RS3480/5357

Lecture

Reflective practice

Tony Wong, Clinical Associate

Department of Rehabilitation Sciences
The Hong Kong Polytechnic University

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 Learning Outcomes
At the end of the lecture, you should be able to
• Understand the importance of reflective
practice in occupational therapy
• Distinguish between “reflection-on-action”
and “reflection-in-action”
• Explain how to use “reflection-on-action” and
“reflection-in-action” in everyday practice

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 Outline
• Reflective practice
a) Old ways of thinking
b) Everyday practice
c) Complex therapy
d) Reflect in action
e) Reflect on action
f) Strategies of reflective practice

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 What is reflection?
Exploration / examination of ourselves and our actions
(often written but also spoken)
– considered
– rational, unemotional*
– in relation to theory / wider context / other
perspectives
Why do it?
– to develop understanding / learning / skills
– and give us a path by which to move forward
*(even though it often deals with feelings, reactions and emotions)
 What is Reflective Practice ?

Reflective
Practice

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 What is Reflective Practice ?
Learn by thinking about things that have happened to us
and seeing them in a different way, which enables us to
take some kind of action
• 3 components
1. Things(experiences) that happen to the therapist
2. The reflective processes that enable the therapist to learn from those
experiences
3. The action that results from the new perspectives that are taken
(Jasper, 2003)

• #2 & #3 are possible only if you adopt a style of Reflective Practice

that encompasses to :
– Your attitude and values
– Systematic critical enquiry, problem solving and clinical reasoning (Blank,
2009)

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 What is Reflective Practice ?
• You are already reflecting and learning from experience as a
person, for survival
• Using reflective practice to learn from clinical experiences:

• Help to identify knowledge and skills deficits

• Identify learning needs and assist us in facing difficulties
• Having experience is USELESS if you don’t REFLECT
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 Reflective practice
How can I
improve
my
practice?

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 a) Old ways of thinking
• In 1969, Line challenged OTs to discard their
old ways of clinical thinking.
1. physician prescription of OT: physician decides
OT goals and interventions
2. standard operating procedures: all clients having
a particular diagnosis receive a standard,
predetermined treatment
3. Customary thinking: clients are treated in a
certain way because 'we have always done it
this way’
Rogers 2010, p.59
 a) Old ways of thinking (cont.)
• These strategies limit the need for OTs to think
in the old days
• As the profession developed, OTs were
challenged to assume responsibility for the
thinking that guides their practice.

Rogers 2010, p.59

• “One definition of insanity is to keep doing
the same things, but expect a different
result.”

• “If you always do what you always did, then

you’ll always get what you always got.”

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 b) Everyday practice –
complex therapy
• In actual practice…
– Complex
– Uncertain
– Not stable
– Unique
– Conflicting values
• Everyday practice is a process of problem
solving
Schön, 1983, p.39
 OT process and reasoning
• Reasoning and decision making take place at
every stage of the OT process
– Data gathering and evidence discovery
• What is important?
– Theory application and treatment planning
• Which direction should I take in providing intervention
– Intervention
• What if my intervention isn’t working?
– Reassessment
– Ethical considerations
• Am I doing the right thing for the patient and the family?
 OR…solving the problem by
reflection-in-action
• Practice involves ACTIONS
• A practice problem is embedded in daily actions,
and solving a practice problem often happens
during the acts of practice
• When we spontaneously work on solving a
everyday problem, we are engaged in reflection-
in-action
• We can solve the problem by action, but we
cannot give a reasonably accurate or complete
description. That is called tacit knowing-in-action
Schön, 1983, p.49
 The basics:

Experience

Action Reflection
 Getting a feel of the action
• While in action, e.g., interviewing a patient,
running a group, in your mind…
– How am I going to do this?
– How well has this been working?
• You adjust the way you do it and continue to get
a feel of it…
• Until you feel it is right, and in your mind …
– It is the exact same way I did that before and it is
working again!
– This is working! I think I can do this again.
Schön, 1983, p.55
 Types of Reflective Practice

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 c) Reflection in Action
• The ability to think in the midst of action and
adapt to meet the demands of situation
• Often occur when USUAL approaches are not
working

Schön, 1983, p.55

• On the patterns of action
• On the situation
• On the know-how

…while performing the action

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 d) Reflection on action
• Critical think after the fact occur
• Explore how they handled the case, what has
worked well, and what hasn’t
• May do this …
– in spontaneous speculation
– in a deliberated effort to prepare themselves for
future cases

Schön, 1983, p.61

 What do OTs reflect on?

• It varies as widely as the practice situations

• An OT may reflect on…

– What is the recurring pattern that underlies a judgment?
– Which theories can be used to understand the behavior?
– How do I feel about the situation when I do it in a particular
way?
– How do I frame the problem?
– What is my role within the larger institutional context?

