Becoming ari through 'giHded reflection

442 Pages·2017·18.69 MB·English

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Becoming an effective practitioner through guided
reflection
Thesis
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Johns, Christopher (1998). Becoming an effective practitioner through guided reflection. PhD thesis The
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Title page
Becoming ari
effecti<y~.:practlitioner
through 'giHded
reflection
Chrlstopher Johns; MN
PhD submission In Nursing
June 1991
Becoming an effective practitioner through guided reflection
Becoming an effective practitioner through guided reflection
Abstract
The study aimed to develop, monitor and explore the process and outcomes
of guided reflection and its impact on enabling practitioners to achieve
desirable and effective caring practice. A secondary focus of the study was to
monitor and explore the process and outcomes of guided reflection as a form of
critical action research which may generate theoretical insights regarding its
use in clinical supervisory practices.
The process referred to as 'guided reflection' was developed and used to guide
this study. Guided reflection represents a form of social action research which
was framed within an ontology and process of critical and reflexive
phenomenology of experience between practitioners and their supervisors over
a period of four years.
Whilst each guided reflection relationship was written as a critical narrative to
illuminate the reflexive development of effective practice, these narratives
became a secondary level of analysis to construct meta-narratives of the nature
of effective work and dynamics of guided reflection. Various frameworks were
developed and tested within a reflexive process that was appropriately
informed and juxtaposed with extant theory to adequately interpret and
present the process and ou.tc omes of the study.
The method and process of guided reflection generated two major empirical
and theoretical insights.
• 'The 'Being available' framework to know effective caring practice,
presented as one major exemplar of 'Pru'.
• Meta-reflection of methods and process of guided reflection. Three
frameworks in particular are significant: .
• 'Being available' as a parallel framework for effective supervision
practice. This parallel framework supports the coherence between
developmental and research processes.
Becoming an effective practitioner through guided reflection
• The Model for Structured Reflection as an heuristic device for knowing
reflection.
• 'Framing perspectives' as a series of integrated lenses to focus on
discrete layers of learning within reflection.
The insights gained through the study have considerable significance for
informing and guiding the future development of reflective practice within
nursing curriculum, clinical sup'ervision within practice, and the future
development of nursing knowledge. The development of nursing knowledge
is of particular significance in understanding the meaning and nuances of
holistic nursing as a lived reality and have significantly contributed to the
reflexive development of the Burford NDU Model: Caring in Practice. The
study has become a springboard for research to gain further insight into the
factors that facilitate or constrain the efficacy of guided reflection in enabling
practitioners to know and realise desirable practice within everyday practice.
Christopher Johns
ii
Becoming an effective practitioner through guided reflection
Acknowledgements
My thanks to the practitioners who worked with me during the four years of
guided reflection relationships who were committed to developing caring
practice.
My thanks to my two supervisors, Dr Moyra Si dell at The Open University,
and Professor Kate Robinson at The University of Luton, for their perseverance
and ability to guide me through the shadows.
My thanks to Susan, my partner, for her endurance and encouragement.
iii
Becoming an effective practitioner through guided reflection
Contents
page no.
Chapter 1
Beginnings 1
Beginnings 1
Primary nursing 1
Defining desirable work 3
Research programme overview 5
Structure of the thesis 5
Style of presentation 6
Chapter 2
Guided reflection as collaborative research 9
Collaborative research 9
'Background' 9
Open dialogue and fusion of horizons 13 -
Reflection-on-experience 15 -
16 _
Contradiction
Acknowledging the significance of context and
intuition. 21 -
Limits to recall? 23 -
Guiding reflection 23 -
Supervision 25
Summary 31
Chapter 3
Method 32
From methodology to method 32
Programme of Research 32
Contracting guided reflection/ research relationships 36
Data Collection 36
The model of Structured Reflection 37.-o-r
Theoretical approaches to reflection 41
Reflection within the situation 48 :.;...
