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Recasting the role of reflection in the theatre of learning
Nurse Education Today 29 (2009) 573–574
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Editorial
Recasting the role of reflection in the theatre of learning
In the debates about reflection which emerge regularly, there is a tendency for us to view it as a relatively recent phenomenon. Lethbridge (2006), for example, observes that it has featured in nurse education for two decades. But because we focus, naturally, on the world of nurse education we tend to overlook the use of reflection in other settings. One such setting is the theatre. Reflection has had a powerful and persistent role in the theatre for more than two millennia. A history as long as that suggests that theatre could have something to teach us about the use of reflection. It has. The aim of this editorial is to compare three classic examples of the use of reflection in theatre with the use of reflection in nurse education and to draw some lessons for nurse education from that comparison. Reflection in the theatre Reflection is a broad term, covering a spectrum of meaning from recall (‘personal reflections’) to the analysis of fundamental concepts underlying practice (‘critical reflection’). That spread of meaning makes definition imprecise. But a description which relates well to both theatre and education is the one which Boyd and Fales (1983, in Bulman and Schutz, 2004, p. 3)) formulated: reflection is ‘the process of internally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self, and which results in changed conceptual practice’. This captures the hallmarks of reflective practice – personal experience, an issue of concern, examination, meaning in respect of self and change in respect of practice. To carry out that kind of analysis theatre uses reflective conventions such as soliloquies and commentaries by other actors; nurse education uses portfolios and reflective accounts. A soliloquy is reflection on stage. The audience hears the actor voice his or her inner thoughts. A classic example – probably the most famous example in all theatrical literature – is Hamlet’s reflection, ‘To be or not to be: that is the question’ (Shakespeare, 1600). Here Hamlet reviews his personal experience (his father, King of Denmark, has been murdered), the issue that distresses him (How should he respond?), changes in his own practice (Should he resort to murder to avenge murder?) and the meaning for himself (Is he personally prepared to face death as a consequence of taking revenge?). To use Schön’s (1988) term, Hamlet demonstrates ‘reflection in action’. Another convention the theatre uses to convey reflection is the chorus. The chorus is a group of on-stage observers who give insightful comment to the audience on the forces that are driving the drama and of which the main character is often only vaguely aware. Classical Greek drama gives us an example of this in Sophocles’s play ‘Oedipus the King’, first produced in 500 BC but still a 0260-6917/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2009.02.011
regular part of the theatrical and operatic repertoire. The chorus alerts the audience to the tragedy that hangs over the king and which eventually begins to dawn on him. He is engaged in a public hunt for a man who has murdered his own father and married his own mother. Gradually events begin to expose Oedipus as that very man. The commentary that the chorus gives on the development of the drama parallels what Schön calls ‘reflection on action’. Some modern playwrights adopt a different approach. They make no overt reflective comments but delegate reflection to the audience. Harold Pinter provides a classic example in his most famous play ‘The Caretaker’ (1962). Two brothers take pity on a homeless man and invite him in to their home. The arrangement is mutually beneficial. They make him their informal caretaker. Then he begins to take over. How should they respond? Pinter creates a modern-day parable which he does not try to explain. He invites his audience to ‘internally examine and explore’ the issue. He allows reflection to remain unexpressed. Reflection in nurse education We should note a significant feature of reflection in theatre from these examples: it occupies a supporting, not a central, role. Reflection adds meaning to the drama, but, importantly, the drama could continue without reflection. In contrast, as directors in nurse education – and by that I mean as teachers and curriculum planners – we show a growing tendency to put reflection centre-stage, to use it as the main means of pedagogy. Nurse Education Today traces that trend well. A search of the journal’s archives shows that reflection has become a pre-occupation of nurse educators. Through the last three decades articles which include ‘reflection’ and ‘reflective learning’ in their title, abstract or keywords have increased from 1 (1979–1988) to 46 (1989–1998) to 60 (1999–2008). By contrast, articles which include ‘practice skills’ and ‘practice skills learning’ have trailed behind, with 2, 8 and 36 in the same time frame. Reflection rather than skills is taking on the main role in nursing’s theatre of learning. But the ‘drama’ or ‘plot’ of the nurse education curriculum in the United Kingdom is that students work to accomplish seventeen proficiencies prescribed by the Nursing and Midwifery Council (NMC, 2004). Of these proficiencies, twelve relate to practice skills, three relate to professional skills and two relate to professional knowledge. Practice skills form the bulk of the curriculum. These are not simply ‘practical’ skills. They include procedural skills by which the nurse shows a grasp of the right sequence of steps and the relevant resources for action. But skills are not learned by ‘internally examining and exploring an issue of concern, triggered by an experience’. They are learned through demonstration, rehearsal, repetition, supervision, feedback and practice.
