Reflective Portfolio examining how my practice and professional work contributes to the enhancement of health and well-being

Introduction

Reflection and reflective practice are of great importance in any profession which involves practice-based professional learning, where practitioners are expected to learn from their own experiences as well as, or instead of, formal learning. This makes reflective practice particularly valuable in the healthcare professions (McBrien, 2007). In such settings, it could be argued that reflective practice is, in fact, the most important source of professional development and improvement, allowing the practitioner to look back at past events while consciously examining not only the event itself, but also their thoughts, emotions, actions and responses. The reflective practitioner then uses that information to gain a deeper understanding, and to inform their future practice (Johns, 2013). This essay will critically reflect on my educational and professional journey, in order to develop an action plan for my own professional development.

Pre-Service Education and Training

Reflecting on my own educational journey, I have come to realise that having started from a work-placement was a significant advantage, since I already had an insight into the difference that radiographers can make to the health and well-being of others; this was, in fact, something that had attracted me to the profession in the first place. The career structure and opportunities for progression were also attractive.

It is interesting to note that although my VARK learning style is read/write (Kolb & Kolb, 2005), during my undergraduate course it was in clinical settings that my learning excelled. Learning through practical experience in this way is more consistent with a kinaesthetic learner. However, a read/write style does explain why I found lectures less effective, since these appeal more to visual and auditory learners.

Reflecting on my own learning during this period, it becomes apparent that without being aware of it, I was applying Piaget’s (1977) and Dewey’s (1910) ideas about experiential learning, using experiences to construct new knowledge. To a certain extent, my learning in clinical settings followed Kolb’s learning cycle (Kolb & Fry, 1975): from concrete experiences, either observing radiographers or carrying out procedures myself, I was able to form concepts and generalisations which could then be tested in new situations. However, I did not carry out any formal reflection unless required to do so by the course.

In general, my experience as an undergraduate radiographer was highly positive. Working with experienced mentors helped me to develop a wide range of clinical skills. In addition to the technical skills required to carry out procedures, I was able through observation to develop soft skills such as communication with patients, which are more practical and, in my opinion, cannot be learned from a textbook or in a lecture theatre. From this point of view, learning in a clinical setting enhanced my ability to promote patient health and well-being once in service.

During clinical practice, there were a small number of radiographers who were not willing to embrace the mentoring of undergraduates, and who seemed quite negative towards us. On the occasions when I encountered this attitude, I found it quite upsetting, and in hindsight I believe it had a negative impact on patient care. Subsequently, the use of Gibbs’ reflective cycle has been valuable in processing this experience and realising that some older and more experienced radiographers, who are not graduates, felt threatened by student radiographers. Had I been aware of Gibbs’ cycle at the time, I would almost certainly have been better able to deal with such situations. However, considering this experience using Gibbs’ cycle has enabled me to consider how I would respond were I in a leadership role and became aware of similar situations arising within my team.

Health and Wellbeing

In order to reflect on how my own educational journey and clinical practice impacts on health and well-being, it is useful to consider a working definition of what is meant by this. According to the World Health Organisation (WHO) (2017), health and well-being can be defined as,

“A state of complete physical, mental and social well-being, and not merely the absence of disease of infirmity.” (WHO, 2017, n.p.).

The WHO’s (2017) definition is a positive one which incorporates the physical, mental and social elements of health and well-being. My own professional body, the Society and College of Radiographers (SCoR), also recognises the importance of health and well-being, and the potential that radiographers have to be a positive influence on the health and well-bing of their patients (SCoR, 2017).  In particular, SCoR (2017) argues that radiographers are often well placed to influence the choices made by their patients and users with regard to health and well-being. This is in addition to the direct impact that the work of radiographers has on patient health and well-being in terms of diagnosis, treatment and radiation protection (SCoR, 2017).

My own values and beliefs regarding health and well-being are in agreement with those of the WHO (2017).  I strongly believe that health and well-being should be regarded in a positive manner.  Health and well-being is not simply the absence of distress or disease, but is something which healthcare practitioners must constantly work to improve for their patients.  For the radiographer, this means taking a holistic approach to a patient’s health, rather than simply focussing on the diagnostic information which has been requested by the referring clinician.  This could be something as simple as ensuring that patient positioning is as comfortable as possible for them during a procedure, or reassuring an anxious or distressed patient.

My own view of the role of the radiographer in promoting health and well-being is that it extends beyond the simple carrying out of diagnostic procedures.  For example, the radiation protection role of radiographers is vital in promoting health and well-being for staff and patients alike, as will be discussed in the next section.  Radiographers’ expertise enables them to promote patient well-being through facilitating rapid and efficient diagnosis, helping to ensure that their condition is managed effectively and contributing towards a succesful outcome.

