1 Ethical problems in psychiatry- Theories and models of reflection

1 Ethical problems in psychiatry- Theories and models of reflection  -by zoran.apostolovski19@bathspa.ac.uk

Many ethical issues in medicine are related to very uncommon scientific circumstances and also are an almost day-to-day the obstacle for mental wellness groups. We describe the honest issues that emerged in relation to a substantial difference of opinion between staff member regarding making use of nasogastric clozapine in the therapy of a drastically sick client. We review how conflicting feelings, as well as point of views within groups, obtain honest relevance and also just how the arrangement and also, reflection is necessary for good-quality honest reasoning to happen.

   “…the way that we learn from an experience in order to understand and develop practice” (Jasper, 2013).

Psychiatric research study has increased incredibly over current decades to assist in understanding the current patterns and much better restorative choices for illness. On the other hand, there is also a pattern towards greater rates of retraction of published documents in recent years. Principles is needed to maintain and increase the overall quality and morality of research study.                                                Psychiatric research study deals with numerous unique ethical difficulties. Ethical standards are a really essential tool of research study and safeguards participants. The present paper intends to review offered ethical problems and standards relating to psychiatric research study. 

 Psychiatric research study has numerous important ethical issues which are different from other medical disciplines. These concerns relate to notified approval, privacy, conflict of interest, therapeutic mistaken belief, placebo related, vulnerability, exploitation, operational obstacles, to name a few. The present paper has actually made a number of suggestions to deal with ethical obstacles frequently faced in psychiatric research study. 

The ethical guidelines are of utmost requirement for Indian psychiatric research. Particular standards are doing not have pertaining to psychiatric research. The issues and suggestions benefit further conversation and factor to consider.

    The term reflection was first identified as a separate special style of thinking as early as 1933 by Dewey (Finlay, 2008). He claimed reflection to be some form of doubt that aroused from the situation one experienced. In his perspective, reflective thinking encouraged problem-solving and shifted people’s usual way of thinking to the more critical and careful style of reflective thinking. Dewey was concerned that established beliefs and knowledge imposed to people by higher authority or social norms limit people’s ability to carefully rethink and make personal judgements on situations they found themselves in and on the actions they have to make or made. Dewey outlines five domains of reflective thinking: suggestion, intellectualisation, guiding idea, reasoning and hypothesis testing. The domains were not claimed to rise in a particular order or directly depend on each other. However, that was a first systematisation of the reflection in thinking, that should have eventually impacted the personal growth of one engaging in this style.

   The primary idea of Dewey became more influential and structured by Schön in 1983 (Farrell, 2012). Schön’s model of reflection was not a circular or step-by-step model, but more of a distinction between reflection-in-action and reflection-on-action. Less discussed part of Schön’s model was Knowing-in-action that literally meant intuition. Reflection-in-action was explained to be acting in a situation in a way that is influenced by one’s previous experience. In other words, the knowledge gained in the past makes people subconsciously remember the similar personal experience and act in a certain way. According to Schön reflection-in-action enables people to react to ongoing in a more dynamic way. Reflection-on-action enables relive the past event, considering all the negative and positive aspects and how one could improve their personal behaviour in order to achieve better outcomes (Kinsella, 2010). The benefits of this model are recognised and widely used in many professional fields, including the health and social care sectors.

 The other well-known model is Kolb’s reflective model, which was created right after Schön’s model, in 1984 (Oelofsen, 2012). Kolb’s model, different from Dewey and Schön, contained the structure of four steps cycle: concrete experience, reflective observation, abstract conceptualisation and active experimentation. The step of the concrete experience was explained as physical and conscious living of the ongoing in a sense of one’s feelings, emotions and thoughts. The step of observation, similar to Schön’s reflection-on-action, was explained to be time for self-questioning: why and how something happened, why and how one or others and behaved in a particular way? The step of conceptualisation, again as Schön’s reflection-on-action, was further self-questioning stage: could my or other’s behaviour be changed to achieve better outcomes in the future? The final step of active experimentation is the future situation where one is actually applying one experience to actions (Kolb, 1984). The model is very popular in the professional world up to today.

