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Reflective Practice Presentation

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  • 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...”
  • Transcript

    • 1. DieteticsReflective practice Orna O’Brien March 2012
    • 2. DescriptionAction plan Feelings Gibb’s Reflective CycleConclusion Evaluation Analysis Gibbs et al. (1988)
    • 3. Framework for reflective practice Rolfe et al. (2001)
    • 4. 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)
    • 5. Feelings OnInitially Reflection
    • 6. 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)
    • 7. 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)
    • 8. 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
    • 9. 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.
    • 10. 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
    • 11. 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]
    • 12. Thank you!Any questions?

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