Discuss about the Teaching and Learning Clinical Reasoning.
Reflective practice incorporates application of own experiences in connecting knowledge and practice for providing quality healthcare to the patients. Critical attention should be given to the theories and practical values. It is authoritative for the nurses to practice reflective process because it is the identity of the professional nursing. It is helpful for the nurses to eliminate uncertainty of nurses at workplace and encourage them to work in competent and ethical manner. Reflective practice is helpful in providing holistic care to the patients. Through reflective practice, not only therapeutic but also personal, emotional, psychological and social aspects off the patients can be addressed. This practice can give quality care to the patients. However, this practice is associated with certain complexities and limitations (Bulman et al., 2012).
In the effective implementation of the reflective practice all the stakeholders in healthcare profession and family members of the patients should be incorporated. Reflective practice is beneficial in providing person centred care to the patients (Glynn, 2012). Reflective practice includes all the components of the nursing practice like getting information about the condition of the patient, collecting past evidence and current clinical data, analysis of the data, making exact conclusion based on the collected data and implementing effective nursing plan for the patient. In this step wise approach, there is very little scope for the errors. According to WHO estimates, approximately 10 million people suffer through medical errors. In such scenario, reflective practice proved to be most useful. It is evident that most of the medical errors occur due to inability of nurse to reflect on their own practice (Pezzolesi et al., 2013).
Participation in ongoing professional development of self and others is the component of critical thinking and analysis. In this nurse should pursue and acknowledge feedback from other healthcare professionals and critically reflect on own nursing practice. It would be helpful in incorporating amendments in the nursing practice for providing holistic care to the patients. Nurse should participate in professional development to enhance nursing practice by reflecting on self-nursing practice to recognize professional requirements for growth. Nurses should use suitable approaches to make fit to the healthcare work environment. For this, nurse should implement reflective practice to recognise personal requirements and pursue necessary support from other healthcare professionals (Chong, 2009). Inter professional and patient centred communication are the important aspect of reflective practice in patient care. This communication should be trustworthy and consistent. It would be helpful in improving trusting relationships with the patients and family members. Clinical reasoning is important component for the effective implementation of the reflective practice (Bartlett et al., 2015).
With the advancement of the technology and sophisticated information sources, there is augmentation in the keenness in the patients. Hence, healthcare professionals need to be think critically and independently to answer patient’s queries. Critical reflection on own practice is an important component of improving professional nursing practice and maintaining expertise. In reflective practice, nurse need to think purposefully on the patient problem and work towards the conclusion of the patient problem. Hence, reflection can be helpful for nurses in facing challenge and solving problem in the patient care. Reflective practice make nurse to understand problem of the patient. In clinical setting reflection can be implemented by following certain steps. In the initial step, event should be described in detail comprising of exact condition of the patient, reason behind the condition of the patient and stakeholders taking part in curing the patient. In the next step, nurse should elaborate own feelings and perceptions about the patient condition. Opinions and feelings of other stakeholders should also be considered (Smith et al., 2015). All the positive and negative aspects of the patient condition should be evaluated. Consequently, patient condition need to be analysed by taking cues from the past and recent clinical data. Existing knowledge and experience should be implemented to conclude exact condition of the patient. In making conclusion about the diagnosis of the patient condition, opinions of the other healthcare professionals should be taken. After making conclusion on the diagnosis of the patient, effective therapeutic plan should be implemented. This therapeutic plan should be useful for the future patients also. Nurse should critically think about the plan in diverse directions and different approaches for implementing therapeutic plan. It would be useful in the self-assessment of the nurse. In summary, in clinical practice reflection can be implemented by using five processes. These five processes include implementation of knowledge, demonstrating comprehension, application of theories and implementing analysis and synthesising the effective care plan (Goudreau et al., 2015).
Reflective practice is useful in engaging healthcare professional with the patients. There is improvement in the personal contacts with the patient and provision of the individualised care to the patients. Patients can receive person centred and holistic care due to reflective process. Complete examination of the patient’s condition by incorporating past history and present data can be carried out. Future predictions of the patient’s condition can be made. Hence, patient can take preventive measures to manage the diseased condition. In reflective practice, patient has the opportunity to share their feelings and opinion. It can be helpful for the patients to communicate with the nurses more comfortably. As there is involvement of the patients and family members in the patient care, there would be augmentation of the medical knowledge of the patients and family members. It would improve adherence of the patients to the treatment (Dunn and Musolino, 2011).
Critical thinking and analysis domain for nursing practice of the NMBA states that reflection on practice, feelings, beliefs and it significance for the patients, family members and other healthcare professionals is vital benchmark. Competent performance by the nurse in patient care can be improved by reflective practice. Reflective practice is one of the important components of the nursing practice which include legal, professional, ethical and reflective framework. During implementation of the reflective practice, nurse should respect diverse values of patients, beliefs and social and cultural aspects of the patients. Reflective practice can be helpful for the nurses for life-long learning. Critical self-awareness, self-learning and self-evaluation are the important components of the reflective practice. Reflective practice is not useful for individual patients but also for practices and procedures in the ward. Reflective practice can provide care to the patients by closing the gap between the theory and practice. Success in the reflective practice for patients can be used as the evidence for nurses to improve nursing intervention (Driscoll et al., 2012; Gray et al., 2016).
