The Occupational Therapist - Essay Example

Reflective Analysis: Optimizing the Learning of the Occupational Therapist Through Insight and Higher Self-awareness The Value of Reflective Learningand Analysis Boyd and Fales (in Getliffe, 1996, p. 362) gives the following definition of reflection: … the process of internally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self and which results in a changed conceptual perspective. As a process, reflection is integrated in numerous conceptual frameworks (Hutchinson & Allen, 1997; Kember et al., 1999; Riley-Doucet & Wilson, 1997). I have chosen to use the three-stage model of reflection proposed by Scanlon and Chernomas’s (1997) three-stage model. The reason for choosing it lies in the fact that it is a relatively simple framework and can be easily explained and utilised. This model purports that the first phase of reflection is awareness. This may be triggered by either disturbing or positive thoughts or feelings about a situation or event – which in this case is the critical incident. During the second phase of reflection, the person undertakes a critical analysis of what transpired. He draws upon his significant knowledge and experiences, and on the application of novel knowledge. Such realizations, in the form of new knowledge, are the expected output of the analysis. This entails critical thinking and self-assessment – this comes with increasing awareness about the self (Scanlon & Chernomas, 1997). The last stage is the development of a novel approach in accordance with one’s critical analysis and the implementation of novel knowledge onto the context or situation for which one has undergone the reflection. The new approach that one intends to adopt may be characterized by cognitive, attitudinal and behavioural modifications. A logical expectation would be adaptive when one considers that the person increases in his effectiveness both as a person and as a team member. Apparently, learning has transpired. In effect, this perspective of reflective learning suits a handful of theoretical models. These include that of Schon (1987) which advocates the reflective practitioner and “knowing-in-action” framework. The Importance of Reflective Learning Journals Reflective learning journals are significant tools in translating theory into viable action, that is, praxis. Reflective learning journals have been utilized for quite some time now, specifically in the nursing and teacher education disciplines, to improve individual learning effectiveness, encompassing critical and creative thinking (Kobert, 1995; McCrindle & Christensen, 1995; Meyers & Jones, 1993). In an early application, Hahnemann (1986) had nursing undergraduates spend 10-15 minutes in class time doing their journal entries over the semester. She reported that: … journal writing has been a valuable tool that encourages clearer thinking and better learning (Hahneman, 1986, p. 215). Recently, Lyons (1999, p. 33) described how journal writing promoted the development of reflective skills among healthcare students. She concluded: … that developing reflective skills made students more confident in their learning, fostered responsibility and accountability and assisted in integration of theory and practice. Client History in Relation to the Critical Incident I would like to relate a specific critical incident to demonstrate the process of reflective analysis. To maintain confidentiality, the identities of the parties involved were withheld. Before relating the critical incident, it may be worthy to note the client’s history in relation to the critical issue. Female client in her fifties, lived by herself in a flat, and apart from weekly contact with her grown up children, she seemed to be socially isolated. She has a 34-year history of heavy drinking and called ambulance suffering from chest pains on the 16.7.05. The Clinical nurse specialist for the Emergency Department then referred her onto the community alcohol team where they had OT intervention by Jane H. for 10 weeks. Prior to my visit, the client had a ‘slip’ four days after three weeks of abstinence. The Critical Incident When on my first unaccompanied home visit, a client stated that they did not want to reward themselves for a period of abstinence… as they did not see their drinking problem as an illness, but as something self inflicted. The Awareness and Analysis Phases While Scanlon & Chernomas’ (1997) reflective analysis model seem to present the awareness and analysis phases as distinct, they are strongly linked, as one comes immediately after the other. Given this, I shall present my reactions to the critical incident, followed by a reflective analysis of these reactions. On the feelings and emotions level, when the client stated her view of how she thought that her drinking was something self-inflicted, I was shocked at how negative clients thought of themselves and others with drink problems. At the time I was shocked and really not prepared for such a statement. I also thought at the time that it was an oversight on my part and a result of not preparing properly. I was also thinking what would Jane do in this situation. I then proceeded to questioning myself at the time, coming up with the following self-reflection questions: Is there a right or wrong answer? Is this a no-win situation?What reaction will I get by disagreeing with the client? Could a client stay abstinent with such low self worth? Will I say the wrong thing and client drinks after I leave? Do all clients feel this way? I explained at the time that she did not choose to have an alcohol problem, and although A.A. defines it as an ‘illness’, it could be seen as something she had been using it to cope with life for 30 years, therefore a learned behaviour, and that