A Rhetorical Reflection
I like the concept of practice being an art. It conjures up a vision of practitioners who rely both on their knowledge and their intuition. Being reflective is a critical part of being an accomplished practitioner, regardless of one’s field. As such, reflection according to Schön’s (1990) description, is something that the reflective practitioner learns to do reflexively.
Finlay, (2008) discusses reflective practice in the context of nurse education and practice. She refers to John’s model of reflection, originally developed for nurses (1994). Over the years, John’s model has become less prescriptive and more holistic, encouraging the use of the nurse’s intuition. But, there is a lack of uniformity in how people understand and critique reflection and reflective practice.
I have a concern that the organisational concept of reflective practice is more akin to what Finlay refers to as the “ubiquitously irreflexive rhetoric of reflective practice”, (Finlay, 2008. p.7.). For me, reflection raises the possibility of challenging received wisdoms or normative practices, wherever they occur. Within the current healthcare environment, it can be challenging to create the environment where such reflective practices are possible. Schön refers to the Squeeze Play (1990. p. 313), the interplay between technical approaches to health and a constriction on intuitive or reflexive practice. Allowing insufficient time or failing to create the correct supportive environment for clinicians to reflect is unlikely to promote best practice. It is more representative of a defensive practice, driven arguably by increasing economic constraints, and a rise in the demand for technical excellence.
A Force for Liberation
I believe that reflection and reflective practice as it is described by Schön and others is a potentially liberating force, because at its centre is a way of being that is essentially explorative and enhancing. I want to know more about and understand more completely the process of reflection and of reflective practice. I am driven to this, both for my own sake and also in a way, if it is not too presumptuous of me, on behalf of my healthcare colleagues.
I start my journey from a place where, as it seems to me, the concept of reflection and reflective practice is not an agreed phenomenon. For example, Mackintosh (1998) describes reflection as a poorly defined concept without adequate frameworks in place within the nursing profession for its implementation. While she seems to be very critical in her analysis, particularly of Schön’s work, she makes the valid point that the widespread invocation of reflection as a practice that can be assessed to mark professional or academic practice is a potentially dangerous and flawed strategy. It is unlikely that a student for example will feel free to be honest in reflection if there is a worry about getting poor marks, or a poor evaluation as a result. A healthcare practitioner, working in an environment that is not explicitly safe is unlikely to feel free to share fully his or her reflections, and may even be well advised not to so do. But this criticism may be based on a misconception that reflection is a one-way process that is about some sort of critical self-evaluation.
This is a real pity, because, the spirit of reflection as I understand it, described by Schön (1990), is poorly served in this way. The operational impact of this kind of assessed or mandated practice is to deny practitioners a real opportunity to grow and develop as people and as professionals. Reflection takes time, a safe environment and support.
So, what I wonder did Schön actually mean? Well, I seem to have been labouring under a misconception, as much my oversight as anyone else’s. I confess, I have been left “cold” at what has been described as “reflection” in, for example, my postgraduate training in higher education.
A Way of Being
Reflective teaching, the reflective practicum, (Schon, 1990, p. 311) is a process that is all encompassing. It is not simply an activity for student or the practitioner nor is it simply an activity for teachers or managers. It is a way of doing things, it is a contextual statement for both. It is a way of being that is in many ways similar to that described by Barnett and Coate much later on, (Barnett & Coate, 2005) when they write about engaging the curriculum in higher education.
Far from being engineered, even as a flexible structure, in a fluid age a curriculum has to be open ended. This open-endedness is not that our kind of curriculum bends with the wind and that its structure has been computed in advance to tolerate such disturbances; rather this open-endedness comes of genuine human engagements with the material environment and with other human beings. (p. 50)
Thus reflection becomes, not an activity to be performed as a milestone, but a way of being in the world and of responding to it as it unfolds itself in front of us. It is an exploration. It is the expression of mindfulness. According to Epstein (1999), critical self-reflection depends on a state of mindfulness. Bishop et al., (2004) describe mindfulness as bringing a state of self awareness to a current experience. Epstein (1999) making use of a case narrative, describes how he must refer to explicit knowledge of breast cancer, but then rely on his knowledge of and relationship with his patient in a particular clinical encounter in order to arrive a safe clinical outcome.
Each in their turn is describing a practice that is situated within a reflective way of being. It is something more than just the practitioner in a specific situation, it is in every sense a way of being.
The real challenge is the same as that posed originally by Schön and more recently by Barnett and Coate; namely, how to express it in one’s practice so that it becomes the “way we do things together”?
References.
Barnett, R., & Coate, K. (2005). Engaging The Curriculum In Higher Education. McGraw-Hill International.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. Retrieved from http://onlinelibrary.wiley.com/doi/10.1093/clipsy.bph077/full
Epstein, R. M. (1999). Mindful Practice. JAMA: The Journal of the American Medical Association, 282(9), 833–839. doi:10.1001/jama.282.9.833
Finlay, L. (2008). Reflecting on ‘reflective practice’. A discussion paper prepared for Practice- based Professional Learning Centre (PBPL CETL). The Open University, 52, 1-27. Retrieved from http://www8.open.ac.uk/opencetl/files/opencetl/file/ecms/web- content/Finlay-%282008%29-Reflecting-on-reflective-practice-PBPL-paper-52.pdf
Mackintosh, C. (1998). Reflection: a flawed strategy for the nursing profession. Nurse Education Today, 18(7), 553–557. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9887754
Schön, D. A. (1990). Educating the Reflective Practitioner: Toward a New Design for Teaching and Learning in the Professions. Jossey-Bass.
Stories That Change 