Productively uses knowledge of own strengths and weaknesses
As Henry Miller once said, "I am my own worst enemy, but unlike most men, I know too that I am my own savior."
I would have to agree with Mr. Miller because I can overextend myself by taking on too many tasks at one time. This is certainly one of my weaknesses that I have learned about myself while in OT school. I have realized that I love to live life through learning and experiencing new things as often as I can. While this is a great quality to have, it can get in the way of me taking the time to care for myself and live a well balanced work-personal life. Additionally, I feel a sense of purpose and accomplishment by helping others, whether it's teaching another student how to write a SOAP note or actively listening to a client who is struggling. This is an admirable trait, and certainly necessary to be a future occupational therapy practitioner, however, it can cause potential ethical problems.
In fact, I learned a difficult lesson while on my third level 2 fieldwork rotation. I learned that it is potentially unsafe to myself and the client when I am not assertive to get out of a situation. I also learned that it is better to attempt communication with my fieldwork educator rather than withdraw from asking her questions due to fear of how she will react when I do ask questions. Along these same lines, I was struggling with my own personal problems due to a sudden and drastic change in my living situation. I quietly took on the burden rather than informing my fieldwork educator of the situation. I believe had I done so, my job performance might not have declined and things would have turned out differently. Lastly, I learned that prior to this mental health fieldwork rotation, I had little to no experience working with individuals with mental illness, therefore, this would have been a prime opportunity to learn how to establish boundaries to prevent similar unsafe situations from arising in the future.
In summary, I know now that my most critical mistakes were in the following areas: communication with a mentor, assertiveness and boundary setting in mental health settings, and common ethical issues that can arise in mental health settings. Over the next few months, I would utilize my strengths in responsibility, resourcefulness, and resilience to learn from my mistakes and grow as an occupational therapy student to become competent in all requires to be considered an entry-level practitioner.
I have been given a second opportunity to demonstrate that I have learned from my past mistakes at my previous fieldwork site. I have also addressed what I should have done in each scenario through research and developed a plan for how I will handle that same or similar situation, should it arise, in this fourth fieldwork rotation. In fact, I realize now how important it is to inform my fieldwork educator when I am struggling with something at home (i.e. Maslow's hierarchy of basic needs). I recently discussed this with my advisor of how important it is to have someone who I can talk to about situations I experience on the job and how to handle those situations to ensure client safety. I also informed her that I plan to seek out mentorship from someone who is similar to my fourth fieldwork rotation fieldwork educator because it's important to feel comfortable when talking to her about delicate issues. I feel this step is necessary when I become an entry-level OT practitioner in order to learn and grow in this field. I also realize that in a mental health setting, I cannot allow clients to mistake my friendliness or ability to actively listen for passivity. This may put us both at risk if they feel they can take advantage of my friendliness. I need to establish boundaries with my clients and be assertive when working with them. And lastly, although I have good intentions to help my client, I cannot compromise the AOTA Code of Ethics when that individual could potentially harm himself or herself.
I had some time between fieldworks to prepare for the trials and tribulations faced in an inpatient psychiatric setting. As I previously mentioned, one of my strengths is my resourcefulness, which I utilized in order to prepare for this fourth fieldwork rotation and improve my chances for success when working in a mental health setting. I used whatever resources I could get my hands on. For instance, I researched and read several journal articles and numerous blogs found on Pinterest that explained assertiveness, setting boundaries, communication, and how to identify unethical situations in a mental health setting. I have provided examples of what I learned from the articles I read. I also used this time to learn more about myself by reading about resilience and emotional intelligence, both of which are pertinent skills for healthcare professionals. When I wasn't researching or reading, I continuously journaled and reflected on my fieldwork coordinator's and my advisor's feedback on how to handle these situations in the future.
