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DEBRIEFING AND REFLECTION

DEBRIEFING AND REFLECTION. Jacqueline A England Dr Mark Wareing David Mathew. Where is Luton?. Luton. University of Bedfordshire. Nursing Campuses. Why Debriefing and Reflection?.

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DEBRIEFING AND REFLECTION

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  1. DEBRIEFING AND REFLECTION Jacqueline A England Dr Mark Wareing David Mathew

  2. Where is Luton?

  3. Luton

  4. University of Bedfordshire

  5. Nursing Campuses

  6. Why Debriefing and Reflection? • The INACSL standard VI (2013) supports debriefing for all simulation–based learning experiences, which should be aimed at promoting reflection. • The Nursing and Midwifery Council (NMC 2015 b) have announced a revalidation process for all registrants that will require reflective evidence every three years.

  7. Background • Staff development and review of Simulation Strategy • Simulation or skills training? • How to develop the use of debriefing rather than feedback • Developing Reflective skills –NMC revalidation • Facilitation rather than teaching • Deep learning

  8. Development of the Tool • Why choose SBAR? • Why Driscoll? • How do these work together? • Defending the strategy • Creating a workable tool

  9. Educational Reasoning SBAR? • We chose SBAR because: • Used by all fields of nursing • Used by all healthcare professionals • International type of handover • Clear and concise • Gives points of reference for the reflection • http://www.institute.nhs.uk SBAR

  10. Educational Reasoning Driscoll • We chose Driscoll (2007) because: • ‘Simple’ questions that can be remembered easily – • Not as simple as some people think as it does require depth and application • Used by all fields of practice

  11. What? Returning to the situation • What is the purpose of returning to this situation • What exactly occurred • What did you see? What did you do? • What was your reaction? • What did other people do? E.g. colleague, patient, relative • What so you see as the key aspects of this situation?

  12. So What? Understanding the context • What were you feeling at the time? • What are you feeling now? Are there any differences and, if so, why? • What were the effects of what you did (or did not do)? • What good emerged from the situation, e.g. for self or others? • What troubles you, if anything? • What were your experiences in comparison to your colleagues? • What are the main reasons for feeling differently from your colleagues?

  13. Now What? Modifying future outcomes • What are the implications for you? • What needs to happen to alter the situation? • What are you going to do about the situation? • What happens if you decide not to alter anything? • What might you do differently if faced with a similar situation again? • What information do you need to face a similar situation again? • What are your best ways of getting information about the situation should it arise again?

  14. The Proposed Tool • An A3 double sided sheet that is set out in a way so as to give the student and facilitator the ability to record the actual information that leads to the reflective work. • The SBAR of what the student perceives • The facilitators debriefing questions and prompts • The Reflective questions • The personal development plan • Second page for evidence base and references

  15. How will this be implemented? • Discussions are underway to introduce the tool in the near future under a project to review its value and ease of use • Sessions will be developed to support colleagues in the use of facilitation and debriefing - coaching • Students will be introduced to the tool as soon as possible in their first year (new cohort starts March 2016) • Older cohorts will be introduced to the tool at the beginning of their academic year

  16. How will this work? • It is seen that the tool will be used in a developmental manner and will start with the development of facilitators • Heron’s 6 dimensions of facilitation will be used in relation to his identified three modes of management of each dimension • The idea being to ensure that the student develops their learning and powers of reflection over time. • By the end of a 3 year curriculum the student should achieve the level required for registrants in terms of reflection

  17. Heron’s 6 dimensions & 3 modes • Heron explains his definition of a facilitator as a person who has the role of helping participants to learn in an experiential group. The experiential group is one in which learning takes place through an active and aware involvement of the whole person –as a spiritual, thinking, feeling, choosing, energetically and physically embodied being. (1989 p11)

  18. Dimensions • Planning: How shall the group acquire its objectives and its programme? • Meaning: How shall meaning be given to and found in the experiences and actions of group members? • Confronting: How shall the group’s consciousness be raised about these matters? • Feeling: How shall the life of feeling within the group be handled? • Structuring: How can the group’s learning experiences be structured? • Valuing: How can such a climate of personal value, integrity and respect be created?

  19. Modes • The hierarchical mode: The facilitator directs the learning process for the group • The co-operative mode: The facilitator shares the power over learning with the group • The autonomous mode: The facilitator respects the total autonomy of the group

  20. Teaching or Coaching? • Many lecturers new to higher education feel the need to ‘teach’; it is their role • The use of teaching obviously has its place or else we cannot deliver new information – however: • Donald Schon (1987) discusses the fact that even Dewey in the 1930s said that ‘the student cannot be taught what he needs to know but he can be coached’ (1974 collected writings cited in Schon 1987)

  21. Historical perspective of reflection • Schon talks about how ‘professional education should be redesigned to combine the teaching of applied science with coaching in the artistry of reflection-in-action.’ (xii). • He reinforces his belief that ‘education for reflective practice, though not a sufficient condition for wise or moral practice, is certainly a necessary one. For how are practitioners to learn wisdom except by reflection on practice dilemmas that call for it?’ (xiii) (1987) • This is now not only accepted but mandated by the NMC (2015 a &b)

  22. Learning from experience • Kolb (2015) and his work on experiential learning also reviews the use of the environment and the situations experienced • Effective learning is seen when a person progresses through a cycle of four stages: of (1) having a concrete experience followed by (2) observation of and reflection on that experience which leads to (3) the formation of abstract concepts (analysis) and generalizations (conclusions) which are then (4) used to test hypothesis in future situations, resulting in new experiences.

