Reflective Practice Workshop

1. Reflective Practice Workshop RCSLT: Sharon Woolf Head of Professional Development Dominique Lowenthal Professional Development Services Manager

2. Reflective Writing • Introduction to writing reflectively • Why do reflective writing? • What does good reflective writing look like? • How do you do it?

3. 1. Introduction to writing reflectively Personal reflection happens as part of day to day living. If we find ourselves in a difficult or challenging situation, we often spend time ‘reflecting on’ (thinking about) what happened, what went wrong, what we could have done or said differently. We discuss the event with friends or family. We may or may not deal differently with similar challenges when they happen again. This kind of personal reflection has much in common with the more sophisticated techniques that are described as ‘reflective practice’ (Kolb 1984).

4. 1. Introduction to writing reflectivelyKolb’s reflective cycle Kolb’s cycle is the basis of many reflective activities undertaken in a professional context. Nursing practice has well established systems and processes which encourage self reflection (Johns, 1995, Foster and Greenwood, 1998, Heath, 1998).

5. 1. Introduction to writing reflectivelyPlease remember Reflective writing is a major part of the learning experience!

6. Reflective practice at work As health professionals become more concerned about ‘professional competence’ and how best to describe it and measure it, the need for personal reflection on skills, knowledge, attitudes and personal values increases. RCSLT places considerable emphasis on a reflective approach in its guidance on continuing professional development. RCSLT defines reflective practice as ‘the means by whichtherapists will extend their knowledge and skills to maintain competence throughout their professional lives’ (RCSLT Competencies Project, 2002, p.2).

7. Over to you… 2. Why do reflective writing?

8. 2. Why do reflective writing? To analyse complex and challenging situations To analyse communication and relationships with colleagues To examine the way you make decisions To make connections between your non-work activities and your practice To improve your memory of your learning activities To make it more likely that you will put what you have learned into practice To improve your researching skills To improve your problem solving skills – you’ll find that you can solve new problems more easily when you develop your analytical ability and have reflected on similar problems before To help you identify gaps in skills and knowledge and learning needs – career plan, personal objectives, Performance Development Plan (PDP)

9. 2. Why do reflective writing? Reflective practice and your PDP The learning needs, objectives and achievements which you specify in your PDP could relate directly to your reflective diary as ‘evidence’. Your reflective diary could contribute to your preparations for completing your PDP. The PDP process should already be a reflective process and might also guide you to choose appropriate learning to shape your career

10. not quantity Quality 3.What does good ‘reflection’ look like? Think of reflective writing as being a development from a basic description to a much deeper analysis of the experience. The challenge is to ‘go beyond’ descriptive writing.

11. 3.What does good ‘reflection’ look like?Extend your thinking Are people more aggressive in hot regions than in cold regions? If discomfort causes aggression, why aren’t people just as aggressive in uncomfortably cold weather? Are workers in hot factories more aggressive than workers in chilly factories? Do Eskimos become aggressive on vacations to hot places? Imagine that you learn this fact from a newspaper article: “Human aggression increases in hot weather. “ Recording this may take a few seconds. Imagine extending this idea - seeing its implications, wondering about possible solutions and applications.

12. 3.What does good ‘reflection’ look like?Extend your thinking Reflective writing development: ‘Shopping list’ of what you did Doesn’t make sense in 6 weeks time Doesn’t connect your new knowledge to your practice It’s not just about saying what you did, it’s about saying why you did it, what you learned from it and what you might change because of it in the future. 2-D 3-D Black & white Glorious technicolour!

13. Courses Attending conferences Peer Review SIGs Supervision sessions e-groups Staff Meetings Updating your knowledge via www/TV/press Bulletin Discussion with colleagues Voluntary work Secondments Role expansion Reflective practice Maintaining and/or developing specialist skills e.g. musical ability Visits to other departments and reporting back Project work/management Involvement in a professional body Critical incident analysis or Significant Event Analysis (SEA) Presentation at conferences Lecturing/teaching Extend your thinking: A world of learning possibilities… Public service Reading journals/articles Distance learning Planning / running a course

14. The CPD Diary has learning activities in different categories (A – E) A – Workbased Learning by doing, Case studies, Reflective practice, Clinical audit, Coaching from others, Discussion with colleagues, Peer review, Gaining and learning from Experience, Involvement in wider work of employer e.g. representative on a committee, Shadowing, Secondments, Job rotation, Journal club, In-service training, Supervision of staff/students, Visits to other departments and reporting back, Role expansion, Critical incident analysis, Completion of self-assessment, questionnaires, Project work/management. B – Professional Involvement in a professional body, Member of specialist interest group, Lecturing/teaching, Mentoring, Examiner, Tutor, Branch meetings, Organising journal clubs or other specialist groups, Maintaining and/or developing specialist skills e.g. musical ability, Expert witness, Member of other professional bodies/groups, Presentation at conferences, Organiser of accredited courses, Research supervision, National assessor

