Role Emerging Practice: a Reflection

This reflection will be shaped utilising Gibbs’s reflective cycle (Jasper 2003). Gibbs’s reflective cycle was chosen due to its simple nature and its malleability (Wilding 2008).

This is a higher level of reflection and it aims to expand on a previous reflection to enhance my learning to aid personal and professional development. I will critically reflect and discuss the key themes of client-centred practice, developing confidence in implementing the Model of Human Occupation (MOHO) through utilising supervision and personal and professional development. Specific, measurable, achievable, realistic and timely (SMART) goals will be set to promote personal and professional development (Thomson and Black 2008).

I aimed to implement the MOHO on my role emerging placement in an attempt to develop professionally, however, I opted to apply the Canadian Model of Occupational Performance (CMOP) as I feared failure in the application of MOHO. As a consequence, my lack of confidence and failure to utilise supervision to address my anxieties compromised my learning.

Generic occupational therapy models act as a conceptual lens to view occupational needs and ensures the occupational therapist provides holistic and client centred services (Hagedorn 2004). Models guide occupational therapists through assessment, interventions and evaluations, improving service delivery and integrating theoretical and philosophical aspects of occupational therapy into practice (Clarke 2003). The implementation of CMOP on my role emerging placement enabled me to truly work holistically and guided client centred practice. Client centred practice is expected of all occupational therapists as outlined by the College of Occupational Therapists (COT) (Clarke 2003; COT 2005a; Duncan 2006; Kronenberg et al 2007). The CMOP focuses explicitly on spirituality and the cultural environment, this seemed to suit a placement in a multicultural setting (Belcham 2004; Clarke 2003). This was my justification for its implementation.

In contrast, I feel that my lack of confidence implementing MOHO, due to practical inexperience, its theoretical complexity and jargon, forced me to implement the CMOP (Duncan 2006; Hagedorn 2004).  I was afraid that if I had applied the MOHO it would result in failure due to my lack of confidence in its complex theory and terminology. I thought I would confuse myself and, even worse, clients with limited English language. Transferring its terminology, such as volition and personal causation, into a simpler format seemed impossible at the time (Kielhofner 2002). Professional standards (COT 2005a; HPC 2008b) stipulate that ensuring clients understand is professional behaviour and coincides with ethical requirements and client centred practice.

I feel I should have read clinical application studies to familiarise myself more with MOHO and utilised supervision with my occupational therapy supervisor to address concerns in its application. Planning supervision better to discuss my anxieties would have ensured that I received the professional support I required to increase my confidence in its implementation.

The Department of Health (DoH) and the COT are committed to client centred practice; the CMOP runs parallel with their agenda, reinforcing its credibility (COT 2005a; DoH, 1998). Over the course of my role emerging placement I identified the CMOP as an appropriate generic model suitable to asylum seekers and refugees and justified its implementation successfully. However, I feel I implemented the CMOP as a safe option due to having experience in its application. I understand that my practice placement was a safe environment to experiment with models and expand on knowledge and experience, but my fear of failure prevented my learning.  The MOHO is client centred and had I applied this, I would have developed professionally (Cook and Birrell 2007; Haglund and Kjellberg 1999; Finlay 2007; Kielhofner 2002). The CMOP is poorly evidence based and this could potentially devalue its use, but the MOHO is validated through theoretical arguments, various assessment tools and widely researched clinical application studies (Clarke 2003; Finlay 2007). This makes the MOHO an evidence based choice for occupational therapists to implement.

My role emerging experience has highlighted the gaps in my knowledge and as an occupational therapist I need to be confident with the MOHO approach and terminology to ensure I follow evidence based practice as some settings may opt to apply MOHO over the CMOP. 

As a client centred occupational therapist I must deliver language in an understandable fashion (COT 2005a). I did this well when implementing the CMOP, however, had I applied the MOHO, I fear I may have experienced difficulties initiating this requirement. The DoH in the Knowledge and Skills Framework (KSF) (2004) express that communication is a core dimension and as part of my duties I should reduce barriers to communication (DoH 2004). Utilising jargon free language would ensure client centred practice and embracement of KSF.

