Читать книгу Becoming a Reflective Practitioner - Группа авторов - Страница 12

In Chapter 1, I envisage reflection. Reflective practice is at risk of being a cliché with its multiple interpretations that begs the question ‘what exactly is reflection and reflective practice’? How can we know it and apply it certain of its validity?’ If known, it can be applied with prediction and control, so everyone knows what it is. However, things are not that simple. Reflective practice will always be interpreted in different ways according to the interpreter’s perception and intentions. I give a brief overview of reflective theories that I have dialogued with over time and which, to a varying extent, have influenced my own conception of reflective practice. In describing reflection, I view learning as a movement through understanding, empowerment and transformation. At each level, insights can be gleaned.

I explore vision as fundamental to reflection. Vision sets out what the practitioner is striving towards. Vision sets up creative tension, the dynamic learning moment within reflection between vision and an understanding of our current reality. In understanding this tension, the practitioner can work towards resolving it so the vision can be more realised. Barriers that constrain are identified and worked towards overcoming. Without vision, reflection has no real meaning except perhaps as a superficial problem‐solving tool. As such, reflection is always an exploration of values that constitute vision and the assumptions and attitudes that support realising the vision as a lived reality.

In Chapter 2, I set out the Six dialogical movements that structure the reflective learning process that is systematically explored through succeeding chapters. I set out the reflective attitude comprised of a number of attributes the practitioner needs to cultivate to engage reflection to gain maximum benefit. One of these attributes is developing bringing the mind home. Bringing the mind home helps to prepare the practitioner to be fully present within‐the‐moment, whether in clinical practice or reflecting on experience.

In Chapter 3, I explore the first dialogical movement concerned with paying attention to a particular experience with the intention to write or portray a description of that experience. This expression is the raw data reflection. Paying attention immediately cuts across the taken for granted nature of much of experience and habitual practice. Over time, through paying attention, the practitioner becomes increasingly self‐aware, leading to mindfulness where nothing is taken for granted and the whole span of practice is an inquiry. I advocate keeping a reflective journal to write descriptions that becomes an ongoing and unfolding reflective record of experience.

In Chapter 4, I explore reflection using the Model for Structured Reflection [MSR]. The MSR has been significantly revised from previous editions and is easy to apply. From feedback, I get the impression that many people think that simply using the MSR is reflective practice. Worse, they view a model of reflection as a prescription. It isn’t! It is a heuristic, a means to an end towards gaining insight. I urge readers to dwell with the MSR, to feel the depth of the cues rather than view it superficially and skid along the surface of reflection. If so, reflection loses its vitality.

In Chapter 5, I explore insight. Insights are the learning accrued through reflection. They are described as embodied learning because they change the person in some way so that they now view and respond to the world differently, however slight. They are not necessarily easy to identify because of their embodied nature. Insights are initially tentative and held loosely. They are most often acknowledged reflexively through subsequent experiences.

In Chapter 6, I explore the third dialogical movement between the practitioner’s tentative insights and informing literature whereby relevant information from whatever source is accessed, critiqued, juxtaposed with insights and assimilated into personal knowing. I show how theory can be explored as theoretical mapping enabling practitioners to position themselves within the theory and plot movement towards a more desirable position.

The second part of this chapter is devoted to the fourth dialogical movement, the dialogue between the practitioner with a guide and peers. Guidance opens a learning space where the practitioner can share their experiences and insights, inviting the guide to offer their own perspectives. As a result of this dialogue, new insights emerge, deepened, and co‐created. Guidance radically shifts the relationship between student and teacher and, as such, has profound implications for curriculum as explored in later chapters.

In Chapter 7, I explore the fifth dialogical movement as weaving insights into threads and patterns represented in reflexive narrative form. The word ‘narrative’ has seeped into everyday speak. I wonder, have we moved beyond the technical rational to value experience and anecdote reflected in this seepage? Or is narrative simply a word to reflect ‘the story’ or ‘vision’. Whatever, it does suggest a valuing of context and subjectivity; that people are not machines. People are human and that experience is human and unique. And that no matter the difficulty, learning through reflection is dynamic. Narrative is creative. The practitioner has a license to construct narrative in ways that best express their reflexive learning and journey, for example, through poetry, art, metaphor and images. It cannot be prescribed even though academic institutions will nevertheless impose criteria about how it should be expressed.

In Chapter 8, I apply the model for structured reflection to my description of being with Peggy one morning at the Day Hospice. I apply the MSR in a systematic way to illustrate my use and understanding of each cue and as an exemplar to readers.

In Chapter 9, I set out my narrative of ‘patients I do not give a therapy to’ written as a series of prose poems about different patients who share the fact I did not give them a physical therapy, challenging myself about my role and the concept of therapy.

In Chapter 10, I explore the sixth dialogical movement as the dialogue between the text and its audience. In doing so, I emphasise that the text is more than simply an account of the practitioner’s journey. It offers an audience a focus for their own reflection and learning. The practitioner invites the audience to dialogue with an intent to stir the audience to draw and act on their own insights. With this idea in mind, the practitioner writes in a way to engage the audience and open this reflective space. Audience can be readers or listeners through performing the narrative.

In Chapter 11, I explore the idea of performing narrative to an audience in contrast with an audience reading a narrative. I give an example of how one practitioner converted her written assignment into a play ‘Musical chairs’ that was performed at a reflective practise conference.

