Rolfes Framework on Reflective Practice and the Impact of Communication Processes - Assignment Example

Part 1 – Introduction to Reflective Practice Reflective Practice is used as an important strategy by health professionals. It is learning from experience, which is put into use by health professionals who have dedicated themselves to life long learning. Reflection allows the development of “autonomous, qualified and self-directed professionals. It allows for improvement in the quality of care, and encourages professional and personal growth. Reflective practice also bridges the gap between theory and practice. There are several levels by which reflection can be undertaken: a) simple problem solving, b) Using literature and theories to illuminate the analysis of the scenario under review, and c) consideration of broader forces, of issues such as justice, and emancipation and of political factors. There are also several models and techniques on reflection which may best suit various practitioners. This paper describes Borton’s framework (1970) as further developed by Rolfe, et al (2001). Rolfe’s framework as developed from Borton’s developmental model asks the general questions: What?, So what?, and Now what?, to stimulate reflection. This method applies to both novices and advanced practitioners. The practitioner initially reflects on the situation so that he would be able to describe it. The second step is for the practitioner to construct a personal theory and knowledge about the situation so that he may learn from it. The third level is for the practitioner to reflect on the possible action to be taken in order to improve the situation. The practitioner also reflects on the possible results or consequences of his actions. The final stage, according to Rolfe, is one – and this can make the most significant contribution to practice. The table below illustrates Rolfe’s Framework on Reflective Practice. Table 1. Rolfe’s Framework on Reflective Practice. Descriptive level of reflection What … ® ã ¬ … is the problem/difficulty/ reason for being stuck/reason for feeling bad/reason we don’t get on/etc., etc.? … was my role in the situation? … was I trying to achieve? … actions did I take? … was the response of others? … were the consequences · for the patient? · for myself? · for others? … feelings did it evoke · in the patient? · in myself? · in others? … was good/bad about the experience? Theory - and knowledge - building level of reflection So what … ® ¬ … does this tell me/teach me/imply/mean about me/my patient/others/our relationship/my patient’s care/the model of care I am using/my attitudes/my patient’s attitudes/etc., etc.? … was going through my mind as I acted? … did I base my actions on? … other knowledge can I bring to the situation? · experiential · personal · scientific … could/should I have done to make it better? … is my new understanding of the situation? … broader issues arise from the situation? Action-orientated (reflexive) level of reflection Now what … ¿ … do I need to do in order to make things better/stop being stuck/improve my patient’s care/resolve the situation/feel better/get on better/etc., etc.? … broader issues need to be considered if this action is to be successful? … might be the consequences of this action? Part 2 - Discuss the impact of communication processes For the past four decades, numerous universities worldwide have been developing interdisciplinary education programs. One of the early meetings held at the National Seminar on Interdisciplinarity, which was organized by the Centre for Education Research and Innovation (CERI) at the University of Nice, France in 1970, saw the earliest attempts at defining the multiple levels of teamwork. It sought to bring together those responsible for creating interdisciplinary programs in their respective institutions all over the world (Schorr, 1998). An interdisciplinary group consists of persons trained in different disciplines who work together on a common problem. Professionals in such a group tend to practice within their own discipline; however, team members exchange information on a regular basis, have open lines of communication, and try to collaborate on program planning. The client or consumer is usually more involved at all levels of service, and the written assessment made by the team is usually integrated. Each member’s contribution is appreciated and respected (Apostel, Berger, Briggs, & Michaud, 1972; Briggs, 1997; Foley, 1990; Garner, 1995; Klein, 1990; Mayville, 1978; Welt-Garland, 1995). In an interprofessional group, people from multiple professional groups are involved in planning and service delivery. Information, knowledge, and skills are exchanged because flexible boundaries support interchangeable roles and responsibilities. Decision-making involves both consensus and collaboration, so that all members have a role in the process and can learn from each other. The consumer or client is an integral member of the team with the highest authority and decision-making power in the group. Some might define this as transdisciplinary (Apostel, Berger, Briggs, & Michaud, 1972; Briggs, 1997; Foley, 1990; Garner, 1995; Klein, 1990; Mayville, 1978; Welt-Garland, 1995). The two terms are often used interchangeably. However, the term “interprofessional also refers to the applied skills orientation of professional education. This involves the preparation of the practitioner who will work with other professionals in schools, hospitals and service agencies. Oftentimes, the practice of interprofessional methods has been based on knowledge and skills acquired during in-service training or on-the-job situations (Schorr, 1998). From its early days in the 1970s, interdisciplinary teams have been used to address social problems. They have been engaged in various settings from schools, hospitals, court systems, rehabilitation centers, mental institutions, public health programs, employees assistance, prisons, and health and welfare agencies (Bassoff, 1976–1977). Though interprofessional practice has been shown to be an effective model, there is an existing need for more skilled and knowledgeable practitioners. Thus, interprofessional education should be included in the curriculum of academic institutions. There are numerous challenges to the interprofessional practitioner and more difficulties arise when it comes to providing education for this kind of work. Many universities have begun to address these difficulties by providing students with classroom experiences and internship programs which would prepare them in helping people whose problems require multidisciplinary expertise. The foremost barrier is the creation of an effective interprofessional education program. In some universities, there is the difficulty of balancing between professional education programs and