Another, the reflective cycle was created by Gibbs in 1988 and contained six steps: description, feelings, evaluation, analysis, conclusion and personal action plan (The University of Edinburgh, 2019). The model was simplified and easy to understand, starting with what happened and how it made one feels before, during and after situation, the moving onto evaluating negative and positive outcomes and what could have possibly been done differently and better, then bringing it all together in order to, finally, produce action plan for the future, that would enable the best learning / professional outcomes. It is important to mention that reliving the situation one was advised not only consider purely self-feelings but extend thinking to the level that it could affect the wider network of those involved (Gibbs, 1988). The model is widely used in academic and professional settings (Timminsa, et al., 2013)

References

Critical Thinking Academy, 2021. Critical Thinking Academy. [Online]
Available at: https://criticalthinkingacademy.net/index.php/ct/benefits-of-critical-thinking
[Accessed 27 May 2021].

Farrell, T. S. C., 2012. Reflecting on Reflective Practice: (Re)Visiting Dewey and Schon. TESOL International Association, March, 3(1), pp. 7-10. doi:10.1002/tesj.10

Finlay, L., 2008. The Open University. [Online]
Available at: http://oro.open.ac.uk/68945/1/Finlay-%282008%29-Reflecting-on-reflective-practice-PBPL-paper-52.pdf
[Accessed 26 May 2021].

Gibbs, G., 1988. Learning by Doing: A guide to teaching and learning methods. Oxford: Oxford Brookes University.

Hegarty, B., 2011. Is reflective writing an enigma? Can preparing evidence for an electronic portfolio develop skills for reflective practice?. s.l., ResearchGate, pp. 580-593. [Online]                               Available at: https://www.researchgate.net/publication/267824820_Is_reflective_writing_an_enigma_Can_preparing_evidence_for_an_electronic_portfolio_develop_skills_for_reflective_practice                [Accessed 28 May 2021].

Jasper, 2013. ELS. [Online]
Available at: https://www.qmu.ac.uk/media/5533/reflection-2014.pdf
[Accessed 26 May 2021].

Aveyard, H. (2015) (2013) A Beginner's Guide To Critical Thinking And Writing In Health And Social Care (UK Higher Education Humanities & Social Sciences Health & Social Welfare). Paperback.

Fook, J. (2012. 1st Edition. Critical Reflection in Context: Applications in Health and Social Care Routledge

Free Ethical Learning and Development Resource for People and Organisationshttp://www.businessballs.com/reflective-practice.htm

Dresser R (1986). Life, death, and incompetent patients: conceptual infirmities and hidden values in the law. Arizona Law Review, 28, 3: 373-405

Dworkin R (1986). Autonomy and the demented self. Milbank Quarterly 64 (suppl. 2): 4-16

Baldwin C, Hope T, Hughes J, Jacoby R and Ziebland S (2005).Making difficult decisions: the experience of caring for someone with dementia. Alzheimer’s Society

Gastmans C (2013) Dignity-enhancing nursing care: A foundational ethical framework.Nursing Ethics, 2, 42, pp. 142-9

Agich GJ (2003). Dependence and autonomy in old age.Cambridge Univesity Press.

2. The value and application of critical thinking in practice

2. The value and application of critical thinking in practice -by maria-lavinia.ungur20@bathspa.ac.uk 

   “Critical thinking is the ability to verify assumptions utilizing available, tangible, and verifiable data and facts” (Open Minds, 2017).

   In order to develop as a person and professional is crucial to think critically and to be open-minded. That cannot be done without reflecting on experienced past events, questioning own beliefs, values and assumptions, bringing up and rethinking errors and failures that have occurred, as well as the actions that have ended in success. Critical thinking involves orientation on details, patterns, constant analysis of own and other people’s actions, internal and external influences, active listening and the ability to make decisions. The important point while engaging in critical thinking is the elimination of cognitive biases. Critical thinking cannot be based on emotions or unwarranted assumptions, only on pure logic and strong evidence (Critical Thinking Academy, 2021).