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Editorial / Nurse Education Today 29 (2009) 573–574
Moreover, we know that learning to become a registered nurse – or learning to become a better nurse once registered – is not the achievement of the individual student. It is the outcome of several people working together. Lave and Wenger (1991) have alerted us to the power of context in the theatre of learning. Learning in context depends on observation of others, responding to others and being dependent on others. This is fundamental to acquiring key nursing skills. Clabo (2008, p. 357), for example, in analysing the pain assessment practice of nurses, points out that hospital nursing is public, observable and subject to scrutiny – like actors in a drama – and concludes that the social context in which nurses learn and practise profoundly affects their skills in assessing pain. Reflection is too individual and ‘mentalistic’ an approach to cope with the demands of learning in the practice context. It parallels the single voice of the soliloquy – and soliloquies on their own cannot carry the whole drama. Our use of reflection in nurse education has to match the demands of the discipline, the curriculum and the context in which it is delivered. These are basic issues of curriculum design. They are the same issues that the theatre director faces – choosing dramatic forms and methods which are consistent with the meaning and intention of the play. We need to use methods where reflection is consistent with content. Theatre can help us do that.
Conclusion Reflection has a much longer history in theatre than in general education and nurse education. Playwrights and theatre directors aim to use reflection selectively and proportionately. They deploy it in the context of a developing drama with many elements of action, interaction, character development and plot. Reflection has a support role in theatre: it does not stand centre-stage. Nurse education has much to learn from this. We can learn to use reflection sparingly and appropriately; identify its strengths as a tool to help nurses analyse specific difficult personal and professional issues; harness its benefits in the context of discussion with others rather than in isolation from others; but also recognise its limitations in delivering the practice skills that registered practitioners require. Reflection has a support role in nurse education: we should not cast it centre-stage. Acknowledgement A different treatment of some of the themes in this editorial was presented by the author at the NET2008 conference, 19th Annual International Participative Conference, Churchill College, University of Cambridge, 2–4 September 2008.
Recasting reflection in the theatre of learning References Shakespeare gives us an insight into the limits of individual reflection. Hamlet’s reflections-in-action are an important but deliberately limited part of the drama. He learns more from observation, experimentation and action than he does from reflection. Sophocles sets reflection in its social context. Oedipus gains insight into the events in which he is enmeshed by his interaction with the chorus – and other characters in the drama – not in isolated reflective rumination. Pinter teaches a third lesson about reflection: that the most effective reflection may be spontaneous, un-assessed and un-formulated into a ‘reflective learning cycle’. Reflection has its place in nurse education as it has in theatre. But in both disciplines that place has to be a proportionate one. There is a current danger in nurse education that reflection replicates the syndrome of ‘viral spread’ that Haigh (2005) diagnosed in problem-based learning, where a particular form of pedagogy shows a tendency to move from proportionate participation to disproportionate domination. We need to resist the tendency to use reflection as a learning method for every setting. I recall, for example, saying to students at the end of a skills laboratory session conducted by myself and my colleagues, ‘Write up a reflective account of what you’ve done today in your journals’. At that point I believe we lost sight of the concept of reflection. Harold Pinter would not have approved. Similarly, we should use reflection not as an isolated activity – too often a strategy for leaving the student to get on with learning in the absence of supervision – but as a paired or group learning session. Insight into learning comes from interaction not isolation.
Bulman, C., Schutz, S., 2004. Reflective Practice in Nursing, third ed. Blackwell, Oxford. Clabo, L., 2008. An ethnography of pain assessment and the role of social context on two postoperative units. Journal of Advanced Nursing 61 (5), 531–539. Haigh, C., 2005. PBL, viral spread and the role of nurse education. Nurse Education Today 25 (1), 1–2. Lave, J., Wenger, E., 1991. Situated Learning; Legitimate Peripheral Participation. Cambridge University Press, Cambridge. Lethbridge, K., 2006. Reflections on reflection – a response to Dr. Burnard’s editorial. Nurse Education Today 26 (4), 263–267. Nursing and Midwifery Council, 2004. Standards of Proficiency for Pre-Registration Nursing Education. NMC, London. Pinter, H., 1962. The Caretaker, second ed. Methuen, London. Schön, D., 1988. Educating The Reflective Practitioner. Jossey Bass, San Francisco. Shakespeare, W., c. 1600. Hamlet..
