Why do non-medical prescribers need to learn to become reflective practitioners?
During your non-medical prescribing course and clinical practice, nurse prescribers and pharmacist prescribers will be required to regularly reflect on their clinical practice to develop reflection and reflective practice skills.
Moreover, if you’re undertaking a non-medical prescribing course, you will be expected to submit as part of your coursework many reflective essays, i.e., a reflective account – so understanding what a reflection is and how to reflect is undoubtedly worth the investment.
Do medical prescribers need to reflect on their practice?
There is no one-size-fits-all answer to this question, as the need for reflection will vary depending on the individual and their clinical practice. However, medical prescribers should generally reflect on their practise to improve patient care and ensure they use evidence-based practices. Additionally, reflection can help medical prescribers identify areas where they need further education or training.
Do independent prescribers need to reflect on their practice?
Independent prescribers need to reflect on their practice to ensure that they prescribe safely and effectively. By reviewing their own practice, independent prescribers can identify areas where they may need to improve and make the necessary changes. This is important to protect patients’ safety and ensure that they are receiving the best possible care.
The above is relevant for all non-medical prescribing students, including; (1) future nurse prescribers, ; (2) allied healthcare professionals and (3) pharmacist prescribers wanting to undertake advanced practice training.
What is reflection?
Reflection is a mental process where people examine their experiences to better understand their whole profession. It allows individuals to enhance their work habits or the care they provide to patients regularly. It is an essential, continuous, and routine element of the job of healthcare and social service providers.
Teams comprised of professionals with different backgrounds, skill sets, and working experiences should be encouraged to reflect openly and honestly on what occurs when things go wrong. These practical reflective activities help develop resilience, enhance well-being, and increase professional devotion.
To be reflective during your prescribing practice, healthcare professionals must first be open to new ideas, explore them from various perspectives, be inquisitive – asking questions – and remain patient if the problem isn’t “simple.” (While this may suddenly leap out at you).
Your prescribing practice and reflective accounts need to make transparent to others and what you’re getting wrong or right. Therefore being honest with yourself is essential as a non-medical or independent prescriber.
Why do nurse prescribers, pharmacist prescribers and non-medical prescribing students need to reflect and write reflective accounts?
Reflection may help you learn a lot from your prescribing practice and prescribing decisions. There are several reasons to reflect. You can use it to:
- Learn from the experience of independent prescribing
- Improve your prescribing decision-making skills
- Help you make decisions in the future
- Identify continued professional development (CPD) needs
You can reflect on anything, but as a non-medical or independent prescriber, you should focus on your prescribing experiences. This will help you understand and develop your skills as a prescriber.
When thinking about your experiences, you should consider both the good and the bad. It’s important to reflect on what went well and what didn’t go so well. This will help you learn from your mistakes as well as your successes. Furthermore, it will ensure you identify gaps in your professional development needs.
There are many different ways to reflect. You can use written reflection, audio recordings, or even video. The important thing is that you’re taking the time to think about your experiences and what you can learn from them.
If you’re not sure how to get started, some helpful reflection templates and examples are below. You can also talk to us at MEDLRN for guidance on how to reflect on your independent prescribing experiences.
Remember, reflection is an integral part of being a successful non-medical prescriber. By reflecting on your experiences, you can improve your practice and make better decisions in the future.
Reflective practitioners and the benefits
The General Pharmaceutical Council, the General Chiropractic Council, the General Dental Council, the General Medical Council, the General Optical Council, the Health and Care Professions Council, the Nursing and Midwifery Council, and the Pharmaceutical Society of Northern Ireland’s top executives have signed a joint statement called Benefits of becoming a reflective practitioner.
This is what they say:
“We are committed to supporting our registrants in their professional development and we recognise the benefits of registrants engaging in reflective practice.
Reflective practitioners are more resilient, and adaptable and have a greater capacity to maintain their registration throughout their careers. They demonstrate professionalism by being able to reflect on their own values and behaviours, and how these might impact the people they care for.
Reflective practitioners are able to make well-informed decisions, using a range of strategies including critical thinking, problem-solving and lifelong learning. They can identify their own development needs and are committed to maintaining their registration by engaging in continuing professional development (CPD).
We would encourage all registrants to reflect on their practice and to use reflective tools and resources to support their professional development.
Reflective practice is a key part of being a healthcare professional. It helps us to learn from our experiences, both good and bad so that we can improve our practice and make better decisions in the future.
