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Reflective Theories Writing Assignment

Tayler Stokes

University of Utah Occupational Therapy

OC TH 6960: Advanced Topics in Occupational Therapy

Dr. Pollie Price

September 7, 2021
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Reflective Theories Writing Assignment

Introduction

My level II fieldwork experience occurred at the University Utah Hospital on the

Cardiovascular ICU. My experience taught me about myself as a developing Occupational

Therapist along with new aspects of treating patients. While I was able to take some time to

reflect on my performance after each client, it has been beneficial to use the following

frameworks to reflect on my experiences: “What? So What? Now What? (Rolfe et al, 2001)”, “A

Reflective Practice Cycle (Gibbs, 1988)”, and “The Strands of Reflection (Fish, 1991)”.

A Reflection Process: What? So What? Now What?

What?

I began a session with a male that had just undergone valve replacement surgery. After

the surgery the male was experiencing weakness in his upper extremities and symptoms of

delirium due to coming off sedation. I had planned a session where I would complete ADLs with

the male incorporating his upper extremities along with cognitive exercises to decrease the

symptoms of delirium. While completing one of the cognitive exercises that I had planned, the

patient asked the nurse if he would bring him a pudding. I encouraged the patient to stay focused

on the cognitive task however once the nurse brought the patient his pudding, there was no way

of reobtaining his focus. This made me feel frustrated and like my session was interrupted.

So What?

Although the nurse was trying to attend to the patient’s needs, it was distracting to the

patient during the session. The patient was so focused on eating that he was no longer following
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cues or completing the cognitive task. I asked the patient if we could finish the session and then

he could eat his pudding, but he just started eating it. I was not very far into the session and

wanted to spend more time with the patient, so I tried to come up with a solution on the spot.

Now What?

I spoke with the patient and discussed that I wanted to continue working with him and

finish our session. I asked him if we could incorporate his pudding into our session and he

agreed. As he scooped each bite, I positioned the pudding at different heights and distances away

causing him to use his upper extremities to reach differing lengths and heights along with

engaging his back and core muscles to stabilize his body. After he finished, we were both

satisfied with how the session went. As I reflect on this situation, I could have asked the nurse to

bring the pudding as soon as we finished the session for it to not pose a distraction. However, I

feel that I was able to come up with a solution that was appropriate and allowed both the patient

and I to be satisfied. Now that I have had this experience, I know that I need to be prepared for

things not to go exactly how I plan, and to have a backup plan or two ready to implement if the

situation arises (Rolfe et al, 2001).

A Reflective Practice Cycle

Description
I completed a session with a patient who had undergone valve replacement surgery and

was able to get up and ambulate with assistance. During the session, the patient would complete

tasks on his own without waiting for my instruction or supervision. Since the patient had just

undergone heart surgery, he was attached to several lines that needed to be arranged before the

patient was able to engage in certain activities. The patient did not wait for lines to be put in

order and I had to keep asking the patient to sit down and wait for further instruction.
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Thoughts/Feelings

This situation was very stressful, and it threw me out of my flow. Since the patient was

very impulsive, I did not have as much time to organize the lines before he kept trying to get up

and move. Because of this, I became flustered and could not think clearly of what my next step

was that I had planned. Although no lines were pulled during the session and the patient was safe

throughout the duration, it was a very unpleasant experience.

Evaluation

This was a very stressful experience, but I feel that I handled it well. Even though I felt

stressed and flustered on the inside, I remained calm and collected on the outside and was able to

retake control of the situation. Something that I could have improved on would be to look for

clues or warning signs that the patient may be impulsive and speak to the patient about the

importance of waiting patiently for me to organize lines and to give him further instruction.

Analysis/Synthesis

This experience has taught me that I need to give my patients clear intentions of what I

plan to do and what I need or expect out of them before I even begin my session. Regarding this

situation, I could have told the patient at the beginning to please allow me some time to organize

the lines and get things ready before we start the session.

Conclusion

Although this situation was stressful and incohesive, it was still successful in that the

patient remained safe and received therapy services. Having good communication with the
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patient is crucial to have a smooth and successful session. I could have implemented better

communication into my session for it to have gone more smoothly.

Action Plan

If this situation were to happen again, I would be prepared to step in and give the patient

clear instructions allowing me to carry on with my session without further interferences. I have

learned that I need to express my expectations at the start of the session, and I will be prepared if

it does occur again. I will adapt my practice by being upfront and clear with my patients from the

start. I will measure my success by observing how my patients follow my requests along with

how I feel the session went once it is finished. Reflecting on this experience will better prepare

me for future treatment sessions (Gibbs, 1988).

The Strands of Reflection

Factual

Since my fieldwork occurred on the Cardiovascular ICU, COVID-19 patients were a part

of our patient population due to lung and heart complications caused by the virus. A particular

patient had a very involved family that would question the judgment of my CI and me during

treatment sessions. During one session, the patient’s family kept watching the monitor that was

displaying his oxygen. For the oxygen reading to be reliable, there had to be a good waveform on

the pleth; when the wave form was not present, the oxygen reading was not accurate. Since the

family did not know this, they would question our actions and point out that the patient’s oxygen

was low and that we should not continue even though the waveform was not present. This made

the patient extremely stressed and agitated and sabotaged the session.

Retrospective
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When taking a step back to review the situation, I do understand the family’s concern for

their loved one. We were involved in a very emotionally charged situation and it is

understandable that the patient’s family be concerned for their loved one’s wellbeing. On the

other hand, having the family’s and patient’s trust is also an important part of having a successful

treatment session.

Substratum

This was a very emotionally charged situation and using the PEO model was a useful tool

in deescalating it. By examining how the family in the patient’s environment was affecting the

patient and his ability to engage in occupations, we were able to adapt the situation by explaining

to the family information regarding the oxygen reading, reassuring them, and then asking them to

wait in the hall for the remainder of the session.

Connective

If something similar were to happen in the future, I will respectfully explain to the patient

or family the information they need to know, and then make some kind of change such as asking

them to step out in order to allow the patient to receive the treatment they need. This framework

has allowed me to analyze the quality of how I handled this situation (Fish, 1991).

Conclusion

During my level II fieldwork experience, I was able to take some time to reflect on my

experiences however using the frameworks, “What? So What? Now What? (Rolfe et al, 2001)”,

“A Reflective Practice Cycle (Gibbs, 1988)”, and “The Strands of Reflection (Fish, 1991)” has

been very beneficial for me to more deeply reflect on my patient care performance which will

help make me into a better Occupational Therapist.

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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. 

Law, M. Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-

environment-occupation model: A transactive approach to occupational performance.

Canadian Journal of Occupational Therapy, 63, 9-23.

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

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