PROFESSIONAL DEVELOPMENT
Reflection: from staff nurse to nurse consultant
Part 6: Reflective teaching John Fowler
440
social background and reactions to illness; the relatives and carers, and the variety of responses they have to their loved ones and the healthcare staff; the other health professionals that are part of the care team and offsite support services; and the standard nursing skills of assessing the needs of the patient and meeting their activities of daily living. If you begin to identify and reflect on the richness of the learning experiences available in your clinical area then you will begin to realise that teaching is indeed about helping others to learn from these experiences, rather than just giving people mini-lectures. Once you can see your clinical environment as a rich source of experiences that can be used to help junior practitioners learn their practice, you need to start exposing the junior practitioner to the appropriate experience. To do this, you need to be aware of the needs and the strengths of the student. This can be achieved by simply talking to the student and asking questions. For example: what experience have you had dealing with elderly people? How confident do you feel caring for someone with challenging behaviours? What are your nursing strengths? What gaps do you have? Is there a list of things you want to achieve? Having identified the learning opportunities in your area, and the learning needs of your student, you then need to facilitate the student’s exposure to the appropriate experience. This may be by allocating them to help look after Mr Jones for the morning shift, or work with staff nurse (SN) Smith who is an excellent role model when it comes to caring for patients with challenging behaviours. Learning from experience is not just about building up months or even years of clinical practice. For learning to occur in any meaningful way, the person needs to reflect on the experience and try and make sense of it by building on it, sorting it and fitting it into their internal framework of knowledge. This is where your role becomes so important. For the student, junior colleague
or patient to learn from their experiences, they need help to reflect on the experiences and then internalise them. One of the best ways to do this is by asking questions. In the example above you have allocated your student to SN Smith with the intention of the student learning how to care for people with challenging behaviour. To help the student reflect on these patients and SN Smith’s skills, you need to give the student some questions to reflect on during that morning shift. How does SN Smith approach the patients? Does she make any physical contact? How does she make conversation? How does she respond to patients who are aggressive? Then, towards the end of the shift, sit down with the student and ask those questions again. What you are now doing is helping the student reflect on and learn what it is that makes SN Smith such a good role model. The final stage of reflective teaching is to help the student internalise what it is they have learnt. This may involve a challenge to take onboard some of the skills shown by SN Smith or adapt them to suit their own personality. This will involve practice by the student with observation and feedback from yourself or possibly from SN Smith, with praise and confirmation when professional skills are developed. The next article in this series will explore BJN your role as a reflective manager. Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to primary care trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2014 MA Healthcare Ltd
T
his series is exploring what reflection is and how it can be applied to your clinical practice. The previous five articles have examined the importance of reflection: what it is, ways to aid reflection, its relationship to feedback and reflective practice. This article will look at how you, the clinically based nurse, can use reflection to enhance the teaching and learning of your colleagues, students and patients. Take a little time to think about one of your typical working weeks, with particular emphasis on how you spend your working time. Out of 100%, what proportion do you spend: clinically with patients, record keeping, in meetings, mentoring students and junior staff, liaising with other staff, answering the telephone and answering emails? The list could go on, but these are probably the key areas of your work. What proportion of your time is spent teaching? Is it just when you are mentoring students and junior staff? Or are you also teaching patients about their illness, medication, wound care and discharge details? I would be surprised if many qualified nurses spent less than 10% of their working week undertaking some form of teaching to either junior staff, colleagues or patients. If we want to enhance our teaching in the clinical area then we need to make time to reflect on what we are teaching, when it is happening, and what our role is.The first thing to do is to recognise when we are taking on a teaching role. This does not mean when we stand up in front of someone and start delivering a lecture. Teaching patients and staff is far more about supporting them as they learn from their experiences. The first point in developing reflective teaching as a clinician is to stand back from the busyness of your routine clinical work, with all its demands, and identify the richness of the learning experiences that are present in your clinical area. This will include the clinical specialty of the patients’ illnesses; the type of patient cared for in terms of age,
British Journal of Nursing, 2014, Vol 23, No 8
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 1, 2015. For personal use only. No other uses without permission. . All rights reserved.
