Taking a reflective approach to supervision Sandra Arthur Ruth 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