Guided Reflection

A Narrative Approach to Advancing Professional Practice

Christopher Johns

• Publisher: Wiley-Blackwell
• Year: 2011
• ISBN:
  9781444347975
• Edition: 2
• Topic: Medicine
• Subtopic: Nursing

"...an important text for practitioners...this text is a valuable tool that develops self-inquiry skills."
Journal of Advanced Nursing Reflection is widely recognised as an invaluable tool in health care, providing fresh insights which enable practitioners to develop their own practice and improve the quality of their care. Guided Reflection: A Narrative Approach to Advancing Professional Practice introduces the practitioner to the concept of guided reflection, in which the practitioner is assisted by a mentor (or 'guide') in a process of self-enquiry, development, and learning through reflection in order to effectively realise one's vision of practice and self as a lived reality. Guided reflection is grounded in individual practice, and can provide deeply meaningful insights into self-development and professional care. The process results in a reflexive narrative, which highlights key issues for enhancing healthcare practice and professional care. Reflection: A Narrative Approach to Advancing Professional Practice uses a collection of such narratives from everyday clinical practice to demonstrate the theory and practicalities of guided reflection and narrative construction. In this second edition, Chris Johns has explored many of the existing narratives in more depth. Many new contributions have been added including several more innovative reflections, such as performance and art.These narratives portray the values inherent in caring, highlight key issues in clinical practice, reveal the factors that constrain the quest to realise practice, and examine the ways practitioners work towards overcoming these constraints.

Chapter 1

The basic scheme

Christopher Johns

The philosophical assumptions that underlie a ‘method’, and whether those assumptions are consistent with the researcher’s own view, seem to me to be at the necessary starting point of inquiry. (Koch 1995:827)

The basic scheme is quite simple – that people can learn through their everyday experiences to become who they want to be. This requires a vision and perhaps some guidance along the journey. The journey is written as narrative. The narrative might then be read or performed in public spaces for dialogue and social action.

What started as scribbling in a journal one evening becomes a performance in a public theatre. Such is the dramatic potential of such inquiry. Nothing can be more significant to a professional, no matter what discipline, than his or her own performance. When we are mindful enough, practice becomes a narrative unfolding. In this way self-inquiry research is something lived, unfolding moment by moment. It becomes a profound way of being in the world.

In the first edition of this book, I opened Chapter 1 with the words ‘Guided reflection is a process of self-inquiry to enable the practitioner to realise desirable and effective practice within a reflexive spiral of being and becoming’.

Since I wrote these words over eight years ago, the world has turned. The reflective turn has evolved into the narrative turn. As I gain greater insight into narrative construction and form, I appreciate that guided reflection is part of the process of narrative, albeit the most vital. Appreciating this turn, I have substituted narrative for guided reflection. I also prefer to talk of the research as a journey of being and becoming, not as a process, as if it were being manufactured.

I now describe narrative as a journey of self-inquiry and transformation towards selfrealisation. The emphasis on self-realisation acknowledges that this journey is about being and becoming. It shifts from an outward focus on realising desirable practice to an inward focus on realising self.

Narrative

This is a book about narrative. Wikipedia informs that:

A narrative is a story that is created in a constructive format (written, spoken, poetry, prose, images, song, theater or dance) that describes a sequence of fictional or non-fictional events. It derives from the Latin verb narrare, which means ‘to recount’ and is related to the adjective gnarus, meaning ‘knowing’ or ‘skilled’. (Ultimately derived from the Proto-Indo- European root gn[oline]-, ‘to know’.) The word ‘story’ may be used as a synonym of ‘narrative’, but can also be used to refer to the sequence of events described in a narrative. A narrative can also be told by a character within a larger narrative. An important part of narration is the narrative mode.

Ideas help to sense and shape meaning but as I shall reveal, narrative can be only known through living and reflecting on it. The idea of living or being narrative reflects an ontological perspective in contrast with an epistemological perspective concerned with ideas and doing narrative. The ontological is a higher level of consciousness.

Mattingly (1994:811) writes:

Narrative plays a central role in clinical work, not only as a retrospective account of past events, but as a form healers and patients actively seek to impose on clinical time.

Narrative, through reflection, nurtures mindfulness. Narrative is mindful practice, mindful research, mindful teaching. Hence the more I reflect on my experience, the more aware I become of those things in my practice. It is a spiral that feeds itself leading to higher level of consciousness, towards enlightenment.

