Daily Dilemmas in Practical Practice, Essay Example

Introduction

The purpose of this study is to examine a daily practice dilemma and to explain the application of theoretical knowledge into the practice. The work of TeenaClouston entitled “Narrative Methods: Talk, Listening, and Representation” reports “occupational therapists are faced with meeting the challenge of users involvement and satisfaction.” (2003, p.136) However, as stated by Clouston “the organizational culture and the drivers for change in delivery health and social care have not, until this point, emphasized and required evidence of user involvement and person-centered practice in a pragmatic way.” (2003, p.136) The result: “effective methods to explore the lived experiences of individuals within intervention and research, including their view of satisfaction, quality of effectiveness of outcome, need to be further developed in occupational therapists’ repertoire of skills.” (2003, p.136)

Clinical Scenario

A dilemma which arose and which is that at focus in this study occurred during the first fieldwork of the summer of the writer of this work. A new patient came in for evaluation. I was adept at evaluating patients and had a very busy day with a full schedule the day of this patient’s visit. The patient was an Iranian woman with a left hip ORIF. The patient is not fluent in English and no family members were present during the evaluation. The patient fully understood the questions that I asked of her however, one question concerning the patient’s  home environment and the goals of her occupational therapy, was not adequately answered by the patient due to her lack of use of the English language. The evaluation was ended early and I spoke with the clinical instructor concerning the need to speak with a family member about the home environment and occupational therapy goals of the patient. I was informed by the clinical instructor that there was no need to go to the patient’s room due to the heavy workload that day. The clinical instructor further told me that I should place all the information gained in the medical chart, make three occupational goals for the patient however, this presents a dilemma in that I do not know the patient very well at all much less what is actually meaningful to the patient, nor did I know specific required information that is needed to formulate a treatment plan. There was also the complication of culture. Seeing as how I was not very familiar with the patients cultural background I felt rather hindered in this regard. The CI instructed the practitioner “there is no need to do so.” The patient had hip surgery two days prior to the evaluation, which generally involves patients being asked to sit on the edge of the bed so that they can be evaluated in terms of their dynamic and static sitting balance, trunk control, pain level and to see if there are any limitations. I informed the CI that the patient’s level of pain is 8 on a scale of 1 to 10 and that the patient had difficulty getting out of bed. The CI informed me that I should decrease the level of pain on the chart since people in the Middle East culture tend to exaggerate their pain.However Iranians are not Arabs and therefore this observation may have some fatal flaws built into it.  In addition, children raised in the Middle East are protected and sheltered much more by parents than are children in the United States. They also live in large extended family structures. That is uncles, sisters, Fathers and so on all live under the same roof.  The dilemma in this case is clearly one that is ethical in nature, as the clinical instructor has informed me in this specific situation, in regards to this patient to change the level of pain reported by the patient, and has additionally instructed me to forego the standard evaluation process. Interwoven into this particular dilemma are issues of culture, professional and interactional issues. This particular case is quite complicated in nature however, the focus will be on the ‘professional dilemma’ and particularly the ethical dilemma presented in this case. The nature of the case is established on the aspect of how the matter of critical thinking will be essential in the profession as it will integrate the elements of culture, professional and interactional. In more applicable terminologies, the case will be based on the importance of interrelating culture, knowledge and narration ability.The case provides an illustration on how the profession will require the essential use of all these aspect so as to create an accurate diagnosis of the case. Another factor that will relevant in the case is experience. Experience will be essential in the therapist profession as it will provide the ideal element of understanding of how to deal with the various patients that may be differentiated on culture, background and other relevant factors. With regard to the matters of the case, Stephen Brookfield’s four critical thinking processes will be essential in providing an outlook on how critical thinking is an essential factor in the profession and how the integration of the relevant factors will provide the essential results in the profession.