   While there are many benefits to critical thinking there are some disadvantages too. Overthinking is probably the biggest limitation to the development of correct critical thinking. Constantly reliving and reviewing past event there is a high risk of falling into a depressive closed repetitive circle of overthinking, which could lead to anxiety and depression and even mental exhaustion (Open Minds, 2017). That is why before engaging in reflection on the past in a critical manner, the knowledge of how to do it right is needed. As mentioned above, the emotional aspect, mainly the blame element, should not be a part of the process, as it is nor beneficial nor leads to any future improvement. The understanding that most of the practices involve error element and that mistakes are part of learning is a good starting point of reflective critical practice.

   The observation, attention to smallest details, reflection on own actions, elimination of personal biases, analytical skills and ability to bring everything together increases the potential to make well-informed decisions in practice (Open Minds, 2017). One of the oldest critical thinking tools is the Greek philosopher’s Socrates method called The Socratic Method (Nelson, 1980). This type of “teaching” is not a usual method where those learning are provided with information and get their questions answered by the one who is teaching. Is a reverse process that works opposite, when the teacher asks a question instead of providing answers, in this way dragging learners out of their comfort zone in order “to realise that they actually know what they did not know they knew” (Nelson, 1980, p. 34).

   The overload of information that arose from the growth of electronic networks, rapid and complex changes in the millennial society accelerated the need for critical thinking in order to solve the chaos of fast-changing environment and more demanding public (Jones-Devitt & Smith, 2007). Moreover, the holistic and person-centred care approach requires professionals to be more critical in their practice instead of just following routine procedures. In other words, professionals are moving away from a one-fit-all approach to individually orientated care practice that empowers the clients and encourages their participation in their own care plan arrangements. In 1977 Barnett stated that the ascendancy has initiated the shift to professional competency rather than some developed routine procedures, and that only could be achieved by developing the professional ability “to question the question” (Jones-Devitt & Smith, 2007, p. 8).

In health and social care practice knowledge, personal professional skills and competency alongside awareness and personal reflective habit, enables one to notice human errors, safeguard the people in their care, identify inconsistency, wrong practices or blame culture and, if necessary, “blow the whistle” in a timely manner. In other words, adapting reflective thinking routine and applying critical thinking skills to professional practice on daily basis could enhance clients’ satisfaction level, improve organisational sustainability and overall performance, increase personal professional competence and even save someone’s life.

References:

Jasper, 2013. ELS. [Online]
Available at: https://www.qmu.ac.uk/media/5533/reflection-2014.pdf
[Accessed 26 May 2021].

Jones-Devitt, S. & Smith, L., 2007. Critical Thinking in Health and Social Care. London: SAGE Publications Ltd.

Kinsella, E. A., 2010. The art of reflective practice in health and social care: reflections on the legacy of Donald Schön. Reflective Practice. International and Multidisciplinary Perspectives, 8 September, 11(4), pp. 565-575. https://doi.org/10.1080/14623943.2010.506260

Kolb, D. A., 1984. Experiential learning: experience as the source of learning and development. Englewood Cliffs(New Jersey): Prentice Hall. [pdf]
Available at: https://www.researchgate.net/profile/David-Kolb-2/publication/235701029_Experiential_Learning_Experience_As_The_Source_Of_Learning_And_Development/links/00b7d52aa908562f9f000000/Experiential-Learning-Experience-As-The-Source-Of-Learning-And-Development.pdf                                                                                                             [Accessed 26 May 2021].

Levey, S., 2013. Linked in. [Online]
Available at: https://www.linkedin.com/pulse/20140623213931-156563678-giving-feedback-with-the-desc-model
[Accessed 28 May 2021].