15. The CPD Diary has learning activities in different categories (A – E) C – Formal Courses, Further education, Undertaking research, Attendance at conferences, Submission of articles/paper, Seminars, Distance learning, Courses accredited by professional body, Planning or running a course. D – Self directed Reading journals/articles, Review of books/articles, Updating knowledge via www/TV/press, Progress files E – Other Public service, Voluntary work, Courses

16. 3.What does good ‘reflection’ look like? Here are some examples of how you might record events submitted by RCSLT members. The first example illustrates how you might reflect on a Formal learning activity. The important part is the reflection on what the event has taught you that will enable you to provide a better service for your patients.

17. 3.What does good ‘reflection’ look like?Example - Computer skills Course Computer skills Course “In my 2007 PDP, my manager and I agreed that there was a need to develop my computer skills, as I had not received any formal training in this area. I was given the opportunity to enrol on a computer skills course locally. Although the course was demanding in terms of time, and I had concerns about its impact in the short term on my work, I found very quickly that there were benefits not only for me but for my team….

18. 3.What does good ‘reflection’ look like?Example - Computer skills Course … cont’d “…As a result of going on this course, I had a better grasp of using the computer to create handouts / documents as well as improving my record keeping. It has also meant that I spend less time on the computer than I used to, freeing me up to spend more time with other work. I’ve also been able to watch other people using the computer and learn some really useful shortcuts that would have been beyond my comprehension before the course. I also received new insights into my own skills and abilities, and realised that I’m not as ‘silly’ as I thought, in fact I’m feeling much more confident and excited about the computer rather than dread. I’m going to do a short presentation/workshop at the next team meeting with my colleagues and show them some of the valuable tips I’ve learned that will save everyone time. “

19. 3.What does good ‘reflection’ look like?Example – Attending a SIG Membership of Special Interest Group Discussed how to adapt Lidcombe therapy for stammering for families who speak other languages. In particular, changes to the service were agreed for when working with children who stammer whose families do not speak any English. Learned further information about working with families who speak other languages and from other cultures. Particular focus on services for children who stammer. Learned about and discussed in groups how to adapt current provision for families for whom English is not their first language. Not all CPD looks the same, the important thing is that it works for you and that it would make sense to a 3rd party

20. 3.What does good ‘reflection’ look like?Example – Watching a documentary Channel 4 documentary “Help me Speak” (Stuttering) Identified this programme as useful for showing to potential clients as part of therapy and use sections as facilitation for brainstorming, problem solving and counting activities. Important media overview of SLT options available for stuttering and how portrayed to general public. Emphasised the variation in services available for stutterers in different parts of the country. Useful accessible info to potential service users to approach the SLT service with and supported questions about therapy options and outcomes. Discussed with specialist SLT in stuttering.

21. 3.What does good ‘reflection’ look like?Attending SLT presentations at staff meeting Alternative ways to deliver a service to autistic pupils in mainstream secondary schools Although not my main work area this was a thought provoking presentation on an innovative way to support high functioning teenagers attending mainstream schools. A very effective lesson on ‘thinking outside the box’! Have since worked with the team to look at creative ways to support our clients who sit outside the main class group. Choosing Health This presentation from the PCT’s health team brought forward the trust’s agenda of health for all by encouraging positive health choices e.g. giving up smoking, healthy eating etc. We explored ways we could implement this by weaving it into our daily practice e.g. during home visits, topic work with clients etc. Has far reaching consequences, easy to implement and yet a powerful way to support the health agenda. Not something I had considered but so easy to do and effective too!

22. 3.What does good ‘reflection’ look like?Peer Observation Peer Observation In order to improve my skills in working with refugee children, I spent several sessions shadowing a more experienced colleague. We undertook several home visits and schools, and I attended two multi disciplinary meetings with her. I also observed a bilingual co-worker with a small parent group. During the therapy sessions I used the RCSLT peer observation guidance to record my observations. I found this experience very helpful, as it gave me practical ideas as well as helpful insights into working effectively. Following the observation sessions, the therapist agreed to become my mentor. This relationship has contributed greatly to my confidence in working with the children and their families. Continued…

23. Over to you… 4. How do you do it? You have seen why it’s valuable to do reflective writing and you’ve seen some examples, now it’s time to start looking at how you could do it.

