Sunday, November 2, 2014

Reflective Practice: Enabled by the Nutrition Care Process & IDNT

Anne de Looy mentioned the importance of reflective practice at her FNCE session, the Wimpfheimer-Guggenheim International Lecture:  Global Dietetic Alliances - The European Experience.     Reflective practice is the ability to experience a patient care episode, document what happened, reflect, and then make plans for future learning/actions. Other descriptions of reflective practice include the value of  "describing" the events that occurred as a way to make sense of it and contemplate whether you took the "right" action and perhaps identify future theories about better alternative actions.    

The model described by Kolb is only one of the models that describes the reflective process.  However most of the models include the essential components of documenting what occurred, reflecting and making sense of the events and formulating theories about why the events unfolded as they did, and making plans to take further action, either to repeat to see if the results are similar or to try something different to see if the results are better.  This reflection process is discussed extensively in the research about critical thinking.

This same concept, how we describe and discuss our dietetics care, came up on October 2 during the Nordic NCP and Terminology Network meeting in Oslo, Norway.  We identified one of the benefits of implementing the Nutrition Care Process with the companion standardized language as discussing our dietetics practice in a new way.

At the FNCE  Open Session, Nutrition Care Process Case Studies:  Developing PES Statements and Interventions in Atlanta, where Jennifer Wooley and Debra Geary Hook facilitated the session and attendees used the NCP and terminology to describe the care they would likely provide in specific cases.   I was lucky enough to join a table and  participate in the discussion regarding how to provide care for one of the case studies.

Three of the participants started their descriptions of what they would do with " I would talk with the patient about".  Each of the dietitians described slightly different approaches to the conversation that they thought they might have used with a patient similar to the one described in the case.  It became obvious that each of them was coming from a slightly different perspective.

When I used the NCP terminology and asked them whether their focus was Nutrition Education (providing information) or whether it was Nutrition Counselling (supportive process facilitating behavior change) each of them paused to think.  The discussion then centered around whether we thought he didn't KNOW, leading to butrition education or whether he "KNEW but wasn't doing" which would lead to nutrition counselling as the preferred intervention approach.

After discussion, the table explored the option that perhaps he really "knew" and thus needed counseling to facilitate his implementation of the knowledge.  The conversation then moved to identifying which of the counselling Theoretical Basis/Approaches from the IDNT (e.g. Cognitive Behavioral, Health Belief, Social Learning, or Transtheoretical) the planned conversation with the patient reflected.  Each of the dietitians was asked to describe their underlying assumptions that were reflected in the type of conversation they imagined they would have.  They were also asked to frame their "conversation" by identifying which specific strategy they would be focusing on.

While this was a hypothetical exercise,  it demonstrates the concept of reflective practice where the dietitian reflects on what they (would have) done and why.  If this had been an actual case, the dietitians would have been able to also see what the outcome was and then reflect on whether their approach had been successful or whether another approach might have been better.  The use of the NCP as a framework for the discussion and using the specific terms for the nutrition intervention allowed a completely different level of discussion about what type of care would or should be provided to the patient.

It isn't that dietitians haven't always wanted to practice in the most effective way.  It isn't that dietitians haven't sought out research that can identify ways to improve their practice.  But without a unifying structure (the Nutrition Care Process) and the common language (IDNT) to describe what was occurring during the care being provided, we really didn't have a way to effectively record what occurred during our patient interactions,  to effectively discuss and debate about what could improve our practice, or a truly effective way to apply research to our own practice.

Schön, D. (1983) The Reflective Practitioner, How Professionals Think In Action, Basic Books. ISBN 0-465-06878-2.
Sheilds R.W., D. Aaron, and S. Wall (2001), What is Kolb's model of experiential education, and where does it come from?, Questions and Answers on Adult Education, The Ontario Institute for Studies in Education, University of Toronto. Web-page accessed 29 November 2010

Also special appreciation to the other table facilitators at the FNCE session:  Maree Ferguson,  Tina Papoutsakis, Joyce Buhler,  Sandra Spann,   Patti Landers, Cathy Christie,  Paula Ritter-Gooder,  Camella Rising, and   Gretchen Robinson

And a special thank you to Sissi Stove Lorentzen, Lene Thoresen, and Ylva Orevall for coordinating the Nordic NCP and Terminology Network in Oslo.  

No comments:

Post a Comment