The power of reflective practice in staff recovery and wellbeing

In my work as a nurse, one of the most powerful tools that I have come across in quality improvement is a process known as reflective practice.

I sometimes come across those who regard reflective practice as a distraction from patient care. But I would challenge this and say that reflective practice is essential if we are to learn from what’s happened to develop and improve not only our future practice, but our personal and professional wellbeing too.

Reflective practice has become an increasingly important element of health care training and professional development. Dedicated space for reflection has the capacity to open creative and critical insight for individuals to turn ad hoc learning and experience into deeper knowledge. Many models for reflective practice have been described. One that I think works well with the ethos and drive for improving quality is the model described by Dewing et al (2008) that integrates reflection as part of active learning.

The authors describe a cyclic process of dialogue with self (self-reflection), dialogue with others (reflection together), observation (not only seeing, but opening all the senses and ways of noticing what’s going on) and action (synthesising information and taking next steps) as a way of becoming more aware of ourselves, our emotional intelligence, knowledge, skills, competencies and workplace practices in general. This has vital benefits, both for us as individuals and the people we work with (including patients and their families).

As a reflective practitioner, I have been involved in designing and facilitating person-centred healing workshops for teams coming back together after the pandemic. The workshops created safe, unique spaces for health care professionals to come together and reflect on their individual experience of the COVID pandemic and to decide how as a team they want to move forward together.

Designed for small groups who work together on a day-to-day basis (around 10 people max), the workshops used a person-centred approach and structure that gave each team member voice to share their insights and experiences and a process for refreshing their ways of working as they come back together in their post-pandemic roles.

Facilitated by experienced facilitators, the workshops were a forum for each member to speak candidly about the way the pandemic affected them and hear colleagues do the same.

The pandemic impacted on every person and each experience was unique. One of the most striking outcomes from the workshops was the understanding that came from hearing colleagues recount their experiences at the peak of the pandemic when everyone was under such pressure. This forum provided the space and time staff and managers needed to pause, take a breath, and confront these experiences from all perspectives. Staff were able to explain how these changes were experienced in their day-to-day work.

Equally, managers had the chance to talk about the challenging, large-scale decisions they were expected to make and deliver on, often very rapidly and without the ability to provide much explanation to staff.

The narrative of each person in the team contributed to a nuanced, collective story that helped to bridge understanding, widen perspectives, and inspire fresh empathy across the whole of the team.

As many Q members were also undergoing the transition from pandemic response to health service recovery, the Health Foundation extended an opportunity for us to adapt this approach for Q members.

My colleague and I took up this challenge with some trepidation. We didn’t know if our model could be adapted from a forum of 10 participants to one involving over 100. We were worried that such large numbers might remove the personal experience. We addressed these concerns by being clear about the purpose of the workshop from the start.

This work resulted in the Person-Centred Healing Workshop, held in December 2021 as part of a Community Space session. The aim was to give members of the Q community some personal space for healing and reflection as they emerged from the pandemic. We opened the workshop to around 140 participants from all across Q’s membership space.

For some, the workshop offered permission to think about and embrace the positive experiences that had come from the pandemic that they hadn’t had time to think about before.

To our delight, members found this to be a highly rewarding and healing experience. For some, the workshop offered permission to think about and embrace the positive experiences that had come from the pandemic that they hadn’t had time to think about before.

Participants were given the opportunity to use the chat function for voicing personal stories. We structured the workshop to allow reflective space to absorb and process the narratives as they were shared. Building a group narrative in the chat gave each person the opportunity to listen and tell the story of their own pandemic.

This type of deep listening and exchange of narrative in a reflective, collaborative and democratic space is at the core of our person-centred programme.

In our workshops, we use these three questions as a simple, direct way into reflective practice on team work:

1. What I am bringing to the team now?
2. What do I need from the team now?
3. How we can all move forward from here?

There are no wrong answers to these questions. Whatever way you choose to reflect will deepen your understanding and move your personal and professional development forward.