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Plan
• Background• Standards for Midwifery Practice &
Supervision• Implementation and Application• Flaws of reflection• Ethical professional issues• Summary
Background
• Tick box approach no longer appropriate
• Increasing concern by SOM that we were unable to identify tangible outcome
• Evidence based approach
Standards
• Standards for pre registration midwifery education
• Guidance on Supervision
• Proposals for a new approach
Proposals
• A reflective approach to supervision
• Tangible outcome
• More meaningful annual supervisory review
• Must be proportionate
Transformative learning involves:
• becoming more reflective and critical
• being more open to the perspectives of others
• being less defensive and more accepting of new ideas
Transformative learning(Mezirow 1981 )
Reflective approach
‘Reflective practice has enabled me to identify a lack of knowledge or weakness in my own practice ‘
(Miller 1999)
Improved Patient Safety
Aim of reflection
• To learn from experience• Share these with colleagues• Analyse
•Actions omissions & feelings •Quality initiative to :
•Inform learning •Improve patient safety
Pre requisite for reflection
• The midwife•Honesty•Desire to seek help•Ability to interpret the evidence
• Sound relationship SOM
• Appropriate cultures
Implementation
• Education and training issues for SOM
•Reflection & The model advocated•Cultures•Relationships•Skills of persuasion
Commonalities in models for reflection
• Explore the experience• Analyse feelings and also actions • The aim is always to• Inform learning and improve practice
•BUT
• There are flaws conceptually, philosophically and practically
Flaws of reflection
• Influenced by :• hindsight• bias and or • retrospective recall•the level of personal involvement
• Therefore the influence on practice may be limited
The Difficulties with Reflection.
• Subjective • Superficial• Distorted• Not always generalisable
Ethical/Professional issues
• Issues that might arise around:
•Substandard care•Professional conflict•Veracity•Impact on the midwife•Positive or negative events
Reflective certainty
• Can create premature closure on situations
• Can block further development towards expertise
• Requires a wider vision of learning and sophistication
Ethical/Professional issues
• Questions we need to ask - What if
• Problems with the implementation
• Midwives / SOM don’t engage
• We’ve got the wrong model
In Summary
An opportunity to: • Reflect on the implementation of a
reflective approach to supervision• Urge caution• Ensure the pre requisites are met
first• Seek your views advice and guidance
References
• Benner P (1984) From Novice to Expert Power and Excellence in Nursing Practice Addison. – Wesley Melno Park
• Gibbs G (1988) Learning by Doing A Guide to Teaching and Learning Methods. EMU Oxford Brooks University Oxford.
• Mezirow J (1981) A critical theory of adult learning and education. Adult Education 32 (1) : 3-24
• Miller S (1999) Critical incidence and the value of reflective thinking.
• Nursing and Midwifery Council (2004) Midwives rules and standards NMC London
• Nursing and Midwifery Council (2009) Modern supervision in action a practical guide. NMC London