How to do reflections and why they are important

george-marks-woman-looking-into-hand-held-mirror

I get a lot of views on my website as a result of people typing into search engines “OT reflection example”. I don’t blame these intrepid Googlers, it means that I am not alone in struggling to get the knack of reflections. This usually leads to a certain amount of grumbling about why we have to do them. Sound familiar?

 

So, why do we have to reflect?

Reflection is essential in getting healthcare students to make links between theory and practice (Jasper, 2013), this in turn helps us to develop our clinical reasoning (Rigby et al.,2012). It’s not just important while we are students. Oh no, it’s not over when you graduate, as British Association of Occupational Therapists (2007) informs us that reflective practice is vital to our continuing professional development (CPD). CPD is really important to keep our skills and knowledge up to date to be able to practice safely, legally and effectively (College of Occupational Therapists [COT], 2010; Health and Care Professions Council [HCPC], 2012a). Using models of reflective thinking make sure our reflections are meaningful to our CPD (Armitage et al., 2012).

Using models of reflection

Models of reflective thinking are the structures that we use to help us think reflectively. There are lots of different models out there for you to mull over. These models vary in how much hand-holding they give you and how much description and critical analysis are needed. The common ones that healthcare students use are; Gibbs, Johns and Borton. You should choose your reflective model based on what you want to achieve and how deep you want to go with your reflection (Jasper, 2006). Although to be honest, I tend to use Gibbs as I am more familiar with it but I have also started using Borton for quick, on the spot reflections.

I am going to give you an example of a reflection that I have done. I’ve chosen Gibbs’ (1988) model. My reflection is to help me understand my behaviour in a critical incident; I felt that I made the right decision but was unsure why. Gibbs’ model is useful examining a completed rather than an ongoing issue as it proposes action (Jasper, 2013). If the incident was ongoing, Borton’s (1970) model may have more use as it makes action happen, rather than just suggesting action (Jasper, 2013).

OK, so from now on I’m going to use more academic language for my reflection, as I think reflections should be written more formally for university. I hope it is helpful and doesn’t make you switch off!

Description

On placement a resident disclosed to my placement buddy and I that he was walking and transferring on his own, against advice. This behaviour resulted in several falls in his room. He had not raised this with the staff; not wanting them to be concerned. The following morning, we informed the client that we had discussed his falls with the care manager. We advised him to await carers for transfers until we could assist him doing this safely.

Thoughts/feelings

I felt uneasy that the client did not want us to tell anyone that he had fallen: my intuition was that we needed to inform a manager. I was concerned that he might injure himself. I felt uncomfortable that I had acted against his wishes and without his knowledge which is contrary to professional standards that advise relationships with service users should be based on trust (HCPC, 2012b).

Evaluation

I was pleased that a safety risk had been identified as a potential intervention. It was important to the resident to be independent with his self-care. I realised that night that we should have told the client that we intended to discuss his falls with staff so the following morning we informed him.

Analysis

Professional practice involves abiding by the codes of conduct, ethics, and standards of a professional body (Jasper, 2006). In the case of occupational therapists this is the HCPC and COT.  Professional behaviour requires complying with legislation and government policies (Jasper, 2006). This behaviour ensures that the therapist acts safely, legally, and in accordance with the values of the profession (COT, 2010).

The incident was an ethical dilemma: resulting from conflicting ethical principles (Alsop & Ryan, 1996). The ethical dilemma was that of autonomy and confidentiality versus beneficence (Beauchamp & Childress, 2009). Autonomy and confidentiality directed us to respect the wishes and privacy of the client by not telling staff of his falls, yet beneficence required us to safeguard the client from harm by doing the opposite. Ethical reasoning can be used to analyse a dilemma and determine the right action (Boyt & Schell, 2008) by evaluating the likely consequences (Beauchamp & Childress, 2006). The likely consequence of informing staff would be that the client would be safeguarded from further harm at the cost of a loss of trust. Conversely not telling would maintain trust but expose the client to potential harm.

