Promoting self-awareness through reflective practice

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Bach S, Ellis P (2011) Leadership, Management and Team. Working in Nursing. Learning Matters Ltd, Exeter. Driscoll J, Teh B (2001) The potential of reflective ...
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Promoting self-awareness through reflective practice Tracey Billington is studying part-time for an MSc Health and Social Care at Northumbria University. She qualified as a mental health nurse in January 2012 and is currently employed as a prison substance misuse nurse.Tracey reflects on how using a self-development diary has helped her to develop her self-awareness and decision-making skills, as well as to recognise her strengths

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motional intelligence requires selfawareness and an ability to be warm and empathetic within interpersonal relationships (Hurley, 2008). The use of reflection through maintaining a reflective diary has helped me to develop my self-awareness. The usefulness of reflection as a concept and the lack of evidence of the benefits for patient care have been debated (Timmins, 2006). However, its inclusion in the Nursing & Midwifery Council’s (2010) standards of competence for preregistration nursing demonstrate the importance of nurses developing as reflective practitioners to improve their practice and ultimately patient care (Department of Health, 2006). Driscoll and Teh (2001) highlight that reflection within nursing practice can help make sense of complex situations. The What? model of reflection (Driscoll and Teh, 2001) encouraged me to challenge previous decisions, skills, attitudes, values and beliefs, giving me a new perspective on my professional practice. This was demonstrated by a home visit to client P, who had a complex mental health history and had been labelled ‘difficult’ by some colleagues. I had a good therapeutic relationship with client P. I had taken her to a nature reserve and then to a local shop to buy essentials. As we neared the end of the visit she demanded to be taken to several other shops. I tried to explain that I was unable to take her because I had other appointments. She responded by talking over me and becoming loud and verbally abusive. I noticed that she had not put her seat belt on. Despite several requests and an explanation that it was illegal to drive the car without the seat belt being used, she still refused to wear it. I tried reasoning with her but to no avail. She got out of the car, shouting, using abusive language and demanding I leave. I decided that if she did not comply I would leave and I explained this to her. I took into consideration various factors to identify risk; for example, she was capable, she knew the area as she lived nearby, a taxi rank was 40 metres away (she regularly used taxis for

British Journal of Nursing, 2013, Vol 22, No 1

transportation) and she had money, since we had only just left the cashpoint. As I drove away I felt guilty yet selfrighteous over my reasoning. My thoughts rapidly changed however. I felt a failure as a mental health nurse, ‘How can you abandon someone you are supposed to be looking after?’ I reflected on the situation, feeling stressed and anxious. I lost perspective, beginning to view client P as incapable, a complete reversal of my earlier assessment of the situation. This incident proved to be a defining moment. Through reflection I realised that I had adopted a paternalistic approach to care (Perkins, 2006). The very nature of the thought that I was ‘looking after’ someone demonstrated that my values were undermining the principles behind recovery and therefore undermining my effectiveness as a mental health nurse. How could I enable recovery if I was disabling client P’s capabilities? I recognised that although I regarded myself as having a good therapeutic relationship with client P, I had lost sight of her strengths and became more focused on her mental health status. Perkins (2006) argues that ‘the challenge for professionals is to discover people’s ambitions and abilities, especially when these are overshadowed by their problems’. I have also had to re-evaluate how I view the role of mental health nurses. Sir David Nicholson, Chief Executive of the NHS described the NHS staff being subjected to physical or verbal abuse as unacceptable (DH, 2011). I recognise that I had accepted client P’s abusive language as an expected part of nursing. On this learner journey, the greatest challenge has been my thought processes, which have led to self-doubt and lack of confidence in my skills as I transferred from the comfort zone of my previous employment as an unconsciously competent practitioner to that of student nurse. I have developed greater insight into my values, beliefs and attitudes and how these can influence decision-making.

The use of reflection has not only helped me to develop my decision-making skills but also to recognise my personal strengths. Compassion is crucial in providing patient care (Heffernan et al, 2010). Heffernan et al (2010) argue that nurses need to be selfcompassionate, to be self-kind, with positive associations with emotional intelligence. Neff (2003) describes self-compassion as being ‘moved by one’s own suffering, experiencing feelings of caring and kindness towards oneself, taking an understanding and non-judgemental attitude towards one’s inadequacies and failures’. I have achieved insight into my values, beliefs and attitudes about mental health nursing and how these have constrained my decisionmaking ability. To be an effective nurse leader requires understanding and awareness of the self in order to fully understand the motivations and viewpoints of others (Bach and Ellis, 2011) and therefore improve patient BJN care and decision-making. Bach S, Ellis P (2011) Leadership, Management and Team Working in Nursing. Learning Matters Ltd, Exeter Driscoll J, Teh B (2001) The potential of reflective practice to develop individual orthopaedic nurse practitioners and their practice. Int J Orthopaedic Nurs 5(2): 95-103 DH (2011) NHS Joins Forces with Designers to Tackle Violence and Aggression in A and E Departments. http://tinyurl. com/d7syqd5 DH (2006) From Values to Action: The Chief Nursing Officer’s Review of Mental Health Nursing. http://tinyurl.com/ yqbtph Heffernan M, Griffin MTQ, McNulty R, Fitzpatrick JJ (2010) Self-compassion and emotional intelligence in nurses. Int J Nurs Pract 16(4): 366-73 Hurley J (2008) The necessity, barriers and ways forward to meet user-based needs for emotionally intelligent nurses. J Psychiatr Ment Health Nurs 15(5): 379-85 Neff KD (2003) Development and validation of a scale to measure self-compassion. Self and Identity 2: 223-50 Nursing & Midwifery Council (2010) The Competency Framework. http://tinyurl.com/brqkuqh Perkins R (2006) First person: ‘you need hope to cope’. In: Roberts G, Davenport S, Holloway F, Tatton T. eds, Enabling Recovery.The Principles and Practice of Rehabilitation Psychiatry. RCPsych Publications, London Timmins F (2006) Critical practice in nursing care: analysis, action and reflexivity. Nurs Stand 20(39): 49-54

Tracey Billington

Part-time Health and Social Care Student, Northumbria University 45

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