My caring values

This is a student’s reflective blog on caring values. Although anonymous, please treat this personal account with dignity and respect. Thank you/ Diolch yn fawr.

Therapeutic use of self is a therapist’s purposeful use of their personal qualities as a component of the therapeutic process (Punwar and Peloquin 2000; Solman and Clouston, 2016). As therapeutic use of self is linked to therapeutic outcomes it can be considered a skill that must be developed in order to maintain fitness to practice as an Occupational Therapist (Seymour 2011).  In order to develop my understanding of these skills this reflection will consider my personal caring values and how they shape my practice as an Occupational Therapy student. I will consider my own values in relation to the Cardiff University Oath and the values inherent within it. This will support me to consider the skills and values I will need to develop particularly in terms of empathy, compassion, dignity, respect, listening and responding.

My Caring Values and the Cardiff University Oath

In order to reflect on my caring values as applied to my practice I began by recording them in a free writing exercise where I described my own personal standards as a practitioner. I then reflected on what I had written and considered what themes or concepts were most prevalent. High prevalence themes and concepts were considered to be evidence of a potential values. The values distilled from this exercise were authenticity, creativity, empathy, acceptance, self-care, compassionate care, self-development, equality, fairness and empowerment. I felt that my values could be expressed in a number of ways, for example authenticity could be expressed by being truthful with a client when I have concerns that a choice they are making is putting them at risk in some way, but it can also be expressed by admitting to a gap in my knowledge. My values were also interdependent, for example, being authentic and admitting gaps in my knowledge to both myself and others is likely to direct me towards opportunities for self-development.  However, for self-development to take place I would need to be taking care of myself well enough for me to have sufficient time and energy to learn and develop new skills.

On reflection of the Cardiff university oath, I feel that the statements within the oath operationalise many of the personal values I hold. For example, I feel that my personal values like equality and fairness are mirrored in the promises not to allow my prejudices to influence my practice or to discriminate against others. Below is a table that illustrates what parts of the oath if feel my values coincide with.

Oath	Value
Make the care of my patient’s my first concern	Compassionate Care
Be considerate to all my patients ad strive to communicate effectively with them	Compassionate Care Empowerment Acceptance Empathy
Respect patients dignity and autonomy and right to be fully involved in decisions about their care	Empowerment
I will at all times be honest, trustworthy, respecting and protecting confidential information	Authenticity
Recognise the limits of my competence and will keep my professional skills and knowledge up to date	Self-development Self-care Compassionate Care
I will not abuse my professional position	Fairness
I will work with my colleagues towards my patients interests	Compassionate Care Acceptance
My personal beliefs will not prejudice my care of patients	Acceptance Compassionate Care Self-development Equality Fairness
If I believe that I or a colleague is not fit to practice I will act quickly to protect the patient from risks	Fairness Authenticity Compassionate Care Self-Care
I will never discriminate unfairly against patients or colleagues	Fairness Equality Compassionate Care Acceptance
I will always be prepared to justify my actions to them	Fairness Equality Authenticity

Overall, I found reading through the oath has also served to remind me how vulnerable patients can be in our care. Reflecting on the oath has also led me to consider that caring has both an affective and behavioural component (Rose and Phillips 2010), thus I need to be aware of what my values are and also how I will actualise them in practice for them to be of benefit to my client. This comparison of my own personal values and the Cardiff university oath has led demonstrated to me that in many ways my personal values are well suited to my responsibilities as a healthcare professional, but it has also identified some gaps in my values. For example, the statement regarding my responsibility to report fitness to practice concerns which could be difficult to do, made me consider the need for integrity as a value. I interpret integrity to mean the quality of holding high moral standards and being able to maintain them through challenges (Cambridge University Press 2017). Although I have a value base I also must be committed to sustaining it when under pressure.