Schön, 1983, p.61

 Outside of ordinary expectations

Being reflective means that…

• When facing an uncertain or unique situation,

the OTs allow themselves to
– Experience the surprise
– Become puzzled
– Get confused

• They don’t just push the problem away or hide it

under the carpet.
Schön, 1983, p.62-3
 When facing uncertainties…
• The OTs reflect on…
– What happens right in front of them?
– Can we explain this based on prior experience?
• The OTs work on …
– Generating a new understanding of what is
happening
– Changing the situation

Schön, 1983, p.66-7

 e) Strategies of reflective practice
1. Comparative analysis
– Between textbook and real cases
– Between cases
– Within cases
2. Hypothesizing
– What the patient suffer ?
– What is the underlying cause
– What will be benefit
 1. Comparative analysis
• Comparative analysis involves examining
similarities and differences between new
clients and textbook scenarios or former
clients to gain insight about diagnoses and
strategies to apply to new clients.
• Students use textbook scenarios to develop
images of impairment in 'typical' clients with a
particular diagnosis.
Rogers 2010, p. 62
 Comparative analysis - examples
• Clients with severe strokes
– have hemiplegia and difficulty with bilateral
activities
• Clients with obsessive compulsive disorder
– manifest disordered thinking and make unusual
repetitive movements
• Children with autism
– exhibit rocking and other self-stimulating
behaviours and are unaware of their environment
Rogers 2010, p. 62
Compare between classroom learning
and placement experiences
• When students engage in fieldwork/placement,
they compare the characteristics of their clients
to the defining features of these prototypes.
• Students' reasoning goes something like this:
– “My client had a left hemisphere stroke with resultant
hemiplegia, and, therefore, if I work with my client
using the same strategies used for people following a
stroke I learned about in the classroom, I will get the
same outcomes in the same time limits.”

Rogers 2010, p. 62
 Building your experience library
• As students observe and work with 'real'
people, prototypes are modified.
• Students develop a cognitive or client library
based on their caseload.
• As professional experiences accumulates,
students not only add more clients to their
cognitive library, they organise their library for
easy retrieval.
Rogers 2010, p. 63
 Within client comparison
• Comparative analysis may be used within
client comparisons.
• During re-assessment, a client's presented
occupational performance may be compared
to the predicted outcome status.
• The comparisons allow therapists to know if
the OT intervention is having the anticipated
effect on occupational performance and
engagement.
Rogers 2010, p. 63
 2. Hypothesizing
• To hypothesize is to give an explanation for a set
of facts that can be tested through the use of
experimentation.
• Early in the assessment phase, therapists may put
forth several diagnostic hypotheses. An
occupational diagnosis is an educated guess,
which is based on foundational knowledge.
• Data collection is guided by hypotheses and data
are organised to support or dispute each
hypothesis.
Rogers 2010, p. 63
 Hypothesizing - examples
• Mrs. Ming is dependent in dressing.
• After observing her performing dressing
activities, the OT hypothesized that the reason
Mrs. Ming has difficulty dressing is due to the
poor motor control of the involved hand and
poor range of motion at the shoulder.
• The OT then evaluates Mrs. Ming's hand function
using the 7-level test and assess the shoulder
range of motion to ascertain if the hypothesis is
correct.
Rogers 2010, p. 63
 Ten actions of a reflective practitioner
1. Recognize your practice experience as an
avenue for learning.
2. Think about and reflect on the meaning of
your practice experience on a regular basis.
3. Recognize “other ways of knowing” as
important for good practice and as a
legitimate focus for your professional
development.

32 (Kinsella, 2001)
4. Work to develop your self-knowledge, political,
social and economic knowledge, and practical
knowledge, as well as traditional
technical/scientific knowledge.
5. Constantly examine your client’s context, the
context of practice, the cultural context, and the
systemic contexts in which your work occurs.
6. Critically reflect on the ideologies that inform
the systems in which you work, and take
meaningful action to advocate for positive
change; envision new possibilities!

33 (Kinsella, 2001)
7. Examine the assumptions that you bring to
your practice.
8. Articulate your espoused theory of practice;
recognize it as a dynamic growing entity.
9. Frequently compare your espoused theory of
practice (what you say) with your theory-in-
use (what you do).
10.Develop praxis: Action informed by
reflection.
34 (Kinsella, 2001)
 Values of Reflective Practice
• Prevent one from forcing a professional model or
theory to a client who requires something else
• Increase one’s sensitivity and adaptability to the
practice contexts
• Allow one to problem solve while doing
• Allow one to actively learn from experiences
• Provide an analytic tool to change one’s actions
to produce better outcomes
• Advance practice and develop professional
EXPERTISE
 Reflecting with your own/others
Do your own
– Written form: daily log,
– Reflective journal

Do with other
– Supervision/appraisal by supervisor
– Discussion with colleagues (in-depth, critical but
with respect)

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 Benefits from Reflecting with others
• More objective stance to you
• May ask questions that you have no thought
of yourself
• May offer a different ways of perspective
• Bring their own knowledge and experiences to
help you more understanding
• May offer options to you to act

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 Considerations
• Not comfort to listen what others say to you
• Feel that others are judging you
• Feel that you have done something WRONG

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 References
1. Blank, A. (2009). Reflection and professional practice. In A. Atwal & M. Jones (Eds),
Preparing for Professional Practice in Health and Social Care (P.41-49). UK: John Wiley &
Sons.

2. Jasper, M. (2003) Beginning reflective practice. Cheltenham: Nelson Thornes Ltd

3. Kinsella, E.A. (2001). Reflections on reflective practice. Canadian Journal of

Occupational Therapy, 68(3), 195-8.

4. Rogers, J. C. (2010). Occupational reasoning. In M. Curtin, M. Molineux & J. Supyk-

Mellson (Eds.), Occupational therapy and physical dysfunction: enabling occupation
(sixth ed., pp. 56-65). Edinburgh: Churchill Livingstone/Elsevier.

5. Schell, B. A. B. (2014). Professional reasoning in practice In H. S. Willard & B. A. B. Schell

(Eds.), Willard & Spackman's occupational therapy (12th ed., pp. 384-397). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

6. Schön, D. A. (1983). The reflective practitioner : how professionals think in action. New
York: Basic Books.

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