|
TOWARD REFLECTIVE PRACTICEReflective practice, effective practice by Christopher Johns Reflection is a developmental process of paying attention to and learning through everyday experiences, with the goal of realizing a vision of practice as a lived reality. In my book Becoming a Reflective Practitioner, I expand on this definition as follows:
Reflection is “being mindful of self, either within or after experience, as if a window through which the practitioner can view and focus self within the context of a particular experience, in order to confront, understand and move toward resolving contradiction between one’s vision and their actual practice. Through the conflict of contradiction, the commitment to realize one’s vision, and understanding why things are as they are, the practitioner can gain new insights into self and be empowered to respond more congruently in future situations within a reflexive spiral towards developing practical wisdom and realizing one’s vision as a lived reality. The practitioner may require guidance to overcome resistance or to be empowered to act on understanding” (Johns, 2004, p. 3). I keep a reflective journal in which I write stories of my practice. The essence of story is rich description, paying attention to detail, drawing on all my senses. I seek to tease out contradiction and work toward resolving it. This is not easy, for the factors that constrain my ability to realize my vision are deeply grounded in issues of power, tradition and embodiment (Fay, 1987) embedded within the fabric of the organization and society. Hence, reflection needs to be guided to enable practitioners to appreciate and shift such forces (Johns, 2004; Kieffer, 1984). Reflection teaches me to pay attention and become sensitive to myself within the unfolding moment. In this way, I cultivate mindfulness. Through mindfulness, wisdom and compassion, I guide my clinical practice as a nurse, complementary therapist and teacher. After writing a story, I stand back to see it more objectively and to systematically reflect, using a model of reflection (see sidebar at end of article) to guide me along a path from identifying significance—what usually appears obvious—to gaining insights or changed perceptions that may be deeply infolded within the experience. I call this path, illustrated below, the hermeneutic tide.
The image is the Koru, the Maori sign for creation or new life—words that conjure the transforming and reflexive spiral of realizing one’s vision. I can then dialogue with my guides and relevant literature to inform, check out and deepen insights along the path. From my journal: A journey begins “What is it?” I ask. “I’ve got some news to tell you.’’ Alice enters the study. She sits down on the offered chair. My desk littered with papers is distracting. Her tears are close to the surface. I pour her some jasmine tea I had made for Lou. She says she has breast cancer. They intend to operate next week. She says: “I know I’ve had the tumor for 18 months ... I put off going to the GP ... I thought I could finish my studies first ... then the nipple became puckered ... then I went to the GP ... the tumor is behind the nipple ... I will need a mastectomy ... I’ve felt a hard lump under the axilla ... I saw the surgeon ... in a matter-of-fact way, he said I would need an axillary clearance ... he wasn’t pleasant ... I didn’t find it easy to make a relationship with him ... his manner ... he kept me at a distance.” I feel Alice’s hurt, not just for the cancer diagnosis but the careless manner of the surgeon, the prospect of treatment. As a lymphoedema therapist, she is fearful of the “clearance.” Much of my complementary therapy practice is with women with breast cancer. I hear a familiar story. Alice knows this. Perhaps that is why she has come to see me? Alice glances at me. She is defiant about not wanting this clearance. “Surely they can differentiate which nodes are affected and which are not and be more selective in their removal?” We both know of recent developments in sentinel node surgery. I ask, “Can you make a fuss about that?” She doesn’t know. I ask, “Why do you tell me?” She looks directly at me, but says nothing. “Do you want me to give you complementary therapy?” She looks up again as if not wanting to ask. “Yes ... if you would.” I say, “I will support you as much as it takes. I will give you reflexology.” We schedule it for the day before the surgery, at her house. Alice is so thankful and departs. My breath has been taken away. How life spins on knife-edges. I am pleased she could seek my help. I have known Alice about two years. As therapists, we share a similar palliative-care world. We had just finished working intensely on her dissertation. Her fear is palpable. She needs to be held and turns to me to hold her. She could ask therapists at the hospice, but I sense she wants some distance from work. She knew that I could not resist the demand and that I would want to hold her. My journal description of our interaction gives attention to both Alice’s and my feelings and why we felt as we did. My response was intuitive and appropriate. I had no options for responding differently. If I had declined the demand, I would have felt bad. Ethically, I had no choice, yet my choice was compassionate. Indeed, I felt such love for her in this moment of trauma, and my response to her was the beginning of the therapy, healing the raw wound the doctor ripped open in his careless manner. I know that therapy the day before surgery will relax and prepare her for healing. I know Alice is experiencing existential crisis (Colyer, 1996), that she is fragmented and that reflexology will help her recover a sense of wholeness. I know she will feel understood and not alone. I know these things through my experience of working with many people with cancer, the way healers know such things rather than as an empirical fact. Later, I talk through this experience with Bella, one of my colleagues whom I trust deeply. I say, “I need to share this with someone,” as if holding Alice’s story was too much for me to carry alone. It is as if I have absorbed Alice’s suffering. I needed to find expression for my own story and recover my poise. Bella reassures me that I am not breaking any confidence. It surprises me how I need that reassurance. She simply listens. The journey continues. Footnote
RNL Christopher Johns, PhD, is professor of nursing, University of Bedfordshire, Education Centre, in Bedford, United Kingdom. Read the honor society's resource paper on the Scholarship of Reflective Practice References: Fay, B. (1987). Critical social science. Cambridge, UK: Polity Press. Johns, C. (2004). Becoming a reflective practitioner. (2nd ed.). Oxford, UK: Blackwell Publishing. Johns, C. (2006). Engaging reflection in practice: A narrative approach. Oxford, UK: Blackwell Publishing. Kieffer, C. (1984). Citizen empowerment: A developmental perspective. Prevention in human services, 84(3) 9-36. |
