Reflective Practice: Models and Benefits

Reflective Practice

• A structured method for learning from practical experience, separate from theoretical knowledge
• It involves self-observation and self-evaluation
• It aims at deriving meaning from experiences to promote understanding and responsive actions.
• It is a tool for transforming thoughts and actions and addressing professional shortcomings.
• Reflection on action involves reviewing an event after it has occurred
• Reflection in action occurs while the event is taking place

Models of Reflective Practice

• ERA cycle involves experience, reflection, and action
• Driscoll’s What Model includes What, So what, and Now what?
• Kolb’s Experiential Learning Cycle involves concrete experience, reflective observation, abstract conceptualisation, and active experimentation
• Gibb’s Reflective Cycle includes description, feelings, evaluation, analysis, conclusion, and action plan

Benefits

• Refined decision making
• Enhanced problem solving
• Personal and professional growth
• Increased empathy
• Improved clinical skills

Skills and Attitudes

• Self-awareness, description, critical analysis, synthesis, and evaluation are key skills
• Honesty, trust, time commitment, and motivation for self-improvement are important attitudes

Unconscious Bias

• These are automatic, often unintentional beliefs that individuals hold without realizing it
• They can influence perceptions, thoughts, and behaviour unconsciously
• They are shaped by background, experiences, and cultural environment
• They can be either positive or negative
• They might contradict conscious beliefs

Sources

• Past experiences
• Assumptions
• Cultural norms
• Opinions of others
• Ingrained assumptions

Types

• Confirmation bias is the tendency to seek information confirming pre-existing beliefs
• Availability bias is the tendency to rely on easily accessible information when making decisions
• Stereotyping is attributing characteristics to individuals based on group membership
• Halo effect is when performance in one area influences perception in another

Identifying and Addressing

• Recognize and challenge common biases in health care
• Self-reflect and seek feedback from others
• Use tools like the implicit bias test

Effective Communication

• It requires mutual understanding
• In healthcare, it requires self and other understanding, plus highly developed communication skills
• Critical self-awareness, self-knowledge, and development are needed
• It is an essential requirement in job descriptions and graduate qualities
• Communication can be vocal with or without words, non-verbal, or in material forms
• Misunderstandings in healthcare communication can result in errors, misdiagnosis, inappropriate treatment, adverse outcomes, or even death

Contributors to Misunderstanding

• Imbalance of power and knowledge
• Lack of time
• Cultural and language differences
• Nonverbal patients/clients
• Patient/client fear and anxiety

Mutual Understanding

• Healthcare professionals should understand their clients/patients to build understanding
• Consider the patient/client mindset and communication environment
• Establish trust, rapport, and common goals
• Understand what the communication in a healthcare setting means

Verbal Communication

• Verbal communication uses spoken or sign language
• Communication phrases must be clear, concise, cohesive, complete, and courteous

Features of Voice

• Prosodic features include volume, pitch, and rate/speed
  • Volume is how soft or loud you speak, needing to be heard but respectful of privacy
  • Pitch is whether voice sound is high or low, varying meaning and intensity
  • Rate/speed should be moderate for understanding without patronising but may need to be slower
• Paralinguistic features include emphasis, pauses, and tone
  • Emphasis refers to stress on words to change meaning, and should be used carefully
  • Pauses are used to breathe, consider responses, or build rapport
  • Tone impacts the meaning of sentences using changes in pitch, volume, and duration to communicate attitudes

Observation in Communication

• Observation is paramount in occupational therapy
• Observe a person in an environment, noting presentation, verbal and non-verbal communication, social skills, tone, behaviour, and motor skills

Non-Verbal Communication

• It considers what happens with the spoken word
• Effective use expresses respect, acceptance, openness, and empathy
• Clients will experience confusion and lack trust if non-verbal aspects do not match messages
• Environment: Layout, disturbances, furniture, and lighting all contribute
• Body language: Gestures, touch, personal space, gait, facial expressions, eye contact, actions, posture, and clothing are all important

Effective and Active Listening

• Focus consciously on the client and visibly tuning in with body language
• Avoid distractions
• Avoid being too procedural
• Make interactions feel relaxed
• Understand verbal and non-verbal methods to demonstrate validation
• Practice active listening skills
• The increased use of technology reduces the need to practice active listening skills

Culture

• A shared worldview of a group
• The ideas, customs, and social behaviour of a particular people or society/community
• Shared patterns of behaviour and interactions learned through socialisation
• Complex and multi-faceted

Iceberg Model

• You shouldn't make assumptions about culture based on what you can see

Cultural Identity

• A feeling of belonging to a group
• Provides a sense of self and how we view the world
• Complex interactive dimensions with individual and collective aspects
• Is important for social and emotional wellbeing
• Is dynamic and evolving

