Reflective Practice In Healthcare: Using Bain’s 5 R Framework

Introduction to reflective practice in healthcare

Question:

Discuss about the Bain Reflective Framework for Clinical Nursing.

Reflective practice is essential in health and social care as it gives scopes to the Healthcare professionals to identify different positive and negative aspects from an experience. It thereby helps to apply strategies so that the negative aspects do not take place in future (Shrader et al., 2013). It can be defined as the procedure of making sense of different events, situations and actions and then learning from those situations so that mistakes made once are not repeated in next time when similar situations arise (van Veen-Berkx et al., 2015). It gives scope to nurses to develop their knowledge as well as skills and also help them to become more responsible in the future. In the present assignment, Bain’s 5 R Framework would be used as it acts as a systematic approach to the description of events and the different reflections and knowledge learn from it.

The first step of the reflection Framework is called reporting. In this step a brief description of the situation of the issue is provided. While I was placed as a graduate registered nurse in XYZ Healthcare Centre, I experienced issues in multidisciplinary team work where I was assigned .in the very first month an old lady was admitted to the ward when she faced a stroke following which she had fell down on the floor.  This had caused her several bruises and skin tear. She was obese with a basal metabolic rate above 30. She also faced serious issues with Arthritis which has affected her few years ago. After her treatments in the emergency ward she was shifted to the general ward as the doctor has prescribed of proper rehabilitation for a week before being discharged to rehabilitation centre. She was facing issues with her speech and was not able to swallow properly and the right side of the body was also not functioning well although paralyses had not taken place. While working in the ward, a large number of issues were noticed by me. The first issue which I noticed was that there was no proper care coordinator who would be maintaining the leadership of the team and performing the evaluation of the work done by different experts in the team. As there was no proper coordinator in the team all the experts were working individually which affected the main goal of the team work (Reeves et al., 2013). Moreover I saw that also the communication between the different experts of the team was not cordial. They usually avoided each other and did not have proper communication skills which are very important for maintaining a strong bond among the team members. While some members are rude, some are escapist. There were many team members who did not follow their own work responsibly and always played a blame game whenever confronted. Inter disciplinary communication was completely absent. All the members conducted their own diagnosis and treatment and jotted down the information in the documentation sheet. There were no proper meeting that were held between the team members and therefore the perceptions of the experts about the development of the health of the old patient could not be analysed. Moreover I also noticed intense tension and stress among the different experts as they were involved into power struggles with each other. As a result of this they were not ready to provide effective feedback and always blamed each other when any negative sequences arose. 

Using Bain’s 5 R framework for reflective practice

The second step is the responding stage where the feeling of the individual is discussed. The continuous blame game that I noticed in the working environment of the team made me quite stressed. I became quite apprehensive because I knew that even if I did my job perfectly I can be blamed by anyone in the team which affected me. I gradually started feeling low on the ward and my enthusiasm with which I started the first day, gradually began to decline. The work which I used to enjoy previously made me felt burdened and therefore I easily become burnt out. No one provided me with effective feedback. I was gradually losing my motivation and this affected the care it was provided to the patient from my end point. I started developing a feeling of apathy towards my work and did not feel like going to the team. Not only that many of the team members acted rudely with me there by showing the power of the position and were not ready to accept any kind of suggestions from me. All this affected myself respect and self image. Moreover no one was accountable for their work and therefore these created a stressful environment in the department. I was also not getting proper guidance from any of the senior members and often made mistakes. However I was seriously criticized whenever I made mistakes and this affected my zeal to continue work in the tensed work environment. However I realised from the entire situation that if all these activities continued in the ward, the health of the patient would ultimately be compromised and therefore I took a decision to report it to the senior authorities so that our ultimate goal of saving the life of the patient and giving her quality life can be achieved. 

The next step of the reflective Framework is called the relating step. In this case the personal or theoretical understanding of an individual to a particular situation needs to be discussed. From the various theories that we have studied in the university years, I came to understand that the main issue of the ineffective teamwork in the general ward are mainly lack of proper communication skill among the different experts. They were not properly communicating among themselves and were only jotting down information in the documentation sheet. This absence of face to face communication has not allowed them to engage in different formal and informal discussions and therefore they were not able to develop strong relationships and Bond among themselves (Muller-Juge et al., 2014). Absence of a friendly approach towards Each Other has been the main reason of tensions as well as blame game among the different members. Researchers are also of the opinion that power struggles often hamper the main motto of health care of providing effective care to patients and prevents proper collaborative approach. Most of the team members were affected by the power struggles and they felt that their expertise and dedication are not respected by the experts of the higher rank. Mainly a lack of feedback providing and receiving skills was responsible for this situation (Al-Sayah et al. 2014). The senior should have provided effective feedback by properly encouraging them whenever they performed in a better way. Moreover when they would have conducted any mistake, they should be provided with the correct strategies in place of severe criticism. Besides absence of communication skills and power struggle there was also lack of a sense of accountability among the different experts as they were not accountable for their own work. They try to put the Blame on others and tried to escape the entire situation. All these affected the main Team Spirit of the multidisciplinary skills. Moreover the absence of a proper leader or care coordinator at the main reason for which all the activities conducted by the experts were taking place in an undisciplined way and no evaluation was made about the Quality of work conducted by the experts (Bookey-Bassett et al. 2017). All these had created workload and stress on different Healthcare professionals for which they have lost their enthusiasm as well as motivation to perform better. They are also no scope of continuous professional development in the ward as no training sessions were conducted for the effective teamwork (Wade, 2014). Therefore, organisation was also to some extent responsible for contribution to the tensed situation in the workplace.

