During my nurse training a student colleague told me that, “reflection is just thinking about what you’ve done and how you could do it better.”
Johns (2004) states that reflection is to confront and resolve the contradiction between what the practitioner wants to be and do (the ‘vision’) and what s/he actually does (the ‘lived reality’). The attempt (or desire) for the practitioner to resolve this contradiction is a sort of tension which is creative because it can be resolved in a way that can move the practitioner forward in their practice. Donald Schon (1985) suggests that there are two forms of reflection: reflection-in-action (i.e., during the event) and reflection-on-action (i.e., after the event).
For example, in mental health recovery the ideal (or ‘vision’) of practice could be said to be that described by the National Institute of Mental Health [NIMHE] in the NIMHE Guiding Statement on Recovery (NIMHE, 2005); and the reality as what the nurse actually does during every day practice. Therefore a nurse who is trying to work in a way which is consistent with mental health recovery may feel that what they should try to do does not correspond to the everyday experience of working in an organisation (with its emphasis on statutory laws, for example). Reflection takes place when the nurse thinks about this apparent contradiction and tries to make sense of it and even resolve it; so that what they do afterwards is more in keeping with the goals for mental health recovery as set by NIMHE.
To guide the nurse in doing this there are several models of reflection such as that suggested by Gibbs, Johns and Rolfe (Ramage, 2005). Ramage (2005) suggests that Gibbs’ Reflective cycle - which is in popular usage - is in fact not sufficiently sophisticated to offer detailed reflection; I prefer to use Johns (1995a ) Model of Structured reflection. Grech (2004) warns that when a nurse reflects they must be wary of the dangers of reducing their experiences to a series of questions posed by a model of reflection; a process which might prevent any real reflectiveness. I agree with the same author that a model of reflection can be rigid; so I prefer to use such a model as Johns’ Model of Structured Reflection as a series of cues or signposts rather than as a succession of questions to be answered religiously in order.
Problems of reflection:
1. Gilbert (2001) and others (eg., Cotton, 2001) view reflection for nurses as a means of self-surveillance so that nurses can make sure what they are doing is ‘right’ (ie., in keeping with the normative culture of the organization, society and nursing).
2. An argument brilliantly argued by Brown and Nolan (1999) is that the ideal to which nursing practice aspires (also known as ‘Clinical Governance’) is in fact decided upon by the decision-making forces of society. That is, these forces of what is called governmentality decide what nursing ‘truth’ is.
3. In other words, if during the process of my reflection I am comparing the reality of my practice with an ideal of practice (say, the ideal offered by NIMHE’s (2005) Guiding Statement on Recovery) then this is somebody else’s ideal and not my own.
4. Organizations are now centrally integrating reflection into personal development reviews. This perhaps looks like the element of self-surveillance inherent in reflection is attractive to organizations, a possibility highlighted by Kitchener et. al. (2003).Such organizations might use reflection to ensure alignment to organizational goals (making those goals the ‘ideal’ of practice). Gilbert (2001), following Foucault, suggests that this was always the purpose of the act of confession in the Roman Catholic Church and has now very subtly been extended to nursing.
5. Reflection often means keeping a diary in which to record practice and reflections upon that practice (Street, 1995). Many nurses tell me that they do not have the time or the inclination to do maintain a reflective diary: the nature of nursing is so stressful (Bond, 1993; Charnley, 1999) that in fact many nurses just want to get home after the completion of the working day and leave work behind them.
6. Johns (1995b) has pointed out that often nurses will only use traumatic experiences as a vehicle for reflection because those are the most memorable; so that the process of reflection is therefore immediately unbalanced towards negative experiences.
7. Can a nurse’s diary of reflection (or their reflective accounts) be used as evidence in a court of law? This is another example of one’s private thoughts being made public through reflection (Cotton, 2001).
Advantages of reflection:
1. Holmes (2001) compares the nurse who is reflective with Foucault’s idea of the specific intellectual: the person who seeks truth for its own sake rather than as a source of power over others
2. Reflection is a way of improving practice and reducing traumatic feelings. Two of the most important questions in Johns’ Model of Structured Reflection are “How do I feel about what happened” and “How can I do this differently next time?”
3. Reflection is a way of seeing the ‘truth’ of a situation (Holmes, 2001). This is why organizations resist reflection (Mantzoukas and Jasper, 2004). Reflection brings a level of perception which is normally hidden, into consciousness.
4. Longenecker (2001) described reflection as “a scholarship of practice”, because it represents the way in which reflection leads the practitioner into other areas of nurse scholarship which will enhance practice and/or consciousness.
5. Reflection has great potential for liberatory action or liberatory consciousness (Habermas [MacIsaac, 1996]).
REFERENCES
Bond, M. (1993), Stress and self-Awareness: A Guide for Nurses, Nursing Today, Butterworth Heinesman;
Brown, B. and Crawford, P. (2001), Clinical governmentality? A Foucaldian perspective on the policy of clinical governance in nursing, unpublished, http://www.academicarmageddon.co.uk/prog/notes.htm, accessed 18/12/05;
Charnley, E. (1999), Occupational stress in the newly qualified staff nurse, Nursing Standard, vol. 13, no. 29, pp. 32-37, April 7;
Cotton, A. (2001), Private thoughts in public spheres; issues in reflection and reflective practices in nursing, Journal of Advanced Nursing, 36 (4), pp. 512-519;
