Taking a reflective approach to supervision

Sandra ArthurRuth Guy

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

Conscious

Competent

Unconscious

Incompetent

Aim of reflection

• To learn from experience• Share these with colleagues• Analyse

•Actions omissions & feelings •Quality initiative to :

•Inform learning •Improve patient safety

Gibbs Reflective Cycle (1988)

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

Thank you for listening

Sandra Arthur Ruth Guy