she had done really well to break this behaviour and abstain for the previous three weeks. I then proceeded reflecting on the external factors that may have influenced the way that Jane reacted to her circumstance. One factor could be my experience on other home visits with Jane, the views expressed by other members of the MDT. Another would be the possible reaction of my client, and their low mood. Moreover, the client might not be prepared to accept that it was not all self inflicted. Finally, previous home visits and knowledge of the client could have significantly affected the client’s perspective on her situation. Theories and Prior Knowledge that Guided My Actions Clinical reasoning and the occupational therapist’s competencies. When this incident happened, my first reaction dealt with the importance of having the necessary competencies expected of an occupational therapist. Such competencies go beyond just clinical exposure. I agree that a competency sums up to more than a set of skills; it is a mix of aptitudes, attitudes and personal traits possessed by effective managers (Weightman, 1995). A competency is a relatively deep and lasting part of an individual’s personality and can predict behavior in a broad array of situations and job tasks. That it has a causal relationship indicates that a competency causes or predicts behavior and performance. Moreover, being criterion-referenced indicates that the competency is a predictor of doing a task effectively or poorly, as evaluated by a particular reference or standard. Why are competencies important in this particular incident? Somehow, the critical incident demonstrates that the occupational therapist needs to be equipped with skills that will allow a holistic evaluation of the patient. Again, this suggests more than clinical experience, but understanding a whole host of factors that may contribute to the patient’s condition, including his emotions and psychological well-being, in general. Given that this and similar critical incidents happen that may be attributed to the lack of soft skills, it may be worthwhile to draft a competency profile of the effective occupational therapist. This profile will specify all of the competencies that he ought to have considering her level and her role. Such a profiling exercise would prove beneficial because he may immediately be informed of both her strengths and weaknesses as a professional. Prescribing these competency requirements would also help in selecting competent health professionals in the future, effectively plan their careers, and constantly ensure external competitiveness and internal equity of their pay packages (Development Dimensions International, 2005). The National Institute for Clinical Excellence (NICE) defines clinical effectiveness as the “provision of high quality treatments or services in a way that allows the recipients to achieve the maximum health gain. This encompasses the provision of interventions/services that are acknowledged as effective (evidence-based practice), and according those services within a system that permits the recipient the most optimal benefit. This will cover environmental, time courtesy, safety (risk management) (The Chartered Society of Physiotherapy, 2005). Moreover, clinical effectiveness must also include offering care based on high-quality evidence-based clinical principles. In addition, this encompasses an assessment of practice or service through the utilisation of clinical audit or outcome metrics, for quality enhancement. Based on these standards, I and other practitioners ought to do “the right thing (evidence-based practice), in the right way (skills and competence), at the right time (providing treatment/services when the patients need them), in the right place (location of treatment/services), and with the right result (clinical effectiveness/maximising health gain). I should be able to give the patient the full package of the patient experience, and contextualise this based on the ‘best available evidence’ (The Chartered Society of Physiotherapy, 2005). It is imperative that health professionals’ people skills be given adequate attention. An effective health professional is someone who is a master at managing through ambiguity; inspires confidence and belief in the future; have a passion for results; are marked by unwavering integrity; set others up for success; have strong rather than big egos; and have the courage to make big decisions. Soft skills are as equally if not more important than technical skills, in the development of potential. These competencies must also be integrated into my success competency profile and adequately addressed through formal classroom or on-the-job training. Critical thinking. Critical thinking is a cognitive process of dexterously undertaking analysis, synthesis, and evaluation of data gathered from observation, experience, reflection, or communication as a guide to belief or action (Paul, 1993). Several researchers have presented critical thinking as a reflective, reasoned thinking process (Ennis, 1985; Halpern, 1989). It is utilised to allow clinical judgments to act based on the information analysed or processed (Ennis, 1985; Halpern, 1989).Clinical reasoning is a cognitive process of progressing from what one already knows to more knowledge (Anderson, 1990). Reasoning is used to make a clinical judgment. Reasoning entails a capacity to remember facts, organise them in a meaningful whole, and then apply the information in a clinical patient care situation. Individuals can make use of reasoning to help in formulating principles or guidelines as a basis for their practice judgment decisions. This demonstrates that occupational therapists ought to have critical thinking skills to enable them to make