24.  4. How do you do it?Activity A Write a piece of reflection on 1 thing you have learned today. 5 mins

25.  4. How do you do it?Remember Kolb? Great, now let’s look at some tips and techniques. As we do that, please keep your piece of reflection handy to: • reflect on whether you have followed this advice • whether you would choose to do your reflective writing differently in the future.

26. 4. How do you do it?Ground rules There are a few ground rules about writing in a reflective way. Always write about yourself and your practice (although your writing may involve narrative about other people as well). Always be explicit about how the learning will positively impact your practice & patients. Write in the first person. Write honestly. Write as if you were writing to your future self. Remember to maintain patient confidentiality in your writing

27. 4. How do you do it?Option 1 for reflective writing Many of the texts on reflective writing encourage practitioners to write about their emotional reactions to situations (Bolton, 2001, Johns, 1995, 2004). Bolton suggests reflecting on; • actions (what you did) • ideas (what you thought about) • feelings (what you made of it all) Writing about these three aspects may be a good place to start if you feel uncertain about reflective writing. It may not seem appropriate to you to explore feelings in the context of reflections on CPD events. However, many of the challenges of therapists’ or assistants’ work do have an ‘emotional’ component to them.

28. This can be anything – an experience with an individual client, a short course, a supervision session, a presentation to a SIG, a review of an article, writing a business plan, completing a funding application, writing an induction course, attending a case conference, designing an audit questionnaire. 4. How do you do it?Option 2 for reflective writing Think of a recent therapy session/CPD activity or event Describe the session/experience What did this session make you feel? What would you want to change? What has this session has taught you?

29. Describe briefly what happened, what you did, who else was involved, how long it took. Write in the first person. 4. How do you do it?Option 2 for reflective writing Think of a recent therapy session/CPD activity or event Describe the session/experience What did this session make you feel? What would you want to change? What has this session has taught you?

30. This question may or may not be relevant. If you are describing a difficult clinical situation, then write about how you felt during and afterwards. If you are describing attending a workshop, then you may not think this question is relevant. 4. How do you do it?Option 2 for reflective writing Think of a recent therapy session/CPD activity or event Describe the session/experience What did this session make you feel? What would you want to change? What has this session has taught you?

31. Again this may or may not be relevant, but it is encouraging you to think reflectively about the experience or event. You may use it to reflect retrospectively, (on what you would have done differently), or you may use it to reflect prospectively (on what you think might change as a consequence of the event). 4. How do you do it?Option 2 for reflective writing Think of a recent therapy session/CPD activity or event Describe the session/experience What did this session make you feel? What would you want to change? What has this session has taught you?

32. Write down what you have learnt from this event. You may be able to make a summative list of what you have learnt, or you may want to write down more ‘subjective learning’ (‘I was really struck by what the speaker said about X…as it related to my own situation at Y clinic.’). Both are equally important. 4. How do you do it?Option 2 for reflective writing Think of a recent therapy session/CPD activity or event Describe the session/experience What did this session make you feel? What would you want to change? What has this session has taught you?

33. An experience on a hospital ward 1. Think of a recent therapy session/experience you have had with a client. 23 September 2006 4.30pm Ward 2a 2. Describe the session/experienceWent to see a patient with aphasia who I had seen several times before on that ward. Wasn’t sure I was going to get to see her that day, as I had been very busy with lots of new referrals. When I arrived at her bedside, she was obviously distressed. I asked her what was wrong. She said something, but I could not make it out at first. Then she pointed to her bed. I saw that it was wet. I realised that she was lying in a soaking wet bed. I told her that I would go and find someone who could change her bed linen for her. She just cried out ‘No! and held out her hand to me. I left her and went to find a nurse or support worker, but there was no one there. I could still hear her crying out in a loud voice; ‘No!’ over and over again. I didn’t know what to do next so I left the ward and went back to the Department. There was no one there, everyone had gone home. So I went home, too.

34. An experience on a hospital ward… cont’d 3. What did this session make you feel? Embarrassed, angry, helpless, panic stricken at the end, wanting to escape from the situation. 4. What would you want to change? My own emotional reaction to the situation. I felt powerless to help, beyond my capacity. I didn’t know if I should stay with her and try and change the sheets, or stay with her and just be there (afterwards I wondered if she was calling out ‘No!’ because she didn’t want me to go away and leave her). I know I left before checking that out with her. I didn’t wait and try and understand what she was trying to say to me in saying ‘No!’ I just left. I felt terrible. 5. What has this session has taught you? Being on a ward can be so demanding emotionally and so unpredictable. I need to work at staying with the situation, even when it feels out of my control, not thinking of ways to escape situations I find difficult or embarrassing. I didn’t see this from the patient’s point of view, but from my own. I probably need to talk about this with a more experienced colleague. Try and work out some way of dealing with this sort of situation.