interprofessional education programs. Some of the issues that arise from this balancing act include: the defence of one’s turf (Apostel et al., 1972; Bassoff, 1976–1977; Jacobs, 1987); professional ethics (Jacobs, 1987); degree of professional independence, training, tradition, and status (Apostel et al., 1972; Jacobs, 1987; Kahn in Rehr, 1974); and consent to share client information between disciplines (Jacobs, 1987). There may also be educational differences among professions. Issues that arise from this factor include: stereotypes and lack of trust (Bassoff, 1976–1977; Casto, 1987); language discrepancies (Jacobs, 1987); lack of knowledge of team dynamics and interprofessional collaboration (Bassoff, 1976-77; Jacobs, 1987; Kane, 1975); "differing conceptual orientations to people, needs, and interventions" (Kahn in Rehr, 1974, p. 19); "differing value systems and cultural substructures which characterize the different occupation groups" (Kahn in Rehr, 1974, p. 19); and different professional values (Wood, 1998). Organizational factors also serve as barriers, such as: salary differentials among professions (Jacobs, 1987); confidentiality (Jacobs, 1987); major operational difficulties, such as scheduling and budgeting (Apostel et al., 1972); inadequately defined goals (Apostel et al., 1972); fees (Jacobs, 1987); and malpractice (Jacobs, 1987). Schorr (1998) cited that there are four considerations for interprofessional educators , in order for them to become effective, which will entail them to depart from past practices and conventional wisdom. Front-line people should be educated so that they may be able to cross boundaries that separate professionals from each other’s domains. Educate practitioners who work “collaboratively and respectfully with clients, patients, children, youth and families, and who pushes the boundaries of her or his job description and sees children in the context of families and families in the context of communities. Encourage a new, much more integrated and coherent way of thinking about knowledge, practice, program design, and policy.” Part 3 - Communication Statement: “I wish I did not find it so difficult to concentrate properly on work, but my father is ill in hospital, and I can’t help worrying about him”. a) The most useful answer, and explain what type of answer you have chosen and what might be the effect of using this. “ It sounds like you feel pulled between being on duty and wanting to be with your dad.” The person is clearly distressed by the fact that the father is in hospital. The degree of distress is not known, which may be influenced by the degree of illness of the parent. The father may be gravely ill, which causes the worker to lose focus on his job. On the other hand, the parent might be in a stable and uncritical condition, and the worker may be unduly distressed. The remark I chose will serve as a means by which the worker can open up to me and give me a more accurate idea about his/her father’s condition. It also conveys sympathy to the person, giving him the knowledge that there are others who care for his welfare and those whom he loves. In the event that the worker describes his father’s condition as not critical and stable, then the practitioner can explain the situation with the end goal of placing things in a more positive light. He can also suggest possible courses of action which the worker could undertake in the conduct of his duties, and in looking after his father. The interprofessional practitioner may suggest a compromise condition which the worker can apply to both his work and his family. In case the parent is critical or gravely ill, then the practitioner can suggest actions the worker will undertake so as to give appropriate time and importance to his father and family. The practitioner can also help other co-workers understand the distressed person’s situation, so that his work or inability to do his work, will no longer add up to his personal problem. b) The most unhelpful, and explain what type of answer this is and what the effect might be. “Well don’t expect me to take on your work; we are far too busy for you not to pull your weight.” This is a most insensitive remark. It closes all avenues for communication. It is unfeeling and impersonal. There is no effort to empathize with the situation of the client, and thus, there is no possibility of arriving at any solution to the situation. It puts up a barrier between the distressed worker and the practitioner. The distressed worker would have a feeling of being alone. He will become more miserable, thinking that there is no one who could understand his/her situation. He will further fall into despondency and eventually become ineffective at his work. It would also put a strain on relationships, with the workers perception that others in the workplace are insensitive and unsympathetic. BIBLIOGRAPHY Apostel, L., Berger, G., Briggs, A., & Michaud, G. (Eds.). (1972). Interdisciplinarity. Problems of teaching and research in universities. Nice, France: Centre for Educational Research and Innovation, Organisation for Economic Co-Operation and Development. Bassoff, B. Z. (1976–1977). Interdisciplinary education for health professionals: Issues and directions. Social Work in Health Care, 2(2), 219–227. Briggs, M. (1997). Building early intervention teams. Gaithersburg, MD: Aspen. Foley, G. (1990). Portrait of the arena assessment. In E. Gibbs & D. Teti (Eds.), Interdisciplinary assessment of infants (pp. 271–286). Baltimore, MD: Brookes. Garner, H. G. (Ed.). (1995). Teamwork models and experience in education. Boston: Allyn and Bacon. Jacobs, L. A. (1987). Interprofessional clinical education and practice. Theory into Practice 26 (2), 116-123. Kahn, A., & Kamerman, S. (1992). Integrating services integration: An overview of initiatives, issues, and possibilities. New York: National Center for Children in Poverty. Kane, R. A. (1975). Interprofessional teamwork. Syracuse, NY: Syracuse University School of Social Work. Klein, J. T. (1990). Interdisciplinarity: History, theory, and practice. Detroit, MI: Wayne State University Press. Mayville, W. V. (1978). Interdisciplinarity: The mutable paradigm. Washington, DC: The American Association for Higher Education. Schorr, Lisbeth. 1998. Common Purpose: Strengthening Families and Neighborhoods to Rebuild America. Anchor. Welt-Garland, C. (1995). Moving toward teamwork in early intervention: Adapting models to meet program needs. In H. G. Garner (Ed.), Teamwork models and experience in education (pp. 139–155). Boston: Allyn and Bacon. Wood, G. J. (1998). An analysis of professional values: Implications for interprofessional collaboration. In J. McCroskey & S. Einbinder (Eds.), Universities and communities: Remaking professional education for the next century (pp. 25–35). Westport, CT: Praeger. Read More