Nelson, L., 1980. The Socratic Method. Thinking: The Journal of Philosophy for Children, 2(2), pp. 34-38. https://doi.org/10.5840/thinking1980228

Oelofsen, N., 2012. Developing Reflective Practice. Banbury : Lantern Publishing Limited.

Open Minds, 2017. Open Minds. [Online]
Available at: https://openminds.com/next-generation-forum/blog/value-critical-thinking-skills/#:~:text=Critical%20thinkers%20can%20reflect%20on,to%20inform%20their%20decision%20making.
[Accessed 27 May 2021].

The University of Edinburgh, 2019. www.ed.ac.uk. [Online]
Available at: https://www.ed.ac.uk/reflection/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle
[Accessed 26 May 2021].

Timminsa, F., Murphya, M., Howeb, R. & Dennehyb, C., 2013. “I hate Gibb’s reflective cycle 1998” (Facebook©2009): Registered nurses’ experiences of supporting nursing students’ reflective practice in the context of student’s public commentary. Procedia - Social and Behavioral Sciences, October, 93(21), p. 1371 – 1375. doi: 10.1016/j.sbspro.2013.10.046

Aveyard, H. (2015) (2013) A Beginner's Guide To Critical Thinking And Writing In Health And Social Care (UK Higher Education Humanities & Social Sciences Health & Social Welfare). Paperback.

Fook, J. (2012. 1st Edition. Critical Reflection in Context: Applications in Health and Social Care Routledge

Free Ethical Learning and Development Resource for People and Organisationshttp://www.businessballs.com/reflective-practice.htm

The Foundation for Critical Thinking website for Students and Professional                    www.Criticalthinking.org

Nursing Times Journal                                                                              https://www.nursingtimes.net/publication-index/

Examples of Health and Social Care online Blogs

https://www.theguardian.com/social-care-network/social-life-blog

https://blogs.kcl.ac.uk/socialcareworkforce/

https://www.icarehealth.co.uk/blog/

3. Using reflection and critical thinking to address health and social care dilemmas and solve problems

3. Using reflection and critical thinking to address health and social care dilemmas and solve problems   -by alexandra-iulia.popa19@bathspa.ac.uk 

One of the tools in enabling one to address health and social care dilemmas and solve problems in the development of a reflective journal. The three-step- the reflective framework is the technique that can help to develop the systematic reflective practice in order to improve one’s personal and professional skills (Hegarty, 2011). It enables one to follow easy steps, taking self away from the situation and viewing it after it happened and emotions are down. 

The first step of the framework is the description of the event. It requires one to write down what has happened, including environmental circumstances, people who were involved and their actions during the event, self-experience, actions, responses to the event and how did it make one feel. Once the description notes are recorded it is time to analyse. The second step of analysis includes many questions, why did the event happen, was is building up/expected or sudden/unexpected event, why one and others reacted in that particular way, did it lead to positive or negative outcomes and why. The purpose of the second step is to become an active and reflective learner. Once all the questions are analysed and answers are proposed, it is time to move to the final step of action. The first part of the final step in case of a negative outcome is to establish errors that occurred and what could have been done to avoid them. In contrast, if the outcome was good, it needs to be identified what has led to the successful result. The second part of step three is to plan actions for the future in case of a similar event. 

The important point of the reflective journal is that it has to be done in writing on regular basis. Writing enables one to concentrate on the details, create sections, graphs or tables for better visual understanding, put emotions aside, take self away from the event and view it from the side. Moreover, it teaches to separate description from the analysis and set the time for reflection. In addition, it allows to go back to the previous section and add things if remember extra details. After completing two steps it allows one to read through them when drafting an action plan for future practice. It teaches to carefully identify and analyse by following simple steps, which in some time would become a habit of doing it on regular basis subconsciously and evolve into a critical reflective person and professional.