How to get started with reflective writing
Most people are unfamiliar with the concept of reflective writing. However, the following comments indicate a lack of clarity regarding reflective writing when it comes to courses and assessments: ‘I thought I wasn’t supposed to use “I” in my work.” ,,,,,,,,,, ‘I won’t say what I truly believe unless it is going to be evaluated.’
The following points will help you to understand what is meant by reflective writing and how it can be used to support your non-medical prescribing course:
- Reflective writing is a way of exploring and analyzing your own thoughts and experiences.
- It can help you learn from your own experiences and make better decisions in the future.
- Reflective writing is different from other types of academic writing as it allows you to share your own thoughts and feelings on a subject.
- When writing reflectively, you should use first-person pronouns (I, me, my) to share your own experiences.
- You should also be honest about your thoughts and feelings, as this will help you learn from your experiences.
- Reflective writing is usually informal in style and can be written in the first or third person.
- It is important to remember that reflective writing is about your own thoughts and experiences, so you should use “I” when sharing your reflections.
- When writing reflectively, it can be helpful to use a reflection template or guide. This will help you to structure your thoughts and ensure that you cover all the essential points.
- Reflective writing is an integral part of the non-medical prescribing course, as it helps you learn from your experiences. By reflecting on your prescribing experiences, you can improve your practice and make better decisions in the future.
What is a reflective essay?
A reflective essay is a type of writing in which you (the author) interact with an audience (readers, listeners, viewers) to describe an experience and how that experience has changed you.
Reflective essays are usually written after a milestone. For example, a student may write a reflective essay at the end of a course of study or after completing an internship or other practical work.
The purpose of a reflective essay is to describe the experience and examine the meaning of the experience and how it has affected you as an individual.
Reflective essays are personal pieces of writing, so they should use first-person pronouns (I, me, my, we, us) and express your own thoughts and feelings about the experience.
Reflective essays can take many different forms. Standard formats include journals, letters to the editor, blogs, and photographic essays.
When writing a reflective essay, it is essential to use descriptive language. This will help the reader to understand your experience and how it has affected you.
It is also important to use concrete details and examples in your writing. This will make your essay more attractive and easier to read.
Finally, remember to proofread your essay before you submit it. This will help ensure that there are no errors or typos in your writing.
Writing critically and reflectively during your non-medical prescribing course
Both critical and reflective may be used in a directive to ‘reflect critically’ on anything. The terms describe a writing trait in which the reader can discern that the text has been carefully considered.
To be critical, you must go beyond description and into the analysis. You evaluate ideas or methods (evaluate), apply them in your work (apply), and defend or refute them (defend). You also reflect on what you have read, thought, or experienced.
In both types of writing, the key features are similar: good, strong, and well-written essays. The major distinctions between critical and reflective writing are as follows:
1 You and your thoughts will be more apparent in your writings.
2 Your personal history – what you have done, thought about, read, and changed throughout your life – is a significant source of evidence in your writing.
3 You are more likely to use the present tense when writing reflectively.
The key features of critical and reflective writing:
Critical Writing
- More formal
- Objective
- Focuses on ideas and methods
- Uses evidence from other sources
- Tends to use the past tense
Reflective Writing
- Less formal
- Subjective
- Focuses on you and your thoughts
- Uses your personal history as evidence
- Tends to use the present tense
Reflective writing for non-medical prescribing students and medical prescribers
Non-medical prescribing students and medical prescribers will be expected to:
- Participate in or observe an incident (such as the care of a patient)
- Discuss what went well and not so well about it
- Examine their thoughts about it by linking to relevant theory/policy/science/guidance and to the experience of others in similar circumstances
- Draw conclusions about what might be done differently next time and how this might improve patient care.
The use of frameworks to help non-medical prescribing students and medical prescribers write reflective essays or reflective accounts
A ‘framework’ is a method for structuring and analyzing an issue, scenario, or experience. It may help you extract the learning points from an event by taking a systematic approach:
- What happened?
- What was my role in it?
- What went well and not so well?
- What could I have done differently?
- What did I learn from it?
- How can I use what I learned in the future?
Reflective writing using the Gibbs Reflective Cycle
The Gibbs Reflective Cycle is a framework for reflection that helps you to think about your experiences and how they relate to your learning. The cycle is made up of six stages:
- Description
- Feelings
- Evaluation
- Analysis
- Conclusion
- Action Plan
These stages can be usefully applied to any reflective writing task.
