knowing is gained by listening and understanding to the experiences of others known through empathy and reflection. Separate knowing is gained through critiquing extant sources of knowledge for its validity to inform. It is an abstract knowing that seeks to understand things in terms of logic and analysis. Both sources of knowing are significant for the reflective practitioner. The left side of the brain fosters rational logical thinking, whereas the connected voice is related to the right brain that fosters creativity, imagination, perception, curiosity, intuition, spirit and wholeness. Pink (2005, p. 22) considers the left hemisphere analyses the details; the right hemisphere synthesises the big picture. Within a technical rational dominated culture that characterises healthcare education and organisation, there is emphasis on developing the left brain. As such, people go around lopsided. The right brain becomes the dark side of the hill neglected with its attributes atrophied. Yet these right brain qualities are essential for professional artistry. The lopsided mind leans heavily towards the masculine, favouring reason over intuition, justice over care, outcomes over process, science over art. Perhaps the feminine must be privileged to find balance? I wonder – do patriarchal patterns of practice privilege masculine values and demean feminine values?
Schön posited two types of knowledge – technical rationality (research‐based theory) and professional artistry (knowing in action). He equates technical rationality as the hard high ground and professional artistry as the swampy lowlands. He argues that professional artistry is the more significant form of knowing because it is the knowing used by practitioners to navigate the largely indeterminate and complex swampy lowlands of everyday practice. The fact is that the practitioner lives in the swampy lowlands and yet can draw on the high hard ground knowledge as appropriate to inform practice. In doing so, they develop their constructed voice.
The Constructed Voice
The constructed voice is the synthesis of connected and separate ways of knowing. It is a fusion between the left and right sides of the brain so that the mind is fully fertilised and uses all its faculties (Woolf 1945). Practitioners with constructed voice speak with an informed and authentic voice. They are able to think and voice outside normal frames of reference, shifting previously abstract frames into personal frames. Through developing the constructed voice, the practitioner puts extant sources of knowledge in its place, no longer succumbing to ‘the belief that the “soft stuff” such as feelings and beliefs and support, are not quite as substantive as the hard data from laboratory reports and sophisticated monitoring’ (Visinstainer 1986, p. 37).
Hardy used voice as a metaphor for her transformation through reflection (Johns and Hardy 2005) is a powerful endorsement of guided reflection. She writes:
By using Belenky et al.’s (1986) idea of voice, I feel I have become more empowered to practice more in tune with my values than previously. Before, I felt I needed to be in control and hence reduced the person to a patient to be controlled. Paradoxically, by letting go of the need to control I am more in control of myself as a person. As a consequence, I am less anxious and more creative, more able to realise desirable practice. When I speak with colleagues, I speak with a more knowledgeable, empathic and passionate voice!. (p. 96)
Having a constructed voice does not mean it is heard or listened to by those who claim authority to make decisions. Belenky et al. (1986, p. 146) with a salutary voice note:
Even among women who feel they have found their voice, problems with voice abound. Some women told us, in anger and frustration, how frequently they felt unheard and unheeded. In our society, which values the word of male authority, constructivist women are no more immune to the feeling of being silenced than any other group of women.
As such, the development of the assertive voice is vital aspect of reflection through such approaches as the assertive action ladder.2
Transformation and Reflexivity
Reflexivity is the practitioner ‘looking back’ to plot their transformation towards realising their vision of desirable practice. Such transformation is evidenced through a chain of experiences whereby one link of the chain leaves a thread that is picked up and developed by the next link (Dewey 1933). This movement is set against an analysis of forces that have constrained realisation. The idea of reflexivity takes the practitioner beyond viewing reflection as a single experience into viewing it as a continuous evolving process of self‐inquiry towards self‐realisation however that is expressed in one’s vision. In doing so, the practitioner constructs a reflexive narrative that may form the basis for assignments, dissertations, and doctoral theses within educational and research programmes.
An Encouraging Note
From the above exploration of reflection, learning can be viewed as moving through three phases based on holding a vision: understanding, empowerment, and transformation. At each phase, insights can be gleaned. Reflection creates stories of resistance and possibility, chipping away at resistance and opening up possibility, confronting and shifting these barriers to become who we desire to be as healthcare practitioners. Nothing can be more meaningful for the serious practitioner intent on finding meaning in their practitioner role and realising the most effective care.
Yet, reading about critical reflection and its implications may feel daunting to many readers. Just the language can feel intimidating. Yet think about vision again. Perhaps, most significantly, shifting barriers to change requires practitioner to really want to realise their visions. Perhaps this stems back to one’s motivation to be a healthcare practitioner, to remember what that was before it was knocked out of you by the harsh realities of everyday practice and training. Fay writes (1987, p. 29):
It is highly unlikely that practitioner will change unless the level of discontent they are experiencing is really quite high; otherwise, what might be called the “natural resistance” to fundamental change will act as a counterweight to the desire for change, and will induce these people to accommodate themselves to the discontent they are suffering.
In other words, faced with daunting reality, many practitioners may prefer to rationalise any discontent and turn their backs on reflection, at least in any deep and meaningful sense. Better to swim along the surface of practice rather than dive deep within its murky depths. Understanding barriers is one thing. As I explore in the third dialogical movement, guidance is vital to enable practitioners to become empowered to act on their insights. Empowering practitioners to action is another thing and action to transform yet another thing. It takes time and effective guidance for practitioners to face and overcome ‘the hard wall of reality’. It also requires communities of practitioners to work collectively to act on insights and change things. Perhaps even more it requires organisational shift towards transformational cultures and leadership that actively facilitates reflection rather than resist it as a threat to its status quo as evident in transactional organisations that seek a docile and subordinate workforce. Yet the individual can make a mark. Carson (2008, p. 139) writes:
When you change the way an individual thinks of himself, you change the way he lives in his community and thereby you change the community in some way to a greater or lesser extent.
This is a vital idea about reflective practice – that whilst it is seemingly an individual learning process, it inevitably impacts on the wider community. The truth of the situation is stark – if practitioners truly wish to truly live their visions of practice then they have no choice but to become political in working towards establishing the conditions of practice where that is possible. The practitioner must come to realise a new reality for themself rather than have this reality explained to them. For example, many experiences that practitioners reflect on are concerned with conflict that has a fundamental power inequality at their root that manifests itself through different attitudes, beliefs, and behaviours. This is not difficult to see or understand providing it is sought and not just taken for granted as part of the ‘natural’ background of the experience. Despite the daunting nature of critical reflection, its rewards are huge for both practitioners and those they serve.