Reflection‐within‐the‐moment
Reflection‐within‐the‐moment is akin to Schön’s reflection‐in‐action but not as a problem‐solving approach but as a way of being. It is being mindful of the way they are responding within each unfolding moment in tune with their vision of the practice. This ability may seem a lot to ask within the turmoil of everyday practice. Yet through dedicated reflection‐on‐experience, it can become a natural posture. It is being a reflective practitioner.
Christopher Johns Conception of Reflective Practice
Reflective practice is ‘Being mindful of self, either within or after experience, as if a mirror in which the practitioner can view and focus self within the context of a particular experience, in order to confront, understand, and become empowered towards holding and resolving the creative tension between one’s vision of desirable practice and one’s actual practice, to gain insight within a reflexive spiral towards realising one’s vision of practice as a lived reality’.
Creative Tension
Senge (1990, p. 142) describes creative tension as ‘The juxtaposition of vision (what we want) and a clear picture of current reality (where we are relative to what we want) generates what is termed “creative tension”’. Thus the learning potential of reflection is revealing, understanding, and working towards resolving the creative tension between one’s vision of practice and one’s actual practice as revealed and understood through reflection on experience. Ryan (2013, p. 145) describes such learning as ‘treating self as a subject in relation to others and the contextual conditions of study or work’. The emphasis on ‘others and the contextual conditions’ reflects how practice is strongly influenced by such factors that need to be understood and shaped towards realising the most effective care.
Vision
To hold creative tension, it is necessary for the practitioner to have a vision of practice, however, tentative that might be. It follows that reflection is also a reflexive inquiry into vision that becomes a moveable feast like shifting goalposts. A vision gives direction and purpose to practice. It shapes one’s attitude. It is constructed from a set of values that are ideally developed with colleagues so that everybody pulls in the same direction. Holding a personal vision is essential to contributing to a shared vision. As Senge writes (1990, p. 231), ‘If people don’t have their own vision all they can do is “sign up” for someone else’s. The result is compliance, never commitment’. Holding a vision fosters commitment and motivation simply because practice has more meaning. Whilst this may seem straightforward, it may not be easy. In reality, practitioners are often at a loss to say what their vision is as if practice is concerned with ‘what I do’ rather than ‘what I value’. Practitioners may feel that holding a vision is unnecessary because it has no function. Practitioners may scoff at the need to have a vision or take offence that someone might suggest what their vision should state or that somehow they are deficient or incompetent in some way. Egos are quickly insulted. As Henry Miller writes (1964, p. 33):
We have first to acquire a vision, then discipline and forbearance. Until we have the humility to acknowledge the existence of a vision beyond our own, until we have faith and trust in superior powers, the blind must lead the blind.
Miller suggests that a vision needs to be salient, not just say anything. Practitioners must accept that they may not know best and have the humility to be guided. Contemporary healthcare is grounded in the ideology of person‐centred practice. Clearly, anybody contemplating a vision must be strongly influenced by this idea.
The idea of person‐centred practice is loaded with cultural significance for both the person and the healthcare practitioner. It demands a working with approach that is culturally aware, sensitive, and safe. It is not so much a question of understanding the person’s culture were different from the practitioner’s own but examining the practitioner’s own attitude and response to ensure cultural safety.
Hence any practitioner’s reflective quest is to find meaning in their vision and work towards realising it as a lived reality rather than just rhetoric. It is easy for any practitioner to believe they are person‐centred. Indeed, it would be difficult to admit that they were not. Yet if practitioners were to be observed, the contradictions would be stark simply because organisations are not person‐centred. They are deeply impersonal.
Visions are a moveable feast as practitioners begin to appreciate and live the vision’s words through reflection. They are always something aimed for,1 raising such questions as – What does person‐centred practice mean as something lived? How do my attitudes need to shift to practice it? How might the organisation of healthcare need to shift to accommodate it? In other words, holding a vision is one thing. Realising it is quite another considering the prevailing social norms that mitigate against realising it.
Mandy Reflects on Having a Vision for Practice
In one reflective practice workshop Chris shared his experience of constructing the Burford model vision. This was a sharp wake up call. I recalled that the department had its own philosophy but if I was challenged as to its contents I would have failed miserably. Once back in the department, I eventually found the operational policy buried away in a filing cabinet. Included in its contents is the department’s philosophy of care however it did not state who had devised it and when. I asked one of my colleagues who had worked in the department for many years as to the origin and author of the philosophy; she looked at me blankly and said ‘I am sorry, I did not know we had one duck’.
In my next management supervision I raised this issue with my manager who also was ignorant of these facts but thought it might have been based upon the acute services philosophy. I compared the department’s philosophy with one of the acute inpatient wards, only to discover that it was exactly the same. Johns ( 2013 ) draws attention to the difficulties caused by having an imported philosophy imposed on a practice: it denies articulation of the practitioner’s own beliefs and values and is easily forgotten. What then is the point in having a generic philosophy devised by someone else, locked away in a filing cabinet? None‐whatsoever. Reflecting upon this, I established that the team believes that we provide a high standard of individualised care for patients within the department. However, we lack evidence to validate this. By not having a philosophy of care constructed on our collective beliefs and objectives of our practice, how do we know where we are going and the rational for the journey?
Barriers
The practitioner strives to understand the nature of creative tension and what must be done to resolve it. Pinar (1981, p. 177) notes that ‘it is only when practitioners truly understand themselves and the conditions of their practice, can they begin to realistically change and respond differently. To understand, the reflective practitioner creeps underneath habitual explanations of his actions, outside his regularised statements of his objectives’. The practitioner must question ‘what constrains me from responding in more desirable ways?’ These constraints or barriers may not be easy to recognise and shift because they form the fabric of everyday practice and are largely taken for granted. Some guidance may be helpful (see Chapter 7). If practitioners were rational, they could change their practice on the basis of evidence that supports the best way of doing something. However, we do not live in a rational world.
Fay (1987) identifies three barriers as tradition, authority, and embodiment (Table 1.1) that govern the fabric of our social world. Fay (1987, p. 75) writes from a critical social science perspective that gives reflection its critical nomenclature:
The