Reflective writing is evidence of reflective thinking: looking back at an event after it has happened and analysing it
Registration with the Care Quality Commission (CQC) can seem a daunting but inevitable prospect, especically if you are working alone without a team for support. The focus of this article will help those working within teams and as sole practitioners to prepare for CQC registration and, most importantly, their rating inspection. Self-reflection in all areas of clinical practice and experience is now part of normal life for nurses working in most areas of healthcare, particularly since the introduction of the Nursing and Midwifery Council (NMC) revalidation in 2016. Reflection underpins much of the process of revalidation that all nurses and midwives in England need to follow to maintain their registration with the NMC (NMC, 2016). It is used by health professionals to consider their experiences and to review their clinical practice. It supports practitioners in improving the way that they work and the quality of care that they provide to their patients (Taylor, 2010). This article will explore how reflection can support the aesthetic nurse when providing evidence of sound governance to the CQC.
The journey to Care Quality Commission registration
When a practitioner is embarking on the journey of CQC registration or preparing for a rating inspection, they will be required to present evidence to assure the inspector of the firm governance that underpins their service. This evidence includes areas such as incident reporting and team learning. As a CQC consultant and CQC specialist advisor, this is an area that often causes procrastination, specifically for those working in a solitary role. The healthcare regulator does not view being a lone practitioner negatively; however, there are some areas where a diverse approach is required to offer assurance of scrutiny. The world of aesthetic medicine has caused the CQC to review their understanding of aesthetic clinic healthcare environments. The diversity of services available to patients accessing this area of healthcare range from large clinics to sole practitioners working from home environments. Inspire to Outstand has worked with an extensive range of clinics varying from large city centre services consisting of large medical teams to sole nurses, doctors and dentists registering clinics based inside their own homes, all of which have successfully registered with the CQC.
The components of the service being inspected are broad and align to the CQC key lines of enquiry (CQC, 2018). One of the areas that is scrutinised is how the registered manager will assure learning from events or incidents and how they will use this learning to improve the service they provide. In the authors' experience, those venturing on the CQC journey are usually clinicians who recognise the benefit of registration, as it can offer additional assurance to their patients through a structured business model of governance and safety. They often have a large portfolio of learning related to aesthetic procedures and complication management, but do not always recognise that they can also demonstrate reflective learning in other areas of their service to support their application.
The process of reflection
The process of reflection is used widely in nursing and midwifery education but often appears to lose momentum once a practitioner ventures into private practice, which is a lost opportunity. In regard to evidence for CQC registration and environment inspection, the use of reflection related to incidents within practice, patient feedback, medical complications and risk is deemed an opportunity for learning. Many practitioners focus on reflection when something goes wrong, because these experiences remain with the practitioner and can often cause self-doubt and questioning oneself on what could have been done differently. However, there is a wealth of opportunity in reflecting on the positive aspects of the business, and this can be used as evidence for offering a safe and caring service. Not only can this be a rewarding experience, but it can also help to build confidence in the practitioner who is providing healthcare and also running a business (Koshy et al, 2017).
» Using a model of reflection can offer the practitioner a template that helps to guide both the thought process and documentation, and the one model often favoured by nurses and midwives is the Gibbs model of reflection «
Models of reflection can offer a structured process, but, for some practitioners, reflection does not always come easy (Bulman and Schutz, 2008). However, using a model of reflection can offer the practitioner a template that helps to guide both the thought process and documentation, and the one model often favoured by nurses and midwives is the Gibbs model of reflection (Gibbs, 1988). This model encourages the learner to work through a process of stages to arrive at an action plan. When this model is applied to an area of learning, such as vascular occlusion, it could include:
- Describing: the treatment and the recognition that an occlusion had occurred, some practitioners might call for a second opinion and not feel equipped to recognise or diagnose a vascular occlusion immediately, specifically those new to medical aesthetics
- Feelings: how did this event make you feel as the clinician? Specifically, as a sole practitioner without readily available peer support, being honest during this point in the reflection can help the practitioner to recognise similar situations in the future and be prepared
- Evaluation: what went well or what good have gone better? For example, did you have everything available to deal with the situation? Could you access a standard operating procedure or some professional support? Having a peer support group is viewed positively by inspectors as benchmarking practice, and sharing learning has been long deemed positive for both nurses and doctors. All of these areas will be reviewed by the inspector and they will require assurance of daily emergency drug checks, evidence of standard operating procedures and an organised clinical environment
- Analysis: what sense can be made of the situation? Use this section to expand your learning and demonstrate how you have increased your knowledge by examining the evidence and research or learning from peers
- Conclusion: write a short section to conclude your reflection to comprehend what happened from start to finish
- Action plan: what now needs to be implemented to help you to move forward? For example, further training, changes to the equipment available in the clinic, sharing the learning with peers or even simple things like having emergency numbers readily available. One of the key points that should be noted is that the incident should be added to the clinic′s risk register.
Conclusion
A critical review of any experience can help aesthetic practitioners to understand the process of events and help to develop transferable skills (Rolfe et al, 2001). Reflective writing is evidence of reflective thinking: looking back at an event after it has happened and analysing it to make changes or increase learning. Part of the CQC application for registration and the following inspection visits will involve an interview with the registered manager. This interview will be based upon the key lines of enquiry (CQC, 2017), and using reflection during this interview will help to evidence compliance and increase confidence that the practitioner recognises the importance of sound governance. Embarking on the journey of CQC registration can be a lonely road when working as a sole practitioner, and many may choose to appoint a consultant to support with the process, assist with the application form and be a sounding board throughout the process.