In Chapter 12, I set out the performance narrative ‘people are not numbers to crunch’. It was written from my perspective as a partner to witness Otter’s experience of undergoing an angiogram. It exposes issues which reflect an unsatisfactory level of care, notably that nursing staff do not introduce themselves and treat Otter as if she is an object and myself as an outsider beyond their gaze. The performance is set against a CQC report of care at this particular hospital. Otter’s graphic storyboard of this experience can be accessed on the Wiley Blackwell website.

In Chapter 13, I explore with Otter how art and storyboard offer as a particular visual approach to reflection and narrative that may offer an alternative to language approaches and hence may benefit visual reflectors. Breaking narrative into visual scenes, like poetry, aids the revelation of insights. Poetry and art are expressive forms that open up the neglected right brain moving away from rational thought to nurture imagination, perception and ultimately intuition. We use Otter’s storyboard of bullying in the workplace. We know from experience that many practitioners will relate to this because bullying is endemic within the workplace. Storyboard’s visual storyboard is easy to relate to, opening a clearing for practitioners to explore their own experience of being bullied and how such pernicious behaviour can be confronted.

In Chapter 14, I contemplate the reflective curriculum. It is fascinating to look back at the previous editions to see this chapter’s reflexive development. It is the most vital chapter because health discipline curriculum is entrenched in a technical rational modus where reflection is viewed as just another teaching technique. If this is the case, then much of the benefit of reflective practice is lost. The reflective curriculum views professional artistry and identity as its education aim, and reflective practice as its primary approach, re‐orientating theory to inform this process. In other words, it turns the traditional relationship between practice and theory on its head. Easier said than done. I imagine how two teachers with differing teaching approaches explore teaching nursing students about stroke. John takes a theory‐driven approach typical of a dominant technical rational approach. Jane takes a reflective approach that embraces performance and with it, cross‐discipline teaching. At Bedfordshire, I involved drama and dance teachers as co‐supervisors for reflexive narrative doctoral students. Their involvement opened up the performance potential as a profound learning space. Performance engages and empowers people. It is an embodied learning that is necessary for practice disciplines where the body has to learn rather than the mind simply think.

Developing post‐registration reflective curriculum is illustrated through two courses; one as part of a ‘top‐up’ degree and one as a total masters degree in leadership.

Much of the reflective practice taught in Universities is by people who are not reflective. As a consequence, they adopt technical rational approaches to teaching reflection that are inadequate. The whole book is itself a treatise on the need to create reflective learning environments if we are to practice reflective practice critically rather than as a superficial problem‐solving exercise. Of course, it has value even at that level if it enables practitioners to pause and reflect on what they are doing in terms of best practice. But much of what we do and the way we think about what we do is culturally prescribed, And so, the reflective teacher, like the reflective practitioner, must pierce this cultural veil to understand and shift the norms that govern teaching of teachers if the value of reflective practice to develop professional artistry is greater than a technical rational approach to do reflection.

In Chapter 15, I explore how reflective academic writing can be meaningfully graded from a professional artistry perspective in contrast with a technical rational perspective. I argue that the focus of all reflective examination should primarily focus on the insights the practitioner draws from reflection, not on the reflective process itself. I use Jill’s reflective assignment on touch and the environment to invite readers to grade and reflect on how they graded.

Chapters 16 and 17 are illuminations of guiding nursing students in dedicated guided reflection sessions. The two situations: ‘Michelle finding a woman upset about her breast biopsy’ and ‘Hank’s complaint’ are real situations shared in guided reflection. As you might expect, guiding the first year group is more directed, whilst guiding the third year group is more open. The chapters illuminate the use of theoretical mapping, the way can be fed into the dialogue between guides and students.

Chapter 18 is a narrative of guiding of Trudy within the context of her clinical practice whilst also undergoing the Becoming a reflective and effective practitioner programme set out in Chapter 14. The narrative reveals how a particular experience is unfolds over six guided reflection sessions leading to profound insights. Of particular note is the richness of Trudy’s reflective description imbibed with MSR cues.

Chapter 19 reveals Sally’s narrative ‘a small voice in a big arena’ which was written as her conflict management assignment on the MSc Leadership in healthcare degree. It reflects how conflict is an everyday occurrence for many practitioners and hence a common focus for reflection. Her effort to respond to conflict from her vision of leadership heightens the conflict tension dramatically revealing the struggle to realize her vision of leadership as a lived reality within a transactional healthcare organization.

Chapter 20 sets out the Learning Organizations inspired by the work of Senge (1990) concerned with creating an environment in which reflective practitioners work collectively towards realising their vision of practice as a lived. This is exemplified through the Burford NDU Model of nursing: caring in practice. This model consists of four reflective systems set against the background of the Learning Organization. Two systems concerned with implementing the vision through reflective cues and communication are explored.

In Chapter 21, I set out ‘A system to live and ensure quality’ through developing clinical audit, standards of care, and group guided reflection that each foster reflection, personal mastery and team learning.

‘A system to enable practitioners to develop personal mastery towards realizing their vision of practice’ is the focus of Chapter 22. Within healthcare organizations guided reflection is usually termed clinical supervision that comes with a political agenda to essentially safeguard the public. Hence a tension exists between its regulatory and developmental intentions. Susan’s narrative, completed as an assignment on the MSc Leadership in Healthcare degree, gives focus on instigating clinical supervision as an element of leadership against the background of developing the Learning Organization.