Reports such as Andrews and Butler (2014) and Francis (2013) have examined serious lapses in care standards  within the health service. Potential challenges cited in both reports include organisational culture’s that devalues care, high work load, staff shortages and lack of attention to personal development and learning around the needs of vulnerable client groups. In contrast factors that facilitate compassion care include personal insight and self-awareness, recognition of own limitations and willingness to develop learning new skills and accept the need to change one’s own world-wide view, altruism and the capacity to recognise one’s own self-care needs (Clouston 2017).  Consideration of the characteristics suggests that in order to develop compassionate care perspective-taking is a vital skill. As my favoured learning style is that of a reflector (Mumford and Honey 1992) I naturally tend to assume different perspectives in situations. I generally consider myself to be an empathetic person, however, I am conscious that this quality can also negatively impact on my ability to care as it can mean that I feel emotionally drained when dealing with others who are experiencing difficulties. Further, empathy is not without biases, for example we can tend to feel more empathy for those that are more similar to ourselves (Bloom 2017) which means that it could negatively impact the equality of my care.

Action Plan

In order to ensure that this quality is utilised positively for both myself and my clients I have considered strategies that facilitate the development of perspective-taking in a more systematic manner. One strategy that appears in the literature is mindfulness. Mindfulness refers to a non-judgemental form of awareness that has the benefit of bringing us in touch with the present moment (Clouston 2015). Mindfulness can cultivate psychological openness to our thoughts, feelings and experiences by developing awareness to immediate experiences. Therefore, this undermines reliance on fixed beliefs about ourselves and avoidant coping strategies to manage emotionally in challenging situations  (Neff and Tirch 2013).  Consequently by making us more open to immediate experiences mindfulness can also enhance perspective-taking, empathy and compassion for both others and ourselves (Hayes et al. 1999), which is likely to promote compassionate care and resilience. As a student I have practiced mindfulness for some time but must now develop my ideas as to how to apply this skills within the workplace and in my practice and how it may be used therapeutically.

References

Andrews, J. and Butler, M. 2014. Trusted to Care. Sterling: Dementia Services Development Centre.

Bloom, P. 2017. Against Empathy. In: Tremonti, A., M ed. The Current.

Cambridge University Press. 2017. Integrity [Online].  Available at: http://dictionary.cambridge.org/dictionary/english/integrity [Accessed: 24/01/2016].

Clouston, T.J. 2015. Challenging stress, burnout and rust-out: Finding balance in busy lives. London: Jessica Kingsley.

Clouston, T. J. 2017. Transforming learning: Teaching compassion and caring values in higher education. Journal of Further and Higher Education. Online version: http://dx.doi.org/10.1080/0309877X.2017.1332359

Francis, R. 2013. Report of  the Mid Staffordshire   NHS Foundation Trust   Public Inquiry   Executive summary. London: The Stationary Office.

Hayes, S., C et al. 1999. Acceptance and Commitment Therapy: An Experiential Approach to Behavior. Guildford Press: London.

Mumford, A. and Honey, P. 1992. Questions and Answers on Learning Styles Questionnaires. Industrial and Commercial Training 24(7).

Neff, K. and Tirch, D. 2013. Self-Compassion and ACT. In: Kashdan, T., B and Ciarrochi, J. eds. Mindfulness, acceptance, and positive psychology: The seven foundations of well-being.  Oakland , CA: Context Press, pp. 78–106.

Punwar, A. and Peloquin, S. 2000. Occupational therapy principles and practice. 3rd ed. Philadelphia: Lippincott Williams & Wilkins.

Rose, P. and Phillips, S. 2010. Caring: Values and Evidence. In: McCarthy, J. and Rose, J. eds. Values-based health and social care beyond evidence-based practice.  London: Sage, pp. 48-69.

Seymour, A. 2011. The use of self in occupational therapy. In: Seymour, A. and Boniface, G. eds. Using Occupational Therapy Theory in Practice.  Chichester: Wiley, pp. 49-60.

Solmon, B. and Clouston, T.J. 2016. Occupational therapy and the therapeutic use of self. British Journal of Occupational Therapy, 79,8, 514-516