Diversity Wheel

• Cultural identity is more than just ethnicity or nationality

Influence on Health Beliefs

• Shapes ideas around traditional medicine, preventative measures, stigma, causes of illness, trust in healthcare, family roles, social norms, language, and communication

Cultural Safety

• The focus is on how care is provided, requiring safe, accessible, and responsive healthcare that is free of racism
• Requires practitioners to recognise and respond to power imbalances
• Requires practitioners to reflect on their knowledge, skills, attitudes, practicing behaviours, and biases
• Proposed by Irihāpeti Merenia Ramsden in the mid 1990s
• Cultural safety is not just understanding different cultures, it is about healthcare practice that does not undermine cultural identities

Aspects of Cultural Safety

• Acknowledges power imbalance between healthcare professional and client
• Recognizes that stereotypes and attitudes affect health outcomes
• Acknowledges Aboriginal holistic models of health
• Respects diversity and valuing the clients viewpoint
• Enables the client to influence the healthcare process
• Determined by the care receiver, not the care giver
• Requires healthcare professionals to engage in self-reflection, continuous learning, and advocacy

The 4 R’s

• Remember: historical events that have led to disempowerment
• Reflect: critical reflection leading to change in attitude and behaviour
• Recognize: strength and resilience
• Respond: working together, establishing trust and respect

What Cultural Safety is Not

• About being an expert in someone else’s culture
• Not something that you achieve, it's an ongoing process

Communication and Culture

• Non-verbal communication and body language should be contextually and culturally considered
• Health professionals should take care of their appearance and remain professional
• Body Position: Postures indicate emotions and interest
• Facial Expressions: Be aware and use these to express respect, empathy, and attention
• Eye Contact: Varies across cultures, indicating attention, disinterest, respect, or emotions
• Gestures: Cultures have different meaning
• Personal space/proximity: Consider cultural and individual variances, and be at the same level

Keys for Healthcare Professionals

• Treat each person as an individual
• Take time to understand cultural needs
• Be open and non-judgemental
• Be aware of your personality, cultural identity, and bias
• Avoid stereotyping

Feedback

• Feedback gives learners information about their work to improve it and appreciate the standards
• Feedback is based on observation, is timely, specific, and descriptive
• Feedback is not judgmental, criticism, or praise

Feedback as an OT Student

• It helps to foster a more trusting and open relationship
• It can be difficult to create a reciprocal feedback relationship when the supervisor has ‘power’
• Knowing your learning style is important to build the collaborative approach

Components for Giving Feedback

• Timing
• Empathy
• Be clear with specific examples
• Be constructive with both positive and negative
• Do it in an appropriate setting
• Get recipient to do reflection

Situation, Behaviour, Impact (SBI) Method

• Ask for permission to give feedback
• Describe the situation
• Describe the behaviour
• Describe the impact

Importance of Balance

• Feedback on what the person did well helps them understand their strengths
• it helps them understand their expectations of those skills in that setting.
• When people are aware of what they did well, they don’t try and improve on everything, just the things they are clear need improvement

Core Abilities Linked to Clinical Placements

• Time management
• Communication with supervisor when help was needed
• Overall professional behaviour
• Ability to make change based on supervisors feedback
• Flexibility with changed schedules
• Organisational skills

Johari’s Window

• You can build trust with others by disclosing information about yourself
• With the help of feedback from other people, you can learn about yourself and deal with personal issues

Areas Within

• Open area: known by the person and others
• Hidden area: known by the person, not others
• Blind spot: not known by the person, but known by others
• Unknown: not recognised by self or others

Building Open Areas

• Feedback: helps us address our blind areas
• Others observation: when you aren’t aware of something about yourself that you didn’t know, but other have now pointed out to you, but you are still unsure about it
• Self-disclosure: you tell someone something private or personal about yourself
• Self-discovery: you learn something new about your abilities, skills, or capacity
• Shared discovery: neither you or others are aware of a skill or capability and discover it together

Receiving Feedback

• Receiving feedback is a catalyst for personal and professional advancement

Feedback Principles

• Mindset shift: view feedback as a gift for growth
• Ask Questions: Seek clarification and specific examples
• Respond, Not React: Pause before responding
• Separate Feedback and Self-Worth: Feedback addresses actions, not character
• Gratitude and Appreciation: Express gratitude
• Reflect: Take time to process the implications
• Identify Actionable Insights: Identify areas for improvement, break it down into steps
• Seek Additional Perspectives: Gather feedback from multiple sources
• Take Action: implement the actionable insights into your practices.
• Feedback loop: revisit the feedback over time to track improvement.
• Self-compassion: understand that growth takes time, and setbacks are part of the process.