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REVIEW

Using reflection on reading for revalidation

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Reflection is a key aspect of revalidation and plays a key role in patient safety. Reflecting on professional reading is a useful way of relating theory to clinical practice and keeping up-to-date

Abstract

Revalidation for nurses, to be introduced in April 2016, will emphasise the need for nurses to show evidence of their continuing professional development through reflection on their learning; one way of doing this is to write a structured reflection on professional reading. This article outlines the reasons for reflecting on professional reading, how you can select the best journal article or guidance framework upon which to reflect, and possible ways to structure that reflection. It suggests a model of reflection that is designed for the purpose of reflecting on an article rather than on clinical practice.

Citation: Collins G et al (2015) Using reflection on reading for revalidation. Nursing Times; 111: 23/24, 14-16.

Authors: Guy Collins is senior lecturer; Jo Brown is senior lecturer; Lorraine Henshaw is senior lecturer; Bill Whitehead is head of department, all at University of Derby.

Introduction

Proposed changes to the re-registration process for nurses and midwives, to be introduced in April 2016, include a system of revalidation. This aims to increase the regulator’s focus on protecting the public (Nursing and Midwifery Council, 2015a). Nurses will be required to undertake a range of revalidation activities, including demonstrating that they are keeping up to date in their practice through continuing professional development, with a focus on reflection and linking their learning to the new NMC Code (NMC, 2015b). They will also be required to provide patient and colleague feedback and evidence of having undertaken discussions regarding personal development.

Benefits of reflection

Reflection has been identified as a means of maintaining patient safety (NMC, 2010). However, it attracts criticism due to the introspective nature of the process and its consequent lack of dialogue, which may not translate to the wider profession (Clouder, 2000). Nevertheless, reflective practice has long been seen as an important aspect of professional behaviour (Schön, 1994). Incorporating reflection into the revalidation process will demonstrate theoretical application, but will also show professional skills and knowledge (Clegg at al, 2002). Linking reflection to their area of expertise and the Code (NMC, 2015b) increases nurses’ potential to shape and develop future care provision.

Reflection should be undertaken using a recognised model as this adds structure and provides direction. The model used should be chosen by the individual and influenced by a number of factors such as ease of use, understanding and ease of flow when writing. Models without these elements will give the writer a negative experience of the reflection process.

The cathartic nature of reflection should validate a situation that has occurred in clinical practice and provide a platform for further analysis and exploration (Johns, 2009). Reading and linking this to the Code (NMC, 2015b) provides a method of relating the theory to an actual practice situation. Researching information relevant to their specialty will ensure nurses’ knowledge remains current. It will also enable them to challenge current views and reassess current care provision.

In preparing to meet the requirements for revalidation, nurses need to:

  • Know how to reflect on journal articles;
  • Know to search for relevant articles;
  • Understand the reflection process and reflection frameworks;
  • Appreciate the relevance of the documentation required by the NMC.

What should nurses read professionally?

A wide variety of sources can be read to keep up to date with the most recent and appropriate information to help nurses deliver the highest-quality care possible and to meet NMC revalidation requirements. Reading can also help to further professional development by increasing nurses’ understanding of other specialties as possible future career choices.

Journal articles can provide a good source of information and evidence; they offer some quality assurance as they have been through peer-review and publishing processes. There is a wide range of journals available to the nursing profession; some are specific to a specialty or area of interest while others are targeted at the whole profession (Box 1).

Box 1. Journals

Specialist

  • Journal of Diabetes Nursing
  • International Journal of Mental Health Nursing
  • Nurse Education Today
  • Nursing Children and Young People
  • Community Practitioner
  • Learning Disability Today
  • Emergency Nurse
  • Mental Health Practice

Generalist

  • Nursing Times
  • Journal of Advanced Nursing
  • British Journal of Nursing
  • Journal of Professional Nursing

In deciding what to reflect on, you should consider a range of factors. For example, does the required information need to reflect care in the UK only, or are you also interested in the international perspective? In the latter case you can access journals that include articles by international authors.

Clinical guidelines such as those developed by the National Institute for Health and Care Excellence and the Scottish Intercollegiate Guideline Network, along with national and local policies, can contain valuable sources of information across the whole spectrum of care delivery. It is important to use the most recent available editions of these and to consider the evidence underpinning the guidelines. The Cochrane Library provides a pre-appraised collection of evidence that has been synthesised into systematic reviews that often form the basis for NICE and SIGN guidelines.