David Kennedy University of The West of Scotland, School of Health, Nursing and Midwifery, High Street, Paisley, Renfrewshire PA1 2BE, Scotland, United Kingdom Tel.: +44 141 848 3837; fax: +44 141 849 4203. E-mail addresses: [email protected], [email protected]
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Editorial
Recasting the role of reflection in the theatre of learning
In the debates about reflection which emerge regularly, there is a tendency for us to view it as a relatively recent phenomenon. Lethbridge (2006), for example, observes that it has featured in nurse education for two decades. But because we focus, naturally, on the world of nurse education we tend to overlook the use of reflection in other settings. One such setting is the theatre. Reflection has had a powerful and persistent role in the theatre for more than two millennia. A history as long as that suggests that theatre could have something to teach us about the use of reflection. It has. The aim of this editorial is to compare three classic examples of the use of reflection in theatre with the use of reflection in nurse education and to draw some lessons for nurse education from that comparison. Reflection in the theatre Reflection is a broad term, covering a spectrum of meaning from recall (‘personal reflections’) to the analysis of fundamental concepts underlying practice (‘critical reflection’). That spread of meaning makes definition imprecise. But a description which relates well to both theatre and education is the one which Boyd and Fales (1983, in Bulman and Schutz, 2004, p. 3)) formulated: reflection is ‘the process of internally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self, and which results in changed conceptual practice’. This captures the hallmarks of reflective practice – personal experience, an issue of concern, examination, meaning in respect of self and change in respect of practice. To carry out that kind of analysis theatre uses reflective conventions such as soliloquies and commentaries by other actors; nurse education uses portfolios and reflective accounts. A soliloquy is reflection on stage. The audience hears the actor voice his or her inner thoughts. A classic example – probably the most famous example in all theatrical literature – is Hamlet’s reflection, ‘To be or not to be: that is the question’ (Shakespeare, 1600). Here Hamlet reviews his personal experience (his father, King of Denmark, has been murdered), the issue that distresses him (How should he respond?), changes in his own practice (Should he resort to murder to avenge murder?) and the meaning for himself (Is he personally prepared to face death as a consequence of taking revenge?). To use Schön’s (1988) term, Hamlet demonstrates ‘reflection in action’. Another convention the theatre uses to convey reflection is the chorus. The chorus is a group of on-stage observers who give insightful comment to the audience on the forces that are driving the drama and of which the main character is often only vaguely aware. Classical Greek drama gives us an example of this in Sophocles’s play ‘Oedipus the King’, first produced in 500 BC but still a 0260-6917/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2009.02.011
regular part of the theatrical and operatic repertoire. The chorus alerts the audience to the tragedy that hangs over the king and which eventually begins to dawn on him. He is engaged in a public hunt for a man who has murdered his own father and married his own mother. Gradually events begin to expose Oedipus as that very man. The commentary that the chorus gives on the development of the drama parallels what Schön calls ‘reflection on action’. Some modern playwrights adopt a different approach. They make no overt reflective comments but delegate reflection to the audience. Harold Pinter provides a classic example in his most famous play ‘The Caretaker’ (1962). Two brothers take pity on a homeless man and invite him in to their home. The arrangement is mutually beneficial. They make him their informal caretaker. Then he begins to take over. How should they respond? Pinter creates a modern-day parable which he does not try to explain. He invites his audience to ‘internally examine and explore’ the issue. He allows reflection to remain unexpressed. Reflection in nurse education We should note a significant feature of reflection in theatre from these examples: it occupies a supporting, not a central, role. Reflection adds meaning to the drama, but, importantly, the drama could continue without reflection. In contrast, as directors in nurse education – and by that I mean as teachers and curriculum planners – we show a growing tendency to put reflection centre-stage, to use it as the main means of pedagogy. Nurse Education Today traces that trend well. A search of the journal’s archives shows that reflection has become a pre-occupation of nurse educators. Through the last three decades articles which include ‘reflection’ and ‘reflective learning’ in their title, abstract or keywords have increased from 1 (1979–1988) to 46 (1989–1998) to 60 (1999–2008). By contrast, articles which include ‘practice skills’ and ‘practice skills learning’ have trailed behind, with 2, 8 and 36 in the same time frame. Reflection rather than skills is taking on the main role in nursing’s theatre of learning. But the ‘drama’ or ‘plot’ of the nurse education curriculum in the United Kingdom is that students work to accomplish seventeen proficiencies prescribed by the Nursing and Midwifery Council (NMC, 2004). Of these proficiencies, twelve relate to practice skills, three relate to professional skills and two relate to professional knowledge. Practice skills form the bulk of the curriculum. These are not simply ‘practical’ skills. They include procedural skills by which the nurse shows a grasp of the right sequence of steps and the relevant resources for action. But skills are not learned by ‘internally examining and exploring an issue of concern, triggered by an experience’. They are learned through demonstration, rehearsal, repetition, supervision, feedback and practice.
