Becoming a reflective nurse or midwife: using complementary therapies while practising holistically

Complementary therapies augment nursing and midwidfery practice, but they do not necessarily make it holistic, nor is that practice guaranteed of being based on systematic reflection. This article argues the need for holistic nursing and midwifery to be based on reflective processes, enabling continual development and renewal of the person and practitioner. Practical hints are suggested to assist nurses and midwives in becoming reflective, thereby increasing the likelihood of incorporating complementary therapies while practising holistically.     

Teaching Labor Support: An Interprofessional Simulation

Support for women during labor encompasses the continuous presence of a person who provides psychosocial, emotional, and physical support. Providing labor support to women in the intrapartum setting is a core midwifery competency and a clinical skill that midwifery students are expected to master. Instruction on labor support is a common objective in midwifery education intrapartum courses and skills labs, yet there is no standard for teaching this skill to midwifery students. Thus, in order to accomplish this objective, we created an interprofessional simulation on labor support that involves the use of a standardized patient, a written scenario, an interprofessional team of nursing and midwifery students, faculty observations, and a reflective debrief. The goals of the labor support simulation are to allow midwifery students the opportunity to practice intrapartum labor support techniques and interprofessional communication prior to entering the clinical setting. A postsimulation structured debrief allows for student learning and reflection. This article describes the design, planning, and implementation of this unique simulation experience. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.     

A day in the life

As a reflective practitioner I write a journal, reflecting on significant experiences through the day. In this paper, I present a day in my life as a part-time nurse and complementary therapist at the hospice where I work. In particular, I focus my reflection on my ability and value of dwelling with patients as a clearing to enhance my therapeutic work.     

Therapeutic caring: a learning disability experience

This paper is a reflective account of our experiences of giving Therapeutic Touch (TT), for the first time within a learning disability setting, to a client who has profound learning disabilities. Using a case study approach, we share our story of this pathfinder journey of discovery and show how the process of reflection was instrumental in enabling us to gain insight on the unfolding therapeutic and caring relationship which we developed with this client. Issues relating to informed consent were addressed, however these were complex and needed special consideration. As client consent could not be achieved through verbal means we needed to draw on our senses and use intuitive skills together with team involvement. IntroducingTT into a learning disability setting was breaking new ground, and as this case study has shown it does appear to have the potential to enhance therapeutic caring.     

Journeying with Peter and Sam: reflections on a healing attitude

Reflection enables the practitioner to learn through everyday experiences towards realising desirable practice however it is articulated. In this paper I share my story in journeying with Peter and Sam in a hospice setting with the intention to ease suffering. In considering what is significant within this story, I pay particular attention to the idea of a healing attitude for deeper reflection in order to develop my appreciation of the nature and significance of a healing attitude.     

Midwifery competence: Content in midwifery students׳ daily written reflections on clinical practice

Objectiveto examine the content in midwifery students׳ written daily reflections and in their supervisors׳ written feedback during clinical practice at birth units.Methoda total of 388 reflections written by a cohort of 18 midwifery students and written feedback provided by their supervisors have been analysed using content analysis.Findingsone main category, transition to midwifery competence emerged and was interpreted as a process of development in midwifery skills over time. This main category encompasses five categories: evaluations, own actions, communication, own emotions and insights comprising fourteen subcategories. As the education programme progressed there was evidence of development from fragmented reflections about care and learning to holistic reflections on learning. Comments from the clinical supervisors contained acknowledgement of the students׳ reflections or comments with a didactic content.Conclusionsdaily written reflections on practice may be a useful pedagogical tool as reflective writing helps students to be active in transition to midwifery competence. Professional development may be facilitated by insights generated by reflection. Amount and content of feedback varied between supervisors which can result in a discrepancy in pedagogical value for individual students.     

Timing of elective caesarean section at term: barriers to guidelines in practice.

The introduction of NICE guidelines in Britain on Caesarean Section provides valuable information on current research findings but little insight into how to implement the guidelines in practice. This is of particular concern when considering the best gestational age to deliver a baby by elective Caesarean Section as this study suggests a major shift in practice would be required to meet recommendations. Guidance on how to achieve recommended practice is ambiguous and requires further reflection by policy makers and practitioners alike.     

