ways in response to job strain’ (p. 5). Maslach (1976) suggested that the major negative change in those experiencing burnout in people‐centred work was ‘the loss of concern for the client and a tendency to treat clients in a detached, mechanical fashion’ (p. 6). McNeely (1983) observed that when practitioners felt they had lost the intrinsic satisfaction of caring, they became focussed on the conditions of work, for example, off duty rosters and workload issues, characteristic of bureaucratic models of organisation. McNeely believes that bureaucratic conditions are antithetical to human service work and strongly advocated that such organisations needed to move to collegial ways of working staff in order to offset the risks of burnout. Burnout is a descent into a black hole when the caring self has been scrapped away on the uncaring sharp edges of systems.
And yet, burnout can be a healing space, where the practitioner can recover/discover herself. It may be dark, lonely, and painful but it can still be a necessary healing space. Such healing is a journey to discover rather than recover because recovery suggests returning to what she was before, only for the hurting to start all over again.
Benner and Wrubel (1989) believe that the answer to stress and burnout is to reconnect to caring rather than the development of personal detachment, as advocated by Menzies‐Lyth (1988). Caring is a reciprocal relationship. If nurses and other healthcare practitioners are expected to care, then they need to work in caring environments. If the practitioner is suffering, it is likely that other colleagues also suffer, sapping their energy and limiting their availability to be with patients. And yet often, practitioners seem to need to cope, to not expose their vulnerability as if it is a weakness not to cope or admit to strain. They would prefer a collusive silence. To care, we need ways to penetrate the silence to support each other and create a therapeutic team – a team whereby its members are actively and genuinely available to each other. As such, the reflective practitioner is mindful of their colleague's well‐being. Then suits of armour can be discarded.
Consider the following questions:
Are adequate support systems in place?
Are people stressed or worse, burnt‐out?
If so, why do you think that is?
Do you see seeking help as a strength rather than weakness?
Do you explore your anxiety as a learning opportunity?
Are you truly available to support your colleagues?
The human response to manage anxiety is to control their environment, and with it, the source of their anxiety. Unfortunately, the mismatch of expectations within healthcare is wide with a consequential impact on morale and patient care.
It follows that the ability to know and manage self or ‘poise’ is a vital attribute of the practitioner seeking to realise desirable practice. Practitioners may well sacrifice integrity to manage anxiety and stress, and thus view the reflective project as an overt threat to their security or rather their insecurity. In my experience, very little education in practitioner training focuses on self‐management except perhaps an hour or two on stress management.
How Do I Now Feel About the Situation?
Having worked through the MSR cues, the practitioner will feel positive and in control of their practice, prepared to move into the third and fourth dialogical movements. Whilst negative feelings and anxiety may not have been totally eclipsed, at least the practitioner can acknowledge and understand them. The value of reflection is reinforced, and with it, a stronger sense of purpose and commitment towards a practice that the practitioner can acknowledge as they close the reflective spiral.
Through writing and reflection, the practitioner naturally learns to pay attention to their everyday experiences. In doing so, their practice becomes more alive and meaningful. They become increasingly mindful of self within practice itself. Things are less taken for granted. Practitioners become more curious, more questioning. The gate is open to becoming a reflective practitioner as someone who lives reflection in his or her everyday practice.
Summary
The MSR is designed to enable the practitioner to reflect on experience towards gaining insight. It offers insight into the potential breadth and depth of reflection yet always remembering that it is a heuristic rather than prescription. Besides enabling practitioners to explore reflection, the MSR also enables the development of clinical skills. An application of the MSR is set out in chapter 8. In the following chapter, I set out a framework for perceiving insights.
Notes
1 1. For a deep understanding of defence mechanisms related to working in institutions see Menzies‐Lyth (1988).
3 3. Google.com
4 4. https://en.wikipedia.org/wiki/Cultural_safety
5 5. I explore the idea of wavelength in more depth in Chapter 19.
6 6. As I indicated in Chapter 1, power is central tenet of critical reflection. See also page – for a more detailed critique of power using French and Raven’s framework.
7 7. As worn by Sheffield United footballers in their match versus Aston Villa. Wednesday, 17 June 2020.
8 8. The application of the ‘becoming assertive action ladder is shown in Chapter 16 – Guiding third year nursing students in guided reflection.
9 9. There are many change theories. I advocate ‘A change strategy to implement new norms, new styles and new environment in the work organization’ Ottaway R (1976) Personnel Review 5.1:13‐18. This approach views change as the need to understand and move to new norms as a process of collaborative social change made to order to fit the particular situation. Made to order
10 10. West Briton – Thursday, 12 March 2015.
11 11. The use of the feeling fluffy‐feeling drained scale is illustrated in Chapter 17 – Guiding third year nursing students within a guided reflection session.
12 12. An application of the feeling fluffy/feeling drained chart as used within a guided reflection session is shown in Chapter 17 – Guiding third year nursing students in guided reflection.
References
1 1. Aristotle (2004) Nicomachean Ethics [revised edition] [trans. J Thomson]. Penguin Books, London.
2 2. Beck CY (1997) Everyday