Reflections on reflective practice.

In recent years, a wide range of professions have adopted 'reflective practice' as an approach to professional development, and many professions have made it a mandatory dimension of their membership credentialling process. Despite the fact that it has been widely taken up in the professional world, there are many different conceptualizations and ideas about what it is. In this paper, six theoretical underpinnings of reflective practice are considered, and suggestions are made about how we can begin to incorporate reflection into our own practices.     

Reflections on independence in nurse practitioner practice

Purpose: To examine factors that influence the ability of nurse practitioners (NPs) to practice as independent primary care providers.
Data sources: Extensive literature search on CINAHL, OVID, MEDLINE, Internet journal sources, and professional association Web sites.
Conclusions: The legal authority for NPs to practice independently is recognized; however, the ability to put that authority into practice is undermined by the historical failure of political, professional, and social entities to recognize NPs as providers capable of providing primary care autonomously. Nonrecognition is responsible for complex reimbursement policies (both federal and state) that economically and professionally restrain the NP role; hence, NPs remain in a financially dependent relationship despite 40 years of proven safe practice. NPs must articulate their independence as practitioners more vociferously in order to meet society's healthcare requirements, as well as to attain professional fulfillment and forge collegial relationships.
Implications for practice: NPs will never be seen as members of a profession by either themselves or others without the practicality of independence and autonomy. Although legal independence is a fact, real practice independence in the pragmatic sense is contingent upon reimbursement. Without fiscal sustainability, practice independence is an impossibility. And, without professional autonomy, NPs will have only an employee's voice in the dynamic healthcare system in which they are really key players in providing healthcare services to the poor and undeserved populations.     

Reflections on the doctorate of nursing practice

A debate is currently raging in many academic nursing circles about a new degree, the Doctor of Nursing Practice (DNP). The degree is envisioned as the terminal degree in the discipline that focuses on clinical practice, and it is proposed to supplant the master's degree by 2015. There are a number of driving forces fueling the proposed change, including the hoped-for parity it will create with other health care disciplines and the potential for addressing the complexity of today's health care system. However, we believe that a substantive debate is required prior to a full-scale adoption of this new degree. In this article, we pose the potential unintended consequences of adopting a practice doctorate within our profession-the ones that might be negative for the nursing profession, for health care, and for society as a whole. We discuss these 3 dimensions and suggest that the DNP may erode the major progress nursing as a scientific discipline has made in universities over the past 3 decades. We suggest that the adoption of a DNP will threaten the generation of theory-based science in our discipline, either by decreasing the number of PhD-prepared nurses that will enter the field in the future or by lengthening the course of study to a PhD, thereby significantly shortening productive scientific careers. We question whether the creation of 2 doctoral tracks will further widen the chasm between nurse scientists and clinicians and result in many nurse clinicians feeling disenfranchised. We also pose questions about the impact of the DNP on health care and society. We are concerned that the number of nurses prepared at an advanced practice level will decrease and that the DNP will, thus, have negative impacts on quality, cost, and access to care. Finally, we question whether the DNP will create confusion among colleagues and consumers. We recommend that the adoption of the DNP only occur after thoughtful discussion both within and outside the profession.     

Reflections on the continuing evolution of advanced practice nursing

While the concept of advanced practice nursing (APN) is still relatively new, distinct patterns of evolution from specialty practice to advanced practice nursing are evident over the last 100 years. The purpose of this article is to describe 3 stages in this evolutionary process, as well as discuss several internal and external issues that represent challenges facing APN educators and clinicians who seek to strengthen advanced practice in the current healthcare system. We clarify our definition of advanced practice nursing, and note the critical need for cohesion within the profession regarding the definition and core competencies of advanced practice. Our aim is to suggest a preferred vision for advanced credentialing. We encourage dialogue among our nursing colleagues to move this agenda forward.     

Reflections on a 'virtual' practice development unit: changing practice through identity development

Aims. This paper draws together the personal thoughts and critical reflections of key people involved in the establishment of a ‘virtual’ practice development unit of clinical nurse specialists in the south of England. Background. This practice development unit is ‘virtual’ in that it is not constrained by physical or specialty boundaries. It became the first group of Trust‐wide clinical nurse specialists to be accredited in the UK as a practice development unit in 2004. Design and methods. The local university was asked to facilitate the accreditation process via 11 two‐hour audio‐recorded learning sessions. Critical reflections from practice development unit members, leaders and university staff were written 12 months after successful accreditation, and the framework of their content analysed. Findings and discussion. Practice development was seen as a way for the clinical nurse specialists to realize their potential for improving patient care by transforming care practice in a collaborative, interprofessional and evolutionary manner. The practice development unit provided a means for these nurses to analyse their role and function within the Trust. Roberts’ identity development model for nursing serves as a useful theoretical underpinning for the reflections contained in this paper. Conclusions. These narratives provide another example of nurses making the effort to shape and contribute to patient care through organizational redesign. This group of nurses began to realize that the structure of the practice development unit process provided them with the means to analyse their role and function within the organization and, as they reflected on this structure, their behaviour began to change. Relevance to clinical practice. Evidence from these reflections supports the view that practice development unit participants have secured a positive and professional identity and are, therefore, better able to improve the patient experience.     