Practice, whatever its nature, is always uncertain, unpredictable, a mystery unfolding simply because human encounter is unique. It has not been lived before. As experts, claiming knowledge, we may think we know but knowing can never be certain with human encounter (Johns 2009a). As such, we must hold our ideas and frameworks loosely for their value to inform each encounter. Research is like this, something lived, a mystery unfolding. An over - reliance on method − ‘this is how you should do this’ resists play, forcing things into a certain shape and in doing so distorting the truth. Truth needs to find its own expression. This is so obvious yet people cling to method as if their life hangs upon it.

There is no ‘correct’ method to guarantee true results (Lather 1986). Methodology is no longer bound by the prescribed rules and boundaries of positivist thinking. Instead, the current era of post positivism allows a multiplicity of methods in order to make sense of human experience (Bentz and Shapiro 1998).

My approach to narrative inquiry is informed by diverse influences woven into a coherent pattern. Since first formulating this research approach, I have continued to dialogue with diverse methodological influences − exploring and playing with these influences in terms of the ‘whole’ as if within a hermeneutic cycle where understanding of the whole deepens. Working on my own narratives, and more recently on performances, and working with students at both master’s and doctoral levels, has enabled me to dialogue with these diverse philosophical ideas from a practical level for, sensing and relishing the subtlety of their nature.

Perhaps as a defensive gesture I adhere to the idea that narrative inquiry is always experiential. It is never certain. However, philosophical and theoretical ides do help shape the path and guide the steps along it. They have a utility - what is their value to inform me? So whilst there is no formula to construct narrative, guidelines are helpful, notably the idea that self -inquiry narrative is always reflexive and coherent. Mighty words indeed. Perhaps other people’s approaches to narrative do not make this demand. Hence when we talk of narrative we must be clear what we are talking about given the diverse usage of this word.

The basic To reiterate – there is no formula. Like a mountaineer feeling his way along the edge of a crevice, the narrator pays attention to each step along the way with care because the terrain is unknown, a mystery unfolding. Ideas can be like crevices where you plunge and lose your way. We can get lost in method or what Janesick (2003:65) describes as methodolatry:

a combination of the words method and idolatry to describe traditional researcher’s preoccupation with selecting and defending methods to the exclusion of the actual substance of the story being told.

We hold a vision of self and practice, and each step is mindfully taken along the narrative path towards realising the vision as something lived. It is called ‘the plot’

Weinsheimer (1985:6–7) citing Gadamer (1974) writes:

Everywhere where one has to come across something which cannot be found by learning and methodical alone – that is, everywhere where invention emerges, where something is owing to inspiration and not methodical calculation – there it depends on ingenium, on genius (TM:50).¹Thus it is clear why Gadamer avows any attempt in TM to ‘develop a system of regulations that could describe or even direct methodical procedures of human science’ (TM:xvi) Such an endeavour would be futile, for there is no art or technique onto things/ there is no method of stumbling.

Stumbling seems to me the perfect descriptor for inventing my approach to narrative inquiry. No doubt if I was to retrace my journey I would do it differently. I would have found other influences that would have been equally persuasive. Hence, those practitioners whom I guide are urged to find their own paths, even as they are informed by my own. I emphasise to hold all ideas lightly because the footsteps of others can lead into blind alleys if you are not mindful enough.

Consider the following description of narrative by Art Bochner (2001:134–135):

I see narrative inquiry as a turn away from as well as a turn towards … the narrative turn moves away from a singular, monolithic conception of social science toward a pluralism that promotes multiple forms of representation and research; away from facts and toward meanings; away from master narratives and towards local stories; away from idolizing categorical thought and abstracted theory and toward embracing the values of irony, emotionality, and activism; away from assuming the stance of the disinterested spectator and toward assuming the posture of feeling, embodied and vulnerable observer; away from the writing essays and toward telling stories.

Bochner inspires and fuels revolution to break out of conformity that chokes the imagination and stifles creative work. He opens the possibility that research is legitimately art not science (and the intellectual and political crisis of legitimacy!). He sets up narrative as a movement away from a monolithic conception of social science towards a pluralism. Of course, he also sets up the problematic of pluralism notably − well these words are all well and good but how does it all fit together and work in coherent ways? The challenge is to move from reflections on experience to telling stories, to constructing narratives and then perhaps to performing them within an agenda of social change.

