- Email: [email protected]
Framing the new reflection
Nurse Education in Practice (2005) 5, 255–257
Nurse Education in Practice www.elsevierhealth.com/journals/nepr
GUEST EDITORIAL
Framing the new reflection
Almost seven years ago, a few days before Christmas, I stood in LondonÕs Barbican in the heart of the city to receive a higher academic award, the last words of which read ÔTowards Reflective PracticeÕ. There I was thinking I had arrived – looking back I now know a little more reflection was required! Reflection in nursing has been tossed around, lauded, applauded, abused, mystified, demystified and even brutalised in the intervening years. Today I set out to reword and rephrase that concept which is the reflective paradigm – that mystical place where educational and nursing thinkers go to lose the rationale quantitative brigade, so afraid to become self aware they have buried themselves neck deep in SPSS and cross tabs. It may be said that it is not the things in life that bother us, but rather the way in which we think about these things that seems to bother us most. In many ways, this understanding is the challenge to nurse education and practice in the 21st century. The way that we practice nursing in whatever arena is constantly changing – how can we cope with these demands if we do not create safe avenues and vistas in which we can process the issues that raise their heads in the me ˆle ´e of every nursesÕ daily experience? We could reflect, but reflection may have negative undertones as a word and concept. Well, just think about it, think of that scary connotation of looking at your reflection in the mirror in the morning and how inaccurate or accurate that glass frame can be at reflecting the true you. Rather like Ômirror, mirror, on the wall, who the fairest of them allÕ? Reflection, in its many guises, does not accurately verbalise or articulate the complex activity of psychologically and emotionally processing the issues that trouble us as nurses/midwives in everyday clinical practice from time to time. How do you deal with, and process psychologically and emotionally, the death of a 4-year-
old child from AIDS? How do you cope with, or care for, the death by suicide of a 19-year-old college student with so much promise? How do nurses address the death of the 32-year-old mother of two young children, as result of the faceless drink driver? How to tell distraught parents that their child has autism? All very real issues, much of which is often left unspoken. These events can often result in a kind of ferocious emotional and psychological assault on nurses, in their everyday work. Can reflection offer a solution? There is no doubt that carefully couched thinking can clearly help and offer therapeutic respite, if we view and accept the writings of Dewey, Schon, Teekman and more recently Rolfe. Rolfe, Freshwater and JasperÕs (2001) attempts to simplify the reflective process goes some way to demystify thinking in practice, exploring what happened, what now and what if something else or other factors came into play. Maybe we need a different word for this process of reflection, which can more clearly explain the activity engaged by the practitioner, when he or she tries to psychologically and emotionally address the ongoing challenges of nurse education and practice. Schon coined the idea of framing in his writings in the mid-1970s and 80s. Framing as a verb/action to describe the activity of processing thought has much utility. You can be framed as a phrase has negative permutations, but framing has much value. Why you might say? Because you can pre-frame an experience before it happens, you can frame an experience as it happens, and you can reframe an experience as it happens and after it has happened. The human mind thinks in pictures rather than words – so the idea of creating mental images in order to understand nursing practice probably more readily depicts the actuality of the experience. What we can create through framing are processable snap shots of the practice experience. The wonderful
1471-5953/$ - see front matter Ó 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2005.07.001
256 thing about framing is the fact that we become the nursing artists of our own experience. Never mind the science of nursing, let us explore the art of nursing!! Through framing, our thinking can be as creative as we wish. We can free ourselves from rigid adherence to difficult to explain reflection on and in action – sorry Donald in perpetuity. Trying to explain reflection in action never was, and never is, easy. Nevertheless, explaining framing is so much more accessible to our everyday practice experiences. Our pictures of practice can become pencil sketches, water colours, pastiches, oil paintings; these images can be still life, portraits or organisational landscapes. In many ways, previous reflective frameworks have offered rigidity, which sometimes did much to confuse nurses, often turning reflection into some kind of mysticism only truly understood by the disciples of Dewey, Schon or Rolfe. Many of those from the research fraternity were at best cynical, and at worst sceptical about reflection. I cite Carroll et al. (2002a,b) and Nicholl and Higgins (2004) as exponents of heavy duty criticism of the reflective in nursing curricula – ease up dear colleagues try reframing instead of reflection, youÕll be pleasantly surprised at the results!! Carroll et al. (2002a,b) and Nicholl and Higgins (2004) almost suggest that reflection is verging on a dangerous activity with which they have had some grave concerns, almost to the point of wanting so many protections and protocols put in place that the activity that is the essence of reflection that of ÔthinkingÕ, was nigh on impossible or could not take place, without a lawyer or psychotherapist present! Colleagues, no need for the psychotherapy or expensive lawyers we can now frame everything – we can have small frames, big frames, tall frames, wooden frames, steel frames, round frames and even bed frames, if we wish. We can take as many pictures of practice as we wish and never have difficulty in framing our experiences. I make it sound simple, it is that simple, but we need a framing tool kit. Framing is really just about thinking. For the tool kit might I propose some key ingredients for the framing process from the works of the now posthumous Donald Schon and Rudyard Kipling? Schon in his frame experiment in 1983 suggested that in framing a given situation we need to take cognisance of number of key issues. This activity offers the nurse artist a grid on which to draw the picture of practice that will form the substance with which he/she can frame an episode of practice. Scho ¨n (1983) suggested that in order to frame an experience we need to think about, in thinking
Guest editorial about the episode of practice, Scho ¨n (1983) recommends that we need to take cognisance of the following issues: The tacit norms and appreciations which underlie a practitionerÕs judgements (mmm. . . hints of Benner here). Strategies and theories implicit in a pattern of behaviour (a little touch of Orem maybe). The practitionerÕs feelings on the situation. The current direction of action in the situation (a sprinkling of process – nursing process Roper, Logan and Tierney). The way in which the nurse might have framed the situation in order to solve it. The practitionerÕs role in the situation and larger organisational context (another spoon of Orem).(Scho ¨n 1983:63–65) Stir this entire mixture up together and you have a framed experience. Now the next thing you need to do is to finish off the frame. For this, some wood and the nails are required for your frame; these can be provided by using KiplingÕs six wise men. Good old Rudyard provides some questions, which need to be asked in framing a given episode of practice as follows. NurseÕs need to consider what happened, how it happened, where it happened, when it happened, why a particular experience happened and consideration also needs to be given to how the episode took place and who was involved. Hey presto the finished and framed portrayal of a clinical practice experience. In literary and poetic terms framing the new reflection is meagrely a type of curiousity we develop as we grow in our professional careers. This can be articulated as becoming a bit like Lewis CarrollÕs Alice in Wonderland – ÔCuriouser and curiouserÕ (Carroll and Tenniel, 2000). You see as Alice finds out in wonderland nothing in Wonderland quite makes sense – so as with Alice we need to become curious about our clinical practice through framing and questioning. I suppose in some ways we need some way of sense making which framing offers. Curiosity like Framing for the rest of us, is a drive that often leads us into unknown waters, echoes of SchonÕs swampy lowlands. However, I suggest that SchonÕs swampy lowlands do not exist – what appears instead is the river of practice – sometimes calm, sometimes parched and at other times a torrential flood. As already mentioned KiplingÕs questions can keep us curious, framing and questioning for a long time: ‘‘I have six honest serving men They taught me all I knew.
Guest editorial
257
I call them Why and When and Where and How and What and Who.’’
References
Questioning and framing are the avenues to satisfying curiosity. Framing like curiosity is the drive that leads us to exploration and an ultimate understanding. It is the driver behind Star Trekkers and many more intergalactic and terrestrial adventurers. So letÕs boldly go and frame our clinical practice experiences. Of all of KiplingÕs questions the why question is the most important – it is our childlike curiosity inside us looking for meaning. For the researchers out there framing is fundamentally a research paradigm – looking for understanding and meaning in the practice experience. By way of conclusion I wish to paraphrase Monty PythonÕs dead parrot – Reflection is now an ex concept – it is a dead concept, a no more concept in clinical practice in nursing and midwifery. It is now and forever replaced by Framing – a new verb to think and do research – reflection will now only exist as a word to explain the image that stares back at us with a certain honest dishonesty from a one-way glass pane on the bathroom wall. Nurses and midwives will be forbidden to reflect about their practice ever again and forthwith will be required to frame their clinical practice experiences forever more.
Carroll, L., Tenniel, J., 2000. Alice in Wonderland. Harper Festival, New York. Carroll, M., Curtis, L., Higgins, A., Nicholl, H., Redmond, R., Timmins, F., 2002a. Is there a place for reflective practice in the nursing curriculum? Nurse Education in Practice 2 (1), 13–20. Carroll, M., Curtis, L., Higgins, A., Nicholl, H., Redmond, R., Timmins, F., 2002b. Is there a place for reflective practice in the nursing curriculum? Clinical Effectiveness in Nursing 6 (1), 36–41. Kipling, R., 1912. Songs From Books. Doubleday, Page & Co., Garden City, NY. Nicholl, H., Higgins, A., 2004. Reflection in preregistration nursing curricula. Journal of Advanced Nursing 46 (6), 578– 585. Rolfe, G., Freshwater, D., Jasper, M., 2001. Critical Reflection for Nursing and the Helping Professions: A User Guide: Palgrave. Scho ¨n, D.A., 1983. The reflective practitioner: how professionals think in action. Temple Smith, London.
