Reflection on Interprofessional Learning

University Degree Subjects allied to Medicine

The purpose of this essay is to discuss 2 learning outcomes from the Interprofessional Studies for Health and Social Care module using my chosen model of reflection. This will allow me to analyse and evaluate my feelings and experiences that I have had during the module and draw conclusions as to how I will use this information in my professional and personal development.

I will reflect on my personal experience from the interprofessional learning module group work periods and from lectures and I will discuss communication skills within interprofessional team working. This will show that every individual takes a different approach to teamwork and has varied ideas of what teamwork is.

Awareness of Clinical Governance is essential in my role in the workplace. As a professional I want to provide a first class service in the workplace and this ongoing initiative will help me to do this. Just as important is my ability to collaborate with my colleagues in the same and different disciplines. I will evaluate and discuss the information that I learned from the lecture I attended and my subsequent research regarding this subject.

To approach these topics reflectively, it is necessary to choose an appropriate model for reflection. A simple definition of reflection might be: Reflection is a form of mental processing – like a form of thinking – that we use to fulfil a purpose or to achieve some anticipated outcome. It is applied to relatively complicated or unstructured ideas for which there is not an obvious solution and is largely based on the further processing of knowledge and understanding and possibly emotions that we already possess (based on Moon 1999). This sums up to me the processes we go through to comprehend events and to learn from them.

There are a number of different model’s each with their own strategies to encourage reflection. The first model I looked at was Borton’s framework (1970, cited in Jasper.2003, p.101). This model presents quite a broad basis for reflection. The model guide is WHAT?, SO WHAT?, NOW WHAT?. Borton identified these as the three basic information processing functions. I found that Jasper (2003) is looking for me to identify and describe the experience at the beginning by asking WHAT? Information is gathered at this stage and we are becoming aware of the situation. The second question SO WHAT? is looking for analysis and feelings to be interpreted, does the individual reflecting now understand the situation or is it still unclear? From the information gathered what generalizations can be made. The third question NOW WHAT? is the acting function and invites you to share what you have learned and reflective on how you would use this to aid your decisions the next time.

The second reflective model is Gibbs (1988) reflective cycle. This model has six stopping points which are - Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan. This has reflection depicted as a cycle starting at Description and asking a series of questions until we reach a conclusion at Action Plan. Firstly an experience takes place which leads us to have new feelings about the event, these feelings must be acknowledged and asks the questions What happened? and What was my response? How did I act? The experience is then evaluated, we compare it to other experiences we have had. We ask ourselves are the feelings good or bad? We continue round the cycle and having reached Analysis, we are asked to explore and understand our feelings and what can be learned from them? Conclusion is asking what other course of action could I have taken and what would I do in similar circumstances if the incident happened again. This takes into account the realm of feelings and emotions which play a part in a particular event.

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My chosen model is Gibbs (1988), I find it is straightforward and it and can be used by novice’s through to advanced levels of reflection. As I am not experienced at writing reflective essay’s I feel Gibbs (1988) is a good model to start out with and it will lead me through the essay and give me the appropriate cues. The cycle approach is flexible and easily to follow which allows it to be applied to most scenarios. Using these headings I will be able to reflect fully on the incident. Kitchen (1999) describes this particular model as: ‘...useful for less experienced reflective practitioners’. Ghaye and Lillyman (1997) also support its strength: ‘... the model endeavours to incorporate knowledge, feelings and action in one learning cycle’, which the author believes are important for the event concerned. Cyclical models are based on the idea that the reflective process is most appropriately described as a cycle, and that deepening awareness and increases in knowledge and skilfulness arise from repeated movements around them (Ghaye and Lillyman 1997). I feel Borton’s framework is a far broader form of experiential learning and one that I may use in the future.

Using reflection of my experiences during my Interprofessional Studies for Health and Social Care Course, I am going to discuss 2 Learning Outcomes. The first of which is ‘The integral role of clinical governance and effectiveness in the delivery of health and social care’. Clinical Governance is an ongoing initiative in the NHS that involves all members of staff. It is ensuring that patients receive the highest quality of NHS care possible. For example, effective clinical governance should guarantee that patient services continuously improve, patients have all the information they need about their care, health professionals are up to date in their practices, health professionals are supervised and clinical errors are prevented wherever possible. It can be defined as : ‘A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.’(Secretary of State for Health, 1998).