An example of reflective writing using Gibbs reflective cycle
I recently observed an incident in which a patient was being discharged from the hospital. I was part of the team responsible for their care. I felt that the discharge process could have been better organized and that the patient could have been given more information about their condition and what to expect after leaving the hospital.
I evaluated the situation and identified some areas for improvement. I discussed my observations with the team, and we came up with a plan of action. I learned that it is important to be organized when discharge planning and to make sure that patients are given all the information they need to make a smooth transition from hospital to home. I will use this learning in future when discharge planning.
Example two of a reflective account using Gibbs reflective cycle
When I was first asked to do this reflective essay on weight loss, I was a little apprehensive. I wasn’t sure if I wanted to share my personal journey in this way or not. But after giving it some thought, I decided that it might be helpful for others who are either considering or currently trying to lose weight. So here goes…
I started my weight loss journey about 6 months ago. I had been feeling unhappy with my appearance for a while, and my health was also starting to suffer. I knew I needed to make a change, but I didn’t know where to start. Thankfully, a friend of mine recommended the Atkins Diet, and I decided to give it a try.
The first few weeks were tough. I had to make a lot of changes to my diet and lifestyle, and it was all very new to me. But I stuck with it, and after a few weeks, I started to see results. I felt better, both physically and mentally, and people were starting to notice the difference too.
Since then, I’ve lost a total of 30 pounds, and I’m still going strong. It hasn’t been easy, but it’s definitely been worth it. I’m now at a healthy weight, and I’m feeling the best I’ve ever felt.
The whole experience has taught me a lot about myself. I’ve learned that I’m capable of making big changes in my life, even when it’s hard. I’ve also learned that I’m stronger than I thought I was.
If you’re considering losing weight, or if you’re currently on a weight loss journey, then I encourage you to keep going. It’s not easy, but it’s so worth it. Trust me, I know from experience.
Non-medical prescribing reflection examples
Gibbs’s Reflective Cycle (Gibbs, 1998) helps you to understand and practice your reflective skills. Use the template to reflect on a recent event in which you demonstrated a reflected ability to improve or demonstrate the need for further learning or development.
Description: what happened?
I had undertaken a supervised consultation as part of the non-medical prescribing course in the presence of my designated medical practitioner(DMP) and university tutor. Mary (pseudonym) middle-aged woman with a previous diagnosis of hypertension, was invited to attend the OSCE, which involved taking a comprehensive medical history in order to undertake a clinical assessment of the patient. Mary was invited to attend the OSCE, and prior to the OSCE, she was informed of the particulars of the assessment, e.g. the presence of my university tutor and DMP etc.
Mary was called to the consultation room, and verbal consent was gained. The consultation involved the following; undertaking a comprehensive history taking using the Cambridge and Calgary model, taking blood pressure, and an explanation of the pathology of hypertension and its management.
Upon completion of the consultation, I was informed by the DMP I had passed my assessment and feedback was given.
Feelings: what were you thinking and feeling?
As a pharmacist, this was the first time I had undertaken a structured consultation using the Cambridge and Calgary model. However, having been qualified for over 5 years, I was confident with my consultation skills, in particular, my communication skills and my knowledge of the pathophysiology and management of hypertension. In addition, I was comfortable and relaxed when taking Mary’s blood pressure as I have had considerable practice during my placement with taking blood pressure and felt confident when explaining the relevance of the readings as well as offering health advice. After the OSCE, I felt satisfied with the outcome and in agreement with the feedback of my DMP.
Evaluation: what was good and bad about the experience?
On evaluation, the event was good for a number of reasons. Firstly, Mary said she was satisfied with the advice and the explanation she was given regarding hypertension and the relevance of her blood pressure readings. In addition, feedback from my DMP included my good use of communication skills, especially eye contact and body language(NICE,2010). Furthermore, another positive of the consultation was that I was able to follow the Cambridge and Calgary model and address all the relevant assessment requirements. However, a negative of the consultation was that Mary had asked me to quantify how much of various fruits count towards your ‘5-a-day fruits requirements; however, I was a bit unsure and had to double-check the advice with my DMP even though it was correct. As such, I would have liked to have been more confident in providing that advice.
Analysis: what sense can you make of the situation?