Reflective practice incorporates reflection on the feedback and incorporates modifications in the practice based on the feedback. It includes nurse’s perceptions, attitudes and beliefs in the nursing practice. It is also helpful in identifying knowledge discrepancy and pursue explanation on this. It also ensures safety of the patients and quality nursing service to the patients. In most of the instances, it has been observed that reflection is mainly associated with the negative issues. Hence, positive aspects might remain unnoticed during this process. Nurse might feel frustrated, if they wouldn’t be able to solve the issues observed during reflective practice. Hence, it can demotivate nurse instead of promoting them for implementation of nursing practice (Oelofsen et al., 2012).
Certain complexities are associated with the implementation of reflective practice. Subjective factors can influence its implementation; hence this process can be manipulated to get the expected outcome. In implementation of reflective practice, nurse need to address personal and social issues associated with the patient. Hence, there would be extra burden on the nurse and it can lead to psychological stress in nurses (Audétat et al., 2013).
Main hindrance for the implementation of nursing practice is lack of consensus among healthcare professionals on reflective practice. Most of the healthcare professionals are not aware of the what exactly reflective practice entail ? Proper mentor support is required for implementation of reflective practice in nursing. Abundant literature is available for the theoretical usefulness of reflective practice, however there is still scarcity of practical validity of reflective practice. Reflective practice is a long duration practice. It is not going to be implemented overnight. Changing perspectives and transforming reflective abilities of healthcare professionals is a lengthy process. Hence, this time constraint is one of the barrier for the implementation of reflective practice. Nurses feel devalued as compared to the physicians, hence nurses can’t take initiation in implementing reflective practice (Mantzoukas et al., 2008). Professional relationship between nurse and physicians is considered as one of the barriers for reflective practice. Lack of culture in most of the clinical settings is responsible for hindrance of reflective practice in nursing practice (Oluwatoyin, 2015).
Conclusion:
Reflective practice is a critical skill for implementation of effective nursing practice. Reflection practice can be implemented individually and also in group. Reflective practice helps nurses to learn from the experiences. Reflective practice is beneficial for the patients for receiving person centred care. NMBA also stated importance of reflection in development of critical thinking and analysis qualities in nurses. Nurses should consider certain complexities and limitations while implementing reflective practice in patient care. In conclusion, reflective practice is imperative to evidence based nursing.
References:
Audétat, M.C., Laurin, S., Sanche, G., Béïque, C., Fon, N.C., Blais, J.G., and Charlin, B. (2013). Clinical reasoning difficulties: a taxonomy for clinical teachers. Medical Teacher, 35(3), e984-9.
Bulman,C., Lathlean, J ., and Gobbi, M. (2012). The concept of reflection in nursing. Qualitative findings on student and teachers perspectives. Nurse Education Today, 27, 192-202.
Bartlett, M., Gay, S.P., List, P.A., and McKinley, R.K. (2015). Teaching and learning clinical reasoning: tutors’ perceptions of change in their own clinical practice. Education for Primary Care, 26(4), 248-54.
Chong, M.C (2009). Is reflective practice a useful task for student nurses? Asian Nursing Research, 3(2),11.
Driscoll, A,, Harvey, C., Green, A., Weatherby, R.P., et al. (2012). National nursing registration in Australia: a way forward for nurse practitioner endorsement. Journal of the American Association of Nurse Practitioners, 24(3), 143-8.
Dunn, L., and Musolino, G.M. (2011). Assessing reflective thinking and approaches to learning. Journal of Allied Health, 40(3), 128-36.
Glynn, D.M. (2012). Clinical judgment development using structured classroom reflective practice: a qualitative study. Journa9l of Nursing Education, 51(3), 134-9.
Goudreau, J., Pepin, J., Larue, C., Dubois, S., Descôteaux, R., Lavoie, P., and Dumont, K. (2015). A competency-based approach to nurses’ continuing education for clinical reasoning and leadership through reflective practice in a care situation. Nurse Education in Practice, 15(6), 572-8.
Gray, M., Rowe, J., and Barnes, M. (2016). Midwifery professionalisation and practice: Influences of the changed registration standards in Australia. Women Birth, 29(1), 54-61.
Mantzoukas, S. (2008). A review of evidence-based practice, nursing research and reflection: levelling the hierarchy. Journal of Clinical Nursing, 17(2), 214-23.
Oelofsen, N. (2012). Using reflective practice in frontline nursing. Nursing Times, 108(24), 22-4.
Oluwatoyin, F. E. (2015). Reflective Practice: Implication for Nurses. IOSR Journal of Nursing and Health Science, 4(4), 28-33.
Pezzolesi, C., Ghaleb, M., Kostrzewski, A., and Dhillon, S. (2013). Is Mindful Reflective Practice the way forward to reduce medication errors? International Journal of Pharmacy Practice, 21(6), 413-6.
Smith, K. M., Brown, A., and Crookes, P.A. (2015). History as reflective practice: A model for integrating historical studies into nurse education. Collegian, 22(3), 341-7.
Veno, M., Silk, H., Savageau. J.A., and Sullivan, K.M. (2016). Evaluating One Strategy for Including Reflection in Medical Education and Practice. Family Medicine, 48(4), 300-4.
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