The second Learning Outcome is ‘The importance of team working within the health and social care context’. According to Mansilla and Gardner (2005) ‘we defined “interdisciplinary work” as work that integrates knowledge and modes of thinking from two or more disciplines. Such work embraces the goal of advancing understanding (e.g., explain phenomena, craft solutions, raise new questions) in ways that would have not been possible through single disciplinary means.’ The first thing we have to learn when entering a workplace is how to integrate with other staff and establish our own role within the current team. This is a fundamental part of a health care workers learning. I have worked in teams in other environments and have some experience of team working but in healthcare the emphasis is great and the importance of team work is crucial. Health Professionals need to be taught team skills as undergraduates if the negative stereotyping associated with particular occupations is to be avoided”. (Pietroni 1991).

Learning Outcome 1.

DESCRIPTION
From the model I had to describe my experience by asking What happened? In my case, it was what do I know about Clinical Governance. The answer to that was the first time I heard the term Clinical Governance was when I attended a lecture by Dr Brian M Ellis during my IPL module. From the name I assumed that it was to do with management of hospitals but did not have any more knowledge about the subject. NHS Argyle & Clyde (2007) state that ‘Clinical Governance is a leading edge initiative aimed at improving all aspects of the patients’ journey, within a more open culture which routinely seeks and takes accounts of patients’ views on their healthcare.’

Dr Ellis gave us examples of declining clinical standards an example being from the British Royal Infirmary Enquiry (2001).- Paediatric cardiac surgery services at Bristol, which led to the deaths of 29 children between 1994 and 1995 were "simply not up to the task": there were shortages of key surgeons and nurses, and a lack of leadership, accountability, and teamwork. Another example was from the Shipman Enquiry (2005), “The latest report from the Shipman Inquiry has made a series of hard-hitting criticisms of the General Medical Council structure and culture”. Other lesser profile examples of wrong limbs being amputated and covering up of clinical incompetence were also given. I was not aware of the changes in Health Care Policy and that there is continual move towards increased management in the NHS, focusing on organisational, managerial, financial, rather than clinical quality.

FEELINGS
After the lecture I was confused as to how Clinical Governance was going to affect me and my role in the Health Care profession. I do know that people are more aware of their rights and I have heard of more and more people going to court to claim for negligence against a hospital or a doctor. It did worry me as to the poor quality of care being given in some instances. Would Clinical Governance remedy this? I wanted to know more about it so that I would be prepared and have the background knowledge as to what would be expected of me working in a hospital environment.

EVALUATION
The negative side of the experience for me was that I did not know enough about the subject to make a knowledgeable judgement about it. I did not factually know if Clinical Governance was good for NHS or not. As I have only been on clinical placement for 6 weeks in total I have not heard as much about it as I’m sure full time workers in the environment have. The positive side is that I am now aware that Clinical Governance exists and it has opened my eyes to the evidence based practice and risk management side of the NHS.

ANALYSIS
I chose this Learning Outcome to discuss as this is topic really held my interest in the lecture. I can see that it will have a big impact on how I work and the procedures and protocols that I will be following are as a result of this initiative. I it is now clear to me from this that the patient is at the centre of everything we do and it is good for me to start my training on the proper foot and have this as my focus.

CONCLUSION
The questions asked here is What else could I have done? I was not satisfied with the extent of the information I knew about Clinical Governance and so with the new information and details I now had I did more research. I found a wealth of sources available on the internet, journals and books. It helped me with my research skills too as I had never searched through journals before and this has given me another route to go down. I am happy with the amount of information I know on the subject now and will be confident and prepared to support the principal in the workplace.

