Reflection, Revalidation, RCN Congress and Research

Thinking Out Loud: Journal 'Regulars'

Like many people I looked forward to experiencing RCN Congress again in June. Now of course Congress itself is a casualty of COVID-19.

Last May as already posted, I picked up several nursing journals too. Having time(!) I've read about reflection, I submitted the required reflective accounts to complete my revalidation last month (so good through to March 31 2023) and I've time to reflect now.

Reading some of the papers and browsing through the journals I notice one has "CPD reflective questions" which are specified for full-length article submissions. Here are some examples from one journal issue:

"If a patient presents with red flag signs of impeding airway obstruction, consider the aspects of the 6Cs in nursing and reflect on the care, compassion, and communication required to the patient and family.
Consider the different dimensions of a person-centred climate of a long-term care setting.
Reflect on the nurse's role in the provision of person-centred care in an older adult residential setting.
How could you make the care of patients in your setting more person-centred?
Reflecting on the case study, what do you consider may help nurses in recognising the condition early and minimise the need for investigations?
Reflect on how the time perspective [can] be an indicator of health and quality of life in people with HIV or another patient group.
Consider how the time perspective can be incorporated into the health care of people with HIV.
Think about how nurses can assess the time perspective in people with HIV."

If you understand Hodges' model then you will appreciate how the model can facilitate reflection on all of the above.

The contents page of many publications usually differentiate between 'features', or 'special focus' and pages listed as 'regulars'.

For quite a while I've not only worked on papers (two advanced drafts at present) but (quietly) wondered about those 'regular' pages and what would it take for journals to adopt Hodges' model as a common resource?

Of course, this begs questions of legitimacy, evidence-base, standards ... and as I have acknowledged Hodges' model is no panacea for a practitioner's or a health system's limitations. Hodges' model itself may constrain the adopted perspectives of readers; as opposed to as I believe, liberating them? If all the posts here were analysed, what is the holistic bandwidth of the content?* If Hodges' model was adopted what trends, if any, would be revealed? If students used Hodges' model to reflect on their own well-being in year 1 - year 3 what would they learn? Are there wells of reflection about which reader's reflections would congregate? Would this in turn be influenced by other recognised biases in publishing and the way the above questions are selected?

It would still be amazing to see Hodges' model as a regular and universal prompt. Even as a research project - the aide-mémoire it is intended to be. The journal would then actively engage with its readership and provide invaluable CPD.

My new folder is already open for the next three years ...

Be Well :: Be Safe All

*I admit that there are topics I have avoided posting, as they are potentially fraught 'politically' or in other respects.

British J. of Nursing, 28,9. 2019 (9 May, Congress Bumper Issue!).

What should be written in a HC Professional's DNA?

Before putting twitter down for a break, I was reminded about a form of DNA.

There are previous posts on the 6Cs in nursing here on W2tQ and taking these essential qualities as an obvious starting-point:

1. care,
2. compassion,
3. courage,
4. communication,
5. commitment
6. and competence

- and mapping them to the care (knowledge) domains of Hodges' model, you realise how they apply across the model. Care, Compassion and Communication are the essence of what it is to be human and humanistic. If however the time 'allowed', environment and accessibility are not attended to, then the mechanistic domains can disrupt the most caring of efforts.

What about courage? This is surely a very individual character trait? A personal quality in this context, with an emphasis on the humanistic domains.

Care is relational and we can consider courage in respect to scientific knowledge. As a member of the multidisciplinary team, or specialist practitioner a nurse may need courage to share scientific knowledge, evidence concerning genomics, for example. The public's knowledge and understanding of science is brought to the fore. There is the alternate scenario with the 'patient' as expert, for example in the case of rare diseases (especially next month).

Courage is a continua, that like strands of DNA runs through all the domains of Hodges' model and the 2020s ... will see the political realisation of courage in nursing and healthcare; locally, regionally, nationally and globally.

Reading (another) book for review, the authors draw attention to how Maslow's hierarchy says little, if anything, about altruism (but is implied?).

As these brief observations should demonstrate, Hodges' model facilitates relational, person-centredness, the cross-fertilization of ideas and high standards of care.

Who needs a double-helix when you can have a quadruple form?

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

	Shankar Balasubramanian in front of a mural in his office representing quadruplex DNA, called ‘Living by the code’ by artist Annie Newman.

