Where Has Schön Led Us? the Impact of the Reflective Practitioner Upon Nurse Education

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Where has Schön led us? The impact of ‘The Reflective Practitioner’ upon nurse education, practice and research

Mary Gobbi, University of Southampton

Introduction

In the 12 years since the publication of Schön’s The ReflectivePractitioner, and its 1987 sequel Educating the Reflective Practitioner, nurse education has undergone radical change. It is the intention of this paper to submit a critical account of the emergence of this ‘reflective philosophy’ from the perspective of a nurse educator who, following a 3-year span overseas, returned to discover that ‘reflective practice’ had become topical. Indeed Jarvis[1] suggested it might be a ‘bandwagon’, whilst Lauder[2] likened it to the pursuit of The Holy Grail! The paper will consider why the concept of the ‘reflective practitioner’ has become such an influential model for the profession, questioning not only ‘Where has Schön led us?’, but perhaps more significantly, how and why have we responded? In undertaking this review, it is hoped that SCUTREA participants will assess the extent to which these comments bear similarity to their own experience and domains of practice.

It will be suggested that Schön’s work was timely, providing a legitimised tool to a group who were seeking status in the professional market place and required a ‘frame’ or ‘stance’ from which to operate. The Reflective Practitioner had been endorsed by the educational sector, was metaphorically attractive and could facilitate a developmental process already in motion. Furthermore, Schön’s work seemed to complement that of Benner[3] which sought to elicit the ‘knowledge embedded in expertise’. The present challenge to the profession is to assimilate and modify those aspects that are compatible with the practice of nursing; to generate alternative frames where appropriate; and to reject influences which may hinder the development of nursing practitioners, the profession and possibly adversely effect patients.

The paper will begin by locating the discussion within the context of contemporary British Nursing and its burgeoning literature on ‘reflective practice’.

A nursing context

The period 1983 to 1995 has been a highly prolific and active time for nursing, with the launch of ‘Project 2000’[4], which ensured Diplomate status accompanied professional registration . Whilst the 1986 report had no mention of Schön or ‘reflective practice’, there were clear intentions to move nursing towards a more student and adult centred pedagogy with the preparation of a practitioner who would be: (1) a ‘knowledgeable doer’: a ‘thinking person with analytical skills’ not removed from practice but one who gave care and (2) a life long learner requiring a ‘coherent, comprehensive and cost effective framework of education beyond registration’[5] The profession was advised to seek contact with other educational colleagues so that further critical discussion could be pursued: a point reaffirmed by the English National Board[6] when they stipulated that pre-registration programmes should ‘reflect contemporary educational thinking’. Indeed projects commissioned to evaluate Project 2000 and to investigate Continuing Professional Education (CPE) were often directed by, or included, general educators (for example, Fish, Purr, Rogers, Shostak, Phillips, Miller). It is from many of these reports that the theme of ‘reflection’ is emphasised. 1992 saw the beginnings of a revolution in CPE as flexible modular programmes incorporating academic and professional qualifications were introduced, often accompanied by Accreditation Schemes (APL/APEL). Concomitant with these events was the economic recession and the market led changes in the public services that influenced not only the labour market in nursing, but also the ‘culture’ of education, training, practice and research, including the commencement of National Vocational Qualifications in Care. Throughout this period, sustained efforts continued to implement the vision of 1986, and so nurse education moves into the Higher Education Sector, and mandatory updating incorporating the concept of self verification commences this year. Self verification will be achieved through the compilation of personal profiles, which the UKCC explained to practitioners, would be ‘created by a continuing process which involves reflecting on and recording what you learn from everyday experiences as well as from planned learning activities’[7]. This statement reveals the assumption that practitioners can and will document their learning experiences through ‘reflection’. Indeed it illustrates James and Clarke’s[8] point that reflective practice may redirect the responsibility for professional development from the organisation to the practitioner: potentially a cost effective strategy.

Towards the reflective practitioner?

An early reference to ‘reflection’ maybe found in ENB guidelines for the first Project 2000 curricula, which stated that all students should be enabled to ‘communicate with sensitivity, observe with understanding, reflect with insight and participate in the delivery of care with knowledge and skill’.[9] However it is only students preparing to be mental health or paediatric nurses who were required to have opportunities to reflect within a ‘guided dynamic practical experience’ (paediatric) or, ‘a supportive environment’ (mental health)[10]. In contrast, the most recent guidelines for pre-registration curricula state that:

Reflection in and on practice is an essential component of pre registration programmes and qualified practitioners continue to develop the skills of reflective practice through continuing education.[11]

Thus within the space of a decade, the professional bodies have moved from seeking to develop a ‘knowledgeable doer’, to preparing ‘reflective practitioners’: that is practitioners able to use reflection to learn from their experiences[12]. Whilst there is no reference to Schön or reflective practice in Rogers and Lawrence’s[13] examination of CPE, by 1991 Larcombe and Maggs[14] cite the works of Schön, Benner and Houle to support their recommendation that practitioners and their employers should define periods when reflection on practice should take place. They also asserted that a key characteristic of the development of a profession is the development of the reflective practitioner. Work into CPE[15] and the Diploma programmes[16], drew attention to the need to prepare practice based supervisors in the techniques of debriefing, reflection and the supervision of practice. Shostak and Phillips advocated that assessment of students should provide continuity of reflective practice based upon the collection of evidence, they considered that the fully competent student is the one who:

can move from situated thinking and planning whilst doing (reflection in action), weighing alternatives and taking decisions across a wide range of contexts (reflection on action), it is necessary to develop processes which promote both the analysis and critique that moves from the particular to the general and back again.