Occupational therapists are autonomous practitioners (HCPC, 2012b) able to make informed decisions that they are able to justify. These decisions involve assessing risks and devising ways to deal with them. Part of this risk management involves an awareness of relevant legislation (COT, 2010).  Occupational therapists have a legal duty of care to act in a way that ensures that no injury occur to a client in their care (COT, 2010; Health and Safety at Work Act 1974). We had a duty of care to tell staff of the high fall risk brought about by the client’s action.  Occupational therapists also have a legal duty to safeguard confidential information about clients (HCPC, 2012b). Information can be disclosed if the client consents, there is a legal justification or to prevent serious harm to the client or another person (COT 2010; HCPC, 2012a; Public Interest Disclosure Act [PIDA] 1998).  We were justified in breaking confidentiality because we were concerned about harm however we should have attempted to gain consent before disclosure (HCPC, 2012c).

Fundamental to occupational therapy is the commitment to client-centred practice (COT, 2010). Client- centred methods recognise the importance of individual autonomy (Creek, 2003; Rodger, 2013). Professional codes instruct a respect for client autonomy if they have mental capacity (COT, 2010; HCPC, 2012a, 2012b).  We knew the client had capacity as he was able to understand, evaluate, retain the information, and consent to our help (Mental Capacity Act 2005). Providing psychosocial support to clients is important to a holistic approach (McKenna, 2010). Advanced communication skills such as active listening, and open questioning could have been used to explore concerns, and explain the importance of telling staff (McKenna, 2010).

Professional behaviour involves knowing the limits of the therapist’s scope of practice: the knowledge and experience needed to practice safely and legally, (HCPC, 2012b).  Care is seldom provided alone; sharing information within the team is good practice and often essential for effective care (HCPC, 2012c). As students it was outside of our practice to keep the client safe at all times and even it was not, sharing information within the team represented best practice.

Conclusion

Although it was the right decision to discuss the client with staff it was undertaken it in the wrong manner. I should have explored disclosure with the client and explained why it would be in his interests. I could have tried to gain consent and prevented the ethical dilemma. It is important to be familiar with current legislation, professional guidelines and policies to be able to make autonomous, informed decisions that I am able to justify. If I had this knowledge I could have reflected in the moment rather than after the moment.

Action Plan

Personal development

Maintaining confidentiality, I use my occupational therapy blog to reflect on my professional experience. I will employ different models of reflection to enable me to select the model that best fits the situation. In practice placement 6 (PP6) and when qualified I will use counselling skills to explore worries that a client may have about disclosing information. I will try to gain client consent.

Professional development

When qualified I will keep up to date with professional issues and by becoming a member of COT, reading the British Journal of Occupational Therapy. I will keep up to date with relevant HCPC policies and guidance by reading the HCPC ‘In Focus’ newsletter. I will access the Department of Health website for current policy and guidelines and regularly maintain CPD by participating in activities suggested by HCPC (2012d). I will document these activities in my CPD portfolio for ongoing registration.

For PP6 I will discuss with my educator the policies most pertinent to the setting to ensure familiarity.  I will be aware for the potential of ethical dilemmas and consider likely consequences of action. I will reflect in supervision on my clinical reasoning skills.

References:

Alsop, A., & Ryan, S. (1996). Making the most of fieldwork education: a practical approach. London: Chapman & Hall.

Armitage, A., Evershed, J., Hayes, D., Hudson, A., Kent, J., Lawes, S.,…Renwick, M. (2012). Teaching and Learning in lifelong learning (4th ed.).  Maidenhead: Open University Press.

 Beauchamp, T.L., & Childress, J.F. (2009). Principles of biomedical ethics (6th ed.). Oxford: Oxford University Press.

 Borton, T. (1970). Reach, Teach and Touch. London: Mc Graw Hill.