35. 4. How do you do it?Option 3: Adopt a questioning mind Useful questions for prompting reflective writing The following questions are ‘prompts’ that may help you to start writing reflectively. They are there to help you move beyond going from basic descriptions towards a more profound learning experience. You may find that these questions are useful to get you started but once you practice writing reflectively you may no longer need them. Description: You may find it helpful to start with a pure description that is not reflective at all – but sets the scene for your reflective thinking. • What is the learning experience? • What happened? • What subject areas did it cover? • When did it happen?

36. 4. How do you do it?Adopt a questioning mind • How did the course /conference/event compare to my learning expectations of what I thought the course would be like to how it actually was?Are there any issues that need to be analysed ? • What have I gained in knowledge or skills from this course/conference? • Has this course/conference enabled me to enhance my service delivery? If yes, how? If no, why not? • What can I put into practice immediately to benefit service users? • What would I like to put into practice in the medium/long term to benefit service users? • What further reading, research or study do I need to do? • How will I share this work/ the outcomes of this course with colleagues and other professionals?

37. 4. How do you do it?Continuing to extend your thinking • Are there any other influences that have shaped your learning? • What other information do you have or need to make a judgment (ideas, knowledge, opinion etc)? • How could you learn more about this subject if you were interested?

38. 4. How do you do it?Significant Event Analysis (SEA) or Critical Incident Analysis (CIA) Prompts for reflecting on a positive or negative event: • How might have you tackled the task differently if the time/place situation was different? • Are there previous instances of this event that will help you to think differently about it? • What are the positive or negative aspects that helped the situation to be successful or unsuccessful? • Is there another point of view that you could explore? • Are there ethical / moral / wider social issues to consider? • In an ideal world what would you change? (don’t hold back!) • What steps could you take to prevent (or repeat) this event in the future?

39.  4. How do you do it?Activity B Swap your piece of reflection with the person next to you and ask each other some ‘reflective prompt’ questions to deepen the reflection.

40.  4. How do you do it?Activity C Now with your partner take a few minutes to discuss what you have learned throughout the day and make notes on your reflective practice form.

41. Providing support…The RCSLT CPD toolkit Guidance on.. • Personal Development Plans • Reflective writing • Significant event analysis • CPD and peer review • CPD and mentoring • NHS KSF and CPD • National Occupational Standards and CPD • Also on the web is guidance for using the online diary.

42. Feedback To help us continually improve, we greatly appreciate and welcome your views, suggestions and comments. Dominique.Lowenthal@rcslt.org Thank you.

43. References Bolton, G. (2001) Reflective Practice. London: Sage. Foster, J., Greenwood, J. (1998) Reflection: a challenging innovation for nurses. Contemporary Nurse 7: 165-72. Gibbs, G.(1988) Learning by Doing: A Guide to Teaching and Learning methods. Oxford: Oxford Brookes University. Heath, H. (1998) Keeping a reflective practice diary: a practical guide. Nurse Education Today 18: 592-8. Johns, C. (1995) The value of reflective practice for nursing. Journal of Clinical Nursing 4:23-30.

44. References Johns, C. (2004) Becoming a Reflective Practitioner (2nd Ed) Oxford: Blackwells. Kolb, D. (1984) Experiential Learning. London: Prentice Hall. RCSLT. (1997) Personal and Professional Development Planner (PPDP). RCSLT. (2002) Demonstrating Competence through Evidence of Continuing Professional Development. London: RCSLT RCSLT. (2004) Understanding CPD. RCSLT Bulletin, December, 632 13-16. Schon, D. (1983) The Reflective Practitioner; How Professionals Think in Action. New York: Basic Books

45. References • Moon, J (1999), Reflection in Learning and Professional Development, Kogan Page, London • Moon, J (1999a), Learning Journals: a Handbook for Academics, Students and Professional Development, Kogan Page, London • Moon, J (2001), Short Courses and Workshops: Improving the Impact of Learning and Professional Development, Kogan Page, London • Kolb’s diagram: http://www.ldu.leeds.ac.uk/ldu/sddu_multimedia/kolb/kolb_flash.htm