Constructing reflection in nursing: a qualitative exploration of reflection through a post-registration palliative care programme

Abstract

This thesis explores the concept of reflection as it exists within the discipline of nursing. It focuses on the social construction of reflection through a post-registration, palliative care programme in the UK. An interpretive ethnographic approach was used to study organisational, contextual and cultural issues, explore teaching and learning interactions and learn more about reflection from student and teacher participants. This was achieved by using ethnographic tools to collect data from observations of teaching and learning; interviews with participants; and extracts from programme documentation and reflective learning contracts.

The thesis portrays a programme culture committed to reflection as a valuable way of helping nurses make sense of their practice and make a difference to it. Reflection in order to make sense of practice was constructed by participants as a way of ‘being’ rather than simply ‘thinking’ or ‘doing’, since it intertwined propositional, affective and active elements.
This process of reflective ‘being’ within the study was apparently associated with a humanistic approach to nursing, which emphasises the importance of actively using and expressing oneself in order to care for people.

Reflection took place through verbal and written dialogue about practice and required both support and challenge. This was achieved through collaborative facilitation from teachers,
clinical supervisors and peers, in addition to largely positive education and clinical environments which supported the development of reflection. It was through this reflective
education that the programme was educating nurses to learn a language through which to communicate and liberate their practice knowledge with ‘confident, authentic’ voices. Thus
learning a language of reflection was important to nurses in order to: articulate their professional knowledge to others; develop meaningful practice; liberate their learning, and
consequently attempt to make an active, positive difference to patient care.

In conclusion, by adopting an approach focused on exploring reflection through its social construction, this study has contributed further knowledge about nurses’ use of the concept
and what it means to them. The thesis argues that there is an inextricable link between how nurses construct the meaning of reflection and their concepts of nursing. It also indicates the significant influence of skilled, collaborative teachers and both education and clinical environments to the use and development of reflection. In addition, it contributes further understanding to the process of teaching and learning about reflection including: support and challenge through facilitation; the necessity of dialogue for reflection; and the ultimate requirement for nurses to find ways to communicate their practice in ways that have
authenticity and currency in modern healthcare.

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