Essentially, occupational therapists are client-centred practitioners; client-centred values ensure clients are central to treatment, and utilising a generic model, whether the MOHO or CMOP, empowers the occupational therapist to provide a package of care that is designed to meet individual occupational needs and provide quality services in traditional and role emerging settings (Creek 2003; Sumsion 2006).

I should have utilised supervision as a coping strategy to overcome difficulties applying the MOHO to increasingly instil confidence in its application and utilised my core skill of problem solving to find methods of transferring its terminology into simple language (COT 2006c; Edwards and Burnard 2003). Supervision is an integral support system that all occupational therapists should utilise to manage stress levels, increase job satisfaction, promote learning and high quality services (COT 2006a). As a band five occupational therapist I may be required to implement the MOHO as part of my role. Without the experience and confidence in its application and ability to transfer its language into accessible English, I fear I may struggle providing the required excellence in care to clients (COT 2005). Effective and well prepared supervision would be a valuable resource to ensure best care is delivered and to promote my own personal and professional development to becoming a confident occupational therapist (COT 2006a).

I am committed to lifelong learning and personal and professional development. This is a requirement of the COT and HPC (COT 2002; COT 2005b; COT 2007; HPC 2008b). The KSF (2004) will enable me to indentify my learning needs and provide a structure for personal and professional development so that I will continually develop as a qualified occupational therapist (Morley 2007). I have gained valuable experience and skills in applying the CMOP, but my learning need is to digest the MOHO and transfer its terminology into user friendly language, ensuring ethical and client centred services are provided, as required by the COT (COT 2005a).

Reflection is a requirement of the COT and the DoH (COT 2005a; COT 2005b; DoH 2004).  Reflection is a crucial tool to critically evaluate actions and thinking to promote learning and changes to behaviour to ensure professional practice is improved upon (Duggan 2005). This reflection has increased my awareness of my actions, the decisions I made and enabled me to identify issues that would prevent excellence in practice, namely my anxieties on implementing the MOHO.

To conclude, occupational therapy has the opportunity to extend its boundaries and branch out into role emerging areas (Clouston and Whitcombe 2008). If I was to work in a role emerging setting I would need to ensure that I utilised professional tools to ensure I was practicing competently and holistically, and the application of generic models is key to providing quality client centred and holistic care (Hagedorn 2004; Sumsion 2006). Moreover, occupational therapists must be confident in delivering quality services and identify the knowledge and skills to be applied in their role (COT 2006b; Hagedorn 2004). However, I need to utilise supervision to ensure professional issues regarding confidence in applying models is addressed. Generic models are a means to a view client’s occupational lives and ensures quality and client centred services are provided (Hagedorn 2004; Sumsion 2006). I have identified that I need to become more confident and competent in applying the MOHO to ensure I meet these expectations.

As an action plan, I will read clinical application studies on the MOHO four weeks before my final practice placement commences to increase confidence in its application and language and then transfer the terms into user friendly terms. I will do this by organising a set of user friendly questions to utilise when applying it. This will ensure that my confidence in its application and the professional terminology is increased on my final placement and as a qualified occupational therapist.

As a band five occupational therapist, I will embrace additional training opportunities on MOHO to continuously improve my knowledge and confidence to ensure quality services are provided and continuing professional development takes place.

A structured format to plan and guide supervision would enhance the supervision process and ensure professional issues were discussed and met. I will devise a structured agenda to guide supervisions in my final practice placement and upon qualifying. I will improve my time management skills by setting out time to plan and organise thorough supervision and set SMART goals to aid optimal development after supervisions. 

I will always utilise reflective practice to critique my own practice to continually improve the client centred services I provide. After reading clinical application studies regarding MOHO and developing a set of questions to guide my way through the terminology, I will reapply Gibbs reflective cycle to direct my learning to ensure optimum knowledge and development.