Table 1.1 Methodological framework, version 1 (c.2002) Hermeneutic cycle/Kosmos/Gestalt

Critical social theory	Hermeneutics	Phenomenology
Evolutionary consciousness	Guided reflection: A co - developmental and collaborative research process	Literature
Dialogue		Ancient and spiritual wisdom
Empowerment theory	Reflective and supervision theory	Feminism

Table 1.2 Methodological framework, version 2 (c.2006)

Critical social science and empowerment	Hermeneutics and dialogue	Narrative inquiry
The feminist slant	Guided reflection as a journey of self - inquiry and transformation	Ancient and spiritual wisdom
Auto - ethnography (autobiography)	Reflective theory	Chaos theory

Table 1.3 Methodological framework, version 3 (c.2009)

Hermeneutics	Performance studies and performance ethnography	Buddhist psychology
Critical social science Empowerment theory Collaborative theory	Narrative is a journey of self - inquiry and transformation towards self - realisation	Narrative is a journey of self - inquiry and transformation towards self - realisation Guided reflection and narrative theory
Auto - ethnography and autobiography	Feminist slant	Chaos theory

So, in constructing narrative I put on my pluralistic hat (well I think it is a pluralistic hat − would I know one if I saw one?) and begin to weave diverse influences into a methodological pattern that shifts as I come to better understand these influences in themselves and their synergy as a pattern. I then attempt to weave these ideas within a patterned whole. My understanding of this pattern continues to evolve as I engage the ideas in practice and read more widely (see Tables 1.1 − 1.3). Bourdieu’s Sketch for a self-analysis (2007) lies invitingly on my desk, as yet unread.

Understanding of ideas must always tentative because of their deep philosophical nature and the inevitable partiality of interpretation as I engage with these ideas within my own experience of narrative, assimilating and simmering such ideas within my narrative knowing. A slow cook to get full flavour.

The basic Collaborative research

Narrative as self-inquiry resonates with collaborative research theory (Reason 1988). Collaborative inquiry exists when all participants contribute to the design and management of the research as a mutual process of co-inquiry, negotiated social action and personal development. It intends a harmonising of power within the relationship in order for dialogue to flourish. Nice idea, yet easier said then done. People’ s shared backgrounds do not necessarily lend themselves to collaborative work within prevailing bureaucratic health care service cultures characterised by an emphasis on a tradition of authority that has imposed subordination and dependency.

In writing my narrative as a complementary therapist, I am telling my own story in relationship with those with whom I practice. I am not telling their story, even though I show an empathic detail about their lives. I obscure identity and even write fiction to protect the identity of those I relate with in my stories. Using my judgement I inform people that I reflect on my practice as routine and construct narrative that may at some time be published or performed. It is an extension of the caring relationship. Practice becomes narrative, empowering and healing for practitioners and patients (Colyer 1996; Kralik et al. 2001).

Beginnings

Let me turn the clock back to the beginning. In 1989, in my role as lead nurse at Burford Community Hospital, I commenced a project to facilitate practitioners to realise holistic practice as set out in the hospital vision (Johns 1998, 2009b). I entered into guided reflection relationships with practitioners whereby I would guide their learning through the experiences they disclosed in the sessions. These sessions were about an hour long and held every two to three weeks. My agenda was to fulfil my assumed leadership role to enable practitioners to become effective practitioners. Through the project we came to appreciate deeper the nature of holism, the holistic practitioner role, those things that constrained its realisation − either embodied within the practitioner or embedded in organisational systems and patterns of relationships, and guided reflection as collaborative inquiry.

On moving to university in 1991 I developed curriculum grounded in reflective practice that fundamentally shifted the relationship between practice and theory. Now we learnt through stories informed by theory as appropriate. Practice was a hook to hang the theory hat on. Theory became more meaningful and more easily assimilated within personal knowing. Assignments were narratives of transformation.² The first guided reflection dissertations were constructed.³ In 2004 I commenced the MSc in Leadership in Healthcare Practice programme whereby students constructed narratives of being and becoming the leader they desired to be.⁴ The programme itself became a community of inquiry to guide this work. In this way teaching and research became one.

