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‘Back to the future’: development and diversity of reflective practice in nurse education
Pat Fairbrother and Christine Hibbert, University of Sheffield
Introduction
The aim of this paper is to discuss the experiences of two facilitators, and through them, the experience of a number of postgraduate student teachers undertaking a reflective practice module as part of a taught Masters course in Health and Social Care Practice. The nature of this experience has meant looking back in order to gain insights into the future.
In this paper we suggest that there are some useful analogies about the use of reflective practice from the film Back to the Future. We will also discuss the appropriate literature to underpin the growing feeling of development and diversity in this field. In addition, comments, opinions and advice from students will be used to illustrate the points being made.
The MA(Ed) course is an initial teacher preparation programme for nurse/midwife teachers. The United Kingdom Central Council for Nursing (UKCC) requires that practitioners who wish to undertake nurse/midwife teacher preparation must be graduates, and have a specified amount of post registration professional experience. Council also stipulates that initial nurse/midwife teacher preparation programmes must be approved by the English National Board for Nursing (ENB).
The notion that reflective practice should have a central place in nurse/midwife teacher education, is clearly set out by the ENB in their curricula guidelines:
Reflection in and on practice is an essential component of pre-registration programmes, and qualified practitioners continue to develop the skills of reflective practice through continuing education.[1]
The Reflective Practice Module is therefore a required core module for students undertaking the MA(Ed) teacher preparation course. As module tutors we had to conceptualise our views about reflective practice, and where these views came from. We also discussed at length how we should work together, to facilitate the student teachers in their (and our) attempts to get to grips with the concept of reflective practice. Our students are novice teachers, but highly experienced practitioners, and in this core module our aim is to help the students to develop an analytical stance of the rationale underpinning their clinical practice.
Definition of reflection
The word ‘reflection’ originates from the Latin verb ‘reflectere’ which means bend or turn backwards. The term is used broadly with a common meaning that does not seem to have changed much over time[2]. This meaning has, moreover, the big advantage that the core meaning of the term corresponds with the core properties of reflection.
Bengtsson highlights four basic aspects of reflection: reflection as self-reflection, reflection as thinking, reflection as self-understanding and the distancing function of self-reflection. He also succinctly notes that reflection is today on everybody’s lips, and this has created the paradoxical situation that ‘reflection’ is often used in an unreflected manner.
Reflection in learning is not a new idea, indeed it is akin to Aristotle’s concept of deliberation[3]. Dewey also discussed the problems in ‘forming habits of reflective thought’[4]. This is supported by Boyd and Fales[5] who see reflective learning emphasising ‘the self as the source of learning and ... therefore inherently an individual and ipsative process’. They also suggest that:
reflective learning 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 a changed conceptual perspective.[6]
They feel that reflection is a natural process used spontaneously by many people and as such is not a new concept, but that its present significance lies in reflection as a ‘paradigm shift’ in professional learning from experience.
In addition, Boud, Keogh and Walker define reflection as:
a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations.[7]
This model emphasises the affective aspects of learning and how these may facilitate or hinder reflection. Feelings throughout the experience are of fundamental importance here, and Boud et al. also highlight the relationship of these to past experiences.
The importance given to the affective nature of learning also emphasises its individuality, and therefore the control must always be with the learner, with the teacher acting as facilitator, with access only to such information as the learner wishes him to have[8]. This is similarly emphasised in Knowles’ work, where he places great stress on the building up of trust between learner and teacher[9].
Reflection, then, provides an opportunity to think about practice, to identify what is satisfactory and what is in need of improvement or validation. This is summarised by Van Manen: ‘the solution to good practice lies in conceptualising a reflective relation between theory and practice’[10].
With the above definitions in mind, we would suggest that there are some useful analogies about the use of reflective practice from the film Back to the future.[11]
In this film a young teenager called Marty befriends an eccentric inventor called Doc Brown. This mad cap professor steals some plutonium and uses ‘scientific theory’ to transform a Delorean car into an inventive time travel vehicle. Doc then proceeds to show Marty how the time travel machine works, and stresses that at the crucial speed of 88 miles per hour, the ‘car’ will transport the driver into a different time zone.
Marty accidentally reaches this crucial required speed to move the vehicle from the present time zone, back to 1955. Whilst back in the past time zone Marty discovers that any interaction with his past will have a serious impact on his future. In true Spielberg style, everything turns out fine by the end of the film. However, Doc Brown categorically states that this is not the end, the story is to be continued by going back to the future again.
Our comparisons from the film with reflective practice
The first of these comparisons concerns the vehicle which was used for time travel. This was a very stylish car, illustrative of what was considered to be very in vogue for its time. Two points arise from this; firstly the ‘vehicle’ or ‘tool’ of reflective practice is currently much in vogue in education and in nursing for both educators and practitioners today. This is highlighted by Darbyshire[12] who voices his concerns that because reflective practice is very much the flavour of the day, it is in danger of becoming the latest fashion victim on the nursing catwalk. This was certainly true of the Delorean car whose demise was widely reported in the popular press.
Secondly Marty was given explicit instructions about how to use the vehicle by its designer, but operating the machine became solely his own responsibility. We feel that this mirrors the way in which we work with our students. We consider that our role is coaching reflective teaching as described by Schön:
Through advice, criticism, description, demonstration, and questioning, one person helps another learn to practice reflective teaching in the context of the doing. And one does so through a Hall of Mirrors: demonstrating reflective teaching in the very process of trying to help the other learn to do it.[13]
The term used by Schön is ‘reflective supervision’ in which the coach helps, provokes and encourages a teacher to reflect on practice. He also points out that in reflecting on practice one often finds vulnerability, anxiety and defensiveness. For Schön, surprise and puzzlement are at the heart of reflective teaching, but this does not mean having a ‘right answer, at least for a time. Similarly Wallace[14] supports this in her ongoing research about nurses, by concluding that ‘there is no single right way of thinking’. It may even mean foregoing the possibility of a ‘right answer’. For our students this meant foregoing the security in thinking that there is one answer.