According to Omura et al. (2017), healthcare settings often experience "communication errors" which have a "negative impact" on "patient safety" in most cases (p. 1). In fact, "human errors" such as "communication" were often times "the root cause of the majority of incidents and accidents" in "high-risk industries" such as healthcare (Omura et al. 2017, p. 18). In my own observations, regardless of the specific healthcare setting, communication is necessary to ensure the highest quality of care possible which includes keeping the client safe. When communication is non-existent the client is most likely the one to suffer the consequences. "Speaking up" is "one form of assertive communication" that refers to "communicating specific observations, requesting clarification or challenging the decision of someone with positional power or authority to act" (Omura et al, 2017, p. 4). Disagreements in practice between healthcare providers is a normal par for the course, and I have noticed that these disagreements may actually make practitioners more defensive and lead to fewer discussions about a client. To reduce defensiveness between healthcare providers, Omura et al. (2017) recommends a two-step communication strategy by identifying a "shared responsibility for safety" while describing "their own opinions" and then following up with an "inquiry about the other person's thinking and opinions" (p. 19). Omura et al.(2017) found that assertiveness communication training programs were found to have some degree of effectiveness with all target groups including medical interns (p. 6) and that these training programs had some degree of impact on the "level of assertiveness and communication behaviors" (p. 12). Omura et al. (2017) did state that "the use of of simulation-based outcome assessment has become prominent in healthcare research" (p. 17), but multi-method interventions, such as support from leaders, teamwork skills training, and communication techniques, most often used and showed promising results (p. 18). For instance, "lectures/presentations were reinforced by small group discussions and/or role plays" (p. 18). This is considered to be "more effective" when participants are "given opportunities for deliberate practice" and are provided "immediate feedback" to enhance learning and to implement corrections (Omura et al, 2017, p. 20). This has furthered my understanding of why mentorship is crucial for not only the OT student but also the entry-level OT practitioner. This has reinforced my desire to acquire a mentor at my future job site to discuss a particular situation and receive feedback to implement into my practice. Additionally, Omura et al (2017) support this idea by stating that "healthcare leaders play an important role in supporting less experienced staff to speak up when patient safety is threatened" (p. 20). In fact, less experienced healthcare providers were less likely to express their concerns if a senior staff member discouraged this assertive behavior (p. 20). This encourages me to find a mentor who is also willing and open to feedback to enhance a greater sense of overall growth.
Boundaries are important for any relationship, but it is especially important for a therapeutic relationship in a mental health setting. Based on my observations, I have learned that individuals with a mental illness demonstrate poor social skills such as atypical speech patterns (i.e. rapid or slurred speech), inappropriate emotional or behavioral responses (i.e. laughing, talking too loudly indoors), and a lack of awareness of appropriate standing distance when talking to someone. My fieldwork educator has also educated me to be wary of clients with personality disorders because they are great at manipulating a situation to get their way. As a student I am more likely to be taken advantage of because I do not have the authority or respect from my clients as my fieldwork educator does. Therefore, it is critical that I apply what I have learned in establishing boundaries to lend myself credibility while also respecting the boundaries of my clients to ultimately ensure safety of everyone involved in these social interactions. For example, Dombeck (2006) explains the difference between aggressive, passive and assertive communication. In Dombeck's (2006) article, "Setting Boundaries Appropriately: Assertiveness Training", I learned that "assertiveness is about finding a middle way between aggression and passivity that best respects the personal boundaries" of all people involved and that assertive people use "aggression defensively" but "never offensively" (p. 1). In fact, the purpose of assertiveness is to simply "make change occur" without disrespecting your boundaries or the other person's boundaries (Dombeck, 2006, pg. 2). I had a chance to practice my assertiveness during a staff meeting here at my fourth fieldwork site. I felt clumsy and a little bossy. As Dombeck (2017) would explain, it is normal to feel this way because it is a "transitional" period and requires a great deal of practice to become accustomed to this new way of communicating with others (pg. 2). When the opportunity presents itself, I utilize assertive communication and I am starting to feel more comfortable when I have to use it. It takes time and practice to learn how to be assertive and even more time to get a better understanding of when to use it.
