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Working with Alice: a reflection.

Abstract

Reflective practice has become established within educational programmes and in clinical supervision. Yet what does it mean to be a reflective practitioner? This paper seeks to give some meaning to this concept by drawing on a story I wrote in my reflective journal one evening. My reflection on this event draws out key issues of practice and reflection that enable me to gain insight and apply to future practice within a reflexive learning spiral.

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BibTeXRIS

C Johns. 2000. Working with Alice: a reflection.. https://doi.org/10.1054/ctnm.2000.0500

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Improving compliance with requirements on junior doctors' hours.

PROBLEM: Compliance with UK regulations on junior doctors' working hours cannot be achieved by manipulating rotas that maintain existing tiers of cover and work practices. More radical solutions are needed. DESIGN: Audit of change. SETTING: Paediatric night rota in large children's hospital. KEY MEASURES FOR IMPROVEMENT: Compliance with regulations on working hours assessed by diary cards; workload assessed by staff attendance on wards; patient safety assessed through critical incident reports. STRATEGIES FOR CHANGE: Development of new staff roles, followed by change from a partial shift rota comprising 11 doctors and one senior nurse, to a full shift night team comprising three middle grade doctors and two senior nurses. EFFECTS OF CHANGE: Compliance with regulations on working hours increased from 33% to 77%. Workload changed little and was well within the capacity of the new night team. The effect on patient care and on medical staff requires further evaluation. LESSONS LEARNT: Reduction of junior doctors' working hours requires changes to roles, processes, and practices throughout the organisation.

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