to their embodied practice. Some practitioners will simply reflect along the surface of their practice, and nothing significant will change. Practitioners can passively accept the ‘normal’ as their truth. Yet to passively accept suggests they have become aware of the contextual nature of their practice.
Empowerment
Understanding inevitably changes practitioners. However, acting on understanding may be difficult as noted above or because of a lack of commitment. It may be better to swim in the shallow waves than drown in the rip currents of critical reflection? Yet, once practitioners become aware of realising desirable practice, they are likely to become restless knowing that there are more effective and satisfactory ways to practice.
Shifting barriers that seemingly constrain realising desirable practice can feel like hitting your head against a brick wall – what I term ‘the hard wall of reality’. It can be painful and frustrating and consequently feel it’s not worth tackling. As Smyth (1987, p. 40) notes ‘most of us, unless we feel uncomfortable, shaken, or forced to look at ourselves, are unlikely to change. It is far easier to accept our current conditions and adopt the least line of resistance’. Lieberman (1989, p. 88 – cited by Day 1993) notes that ‘working in bureaucratic settings has taught everyone to be compliant, to be rule‐governed, not to ask questions, seek alternatives or deal with competing values’.
Practitioners need to feel empowered to act. Empowerment is enhanced when practitioners are committed to and take responsibility for their practice, have strong values, and understand why things are as they are. Practitioners may sense they lack agency to formulate and attain their goals. They depict their lives as out of their control, shaped by events beyond their control. Others’ actions determine life outcomes, and the accomplishment or failure to achieve life goals depends on factors they are unable to change. They may view themselves as victims of circumstance. To view self as a victim is to experience a loss of personhood and to project the blame for this loss onto others rather than take responsibility for self. Victims are oriented towards avoiding negative possibilities than to actualising positive possibilities. Bruner (1994, p. 41) notes that persons construct a victimic self by:
Reference to memories of how they responded to the agency of somebody else who had the power to impose his or her will upon them, directly or indirectly by controlling the circumstances in which they are compelled to live.
In theory, reflection would enhance the core ingredients of personal agency, self‐determination, self‐legislation, meaningfulness, purposefulness, confidence, active‐striving, playfulness, and responsibility (Cochran and Laub 1994 cited in Polkingthorne 1996). These qualities are essential to a sense of empowerment. ‘I am not a victim! I have agency! I can assert myself!’ Not easy for the individual working within organisations. Collective action may be necessary to bring about deeper shifts in tradition and authority. And yet it does happen and quite dramatically.
Finding Voice
The idea of asserting self and empowerment can be viewed as ‘finding voice’ based on ‘Women’s ways of knowing’ (Belenky et al. 1986). This is particularly apposite for professions that are predominantly women, such as nursing, although equally valid for men. Their typology of voice moves through a number of levels from silence, the most impoverished level of voice, through the received voice, the subjective voice, the procedural voices, to the constructed and assertive voice.
The Silent Voice
So many practitioners’ voices are silent or suppressed. Perhaps you can remember being silenced, not so much by others but by yourself. Imagine the practitioner’s reflection – ‘I wish I had said something but…’.
Is it a fear of repercussion, humiliation, or a sense of subordination? Either way it is a reflection of knowing your place is to be silent. Cumberlege (DHSS 1986) observed at meetings concerned with the discussion of her report on community nursing that doctors sat in the front rows and asked all the questions, whilst nurses sat in the back rows and kept silent. She commented how nurses needed to find a voice so they could be heard, otherwise, they would have no future in planning healthcare services. Her comment reflects how nurses have been socialised into a subordinate and powerless workforce through educational processes and dominant patterns of relationships with more powerful groups (Buckenham and McGrath 1983).
Writing ‘I wish I has said something but…’ opens the voice if just on paper. It begs the questions ‘what did I want to say?’ and why didn’t I say it?’
The Received Voice
As a student nurse, I remember sitting passively in the classroom being filled with facts. Often the teacher would write them on the board for the students to copy. Such facts were authoritative to be reproduced as rationale for action. I have no sense of being enabled to develop critical thinking skills, and even if I had, the all‐knowing authorities within clinical practice would have soon put me in my place. The received voice reflects how practitioners learn to speak with the authoritative voices of others. They conceive themselves as capable of receiving, even reproducing knowledge from the all‐knowing external authorities but not capable of creating knowledge of their own. So if I ask a practitioner, ‘why do you practice like that? They are likely to reproduce knowledge from an external authority that has been unquestioned. If I ask, ‘how else could you respond in tune with your vision of practice?’ You might struggle to think laterally because you have never been enabled to think for yourself. Reflection opens up received knowing for its validity to inform.
The Subjective Voice
The subjective voice breaks through the received voice. It gives vent to self‐expression. Its learning mode is one of inward listening and watching, valuing, and accepting one’s own voice as a source of knowing. As Belenky et al. (1986, p. 85) note:
subjective knowing is the precursor to reflective and critical thought. During the period of subjective knowing, women lay down procedures for systematically learning and analysing experience. But what seems distinctive in these women is that their strategies for knowing grow out of their very embeddedness in human relationships and the alertness of everyday life.
The subjective voice is the gateway to self‐inquiry. The practitioner has an opinion. They begin to question received knowledge, no longer accepting on face value what they have been told as to their thoughts, beliefs, and actions. As one of Belenky et al.’s respondents noted (p. 85) ‘I keep discovering things inside myself. I am seeing myself all the time in a different light’. Such words reflect an awakening of self. Life suddenly becomes interesting with the focus on the self. Such practitioners are curious and open to new experiences. They are ripe for reflection.
Subjectivist women value what they see and hear around them and begin to feel a need to understand the people with whom they live and who impinge on their lives. Though they may be emotionally isolated from others at this point in their histories, they begin to actively analyse their past and current interactions with others. The idea that practitioners might be isolated is intriguing. Does the received voice mode of being deny expression of opinion and feelings, and hence isolate the practitioner from others? It seems likely. However, the subjective voice is tentative, vulnerable in its uncertainty and hence may need to be guided in a community of like‐minded people. It may be confusing because it is competing with received voices. As such, it is easy to discount one’s own subjective voice as being unsubstantiated, even ridiculed by more ‘knowing’ others. Listening to yourself, it may seem to be an uncanny stranger on display (Cixous 1996). Reflection opens a space for expression and development of the subjective voice and the means to confront the authoritative voice that has dominated the way they had previously viewed themselves and their practice.
The Procedural Voice
The procedural voice has two divergent ways of knowing: