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Practice Learning Opportunity (PLO) Reflection

Info: 4872 words (19 pages) Essay
Published: 8th Feb 2020 in Nursing

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Reflection on Practice Assignment

Introduction

The Practice Learning Opportunity (PLO) is an integral part of a SW’s training.  To complete my PLO, I was assigned a placement in the Belfast Trust in a hospital setting, for children aged 14 and under.  The team that I was part of was made up of SW’s, but liaised closely and worked as part of a multi-disciplinary team method including nurses, doctors, occupational therapists, physiotherapists and psychologists.  My role as a student SW involved liaising with said professionals on a daily basis, as well as private and voluntary based organisations, as well as carrying out statutory tasks such as SW assessments, care-plan reviews, multi-disciplinary assessments, and risk screenings.  As it was my first placement, I wasn’t completing risk assessments alone, but I was afforded the opportunity to complete these alongside other SW’s.  I was fortunate that I was able to complete a variety of challenges that I was faced with in this type of placement, as it there were so many aspects of SW required, in such a fast-paced environment.  Upon reflection, I can view this placement and the challenges it presented as a positive overall experience, and gave me the chance to acquire a variety of new skills and afforded me the opportunity to develop and deepen my base knowledge of social work (SW) implementations.  I was given the opportunity to engage in every aspect of the SW process on the placement from assessment, to planning and intervention and reviewing the whole process.  I definitely believe that my PLO provided me with an invaluable amount of experience.  Even though the placement was only 85 days, it gave me the opportunity to develop the skills and values needed to continue on my journey to completion of my degree. 

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At the beginning of my PLO I was apprehensive and anxious due to the types of SU’s (SU) that I would be meeting and assisting, as well as the range of tasks that I would have to be completing in a professional manner.  My apprehension may have stemmed from the never working in such a professional capacity where there was so much responsibility upon one’s shoulders. I didn’t expect there to be so much pressure placed on a SW within the setting that I was in, along with the countless challenges that the SU’s would be facing; ranging from routine discrimination, to difficulty in accessing community services.  My Practice Teacher (PT) gave me the opportunity to get straight into the thick of the SW role, and allowed me to interact with Service User’s (SU) whose conditions included physical and complex learning difficulties.  Initially I felt completely out of my depth working along with SU’s, but with the support of my PT I knew that I would be able to develop the skills and knowledge required to work competently with SU’s.

This paper will use a constructive self-critique approach to reflect upon my PLO.  It will scrutinise my experiences, my practice and identity key areas for professional development. Reflective practice is the self-recognition of limitations within the vocation which can highlight the groundwork for present and future professional development (Ingram et al, 2014).  The Gibbs (1988) model had been used to reflect upon my learning in relation to two of the SU’s that I have worked with, in connection with two themes.  I will identify and demonstrate key learning points along with my future learning needs for my practice to anti-oppressive.

Critical Reflection:

Kolb (1984) states that the feelings of incompetence that a student may feel can restrain their capability to engage professional self-awareness.  This type of insight was significantly relevant to my PLO which began with my accepting guidance from my PT, and relying upon it rather than exploring my feelings of initial incompetence (O’Hagan, 2005).  Initially, this presented itself as an obstacle, as I was relying upon the direction and guidance of my PT, rather than reflecting upon my self-awareness and initiative appropriately when completing tasks in a professional manner.  On reflection, the feelings of trepidation were removed when my PT stated that I was displaying competency in my practice.  Through supervision, I soon found that being open and honest with my PT, gave me the change to reflect upon cases, and gave me confidence in my practice.  Through speaking with my PT, I knew that I was accountable for my own learning, and the quality of work that I completed (NISCC, 2015).  It was through supervision that I committed myself to develop my own critical reflection skills by challenging myself more about the potential influences my personality and my use-of-self had on practice (Douglas, 2008) as I had not realised how much of the self can directly influence the type of intervention that may be completed.  Again, through supervision I identified assumptions that were subconscious, prejudices and personal values, which gave me the opportunity to explore ways of managing these in my own practice.  By recognition of a response to particular situations, I was able to develop my own self-awareness, and gave me the opportunity to inspect my own thoughts and feelings of prejudice (Trevithick, 2013).