Structured reflective diaries 50
Constructing supervision dialogue 51
Recording dialogue 51
Constructing Narratives 52
Nursing phenomena 53
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Becoming an effective practitioner through guided reflectiOll
Time/ space considerations 55
'Patterns of knowing' meta-narrative 57
'Dynamic of guiding reflection' meta-narrative 58
Coherence 58
The coherence of collaboration 59
The coherence of process with outcome 61 ....
'Validity' themes 65
Reading the text- completing the narrative 68
Monitoring effectiveness 69
Reflective Reviews 70
Development of monitoring tools 70
Summary 73
Chapter 4
Developing the individual narrative 74
Development of the learning domains 74
Being available framework . 76
Dimensions of being available 76
Pru's narrative 77
Session 1 78
Session 2 80
Session 3
84
• Session 4
89
Session 5
92
Session 6
94
Session 7 96
Session 8 98
Session 9 102
Session 10 110
Session 11
113
Session 12
121
Session 13
116
Session 14
119
Session 15
121
Summary
128
v
Becoming an effective practitioner through guided reflection
Chapter 5
Unfolding the pattern of being available 129
Knowing in practice 129
The dimensions of 'being available' 131
Knowing what is desirable 132
"Being concerned' 132
Jade with Molly 135
'Knowing' the person 136
Leslie with Mrs Banning 136
Jade with George 139
Jade with Philip 140
Opportunity for knowing the patient 143
Responding with appropriate and skilled action 144
Negotiation skills 145
Karen with Mrs Kitchen 145
Jade with Nancy 147
Using Transactional Analysis 148
Ethical decision making and action 150
Situations of conflicting values within the
practitioner - Jade with Geoffrey 151
Situation of conflicting values between the
practitioner and the patient/ family 152
Jade with Hilda 152
Karen with Mrs Fenner 154
Managing time/ prioritising work 157
Managing involvement of self 157
Leslie with Alec 158
Personal concerns as a barrier to involvement 163
Karen with Maud 163
Rachel's love- accepting gratitude 164
'Involvement' 164
Jade with Dick 167
Jade with Pauline 167
Conclusion 169
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Becoming an effective practitioner through guided reflection
Chapter 6
Creating and sustaining an environment
where being available is possible 170
Managing interpersonal conflict between the practitioner 170
an other workers/ organisation
Gayle with Maggie Bryant 171
Working with Doctors 176
Leslie and the GP 177
Relationships between primary nurses at \Vindrush 179
Jade and Myrna 180
Jade and Leslie 182
Situations of conflict outside the practice setting 183
The impact of 'ownership' behaviour on
associate nurses 183
Hank's complaint 184
'Blowing your top' 188
Dialectic of Visibility 189
Horizontal violence 189
Managing conflict style 190
Sustaining self 192
Sources of anxiety 193
'Being exposed' - the threat of accountability 193
Being in control 194
Fear of making mistakes 196
Working with difficult or distressed patients 197
Workload/ organisational issues 199
Interpersonal conflict 200
Not being supported 200
Bum-out 201
Support . 203
'Good nurses cope' 204
Therapeutic Team 205
Towards collaborative teamwork 206
Support through guided reflection 208
Limitations of supervision as support 211
Summary 212
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Becoming an effective practitioner through guided reflection
Chapter 7
Empowerment: Storming the barriers
that limit the achievement of effective action 213
Norms 213
Gill's mind-set 214
Power 216
Professional domination 217
Patriarchy 218
Visualising & Valuing Care 220
Enlightenment, empowerment, & Emancipation 221
Habits of Mind 229
Summary 230
Chapter 8
Knowing the practitioner 231
Preamble 231
The nature of shared experience 233
Model for structured reflection 237
Keeping a reflective diary 237
Establishing a culture for disclosure 243
Establishing trus t 243
Telling tales 246
Assuring confidentiality 247
Third parties 249
Reciprocity of disclosure 250
The environment of supervision 252
Conclusion 253
Chapter 9
Responding with an appropriate helping style 255
Model of structured reflection 255
Setting tasks 258
Doing homework 259
Structuring the diary to focus on significant
experiences 260
Movement within helping style 261
Being approachable 261
Framing perspectives 264
Philosophical framing 264
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