In addition, it is my belief that mental health and well-being is just as important as physical, and that radiographers have an important role to play in promoting a patient’s mental well-being.  In this regard, I believe that patient communication is a vital element in the radiographer’s role in ensuring patient health and well-being by alleviating any anxiety or distress surrounding a procedure.  This is particularly important during lengthy or invasive procedures such as MRI or coronary angiography, where effective communication before, during and after the procedure can be vital in ensuring that the patient’s mental health and well being are not adversely affected.

In addition to the health and well-being of patients, it is also important that radiographers are aware of how their work impacts on their own health and well-being, and how their own health and well-being, and that of other staff, impacts that of their patients. NHS Employers, which is an organisation representing leaders and human resources (HR) workers in the health service, recognises the importance of health and well-being in ensuring that staff are able to provide effective healthcare for their patients (NHS Employers, 2017).  My own employer, Mid-Essex Hospital Services NHS Trust (MEHT) also recognises the importance of health and well-being among staff, and the ways in which this impacts directly on patient safety, patient experience and patient care (Mid-Essex Hospital Services NHS Trust, 2014).

The health and well-being of other staff is not something I had really considered prior to embarking on this course.  However, reflecting in more depth on health and well-being, I have come to realise that if I progress in my career into a supervisory role, I will have a duty of care towards other staff with regard to health and well-being.  I believe that promoting the physical and mental health and well-being of staff is crucial not only for them, but in order to make them more effective in improving patient health and well-being.

As a supervisor I believe that I will have an important role to play in promoting the physical health of my staff, for example by ensuring that manual handling is carried out safely, and that infection control and radiation protection procedures are carried out adequately.  It is my belief that staff mental health and well-being is equally important, and that supervisors have a vital role to play in this regard. 

Practice and Professional Work

Following qualification, my ongoing education and training followed a clinical route; this is due to the fact that during my undergraduate training, I felt that my learning had been optimised during clinical placement. This involved attending study days on cross-sectional imaging as a route into becoming an MRI radiographer.

This period in my career once again demonstrates my preference for experiential learning, since I was able to successfully fill a role as a locum MRI radiographer with no previous experience. In this role, the fact that my learning style is read/write was a significant benefit, since it enabled me to carry out effective self-directed study using textbooks and manuals. This was in addition to experiential learning provided by clinical work, and mentoring from experienced MRI radiographers. In the following years, I took up a range of MRI posts which enabled me to further develop my skills.

My role as a MRI radiographer was highly significant in enhancing patient health and well-being. In addition to providing important diagnostic information, MRI does not involve ionising radiation, meaning that it is preferable to techniques such as CT as long as it can provide the necessary information.  However, I have become increasingly aware that the current shortage of MRI radiographers in my department is detrimental to the health and well-being of both staff and patients.  Staff, due to heavy workload and lack of opportunities for role expansion; patients, due to longer waiting times and potential for delayed diagnosis.  This has created something of a dilemma for me, since I am aware that in seeking to progress my career, I may have to leave my present role; this could, at least in the short-term, be detrimental to the health of patients if the shortage of MRI radiographers is exacerbated.

A key role of the radiographer in enhancing the health and well-being of both patients and other staff is in radiation protection.  The Ionising Radiation (Medical Exposures) Regulations 2000 (IRMER 2000) set out very clear guidelines as to the role of the radiographer in ensuring that neither staff nor patients are exposed to unnecessary ionising radiation (UK Government, 2000).

When considering my role as an MRI radiographer, I initially thought that I had little or no role to play in radiation protection. However, reflecting on my role in more depth, I have come to realise that this is not, in fact, the case, since my skills as an MRI radiographer mean that vital diagnostic information can be obtained without exposing patients to ionising radiation.

One situation in which I have significantly improved patients’ health and wellbeing is in cases where patients are reluctant to enter the MRI scanner, or become distressed during the scan. Although this is rare, it can have a significant effect on a patient’s health and well-being due to the mental distress that results; in addition, it I became aware that such situations frequently resulted in CT being used as an alternative, exposing the patient to potentially harmful radiation.  In my early years as an MRI radiographer, I observed such situations on a number of occasions and it seemed to me that patients were being given CT scans without any real effort having been made to allay their concerns about MRI.  Having reflected on this, I believe that resorting to CT without any attempt to convince the patient to undergo MRI is, in fact, both detrimental to their health and a breach of IRMER 2000.  I also became concerned that clinicians were resorting to easily to the use of medication such as diazepam in such situations, with significant potential for adverse effects to patient health and well-being.