In 2003, in my role as visiting professor at City University I started working with Louise Jarrett, guiding her PhD narrative of being a spasticity nurse (Jarrett 2008). In 2005 I created the School of Guided Reflection and Narrative Inquiry at the University of Bedfordshire, recruiting Lei Foster and Maria Fordham (see Chapters 16 and 8, respectively). In 2007, I began working with Amanda Price, April Nunes and Antje Diedrich, dance and drama teachers at the University of Bedfordshire, as co-supervisors expanding the community of inquiry into an inter- disciplinary approach, and most significantly fuelling the performance turn. The Community of Inquiry meets for four hours every four weeks throughout the year, supplemented by two three- day intensives. The intensives were created primarily for overseas students to join the community. A Google group enables continuous dialogue within the community. In 2009 I launched the Reflective Practice Forum website⁵ to open dialogue with a wider world.

Reflection

At the core of narrative inquiry is reflective practice. Intellectually I describe it as:

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 move toward resolving contradiction between one’s vision and actual practice. Through the conflict of contradiction, the commitment to realise one’s vision, and understanding why things are as they are, the practitioner can gain new insight into self and be empowered to respond more congruently in future situations within a reflexive spiral towards self- realisation. The practitioner may require guidance to overcome resistance or to be empowered to act on understanding. (Adapted from Johns 2009b)

I write within a reflexive spiral towards self- realisation in contrast with earlier descriptions where I stated within a reflexive spiral towards developing practical wisdom and realising one’s vision as praxis (Johns 2006). This adaptation reflects the idea that reflection is more about ‘who I am’ and less about ‘what I do’, although the two are intrinsically linked – as ‘what I do’ is reflected in ‘who I am’.

Whilst I have written extensively elsewhere on the nature and method of reflective practice (Johns 2009b), I would emphasise a number of key points:

• Reflection is essentially concerned with being in the world (ontological) rather than doing (epistemological);
• Becoming mindful of self is the quintessential quality of reflective practice as something lived, more than merely a technique to learn through experience;
• Reflection is always being mindful in practice or on practice, i.e. that the act of reflection on experience is an experience in itself;
• The reflective outcome is insights that enable people to live more effective, more desirable, and more satisfactory lives;
• Reflective practice is energy work – nurturing commitment, dissipating anxiety, realising power, finding meaning, becoming vision, enabling healing, knowing self;
• Guidance (in guided reflection) is collaborative dialogue towards creating better worlds.

Personal knowing

Knowing through reflection is subjective and contextual. Such knowing is the very stuff of professional practice, the knowing that practitioners use in everyday practice in response to the complex and indeterminate issues that practitioners face (Schön 1987). Schön described professional practice as the swampy lowlands where there are no prescribed answers to the situations of human – human encounter. Schön claimed a new epistemology of professional practice, which gave primacy to personal knowing in contrast with the high hard ground of technical rationality that was of limited use to practitioners. Personal knowing is largely tacit. Being tacit is not easily expressed in words. Practitioners know more than they can say (Schön 1983). Reflection taps the tacit, lifting it to the surface so to speak. Such learning is subliminal, cultivating personal knowing and the intuitive response within future experiences. It is only by looking back over reflected-on experiences that the practitioner becomes aware of the insights she has gained.

Dreyfus and Dreyfus (1986), in their model of skill acquisition appropriated by Patricia Benner (1984) in her work on expert practice, suggest that people do move along a continuum from novice to expert without consciously being aware of being reflective. In...

Table of contents

• Cover
• Title page
• Copyright
• Preface
• Contributors
• Chapter 1: The basic scheme
• Chapter 2: Constructing the reflexive narrative
• Chapter 3: Deepening insights
• Chapter 4: Weaving the narrative
• Chapter 5: A feminist slant
• Chapter 6: Awakenings
• Chapter 7: Finding a new way in health visiting
• Chapter 8: Falling through the net and the spider’s web: two metaphoric moments along my journey
• Chapter 9: Climbing walls
• Chapter 10: Refl ections on performance
• Chapter 11: More than eggs for breakfast
• Chapter 12: Shifting attitude with deliberate self-harm patients in Accident and Emergency (A&E)
• Chapter 13: Jane’s rap: guided refl ection as a pathway to self as sacred space
• Chapter 14: Audiencing
• Chapter 15: Coherence and ethics
• Chapter 16: An accidental tourist
• Chapter 17: Reflections
• Appendices
• Index