Practice Expectation Spotlight: Self-Reflection in Action

There are opportunities all year long to develop your competence through self-reflection and analysis. Thinking about your feelings, behaviors and the reasons that may be behind them, can be one of the best methods to improve your self-reflection and reap benefits such as:

• Identification of personal and professional strengths and areas for improvement
• Improved critical-thinking and decision making
• Strengthened communications and relationships and
• Enhanced leadership capabilities and capacity.

So this month, let’s take another look at self-reflection demonstrated by a practice scenario that speaks to a son’s concern around his mother’s care. The practice scenario is presented in steps, to show the self-reflective process in understanding an impact to an RN’s practice.

1. Think of a recent practice scenario (who, what, why).

I was answering questions from a client’s son who felt that that his mom (the client) was not receiving adequate pain relief. He stated that she doesn’t speak up because she thinks staff are rushing and she doesn’t want to seem ungrateful. He also stated I wasn’t truly aware of the impact of colonization residential schools on the his mom’s care.

I answered by restating the client’s care plan and discharge plan.

2. How did it make you feel?

I was startled because I did spend time with this client during the time I had to provide her care, limited as that was. She was very nice and did not ask for anything despite my checking with her.

I also felt defensive. The son doesn’t know that I am trying to understand the impact of colonization on the health care system and on Canadian society. I’m trying, even though he has a point.

3. Why did it happen? What do you know for sure?

The client doesn’t complain. She has said she wishes her family could come with her as it’s hard to come to a big building alone but she’s heard it is not possible these days.

Second, everyone on the care team’s time only goes so far because we are busy, like everyone else. And visitation is very limited.

Then, the impacts of colonization are real, far-reaching and challenging to comprehend fully all the time. In many residential schools, visiting was intentionally limited.

4. Could you have done anything differently?

I could have acknowledged his thoughts and feelings. I could have reconfirmed that I will reassess his mom’s pain level so we can provide any necessary pain relief.

5. What will you do differently next time? What would great look like?

I could have asked the son an open-ended question about suggestions to make the care more relevant and culturally safe.

I can discuss with my team what we can do now to make our services culturally safe.

6. How can I optimize the impact to my practice?

Learning Goal:

I will continue learning about the impacts of colonization on people’s response to health care.

Learning Activities:

I will participate in an 8-week course about Indigenous Cultural Safety.

I will rehearse a strategy to stay present while listening to people who provide feedback.

Impact to Practice:

I am closer to understanding the history of colonization in Canada with its ongoing impact. I better appreciate that despite my intentions, clients can feel mistrustful of the health care system or reluctant to appear ungrateful. I am practising presence while listening to clients and their families, and consciously reminding myself that when I feel defensive, this is a trigger for me to listen to what the client/family might be trying to share about their experiences.

All of this assists me to better meet the Practice Expectations for RNs, notably the responsibilities to:

• Taking part in development of your continuing competence to maintain and enhance your nursing knowledge, skill and judgment so your practice is both safe and relevant to your clients’ health-care needs.
• Identifying barriers to clear communication and take steps to manage them.
• Providing nursing care that includes sufficient and timely communication with the client or their representative that takes into account the client’s needs, circumstances, understanding and use of health information and enables the client or their representative to make informed decisions about their health care;

References

CRNM (2020). Continuing Competency Workbook.

CRNM (2018) Practice Expectations for RNs.

Myers, K. (2020). Nurses’ Active Empathetic Listening Behaviors from the Voice of the Patient. Nursing Economic$, 38(5), 267–266.

Phillips-Beck, W., Eni, R., Lavoie, J., Kinew, K., Kyoon-Achan, G. & Katz, A. (2020). Confronting Racism within the Canadian Healthcare System: Systemic Exclusion of First Nations from Quality and Consistent Care. International Journal of Environmental Research and Public Health, 17, 8343.

WRHA (2021). Manitoba Indigenous Cultural Safety Training (MICST). https://wrha.mb.ca/indigenous-health/cultural-initiatives/micst/.