574
Editorial / Nurse Education Today 29 (2009) 573–574
Moreover, we know that learning to become a registered nurse – or learning to become a better nurse once registered – is not the achievement of the individual student. It is the outcome of several people working together. Lave and Wenger (1991) have alerted us to the power of context in the theatre of learning. Learning in context depends on observation of others, responding to others and being dependent on others. This is fundamental to acquiring key nursing skills. Clabo (2008, p. 357), for example, in analysing the pain assessment practice of nurses, points out that hospital nursing is public, observable and subject to scrutiny – like actors in a drama – and concludes that the social context in which nurses learn and practise profoundly affects their skills in assessing pain. Reflection is too individual and ‘mentalistic’ an approach to cope with the demands of learning in the practice context. It parallels the single voice of the soliloquy – and soliloquies on their own cannot carry the whole drama. Our use of reflection in nurse education has to match the demands of the discipline, the curriculum and the context in which it is delivered. These are basic issues of curriculum design. They are the same issues that the theatre director faces – choosing dramatic forms and methods which are consistent with the meaning and intention of the play. We need to use methods where reflection is consistent with content. Theatre can help us do that.
Conclusion Reflection has a much longer history in theatre than in general education and nurse education. Playwrights and theatre directors aim to use reflection selectively and proportionately. They deploy it in the context of a developing drama with many elements of action, interaction, character development and plot. Reflection has a support role in theatre: it does not stand centre-stage. Nurse education has much to learn from this. We can learn to use reflection sparingly and appropriately; identify its strengths as a tool to help nurses analyse specific difficult personal and professional issues; harness its benefits in the context of discussion with others rather than in isolation from others; but also recognise its limitations in delivering the practice skills that registered practitioners require. Reflection has a support role in nurse education: we should not cast it centre-stage. Acknowledgement A different treatment of some of the themes in this editorial was presented by the author at the NET2008 conference, 19th Annual International Participative Conference, Churchill College, University of Cambridge, 2–4 September 2008.
Recasting reflection in the theatre of learning References Shakespeare gives us an insight into the limits of individual reflection. Hamlet’s reflections-in-action are an important but deliberately limited part of the drama. He learns more from observation, experimentation and action than he does from reflection. Sophocles sets reflection in its social context. Oedipus gains insight into the events in which he is enmeshed by his interaction with the chorus – and other characters in the drama – not in isolated reflective rumination. Pinter teaches a third lesson about reflection: that the most effective reflection may be spontaneous, un-assessed and un-formulated into a ‘reflective learning cycle’. Reflection has its place in nurse education as it has in theatre. But in both disciplines that place has to be a proportionate one. There is a current danger in nurse education that reflection replicates the syndrome of ‘viral spread’ that Haigh (2005) diagnosed in problem-based learning, where a particular form of pedagogy shows a tendency to move from proportionate participation to disproportionate domination. We need to resist the tendency to use reflection as a learning method for every setting. I recall, for example, saying to students at the end of a skills laboratory session conducted by myself and my colleagues, ‘Write up a reflective account of what you’ve done today in your journals’. At that point I believe we lost sight of the concept of reflection. Harold Pinter would not have approved. Similarly, we should use reflection not as an isolated activity – too often a strategy for leaving the student to get on with learning in the absence of supervision – but as a paired or group learning session. Insight into learning comes from interaction not isolation.
Bulman, C., Schutz, S., 2004. Reflective Practice in Nursing, third ed. Blackwell, Oxford. Clabo, L., 2008. An ethnography of pain assessment and the role of social context on two postoperative units. Journal of Advanced Nursing 61 (5), 531–539. Haigh, C., 2005. PBL, viral spread and the role of nurse education. Nurse Education Today 25 (1), 1–2. Lave, J., Wenger, E., 1991. Situated Learning; Legitimate Peripheral Participation. Cambridge University Press, Cambridge. Lethbridge, K., 2006. Reflections on reflection – a response to Dr. Burnard’s editorial. Nurse Education Today 26 (4), 263–267. Nursing and Midwifery Council, 2004. Standards of Proficiency for Pre-Registration Nursing Education. NMC, London. Pinter, H., 1962. The Caretaker, second ed. Methuen, London. Schön, D., 1988. Educating The Reflective Practitioner. Jossey Bass, San Francisco. Shakespeare, W., c. 1600. Hamlet.
David Kennedy University of The West of Scotland, School of Health, Nursing and Midwifery, High Street, Paisley, Renfrewshire PA1 2BE, Scotland, United Kingdom Tel.: +44 141 848 3837; fax: +44 141 849 4203. E-mail addresses: [email protected], [email protected]