the lost path to emancipatory practice: towards a history of reflective practice in nursing

The lost path to emancipatory practice: towards a historyof reflective practice in nursingnup_535 202..213

Sioban Nelson RN PhDDean and Professor, Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

Abstract This paper historicizes the taken-for-granted acceptance of reflection asa fundamental professional practice in nursing. It draws attention to thebroad application of reflective practice, from pedagogy to practice toregulation, and explores the epistemological basis upon which theauthority of reflective discourse rests. Previous work has provided aseries of critiques of the logic and suitability of reflective practice acrossall domains of nursing.The goal of this paper is to commence a history ofnursing’s reflective identity.The paper begins with a discussion of Deweyand Schön then focuses on Habermas’s Theory of CommunicativeAction as the epistemological basis of reflective practice’s standing as aauthoritative discourse in nursing.

Keywords: reflective practice, history of ideas, Habermas.

Foucault work’s defied categorization: philosopher,psychologist, historian, archaeologist. But as theChair of the History of Systems of Thought, a title hedevised to describe his work, his fundamental curios-ity always leaned towards the origins of ideas andpractices. ‘How was it we came to think this way?’‘Why is it we are asking these questions now?’ was hisfrequent and infuriating answer to many a seeminglystraightforward question from a journalist or studentat one of his public lectures. This paper takes this

Foucauldian curiosity as its starting point. It aims tounravel the epistemological family tree of reflectivepractice in nursing, and in so doing achieve somerecognizably Foucauldian aims: to work against teleo-logical assumptions of progressive intellectual andsocial development and illuminate the way in whichsystems of thought or discourse arise contingently, asopposed to inevitably. My goal is to begin an under-standing of the way in which this particular discourse,reflective practice, came to be constituted as authori-tative in nursing.

This kind of historical project makes no attempt toengage in a philosophical exegesis of reflective prac-tice per se, nor to critique either its genesis or currentprestige in nursing’s professional armoury. Rather, asIan Hunter says about his provocative History ofTheory project:

Correspondence: Dr Sioban Nelson, Dean and Professor,

Bloomberg Faculty of Nursing, University of Toronto, 55

College Street, Suite 130, Toronto, ON, Canada M5T 1P8.

Tel.: +416 978 2862; fax: +416 946 5798; e-mail: sioban.nelson@

utoronto.ca

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202 © 2012 Blackwell Publishing Ltd

Nursing Philosophy (2012), 13, pp. 202–213

Applied to the history of philosophy more narrowly, my

approach to intellectual history leads to what might be called

a regionalization of philosophy and the philosopher. It treats

what counts as philosophy and what it means to be a phi-

losopher as something varying with the deployment of arts

of thinking valorized as philosophical within a particular

historical context or cultural milieu. (Hunter, 2008, p. 589)

It is this local and particular cultural milieu, the onethat produced reflective practice, that this paper seeksto explore.

As a registered nurse in the Canadian province ofOntario I am obliged to perform a number of actions.Each year as I renew my registration I must discloseany criminal offences or any other information thatwould be affect my ability to practice in the province.I must declare whether I have been actively involvedin practice in order to fulfil the recency of practicerequirements that come with registration, and I mustengage in reflective practice (CNO, 2011).

Contemporary nurses know all about reflectivepractice. Nursing students journal their practice expe-rience, practising nurses review their performanceand perhaps write practice narratives for perfor-mance appraisal, continuing education or practicereview. Prizes, awards and nurses’ week activities typi-cally send nurses into narrative mode – it is howexpertise is defined and expressed (Nelson, 2004).Finally, for Canadian nurses, the annual registrationrenewal in some provinces involves the explicit exer-cise of reflection as an annual form of self-review.Thisis an auditable exercise and records of the activitymust be kept (CNO, 2011; CRNBC, 2011).

The widespread adoption of reflective practicefrom education to competency assessment to regula-tion is worth a pause. So integrated and ingrained is it,from student through to seasoned clinician or leader,that only with a great deal of effort is it possible to seehow central reflection is to way we think about pro-fessionalism and competence.

This paper aims to build on previous work thatchallenged the epistemological basis of reflectivepractice in the regulatory domain. It looks to thedevelopment of the reflective movement in nursing inthe 1980s and the attempts to map its intellectualorigins and political aspirations. What I am trying to

uncover is the trajectory of reflective practice from itsgenesis as a radical technology to challenge habitualpractices and enable a transformation of practice intoa mindful and critically engaged activity, to an insti-tutionalized set of processes that are auditable understate sanctioned professional self-regulation.

Reflective practice is the process coined byDonald Schön in 1983 to describe the cyclical inter-action of learning and experience (Schön, 1983), or,as David Boud recently phrased it, it is ‘a way ofthinking about productive work’ (Boud, 2010, p. 36).Over the past three decades reflective practice hasbecome a cornerstone of pedagogy in professionalpreparation in education, health sciences, manage-ment, and other fields, as well as a key concept inlife-long learning and professional development. It isalso the basic technique of a field of research knownvariously as Action Research and ParticipatoryAction Research.

Although reflective practice has a strong base inmany professions, nursing has some claims to distinc-tion in the way reflective practice has been operation-alized and institutionalized. For the most part, healthprofessions continue to rely on mandated continuingeducation or CE, and in some cases re-credentialing,for continued licensure or registration (medical prac-titioners, teachers, physiotherapists, and so forth).According to UK scholars, Bradbury, Frost, Kilmin-ster and Zukus, in their critical collection Beyond

Reflective Practice, ‘Nursing was perhaps the firsthealth care profession to adopt notions about reflec-tive practice and it is still the profession where theideas are most prevalent’ (Bradbury et al., 2010, p. 2).It is only in nursing that reflective practice has actu-ally replaced content-driven professional develop-ment requirements for continued competency, at leastin much of Canada, and is viewed as an essentialcomponent of, and perhaps even proxy for, continuededucation.

I have explored nursing’s passion for reflectionwith various colleagues over the past decade. MaryEllen Purkis and I critiqued the use of reflection inthe regulatory context as inappropriate, unauditableand ineffective against poor performers – thus failingas a mechanism to ensure quality assurance to protectthe public.We argued that what was at stake here was

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the troubled issue of defining nursing knowledge andtherefore competence. Moreover, we contended thatthe regulators, through reflective practice, in effectconfine their jurisdiction to the moral and ethicaldomain of professional attitudes and beliefs and whatis being regulated is the capacity of individuals torehearse those values on cue. In the regulatorycontext, mandating nurses to undertake an annualreflective practice exercise that may be subject toaudit reveals what we considered to be a worrisomeconfusion on the part of the regulators, and perhapsthe wider profession, between actual practice compe-tence (being able to perform competently) and dis-cursive skill (being able to talk about practicecompetently) (Nelson & Purkis, 2004).

Michael McGillion and I picked up this issue of‘talking the talk’ versus ