Be the very best ancestor you can be

19 December 2017

Abigail Masterson, FoNS Associate Facilitator and Independent Consultant

One of the many interesting things that happens when you have been around in the profession as long as I have is that you get asked to talk to people about your career; an invitation which always provokes deep reflection in me. Preparing to give such a presentation a few months ago to soon-to-graduate student nurses at the University of Brighton, where I am an Independent Governor on the Board, I was struck by the importance of my ancestors in my career; the generosity of the many individuals who have encouraged and supported me right from my early days as a student nurse. Through their actions they offered me opportunities, challenged me to be the best I could be, provided a sense of endless possibility and dared me to think big.

My ancestors include people like the professor of nursing when I was a first year student nurse who asked us – “What is normal?” a question which still guides and challenges my practice today. The surgical ward sister in my third year whose challenging feedback punctured my hitherto arrogant sense of entitlement and made me think long and hard about whether or not I really had what it takes to be a good nurse. The nursing officer who gave me an excellent piece of career advice which I now share with people I mentor and coach and that is always to think two jobs ahead rather than one. This helps you think about the potential of the routes out of the job you are contemplating as well as what it might offer you now.

My ancestors include both people within nursing and outside it. The geriatricians, OT, physio and social worker who I worked with as a ward sister and who supported me both to develop and improve the nursing practice on the ward and the quality of care we gave as a multi-disciplinary team and who fostered and encouraged my interest in teaching and research. As well as people I know personally my ancestors include people who I have never met but whose actions have had a tremendous impact on the possibilities open to me. For example, the visionaries who established the first department of nursing at the University of Edinburgh. We are all someone’s ancestors whether consciously or not and however old or established we are.

Who are your ancestors? Whose future are you shaping today?

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Thinking about reflection…

12 December 2017

Kate Sanders, FoNS Practice Development Facilitator

We are proud at FoNS and the IPDJ to support the publication of critical reflections. Our recent issue (and past issues too) contains an eclectic mix of reflections, both in terms of the focus of the reflection but also the methods used. Writing these reflections has enabled the authors to develop a greater self-awareness, a deeper understanding of practice and to share their learning and proposed actions with others. 

But reflection is not just an academic activity. In many aspects of our life, it helps us to evaluate what is going well, or not so well, to think about the things that may be limiting or hindering us in doing or achieving what is important to us, and enables us to make plans and to take action. Indeed, some philosophers e.g. Paulo Freire would argue that it is essential for humanity, to enable us to be active participants in the creation and re-creation of our culture and society. 

Critical reflection has a long history in nursing, with a number of models to guide reflection emerging from the 1980s onwards (e.g. Gibbs, 1988; Johns, 1995; Driscoll, 2007). However, it could be argued that engagement in critical reflection by nurses features more frequently in nursing education than in everyday practice. Similarly, whilst clinical supervision that is underpinned by a reflective process is recognised as a valuable approach to supporting both professional and practice development, it seems that uptake in nursing is ‘patchy’ (Hatchett, 2013). Additionally, a recent review of the literature by Pollock et al. (2017) identified large variations and a lack of consistency in the delivery of clinical supervision. Anecdotally, the people that we work with in practice would support this view, calling into question whether critical reflection is being used effectively to enable individuals and groups to be self-directed learners. 

The NMC revalidation process has certainly raised the profile of critical reflection in nursing and I have heard many talk about how much they have valued their reflective discussion. But I wonder if this will be something that only happens every three years, or whether the perceived value will be such that nurses begin to seek out more opportunities for such conversations. We know that the revalidation process has created this opportunity as it is a mandatory activity; I wonder if in the busyness of practice whether time for reflective discussions will be prioritised – unfortunately my sense is, probably not. 

Similarly, we know that the opportunity provided by Schwartz Rounds to engage in reflective discussions with others in a ‘safe’ environment is valued by those that are able to attend (Maben et al., 2017). The Rounds reportedly facilitate a deeper understanding of others and the context, and over time there is evidence of enhanced relationships, a change in culture and improvements in staff well-being (Maben et al., 2017). But this evaluation also acknowledges the challenges faced by ward staff to attend. 

Although the evidence on the impact of 12 hour shifts for both staff and patients is still quite limited, it would seem logical to say that these shifts reduce the potential for staff to get together and the shift handover in the middle of the day has been lost for many. As 12 hour shifts are preferred by many nurses and it seems employers prefer them due to lower staffing costs, it seems that there won’t be a change anytime soon. 

At FoNS, we believe that it is important to prioritise staff engagement and well-being (see the culture change resources), and key activities to enable this are having clear and shared goals and meeting regularly to reflect on progress. So how can this be achieved? 

A recent blog by Liz Green described how she had worked creatively to enable all the ward staff to participate in an away day as a means of working together to create shared goals. Other staff we have worked with have shared how they have used activities that are part of their everyday practice to create opportunities for reflective discussion – this includes huddle boards, handovers and team meetings. The impact and outcome of ‘corridor conversations’ can also perhaps become different if we think more carefully about our contributions to these. Do we jump to offer solutions or can we ask facilitative questions that prompt reflection by acknowledging feelings and emotions, challenging assumptions, and exploring options and consequences? 

What are you now thinking about reflection and do you have any ideas that you could share?