References

Belcham, C. (2004) “Spirituality in Occupational Therapy: Theory in Practice?” British Journal of Occupational Therapy. 67 (1), pp. 39-46

Clarke, C. (2003) “Clinical Application of the Canadian Model of Occupational Performance in a Forensic Rehabilitation Hostel”. British Journal of Occupational Therapy. 66 (4), pp. 171-174.

Clouston, T. and Whitcombe, S. (2008) The Professionalisation of Occupational Therapy: a Continuing Challenge. British Journal of Occupational Therapy, 71(8), pp.314-320.

College of Occupational Therapists (2002) “College of Occupational Therapists: Position on Lifelong Learning”. British Journal of Occupational Therapists. 65 (5), pp. 198-200

College of Occupational Therapists (2005a) College of Occupational Therapists Code of Ethics and Professional Conduct. London: COT

College of Occupational Therapists (2005b) COT/BAOT Briefings: 10 Key Roles. London: COT.

College of Occupational Therapists (2006a) COT/BAOT Briefing: Supervision. London: COT.

College of Occupational Therapists (2006b) COT/BAOT Briefing: Knowledge and Skills Framework for Occupational Therapy Staff. London: COT.

College of Occupational Therapists (2006c) COT/BAOT Briefings: Definitions and Core Skills for Occupational Therapists. London: COT.

College of Occupational Therapists (2007) Professional Standards for Occupational Therapy Practice. London: COT.

Cook, S. and Birrell, M. (2007) “Defining an Occupational Therapy Intervention for People with Psychosis”. British Journal of Occupational Therapy. 70 (3), pp. 96-106

Creek, J. (2003) Occupational Therapy Defined as a Complex Intervention. London: COT.

Department of Health (1998) A First Class Service: Quality in the New NHS. London: HMSO.

Department of Health (2004) The National Health Service Knowledge and Skills Framework and Development Review Process. London: HMSO.

Duggan, R. (2005) “Reflection as a Means to Foster Client-Centred Practice”. Canadian Journal of Occupational Therapy. 72 (2), pp. 103-112

Duncan, E.A.S. (2006) Foundations for Practice in Occupational Therapy. 4th Ed. London: Churchill Livingstone.

Edwards, D. and Burnard, P. (2003) “A Systematic Review of the Effects of Stress and Coping Strategies used by Occupational Therapists Working in Mental Health Settings”. British Journal of Occupational Therapy. 66 (8), pp. 345-355.

Finlay, L. (2007) The Practice of Psychosocial Occupational Therapy. Cheltenham: Nelson Thornes.

Hagedorn, R. (2004) Foundations for Practice in Occupational Therapy. 3rd Ed. London: Churchill Livingstone.

Haglund, L. and Kjellberg, A. (1999) “A Critical Analysis of the Model of Human Occupation”. Canadian Journal of Occupational Therapy. 66 (2), pp. 102-108

Health Professions Council (2008a) Standards for Continuing Professional Development. London: HPC.

Health Professions Council (2008b) Standards of Conduct, Performance and Ethics. London: HPC.

Jasper, M. (2003) Beginning Reflective Practice. Cheltenham: Nelson Thornes

Kielhofner, G. (2002) Model of Human Occupation: Theory and Application. 3rd Ed. Baltimore: Lippincott, Williams and Wilkins.

Kronenberg, F,. Algado S., S., and Pollard, N. (2007) Occupational Therapy Without Borders: Learning from the Spirit of Survivors. London: Churchill Livingstone.

Morley, M. (2007) “Building Reflective Practice through Preceptorship: the Cycles of Professional Growth”. British Journal of Occupational Therapy. 70 (1), pp. 40-42

Sumsion, T. (2006) Client-Centred Practice in Occupational Therapy: A Guide to Implementation. 2nd Ed. London: Churchill Livingstone.

Thomson, C. and Black. L. (2008) “An Exploratory Study of the Differences between Unidisciplinary and Multidisciplinary Goal Setting in Acute Therapy Services”. British Journal of Occupational Therapy. 71 (10), pp.422-426.

Wilding, P. M. (2008) “Reflective Practice: a Learning Tool for Student Nurses”. British Journal of Nursing. 17 (11). pp. 720-724.