Reporting: Describing the situation

The next step of the reflective Framework is called reasoning. This mainly describes the rationale behind providing the comments in the previous step of the reflective framework. Effective communication helps the members of a team to communicate effectively. It reduces the chance for misinterpretation and miscommunication. The message which is delivered by proper communication is effective and brings successful results (Sawyer et al., 2016). Moreover effective communication also helps in the development of proper relationship among the different members. Development of both a formal and informal relationship is very important for maintaining harmony in relationship and also in different team work (Komer et al., 2016). Effective communication also helps in development of an understanding of each other’s perspectives of Work and thereby helps people to respect each other in the team. I also believe that power struggles hampers the smooth workflow in the workplace and affects the self respect of different individuals. This may result in development of negative feelings, anger and disappointment against other members of the team for which the ultimate goal might be affected. Therefore it is very much important for each and every team members to understand the disadvantages of the power used by them and thereby modify their Behaviour for the betterment of the team performance (West & Lynbovinikova, 2013). The senior should use their experience to help the junior nurses 2 develop their skills and enhance their knowledge. They should also provide effective feedback to them so that they feel motivated and encouraged at workplace (Weller et al., 2014). On the other hand the juniors should also develop collaborating and accommodating styles of work where they should be receptive of the feedback of the senior and work accordingly to develop the skills (Schaik et al. 2014). I have gone through different journal articles where researchers have placed and importance of accountability in nursing and health care feels. They are of the opinion that being accountable of one’s own work is very much essential for patient advocacy and continuity of care. They also help in lifelong learning and being accountable to colleague the patient as well as to nursing profession and organisations can in turn help the individuals to serve the main motto of social contribution (Thomson et al., 2015). This value should be developed by every professional from the core of the heart. These would help to prevent the development of an environment where blame game and cursing each other or providing negative feedback to each other can be prevented. This would automatically reduce stress and workload on nurses as well as make them feels respected and loved by the team members and the organisation (Salas & Rosen, 2013). Moreover an effective leadership by the care coordinator is very important who would help in maintaining unity among the different team members, develop their communication skills, overcome any barriers faced by the team members while developing relationship among themselves and many others. They would also analyse the different situations and provide suggestions for the scopes of development for effective teamwork (Deneckers et al. 2013).

Responding: Addressing personal feelings

The last step of the reflective cycle is called the reconstructing state. The reconstructing state mainly includes drawing conclusions from the above Steps and thereby developing a future Action Plan. The step mainly helps in proposing strategies which would help in overcoming the barriers of the situation. After the condition if the ward revealed by me to the senior authority about the present scenario going in the general ward of the rehabilitation department, the first strategy that was taken by them was assigning a proper care coordinator. He was to be the main leader of the entire multidisciplinary team. He was assigned with the duty of fixing proper meetings, assigning time slots for each of the expert so there that there are no clashes, evaluating the care provided by each of the expert and to see that no blame game arises in the future. Proper leadership would help in the development of an ethical teamwork (Weaver et al., 2014).

In order to develop the communication skills of the different team members as well as of myself, I requested the senior authority to take important steps. For this they conducted communication workshops at the different healthcare professionals for about twice a week. This helps in the development of the communication skills (Rosen et al., 2014). I also arranged for meeting twice of week where all the members are requested to attend and describe about the case of the patient with transparency. This helps each other to know about the perception of the other members of the team about the health of the patient and thereby develop for the care plan for the patient (Valentino et al., 2015).

I also arranged for meetings on the weekends where all members would come forward and express their views and feedback of each other. Both negative and positive feedbacks were expected from them in such a way so that the help in the development of skills of the other members. This usually helps in the development of relationship among the members and also helps to maintain a transparency in workplace.