Assisted conception and the audit culture

This paper explores the benefits and burdens of regulation in assisted conception, drawing on a series of interviews with practitioners and a range of recent writings on the social and political context of audit and bureaucracy. The process of regulation brings accountability and new competencies to assisted conception professionals, increasing their influence locally and nationally. Early career and laboratory staff are able to draw on protocols and standard operating procedures to improve their practice and enhance their authority within the assisted conception team and the wider institution. However, audit intensifies the focus upon paperwork rather than practice. Measures such as double witnessing can undermine trust amongst professionals, and this can have detrimental effects on performance. Systems such as incident reporting can become overloaded with minor problems, and do not necessarily allow sufficient time for reflection and feedback regarding the best ways of preventing errors. Performance data designed to increase patient choice can undermine it when clinics have to limit their treatment options or change practices to try to 'improve' their results. In conclusion, feedback and discussion between the regulator and a range of staff groups enhances the benefits of regulation and reduces its burdens.     

Integrating complementary medicine into the nursing curriculum

As nursing moves into the next century, the changing role of the nurse and increasing scope for practice will create the potential to develop an integrated approach to healthcare and the use of complementary medicine alongside more orthodox care. This paper outlines some of the forces which are creating a change in healthcare integration and discusses the value of pre-registration education and training in helping to make future nursing practitioners understand the use and benefit of complementary medicine. In promoting complementary medicine within the pre-registration curriculum, the process of reflection helped nurse teachers to appreciate the potential to integrate it into nurse training.     

Relationship of maternal placental blood flow to the placental clearance of maternal plasma dehydroisoandrosterone sulfate through placental estradiol formation

We have suggested that the placental clearance of maternal plasma dehydroisoandrosterone sulfate (DS) through estradiol (E2) formation (PC-DSE2) is reflective of uteroplacental blood flow (F). Clewell and Meschia13 suggested that PC-DSE2 is related to F as follows: Cobs = F(1-e-C/F), where Cobs = PC-DSE2 and C = total placental clearance of maternal plasma DS. This equation contains two unknown quantities, F and C. To solve the equation, Clewell and Meschia assumed that C was constant. Using 19.7 ml/min for C, they allowed PC-DSE2 to vary widely and computed F. Upon finding that F was unrealistically low for some values of PC-DSE2, they concluded that reductions in PC-DSE2 do not reflect alterations in uteroplacental blood flow. In the analysis of the relationship of F to PC-DSE2, it is important to know the value of C. Since the direct measurement of C is not possible at this time, we have evaluated C by measuring the difference between the metabolic clearance rate of DS (MCR-DS) prior to and immediately following delivery. Any change in MCR-DS before and after delivery should be a reflection of the amount of maternal plasma DS cleared by the placenta through all metabolic routes including PC-DSE2, providing nonplacental clearances of maternal plasma DS before and immediately after delivery are the same. We measured MCR-DS and PC-DSE2 in 15 pregnant women within 5 days before delivery and repeated the MCR-DS measurement in these women beginning 90 minutes after delivery. Among these 15 women, C ranged from a low of 4.7 ml/min in a woman with severe pre-eclampsia to a high of 28.5 ml/min in a woman with twins. In addition to the finding that C varied widely, it was also ascertained that PC-DSE2 was positively correlated with C (r = 0.908; p less than 0.001). The finding that low or high values for PC-DSE2, observed in complicated pregnancies, were associated with similar changes in C is suggestive that a change in PC-DSE2 is reflective of a change in uteroplacental blood flow.     

Critiquing the Unintended Pregnancy Framework

The unintended pregnancy framework, a central tenet of sexual and reproductive health care delivery and research, has been depicted as an adverse outcome that should be prevented. There is growing criticism of the inadequacies of this framework, although little modification in public health guidelines, measurement, or clinical practice has been seen. This article critically reviews the literature on unintended pregnancy to encourage reflection on how this framework has negatively influenced practice and to inspire the advancement of more patient-centered care approaches. We begin by outlining the historical origins of the unintended pregnancy framework and review how this framework mischaracterizes patients’ lived experiences, fails to account for structural inequities, contributes to stigma, and is built upon weakly supported claims of a negative impact on health outcomes. We close with a discussion of the relationship between health care provision and unintended pregnancy care and the implications and recommendations for realigning clinical practice, research, and policy goals.     