sound judgment in a wide array of clinical situations. Moreover, care should be taken so that no conclusions are made unless all protocol have been carried out; this helps in avoiding the errors that occurred during the critical incident. Other factors which may have influenced the client’s perspective was the need for the client to rationally realize and understand his situation. That is, he should be able to comprehend all the factors that may have caused his condition, and systematically address each one of them. The fact that she has been able to abstain from alcohol intake indicates some sense of control over the situation, which he could leverage on to totally ‘cure’ herself of alchohol abuse. It was also helpful to have referred to the various literature on acohol misuse; this has siginificantly helped me come up with a better evaluation of the client’s circumstance. Finally, I had to reconsider my commitment to occupational therapy values that advocates client-centered care; that is, the well-being of my client comes before anything else. My Evaluation of the Experience It was a valuable learning experience and reinforced the fact that all clients have complex feelings, and views on themselves. I feel I could have planned my interview better; however there are situations that you cannot plan for and I have to take into account my own level of experience, and reflecting back on the situation if a similar situation comes up again I would handle it differently, with adequare preparation. I chose this incident to reflect upon because I thought it important to show that before this incident I had never considered the client’s feelings or view towards themselves and others with drink problems. Also reflecting back on the situation, the client’s low mood and guilt over recent ‘slip’ may have caused them to feel particularly harsh towards their drinking behaviour. This is why on reflection I felt in this particular situation it was important to raise the clients, mood and self esteem by reinforcing their previous positive behaviour. Also at the time my feelings of that I could say something to the client that could lead them to lapse. After talking this experience through with Jane. We discussed the multitude of influences that could influence a client to lapse, that were totally out of my control So although I cannot take the credit for the client for abstaining for alchohol intake, I could not be the one cause for the client to lapse; ultimately the client makes the decision for himself. Conclusions This critical incident has been a significant learning experience which has allowed me to reflect upon an unfamiliar situation. Overall I have found it very rewarding reflecting on this incident, I have been able to identify a difficult situation that can now be turned into unique learning experience. Moreover, this experience has given me confidence about which actions I could take in the future should a similar situation arise. I also feel that at the time my actions were valid and appropriate, and I was aware of my professional limitations in relation to my experience. Using Scanlon and Chernomas’ (1997) reflective cycle has helped me make more sense of the situation and put things into perspective, recognising how I can put this learning experience to more sensible use in my future practice. Action Plans For Myself As concrete outcomes of reflecting on this critical incident, I intend to discuss my experiences and feelings with my practice educator and members of the MDT. This exercise on sharing and exchange of ideas may lead to more profound insights about the incident. Moreover, I also plan to keep a reflective diary to make the reflective exercise an integral part of my learning; I would be able to reflect on critical incidents on a more regular basis, improving my critical thinking skills and holistic view about client experiences. I like the idea of a learning journal because I am able to document my thoughts in black and white, which is what I know I need. I do agree that learning journals are a powerful tool in helping students become more effective learners through reflective thinking and analysis of their learning experiences. Perhaps, this action plan may be difficult to undertake at first because I would feel I am being forced to write. However, I know that as time passes by and I see the benefits of reflection, the change in attutude would come with it. Keeping a reflective journal would help me become a more effective learner through critical reflective thinking about my learning experience. Some Recommendations on Keeping Reflective Learning Journals for OT Students The use of reflective learning journals may serve as an effective tool to stimulate critical reflection about both one’s own learning and group processes, as well as stimulating participants to take particular actions to enhance their own learning and team effectiveness, especially for those who aspire for future managerial careers. The following recommendations are offered in the use of reflective learning journals for OT students: Give participants clear and particular journaling objectives. The following questions may be a good starting point: (1) What was the learning situation/event? (2) What have I learned and how did I learn it? (3) How do I feel (good and bad feelings) about what I learned? (4) How could I have learned more effectively/efficiently? (5) What action(s) can I take to learn more effectively/efficiently in the future? (6) In what ways do I need to change my attitudes, expectations, values and the like to feel better about learning situations? I also feel that there ought to be emphasis that these are reflective learning journals, not merely diaries or logs. Moreover, it must also be ensured that