Paul Horan Poet and Lecturer in Nursing Trinity College School of Nursing and Midwifery University of Dublin Ireland E-mail address: [email protected]
Nurse Education in Practice www.elsevierhealth.com/journals/nepr
GUEST EDITORIAL
Framing the new reflection
Almost seven years ago, a few days before Christmas, I stood in LondonÕs Barbican in the heart of the city to receive a higher academic award, the last words of which read ÔTowards Reflective PracticeÕ. There I was thinking I had arrived – looking back I now know a little more reflection was required! Reflection in nursing has been tossed around, lauded, applauded, abused, mystified, demystified and even brutalised in the intervening years. Today I set out to reword and rephrase that concept which is the reflective paradigm – that mystical place where educational and nursing thinkers go to lose the rationale quantitative brigade, so afraid to become self aware they have buried themselves neck deep in SPSS and cross tabs. It may be said that it is not the things in life that bother us, but rather the way in which we think about these things that seems to bother us most. In many ways, this understanding is the challenge to nurse education and practice in the 21st century. The way that we practice nursing in whatever arena is constantly changing – how can we cope with these demands if we do not create safe avenues and vistas in which we can process the issues that raise their heads in the me ˆle ´e of every nursesÕ daily experience? We could reflect, but reflection may have negative undertones as a word and concept. Well, just think about it, think of that scary connotation of looking at your reflection in the mirror in the morning and how inaccurate or accurate that glass frame can be at reflecting the true you. Rather like Ômirror, mirror, on the wall, who the fairest of them allÕ? Reflection, in its many guises, does not accurately verbalise or articulate the complex activity of psychologically and emotionally processing the issues that trouble us as nurses/midwives in everyday clinical practice from time to time. How do you deal with, and process psychologically and emotionally, the death of a 4-year-
old child from AIDS? How do you cope with, or care for, the death by suicide of a 19-year-old college student with so much promise? How do nurses address the death of the 32-year-old mother of two young children, as result of the faceless drink driver? How to tell distraught parents that their child has autism? All very real issues, much of which is often left unspoken. These events can often result in a kind of ferocious emotional and psychological assault on nurses, in their everyday work. Can reflection offer a solution? There is no doubt that carefully couched thinking can clearly help and offer therapeutic respite, if we view and accept the writings of Dewey, Schon, Teekman and more recently Rolfe. Rolfe, Freshwater and JasperÕs (2001) attempts to simplify the reflective process goes some way to demystify thinking in practice, exploring what happened, what now and what if something else or other factors came into play. Maybe we need a different word for this process of reflection, which can more clearly explain the activity engaged by the practitioner, when he or she tries to psychologically and emotionally address the ongoing challenges of nurse education and practice. Schon coined the idea of framing in his writings in the mid-1970s and 80s. Framing as a verb/action to describe the activity of processing thought has much utility. You can be framed as a phrase has negative permutations, but framing has much value. Why you might say? Because you can pre-frame an experience before it happens, you can frame an experience as it happens, and you can reframe an experience as it happens and after it has happened. The human mind thinks in pictures rather than words – so the idea of creating mental images in order to understand nursing practice probably more readily depicts the actuality of the experience. What we can create through framing are processable snap shots of the practice experience. The wonderful
1471-5953/$ - see front matter Ó 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2005.07.001
256 thing about framing is the fact that we become the nursing artists of our own experience. Never mind the science of nursing, let us explore the art of nursing!! Through framing, our thinking can be as creative as we wish. We can free ourselves from rigid adherence to difficult to explain reflection on and in action – sorry Donald in perpetuity. Trying to explain reflection in action never was, and never is, easy. Nevertheless, explaining framing is so much more accessible to our everyday practice experiences. Our pictures of practice can become pencil sketches, water colours, pastiches, oil paintings; these images can be still life, portraits or organisational landscapes. In many ways, previous reflective frameworks have offered rigidity, which sometimes did much to confuse nurses, often turning reflection into some kind of mysticism only truly understood by the disciples of Dewey, Schon or Rolfe. Many of those from the research fraternity were at best cynical, and at worst sceptical about reflection. I cite Carroll et al. (2002a,b) and Nicholl and Higgins (2004) as exponents of heavy duty criticism of the reflective in nursing curricula – ease up dear colleagues try reframing instead of reflection, youÕll be pleasantly surprised at the results!! Carroll et al. (2002a,b) and Nicholl and Higgins (2004) almost suggest that reflection is verging on a dangerous activity with which they have had some grave concerns, almost to the point of wanting so many protections and protocols put in place that the activity that is the essence of reflection that of ÔthinkingÕ, was