Reflections by clinical nurse specialists on changing ward practice

In September 2010, palliative care clinical nurse specialists at North Middlesex University Hospital Trust introduced competencies for all nurses in setting up and using syringe drivers. This was done after the trust identified a high level of clinical incidents involving syringe drivers. This article discusses how the competencies were implemented and assessed, explores the importance of understanding change management to achieve change, and how different leadership styles affect changes to practice.     

体质调养在健康管理实践中的应用体会

在慢性生活方式疾病高发的现状下,健康管理具有鲜明的时代特征与重大的现实意义。丰富的中医体质学研究成果彰显了中医在调体治病方面的特色与优势,体质调养与健康管理相结合,既丰富了健康管理实践,同时使中医＂治未病＂学术思想找到了实现的载体。展望未来健康风险评估领域能够建立包含体质因素在内的多元回归模型。     

The role of theory in clinical practice: Reflections on model building

Although previous studies have demonstrated the benefits of using electropalatography (EPG) for treating therapy-resistant articulation errors associated with cleft palate, until recently access to this form of treatment has been limited. For the past 10 years, however, the CLEFTNET Scotland project has provided individuals with cleft palate access to EPG therapy. CLEFTNET Scotland represented a novel form of EPG service delivery—it linked the cleft palate centres throughout Scotland to Queen Margaret University College (QMUC) in Edinburgh through an electronic network. EPG data collected in the centres were sent to QMUC, where experts conducted detailed analysis leading to a precise diagnosis of each individual's specific articulation difficulty and suggested therapy guidelines to the specialist speech-language therapists based on their analysis. This form of service delivery has recently extended to include England, Wales and Northern Ireland to form CLEFTNET UK. This paper describes the CLEFTNET projects, discusses orthodontic issues relevant to EPG therapy for individuals with cleft palate, and presents a case study to illustrate how therapy guidelines for speech-language therapists are derived from data analysis.     

Reflections on leadership in advanced and consultant radiographic practice within the UK

IntroductionThis Educational Perspective provides an overview of how leadership fits into advanced and consultant radiographic roles within the UK setting. It draws on research in the area as well as reviewing some of the wider healthcare literature beyond the medical radiation sciences. The reflections outlined suggest how leadership at these levels may look and differ in practice.DiscussionLeadership should be seen as fundamental to practice and not necessarily a discreet element to either role, but one that supports all other areas. The proportion of the role that leadership takes up, along with the degree of influence, increases from advanced to consultant practice. Consideration over conflict with management and leadership within roles is also important. Ultimately leadership is about relationships with people, for which interpersonal skills are required, along with establishing networks, supported by training and development to maximise effectiveness.ConclusionA clearer understanding of leadership is needed to help conceptualise and measure its impact at advanced and consultant levels of practice. The content is intended to provide an opportunity for reflection and discussion around the topic, serving as a development tool in practice.     

Reflections on...a disability methodology for the client-centred practice of occupational therapy research

BACKGROUND: Occupational therapists' stated commitments to client-centred practice and to enabling participation in the occupations of daily life are not universally reflected in either the practice or the occupation of occupational therapy research. Nor have the profession's researchers generally engaged with those critiques of their endeavours that have been articulated by disability theorists. PURPOSE: Because no guidelines exist for the client-centred practice of occupational therapy research this paper draws from the work of disability theorists to sketch a disability methodology: a specific philosophical, political and ethical approach to developing knowledge that is fundamentally concerned with realigning power within the research relationship and throughout the research process. PRACTICE IMPLICATIONS: The proposed disability methodology attempts to align the practice of occupational therapy research with the client-centred philosophy underpinning occupational therapy practice and aspires to enable clients' meaningful participation in the occupation of research.     

Reflections on the role of the nursing development facilitator in clinical supervision and reflective practice

The notions of clinical supervision and reflective practice are attracting considerable interest across the spectrum of nursing. This paper focuses upon how the two were linked together and, with the support of an independent survey, were used to evaluate the nursing development facilitator role. It is argued that reflective practice, as a model of clinical supervision, may provide a forum for nurses to explore the value of their actions. Linked to this, the personal knowledge that is revealed may mirror reality and as a result it is argued that there is benefit in evaluating practice through reflection.