Rolfe et al 2001:Descriptive reflectionReflection on theoryAction-based reflection
Supervised by senior community dietitianA 36yo gentleman presented to the community dietetics dept. for weight loss adviceAs you can see, he was class 3 obese, and had many co-morbidities as a result of his weightPoor social supportTrouble losing weight in the past – little confidence, but important to himNutritional Ax: tried to draw out where the patient was mentally at – I found this useful in prior experiences. Happy to accept wt loss advice @ this time as was unhappy/frustrated with weight and was impacting on lifestyle.Made 3 very small goalsSupervising dietitian signalled to me to wrap up
Initial:Confident in weight reduction adviceRelief that there were clear areas for improvement in diet historySatisfaction that I had linked eating patterns (binge eating and night eating)Frustration @ supervising dietitian because I felt I was doing well.On reflection:Disappointment about areas I focused on.In hindsight, I should have spent more time assessing his past failures, and his readiness to change.Realisation – of significant learning experience – will talk about later.
Insight into human behaviour (confidence, motivation)I should have focused more on assessing his readiness to change, motivators, perceived barriers and support.More time would have been needed to successfully complete a behavioural lifestyle assessment: 45-60minutes (DOM, UK 2008)Cognitive behavioural approach – self monitoring, stimulus control, goal setting, problem solving, cognitive restructuring, social support (DOM, UK 2008)
Assessment of barriers to change:Sleep apnoea, poor social support, lack of confidenceHow I should have addressed these:Referral to Sleep Clinic, explore more social support options, ? Psychological input re overeating.Psych referral: “some of my patients find it helpful to talk to the...”
DieteticsReflective practice Orna O’Brien March 2012
DescriptionAction plan Feelings Gibb’s Reflective CycleConclusion Evaluation Analysis Gibbs et al. (1988)
Framework for reflective practice Rolfe et al. (2001)
Description (summary of patient case)PC: 36yo , referred to Community dietetics dept. by GP, for weight loss adviceDx: Wt: 138kg (rising) Ht: 1.76m Obesity III (BMI 44kg/m2)PMHx: Sleep apnoea x 1y (untreated) Dyslipidaemia (total cholesterol↑, LDL↑., HDL↓, Trigs↑) SOBOE, attended PLAN in past, ? mild learning difficultySocial Hx: Lives alone, unemployed non-smoker, non-drinker, poor mobility 2 to weightNutritional Why did pt. feel he was here; previous wt loss attempts; acceptabilityAx: of weight/being weighed. Little confidence in weight loss ability. Explained benefits of 5-10% wt loss. Diet Ax: Poor meal pattern, portion size+++, treats+, good F&V, PA 3/7 (cycling/walking 45mins), night eating.Goals set: Breakfast (porridge measurements, toppings, fruit, water) Biscuits (buy ½ packet, have after evening snack) Plate model Sleep clinic discussion (potato portions)
EvaluationPositive• Sensitive, non-judgemental attitude and approach1• Expanded knowledge• Insight into human behaviourNegative•Bad judgement – put my own assumptionsahead of the patient’s capabilities•Readiness to change 1 DOM, UK (2008, 2011)
Analysis Significant learning Flexible Practical experience Input Research1,2,3 from others What Did my What did I was I advice base mytrying to help? actions on?achieve? 1 Dept. of Health, UK (2006); 2 INDI (2007); 3 DOM, UK (2008)
ConclusionHow does this learning experienceintegrate into my dietetic practice? • Lessened the gap between theory I learned in college and practice I learned in placement • Improved quality of care for patients through patient-tailored assessment and goals
Action plan• Assess readiness to change: • Understanding patients thoughts on referral o Is your weight affecting your life in any • Expectations of treatment way at the moment? (UK DH, 2006) • Motivation to change lifestyle • Weight history• Referral to relevant health services • Dieting history • Patient understanding of obesity• If patient not ready to change: • Potential barriers to o Reassure that I am available to talk change about it when he/she is ready • Eating patterns o Briefly advise on the risk of overweight • Current lifestyle: dietary intake and physical & benefits of weight loss activity o Offer an appointment in, e.g. 6 • Support networks months.
ReferencesUK Department of Health (2006) Care pathway for the management ofoverweight and obesity. London: DH.Weigh Management Interest Group, INDI (2007) Position of the IrishNutrition and Dietetics Institute: weigh management. Available at:http://www.indi.ie/docs/979_94_wmig.pdf [accessed March 16th 2012]Grace C, Pearson D et al. (2008) DOM, UK: The Dietetic WeightManagement Intervention for Adults in the One to One Setting: is it timefor a radical rethink? Available at: www.domuk.org/docs/dietetic-interventionfinalversion301007.doc [accessed March 18th, 2012]Grace, C. (2011), A review of one-to-one dietetic obesity managementin adults. Journal of Human Nutrition and Dietetics, 24: 13–22.doi: 10.1111/j.1365-277X.2010.01137.x
ReferencesRolfe et al. (2001) Framework for reflective practice, as cited by StudentsLearning with Communities: information for students: resources. Availableat: http://www.communitylinks.ie/students-learning-with-communities/information-for-students/resources/[accessed March 23rd, 2012]Gibbs et al. (1988) Gibb’s Reflective Cycle, as cited by Students Learningwith Communities: information for students: resources. Available at:http://www.communitylinks.ie/students-learning-with-communities/information-for-students/resources/[accessed March 23rd, 2012]