenced-based way. Chapter 14 provides a detailed discussion of critical thinking as a com- ponent of clinical reasoning. Self-awareness Self-awareness is the foundation stone of reflective prac- tice. Rungapadiachy (1999) has highlighted three layers of self-awareness: • First layer is a superficial awareness of basic personal attributes, such as age and gender. • Second layer is a selective awareness that includes things we may feel we need to be aware of, such as our outward appearance and how we express our attitudes. • Third level is a deeper awareness that reflects our deepest thoughts, our secrets and issues known only to ourselves.

This self-assessment is mandatory, and all nurses and mid- wives are required to demonstrate their competence for re-registration using all the components of the framework. For the competency frameworks relevant to your registra- tion jurisdiction, see the NMBA, NCNZ and MCNZ websites listed at the end of this chapter. Professional portfolios The product of the self-assessment described above will be the compilation and maintenance of a professional portfolio that provides documentary evidence of continuing profes- sional competence (Andre & Heartfield, 2011). In Chapter 1, the concept of the learning portfolio is introduced. Through- out this book you are encouraged to collect focused reflections and critical thinking activities that provide evi- dence of your growth and development, compiling them to form a learning portfolio. This may then be converted into a professional portfolio that can be used after registration. Although the NMBA does not stipulate that an actual portfolio is required, verifiable records of a minimum of 20 hours of continuing professional development (CPD), with learning outcomes that can be used for reflection and to create a personal learning plan, must be available if required for registration or random audit (Andre & Heartfield, 2011). Many organisations also now require a professional port- folio to be provided at times of staff assessment. The NMBA acknowledges that portfolios may take various forms, but recommends that they meet the following requirements for demonstrating ongoing competence. Nurses and midwives must demonstrate: • Self-assessment of their role as a nurse/midwife, and have received professional feedback on that assessment • Planned participation in continuing professional development and practice activities • Reflective activity related to the impact of this on their continuing competence (Australian Nursing and Midwifery Council, 2006). Although the form of the professional portfolio may vary, most contain a professional history with a curriculum vitae, job descriptions, registration certificates and educational transcripts or awards. Evidence of professional activities should also be included, such as presentations, records of conference attendance, publications, membership of profes- sional organisations and any other documents that demonstrate ongoing professional growth. There are different ways of providing evidence of reflec- tive activity. During your course you may have undertaken reflective journaling of your clinical placement experiences in preparation for practice. You may also have undertaken studies where narrative and critical incidents were analysed for the purpose of improving your individual practice (Levett-Jones, 2007). The work produced through both of these methods, as well as other reflections such as those you have been undertaking throughout this text, are also accepted as evidence of reflective practice for your portfolio (Jack & Smith, 2007).