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Reflective Theories Writing Assignment

According to Rolfe et. al. (2001) the reflection process should follow the “What? So

What? Now What?”, format. When reflecting on the following experience, the Rolfe et. al.,

(2001) criteria was considered. Early on during my fieldwork at Nielsen Rehabilitation Hospital

we were assigned a patient who had a C1/C2 spinal cord injury. Her medical status was

extremely complex and her cognitive status which was accompanied by severe anxiety made

working with her even more daunting. Meeting this patient for the first time was emotional as we

watched her try to piece together where she was, how she got there, and how drastically her life

had been altered. It was the first time during my fieldwork experience where I was almost

brought to tears instantly. After analyzing the feelings and facts associated with the experience, I

believe my emotions were not only coming from a place of empathy but also from a place of

fear. I feared knowing that she would eventually become my responsibility, and, in that moment,

I doubted my ability to help her progress. There was an overwhelming sense of the potential

impact I can have as an occupational therapist and an undeniable pressure to live up to that

potential.

After this experience, I have developed a new perspective on situations that seem bigger

than what I am equipped to handle. I am more aware of the fact that throughout my profession I

will have patients who cause me to doubt my abilities as a therapist. I will have patients whose

medical and situational complexity will overwhelm me with emotion and each time I will have to

remind myself to take it one day at a time, use my resources, and provide care that I am proud of.

I will always remember this experience as one that helped me gain perspective on how to think

outside of the box and use fear as a driving force to continue to learn and grow as a therapist.
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Gibbs (1998) encourages the reflection process to follow the description,

thoughts/feelings, evaluation, analysis/synthesis, conclusion, and action/plan format. When

reflecting on the following experience, Gibbs, (1998) was utilized. During my fieldwork I

worked with a patient who had a high-level spinal cord injury and was facing the additional

challenge of not being a U.S. citizen. Due to the patient’s status, he could not receive or apply for

any form of insurance, which caused his length of stay to be significantly shorter than the typical

length of stay for his level of injury. As I processed what this meant for my patient, I felt

frustrated and completely disheartened. I felt as though there had to be something more we could

do and as I quickly realized we were already exhausting all of the hospitals resources I had a

difficult time digesting the reality of the situation. I additionally questioned how I was going to

prioritize interventions and optimize the time we had left.

As I evaluated and processed all of the facts, I was able to better understand the

complexity and hardship this patient would face upon discharge. During my time with him I tried

to be receptive to his concerns and emotions, which I believe helped to create a safe space where

the patient felt comfortable expressing himself openly. As one of the only people on his care

team who knew the state of his psychosocial health, I became his biggest advocate in team

meetings. Contrary to my successes, there were also areas of care where I could have done

better; including optimizing our time and ensuring each intervention was working towards goals

that were the most critical for a successful discharge home.

A thorough analysis of this experience allowed me to recognize that the time patients

have in therapy is extremely valuable, which means prioritizing interventions and obtaining

appropriate adaptive equipment is crucial when time is limited. This experience also taught me

that the therapist - patient relationship is unique, patients confide in therapists due to the high
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level of trust that is built during therapy sessions. Being an advocate for my patients who are

struggling with the psychosocial components of their condition or injury is just as important as

providing effective treatments. Using Gibbs’ (1998) reflection process brought me to the

conclusion that if I were to face a situation like this again, I would focus on how each individual

treatment session will be beneficial to the patient’s safe discharge home. In order to do this, I

would encourage an open dialogue between myself, the care team, and the patient/patient’s

family. I would ask about their concerns for discharge and work through the best ways to address

those concerns. My sessions would focus on strategies and the practicing of skills to help the

patient feel as comfortable as possible with the discharge plan.

Fish, (1991) incites the reflection process to follow the factual, retrospective, substratum,

and connective, layout. The following experience was processed using this type of reflection

layout. During my fieldwork I had a young adult female patient who had a spinal cord injury.

The patient was still living at home with her mother and siblings when her accident happened,

and her mother was her primary social support during her time in the hospital. The patient was

legally an adult and had the cognitive ability to make decisions and independently participate in

therapy. The patient’s mom was very protective of her daughter and had anxiety about her

child’s safety and progression during rehab. As I reflect on the facts of this situation, I am able to

retrospectively understand the patient’s mother was fulfilling her role as a parent and was an

essential part of the patient’s success during her time on inpatient rehab. However, at first, she

was also a barrier to the patient’s success. Parents instinctually want to nurture and help their

children but sometimes in this setting an overprotective or overly helpful parent unintentionally

prevents the reinforcement of skills learned during therapy.

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In order for patients on inpatient rehab to be successful, it is imperative that they

continuously implement skills they learn during therapy. When people who are part of their

environment create barriers to the implementation of skills it slows down the rehabilitation

process and could create permanent barriers. The PEO model is, therefore, important to consider

during every patient’s time on inpatient rehab. In this case the environment was the patient’s

mother who had to be educated on the importance of letting the patient complete tasks

independently despite them being challenging. In the future I will have a conversation with the

adult patient to ensure they understand the importance of completing tasks independently.

During therapy sessions I will explain to the patient’s social supports that task completion during

this stage of rehab is challenging, but it is imperative to let the patient work through their

struggles in order to begin the process of regaining independence.

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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.

Rolfe, G., Freshwater, D. & Jasper, M. (2001). Critical Reflection for Nursing and the Helping
Professions: A User's Guide. Basingstoke. Palgrave Macmillan.