  23. Reflection • Moon (2004) suggests that the differences in approach are accounted for largely by different focuses • On the process of reflection • On the purpose for it • On the outcomes of reflection • How it is used.

  24. Moon (1999) Stages of Learning • Noticing, - the least detailed form of learning – you cannot learn something if you do not notice it at some level (which could be unconscious). Representation is of the material is as memorised, modified only by the degree to which it is forgotten. • Making sense – getting to know the material as coherent – but only in relation to itself. Facts may be fitted together like a jigsaw but not related to previous understandings. Representation is coherent reproduction, but not related to other ideas and not processed. • Making meaning – the beginnings of deep approach – there is a sense of meaningfulness but there is not much evidence of going beyond the given. Representation is of ideas that are integrated and well linked. There is the beginning of development of a holistic view. • Working with meaning – a sense now of going beyond the given, linking into other ideas. There is the creation of relationships of new material with other ideas. Representation is reflective, well structured and demonstrates the linking of material with other ideas which may change as a result. • Transformative learning – evidence that the new learning has transformed current understandings in reflective processes. Representation demonstrates strong restructuring of ideas and ability to evaluate the processes of reaching that learning. There are creative / idiosyncratic responses. • In Moon 2004

  25. Feedback vs Debriefing • So if we combine the educational principles of Dewey, Schon, Kolb and Moon then the development of critical, analytical, reflective practitioners is eminently achievable • However the role of the facilitator is not an easy one to ‘learn’ • It is far easier to give didactic feedback and to teach than it is to facilitate the students progress in the reflective process and to prompt them into exploring the situation and synthesising their knowledge

  26. Why do we need reflective practitioners? • The NMC Code (2015 a) states that all practitioners must reflect on any feedback to improve practice • The NMC Revalidation (2015 b) requires all practitioners to be part of reflective practice to develop our skills and to participate in reflective discussions with other practitioners as necessary • To develop our own and others future skills and practice

  27. Revalidation: The requirements • 450 practice hours • 35 hours of Continuing Professional Development - 20 of which must have included participatory learning (physical or virtual) and which can be evidenced and is recorded linking it to the Code (NMC 2015, a) • 5 pieces of practice related feedback (PRF) • 5 written reflective accounts that link to your PRF and how it relates to the code • A reflective discussion that relates to your 5 reflections (NMC 2015, b)

  28. How can the tool be used? • For students as part of their curriculum in simulated practice • For educators as part of their CPD in developing skills of debriefing and facilitation • For registered practitioners as part of their CPD for revalidation • For inter-professional learning and education when shared with other fields of practice and disciplines of healthcare

  29. Proposed Research • The clinical skills and clinical simulation team at the University of Bedfordshire plan to undertake a piece of research using participant observation and documentary analysis to evaluate the use of the A3 sheet. • It is proposed that lecturers will undertake participatory observation of small cohorts of students (x6, adult, child and mental pre-registration nursing students) using the sheet while undertaking a clinical simulation incident that requires de-briefing. • Students will be given a clinical incident, including a history of presenting illness, clinical features and nursing needs

  30. Proposed Research • They will respond to the incident (while being filmed in the clinical skills/simulation suite) and then be de-briefed appropriately. • In addition to field notes completed by two participant observers (lecturers), videos will be analysed to examine how students have utilised the SBAR tool. Documentary analysis will be undertaken to evaluate the accuracy of notes taken in response to the de-briefing and an analysis will be completed to explore the depth or reflective writing completed by each student using Moon’s (1999) levels of learning from reflection.

  31. Possible research expansion • At present two Partnership Trusts and another professional education faculty are interested in taking part in research to develop the tool and to implement its use in their own areas • The Trusts see it as a good tool for critical incident analysis and personal development (especially for NMC registrants under revalidation) • Educational faculty using simulation also wish to see the development of critical, analytical reflective practitioners

  32. Developments and dissemination • The research will lead to a review of the tool and to any alterations/developments that are required/indicated • The research will be written up and published to allow for others to use our experience in developing the critical thinker and reflective practitioner

  33. References • Driscoll 2007 http://www.nottingham.ac.uk/nmp/sonet/rlos/placs/critical_reflection/models/driscoll.html • Heron J 1989 The Facilitators’ Handbook, Kogan Page Ltd, London • http://www.institute.nhs.uk SBAR accessed February 2016 • http://www.luton.gov.uk/community_and_living/luton%20observatory%20census%20statistics%20and%20mapping/pages/who%20lives%20in%20luton.aspx • https://www.nmc.org.uk/standards/code/2015 (a) accessed February 2016 • https://www.nmc.org.uk/standards/ 2015 (b) accessed February 2016 • Kolb David A 2015 Experiential Learning, Experience as the Source of Learning and Development 2nd Edition, Pearson Education Inc, New Jersey • Moon J 2004 A Handbook of Reflective and Experiential Learning , RoutledgeFalmer, London • SchonDonald A 1987 Educating the Reflective Practitioner , Jossey-Bass Publishing San Francisco

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