Paula Ingram and Marianne Murdoch with advice on reflecting for revalidation
What is reflection?
Reflection is the process of making sense of an experience in order to learn and improve as a practitioner.1 Often, we reflect as part of our everyday practice without being aware that we are doing it – for example, on the way home from work.
Using reflection within health and social care has benefits for patients and the profession. In order to do this effectively, reflection involves describing, analysing and evaluating experiences from practice in a way that helps you make sense of it. Reflection can occur prior to, during and often after an event or experience, all of which can allow learning.
When reflecting try not to choose a negative incident, as we tend to dwell on things that do not go well rather than focusing on what did go well.2 So be mindful of the things you reflect upon and try to choose some positive experiences or events. Reflection is often undertaken individually, but this can also take place in groups or teams, depending on the situation. This can be done informally or more formally, which includes reflection for revalidation purposes.
There are many opportunities that may prompt reflection, for instance:
- Team meetings.
- Reading a journal or article about a topic and then applying the learning to your practice.
- Discussion with other clinical staff about critical incidents or near misses including lessons learned and good practice.
- Compliments and complaints from patients, which may involve changing practice or policies and procedures.
- GP case conferences where complex patients are discussed.
- CPD sessions that relate to your role.
Using these opportunities you can choose to reflect informally or formally as part of the revalidation process.
Informal reflection occurs most of the time and this can be invaluable – providing you acknowledge that this is reflection and take time to recognise the learning you have undertaken.
By spending even 10 minutes at the end of each day considering what you have learned, you may identify further learning you want to undertake or consider how you may improve your practice.
Informal reflection is often unstructured, so it is a good idea to impose a structure on your thinking.
You could try asking these three simple questions:
- What went well?
- What did not go so well?
- What would you do differently next time?
This simple approach can enable reflection on practice and can be used either individually or with the team at the end of each day to debrief. In some practices, groups of staff have used these questions as prompts at the end of a shift to both support and learn from each another.
When reflecting informally these thoughts are not usually recorded, so you may want to jot something down. This might just be a few words or thoughts initially; you may want to use these to reflect more deeply or formally at a later point. Informal reflection has many benefits but can result in superficial learning. However, more meaningful reflection and learning can be undertaken if formal reflection takes place.
Formal reflection (which includes reflection for revalidation)
With the mandatory requirement from the Nursing and Midwifery Council (NMC) to revalidate every three years, the need to provide five reflective accounts has become compulsory.3 This is formal reflection, as evidence must be produced to demonstrate that you have learned from events and developed your practice.
The NMC3 states the reflective account must be based on either:
- A piece of practice-related feedback you have received
- An event or experience in your own professional practice and how this relates to the code
- Practice-related feedback
These reflections should outline what you have learned, how you improved your practice and how it is relevant to the NMC Code.4,5 You may even want to start your reflection with an aspect of the Code and consider how you have applied this to your practice.
Example scenario and NMC reflective account
You see Patient A for their regular asthma check. They ask you about a new treatment they have read about on the internet and wonder if it is something they could have prescribed by the NHS. You advise them that you are not aware of this new treatment and that they should continue with their current medication.
NMC reflective account template
Describe the nature of the CPD activity or practice-related feedback or event or experience
This was an experience from my practice where I had a consultation with a patient.
What did you learn from the CPD activity or practice-related feedback or event or experience?
I felt I gave the patient the correct advice. It is in the patient’s best interests to keep taking the medication prescribed for them rather than searching for new treatments on the internet that may not be available
However, I felt I dismissed the patient’s query quite quickly. I could have taken more time to listen to the patient and perhaps ask some probing questions as to why they were seeking alternative treatments. Maybe they were experiencing symptoms or side-effects with their current treatment and finding them difficult to deal with.
How did you change or improve your practice as a result?
When patient A returns for their follow-up appointment I will check if they have any concerns about their current treatment regime and explore the perceived benefits of the treatment the patient has found on the internet. I also know the local hospital often have clinical trials patients can participate in so I am going to find out more and whether my patient might be eligible.
If I am faced with this situation again I will make sure I take more time to understand why my patient was searching for alternative treatments on the internet and ensure I offer more tailored support and advice.
How is this relevant to the Code (one or more theme from the code)?
This is relevant to:
2 Listen to people and respond to their preferences and concerns.
To achieve this, you must:
2.1 Work in partnership with people to make sure you deliver care effectively.
6 Always practise in line with the best available evidence.
To achieve this, you must:
6.1 Make sure that any information or advice given is evidence based, including information relating to using any health and care products or services.
Whether you prefer to reflect formally or informally, it is best to record reflections on a regular basis as it can be easy to forget details over time. It is more beneficial to your practice to reflect regularly because the more you reflect the easier the process becomes. If you are reflecting informally, the reflection may not be overly detailed at this point, you may just use bullet points to record the most important points at the time, then go back to writing more details when you can. Alternatively, you can record your reflections using an audio feature on your phone or a dictaphone, which you can transcribe or listen to later on.
However, make sure any reflections you record or write down are anonymised in line with revalidation guidelines and the NMC Code.3,5 This means not using names of patients or colleagues or information that could identify them.
When reflecting for the purposes of revalidation, the most up-to-date NMC reflective account template must be used. This follows a structured format, which encourages you to link any reflections to the NMC Code5 and enables you to ‘live the Code’. These accounts must then be discussed with another NMC registrant as part of your reflective discussion.
The NMC states that the Code5 should be the focal point for any reflective discussion. It is therefore essential that reflection becomes an integral part of your practice.
When reflecting there are a few key things to consider:
- Make time to reflect.
- Value the benefits it may bring to your practice.
- Use a structure only if you feel comfortable doing so.
- Write notes – even if these are short, bullet points and in informal language, that is fine
Using tools such as a reflective diary can allow you to see how you have developed both personally and professionally.
Reflection has been shown to provide valuable professional development. It also enables you to learn more deeply about a variety of situations and events, not just for revalidation.
Paula Ingram is the practice education co-ordinator at NHS Education for Scotland
Marianne Fairley-Murdoch is a lecturer and practice educator at the University of Stirling and NHS Education for Scotland
1 Fairley-Murdoch M, Ingram P. Revalidation: A Journey for Nurse and Midwives. Open University Press; 2017
2 Taylor J. Reflective Practice for Healthcare Professionals. Third Edition. Open University Press; 2010
3 Nursing and Midwifery Council. How to Revalidate with the NMC nmc.org.uk/globalassets/sitedocuments/revalidation/how-to-revalidate-booklet.pdf
4 Williams R. Revalidation Reflection. Nursing Management 2016;23:6-10
5 Nursing and Midwifery Council. The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf