This reflection was written on an Acute Mental Health Placement.
2008
Today I rounded up every one I could to join a positively me group (psycho-education) on ward 35. From 34 I brought up 3 clients and while waiting for the clients from 35 one of the 34 clients became agitated, he is 21, and has only been admitted to the ward in the last few days for psychosis. He appeared to begin to hallucinate and was getting angry that the group had to wait for more clients before it could start. He began to yell at the senior therapist telling her that she was useless. She very calmly tried to verbally calm the man but he remained tense and angry, the therapist and I eventually managed to convince the man that it was a good idea for him to return to 34 so he could relax. As the wards are separated by lock doors with a stairway in between I had to walk the man down, I was comfortable with this and reported the incident to his nurse. On my return to the group one of the clients, a women in her 30’s with anxiety issues and paranoia was in tears she stated that she though it was her fault that he had become upset, the second women in the group who had some cognitive difficulties also thought the outburst was her fault, it took some time to explain to the women that in fact he was just very unwell and it had nothing to do with them. Later on the therapist apologised to me for asking me to walk the man to his ward as this could have put me in a dangerous situation, this was something she stated she would later reflect upon as she felt she had put me in an un-safe situation. To me this demonstrated a lack of awareness in my self as I had not thought it was an unsafe situation, I had an alarm on and the man had appeared to react well to my suggesting he return to his ward. By this stage in my training I have acknowledged the effects of mental illness and there for while I was surprised by the outburst I understood that it was not provoked by any one person’s actions but a general un-wellness and uncomfortable situation. This experience has taught me that one persons actions can really upset another person in a setting such as a mental health group where people are often in a vulnerable state of mind, also I need to think more objectively when it comes to my own physical safety in a situation such as this, having never spent a lot of time in unsafe areas I have noticed a tendency in myself to put a lot of trust in people, and while in many situations I see this as a virtue, in situations such as this it has potential to be very dangerous.
GOAL: When gathering people for groups, think objectively about what sort of group it is (psycho-education, art, etc) and who is suitable for that group as well as where the group is being held and what staff are available to help when needed.
Julia Coleman
Sunday, September 14, 2008
Reflection: 2006 IDS
This reflection was written while on a field work placement in an Intellectual Disability Services (IDS) facility.
2006
Today we took a group of clients to the physiotherapy pool, it’s great how you can see them relax both physically and mentally, they obviously really enjoy it. When it came to dressing the clients afterward I was helping one client in particular, he is 42 and has developmental delay but appears physically fine. For my first time ever dressing an other person I was surprisingly at ease, however obviously not known the client well, I was unaware of his level of tolerance and in an attempt to use backward chaining I put is shoe half on and was asking him to push the other half on. He quickly became visibly agitated but was still trying so I continued to encourage him. He then grabbed me by the arm and began to hit him self in the head with my hand. I was mortified and had no idea what to do. I tried my best to pull away. My supervising therapist quickly stepped in and swung me out of the way and managed to verbally calm the man. Later during an informal supervision she explained that having been in an institution most of his life he was use to having every thing done for him and having just been for a swim was probably exhausted, this was most likely what lead to the out break. I learnt 3 major lessons from this ordeal; to always be watching and reading a client for cues as to any changes in mood or irritation, not to take these incidents personally. Initially after the incident I felt horribly guilty for upsetting the client and thought I must have done some thing to upset him, and in turn was unable to build rapport with clients and would make a horrible therapist. In fact I had simply asked too much of him. And thirdly always find out as much relevant information about a client and their condition before working with them. Next time I would read his cues when they appeared and helped him more in achieving the activity.
GOAL: In week 3 I will work with this client during the dressing portion of the swimming group, and by reading his cues he will remain relaxed through out the task, this will result in no violent or aggressive behaviour.
Julia Coleman
2006
Today we took a group of clients to the physiotherapy pool, it’s great how you can see them relax both physically and mentally, they obviously really enjoy it. When it came to dressing the clients afterward I was helping one client in particular, he is 42 and has developmental delay but appears physically fine. For my first time ever dressing an other person I was surprisingly at ease, however obviously not known the client well, I was unaware of his level of tolerance and in an attempt to use backward chaining I put is shoe half on and was asking him to push the other half on. He quickly became visibly agitated but was still trying so I continued to encourage him. He then grabbed me by the arm and began to hit him self in the head with my hand. I was mortified and had no idea what to do. I tried my best to pull away. My supervising therapist quickly stepped in and swung me out of the way and managed to verbally calm the man. Later during an informal supervision she explained that having been in an institution most of his life he was use to having every thing done for him and having just been for a swim was probably exhausted, this was most likely what lead to the out break. I learnt 3 major lessons from this ordeal; to always be watching and reading a client for cues as to any changes in mood or irritation, not to take these incidents personally. Initially after the incident I felt horribly guilty for upsetting the client and thought I must have done some thing to upset him, and in turn was unable to build rapport with clients and would make a horrible therapist. In fact I had simply asked too much of him. And thirdly always find out as much relevant information about a client and their condition before working with them. Next time I would read his cues when they appeared and helped him more in achieving the activity.
GOAL: In week 3 I will work with this client during the dressing portion of the swimming group, and by reading his cues he will remain relaxed through out the task, this will result in no violent or aggressive behaviour.
Julia Coleman
Thursday, August 28, 2008
Helpful questions to ask when reflecting
Helpful questions to ask when reflecting:
· What was your role in the situation ?
· Did you feel comfortable or uncomfortable and why ?
· How did the other people involved in the situation act ?
· How did you interact with them ?
· Did you feel that you and the others involved acted in appropriately in that situation ?
· How could you have improved the situation for yourself, the patient or others involved ?
· Is there anything that you would have done differently next time in a similar situation and why?
· Do you feel, you have learnt anything about yourself from this situation ?
· What can you learn from this situation for the future ?
· Has this situation changed the way you think in any way ?
· Has this situation changed the way you will act in similar situations in the future ?
· What knowledge from theory and research can you apply to this situation ?
· What broader issues e.g ethical ,political or social arise from this situation?
· What do you think about these broader issues ?
(Johns 2000)
· What was your role in the situation ?
· Did you feel comfortable or uncomfortable and why ?
· How did the other people involved in the situation act ?
· How did you interact with them ?
· Did you feel that you and the others involved acted in appropriately in that situation ?
· How could you have improved the situation for yourself, the patient or others involved ?
· Is there anything that you would have done differently next time in a similar situation and why?
· Do you feel, you have learnt anything about yourself from this situation ?
· What can you learn from this situation for the future ?
· Has this situation changed the way you think in any way ?
· Has this situation changed the way you will act in similar situations in the future ?
· What knowledge from theory and research can you apply to this situation ?
· What broader issues e.g ethical ,political or social arise from this situation?
· What do you think about these broader issues ?
(Johns 2000)
Definitions of reflection
Reflection has been defined as:
“ The higher order intellectual and affective activities in which physiotherapists engage to critically analyse and evaluate their experiences in order to lead to new understandings and appreciation of the way they think and operate in the clinical setting”. (Donaghy and Morss 2000).
“Reflective learning is 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” ( Boyd and Fales 1983, p 100).
“ a window through which the practitioner can view and focus self within the context of his/her own lived experience in ways that enable him/her to confront, understand and work towards resolving the contradictions within his/her practice between what is desirable and actual practice” (Johns 2000 p.34).
“Reflection – in- action which he states as critical practice on the spot thinking serves to reshape what we are doing while we are doing it” (Schon 1987).
And reflection – on – action ‘post hoc’ “ making sense of the action after the event “.
“Reflection is a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice” (Reid, 1993 p.305).
“Reflective practice is something more than thoughtful practice. It is that form of practice that seeks to problematise many situations of professional performance so that they can become potential learning situations and so the practitioners can continue to learn, grow and develop in and through practice” (Jarvis, 1992 p.180).
“ The higher order intellectual and affective activities in which physiotherapists engage to critically analyse and evaluate their experiences in order to lead to new understandings and appreciation of the way they think and operate in the clinical setting”. (Donaghy and Morss 2000).
“Reflective learning is 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” ( Boyd and Fales 1983, p 100).
“ a window through which the practitioner can view and focus self within the context of his/her own lived experience in ways that enable him/her to confront, understand and work towards resolving the contradictions within his/her practice between what is desirable and actual practice” (Johns 2000 p.34).
“Reflection – in- action which he states as critical practice on the spot thinking serves to reshape what we are doing while we are doing it” (Schon 1987).
And reflection – on – action ‘post hoc’ “ making sense of the action after the event “.
“Reflection is a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice” (Reid, 1993 p.305).
“Reflective practice is something more than thoughtful practice. It is that form of practice that seeks to problematise many situations of professional performance so that they can become potential learning situations and so the practitioners can continue to learn, grow and develop in and through practice” (Jarvis, 1992 p.180).
Why and when to reflect
Why we reflect
We reflect in order to engage in personal and self development and in order to make decisions or resolve uncertainty. Simply having and experiencing is not sufficient. Reflection upon this experience is needed in order to learn from it, with out reflection, experiences are often quickly forgotten and therefore the opportunity for development is lost. The feelings and thoughts developed through reflection are what generate concepts and it is through these concepts that we learn and accordingly adapt our attitudes, beliefs and actions. (Gibbs, 1988)
When to reflect
-Something that went really well
-A crisis
-An uncomfortable situation
-A situation where what usually works was not working
-An occasion when a usual explanation did not suffice prompting the need for a new explanation.
Framework 3:Johns model for structured reflection
Johns model for structured reflection (2000)
This model not only provides a framework but also encourages guided reflection; this involves sharing reflections with a supervisor or peer in order to obtain greater understanding of an experience.
Johns model for structured reflection is a very in depth framework in that it explores empirics, this is looking at what knowledge did or could have informed the writer in the given situation, this is the main differentiating point of Johns Model, and helps the writer understand their actions and others reactions.
Looking in
· Find a space to focus on self
· Pay attention to your thoughts and emotions
· Write down those thoughts and emotions that seem significant in realising desirable work.
Looking out
· Write a description of the situation surrounding your thoughts and feelings.
· What issues seem significant?
Aesthetics
· What was I trying to achieve?
· Why did I respond as I did?
· What were the consequences of that for the patient/others/myself?
· How were others feeling?
· How did I know this?
Personal
· Why did I feel the way I did within this situation?
Ethics
· Did I act for the best? (ethical mapping)
· What factors (either embodied within me or embedded within the environment) were influencing me?
Empirics
· What knowledge did or could have informed me?
Reflexivity
· Does this situation connect with previous experiences?
· How could I handle this situation better?
· What would be the consequences of alternative actions for the patient/others/myself?
· How do I now feel about this experience?
· Can I support myself and others better as a consequence?
· How available am I to work with patients/families and staff to help them meet their needs?http://staffcentral.brighton.ac.uk
This model not only provides a framework but also encourages guided reflection; this involves sharing reflections with a supervisor or peer in order to obtain greater understanding of an experience.
Johns model for structured reflection is a very in depth framework in that it explores empirics, this is looking at what knowledge did or could have informed the writer in the given situation, this is the main differentiating point of Johns Model, and helps the writer understand their actions and others reactions.
Looking in
· Find a space to focus on self
· Pay attention to your thoughts and emotions
· Write down those thoughts and emotions that seem significant in realising desirable work.
Looking out
· Write a description of the situation surrounding your thoughts and feelings.
· What issues seem significant?
Aesthetics
· What was I trying to achieve?
· Why did I respond as I did?
· What were the consequences of that for the patient/others/myself?
· How were others feeling?
· How did I know this?
Personal
· Why did I feel the way I did within this situation?
Ethics
· Did I act for the best? (ethical mapping)
· What factors (either embodied within me or embedded within the environment) were influencing me?
Empirics
· What knowledge did or could have informed me?
Reflexivity
· Does this situation connect with previous experiences?
· How could I handle this situation better?
· What would be the consequences of alternative actions for the patient/others/myself?
