Why the rise of reflection now?

1. Why the rise of reflection now? Perspectives from Nurse Education Chris Bulman School of Health and Social Care Oxford Brookes University

2. Reflection in Nurse Education • Interest since 1980s • Process of critically reviewing experience in order to learn from it (Freshwater et al. 2008) • Learning from/about practice is fundamental to the education of nurses • Promoted in nursing education internationally (Ruth-Sahd 2003, Bulman and Schutz 2008, Freshwater et al. 2008).

3. Knowledge Tensions in HE • Difficulties with integrating professional education into higher education • Tensions between university and professionally orientated perspectives on knowledge (Eraut 1994). • Universities seek to develop and broaden academic knowledge and consequently to challenge long-established professional practices. • Importance and status of propositional knowledge in western society. • Difference between propositional knowledge and practical ‘know how’.

4. Objectivity and ‘Knowing more than we can tell’ • Complete objectivity, in science, is a false ideal (Polanyi 1958). • Personal knowing influences and enhances the objective. • Knowledge is embodied through practical knowing. • This kind of knowledge cannot always be articulated in words - ‘we know more than we can tell’ (Polanyi 1967.4). So there will be knowledge that may never be expressed. • Need to seek out ways to help people to communicate and express themselves as adequately as possible. • Reflection has the potential for providing such a route (Bulman 2008).

5. Legitimising Nursing Knowledge • Oppression and disparagement towards practice knowledge and the expression of nurses’ ‘ideals of care’ (Meerabeau 2005) • Reflection provides a vehicle through which to communicate and justify the importance of practice and practice knowledge (Johns 1995). • Legitimises knowledge derived from the realities of practice rather than from more traditional forms of knowing (Brockbank and McGill 1998). • Nurses, along with other professionals, have been interested in reflection and consequently have contributed to the growing body of literature on the concept • Consequently, nurse education includes reflection into preparation and CPD. (NMC 2010)

6. Learning how to learn • Zeitgeist in HE - ‘banking’ notion of education challenged by emphasis on enabling learning how to learn (Friere 1972) • Developing effective critical thinking skills (Brookfield 1987, Barnett 1997, Moon 1999). • Criticism of the technical, rational approach to professional education (Schon 1987). • Theory-practice gap • Need to educate nurses to learn from their practice, develop their thinking and ultimately make a difference to their patients.

7. Communicating Practice • Nurses need to find ways to critically communicate their stories about practice. • Not always achieved through a traditional technical route, nor can be found in conventional nursing textbooks

8. Nurses need to be educated in ways that develop their autonomy, critical thinking, open-mindedness and ability to be sensitive to others (Freshwater and Stickley 2004). • Reflection has the potential to develop these qualities in nurses

9. EBP doesn’t have all the answers • Nursing research and evidence- based practice - akin to a new religion; evidence-based practice linked to status for nurses and the work they do (Hart 2004) • Real practical insight and understanding is a complex matter involving the whole soul, so much so that over-theorising and not drawing on these can actually get in the way of vision Nussbaum (1990).

10. Nursing ‘With Grace’ • Nursing work involves working with people in intimate, emotional and often distressing aspects of care (Johns 1993) . • Professional motivation to learn about, and improve, practice (Johns 2001, Bulman 2009). • About wanting to nurse ‘with grace’ • Unresolved issues and continuing mistakes matter, to everyone in need of nursing.

11. References • Brockbank, A. and McGill, I. (1998). Facilitating Reflective Learning in Higher Education. Society for Research in Higher Education and Open University Press, Buckingham. • Brookfield, S. D. (1987). Developing Critical Thinkers. Challenging Adults to Explore Alternative Ways of Thinking.Jossey Bass, San Francisco. • Barnett, R. (1997). Higher Education: A Critical Business. The Society for Research into Higher Education and Open University Press. Buckingham. • Bulman, C. and Schutz, S. (2008). (Eds) Reflective Practice in Nursing (4th Ed.) Blackwell Scientific Publications, Oxford. • Bulman, C. (2008). An Introduction to Reflection. In: Bulman, C. and Schutz, S. (2008). • Eraut, M. (1994). Developing Professional Knowledge and Competence. The Falmer Press, London. • Freshwater, D. and Stickley, T. (2004). The heart of the art: emotional intelligence in nurse education. Nursing Inquiry 11(2): 91-98. • Freshwater, D., Taylor, B. and Sherwood, G. (2008). International Textbook of Reflective Practice in Nursing. Blackwell Publishing. Oxford. Sigma ThetaTau International Honor Society of Nursing. • Friere, P. (1972). Pedagogy of the Oppressed. Herder and Herder, New York. • Johns, C. (1993). Professional Supervision. Journal of Nursing Management. 1: 9-18. • Johns, C. (1995). The value of reflective practice for nursing. Journal of Clinical Nursing. 4: 23-30. • Hart, C. (2004). Nurses and Politics: The Impact of Power and Practice. Palgrave Macmillan, Basingstoke. • Meerabeau, L. (2005). The Invisible (Inaudible) Woman: Nursing in the English Academy. Gender, Work and Organization. 12 (2): 124-146. • Moon, J. (1999) Learning Journals: A Handbook for Academics, Students and Professional Development. Kogan Page, London. • Nussbaum, M.C. (1990). Love’s Knowledge: Essays on philosophy and literature. Oxford University Press, New York/Oxford. • Polanyi, M. (1958). Personal Knowledge.Routledge and Keegan Paul, London. • Polanyi, M. (1967) The Tacit Dimension. Anchor Books, New York. • Ruth-Sahd, L. A. (2003). Reflective Practice: A critical analysis of data-based studies and implications for nurse education. Journal of Nursing Education 42 (11): 488-496. • Schon, D.A. (1987). Educating the Reflective Practitioner.Jossey Bass, San Francisco.