Reflective Theories Writing Assignment

Megan Wilson

University of Utah Occupational Therapy

OC TH 6960: Advanced Topics in Occupational Therapy

Dr. Pollie Price

September 7, 2021
 Reflective Theories Writing Assignment

Reflecting on one's practice can be extremely beneficial for not only the practitioner but

also those they care for. This summer, I had the opportunity to do my own reflecting during my

time with Intermountain Health Care Home Health. I had countless positive and negative

experiences. I reflected on my own knowledge and what happened during a therapy session to

figure out what I needed to do to become a better occupational therapist and provide more

effective occupation-based therapy. However, utilizing the frameworks: "What? So What? Now

What?", (Rolfe et al., 2001), "A Reflective Practice Cycle" (Gibbs, 1988), and "The Strands of

Reflection" (Fish, 1991), I have been able to reflect deeper and learn even more from my

experiences.

What? So What? Now What?

For an initial evaluation, I went into the home of a single older gentleman recovering

from hip surgery due to a motor vehicle accident. Every time I tried to ask a question, he would

begin telling a long and unrelated story. It became difficult to redirect the conversation. An hour

passed, and I had gotten little information related to his occupations from the interview.

I felt frustrated that I spent that long during an evaluation without gleaning the important

information. I did not want to be rude and interrupt him, but I also needed to move the evaluation

along without wasting time. An evaluation is critical to gaining the information needed to create

and providing a quality plan of care, and I was unable to gather it. I learned in school how to

redirect, but it was more difficult when trying on a real individual rather than a classmate

pretending.
 After the evaluation, I had a valuable discussion with my clinical instructor about how to

handle a similar situation in the future because it is very likely I will encounter a chatty patient

again. He explained that sometimes individuals do not catch onto social cues, and we have to be

blunt but respectful and explain that we have limited time and need to gather important

information. I still used my observation skills to gather some information and combine it with the

little I gathered from the interview to decide that patient would not need services with the

approval from my clinical instructor. I am glad I could still gather some information in the

evaluation despite the challenge. Still, I hope to use the skills I learned from my clinical

instructor and this experience to successfully redirect patients in the future if an evaluation

becomes unproductive.

A Reflective Practice Cycle

At the end of my fieldwork, I had a patient who was non-weight bearing on her right leg

due to a diabetic wound on her left foot. Through the evaluation, I discovered that she had

difficulty maintaining her weight-bearing precautions during transfers and had not taken a

shower in weeks. I did a home evaluation and found that grab bars in the shower and a tub

transfer bench would be beneficial in helping her transfer into the shower safely and help her

maintain her weight-bearing precautions. I recommended a relatively affordable option, but she

expressed to me she could not even afford that. I contacted a company that rents equipment for

free and discovered they had a tub transfer bench she could use, but she would need to drive 45

minutes to Salt Lake City to pick it up. The patient informed me she had no way to drive and had

no family or friends nearby to pick it up for her. She asked if I could pick it up for her but
expressed I would be unable to do so. The next session, when I came, a younger lady there said

she was her niece. I asked if she would be able to pick up the equipment, and she agreed.

I felt disappointed at first when I found that she would be unable to get the equipment. I

knew there was no other way to safely take a shower and wanted her to achieve that goal. I was

tempted to pick it up for her, but I knew that would be crossing a professional boundary as I

could not do that with every client that needed it. However, when I discovered she did have

family, I was excited and relieved when she agreed. It was good to have the opportunity to

advocate for a patient and reach out to resources for them to get help. I was proud of myself for

maintaining professional boundaries even though it was hard. It was a learning experience to be

involved in an ethical situation, even if it was small. I wish I would have done a better job of

understanding and asking about her social support since she did have one in reality. I also wish I

would have had more knowledge of local community resources that could have also helped.

This experience reminded me how hard it can be for individuals who do not have a good

support system and have a context and environment that does not support occupational

performance. I learned that patients do not always have the ideal situation, but it is our job to

advocate and do what we can to help them achieve their occupational goals. I am glad I knew

some community resources that my patient could use and learned how important community

resources are. In the future, wherever I have a job, I want to always be aware of community

resources I can provide for my patients.

I had a patient with late-stage Parkinson's whose goal was to walk down the stairs to eat dinner

and ultimately attend his son's wedding as he was currently homebound. He had a very involved

and encouraging family as well as a full-time caregiver. In the session following the evaluation,

the patient refused every attempt to get out of bed and only would do postural and upper

extremity exercises in his bed. I even tried to use his desire to go downstairs to eat and attend his

son's wedding to motivate him to get out of bed. He expressed the desire to complete these things

but still refused to get out of bed for therapy.

I found myself frustrated that he wanted to reach the goals but did not want to complete

the therapy required to do it. I wondered how I was going to motivate him to participate in therapy.

Usually, if you find a goal a patient is interested in, it will help motivate them to participate in

therapy, but not in this case. I realized there could be a cognitive component, but that should not

make it impossible to get him to participate in therapy. I thought about possibly needing to build

more rapport with him and improving the therapeutic relationship to foster more participation in

therapy. I also thought to come up with more research and purpose behind my proposed therapeutic

activities and explain it better to my patient.

If I were the patient, why would I not participate? Lack of understanding behind the

purpose? Unclear connection to the goal? Is it a boring activity? Are they tired or uninterested?

How can I incorporate therapy into his routine already to foster greater participation? I decided

to look more into the Model of Human Occupation and how I could apply its concepts of

habituation and volition to this situation (Kielhofner, 2009). I talked to the caregiver to see when

my patient takes breaks out of his bed to see if there was a time where he had more energy that I
could see him for therapy. The caregiver explained she put him in bed after lunch, and he was in

his chair all morning. I scheduled to come late morning while he was in his chair. I chose to use a

modified interest checklist with him to work on rapport, get to know him better, see what

occupations he is interested in, and include them in therapy. Through the interest checklist, I

found he enjoyed bowling, so I created a bowling game where he could work on his deficits and

increase his capacity to reach his goal. I then used the momentum to practice stairs and used his

desire to get in bed as a reward for his participation in therapy.

In the future, I hope to take the same approach using both formal and personal theory to

guide my practice and find out what is personally meaningful and motivating for my clients. This

way, I will be able to provide effective, client-centered, and occupation-based practice.

Conclusion

Although I did my best to reflect on my experiences during my fieldwork, these exercises

in using formal frameworks to guide further reflection have been very beneficial. I have learned

that there can still be much to learn, reflecting on experiences later on and right after the

experience. I hope to continue this reflective practice in my future career as an Occupational

Therapist.
 References

Fish, D. (1991). Developing a theoretical framework. In D. Fish, S. Twinn & B. Purr (Eds.),

Promoting reflection: Improving the supervision of practice in health visiting and initial

teacher training (pp. 17-31). London: West London Institute of Higher Education.

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education

Unit, Oxford Polytechnic, Oxford.

Kielhofner, G. (2009). Conceptual foundations of occupational therapy practice (4th ed., pp. 147-

174). Philadelphia: F. A. Davis Company.

Rolfe, G., Freshwater, D. & Jasper, M. (2001). Critical Reflection for Nursing and the Helping

Professions: A User's Guide. Basingstoke. Palgrave Macmillan.