Process Analysis

Process analysis in this case will involve the examination of the four critical thinking processes of Stephen Brookfield, which assist the practitioner in focusing on their thinking during an everyday practice dilemma. First, Brookfield states in regards to contextual awareness and decision making that contextual awareness includes “an awareness of what’s happening in the context of the situation, including values, cultural issues, and environmental influences.” (nd, p.1) Brookfield states that questions that should be addressed are of the nature of the following questions: (1) What is going on in the present context that affects the patient outcome? (2) What is and is not important? (3) Is information lacking concerning this situation? (and, paraphrased)Therefore I asked myself what it was in this dilemma that might affect the outcome of the patient and answered that lack of credible information on the level of pain the patient was experiencing was relative. As to what is and what is not important, my personal feelings were adjudicated as not important in this instance but instead the patient’s welfare was of utmost importance. Insofar as information lacking, there is information that is pertinent to the treatment and care of the patient, which I was unable to gain from the patient. The second step in Brookfield’s critical thinking process is the exploration and imagination of alternatives, which is stated to involve “thinking about and imaging other ways of looking at the situation.” (Brookfield, nd, p.1) Brookfield states that one should seek alternative explanations for what is happening as well as examining what else the therapist might need or want to know in this situation. The therapist should further examine what actions are the most reasonable in the given situation to address the dilemma. For this reason I examined why the clinical instructor might have told me that I should lower the level of pain reported by the patient and considered that due to the CI’s higher level of knowledge concerning the Middle Eastern culture that it is reasonable that I should trust the CI’s judgment. The third tool for critical analysis posited in the work of Brookfield is that of ‘Assumption Recognition and Analysis’ which involves the therapist’s analysis of any assumptions they have made about the situation. This involves the analysis of beliefs and values held by the therapist that served to shape these assumptions as well as the analysis of the rational that exists to support the assumptions. I am unaware of any assumptions that I may have made in this situation except that I suppose I assumed that patient’s generally report a level of pain similarly throughout various cultures. This was informed by my universalist views that pain is pain and there are no cultural connotations to it. The fourth tool for critical thinking processes stated by Brookfield is that of “Reflective Skepticism/Deciding What To Do” which involves the therapist asking specific questions regarding their interpretation of the situation and the importance, if any, of intervention, and what options exists in this situation. This tool was used in my decision to trust the CI and her superior experiential knowledge of this particular culture in regards to the level of pain reported by the patient. However, I felt that I should question her motivations in instructing me to forego gaining information from the patient in regards to her rehabilitation plan. The focus of this analysis is that relating to professional ethics however, as the culture of the patient has influenced the instructions given by the Clinical Instructor to the Therapist, the Middle Eastern culture must be examined so as to make a determination of the validity and efficacy of the instructions provided to the therapist by the CI. Based on the advice and instructions that were provided by my CI, I learned that the aspect of culture must not be ignored and it must be an integral factor in the decision making. The information provided regarding the Middle Eastern has served to provide a general understanding of the cultural values and their importance. The factor is missing is the case of the definitions as to the levels of pain and how they are relevant in the aspect of determining how much pain an individual can endure during treatment as well as how the matter of pain can affect a related individual.

Conceptual Analysis

The general dilemmas that are presented in my case are critical as they provide a fine line between the essential function of me in my profession and the general application of what I know in an ethical manner in the interest of any given patient. I have generally come to the realization that the experienced therapist has developed a general understanding of how they must establish or integrate the aspects of culture, experience and knowledge into the profession and this is a factor that I will need to develop as I grow in the profession. In the case of experience, it is an element that cannot be rushed, and it will only develop with time. The other matters of knowledge and culture are factors that I can integrate into the profession that will serve to increase my general understanding of the nature and manner of application of the ideologies in my profession. Based on Brookfield’s critical thinking measures, they will be essential my ability to cope with the demands of the profession. The elements of critical thinking will serve to provide the essential guidelines that will facilitate the effective decision making in the profession that will ensure that the patients are treated and dealt with in the appropriate manner. The critical thinking measures will be beneficial in the case that the patient may have some concerns and administering the aspects of treatment will need to be revised or a  patient’s reaction to therapy may not be as expected and I will be required to provide an essential solution immediately that will solve any immediate predicaments.In the case of Clouston’s narrative methods, a number of the techniques will be essential in the case of dealing or interacting with the patient. The aspect of narration will provide an ideal level of communication between patient and practitioner that will serve to establish and solve the general problem that the patient will have. It will be important for me to be able to interact with the patient in an ideal manner so as to ensure that the patient does not have any misunderstanding of the therapy or any other related therapy. Narration will be vital in patient-therapist interaction as I will be able to make the essential diagnosis using accurate information and providing the patient with the accurate account on the procedure and ensuring that the patient will be able to provide additional information that may be relevant to the therapy. It is essential that I develop an integration of the various factors provided by the CI and the information that is the basis of my knowledge on the profession. The basic implementation of the critical thinking skills will be important in providing the right result from the treatment of the patient. Other aspects that will serve to benefit me in the profession are gaining an understanding of the patient’s emotional state and their ability to endure any of the treatments that will be related to their general ailment. The critical thinking will be important in assessing the general understanding of the patient in terms of their ability to receive treatment and how they can be able to handle the treatment. Stephen Brookfield provides the essential critical thinking factors that will allow me to assess the patient’s body capability and how they will be able to withstand or accept treatment. My general analysis is based on the understanding on the essential value of the integration of culture, knowledge and ethical behavior in the profession.