Reflection: from staff nurse to nurse consultant
Part 6: Reflective teaching John Fowler
440
social background and reactions to illness; the relatives and carers, and the variety of responses they have to their loved ones and the healthcare staff; the other health professionals that are part of the care team and offsite support services; and the standard nursing skills of assessing the needs of the patient and meeting their activities of daily living. If you begin to identify and reflect on the richness of the learning experiences available in your clinical area then you will begin to realise that teaching is indeed about helping others to learn from these experiences, rather than just giving people mini-lectures. Once you can see your clinical environment as a rich source of experiences that can be used to help junior practitioners learn their practice, you need to start exposing the junior practitioner to the appropriate experience. To do this, you need to be aware of the needs and the strengths of the student. This can be achieved by simply talking to the student and asking questions. For example: what experience have you had dealing with elderly people? How confident do you feel caring for someone with challenging behaviours? What are your nursing strengths? What gaps do you have? Is there a list of things you want to achieve? Having identified the learning opportunities in your area, and the learning needs of your student, you then need to facilitate the student’s exposure to the appropriate experience. This may be by allocating them to help look after Mr Jones for the morning shift, or work with staff nurse (SN) Smith who is an excellent role model when it comes to caring for patients with challenging behaviours. Learning from experience is not just about building up months or even years of clinical practice. For learning to occur in any meaningful way, the person needs to reflect on the experience and try and make sense of it by building on it, sorting it and fitting it into their internal framework of knowledge. This is where your role becomes so important. For the student, junior colleague
or patient to learn from their experiences, they need help to reflect on the experiences and then internalise them. One of the best ways to do this is by asking questions. In the example above you have allocated your student to SN Smith with the intention of the student learning how to care for people with challenging behaviour. To help the student reflect on these patients and SN Smith’s skills, you need to give the student some questions to reflect on during that morning shift. How does SN Smith approach the patients? Does she make any physical contact? How does she make conversation? How does she respond to patients who are aggressive? Then, towards the end of the shift, sit down with the student and ask those questions again. What you are now doing is helping the student reflect on and learn what it is that makes SN Smith such a good role model. The final stage of reflective teaching is to help the student internalise what it is they have learnt. This may involve a challenge to take onboard some of the skills shown by SN Smith or adapt them to suit their own personality. This will involve practice by the student with observation and feedback from yourself or possibly from SN Smith, with praise and confirmation when professional skills are developed. The next article in this series will explore BJN your role as a reflective manager. Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to primary care trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2014 MA Healthcare Ltd
T
his series is exploring what reflection is and how it can be applied to your clinical practice. The previous five articles have examined the importance of reflection: what it is, ways to aid reflection, its relationship to feedback and reflective practice. This article will look at how you, the clinically based nurse, can use reflection to enhance the teaching and learning of your colleagues, students and patients. Take a little time to think about one of your typical working weeks, with particular emphasis on how you spend your working time. Out of 100%, what proportion do you spend: clinically with patients, record keeping, in meetings, mentoring students and junior staff, liaising with other staff, answering the telephone and answering emails? The list could go on, but these are probably the key areas of your work. What proportion of your time is spent teaching? Is it just when you are mentoring students and junior staff? Or are you also teaching patients about their illness, medication, wound care and discharge details? I would be surprised if many qualified nurses spent less than 10% of their working week undertaking some form of teaching to either junior staff, colleagues or patients. If we want to enhance our teaching in the clinical area then we need to make time to reflect on what we are teaching, when it is happening, and what our role is.The first thing to do is to recognise when we are taking on a teaching role. This does not mean when we stand up in front of someone and start delivering a lecture. Teaching patients and staff is far more about supporting them as they learn from their experiences. The first point in developing reflective teaching as a clinician is to stand back from the busyness of your routine clinical work, with all its demands, and identify the richness of the learning experiences that are present in your clinical area. This will include the clinical specialty of the patients’ illnesses; the type of patient cared for in terms of age,
British Journal of Nursing, 2014, Vol 23, No 8
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 1, 2015. For personal use only. No other uses without permission. . All rights reserved.