The senior authority also arranged for continuous professional development courses for the experts so that the virtues of accountability and the negative aspects of power struggles could be discussed effectively. Moreover the different strategies to maintain an effective teamwork would also be taught in the training classes (Casimiro et al., 2015). All the above mentioned strategies are believed by me would help in changing the present scenario of the situation 

Relating: Personal and theoretical understanding

With the help of the reflective Framework provided by Bain, the issues in the team work which I faced in the first month of my placement were properly accessed by me. Following this, I tried to relate them with the theory that I studied in my University years. Then I tried to reconstruct the situation by implementing proper Strategies and helping the authorities of the organisation to implement different courses which help in developing the condition of the rehabilitation ward. This ensured effective teamwork which helped in maintaining a quality care to the patient and improving Patient Safety.

References:

Al Sayah, F., Szafran, O., Robertson, S., Bell, N. R., & Williams, B. (2014). Nursing perspectives on factors influencing interdisciplinary teamwork in the Canadian primary care setting. Journal of clinical nursing, 23(19-20), 2968-2979.

Bookey?Bassett, S., Markle?Reid, M., Mckey, C. A., & Akhtar?Danesh, N. (2017). Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis. Journal of advanced nursing, 73(1), 71-84.

Casimiro, L. M., Hall, P., Kuziemsky, C., O’Connor, M., & Varpio, L. (2015). Enhancing patient-engaged teamwork in healthcare: An observational case study. Journal of interprofessional care, 29(1), 55-61.

Deneckere, S., Euwema, M., Lodewijckx, C., Panella, M., Mutsvari, T., Sermeus, W., & Vanhaecht, K. (2013). Better interprofessional teamwork, higher level of organized care, and lower risk of burnout in acute health care teams using care pathways: a cluster randomized controlled trial. Medical care, 51(1), 99-107.

Körner, M., Bütof, S., Müller, C., Zimmermann, L., Becker, S., & Bengel, J. (2016). Interprofessional teamwork and team interventions in chronic care: a systematic review. Journal of interprofessional care, 30(1), 15-28.

Körner, M., Lippenberger, C., Becker, S., Reichler, L., Müller, C., Zimmermann, L., … & Baumeister, H. (2016). Knowledge integration, teamwork and performance in health care. Journal of health organization and management, 30(2), 227-243.

Muller-Juge, V., Cullati, S., Blondon, K. S., Hudelson, P., Maître, F., Vu, N. V., … & Nendaz, M. R. (2014). Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality. PloS one, 9(4), e96160.

Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional education: effects on professional practice and healthcare outcomes (update). The Cochrane Library.

Rosen, M. A., Dietz, A. S., Yang, T., Priebe, C. E., & Pronovost, P. J. (2014). An integrative framework for sensor-based measurement of teamwork in healthcare. Journal of the American Medical Informatics Association, 22(1), 11-18.

Salas, E., & Rosen, M. A. (2013). Building high reliability teams: progress and some reflections on teamwork training. BMJ Qual Saf, 22(5), 369-373.

Sawyer, T., Eppich, W., Brett-Fleegler, M., Grant, V., & Cheng, A. (2016). More than one way to debrief: a critical review of healthcare simulation debriefing methods. Simulation in Healthcare, 11(3), 209-217.

Schaik, S. M., O’brien, B. C., Almeida, S. A., & Adler, S. R. (2014). Perceptions of interprofessional teamwork in low?acuity settings: a qualitative analysis. Medical education, 48(6), 583-592.

Shrader, S., Kern, D., Zoller, J., & Blue, A. (2013). Interprofessional teamwork skills as predictors of clinical outcomes in a simulated healthcare setting. Journal of allied health, 42(1), 1E-6E.

Thomson, K., Outram, S., Gilligan, C., & Levett-Jones, T. (2015). Interprofessional experiences of recent healthcare graduates: A social psychology perspective on the barriers to effective communication, teamwork, and patient-centred care. Journal of interprofessional care, 29(6), 634-640.

Valentine, M. A., Nembhard, I. M., & Edmondson, A. C. (2015). Measuring teamwork in health care settings: a review of survey instruments. Medical care, 53(4), e16-e30.

van Veen-Berkx, E., Bitter, J., Kazemier, G., Scheffer, G. J., & Gooszen, H. G. (2015). Multidisciplinary teamwork improves use of the operating room: a multicenter study. Journal of the American College of Surgeons, 220(6), 1070-1076.

Wade, P. (2014). Developing a culture of collaboration in the operating room: more than effective communication/Developper une culture de collaboration en salle d’operation: mieux que la communication efficace. ORNAC journal, 32(4), 17-31.

Weaver, S. J., Dy, S. M., & Rosen, M. A. (2014). Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf, 23(5), 359-372.

Weller, J., Boyd, M., & Cumin, D. (2014). Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate medical journal, 90(1061), 149-154.

West, M. A., & Lyubovnikova, J. (2013). Illusions of team working in health care. Journal of health organization and management, 27(1), 134-142.