Reflections of influences on mental health placements: these were in Community Mental Health Teams (CMHT) and secure inpatient units.
- Politics removal of benefits
- reduction in PIP* for one lady with severe anxiety reduced her support and reduced access to the community as a result, she felt her MH was worsening
- What? middle aged man with EUPD & psychosis felt it was unfair the cuts to disabled benefits, when he was assessed for his PIP he felt because he could ‘function’ in the interview and speak coherently he was marked up in his ability whereas he felt he could not manage day to day. He said this reflected people often dismissing mental health because it cannot be seen and he looks ‘normal’.
- So what? He felt very angry about this and sometimes this was directed at any healthcare staff even those not responsible for benefits, such as when groups were cancelled due to staff shortages.
- Now what? Reflected at the time that it must be difficult to find an outlet for your frustration and anyone working for public sector could be a symbol of the government, remember to not take anger at service constraints personally.
Rolfe (2014) goes straight for the jugular and says that reflective practice has failed to become an everyday part of healthcare practice (and as a result failed to improve it), and that this is the fault of managers and educators as well as practising therapists.
He thinks reflection has been misunderstood- it’s really how we DO reflection-in-action (Schön 1987), not how we WRITE about reflection-on-action after the fact using structured models. Rolfe says believing that reflection-on-action is reflection is how managers/educators/therapists have misapplied it. they should be focusing on reflection-in-action, the bit that Schön thought reflection actually was anyway.
So most reflection takes place at a desk with pen and paper after the event, whereas the people who ‘invented’ it thought it was more reflecting with the situation while you were in it. If you’re rationalising things afterwards it’s the same as a technician carrying out research recommendations, which is fine if it’s an easy patient “tame problem” but if it’s a complicated “wicked problem” which is complex and unique and cant be applied to other previous situations… it’s not much use.
Fish & Coles (1998) also looked at clinical judgement in relation to reflection and tame/wicked cases (except they called them technical rationality and professional artistry). Technical rationality/tame problem are being a drummer in a pop band- following predictable formulaic beat patterns from instructions that already exist; whereas wicked problems requiring professional artistry are like a saxophonist in an improvised jazz ensemble- you’ve got to play along in harmony to sounds you haven’t heard before or will hear again. It is like being a mini-researcher experimenting on small scale on individual case in the moment, rather than carrying out actions based on existing research done by someone else.
Being taught in a classroom doesn’t allow you to experience the complex wicked problems of the real world and the associated reflection-in-action. Rolfe therefore sees the current classroom method as an inefficient way of training healthcare professionals and he thinks apprenticeships -which involve more exposure to practical elements than placements do- would be better.
Should students be exposed to tame or wicked problems in their learning? Schell & Schell (2008) said a series of similar tame problems are helpful so a student can recognise patterns and build up a repertoire of ‘answer templates’ to problems. Solving wicked problems happens when one can piece together tame problems relevant to the complex one. It can be seen that the student/novice needs to have tame solutions down to pat first before they can successfully solve wicked problems.
Standing on the shoulders of giants- learning something by building on the existing knowledge/experiences others (Sir Issac Newton)
Rolfe stresses that this opinionated article isn’t written as fact, but a one-sided opinion in order the stimulate a response and a debate. He thinks that more opinion pieces and proposed hypotheses for complex problems should be included in professional journals and not just research studies, because it would create official debate in order to decide which new areas needed research.
“Difficult, but important”
Reflection is an important yet ethereal skill that all Occupational Therapists need to master.
Part of completing a reflection is an inner sense of discomfort (in fact the first stage of reflection as described by Boyd & Fales 1983) so it’s no wonder many people put it off and may even try to get by without it, perhaps carrying out token reflections just to comply with CPD or course requirements. To begin with, reflecting on your actions is something that requires conscious effort after the event but eventually, according to Johns (2000), it will become an automatic thought process even when you’re in the middle of experiencing the event. When deciding which model to use, it can helpful to find out what learning style you are according to Honey & Mumford. You can relate these to the knowledge types shown in Carper/Johns’ reflective models.
Below is a rough guide to the different models of reflection out there, and which situations they’re best geared towards. They are ordered (in my opinion) from the easier ones for the beginner who is trying to break down and evaluate a situation, to the more complex ones that build on the basics and hope to elicit a change in your personal beliefs and challenge your assumptions. Gillie Bolton suggests exercises for creative ways to reflect in her book Reflective Practice: Writing and Professional Development (chapter 4).
Like Inception, you’ll naturally find yourself going deeper with your analysis of an event the more experience you gain with reflective models. Enjoy the ride!
Gibbs reflective cycle (1988)
Good for: Good old Gibbs. Basic, good starting point, six distinctive stages. Makes you aware of all the stages you go through when experiencing an event.
Criticisms are: superficial reflection- no referral to critical thinking/analysis/assumptions or viewing it from a different perspective (Atkins & Murphy 1993). Does not have the number or depth of probing questions as other models.
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