Within this written work, the writer will describe three examples using their own experiences in working within a health and social care practice. It will also reflect upon those personal experiences.to ensure confidentiality and anonymity of service users and employer will be maintained throughout, service users and employers will be referred to as initials. The writer will also refer to academic research, further reading and theories on reflective practice and values and ethics of professional practice.
Edgar Schon, an influential writer on reflection, described reflection in two main ways: reflection in action and reflection onaction. Reflectionon action is looking back after the event whilst reflection in action is happening during the event. Reflection in action is defined as:
“To think about what one is doing whilst one is doing it; it is typically stimulated by surprise, by something which puzzled the practitioner concerned” (Greenwood, 1993).
Reflection in action allows the practitioner to redesign what he/ she is doing whilst he/she is doing it. This is commonly associated with experienced practitioners. However, it is much neglected. Reflection on action is defined as:
“The retrospective contemplation of practice undertaken in order to uncover the knowledge used in practical situations, by analysing and interpreting the information recalled” (Fitzgerald, 1994:67)
Alternatively Boyd & Fales suggest reflection on action is:
“The process of creating and clarifying the meanings of experiences in terms of self in relation to both self and world. The outcome of this process is changed conceptual perspectives” (Boyd & Fales, 1983:101)
Boyd and Fales focus more on self-development. Here refection does not only add to our knowledge but challenges the concepts and theories we hold. As a result we don’t see more, we see differently. Atkins and Murphy (1994) take this idea one step further and suggest that for reflection to make a real difference to practice we follow this with a commitment toaction as a result.
Using Borton’s (1970) framework for reflection; while working in an Extra-Care establishment, service user A, a Jewish man, partially sighted and almost deaf, was given a meal of bacon, tomato and pork sausage. Being Jewish, according to Hawker and Campbell (2009) should have been kosher meat, service user A should not have been served that meal. Upon reflection, service user ‘A’ should have been given a choice of what to have for lunch, which he had not as he would not have chosen pork. He should also, being partially sighted, been shown what was on his plate. Moore (2000) states individuals suffering from visual impairments may require assistance in orientating themselves; carers could have accomplished this by the time method, i.e. your potatoes are at three o’clock.
According to Nzira (2009) this could be seen as oppressive practice- and trivialising his religious faith. The lack of choice in daily living activities, disempower service users and take away their dignity and independence. Thompson (2009) denotes; out-dated approaches to disability disempower individuals with impairment; which Harris and Meridith (2005) proposes that each individual is vulnerable from having little or no control over their lives. Brisenden (1986) theorises; to deny them of facets of control over their personal lives, they become excluded by isolation, thus suffering from marginalisation and dehumanisation-at an individual level through bigotry and misapplied pity.
Britain is now multi-cultural through social acceptance and the promotion of diversity. In relation to service user A, implementation of anti-oppressive practice, would maintain a power balance between service user and practitioner. Thompson (1997:32) defines oppressive practice as degrading treatment of a person or people; the negative exercise of power which can involve disregarding the individual or group’s rights- thus a denial of citizenship.
This instance has, through my reflection on action, improved my practice.
Within my work I have implemented new strategies to work with and informed several service users of entitlement and what their rights were and what aids or tools were available to support them and promote their independence. But, I had little knowledge of the Jewish faith and felt unable to speak about it until I had more knowledge.
My reflection in action advised me that I must take steps to prevent this situation occurring again. After looking at policies and procedures in place, which advised to take this issue first to my line manager in private and made her aware I was going to raise the issue in the next team meeting to hopefully reach a collective solution and also gather staff names to attend training days on this issue.
A gentleman with progressive dementia, who attended the day opportunities/ lunch club, was sat on his own at a table. This service user cannot walk without support and I was aware he was supported into dining room.. After lunch he was supported to the lounge and taken to an armchair, away from other service users who were playing dominoes on one side of the room. Excluded from the other service users, no offer of participation with other’s and unable to express wishes fully, this gentleman had little, if any, interaction with the group in the time he was there. Arber and Ginn (1995) propose this would be undervaluing and disregarding older people, dismissing their involvement in society and their wishes and presenting them as a problem or irritation. The exclusion of this gentleman was not only accepted by staff but also by the group. Thompson (2009) enthuses;
“Day centres can be utilised to reduce an individual’s social isolation and the associated problems that go with it […] Monitoring someone who has complex needs; developing skills, social and life skills; communication skills, and so on ” (Thompson; 2009)
I initially pre-judged the group, both carers and service users. I precluded that the culture of this small group of people over time had developed negative values and beliefs, and ethics. It appeared there was a non-acceptance of any diversity in others. Open discrimination and oppression which I perceived had been accepted as the norm. However; on reflection, Social work is about working with people to resolve their difficulties as far as possible, and doing things to or for people should only happen when necessary. Thompson (2009) enthuses; An significant portion of empowerment is partnership, which; (i) involves not assuming a top down approach presuming the expert knows best (ii) working within a multidisciplinary complex system […] identifying that whilst social workers have an vital role to play, so do further professionals we work along with.
Upon meeting service user B for the first time; a lady who had suffered a stroke which left her paralysed down her right side and unable to form words in speech. This led to communication issues with not only care and medical staff but even her family found great difficulty in understanding and conversing with her. Sife, W (1998) theorises, attitudes to persons with a speech dysfunction set aphasia apart as an impairment which dehumanizes and isolates the person This together with the prevalent opinion of the aged as second class citizens- conveys a demeaning insignificant status to the older aphasic patient. Giving this lady a letter-board to point to individual letters to communicate hasgiven a liberation of thought. This has led to confidence building in service user B thus realization of her potential through the process of further re-ablement, enhancements and the promotion of independence.
In conclusion, being a reflective practitioner, it is essential to be honest with yourself and others. It is not, however, always a comfortable process. Eby (2000a) defines reflection as enabling practitioners to make sense of their lived experiences through examining such experiences in context. Reflection is thinking about our actions. Initially, it is a conversation with ourselves.
BIBLIOGRAPHYMoore, D. (2000) Substance Use Disorder Treatment for People with Physical and Cognitive
Disabilities: Treatment Improvement Protocol. DIANE Publishing,
Hawker, F and Campbell, B.(2009) Judaism in Israel. London. Evans.
Harris, N and Meridith, P (2005) Children, education, and health: international perspectives on law and policy .Hampshire. Ashgate. 10:201
Sife, W. (1998) After stroke: Enhancing quality of life. London. Routledge, 7:85
Thompson, N. and Thompson, S.(2005) The Social Work Companion. Palgrave.Macmillan.