Not only is assertiveness training useful for therapeutic relationships, but it also helpful with reducing anxiety and improving decisiveness. For most of my peers, school comes easily, whereas I require additional learning strategies and help to learn the material. I have always had to work hard at school and I used to have terrible test anxiety. However, I believe that my struggles in school have made me more resourceful since I had to figure out various ways to teach myself and overcome my test anxiety. Interestingly enough, while researching assertiveness, I came across an interesting article by Mohebi et al. (2012) which talked about the effect of assertiveness training on a student's academic anxiety. It states that while "a low level of [academic] anxiety" is positively motivational to contribute to the student's ability to learn, "high levels of it" can actually lead to a "disturbance in concentration, attention, storage of knowledge, recall and educational reduction" (Mohebi et al., 2012, p. 37). Based on my own experience, I can attest that not eating properly and sleeping poorly can definitely contribute to higher levels of anxiety. When my anxiety levels are higher than normal for an extended period of time, it takes a serious toll on my ability to perform as a student. In addition, while in that state, I acknowledge that I had allowed myself to be emotionally be affected by my third fieldwork educator's reactions to the point that I was experiencing even higher levels of anxiety that affected my ability to focus on what needed to be learned and potentially apply that knowledge to future situations that would have shown learning and growth as an occupational therapy student. This study also points out that there is a "relationship between anxiety and assertiveness", therefore, Mohebi et al (2012) wanted to determine "the effect of assertiveness training on reducing anxiety levels" in college students (p. 37). The results of the study did find a significant decrease in anxiety in the experimental group post-intervention. It noted that due to a decrease in anxiety there was an increase in decisiveness in the experimental group as well, therefore, "assertiveness training" was an "effective non-pharmacological method for reducing academic anxiety" which ultimately improved "academic performance" of the college-age students (Mohebi, 2012, p. 39). While at my fourth fieldwork site, I have had several opportunities to be assertive with my clients and I do feel less anxiety or stress. For example, I have to be more assertive with one of the lower functioning groups because my clients have poor attention and poor impulse control skills. These deficits require a greater amount of assertiveness than my other groups. When I led my first session with this group, I had a hard time managing the group because I was not being assertive enough for what my clients needed. Although I had read a great deal about assertive communication, I had not had much practice implementing it before now. My fieldwork educator also provided helpful feedback for how I should approach this group the next time I lead it. She encouraged me to be more assertive. The next time I worked with this group I did a much better job, according to my fieldwork educator. I applied both what my fieldwork educator had told me to do and the material I had previously read about in the aforementioned articles and my preparation had paid off. Her encouragement and my ability to implement a larger amount of assertive communication also reduced my anxiety and I now felt competent to independently lead this group in the future.
Over the past few months I have learned that "life includes adversities" and that "resilience is the key" to overcoming those adversities (Reivich & Shatte, 2002, p. 1). As Henry Miller once said, while I am my worst enemy, I know too that I am my savior. While most people may identify my situation as a failure or setback, I have decided to transform my hardship into an academic challenge that I must overcome. My resilience has played a huge role in my ability to bounce back and use this stumbling block as a learning experience. Anything I have learned from previous mistakes, as well as what I have learned through my self-edification, has been implemented into my practice during my fourth fieldwork rotation. I believe this whole experience has been one of the greatest attestations to my ability to be resilient regardless of what life throws my way. Not only do I want to demonstrate growth as an OT student to my advisor, fieldwork coordinator, and the board, but most importantly I want to prove to myself that I have learned from these experiences and applied that newfound knowledge to ensure success at this fourth and final fieldwork rotation.
Resources:
Dombeck, M. (2006). Setting boundaries appropriately: Assertiveness training. Mentalhelp.net. Retrieved from https://www.mentalhelp.net/articles/setting-boundaries-appropriately-assertiveness-training/ .
Dombeck, M. (2006). Setting boundaries appropriately: Assertiveness training (continued). Mentalhelp.net. Retrieved from https://www.mentalhelp.net/articles/setting-boundaries-appropriately-assertiveness-training-continued/ .
Mohebi S., Sharifirad G.H., Shahsiah M., Botlani S., Matlabi M., and Rezaeian M. (2012). The effect of assertiveness training on student's academic anxiety. Journal of Pakistan Medical Association, 62(3), p. S37-41.
Omura, M., Maguire, J., Levett-Jones, T., and Stone, T.E. (2017). The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. International Journal of Nursing Studies, 76, p. 120-128.
Reivich, K. & Shatte, A. (2002). The resilience factor: 7 keys to finding your inner strength and overcoming life's hurdles. Bright & Happy Books, first edition, p. 1-321.