My source:
MindScience, Biochemistry, FT Magazine, FT Weekend. 26-27 January 2013, p.50.

Reminded via:

Thanks David, It's that last bit my focus (meme won't let go!)
individual and a collective 'mindset' all disciplines have from intro 101.
Professional DNA vital
*must* be preserved too [#AI]
*Rapid response calls for X-fertilization Quad-DNA?* ;-)https://t.co/CUuRsRPXl0#h2cm

— Peter Jones: 2020s will demand '2020' vision #h2cm (@h2cm) January 24, 2020

Compassion TO Governance: "Meet you in the middle?"

Governance:
"Yes, in theory and practice!"

SELF - individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - POPULATION

compassion	THEORY
PRACTICE	governance

While compassion must be demonstrated by the individual practitioner [as one of the 6Cs], it is also a positive phenomena that should be found, experienced and readily transferred - communicated within the team and community of practice.

Allied with governance, health systems should then ensure that there is time and space for compassionate care. While 'middle' might work as a metaphor in Hodges' model, the qualities of compassion and governance are not about the 'middle', as in, being average.

Hodges' model can also help us appreciate the role that self-governance plays in personal responsibility, accountability and professionalism.

The great amount of effort and work to place assure the person is at the center of care (and #h2cm) also becomes apparent.


My prompt: https://twitter.com/PippaJL01/status/1121399893225037824

Courage: One of the 6Cs - for Individual & Governments? [i]

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Courage is perhaps one of the more challenging of the 6Cs for learners to grasp and even for experienced staff  to exercise. As a concept a definition is easy to find. Courage is often associated with whistleblowing. Over the decades whistleblowing has proved critical and vexed to both an individual's career and organizations.  Hodges' model encourages us to expand on this ...

The courage of seeking data, information, knowledge, diagnosis and prognosis Address: assumptions : misinformation : disinformation ["Dr Google", fake news, drugs online..?] Disclosure or withholding information ||||||||||||||| LONG GRASS |||||||||||||||

Husbands, wives, partners, sons and daughters with many friends find courage every moment of everyday (and many nights) when caring for someone living with dementia and other chronic illnesses. Practitioners may need courage to challenge promises made by family members that - "A nursing home? Never!" But, is the patient still at the centre of concern in these cases? Care at home at any cost? This can be the 'record' that matters to families.

Governments of all hues and globally are vested with courage, but how they exercise this quality depends vitally on governance. This is same reason, constraint that operates on the individual. "Do I? Don't I?" becomes "Do we? Don't we?" But then that individual practitioner is (must be) supported (governed) by supervision and the deliberations of the multidisciplinary team. What is the governments' record? Do governments have the courage to address the problems sustainable health and social care presents? Or, do they just kick the  problem...

Courage [ii]: One of the 6Cs - for Individual & Governments?

'Virtuous Practice in Nursing' Research Report c/o The Jubilee Centre

6Cs

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

individual character                virtues and values philosophy         ethics        courage          commitment             [moral selection / recruitment criteria      caring         attitudes       compassion reflective practice-think, think, think? knowledge and skills subjective - 'soft'?	time, pressures, tasks, robotic competence vacuum]              theory -(ethical)- practice gap evidence-based care  objective - 'hard science'? e-learning platforms-things to read, read, read?
(professional) socialisation role modelling mentoring         practice patient's experience    communication public perception, media public involvement patient/person-centeredness	policy Professional bodies autonomy     whistleblowing      advocacy     career pathway, education and training, organisational culture, appraisal and development of staff management, business, finance*

See also 'Virtuous Medical Practice' plus others*

What does professionalism mean to me? #IND2017 (dnf: draft never finished)

Something along, within and across these lines...

INDIVIDUAL

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

POPULATION

Being self-aware, reflective and reflexive including aspects of your role that either you don't especially like, or you're just not 'good' at. Recognise when to ask for help, advice, supervision. Anticipating needs. Indicating pros and cons. Keeping up-to-date. *Have the courage to blow that whistle if you must. Communicate to the best of your ability and learn constantly as human nature dictates you must. Look after yourself: if ill Be ill. Take care of your personal ethics and values, don't be bullied into lowering them and running with the crowd. Nurse = Lifelong Learner ... then you will question your own competence. As you strive to be someone else remember you can be yourself. The things you take personally are those you open the door to. Learn from them. Never forget your shield, protect yourself and others in what you disclose about yourself and others.

