Practice Expectation Spotlight

Registered nurses are responsible for the development of their own continuing competence which maintains and enhances their nursing knowledge, skill and judgement so their practice is both safe and relevant to their client’s health-care needs. The continuing competency program (CCP) is an opportunity for you to reflect on your nursing practice and lead your own learning. Self-reflection improves empathy, listening, critical thinking and decision making skills. It also allows RNs to improve their communication with others and enhance their leadership qualities. Participating in self-reflection and completing a self-development plan demonstrates to the public that you are engaged in life-long learning and committed to enhancing your practice.  

What is Self-Reflection? 

Self-reflection can be defined as “the activity of thinking about your own feelings & behaviors and the reasons that may be behind them”. 

Benefits of Self-Reflection include: 

  • 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.  

The more you self-reflect, the better you know yourself; your strengths, weaknesses, abilities and areas to be developed. Reflective practice enables individuals to review and improve their own practice and has been identified as a method by which we can become effective self-directed learners  

Limitations to reflective practice include: 

  • Not all practitioners may understand the reflective process 
  • Some may feel uncomfortable challenging and evaluating their own practice 
  • Perception that reflective practice is time consuming 
  • May have confusion as to what to reflect upon 

How do we get better at self-reflection/reflective practice? Simply Put - With Practice.  

Through practice, you will develop your own skills and become a better self-reflector.  

Practice Exercise Example: 

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

I was providing care to a client with advanced dementia. The client’s behavior quickly escalated to involve yelling and striking out. A family member arrived to visit right when the client’s behavior had escalated and immediately asked me what I had done to upset the client.  I ignored the family member’s question and did not explain why the behavior was occurring.  

2. How did it make you feel?  

I felt frustrated and a bit angry that the family member would immediately assume that I had done something to upset the client.  

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

The client often had escalation in behavior after participating in unit activities. The family had other events going on which prevented them visiting as regularly as they once had. I did not feel equipped to manage the client’s behavior or the difficult conversation with the family member.  

4. Could you have done anything differently? 

 I could have utilized various strategies to support the client and their family. I could have tried to understand the client’s and the family member’s perspective. I could have accessed another member of the health care team for support and information.  

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

 I will make sure that I support the client and then approach the family to better understand their concerns and fears. 

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

Learning Goal:  

 I will learn three different techniques on handling clients who display challenging behaviors; specifically on how to manage disruptive and aggressive behaviors.  

Learning Activities:   

I will review current literature related to de-escalation techniques for managing dementia client with escalating behaviors. I will read the article “XXX, by on XXX, 2021” and attend a webinar titled “De-escalation Techniques for Dementia Clients, provided by XXXX on XXXX, 2021”. 

Impact to Practice: 

I am now better to identify early warning signs that a client may begin exhibiting aggressive and/or disruptive behavior. My clients have care plans that identify triggers to the behavior and suggested approaches to manage. I understand that family may have different reactions to the stress of seeing an upset loved one.  I check in with family members regularly and provide updates related to the client and care plan and modify as required. I have noticed that since I began using these new techniques, my clients have had less incidents of disruptive and/or aggressive behaviors. I have also had the opportunity to share my learnings with my colleagues during a unit team meeting.  

As registered nurses we reflect on our practice each and every day that we enter our work environment. We often adjust approaches and client’s care plan to optimize the client and family experience. Self-reflection allows us to consider our role and how we can either build on existing knowledge, skill and competency or complete some type of learning activity that supports learning something knew. “To reflect is to grow and thrive in the nursing profession” (Lim & Shi, 2013). 

The Continuing Competency Program team is here to support you during the process. Please contact us at ccp@crnm.mb.ca   

References 

Continuing Competency Workbook https://www.crnm.mb.ca/uploads/ck/files/CCP%20Workbook-may82020.1.pdf 

CRNM (2018) Practice Expectations for RNs. 

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