   The other good way to address the issues in the health and social care sector is the establishment of two-way communication through the implementation of the feedback system for both: colleagues and clients. It is important to note that feedback is closely linked to reflective practice as enables multiple dimensions’ view and eliminates personal biases. It allows to take into account the opinion and feeling of the other people of interest and assess the impact of self-actions on the wider social network which is crucial in health and social care practice. There are frameworks that help the feedback implementation. One of the widely used feedback models is the DESC feedback receiving/giving technique that contains four steps: description, effect, solution and conclusion (Levey, 2013). It is strongly advised to collect/do it in a writing manner and use notes for communicating it back to those concerned. The first step of description includes identifying personal observations, event or course of actions. The second step is the effect that the event or course of actions had on one personally. This includes the emotions and feeling, or disciplinary effects like warning or notices from above as a direct result of the mentioned event/actions. The step of the solution is the personal opinion of what could have been done differently in order to avoid failures, errors and achieve better outcomes in the future. This could either be a firm form of an opinion or an invitation to collectively propose problem-solving action. The final step of the conclusion includes an explanation of consequences for all the parties if the behaviour would change to the proposed one. It is like “building a contract of commitment” between all people involved. Feedback is an extremely useful part of reflective practice, as well as, of overall communication.

 

The paper provided insight into reflection within the health and social care settings, by breaking it down into three main parts of theories and models of reflective practice, value and application of critical thinking, and application of reflection and critical thinking in order to tackle the problems. It introduced and explained the various tools and frameworks that enable and encourage the learning of reflective practice. Moreover, it evaluated the significance of developing self-reflection in a sense of personal and professional growth.

References:

Aveyard, H. (2015) (2013) A Beginner's Guide To Critical Thinking And Writing In Health And Social Care (UK Higher Education Humanities & Social Sciences Health & Social Welfare). Paperback.
Fook, J. (2012. 1st Edition. Critical Reflection in Context: Applications in Health and Social Care Routledge
Key web-based and electronic resources
Free Ethical Learning and Development Resource for People and Organisations
http://www.businessballs.com/reflective-practice.htm
The Foundation for Critical Thinking website for Students and Professionals
www.Criticalthinking.org

Gibbs, G., 1988. Learning by Doing: A guide to teaching and learning methods. Oxford: Oxford Brookes University.
Kolb, D. A., 1984. Experiential learning: experience as the source of learning and development. Englewood Cliffs(New Jersey): Prentice Hall. [pdf]
Available at: https://www.researchgate.net/profile/David-Kolb-2/publication/235701029_Experiential_Learning_Experience_As_The_Source_Of_Learning_And_Development/links/00b7d52aa908562f9f000000/Experiential-Learning-Experience-As-The-Source-Of-Learning-And-Development.pdf                                                                                                           
Atkins, S. and Murphy, K. (1993) ‘Reflection: a review of the literature’, Journal of Advanced Nursing, vol. 18, pp. 1188–1192.
Cottrell, S. (2013) ‘The Study Skills Handbook’, Palgrave Study Skills Series, 4th edn, Palgrave Macmillan.
Dewey, J. (1903) Studies in Logical Theory, University of Chicago Press, Chicago.
Dewey, J. (1910) How We Think, DC Heath, Boston.
Dye, V. (2011) ‘Reflection, Reflection, Reflection: I’m thinking all the time, why do I need a theory or model of reflection?’ in McGregor, D. and Cartwright, L. (eds) Developing Reflective Practice: A Guide for Beginning Teachers, Open University Press.
Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods, Further Education Unit, Oxford.
Mezirow, J. (1990) Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning, Jossey-Bass, San Francisco.
Schön, D. (1983) The Reflective Practitioner: How Professionals Think in Action, TempleSmith, London.
Syed, N., Scoular, A. and Reaney, L. (2012) ‘Faculty of public health tips on writing effective reflective notes’, Faculty of Public Health of the Royal College of Physicians of the United Kingdom [Online]. Available at: http://www.fph.org.uk/ uploads/ FPH%20Tips%20on%20Writing%20Effective%20Reflective%20Notes.pdf