Justification for Structure:

The best and most effective way of reflection is garnered when practitioners follow the direction of a model of reflection, which can be found from Kolb (1984), Gibbs (1988) and Fook (2003).  These are the main models that practitioners use, and they all have strengths and weaknesses, but altogether they play an important role in allowing practitioners to enhance reflective learning.  Kolb’s (1984) model allows for a broad approach in self-reflection and is used by some of the best practitioners in the field.  His cycle is used for both a broad and in-depth approach towards learning.  I found it to a very efficient approach for my own critical self-reflection.  Fook’s (2003) cycle allows for the practitioner to reflect upon theory and practice; as it focuses on learning from experience and creates a practice theory and develops meaning from it.  It is quite a complex approach to learning, and it is used by seasoned practitioners who have the experience in using such complex methods of reflection. (Pockett and Giles, 2008).  Fook’s cycle can useful but for this reflective piece I have chosen to use Gibb’s (1988) model whilst drawing upon Schon’s (1983) framework as the majority of my learning happened to occur through ‘reflection on action’.  Gibb’s model gives a much more sophisticated focus on areas of reflection through a six-stage framework which can applied suitably to my PLO (Ingram et al, 2014).

Dealing with life threatening condition & need for SW support during family crisis

Ms A (A) is a seven-year-old girl, who had been diagnosed with a spinal tumour, and limpness of the right side.  A had recently been an inpatient in a hospital setting for many weeks as she had under-went serious surgery to remove a tumour.  It had been reported by A’s mother that post surgery, A had been having difficulties with her behaviour, and it was having an effect on familial relationships.  A’s mother had stated that she needed the support of social services in terms of financial support as well as housing support.  It was an ongoing issue with familial relations that was the main problem the family had been facing, and they were in need of direction and support from whoever could give it. 

Initially I felt quite apprehensive about interacting with A, and her family, as it had been identified of her poor behaviour and lashing out at those around her; both verbally and physically.  A had a poor attention span, and post-surgery, had limited concentration levels, which had not been apparent prior to surgery, which could potentially mean that A was displaying these characteristics because of the surgery and it was how she was dealing with it (White, 2011). In first meeting with A, I felt out of my depth and ill-equipped to support A and her family, due to a lack of understanding and knowledge surrounding the condition and the support needs (PPDW, 2018). I acknowledged this was due to being a student and not having worked in a hospital setting prior to this.  I also acknowledged that I had to work in a professional manner with A and her family and therefore it was my duty to research the condition and ask questions to those who could answer.  When I reflected upon my feelings with my PT, I was encouraged to take personal ownership of my own learning, and reflect on the self-awareness of unintentional prejudice towards individuals with disabilities and their families (Trevithick, 2012).

Through the use of reflection-on-action (Schon, 1983), I was able to acknowledge my role, in which I was committed to support and empowering those who cannot support or advocate for themselves.  The preconceived ideas, and prejudices that I identified through supervision, related to my own attitudes and beliefs towards individuals with disabilities and need I felt for A to have the same capabilities as everyone else (PPDW, 2018). Upon reflection of these emotions and using Thompsons (2006) PCS model, I felt that I was unintentionally oppressive towards A and her family.  I found myself supporting the medical model of disability instead of advocating the social model.  In a hospital setting it is quite easy to tend to lean towards the medical model, as nearly every other profession in the setting relied upon the medical model, and it was only the social service department that would tend to see illness and disability through a social lens. I should have focused on the fact that disability is caused by the way society is organised rather than the individual’s personal impairment or difference (Shulman, 2006).  Therefore, in the role as a practitioner I was attempting to find ways to break down the barriers between the medical and social model, and give A more choice and support (Coulshed and Orme, 2012).

It is claimed by Grant (2014) that a practitioner’s self-awareness requires them to recognise their own person values and should identify how it can possibly mould their attitudes.  Through using Schon’s (1983) ‘reflecting-on-action’, I realised that individuals all have different standards and different viewpoints on the world, which may not always align with my own personal values (Thompson, 2015). I was able to recognise through the guidance of my PT, that these views can reinforce the theory of ‘disabilism’, which Dominelli (2009) states as viewing disabled people as “lesser beings who are incapable of leading normal lives” (p.65). I feel that the feelings I had can relate to Thompson’s (2006) PCS model which can allow individuals to feel as being less able to due their differences.  Through this reflection I feel that it has provided me with the ability to recognise that the values I possess in practice, can have the potential to reinforce structural oppression which can in turn disempower SU’s (O’Hagan, 2005).

A was acting out towards her father more-so than her mother, and that was a difficult situation, and was causing familial problems (PPDW, 2018).  The relationship that had formed between A and her mother was that of great strength, but on the opposite side, the relationship that she had carved with her father was becoming more strained, on A’s part.  On reflection I felt that there were some serious attachment issues.  Upon discussion with my PT, I felt that the attachment issues could be stemming from A’s mother being by her side during the surgery she had undergone, and her father going home to look after her siblings.  There could be feelings of resentment of being abandoned (Bowlby, 1998).