 Boyt Schell, B.A., & Schell, J. (2008). Clinical and professional reasoning in occupational therapy. Baltimore: Lippincott Williams and Wilkins.

 British Association of Occupational Therapists.(2007). Recording CPD: transforming practice through reflection. Retrieved from http://ilod.cot.org.uk/files/cpdtools/recording_cpd_transforming_prac_1.pdf

 College of Occupational Therapists.(2010).  Code of ethics and professional conduct. London: College of Occupational Therapists.

 Creek, J. (2003). Occupational therapy defined as a complex intervention. London: College of Occupational Therapists.

 Finlay, L. (2008). Reflecting on ‘reflective practice’. Retrieved from http://www.open.ac.uk/cetl-workspace/cetlcontent/documents/4bf2b48887459.pdf

 Gibbs, G .(1988). Learning by doing: a guide to teaching and learning methods. Oxford: Further Education Unit, Oxford Polytechnic.

 Health and Care Professions Council. (2012a), Standards of conduct, performance and ethics. Retrieved from http://www.hpc-uk.org/assets/documents/10003B6EStandardsofconduct,performanceandethics.pdf

 Health and Care Professions Council.(2012b). Standards of proficiency occupational therapists. Retrieved from http://www.hpc-uk.org/assets/documents/10000512Standards_of_Proficiency_Occupational_Therapists.pdf

Health and Care Professions Council. (2012c). Guidance on confidentiality. Retrieved from http://www.hpc-uk.org/assets/documents/100023F1GuidanceonconfidentialityFINAL.pdf

Health and Care Professions Council. (2012d). Continuing professional development and your registration. Retrieved from http://www.hpc-uk.org/assets/documents/10001314CPD_and_your_registration.pdf

 Health and Safety at Work Act 1974

 Jasper, M. (2003). Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas Ltd. Jasper, M. (2006). Vital notes for nurses: professional development, reflection and decision making. Oxford: Blackwell publishing.

Jasper, M. (2013). Beginning reflective practice (2nd ed.). Australia: Cengage Learning

Johns, C. (2009). Becoming a reflective practitioner (3rd ed.). Chichester:Wiley-Blackwell.

McKenna, J. (2010).Psychosocial support. In M. Curtin, M. Molineux & J.  Supyk-Mellson (Eds.), Occupational therapy and physical dysfunction: enabling occupation (6th ed.)(pp.190-212). Edinburgh: Churchill Livingstone.

Mental Capacity Act 2005

 Public Interest Disclosure Act 1998

 Rigby, L., Wilson, I., Baker, J., Walton, T., Price, O., Dunne, K., & Keeley, P. (2012). The development and evaluation of a ‘blended’ enquiry based learning model for mental health nursing students: “making your experience count”. Nurse Education Today (32), 303-308. doi: 10.1016/j.nedt.2011.02.009

Rodger, S., & Keen, D. (2013). Child and family centred service provision. In S. Rodger (Ed.), Occupation centred practice with children: a practical guide for occupational therapists. Retrieved from http://books.google.co.uk

 

 

Advertisements

20 thoughts on “How to do reflections and why they are important

  1. Thank you for this piece. It definitely captures the importance of evidence based practice, and reflection on our practice. A very professional way of dealing with a common and sometimes confusing ethical issue. I really liked your conclusion and the emphasis for an action plan. We can reflect but we do not improve our OT practice unless we then learn from our reflections.

    • Thanks Tara, nice to see you on my blog. I really found reflecting on the dilemma so helpful and what I have learned from this incident will definitely stick in my mind if I came across this type of situation again.

  2. This has been really helpful, I am doing my final paper and right at the end of the degree course I still struggle with reflections

    • Hi Liam, sorry it’s taken so long for me to respond to you, have been in the throes of final placement, essays and job hunting. Thanks for reading the blog, glad you found my post helpful. Good luck!

