Reflective writing for clinicians – one particular session from HLG

HLG Nursing Bulletin Vol 36 (1)

Daniel Park
Library & Evidence Research Centre
Leeds General Infirmary

Although rather “long in the tooth” as a librarian, I have worked in hospital libraries for less than two years and so it was a very great privilege to be selected to attend the CILIP Health Libraries Group Conference in Scarborough from 15th-16th September 2016.

The main theme of the conference was centred on the Knowledge for Healthcare agenda which focused my mind on the crucial importance of remembering why we’re working in health libraries in the first place: to support safe and effective healthcare. Yes, we all use different (and often complex) tools to facilitate that, but in the end it doesn’t matter how sharp the scalpel is if we don’t look after the patient and consider their needs above all others. Healthcare librarians and information staff may not be wielding scalpels, but we are – either directly or, more usually, via clinical and nursing staff, helping patients to make good choices about their own health and wellbeing through the use of good quality and up to date information.   

In his keynote address on 16th September, Nick Poole, the Chief Executive of CILIP, summarised this by highlighting the importance of health librarians in promoting Information Literacy:  the process of making sense of the evidence and taking control of information to make better decisions “from the bedside to the boardroom”. Of course, that’s easier said than done. There’s never been more evidence out there to sift through and there’s a temptation, as a clinician, to rely on SOPs (Standard Operating Procedures), and suggest that thinking about new evidence isn’t strictly necessary, but we all know that nothing ever changes for the better if we’re not reflecting on what’s new and relevant to our professional practice, even when we’re hard pressed to do so because of time pressures and a fear that we might be doing it all wrong!

Given these pressures, I was keen to attend a learning session on 15th September from Mary Hill, the Library Manager of The Christie NHS Foundation Trust, on how to offer reflective writing sessions to clinicians, and particularly to nursing staff.

Mary is very passionate about the importance of helping nurses to read and think critically as part of their revalidation. She had spoken to the NHS Trusts in the North West of England and discovered that many were moving towards collaborating with clinical departments to help develop the reflective writing section of doctor and nurse revalidation training. Currently Warrington and Halton hospitals NHS offer a reading and reflecting section as part of a day’s revalidation, Mid Cheshire carry out 1-2-1 sessions and The Christie NHS Foundation Trust are moving towards providing an online version backed by personal advice.

Reflective writing needs to be customised and, where appropriate, shared. When starting out on providing such training, it is important to aim to get immediate feedback from those being trained so that amendments can be made quickly in the first instance. The questions that form the basis of library-based training include:

  1. What is reflection?
  2. What should I reflect on?
  3. How do I write a reflective piece for revalidation?

Methods of training can include videos, practical tasks, using papers for reflective discussion, identifying good reflective writing examples and just having a go at writing your own reflective piece on the training as a demonstration. At the end of this article, I have attached a list of helpful online tools for reflective writing practice that Mary provided during this training with her kind permission.

Delving deeper, Mary gave us the opportunity to “get stuck in” to some practical examples. As part of a 90 minute session entitled: “How the knowledge and evidence service can support your revalidation”,  Warrington and Halton NHS Trust help nurses to choose an article from a list of pre-prepared material  and guide them to read and discuss the article in pairs, with a practical review sheet helping prompt them to reference and discuss the article’s subject matter and then think about the impact that the learning might have and how they could use it to influence or change practice on the ward/in the community. Even if these articles available aren’t directly relevant to a nurses’ revalidation, the process is applicable in terms of applying it to their own practice.

Stockport NHS Foundation Trust library have developed an “Identifying good reflective writing” session in which nurses are guided to read real life case studies  from fellow nurses and highlight (in different colours) the “feelings” and “learning points” within the passages provided. This helps nurses to think about how their reactions to events on the ward/in the community can result in learning experiences.

Another essential point to make is that nurses generally discuss actions as a team approach, but for reflective reading and thinking, there needs to be much more emphasis on individual learning. The “I” word is very difficult in both the nursing and librarianship professions, so this reflective technique is good for both. With the case studies, nurses are then asked to discuss which case study best meets the requirements of reflective writing.

In our HLG training session, both of these examples were tried out by me and my fellow library/information staff and the results were very positive.

Finally, Mary talked about some additional techniques in the North West. The previous training was part of a larger session, but sometimes there simply isn’t sufficient time for nurses to attend full day workshops, and smaller bite-size sessions are more manageable. As part of hour’s session each month, Christie, Stockport and Morecombe Bay’s revalidation training features a 5 minute guided think in pairs to discuss what might have been suitable to reflect on during the week and how this might be matched to the Nursing and Midwifery Council (NMC) standards they have to refer back to. Library and information staff are prepared to prompt the group with some pre-prepared examples to help prompt contributions. Another helpful prompting technique involves a little bribery! Librarians prepare a “prize jar” with goodies attractive to nurses (pens are apparently very popular) and offer the jar around when nurses are able to think of practical examples of answer questions about reflective thinking and writing related to the NMC standards.

So, what have I learned as a result of this very interesting and practical training session? It very much confirms that bottom line of health librarianship: that our job is primarily about clinical priorities irrespective of if we’re holding a scalpel or a book scanner. Helping doctors and nurses with reflective reading/thinking may not be a subject directly relevant to librarianship (although we should be regularly doing this as part of our continuing professional development) but it is directly relevant to the people we’re here to serve. And if we’re supporting of doctors and nurses, then we’re supporting their patients as well. And if the CILIP Health Libraries Group Conference has taught me one thing, it’s that patient care is all of our business.

Links to reflective writing resources reproduced with kind permission of Mary Hill, Library Manager, The Christie NHS Foundation Trust

Useful videos

Video by Bill Laughey, a GP in North Yorkshire. Appraiser, trainer and medical school tutor

Reflective writing practice video, London Deanery

Hull University – reflective writing

Nursing and Midwifery Council (NMC) selection of videos for nurse revalidation

Reflective models

Nurse revalidation

This site provides excellent material from videos (look in resources) to forms.  The video on the application process has been very helpful, along with the example forms that have been filled out.  It has information for confirmers too

Doctor revalidation

Useful templates and guidelines can be found on the Academy of Medical Royal Colleges site.

Examples of reflective writing

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