Mary had asked me to explain to her what amount of different fruits count toward the ‘5-a-day’ requirement (NHS,2015), and I was unable to provide the answer confidently as mentioned above; this was the ‘part’ of the OSCE that did not go too well. A reason for this was that I had assumed certain health advice is ‘common knowledge and would not require much explanation. As such, It had never occurred that this was a gap in my knowledge. This negative aspect could have been avoided had I thought more deeply about the advice I offered and affirmed the understanding of patients. Conversely, a part of the consultation that did go well was that I was able to utilize the Cambridge and Calgary model to structure my consultations.
This was because I had undertaken considerable learning regarding structuring a consultation and practised the Cambridge and Calgary model on multiple occasions with my DMP and modified it slightly to address my needs. Furthermore, with regards to taking blood pressure, during my training with my DMP, I had reviewed best practice guidelines when undertaken taking blood pressure and asked for regular feedback, which ensured I was constantly improving my technique and skills.
Conclusion: what else could you have done?
As a result of the consultation, I have learned that I must confirm the understanding of the patient with regard to the health advice that is being given (Nursing Times, 2017) and ensure there is no confusion or misunderstandings. In addition, this experience (of undertaking a consultation) has highlighted the importance of ensuring there is structure to consultation and how I can use a model of consultation to suit the needs of the situation (Royal College Of General Practitioners Curriculum, 2010). Furthermore, I would have liked to have undertaken a level 3 clinical medication review (Brent CCG,2014) to determine adherence to the medication, as many hypertensives have poorly controlled blood pressure (heart Foundation,2016) with a lack of adherence to treatment cited as a major reason (Izzat,2009).
Action plan: if the situation arose again, what would you do?
In order to be better prepared to face a similar experience, I have decided I will continually practice using the Cambridge and Calgary model of consultation wherever possible and undertake self-appraisal (Royal College of General Practitioners,2013); in addition, in order to ensure I have adequate knowledge in health education, I will continue to undertake CPD and have decided to attend a training course within the next 4-8 weeks. Also, currently, I am trained to take blood pressure using an electronic machine but am not confident in measuring blood pressure manually, which would be useful if a patient had atrial fibrillation (NICE,2016). As such, I have decided to take further training under the supervision of my DMP to develop this clinical skill.
References
- Brent CCG ,2014.Medicines Optimisation:Clinical Medication Review[pdf]. Available at:<https://www.sps.nhs.uk/wp-content/uploads/2016/08/Brent-CCG-Medication-Review-Practice-Guide-2014.pdf> [Accessed 2nd April 2018].
- Heart Foundation,2016. Guideline for the diagnosis and management of hypertension in adults[pdf]. Available at:<https://www.heartfoundation.org.au/images/uploads/publications/PRO-167_Hypertension-guideline-2016_WEB.pdf> [Accessed 2 April 2018].
- Izzat, L.,2009. Antihypertensive concordance in elderly patients [Online] Available at <https://www.gmjournal.co.uk/media/21571/gm2april2009p28.pdf> [Accessed on 28 February 2018]
- National Institution for Health and Clinical Excellence, 2010. Principles of Good Communication[pdf].Available at:<file:///C:/Users/ProScript%20Link/Downloads/supportsheet2_1.pdf> [Accessed 1 April 2018].
- National health service, 2015. Nhs Choices 5 A Day portion sizes. [Online] Available at:<https://www.nhs.uk/Livewell/5ADAY/Pages/Portionsizes.aspx> [Accessed 1st April 2018].
- National Institute for Health and Care Excellence (2016). The clinical management of primary hypertension in adults (NICE Guideline 127).[Online] Available at: https://www.nice.org.uk/guidance/cg127 [Accessed 25 February 2018]
- Nursing Times, 2017. Communication Skills 1: benefits of effective communication for patients[online]. Available at:<https://www.nursingtimes.net/clinical-archive/assessment-skills/communication-skills-1-benefits-of-effective-communication-for-patients/7022148.article> [Accessed 1 April 2018].
- Royal College Of General Practitioners Curriculum, 2010. The GP Consultation in Practice[pdf]. Available at:<https://www.gmc-
- uk.org/2_01_The_GP_consultation_in_practice_May_2014.pdf_56884483.pdf> [Accessed 1st April 2018].
- Royal College Of General Practitioners, 2013. What are consultation models for?[pdf]/ Available at:<http://journals.sagepub.com/doi/pdf/10.1177/1755738013475436> [Accessed 2nd April 2018].