In addition, such situations were occasionally handled insensitively, which was distressing for staff, the patient and their families. One such incident proved pivotal for me. I was assisting a more experienced colleague when a patient became upset and refused to enter the scanner. This was handled insensitively by the radiographer and other staff, particularly the referring clinician, resulting a formal complaint being brought against all staff involved, including myself.  I found this very upsetting as I felt that I had done my best to handle the situation as sensitively as I could. I had also been concerned for a while that staff were too quick to take what I regarded as the easy option and refer patients for CT. My team leader was supportive and suggested that I use Gibbs’ reflective cycle to process the incident.  This was extremely valuable, since the first two stages of the cycle allow the practitioner to process the emotional aspects of a situation, enabling them to then carry out a more objective analysis and create an action plan. The action plan I developed as a result of this incident was to develop effective strategies for communicating with reluctant patients to allay their fears about MRI; this meant that subsequently, I was able to use my patient communication skills to persuade such patients to undergo an MRI scan. This is perhaps the first example in my career of an occasion where reflective practice has had a direct and positive effect on health and well-being, since I have been able to prevent a number of patients from unnecessary radiation exposure from CT scans, simply by being able to persuade them to undergo an MRI. Through processing the negative emotions arising from the incident, reflection had a positive effect on my own mental health and well-being, and this in turn had a benefit on the health and well-being of my patients, since I was able to work through the more analytical stages of Gibbs’ cycle and develop strategies for dealing with such situations in the future. As a result, I have been able to avoid exposing a number of patients to unnecessary ionising radiation; this has also had the effect improving their health and well-being by alleviating mental distress without the need for medication.

Reflecting on my work as an MRI radiographer has enabled me to identify radiation protection as an area in which I need to update my knowledge if I am to optimise my ability to enhance the health and well-being of patients.  In order to progress my career, it is likely that I will need to work with modalities that use ionising radiation, and I am aware that my knowledge may be up to date.  In addition, progressing my career is likely to involve undertaking roles in which I have supervisory responsibilities for radiographers working with ionising radiation.  Furthermore, progressing my career means that I may in future be acting as the practitioner within IRMER 2000, meaning that I am the final ‘gatekeeper’ in ensuring that the health of patients is not damaged by unnecessary radiation exposure (UK Government, 2000).

Post-graduate development

While my work as an MRI radiographer was clearly beneficial to the health and well-being of my patients, my own health and well-being was being adversely affected by a lack of opportunities for further career progression. A lack of opportunities to access professional development and training, and a lack of career progression, have been identified as significant sources of occupational stress among radiographers (Rutter & Lovegrove, 2008), and reflecting on my own recent career, I have come to recognise that this was certainly the case for me.

I also felt frustrated that when I had undertaken training to advance my clinical skills, I had been unable to put this into practice. For example, I attended a course on reporting orbit X-rays and was enthusiastic about putting this training into practice; however, I was unable to do so due to negativity from the radiologist regarding radiographers reporting on X-rays. This is a widespread issue in the NHS due to ongoing opposition from the Royal College of Radiologists (RCR) towards the expansion of the role of radiographers (Royal College of Radiologists, 2010); according to Field and Snaith (2013), such attitudes are a significant source of occupational stress for radiographers who have been trained in a reporting role and are subsequently unable to put this training into practice.

Although I had wanted from the outset to become an MRI radiographer, and am passionate about my role, I have come to recognise that in recent years, opting for this speciality has hindered my career progression. This is due, quite simply, to a shortage of MRI radiographers, which has meant that I have been unable to develop my role due to lack of staff cover to release me for training or other opportunities. For example, following a study day in incident reporting, I applied for a role as an assistant t governance radiographer, but the role never developed due to the lack of staff to cover me in MRI.

Following a single-loop learning cycle, I have been able to identify the gap between where I am currently and where I want to be, and the actions I need to take in order to bridge that gap. In particular, although my clinical knowledge and practical skills are excellent, the use of a single-loop reflective model has enabled me to identify that a lack of leadership skills is the principal gap in my skill set which is preventing me from progressing my career. Use of the single-loop model highlighted that I was not developing these skills from either clinical practice or profession development in the workplace and that this was not likely to change. As a result, I was able to formulate a clear action plan; namely, obtaining a post-graduate qualification with leadership skills.