This description illustrates one of Greenwood’s[17] criticisms of Schön, namely that he neglected the importance of reflection before action: the intentional aspects of propositional behaviours and practical reasoning: indeed Lauder[18] argued that Aristotle’s practical syllogism maybe more apt. Schön’s exemplars did not resemble practices where there is considerable emotional labour, interaction, and tension within institutional settings like nursing. However, Schön[19] articulated that he had not addressed either the teaching of the applied sciences and the reflective practicum; or the professional within the institutional bureaucracy: settings in which most nurses currently operate. The ENB[20] recognising the importance of the institution advocated a cultural shift towards developing the ‘learning organisations’ described by Argyris and Schön[21]. They state that these organisations require a commitment to encourage reflective practice and clinical supervision: factors considered to be essential to professional education. Jarvis[22] asserted that no profession can be said to have reflective practice as a claim, although a professional group may endeavour to provide the structures and frameworks which foster reflective practice. Whilst Schön offered little practical guidance on teaching strategies which may promote reflection, this gap has been filled by the emergence of ‘models of structured or guided reflection’ (for example, Fish, Johns, Gibbs), frequently accompanied by established learning tools, for example journal keeping, critical incident analysis, and experiential techniques. These techniques are the tool box of the educator, but can they be reasonably expected of practitioners, students and their practice-based supervisors who in some case have only 12 month’s seniority?

Similarities, differences, influences and criticisms

The benefits attributed to reflective practice enables one to ascertain why it has been appropriated by the profession. Reflection is considered to be essential to learning, having the capacity to reduce the theory practice gap, promote critical thinking and improve practice. Through the empowerment and development of individuals, reflection may be perceived as a vehicle for enhancing altruistic notions of service, whilst furthering an occupational goal of professional status, in which an oro-practical tradition seeks legitimacy for its discourse and knowing. Whilst the validity of these claims has been challenged by authors like Greenwood[23], Lauder[24], Newell[25], and James and Clarke[26], the move towards developing ‘reflective practitioners’ seems inexorable. Usher[27] discussed how Schön’s work enabled practitioners to have an alternative discourse to examine and recreate work. Reflective exercises may thus facilitate practitioner development, perhaps along the ‘reflective spectrum’ mentioned by Day[28], revealing theories in use and a body of nursing knowledge/knowing. Is this when Plato’s ‘right opinion’ becomes knowledge, tethered by the approbation of public scrutiny and delivered by the midwife called 'reflection’? However, when practitioners ‘tell their stories’, they may engage their espoused theories rather than those in use[29]. Similarly they may be influenced by the effects of anxiety, memory and hindsight bias[30]. I would contend that, at present, insufficient attention is being paid to just what is being created or recreated through reflection and indeed which approaches are ‘guiding’ these ‘creations’. These accounts are often analysed using existing frameworks like Carper’s forms of knowing in nursing: frameworks that may transform the ‘raw’ material. It would be unfortunate if a process that may have the potential to articulate a nursing discourse, ended up resembling the techno-rational model, rather than revealing the ‘embedded’ knowledge.

In revisiting Schön, I discover significant differences between Schön’s illustrative examples and the contexts in which I have operated. These differences include: the students, the coaches and the demands placed upon this ‘reflective practitioner’. Argyris and Schön’s students were either postgraduates or students of the graduate professional schools who had ‘volunteered’ for the scenarios described. The coaches like Quist were ‘expert practitioners’ but presumably were not also qualified educators, nor (apart from the psychotherapy vignette) supervisors in the workplace. The settings were virtual practica similar to practice, predominantly dealing with inanimate thus enabling immediate replay of the scenario in the action present, that is, the studio and music classes. The curricula differ in respect to the balance, sequence, and role of theory and practical experience. It is also assumed that the reflective practitioner is competent, having the attributes of a Model 2 person. In pursuing this ‘model’ person, the profession is possibly overlooking Schön’s comments that he did not consider how in practice the individual could afford to be a Model 2 person at all times. Discussions about the reflective practitioner, ‘reflection’, and learning, reveal assumptions that the process ‘must involve the self and lead to a changed perspective’[31] and, in the context of teaching, that ‘confrontation either by self or others must occur’ if professional development is to be enhanced[32]. This debate shows that these assumptions concern not only an individual’s capacity and consent to accept change or challenge, but also the educator or supervisor’s right to initiate these processes. These issues substantiate James and Clarke’s[33] remarks that Schön’s account offered little discussion of the moral and ethical dimensions to reflective practice.

Where are we going?

Answering this question, I find myself faced with two different avenues, one leads through genuine empowerment to ‘fresh pastures’ as yet unknown, whilst the other returns to an ‘old’ destination by a different route. It has been demonstrated that the professional bodies and the NHS have articulated a commitment towards developing ‘learning organisations’, ‘reflective practice’ and ‘supervision’. Whilst applauding the attributes, I have questioned the general applicability of the ‘reflective practice model’, given the constraints of practice, the settings, and the present non graduate status of nursing. The role of professional education is thus seen to be quite critical: it needs to be responsive to the similarities and differences found in the various professional groups: celebrating the richness and diversity of practises, whilst sharing common ground through collaborative ventures. When celebrating the ‘Golden Anniversary’ of SCUTREA, it is hoped that someone will be able to describe the journey to the ‘unknown pasture’.

[1] Jarvis, P. (1992) Reflective practice and nursing. In Nurse Education Today, 12, pp 174 -181

[2] Lauder, W. (1994) Beyond reflection: practical wisdom and the prac