Te Kaunihera wish to thank and acknowledge the Kaitohutohu Ngaio | Professional Advisors, Board members, employers, and the manapou | paramedics who contributed to this mahi | work. Ehara taku toa i te toa takitahi, engari he toa takitini | My strength is not mine alone, it is the strength of many people.

'Reflection enables the opportunity for paramedics to self-assess their strengths and areas for improvement, and identify learning needs'

Ka Mua Ka Muri | Walking backwards into the future

This whākatauki acknowledges the process of looking to the past to inform the future. It is important to understand that we carry our past into our future.

Being able to critically analyse and reflect on thoughts, memories, actions, activities, decisions, and interactions is an important part of being a health practitioner. Self-reflective practice is relevant to, and looked for in, many areas of your practice, such as:

• Your current emotional and psychological wellbeing

• Analysis of patient treatment outcomes

• Review of specialist reports

• Continued professional development (CPD)

• Audit

• Collaborative practice with peers and colleagues

• Processes that your employer may go through

• Common health trends in the community

• Notification and/or complaints processes with both Te Kaunihera Manapou | Paramedic Council (Te Kaunihera) and the Health and Disability Commissioner.

Reflection enables the opportunity for paramedics to self-assess their strengths and areas for improvement, and identify learning needs. It is also important to both actively seek and accept any feedbac you receive from colleagues (including those who work in other disciplines), employers, and patients.

The working environment of a paramedic can be complex and, in some circumstances, errors in clinical practice and professional conduct can occur. Te Kaunihera acknowledges that human error can occur; however, it is important we take these as opportunities to improve our practice. Whether this is a communication misunderstanding or a clinical error, we cannot always stop difficult things from happening, and one-off mistakes or errors of judgment may occur. How you grow from this is key. This is where the importance of reflection is seen.

Reflection is the skill of self-monitoring and a powerful tool for growth and improvement. It allows you to step back from the situation, gain insight and perspective, and consider what happened in an objective way. Taking the time to reflect after something difficult has occurred or where you feel you have made a positive difference is crucial. In addition, it is important to not only reflect on clinical practice but also professional conduct, including cultural competency and safety.

If you can objectively identify the areas within your practice where you can improve, and then seek out courses or training relevant to this, it will enhance your confidence to practice. This type of learning doesn’t always have to take place in a classroom. Reflection can encourage conversations among colleagues and communities that give you different points of view on your actions or decisions. For example, if you aren’t sure how to address the whānau of a patient within a specific community, taking the time to understand and learn this will make your interactions with that community in future more comfortable, and will ultimately lead to better outcomes for your patients.

Being reflective encourages accountability and ownership of your actions, which is particularly important if a notification or complaint is made about your practice. This can be seen in various practitioner cases which have been considered by the Health Practitioners Disciplinary Tribunal (HPDT) and the Health and Disability Commissioner (HDC). For example, a recent HPDT finding for a doctor, where the Tribunal noted “despite the many occasions on which his correspondence with the authorities over the years should have given him cause to reflect, and stop what he was doing, he stubbornly refused to accept any suggestion that he might be acting improperly”.

Reflecting plays a key part in ensuring that the same mistakes do not repeat in the future. It helps to make sure that you don’t end up in the same situation, facing the same difficulties time and time again.

Reflection is not only important when something does not go as expected. It can also be a powerful tool and driving force for making a positive change, both for your own individual practice and within the communities of which you are a part. If during your reflections you identify where something positive has happened, such as connecting and engaging well with a patient and their whānau with whom you have previously not been able to connect, this can be used and implemented in an organisational model or process to reduce health disparities or inequities in a wider context.

There are many different models for reflection, some of which are included in the resource list below. However, reflection can be as simple as asking and answering these pātai | questions:

• How did I end up here?

• Why do others view that something has gone well or gone wrong?

• What would or could I do differently if I was in the same situation again?

• What did I learn?

• How has this changed or improved my practice?

By recording your answers to these pātai | questions, you can refer to them in future. This does not have to be a written document; it could be a video or voice recording. Recording your reflection allows you to enhance your understanding and memory retention and be accountable for your own growth and development.

If Te Kaunihera receives a notification or complaint, we specifically look to see how the paramedic involved has reflected on their practice. An important part of any notification or complaint process is applying a self-reflective lens, considering, and in some cases accepting, accountability as well as outlining steps to reduce the risk of harm to patients in future.

Ultimately, embracing reflective practice helps to grow a mindset of continuous learning and improvement.

'The longer you can look back, the farther you can look forward'- Winston Churchill

Useful resources: • Video – Reflective Practice Explained – Australian Paramedical College – https://www.apcollege.edu.au/blog/reflective-practice/

• Reflective Practice Toolkit – University of Cambridge - https://libguides.cam.ac.uk/reflectivepracticetoolkit/models

• Gibbs’ Reflective Cycle – Mind Tools – https://www.mindtools.com/ano9qiu/gibbs-reflective-cycle

• Taking the pain out of reflective practice – Australasian College of Paramedicine (free for members) – https://paramedics.org/recordings/reflective-practice