A’s mother had been the first person to bring up the intense situation that they were facing as a family with the strained relationship with A and her father.  She felt that someone needed to speak to A and explain that her father was there for her too, as A did not want to hear it from her parents.  During a visit to A, it was very apparent the differences in the relationships she had formed post-surgery with both her parents, and through reflection-in-action (Schon, 1983) I found myself agreeing with A’s mother that someone needed to speak to A on a personal level in which she could understand without her father there (PPDW, 2018). However, when reflecting after the visit, I recognised the need for A’s father to be present when discussing the issues, as it would incorporate all their feelings in the conversation.

Through supervision, my PT gave the me the opportunity to explore how oppressive the imbalance of power can have in practice.  My PT gave me the insight that my role is mandated under legislation and key policy, which requires me to advocate on another’s behalf (White, 2004).  Oppression can be explained as the process of restricting an individual who may potentially not have the same capability as others (Barker, 2003) or an individual who is deprived of opportunities and choices by another individual who has more power (Thompson, 2015). Through this understanding of oppression, I was able to relate it to my professional relationship with A and her family.  Had I used my professional position to facilitate a meeting with someone to discuss A’s feelings without her father present, it may have caused a further rift (Milner et al, 2015).

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Upon further reflection, in carrying out visits with A, I became aware that her capacity to make informed decisions had not been considered or appropriately assessed (Davies, 2013).  Through speaking with the clinical psychologist who had worked with A, I found that she was able to make the decisions herself, and was able to decide if she wanted to form a relationship with her father, but that it was important that she understood all the circumstances surrounding her illness, and her fathers involvement.  This clarification from the clinical psychologist made me aware that I had not considered A’s capacity at such a young age to make these types of informed decisions, and therefore were unintentionally judgemental and oppressive (Trevithick, 2012).  I realised that I had to change my person-centred attitude, and give A guidance and advice rather than coerce her into having the conversations with her father present. This type of understanding made sure that I was empowering A, rather than oppressing her.

It was through building a rapport with A that I became aware of her frustrations towards her father, and that she felt that he loved her siblings more than her.  It became apparent that as with any relationships, it can be difficult to navigate, and it must have been very frustrating and confusing for a seven-year-old girl to try and navigate with her father.  This journey of learning had given me the opportunity to reflect on my interaction with A, and I feel has increased my professional development regarding the challenges of working in a person-centred focus.  I feel that as it is evident above my own values an perspectives can unintentionally affect my practice and my way of thinking, and it demonstrates the need to reflect on action, to rectify the oppressive feelings one may have unintentionally or subconsciously.  By taking ownership of my own learning and being aware of the unintentional prejudice towards individuals with disabilities ensured that my attitude stayed focused in a person-centred way (Trevithick, 2012).  Through working with A, I feel it has provided me with an increased awareness of theories such as ‘disablism’, and developed my knowledge of such theories, as well as my own views of disability, and can be seen to highlight the social model which is closely linked to my own value base and attitude towards disability (Thompson, 2015).

Comprehensive Needs Assessment: Child B

Child B (B) is a new born who was born with spina bifida which was diagnosed antenatal. B has since been discharged since my needs assessment, and is living with his mother and father and aunt.  My role as a student SW was to complete a comprehensive needs assessment to ensure that all B’s needs were being met, and to seek whatever support was available.  B was referred to us through the nursing team, as is standard when a child is born with spina bifida.

In preparation for contact I recall being quite nervous and anxious about meeting B and his mother, as I had never met a child with spina bifida before, and his mother did not speak English and there was the necessity for a translator to be present during the needs’ assessment.  I was concerned as I had never spoken to anyone via a translator, and I had concerns; that information could be lost in translation. It is characterised by Westlake (2017) who stated that although workers find using interpreters challenging, in practice it is skilled professionals who are able to work best when they adopt an assertive approach.  This is what caused concern, as I was a student on placement, I did not have the seasonality, and the experience of working with interpreters to be assertive. I questioned if I was able to remain person centred and non-judgemental which is an essential characteristic of a SW role (William and Evans, 2013).