We also found that our students felt that in this module we were asking them to ‘break the rules’. There was definitely a prevailing belief that one should know, that there are right answers, whose source lies outside oneself. This belief was reinforced from their previous experiences of professional and academic programmes.
Unlike Doc in the film, we did not design the ‘tool’ of reflective practice which we require our students to use. Therefore, we attempt, alongside our students, to conceptualise its use and use the approach suggested by Brubacher et al[15], this being not to view reflective practice in a hierarchical manner[16], but rather to focus instead on elements that appear to play significant roles in fostering reflection and reflective practice on the part of classroom teachers.
In addition, we used the research of Sparks-Langer and Colton[17] who argued that there are three such elements: the cognitive, the critical and the narrative elements. The cognitive is concerned with the knowledge of decision-making in practice; the critical element with the moral and ethical aspects of social compassion and justice; and the narrative element being the students’ narratives. Students were required to keep a private learning journal for recording incidents in practice, and to develop one of these practitioner incidents to be submitted as their summative assignment for the module.
We also use our own experiences and the plethora of available ‘models’ to demonstrate how the ‘vehicle’ could work, in the belief that ‘a particular method or strategy that works for one person may be a hindrance to another’[18]. Evidence that this approach is helpful comes from the student evaluations; for example, one student advised others to ‘enjoy being led along and then make your own way’.
Another point of interest for us from the film, is that Doc Brown seems to use ‘scientific theory’ to build a vehicle which is able to transcend the existing rules of time and space. This appears plausible to the audience as it appears (in true Spielberg style) to be based on the laws of physics.
Comparing these ‘scientific laws’ to reflective practice James and Clarke[19] posit that models of reflective practice have an appeal at a fundamental level, because they ground practice in established theory and frameworks in which to operate. They also identify that ‘implicit in the status currently being given to reflective practice in nursing is an accepted view that reflection will lead to better practice and to greater competence’[20].
From our experience in exploring reflective practice together with our students, we would concur with James and Clarke, in that this approach has led to an increasing questioning of our practice as teachers, together with a tentative increase in confidence, in our facilitation of reflective practice with students. We are undecided whether this is due to the processes we ourselves undergo as we attempt to practise reflection, or whether we recognise our experiences coming to life as we become more familiar with the literature.
In addition, we believe that analysing the various frameworks provided in the literature[21] together with our students, assists them as they attempt to grapple with the difficult process that is reflective practice. Evaluation from the students supports this view; for example a student commented that ‘it provided something concrete to refer to when it all seemed too much’.
In the film Spielberg makes use of the term ‘temporal displacement’ to explain a gap in the time space continuum, and also to explain events which were a result of Marty’s interactions with his own past. The term ‘temporal displacement’ is a useful analogy for the uncomfortable feelings described by Atkins and Murphy as being the first stage of the reflective process. Similarly, Mezirow[22] used the term disorienting dilemma as an essential element in perspective transformation.
Feedback from our students would appear to reinforce the above views as exemplified in the following student comments in their formal written evaluations when asked what advice they would give to other students about to start the reflective practice module:
Watch where you walk some of it is thin ice.
At times the group were very irritable about reflective practice. I know I was.
Do it! Be prepared to have your ideas shaken about.
I went through a complex learning process through this (reflective practice) module and it has certainly made me look at a lot of things from a new perspective.
With regard to futures in the education of adults, there are similarities with the film again, in that Doc Brown cautioned that encounters with the past ‘could screw up the future’. In a similar vein Wallace[23] cautioned that there should be an awareness about ‘potential mismanagement’ when teachers choose to use reflective practice to aid critical thinking. However, in our experience, this is not necessarily the case. This view is supported in the literature by Killion and Todnem[24] who argue that reflection for practice is the desired outcome of reflection. We undertake reflection, not so much to revisit the past or to become aware of the metacognitive processes one is experiencing, but to guide future action. In other words, reflection for practice is in essence proactive in nature.
For Killion and Todnem the process of engaging in reflection for practice should be seen, not as a linear one, but as an ongoing spiral in which each of the elements of reflective practice is constantly involved in an interactive process of change and development. It is also suggested that reflective practice can have an effect on the individual’s future. For example, Boud et al. identify that
by relating current experience to past experience, the learner builds up a rich network of interconnected memories, which in turn can provide access to alternative behaviour in the future.[25]
Finally, it has been our experience that ‘it is the process of learning that is important; there is only the journey never the destination’[26]. As we seek to develop our own reflective practice skills, we become even more acutely aware of the development and diversity for the use of reflective practice in adult education. However, we have also become increasingly aware of the potential for mismanagement unless handled with great sensitivity and care. If we are not to ‘screw up the future’ we have a responsibility to ensure that our student teachers understand these implications by experiencing the process of reflective practice. We also hope that they understand, to use the words of Steven Spielberg, this process is ‘to be continued’.
Further references
Greenwood, J (1993) Reflective practice: a critique of the work of Argyris and Schön. In Journal of Advanced Nursing, 18, pp. 1183-1187.
Schön, D (1987) Educating the reflective practitioner. Jossey-Bass, San Francisco.
[1] English National Board for Nursing, Midwifery and Health Visiting (1994) Creating lifelong learners: partnerships for care. Guidelines for