ACTION PLAN
The last question posed by Gibb’s cycle is ‘If this situation arose again what would I do?’ This gives me the chance to reflect on what I have learned and any actions I would have for the next time I come across a subject that I am unsure about. Tate(2004) states that’ to learn from your experiences is a central aim of reflective practice’, so I should take forward the information and experience I have gained and use the internet, journals and books to make myself more aware of the details and have on-going knowledge and personal development.

Learning Outcome 2.

DESCRIPTION
We were split into groups each of which consisted of 5 people from different disciplines. ‘Interdisciplinary practice refers to people with distinct disciplinary training working together for a common purpose, as they make different, complementary contributions to patient-focused care.’ (Leathard, 1994). As a group we had to put ideas together with reference to teamwork and decision making involved in a patients discharge from hospital and present this back to the class. It was agreed to meet up as a group in our own time to discuss the task and decide on the direction we would take. I found from our first meeting that I had the role of ‘shaper’ in the team. I found that most of the team were very quiet and even lacked enthusiasm for the project. As other team members were quiet I found communication was a problem and was not sure whether my ideas were good or they were just agreeing for a quick end to the meeting. As I am going to be working in a very team oriented environment I was looking to increase my team working skills within this module. Teamwork is not the same thing as a team. Katzenbach & Smith (1993) see the team as a means rather thanan end, while teamwork is about performance and how to achieve the primary objective. I introduced ideas and pushed forward the ones that were good for our presentation. Tuckman (1965) identified 4 stages of team development Forming, Storming, Norming and Performing. I believe when our group came to do our presentation we were still at the ‘Storming’ stage. Most of the work had been done by myself and another member and on the day of the presentation two members were absent. Kezsbom et al. (1989) warned that all groups are not teams, and too many teams are simply groups. They also argued that an effectively functioning team integrates group effort, complementary competence and skills with the identified goals. I believe that communication and decision-making are the core skills and attitudes needed for professionals to collaborate interprofessionally and this was not happening with my team.

FEELINGS
I felt disappointed and a little angry at being let down by the team members. Myself and the team member who were doing the presentation on behalf of the five of us were irritated and anxious. The initial stages of this incident caused an awareness of uncomfortable thoughts and feelings. Boyd and Fales (1983) describe this stage as a sense of inner discomfort.

EVALUATION

The negative side of the whole experience was that I was put into a situation where I was working under stress. I felt it could have been avoided had my colleagues shown some consideration. On the positive side the facilitator understood the position we were in and guided us through the presentation. It was an accomplishment to get through the task and I felt very satisfied once it was over and we received good feedback from the class.

ANALYSIS

To analyse this incident I refer to (Benner 1982), who suggests that we can be both a novice and an experienced person at the same time within a situation.’ On reflection this was the situation I was in. It was a new module and way of learning for me but also I had to draw on my own experiences to deal with it. I have gained confidence from this incident but would probably ask for help and more time if this happened again.

CONCLUSION

Using Gibbs reflective cycle has helped me make more sense of the situation and put things into perspective. It’s made me realise how I can put this learning experience to positive use in my future practice as a professional. It has also helped me to understand difficult situations better, to alleviate anxieties and share problems with my colleagues. According to Wondrack (2001) fear and feelings of guilt often accompany emotions, which spring from a lack of confidence in how to resolve the situation. I have now learned from experience that if this incident arises again I would be able to deal with the situation more professionally.

ACTION PLAN
If a similar situation arose, I would try to be assertive in a different way. I would try to speak to the tutor privately, although this is not always possible. I will be more positive and not let my anxious feelings takeover. I have definitely benefited from this experience and my confidence has grown.

In conclusion knowledge of the two Learning Outcomes - Clinical Governance and Team Work are essential to my development as a Health Care Professional. By reflecting on these I have gained new skills and attitudes. Research will be invaluable for my Continuing Professional Development to keep me up to date with Health Care initiatives and procedures in my job. I can use the techniques that I adopted to look at Clinical Governance to do this. I always enjoy working in a team, however by adapting better to new situations I will grow as an effective team member. Jasper (2003) quotes ‘reflective skills allow us to improve all we do by enabling us not only to use skills learned, but to anticipate future situations and be better to cope.’

References

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