  3. Pingback: The OT process is one year old: developing a professional blog-my journey so far (3) | The OT process

  4. I think this is a really great reflection and blog in general! I really struggled on my 1st and 2nd placements as my educators told me I had to use a reflective model. None of the models I discovered seemed to fit with the way my brain worked and so I didn’t feel that I was getting much from my reflections. The models were either too prescriptive, like I was filling boxes or too broad. In my final placement my educator let me do reflections however I wanted. I chose to do a mind map style and that suited me much better! I would put the event in the middle and then write learning points surrounding it, which I would expand to include theory, clinical reasoning etc. At the bottom I would have a learning/future practice box which encouraged me to think what I had learnt and look forward.
    Only when completing reflections my own style did I “get” it and start to realise the benefits of reflecting. My reflections improved 10fold and I actually felt proud of them and looked forward to showing them to my educator.

    I would say to anyone struggling, to not be afraid to explore different models and find one you’re comfortable with. Persevere and at one point it might just click, like it did for me!

    Regards
    A final year dreading the next few months!

    • Hi Rebecca, thanks for reading the blog and your nice comments. Yes I think a lot of people find reflection hard which is why I wanted to write a blog post about it. It’s really helpful to find your style, it’s hard as a student that you have to fit it into a model well to gain better marks but more importantly it has to allow you to reflect. I’m glad you’ve found a way that works for you. If you are dreading the final few months you may be interested in my compassionate letter to final year students. Keep your chin up, the finish line is in sight! Best wishes Helen.

  5. Hello,
    I am a Children’s OT working in one of the NHS trust. Currently, a lot of talk about CPD is going on in our team as HCPC CPD audit is appoaching. My team lead wanted me to educate the team about reflective practice in our regular peer review group.
    I personally found this post really helpful and it provided a required insight. I hope we all start writing our reflective logs ASAP.

  6. Pingback: The Mountain. Thoughts on Reflection. – Site Title

  7. id like to reference some of this in my masters piece.
    Can I have an author name please? I got Hellen but no surname.
    Also are you happy for me to cite you?
    Excellent work! writing an essay on reflective practice and this is really helpful in putting it into perspective

    • Hi Carla, thanks for reading the blog. Of course you can cite me, I am very flattered. I’d be interested to know what exactly you are citing and what your masters is about. Your citation will be: Hampson, H. (2014).

  8. My essay is the second of a two part assignment for a module called advanced skills.
    It is a one year full time Advanced Practitioners Course in Occupational Therapy.
    The first essay was a critique of literature on a chosen skill used in OT practice.
    For this I chose clinical reasoning as it is one particular skill that I have never really advanced in and I found it quite fascinating just how much there was to it!
    Following the completion of the critique I found that reflection was a key theme and decided to focus on this in my second essay. The essay focuses on how the advanced knowledge on the skill chosen (in my case clinical reasoning) can advanced our professional practice.
    Having spent now two months (slightly ridiculous i know) writing the papers I came across your blog by pure accident and I just felt it summarised reflection and its application to practice really well. Its so nice to be able to read someones experience of actually using reflection in practice and seeing how it has benefited them in ‘real life’ now how the text book says it will 😀
    I appreciated you letting me cite you!
    I would love to write a blog but I could never explain it as well as you have.

    • Hi Carla, thanks for replying and for your positive feedback. I am always very surprised when anyone wants to link to me or cite me but it makes me feel proud that my blog is helping people with their OT journeys so thank you. Good luck with your essay and your qualification. Best wishes, Helen

  9. Hello Helen:
    Thank you so much for this blog!! I am a first year MSc Occupational Therapy student and I start my first placement in a few day. I found your blog, like those you mention above, when I googled “Occupational Therapy and reflection”. 😉 Based on your post I now have some new models of reflection to consider and try out on placement. Demonstration of reflection is one of my main goals while on placement. I will definitely be citing this post in the journal that I will be keeping while on placement.
    Thank you again!!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s