Through ‘reflection-in-action’, I was able to acknowledge that these feelings were based upon my competency, and when I ‘reflected-on-action’ (Schon, 1983) I realised I needed to challenge these feelings of incompetency to ensure that I remained professional and capable throughout the contact.  I also needed to ensure that these feelings did not influence my attitude or responses to B’s mother (Egan, 2008). To combat these feelings, I researched the condition to allow a deeper understanding of spina bifida, as well as trying to learn a little about cultural interactions that were appropriate with B’s mother (Milner et al, 2015).

Prior to the initial visit with B and his mother, my anxieties perhaps clouded my judgement, yet, on reflection after meeting B and his mother, I realised that my anxiety and nerves were unnecessary.  Using ‘reflection-in-action’ (Schon, 1983), I realised that B’s mother was feeling more nervous than I, and that she was displaying signs of anxiety about meeting me.  I could tell this even with the language barrier through her body language, and I made sure to reassure her through the translator that I was there in a support capacity. Through speaking with B’s mother, I soon found that we could build a rapport even though there was a language barrier.  I ‘reflected-in-action’ and noted that by making an effort in communicating effectively, and by confirming things back with B’s mother, that we were able to communicate to a required level.  During supervision I placed myself in B’s mother’s shoes, and noted again how she must have been feeling anticipating the visit from social services, and the fear of the unknown as to why I was visiting.  I developed an empathetic approach to allow me to realise that B’s mother had been denied the basic understanding that I was not there out of risk assessment, but needs assessment.

Initially with B, and his mother, I was concerned about my ability to complete the needs assessment alone, as this was my first time, with the added dimension of having a translator present.  Therefore, in supervision, I received guidance from my PT who advised me to research ‘the effectiveness of translator services in the NHS’, and read policies surrounding the need.  I recall feeling shocked at the costing of translator services in the United Kingdom, but still understanding there was a need for the service, and that cost should be irrelevant, I must adhere to in collaboration with regional policies, SW values and Trust guidelines to ensure the SU gets the most appropriate service (Banks, 2012).

The main principles of any SW team should ben based upon inclusion, partnership and equality.  Therefore, regardless of any preconceived ideas of B’s mother I was conscious of my role as a practitioner to empower and advocate for social justice (NISCC, 2015). Through my research I came to the conclusion that I needed to facilitate an anti-oppressive assessment, and that I needed to include B’s mother as a vital part of that (Coulshed and Orme, 2012).  I unintentionally disempowered B’s mother initially by offering to help which Egan (2002) states can be the dark side of helping as “help itself can be disempowering” (Beckett, 2009, p.38). This was a vital lesson to learn as I needed to ensure that I was using wording and phrasing as positive as possible and not be perceived negatively.  My role as a student SW, is not to ‘help’ individuals and families, but to support, advocate and work on their behalf (PPDW, 2018).

My time with B and his mother was an integral part of my learning journey in my placement as it afforded me the opportunity to work with a SU and their family in which the situation as not as straight-forward; being that they were from a foreign country, and their language was unknown to me.  It gave me the ability to be held accountable as a SW, as I was the sole practitioner completing the needs assessment and therefore, I was the one who could ensure that B was sign-posted to the best services, and given the best support available, in the most anti-oppressive way possible.  By understanding the stigmas surrounding disability and the limited opportunities that those who have a disability can face, including choice should help me to empathise in future with other SU’s, and advocate more effectively, on behalf of those SU’s, with similar disabilities (Ingram et al, 2014).

Conclusion

This paper has reflected critically on my practice in placement and has highlighted key learning moments in my PLO.  I have identified certain aeras of professional development in relation to remaining person-centred and anti-oppressive.  The ability to reflect on practice has most certainly improved in this PLO due to the support I received from my PT and the team.  Whilst I acknowledge how my competence has improved during my PLO, I also recognise that I have some way to go to being completely competent as a SW.  I need to enhance my confidence to a point where I am comfortable to advocate proactively for those who are unable to do so themselves, as well as addressing all forms of oppression faced by SU’s in society (Wilson et al, 2008). I am aware than the practice of reflection is an area for continuous development and should be continued throughout one’s career, and is a continuous process of developing knowledge, skills and values (Taylor, 2010).  I am also aware that an effective practitioner does not limit themselves to what they learn in the degree, but continue to learn and evolve when qualified. This assignment has demonstrated how I have developed my values and skills since starting my PLO.  I am also aware that that self-awareness is key to ensure non-discrimination or unintentionally developing prejudicial values.  By integrating Gibbs (1988) model of reflection, I developed a process that enabled me to identify the similarities and differences in practice.  By reflection upon Schon’s (1983) model I became more self-aware during my PLO.

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