Being compass-ionate requires 360 degree vision, hearing ... learning and forgetting... Your keen are you? So really observe. Care about time, your management of it as a resource and the time frames of past, now, future, hoped for and imagined. Remember you need to understand information systems, data management in so far as it supports or places at risk the care you deliver and the safety of your patients. If I use IT based media I bear in mind the scope of the platform. Open to innovation: but see the elephant as an elephant. When the robots knock on your door being professional means you won't be in: "Moved On" As you care, draw on learning regards where you stand -  you are a guest in someone's home, As your feet are then grounded politically, so too is touch and negotiating personal spaces.

Learn from others  Expectations Expectations Expectations Manage them in a way such that you do not make promises you can not keep. Be committed to what you do. Learn from your peers, especially for safety's sake, but also form your own opinion. Talk this and work through with colleagues. Not everyone will 'like' you; you in turn may not 'like' people. Working through this (without experiencing abuse) as your role demands is being professional. By all means be a team player, but don't let the games that people play distract you from being professional. Patient-Carer Community Care End of Life Care  As you learn from others  pay most attention to the lessons  in Love as you will witness many.

The trust and respect of others take time to earn, but can be lost in an instant; if you have 'it' use it to foster trust and self-respect in others. You have to remember constantly you are accountable here. Remind yourself of codes of conduct the legal aspects of your role. Know your lines - especially when crossed | STANDARDS. With your ID have your whistle ready*. What you do and who you are is a privilege. Know your scope of practice, but be ready to question it. If you do not the future will. This domain is the most powerful and neglected to the professional nurse. As a professional what are YOU going to DO here? The art of leadership is filled with wonder: at what together you can all achieve. Take stock and ask in Year 1 what are the legacy issues my seniors are wrestling with? In years 10 20 30 40 ... (robotics permitting) repeat and reflect.

... because, being professional means learning and unlearning when the lines are there for a purpose and when they need to be shifted, lifted or plain erased ...

Previous post c/o NMC

How do you Balance and Elevate Holism and Patient Safety?

We have tended to focus on problems in isolation, one harm at a time, and our efforts have been simplistic and myopic.

To significantly reduce patient harm, we need to adopt a holistic, systematic approach that extends across cultural, technological and procedural boundaries - one that is based on the evidence of what works.
...
Taking its lead from developments in highway and airline safety, the report^* argues in favour of a holistic approach, integrated systems, comprehensive risk assessment and performance reporting, regulation and the creation of a "science for safety".
Darzi (2015).

What instruments does a "science for safety" need?

How can we balance procedure, patients, practice, drug delivery connections, cost, staffing and technology... How can we elevate care, competency, compassion, communication, commitment, courage and values between individual and group levels?

Having agreed and identified the essential sources of evidence (humanistic and mechanistic), how can we integrate them?

Ara Darzi (2015) Patient safety needs to be improved. Health Service Journal, 13 February. 125: 6434, p.18.

^*Transforming Patient Safety: A Sector-Wide Systems Approach
Peter J Pronovost, Alan D Ravitz, Robert A Stoll, Susan B Kennedy
https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/public/Patient-safety.pdf

Pushing the envelope: Reflections in mind, health and social care ...

Hodges' model can do 'envelopes', but it's first form is as an aide-mémoire. In this way it helps facilitate reflection, reflective practice and more besides.	Envelopes are just a start, the germ of ideas. Hodges' model needs to be evidence based - can you assist?
If you need to share your reflections as case formulations, care plans, or evaluations; the model can help to engage with patients, clients, carers, staff and residents...	Amid healthcare's legacy issue which is achieving integrated, person-centred and holistic care, Hodges' model can help the practitioner assure integrity on several levels (6Cs).

Original image source:
http://www.strengthweekly.com/2014/10/02/new-blue-towel/envelope-back/

Nursing Rubens

6Cs Care Compassion Competence Communication Courage Commitment

Rubens Tour - themes Poetry Elegance Power Compassion Violence Lust

Health as Art and Science?

"The triumph of Ruben's nudes is his magnificent evocation of the texture of human skin, represented in such a way it feels almost palpable. We see blood coursing through the veins of voluptuous flesh. The delicate mother-of-pearl complexions of the female bodies radiate with light. ..." 

(Lust, Royal Academy of Arts, Gallery Guide)

Rubens and His Legacy

B(e) nurse