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Wednesday, November 11, 2015

Reflective Practice in Hospice and Palliative Medicine

by Allie Shukraft
As a pediatric palliative care social worker, I am at an interesting point in my career. Currently, I am supervising a student in the final year of her Master’s in Social Work internship while also working on becoming a Licensed Clinical Social Worker. As part of both of these processes, I engage in ongoing supervision, both as a leader and a participant in group and individual sessions. In both roles, I am pushed to view my practice through a learner’s lens. How would I assess this? What is the theoretical basis for that? These questions help me to constantly re-evaluate my knowledge and potentially re-frame my approach to align with new information. Although this helps encourage me to remain as current as possible, it also creates a creates a tenuous feeling to some long-held convictions which can be somewhat unnerving. Opinions I used to hold dear about options that constitute appropriate choices for families have shifted, and with them, so did some of my approaches.
What is Reflective Practice?
With all of this input into what I am doing and why I am doing it, I have a significant amount of time to reflect on my practice. When I talk about reflective practice in hospice and palliative care I imagine that most people in health care will immediately think about patient satisfaction surveys, those tools that have a growing impact on how we are paid, how our work is measured, and how we justify our work with data. However, what I am talking about here is personal reflection on our own work. According to Wikipedia, reflective practice is “the capacity to reflect on action so as to engage in a process of continuous learning”. (Wikipedia, 2015) When we truly reflect on our practice, we turn our gaze on ourselves and engage in critical reflection on what we are doing well and what we need to do better. This involves considering our strengths and weaknesses, being mindful of our professional ethics and values within the context of the industry’s ethics and values, and staying current on the evidence base for cutting edge theoretical and practical approaches. In addition, this process is ongoing, requiring repeated self-assessment and adaptation to what you observe about yourself and absorb from the growing evidence base.
How do we Engage in Reflection?
One of the coolest ways to reflect on your practice is simply to talk about it. Opportunities for this are growing; there are more conferences for hospice and palliative care professionals and listservs, blogs, and #hpm tweets abound. If you take part in the Wednesday night #hpm tweetchat you will be reflecting. One of my favorite ways to do this over the years had to be when Storycorps came to our hospital. Besides getting to interview several families, I got to spend an hour talking to my then program coordinator, an RN I had been working with for the past 3 years, about what working together had been like. We reminisced about our favorite memories and the patients and families who had impacted us. It felt like a mix of honoring their stories and highlighting our own, and gave us a chance to see our successes, both together and alone.
What are the Challenges of Self Reflection?
Of course, one of the challenges to true reflective practice is that involves aligning your practice with an ever-growing evidence base. The number of articles out there in the palliative care world that can apply what to what we do is staggering, both in the popular press and in academic literature. So one of the challenges becomes, how do we keep up? How do we stay current in an ever-changing world? Do we limit our article intake to key changes in the industry? For example there of been shifts in the treatment of certain pediatric diagnoses as technology and surgical techniques have advanced. With trisomy 13 and 18, there was a point where the literature indicated that providing cardiac surgeries for these patients did not show a statistically significant change in either length or quality of life for patients. But the thinking on this is changing and practice recommendations are changing with it.

Join me for the #hpm tweetchat on Wednesday, November 11 where we will be reflecting on our own practices, as well as talking about how to foster reflective practice. Remember, we are talking about how to strengthen our own personal practice or encourage that growth in others, not venting about our workplaces or teams.
Topic 1 (T1): What are the strengths of your #hpm practice?
T2: What are you looking to add to your practice?
T3: How can you cultivate a reflective practice?
T4: How can you encourage others to engage in reflective practice?

Join me @alifrumcally this Wednesday night at 9pm EST to explore self reflection in hospice and palliative medicine.

What: #hpm chat on Twitter 
When: Wednesday, November 11, 2015 – 9 p.m. ET/6 p.m. PT 
Host: Allie Shukraft @alifrumcally

Follow @hpmchat on Twitter for all the latest on #hpm chats. If you are new to Tweetchats, you do not need a Twitter account to follow along. Try using the search function on Twitter.

If you do have a Twitter account, we recommend using, for ease of following. You can access the transcripts and analytics of #hpm chats through @Symplur.

Allie Shukraft, MAT, MSW, LCSWA is a reformed high school English teacher turned pediatric palliative care social worker with Carolinas Healthcare System in Charlotte, NC. She enjoys spending time with her family, trying out new recipes, and exploring the country whenever she can. You can find her on Twitter @Alifrumcally.

Image credit: Image via Wikipedia Creative Commons Attribution 3.0

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