A range of other resources available in the form of websites, blogs, forums and social media can provide useful information. However, it is essential to consider their credibility before using them to support practice. Reflecting on what you have read might help you to decide whether an information source is reliable and can be used to inform practice.

Finding the information can sometimes be time-consuming but a number of user-friendly online databases can help. NICE’s evidence search facility provides access to some excellent accredited sources and is available to anyone who has signed up for a NICE account. NICE also provides access to OpenAthens and a large range of journals and databases. It is free to anyone with an NHS email address and those who support NHS patients.

When using these databases a key step is to identify the best search terms to enter. When an article is published and entered into a database it is filed under a number of key terms, which are used to search for the information needed. Table 1 (attached) shows some examples of what these search terms might be. Guides are available on the database help pages to support this.

Reflective models

Traditionally, reflective models encourage working through a situation to:

  • Define it;
  • Review the challenges;
  • Rework it to find an outcome favourable to the individual and the patient experience (Schön, 1994).

Reflective models guide this process by providing a structure to work through and suggesting key areas to shape learning and enable resolution. This promotes the premise of lifelong learning and CPD.

Reflective models are mainly classified into two types:

  • Structured reflection;
  • Reflective cycles.

Structured reflection, as discussed by Johns (2007), provides a series of prompt questions you can work through to explore the reflective process in more depth from the perspective of exploring the feelings evoked. Johns promotes “bringing the mind home” as the initial thought process to help you concentrate on the situation on which you are reflecting. A series of cue questions are then explored to achieve a resolution.

An alternative is Atkins and Murphy’s model (1995), which consists of three prompts, exploring the thoughts, feelings and knowledge required to analyse the situation to improve future learning and development.

Cyclic models as described by that of Gibbs (1988) differ in that they acknowledge that, although a reflective process has taken place, this may not fully resolve the matter and the cycle may arise again requiring further review. By incorporating evaluation of the situation early in the cycle, Gibbs developed a process that enables previous experiences to influence decisions yet to be made.

The choice of model is an individual one and may be linked to understanding, ease of use and positive experiences working through the reflective process. Individual models may not lend themselves to all situations and the ability to select and have awareness of what models are available is an essential skill to develop.

Reflecting on professional reading

To undertake a purposeful reflection on something you have read that has the potential to inform your clinical practice, the reflective exercise is best structured around a framework. The use of the reflective models outlined above may be more useful when reflecting on participatory or observational clinical experience.

When applied to reflecting on written formats, including published articles, these models may not offer a clear user-friendly structure to stimulate the right questions before, during and after reading. If an article is not read and reflected on in a wider context than the confines of your own background, it will have limited potential to inform wider clinical practice.

The following framework is designed to assist the process of reflection when accessing, reading and applying published articles into clinical practice. The Searching, Reviewing, Linking and Action (SRLA) article reflective tool (Fig 1, attached) provides an easy-to-use four-stage process that includes a series of guiding question points (Collins and Brown, 2015). Table 2 (attached) outlines the phases of an SRLA reflection, with phase-specific guiding questions and written documentary evidence of the completion of action.

The collation of written evidence when using the SRLA reflection tool should not be too onerous. Associated writing should provide concise documentary evidence to assist personal development and review that can be used for revalidation purposes.

Conclusion

This article has outlined the reasons for reflecting on professional reading, how to select relevant journal articles or guidance frameworks to reflect on, some possible ways to structure reflection and a suggested model of reflection that is specifically designed for reflecting on articles rather than clinical practice. Although the principle of reflecting on both are similar, the practical activities of active reading are better approached using the SRLA structured format. Once you have tried out this SRLA method of reflection on professional reading you can share your learning and action points on Twitter using the hashtag #SRLAref.

Key points

  • Revalidation for nurses will be introduced in April 2016
  • Reflection is a well-established means of maintaining patient safety
  • Reflection on practice and on professional reading will be part of revalidation activities
  • Reflective models guide the process, providing a structure to shape learning and enable resolution
  • There is a wide range of journals for the nursing profession, some that are specific to a specialty, others across nursing as a whole
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