Becoming a Reflective Practitioner

Christopher Johns, Christopher Johns

• Publisher: Wiley-Blackwell
• Year: 2017
• ISBN:
  9781119193944
• Edition: 5
• Topic: Medicina
• Subtopic: Tecniche infermieristiche

'Christopher Johns is an internationally recognised pioneer of reflective practice in nursing and health care.' – Nursing Standard

Becoming a Reflective Practitioner provides a unique insight into reflective practice, exploring the value of using models of reflection, with particular reference to Christopher Johns' own model for structured reflection. Now in its fifth edition, this book has been completely revised and updated to include up-to-date literature and reflective extracts.

Contemporary in approach, this definitive text contains a variety of rich and insightful reflective extracts that support the main issues being raised in each chapter, and challenges practitioners and students to question their own practice. Now with further scenarios and case studies included throughout, these extracts provide the reader with access to the experience of reflective representation helping to explicate the way in which reflective practice can inform the wider notion of professional practice.

With an increase in professional registration requiring reflective evidence, this new edition of Becoming a Reflective Practitioner is an essential guide to all those using reflection in everyday clinical practice.

Chapter 1
Imagining Reflective Practice

Christopher Johns

Experience is a creative encounter

Hi, I'm beady eye. I'm called beady eye because I like to keep my eye on what's going on the quality of healthcare.

I was sitting in the train the other day

When a woman hobbles on

Finds a seat to put her leg up

She says to her mate

‘They just don’t care anymore

She didn't look properly at my foot

She wasn't interested

Told me it was probably a corn

Wasn't listening to me

Told her the pain was in me 'eel

In the end she said

‘Your 10 minutes are up

Got to see someone else.’

Her mate rolls her eyes

‘Bloody awful ain’t it

Chiropody on the NHS.'

Such experience reminds me of the fragile quality of health care. I wonder how the chiropodist would recall the event? Bet she isn't a reflective practitioner!!

You'll meet me again in some later chapters. Until then enjoy the book.

O'Donohue (1997: 26) writes, ‘Everything that happens to you has the potential to deepen you.’ This potential is actuated through reflection as a self-inquiry into experience to find meaning, gain insight and prompt action that will deepen you.

Reflection enables you to understand yourself and, on that basis, to take leadership of your professional life. By leadership I mean the action towards realising your values or vision about your practice.

Recall a situation when you were last at work and ask yourself – ‘Did I respond in tune with my values?’ which, of course, raises the question ‘What are my values?’ I assume as a healthcare practitioner you hold a set of values or a vision that is important in guiding your individual and collective practice. Now, ask yourself – ‘Did I respond in the most effective way?’ Be open and curious about that. Did you choose to respond in that way or was it your normal practice? How do you know if you were effective? Perhaps there are more effective ways? Think about what factors influence your response. What interferes with realising effective practice? As a consequence of this self-inquiry, you become more sensitive to your values and the notion of your effective practice. As such, you step along a reflective road.

Reflective Practice

Reflective practice has become a normal requirement within professional curriculum and, as such, demands serious consideration. However, the words reflection and reflective practice are often used glibly in everyday discourse, as if reflection is simply a normal way of thinking about something that has happened and which requires little skill or guidance. Smyth (1992: 285) writes:

Reflection can mean all things to all people… it is used as a kind of umbrella or canopy term to signify something that is good or desirable… everybody has his or her own (usually undisclosed) interpretation of what reflection means, and this interpretation is used as the basis for trumpeting the virtues of reflection in a way that makes it sound as virtuous as motherhood.

Smyth's words are both salutary and provocative. They remind us to be careful about defining reflection in an authoritative way and yet, on the other hand, practitioners do need something to grasp, a conceptual grasp on reality.

Turning to the Compact Oxford English Dictionary 3rd edition (2005: 86), it defines ‘reflect’ as:

throw back heat, light, sound without absorbing it

[of a mirror or shiny surface] show an image of

represent in a realistic or appropriate way

bring about a good or bad impression of someone or something [on]

think deeply or carefully about

Interpreting this array of definitions, reflection can be viewed as a mirror to see images or impressions of self in the context of a particular situation in a realistic way. It is an awareness of the understanding about the way the person thinks and feels about whatever he is experiencing. It is also judgemental, distinguishing between good and bad. If healthcare is concerned with understanding and responding to the experiences of people who require care then it is first necessary for the practitioner to understand herself.

My description of reflection is always evolving –

Being mindful of self, either within or after experience, as if a mirror in which the practitioner can view and focus self within the context of a particular experience, in order to confront, understand, and become empowered to act towards resolving contradiction between one's vision of desirable practice and one's actual practice to gain insight within a reflexive spiral towards realising one's vision of practice as a lived reality and developing professional identity and artistry.

Contradiction

The learning potential of reflective practice is the contradiction between one's vision of practice and one's actual practice as recalled. Contradiction is usually experienced as a ‘disturbance’ that things are unsatisfactory in some way. However, because contradiction is so normal, it may not be noticed, or simply shrugged off. As such, much of experience is unexamined.

To explore contradiction it is necessary for the practitioner to have a vision of her practice. A vision gives purpose and direction to clinical practice. It is constructed from a set of values that are ideally constructed and shared with colleagues. In this way everyone pulls in the same direction. The practitioner must inquire into her vision. For example, if the vision states words such as ‘caring’, ‘holistic’ or ‘excellent’, then what do these words mean as something lived? Vision is thus a moveable feast.

Yet, It is one thing having a vision of practice it is another thing to realise it as something lived (Rawnsley 1990).

The practitioner must first seek to understand the nature of the contradiction. Only when practitioners truly understand themselves and the conditions of their practice can they begin to realistically change and respond differently. To understand, the reflective practitioner creeps ‘underneath his habitual explanations of his actions, outside his regularized statements of his objectives’ (Pinar 1981: 177).

The practitioner must then act towards resolving the contradiction. If people were rational they would change their practice on the basis of evidence that supports the best way of doing something. However, we do not live in a rational world. There are powerful barriers that limit the practitioner's ability to respond differently even when they know there is a better way to respond. Fay (1987) identifies these barriers as tradition, authority or force, and embodiment. These barriers govern the fabric of our social world. Their influence lies thick within any experience. They are evident in patterns of talk that reflect deeply embodied and embedded relationships that serve the status quo (Kopp 2000). Reflections are stories of resistance and possibility; chipping away at resistance and opening up possibility; confronting and shifting these barriers to become who we desire to be as health care practitioners.

Barriers to rational change (Fay 1987)

• • Tradition: a pre-reflective state reflected in the assumptions and habitual practices that people hold about the way things should be.
• • Force: the way normal relationships are constructed and maintained through the use of power/ force.
• • Embodiment: the way people have been socialised to think, feel and respond to the world in a normative and pre-reflective way.

Fay (1987: 75) writes from a critical social science perspective,

The goal of a critical social science is not only to facil...