Initially, I was unable to obtain funding for a postgraduate course due to financial constraints within MEHT, and the fact that other areas in my department were regarded as more important. Despite my passion for the job and my enjoyment of the work on a day-to-day level, the fact that the department has only two full-time MRI radiographers has meant that my career has not advanced, while those of staff in other specialities have. This lack of progression is impacting negatively on my own health and well-being, and is also limiting the extent to which I can enhance the health and well-being of patients, since I am unable to bring my considerable skills and experience to bear in a leadership role. As a result, I am determined and more committed and ready to undertake this new venture in further studying and developing my professional development skills for the next step in my career.

Action Plan

In addition to reflecting on my educational and career journey, I have used strengths, weaknesses, opportunities and threats (SWOT) analysis to inform my action plan for future development. My strengths include communication skills, my experience as an MRI radiographer, self-motivation and the ability to function as a self-regulated learner. The weaknesses I have identified are a lack of confidence in communicating my ideas, a lack of confidence as a speaker, a lack of confidence as a teacher, and a lack of leadership skills.

This course opens significant opportunities to me that were not accessible through clinical practice and workplace professional development. These include the development of academic skills such as research and academic writing; the opening up of opportunities to progress my career to more senior roles; opportunities to use my skills in new ways; a chance to develop leadership and teaching skills; and the time and space in which to change and improve myself. Potential threats that may prevent me from maximising these opportunities include a lack of time; financial constraints; limited opportunities for advancement in my current workplace; the fact that others have a stronger skills base; and changing technology. As a result, I have created the following points for action.

1. Use my excellent patient communication skills as a basis from which to develop my confidence as a speaker and as a teacher.
2. Develop skills in academic research and writing, building on my strengths as a read/write learner, and my ability to carry out effective self-regulated learning.
3. Make maximum use of the opportunities presented on this course to develop leadership, speaking and teaching skills.
4. Use my capacity for self-regulated learning to update my technical knowledge, particularly in modalities other than MRI, and in radiation protection.
5. Use Gibbs’ cycle to reflect on my reluctance to pursue career opportunities outside MEHT; in particular, to identify and process any emotional elements which may be inhibiting me from pursuing career opportunities elsewhere.

The most significant resource which is needed in order to achieve these objectives is time; this could cause difficulties due to the current shortage of MRI radiographers in my department.  If my current employer is unwilling or unable to give me the time that I need in order to work towards these objectives, I may need to consider either reducing my workload by becoming part time, or seeking employment elsewhere in a setting where there are fewer staffing issues.  However, opting for part-time work will impose financial constraints which may be problematic.

Another resource that I will need is access to training and professional development.  Some of the professional development I need can be accessed through SCoR; for example, they provide online self-study training in radiation protection.  However, in order to develop my expertise outside the field of MRI, I will need access to training in other modalities; in particular, I am aware of the need to update my knowledge of recent developments in CT scanning.  Ultrasound is another area where I need training in order to progress my career; I have not worked with this modality for many years and would need to update my knowledge if I am to progress into a supervisory role.

I am confident that implementing this action plan will improve my ability to contribute to the health and well-being of patients, since it will enable me to use my experience to provide leadership to less experienced radiographers, and to teach and mentor student radiographers. In addition, updating my knowledge of fields other than MRI will improve my ability to enhance patient well-being should I undertake a leadership role which involves supervision of other modalities.

Implementation of this action plan will also improve my own health and well-being by directly addressing a major source of stress and frustration, which is my lack of career progression. Improving my own health and well-being will also have a positive effect on the health and well-being of my patients.

References

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Field, L. & Snaith, B., 2013. Developing radiographer roles in the context of advanced and consultant practice. Journal of medical radiation sciences, 60(1), pp. 11-15.

Johns, C., 2013. Becoming a Reflective Practitioner. Chicester: Wiley-Blackwell.

Kolb, A. Y. & Kolb, D. A., 2005. Learning styles and learning spaces: enhancing experiential learning in higher education. Academy of Management Learning and Education, 4(1), pp. 193-212.

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McBrien, B., 2007. Learning from practice—reflections on a critical incident. Accident and Emergency Nursing, 15(3), p. 128–133.

Mid-Essex Hospital Services NHS Trust, 2014. Staff health and well-being policy, Chelmsford: MEHT.

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Royal College of Radiologists, 2010. Medical image interpretation by radiographers: Guidance for radiologists and healthcare providers, London: RCR.

Rutter, D. & Lovegrove, M., 2008. Occupational stress and its predictors in radiographers. Radiography, 14(2), pp. 138-143.

SCoR, 2017. Health improvement. [Online] Available at: http://www.sor.org/practice/hot-topics/health-improvement [Accessed 6th June 2017].

WHO, 2017. Constitution of WHO: principles. [Online] Available at: http://www.who.int/about/mission/en/ [Accessed 6th June 2017].