Participation in and a critical review of educational audit

In this reflection I discuss my first engagement with the educational audit process. Audit of the environment is a crucial element in the education of student midwives; educational audit is complex as placement areas are dynamic, fast-changing environments. It is important for all involved parties to recognise that the quality of the learning experience is far more reliant on the 'virtual environment' provided by quality mentors rather than on the more concrete practice setting.     

'Just the ticket': the findings of a pilot complementary therapy service (Part II)

In part I of this series of articles (Dryden et al. 1998) the authors detailed the background to a project offering hand and foot massage incorporating reflexology techniques. The following paper reports back on the findings and evaluation. Over a 4-month period a total of 61 recorded treatments were given to 18 in-patients. Each session was to last approximately 30 minutes and included recordings of physiological data as well as pre- and post comments from the patient. The six practitioners, who were already working within the ward setting in various capacities, were asked to record reflective comments after each treatment. This paper will conclude by discussing future recommendations. Part III of this series (CTNM 5: 2, 1999) will focus on a subgroup of patients within the study highlighting the experiences of both practitioners and patients.     

Education in ethics

Ethics is the system of thought that analyzes moral judgments. Among the key features of ethics are: (1) it must be translatable into moral action; (2) it is a public system rather than a private activity, and no one can act morally without reference to other individuals; and (3) the fundamental ethical principles underpinning medical ethics are those of society in general. Among the purposes of education in ethics are the development of consistent, critical, and reflective attitudes to ethical decision-making; increasing awareness of ethical dilemmas in one's own practice and that of others; and reinforcement of best practices in clinical and research governance. Ethics is the system of thought that analyzes moral judgments. Among the key features of ethics are: (1) it must be translatable into moral action; (2) it is a public system rather than a private activity, and no one can act morally without reference to other individuals; and (3) the fundamental ethical principles underpinning medical ethics are those of society in general. Among the purposes of education in ethics are the development of consistent, critical, and reflective attitudes to ethical decision-making; increasing awareness of ethical dilemmas in one's own practice and that of others; and reinforcement of best practices in clinical and research governance.     

Influence of Research on Health Policy and Clinical Practice

Clinical research is a type of biomedical research conducted to aid and support the development of knowledge wherein there is involvement of patient. One of the key duties of healthcare professionals is to involve in research and change existing practice, when there is robust evidence in favour of new strategies that can have better patient care. Knowledge derived from research and experience may be of little value unless it is put into practice. Evidence-based medicine (EBM) is the diligent, clear, and wise use of current best research evidence in making decisions about clinical care of patients. The practice of EBM is incorporating clinician’s expertise with the best available clinical evidence from research. It leads to improved patient outcomes and promote critical thinking and reflective practice. Effective research utilization can enhance policy decisions, resource allocation for programmes, and decisions about how to deliver those services.     

Journeying with Alice: some things I don't know for certain

In this narrative I reflect on those things I do not know for certain. The narrative is constructed around my experience of giving Alice, a patient at the hospice where I worked as a complementary therapist, a foot massage. The narrative reveals the possibility of caring in the context of hospice, notably the significance of paying attention to little things such as a foot massage, that made such a difference to Alice's care. The narrative further reveals factors that resist caring, in particular the impact of labelling people as difficult for whatever reason.The narrative stands as an exemplar of reflective practice as an opportunity to reveal and challenge those things I might claim to know but which in the mystery of the human–human encounter can never be known for certain. Only by being non-attached to knowing can the practitioner truly realise her or his caring potential.     

The evolution of advanced practice nursing in the United States: caring for women and newborns

The evolution of advanced practice nurses to care for women and newborns has its roots in public health nursing of the latter decades of the 19th century. As we consider the challenges of practicing as advanced practice nurses in the 21st century, it is instructive to look back on 100 years of creating new programs and systems for delivering care. Such reflection helps us to clear our vision to imagine the future.     

Bridging the gap: teaching ethics in midwifery practice

Teaching is an integral part of all midwives' practice, wherever they work. Midwives face ethical issues of greater or lesser significance throughout their careers. In a multitude of different situations and cultures worldwide midwives confront, on a daily basis, the need to make or help others make critical decisions that will impact lives. Midwives need tools to address this reality constructively, consistently, and respectfully if they are to remain true to themselves. They need also to be able to transmit such skills to the students they teach and the women to whom they offer care. Translating ethical thought and reflection into action--bridging the theory-practice gap--is the perennial challenge. This article presents some of the tools available to professionals who take up the challenge of using ethical thinking to shape best practice in any setting.