these journals are regarded as confidential personal documents. The journaling exercise may be facilitated journaling by periodically reminding participants to do their journaling and reinforcing the benefits of journaling to us. I also think that monitoring our journaling and providing opportunities for participants to ask questions, obtain advice, and receive feedback on their journal entries. “Coached reflection” would be a precise description of this more guided approach to journaling. Provide personalized and detailed feedback for each completed journal, so participants receive constructive and critical feedback on their journaling as well as encouragement to carry through with specific actions to improve their personal and group performance. Those who mentor on the reflective journal should have first hand experience in journaling; first-hand experience is essential to appreciate truly the usefulness and pitfalls of journaling. OT students using journaling must bear the following points in mind. Learning is an active, not a passive process. Participants in journaling need to be active learners who manage their own learning experiences, partly through reflective learning journals, and who set goals and take specific actions to improve their own learning effectiveness and performance in teams. Such an approach leads to empowerment of the individual, and eventually may empowers their respective teams to attain its goals successfully. Reflective Journaling can be an important tool to help participants identify training and development needs and then concentrate on specific skills and knowledge that need to be developed for their future effectiveness. I also have high hopes that this experience is a step closer to mastery of addressing client’s problems on alcohol misuse, and that I would be able to handle similar problems in future more skillfully. Specifically, I feel I am better equipped in addressing client’s issues on low mood and self-esteem. Recommending a Competency Profile for the Occupational Therapist One other idea which I have yielded from the experience is drafting a competency profile for the ideal occupational therapist. This may be drafted by level; say for instance, what are the skills expected from a third year OT student vis-à-vis from a student belonging to another, more advanced level or year? The following literature underscores the importance of competency profiling and development: Contemporary interest in competencies has been brought about by the acknowledgement that the acquisition of knowledge does not of itself necessarily lead to an enhancement in performance by learners. Individuals may have knowledge, but be unable or unwilling to make practical use of novel information. Nor does training in the practical skills that make use of this newly acquired knowledge ensure an improvement in performance. Also required are appropriate attitudes (of which motivation is usually the most important), and the provision of adequate support services and equipment. The term “competencies” has mainly come about in pursuit of more advanced performance levels. To date, a substantial portion on the work on competencies has been related with management development, specifically on coming up with acceptable defnitions of effective management. The most thorough investigation has been undertaken by Boyatzis (1982) and engaged 2,000 US managers. This inevstigation attempted to address the characteristics that distinguish superior performance. This and other studies suggest that competency is more than a set of skills; it is a mix of aptitudes, attitudes and personal attributes possessed by effective managers (Weightman, 1995). Further work has been carried out in the UK by major employers and by management training institutions such as the Management Charter Initiative (MCI,1990). Adopting an occupational psychology perspective, Woodruffe (1992) defines competency as a “dimension of overt manifest behaviour that allows a person to perform competently”. This emphasis on behaviour is attractive to practising managers and professionals. Given the lack of a generally accepted definition of competencies and procedures for identifying them (Strebler & Robinson., 1997), the authors of this study have opted to focus on the skills, knowledge, experience, attributes and behaviours that a sample of practising healthcare professionals perceive that they need in order to practice EBH. The terms skills is widely used by Sackett and other leading writers on EBM. For instance, in notes prepared with a workshop on EBM at Oxford in 1996, Sackett referred to question-posing skills, evidence-searching skills, critical appraisal skills, communication skills, teaching skills and self/group evaluation skills. It is imperative that a competency profile for occupational therapists be drafted to have clearer directions on learning and development. For Others The reflective exercise proves useful also for the other members of the MDT and future students who may encounter similar siutations. Hopefully, the addition of this scenario to the OT Student ‘Tricky’ Scenarios Tutorial may be possible. For example “what to do if a client states that there own drinking is self inflicted” a possible answer could be given as follows (on the basis of my reflective analysis). The student may explain to the client that even though they are pouring the drink themselves, they should not ignore the fact that they are/or have been physically/mentally dependent on alcohol, which is something they did not choose to be. Thus, they are resolute on uplifting the client’s immediate alcohol abuse condition, and more importantly enhance their self-esteem. References Anderson, J.R. (1990). 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