nigh on impossible or could not take place, without a lawyer or psychotherapist present! Colleagues, no need for the psychotherapy or expensive lawyers we can now frame everything – we can have small frames, big frames, tall frames, wooden frames, steel frames, round frames and even bed frames, if we wish. We can take as many pictures of practice as we wish and never have difficulty in framing our experiences. I make it sound simple, it is that simple, but we need a framing tool kit. Framing is really just about thinking. For the tool kit might I propose some key ingredients for the framing process from the works of the now posthumous Donald Schon and Rudyard Kipling? Schon in his frame experiment in 1983 suggested that in framing a given situation we need to take cognisance of number of key issues. This activity offers the nurse artist a grid on which to draw the picture of practice that will form the substance with which he/she can frame an episode of practice. Scho ¨n (1983) suggested that in order to frame an experience we need to think about, in thinking
Guest editorial about the episode of practice, Scho ¨n (1983) recommends that we need to take cognisance of the following issues: The tacit norms and appreciations which underlie a practitionerÕs judgements (mmm. . . hints of Benner here). Strategies and theories implicit in a pattern of behaviour (a little touch of Orem maybe). The practitionerÕs feelings on the situation. The current direction of action in the situation (a sprinkling of process – nursing process Roper, Logan and Tierney). The way in which the nurse might have framed the situation in order to solve it. The practitionerÕs role in the situation and larger organisational context (another spoon of Orem).(Scho ¨n 1983:63–65) Stir this entire mixture up together and you have a framed experience. Now the next thing you need to do is to finish off the frame. For this, some wood and the nails are required for your frame; these can be provided by using KiplingÕs six wise men. Good old Rudyard provides some questions, which need to be asked in framing a given episode of practice as follows. NurseÕs need to consider what happened, how it happened, where it happened, when it happened, why a particular experience happened and consideration also needs to be given to how the episode took place and who was involved. Hey presto the finished and framed portrayal of a clinical practice experience. In literary and poetic terms framing the new reflection is meagrely a type of curiousity we develop as we grow in our professional careers. This can be articulated as becoming a bit like Lewis CarrollÕs Alice in Wonderland – ÔCuriouser and curiouserÕ (Carroll and Tenniel, 2000). You see as Alice finds out in wonderland nothing in Wonderland quite makes sense – so as with Alice we need to become curious about our clinical practice through framing and questioning. I suppose in some ways we need some way of sense making which framing offers. Curiosity like Framing for the rest of us, is a drive that often leads us into unknown waters, echoes of SchonÕs swampy lowlands. However, I suggest that SchonÕs swampy lowlands do not exist – what appears instead is the river of practice – sometimes calm, sometimes parched and at other times a torrential flood. As already mentioned KiplingÕs questions can keep us curious, framing and questioning for a long time: ‘‘I have six honest serving men They taught me all I knew.
Guest editorial
257
I call them Why and When and Where and How and What and Who.’’
References
Questioning and framing are the avenues to satisfying curiosity. Framing like curiosity is the drive that leads us to exploration and an ultimate understanding. It is the driver behind Star Trekkers and many more intergalactic and terrestrial adventurers. So letÕs boldly go and frame our clinical practice experiences. Of all of KiplingÕs questions the why question is the most important – it is our childlike curiosity inside us looking for meaning. For the researchers out there framing is fundamentally a research paradigm – looking for understanding and meaning in the practice experience. By way of conclusion I wish to paraphrase Monty PythonÕs dead parrot – Reflection is now an ex concept – it is a dead concept, a no more concept in clinical practice in nursing and midwifery. It is now and forever replaced by Framing – a new verb to think and do research – reflection will now only exist as a word to explain the image that stares back at us with a certain honest dishonesty from a one-way glass pane on the bathroom wall. Nurses and midwives will be forbidden to reflect about their practice ever again and forthwith will be required to frame their clinical practice experiences forever more.
Carroll, L., Tenniel, J., 2000. Alice in Wonderland. Harper Festival, New York. Carroll, M., Curtis, L., Higgins, A., Nicholl, H., Redmond, R., Timmins, F., 2002a. Is there a place for reflective practice in the nursing curriculum? Nurse Education in Practice 2 (1), 13–20. Carroll, M., Curtis, L., Higgins, A., Nicholl, H., Redmond, R., Timmins, F., 2002b. Is there a place for reflective practice in the nursing curriculum? Clinical Effectiveness in Nursing 6 (1), 36–41. Kipling, R., 1912. Songs From Books. Doubleday, Page & Co., Garden City, NY. Nicholl, H., Higgins, A., 2004. Reflection in preregistration nursing curricula. Journal of Advanced Nursing 46 (6), 578– 585. Rolfe, G., Freshwater, D., Jasper, M., 2001. Critical Reflection for Nursing and the Helping Professions: A User Guide: Palgrave. Scho ¨n, D.A., 1983. The reflective practitioner: how professionals think in action. Temple Smith, London.
Paul Horan Poet and Lecturer in Nursing Trinity College School of Nursing and Midwifery University of Dublin Ireland E-mail address: [email protected]