I would have to agree with Mr. Miller because I can overextend myself by taking on too many tasks at one time. This is certainly one of my weaknesses that I have learned about myself while in OT school. I have realized that I love to live life through learning and experiencing new things as often as I can. While this is a great quality to have, it can get in the way of me taking the time to care for myself and live a well balanced work-personal life. Additionally, I feel a sense of purpose and accomplishment by helping others, whether it's teaching another student how to write a SOAP note or actively listening to a client who is struggling. This is an admirable trait, and certainly necessary to be a future occupational therapy practitioner, however, it can cause potential ethical problems.
In fact, I learned a difficult lesson while on my third level 2 fieldwork rotation. I learned that it is potentially unsafe to myself and the client when I am not assertive to get out of a situation. I also learned that it is better to attempt communication with my fieldwork educator rather than withdraw from asking her questions due to fear of how she will react when I do ask questions. Along these same lines, I was struggling with my own personal problems due to a sudden and drastic change in my living situation. I quietly took on the burden rather than informing my fieldwork educator of the situation. I believe had I done so, my job performance might not have declined and things would have turned out differently. Lastly, I learned that prior to this mental health fieldwork rotation, I had little to no experience working with individuals with mental illness, therefore, this would have been a prime opportunity to learn how to establish boundaries to prevent similar unsafe situations from arising in the future.
In summary, I know now that my most critical mistakes were in the following areas: communication with a mentor, assertiveness and boundary setting in mental health settings, and common ethical issues that can arise in mental health settings. Over the next few months, I would utilize my strengths in responsibility, resourcefulness, and resilience to learn from my mistakes and grow as an occupational therapy student to become competent in all requires to be considered an entry-level practitioner.
I have been given a second opportunity to demonstrate that I have learned from my past mistakes at my previous fieldwork site. I have also addressed what I should have done in each scenario through research and developed a plan for how I will handle that same or similar situation, should it arise, in this fourth fieldwork rotation. In fact, I realize now how important it is to inform my fieldwork educator when I am struggling with something at home (i.e. Maslow's hierarchy of basic needs). I recently discussed this with my advisor of how important it is to have someone who I can talk to about situations I experience on the job and how to handle those situations to ensure client safety. I also informed her that I plan to seek out mentorship from someone who is similar to my fourth fieldwork rotation fieldwork educator because it's important to feel comfortable when talking to her about delicate issues. I feel this step is necessary when I become an entry-level OT practitioner in order to learn and grow in this field. I also realize that in a mental health setting, I cannot allow clients to mistake my friendliness or ability to actively listen for passivity. This may put us both at risk if they feel they can take advantage of my friendliness. I need to establish boundaries with my clients and be assertive when working with them. And lastly, although I have good intentions to help my client, I cannot compromise the AOTA Code of Ethics when that individual could potentially harm himself or herself.
I had some time between fieldworks to prepare for the trials and tribulations faced in an inpatient psychiatric setting. As I previously mentioned, one of my strengths is my resourcefulness, which I utilized in order to prepare for this fourth fieldwork rotation and improve my chances for success when working in a mental health setting. I used whatever resources I could get my hands on. For instance, I researched and read several journal articles and numerous blogs found on Pinterest that explained assertiveness, setting boundaries, communication, and how to identify unethical situations in a mental health setting. I have provided examples of what I learned from the articles I read. I also used this time to learn more about myself by reading about resilience and emotional intelligence, both of which are pertinent skills for healthcare professionals. When I wasn't researching or reading, I continuously journaled and reflected on my fieldwork coordinator's and my advisor's feedback on how to handle these situations in the future.