· How do I now feel about this experience?
· Can I support myself and others better as a consequence?
· How available am I to work with patients/families and staff to help them meet their needs?http://staffcentral.brighton.ac.uk
framework 4: Kolb's Learning Cycle (1984)
Kolb's Learning Cycle (1984)
Kolb’s Experiential Learning Theory is a four-stage cycle which is applied to the way people learn through experience. The four stages are:
Concrete Experience - Situation taking place.
Reflective Observation - A description of what happened and what were you feeling at the time.
Abstract Conceptualization - Why did this happen and what do you plan to do to either change this or prevent reoccurrence.
Active Experimentation – plan/practice the concepts developed in stage 3 so when the concrete experience occurs again you take a different action.
Image: Kolb's Learning Cycle (1984)
Framework 2: Gibbs Reflective Cycle
Gibbs Reflective Cycle: 1988
This is a fairly popular and simple method of reflection which involves the writer describing a situation, identifying how they felt or what they were thinking at the time, evaluating the situation including stating what was good and bad about the situation, analysing, concluding and finally creating an action plan as to what they would do differently or the same next time.
This framework is simple to follow while at the same time encourages the writer to think critically about the situation.
This is a fairly popular and simple method of reflection which involves the writer describing a situation, identifying how they felt or what they were thinking at the time, evaluating the situation including stating what was good and bad about the situation, analysing, concluding and finally creating an action plan as to what they would do differently or the same next time.
This framework is simple to follow while at the same time encourages the writer to think critically about the situation.
Framework 1: Rolfe et al (2001) Framework for reflective practice
Rolfe et al (2001) Framework for reflective practice
This is a simple model which poses the questions ‘What? So what? And Now what?’
What – describe the situation; achievements, consequences, responses, feelings, and problems.
So what – discuss what has been learnt; learning about self, relationships, models, attitudes, cultures, actions, thoughts, understanding, and improvements.
Now what – identify what needs to be done in order to; improve future outcomes, and develop learning
It is believed that the third and final stage is of the greatest importance in contributing to practice Rolfe et al (2001).
This is a simple model which poses the questions ‘What? So what? And Now what?’
What – describe the situation; achievements, consequences, responses, feelings, and problems.
So what – discuss what has been learnt; learning about self, relationships, models, attitudes, cultures, actions, thoughts, understanding, and improvements.
Now what – identify what needs to be done in order to; improve future outcomes, and develop learning
It is believed that the third and final stage is of the greatest importance in contributing to practice Rolfe et al (2001).
Introduction
Reflective practice promotes clinical reasoning and analytical and evaluative abilities in students and health professionals. It is the process of recognizing, analysing and questioning experiences in order to learn, develop, understand, and problem solve a given situation. This can take some time to perfect. (Department of Health 1993).
Reflection comes in many forms; this blog however will concentrate specifically on journaling or reflective writing. There is no correct way to reflect as it is a personal process, however it may be helpful to follow a framework to ensure that reflection is as effective as possible. It is important to identify a framework which you feel comfortable using and which you find best demonstrates your learning. It is often helpful to share reflections through peer supervision; this is an important part of Occupational Therapy (OT) practice and may assist in the process of identifying new perspectives. staffcentral.brighton.ac.uk
This blog will out line several models to reflect by, as well as give examples of reflections, and links to helpful sites.
This information was learnt and obtained through various fieldwork placements, and has proven to be invaluable to my development as a student and future health professional.
Reflection comes in many forms; this blog however will concentrate specifically on journaling or reflective writing. There is no correct way to reflect as it is a personal process, however it may be helpful to follow a framework to ensure that reflection is as effective as possible. It is important to identify a framework which you feel comfortable using and which you find best demonstrates your learning. It is often helpful to share reflections through peer supervision; this is an important part of Occupational Therapy (OT) practice and may assist in the process of identifying new perspectives. staffcentral.brighton.ac.uk
This blog will out line several models to reflect by, as well as give examples of reflections, and links to helpful sites.
This information was learnt and obtained through various fieldwork placements, and has proven to be invaluable to my development as a student and future health professional.
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