Conclusion/Resolution/Summary

I am meant to ensure that based on the relevant information provided by the clinical instructor on the Middle Eastern culture, I should abide by the instruction provide as to how I must operate in my profession. I must make sure that the issue is discussed at full length so as to ensure that all instructions and the relevant information is fully understood referring to the therapist profession. I must ensure that the necessary adjustments are made that deal with the aspect of pain in the profession. The study has provided an essential understanding that there is a probability of error, which may be based on the determination of the actual factor of pain in a patient. The cultural elements are an influential factor in the case of ethical decision making. There is also the element of age in a culture as well and how it responds to pain. As stated earlier, people of Middle Eastern origin tend to exaggerate pain. However men from the same culture of the older generation tend to understate the pain for it like Hispanic culture is very macho. The health care service and therapists who have the benefit of clinical essential instructions are able to apply a high level of knowledge and experience. It will be important for the application of the knowledge in the occupational therapy for therapists who have obtained a large volume of knowledge and can be utilized in their daily practices. This has enabled me to decide to adhere and follow the superior knowledge as well as experience of the clinical instructor in this scenario. My general understanding based on the matters that deal with this case have revealed that my profession will be based on the general ability for me to integrate the cultural, profession and ethical factors of the profession. With the guidance using the Stephen Brookfield critical thinking elements, they will serve to provide the ideal understanding and application in my profession that will facilitate my development. My CI provided me with adequate information on the matters that deal with culture in the Middle Eastern and it will be essential in developing a level of understanding of the cultural matters that may influence the decisions of the patients and the general matter of the treatment measures that may or may not apply to the related patients. It is also important to develop a virtual encyclopedia of every possible culture I would encounter in order to be ready to deal with all manner of cultural nuances in respect to the profession. The general matter of experience will be essential in the profession as it will be important in the development of the aspects of the patients and how they may accept or reject certain treatments from therapy.The general aspects of my profession are illustrated in the case and they are intended to illustrate the essential factors that will make me successful in the professional and it will be a guide as to how well I will be able to apply myself in the profession as well as how my ability to use all the methodologies provided in the case will prove to be the fine line between success and failure. The case has provided the analysis on the factors that are essential in the profession.

Bibliography

Clouston, Teena (2003) Narrative Methods: Talk, Listening and Representation. British Journal of Occupational Therapy. April 2003. 66(4).

Occupational Therapy Code of Ethics and Ethics Standards (2010). Retrieved from: http://www.aota.org/Consumers/Ethics/39880.aspx

Sladyk, Karen; Jacobs, Karen, and MacRae, Nancy (2009) Occupational Therapy Essentials for Clinical Competence. Black Incorporated 2009. Retrieved from: http://books.google.com/books?id=AdAJqEFWJkgC&dq=occupational+therapy:+learning+from+dilemmas&source=gbs_navlinks_s

Stephen Brookfield’s Four Critical Thinking Processes From: Using your Head to Land on your Feet: A Beginning Nurses’ Guide to Critical Thinking. Raingruber&Haffer, 2001.