According to Omura et al. (2017), healthcare settings often experience "communication errors" which have a "negative impact" on "patient safety" in most cases (p. 1). In fact, "human errors" such as "communication" were often times "the root cause of the majority of incidents and accidents" in "high-risk industries" such as healthcare (Omura et al. 2017, p. 18). In my own observations, regardless of the specific healthcare setting, communication is necessary to ensure the highest quality of care possible which includes keeping the client safe. When communication is non-existent the client is most likely the one to suffer the consequences. "Speaking up" is "one form of assertive communication" that refers to "communicating specific observations, requesting clarification or challenging the decision of someone with positional power or authority to act" (Omura et al, 2017, p. 4). Disagreements in practice between healthcare providers is a normal par for the course, and I have noticed that these disagreements may actually make practitioners more defensive and lead to fewer discussions about a client. To reduce defensiveness between healthcare providers, Omura et al. (2017) recommends a two-step communication strategy by identifying a "shared responsibility for safety" while describing "their own opinions" and then following up with an "inquiry about the other person's thinking and opinions" (p. 19). Omura et al.(2017) found that assertiveness communication training programs were found to have some degree of effectiveness with all target groups including medical interns (p. 6) and that these training programs had some degree of impact on the "level of assertiveness and communication behaviors" (p. 12). Omura et al. (2017) did state that "the use of of simulation-based outcome assessment has become prominent in healthcare research" (p. 17), but multi-method interventions, such as support from leaders, teamwork skills training, and communication techniques, most often used and showed promising results (p. 18). For instance, "lectures/presentations were reinforced by small group discussions and/or role plays" (p. 18). This is considered to be "more effective" when participants are "given opportunities for deliberate practice" and are provided "immediate feedback" to enhance learning and to implement corrections (Omura et al, 2017, p. 20). This has furthered my understanding of why mentorship is crucial for not only the OT student but also the entry-level OT practitioner. This has reinforced my desire to acquire a mentor at my future job site to discuss a particular situation and receive feedback to implement into my practice. Additionally, Omura et al (2017) support this idea by stating that "healthcare leaders play an important role in supporting less experienced staff to speak up when patient safety is threatened" (p. 20). In fact, less experienced healthcare providers were less likely to express their concerns if a senior staff member discouraged this assertive behavior (p. 20). This encourages me to find a mentor who is also willing and open to feedback to enhance a greater sense of overall growth.
Boundaries are important for any relationship, but it is especially important for a therapeutic relationship in a mental health setting. Based on my observations, I have learned that individuals with a mental illness demonstrate poor social skills such as atypical speech patterns (i.e. rapid or slurred speech), inappropriate emotional or behavioral responses (i.e. laughing, talking too loudly indoors), and a lack of awareness of appropriate standing distance when talking to someone. My fieldwork educator has also educated me to be wary of clients with personality disorders because they are great at manipulating a situation to get their way. As a student I am more likely to be taken advantage of because I do not have the authority or respect from my clients as my fieldwork educator does. Therefore, it is critical that I apply what I have learned in establishing boundaries to lend myself credibility while also respecting the boundaries of my clients to ultimately ensure safety of everyone involved in these social interactions. For example, Dombeck (2006) explains the difference between aggressive, passive and assertive communication. In Dombeck's (2006) article, "Setting Boundaries Appropriately: Assertiveness Training", I learned that "assertiveness is about finding a middle way between aggression and passivity that best respects the personal boundaries" of all people involved and that assertive people use "aggression defensively" but "never offensively" (p. 1). In fact, the purpose of assertiveness is to simply "make change occur" without disrespecting your boundaries or the other person's boundaries (Dombeck, 2006, pg. 2). I had a chance to practice my assertiveness during a staff meeting here at my fourth fieldwork site. I felt clumsy and a little bossy. As Dombeck (2017) would explain, it is normal to feel this way because it is a "transitional" period and requires a great deal of practice to become accustomed to this new way of communicating with others (pg. 2). When the opportunity presents itself, I utilize assertive communication and I am starting to feel more comfortable when I have to use it. It takes time and practice to learn how to be assertive and even more time to get a better understanding of when to use it.
Not only is assertiveness training useful for therapeutic relationships, but it also helpful with reducing anxiety and improving decisiveness. For most of my peers, school comes easily, whereas I require additional learning strategies and help to learn the material. I have always had to work hard at school and I used to have terrible test anxiety. However, I believe that my struggles in school have made me more resourceful since I had to figure out various ways to teach myself and overcome my test anxiety. Interestingly enough, while researching assertiveness, I came across an interesting article by Mohebi et al. (2012) which talked about the effect of assertiveness training on a student's academic anxiety. It states that while "a low level of [academic] anxiety" is positively motivational to contribute to the student's ability to learn, "high levels of it" can actually lead to a "disturbance in concentration, attention, storage of knowledge, recall and educational reduction" (Mohebi et al., 2012, p. 37). Based on my own experience, I can attest that not eating properly and sleeping poorly can definitely contribute to higher levels of anxiety. When my anxiety levels are higher than normal for an extended period of time, it takes a serious toll on my ability to perform as a student. In addition, while in that state, I acknowledge that I had allowed myself to be emotionally be affected by my third fieldwork educator's reactions to the point that I was experiencing even higher levels of anxiety that affected my ability to focus on what needed to be learned and potentially apply that knowledge to future situations that would have shown learning and growth as an occupational therapy student. This study also points out that there is a "relationship between anxiety and assertiveness", therefore, Mohebi et al (2012) wanted to determine "the effect of assertiveness training on reducing anxiety levels" in college students (p. 37). The results of the study did find a significant decrease in anxiety in the experimental group post-intervention. It noted that due to a decrease in anxiety there was an increase in decisiveness in the experimental group as well, therefore, "assertiveness training" was an "effective non-pharmacological method for reducing academic anxiety" which ultimately improved "academic performance" of the college-age students (Mohebi, 2012, p. 39). While at my fourth fieldwork site, I have had several opportunities to be assertive with my clients and I do feel less anxiety or stress. For example, I have to be more assertive with one of the lower functioning groups because my clients have poor attention and poor impulse control skills. These deficits require a greater amount of assertiveness than my other groups. When I led my first session with this group, I had a hard time managing the group because I was not being assertive enough for what my clients needed. Although I had read a great deal about assertive communication, I had not had much practice implementing it before now. My fieldwork educator also provided helpful feedback for how I should approach this group the next time I lead it. She encouraged me to be more assertive. The next time I worked with this group I did a much better job, according to my fieldwork educator. I applied both what my fieldwork educator had told me to do and the material I had previously read about in the aforementioned articles and my preparation had paid off. Her encouragement and my ability to implement a larger amount of assertive communication also reduced my anxiety and I now felt competent to independently lead this group in the future.
Over the past few months I have learned that "life includes adversities" and that "resilience is the key" to overcoming those adversities (Reivich & Shatte, 2002, p. 1). As Henry Miller once said, while I am my worst enemy, I know too that I am my savior. While most people may identify my situation as a failure or setback, I have decided to transform my hardship into an academic challenge that I must overcome. My resilience has played a huge role in my ability to bounce back and use this stumbling block as a learning experience. Anything I have learned from previous mistakes, as well as what I have learned through my self-edification, has been implemented into my practice during my fourth fieldwork rotation. I believe this whole experience has been one of the greatest attestations to my ability to be resilient regardless of what life throws my way. Not only do I want to demonstrate growth as an OT student to my advisor, fieldwork coordinator, and the board, but most importantly I want to prove to myself that I have learned from these experiences and applied that newfound knowledge to ensure success at this fourth and final fieldwork rotation.
Resources:
Dombeck, M. (2006). Setting boundaries appropriately: Assertiveness training. Mentalhelp.net. Retrieved from https://www.mentalhelp.net/articles/setting-boundaries-appropriately-assertiveness-training/ .
Dombeck, M. (2006). Setting boundaries appropriately: Assertiveness training (continued). Mentalhelp.net. Retrieved from https://www.mentalhelp.net/articles/setting-boundaries-appropriately-assertiveness-training-continued/ .
Mohebi S., Sharifirad G.H., Shahsiah M., Botlani S., Matlabi M., and Rezaeian M. (2012). The effect of assertiveness training on student's academic anxiety. Journal of Pakistan Medical Association, 62(3), p. S37-41.
Omura, M., Maguire, J., Levett-Jones, T., and Stone, T.E. (2017). The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. International Journal of Nursing Studies, 76, p. 120-128.
Reivich, K. & Shatte, A. (2002). The resilience factor: 7 keys to finding your inner strength and overcoming life's hurdles. Bright & Happy Books, first edition, p. 1-321.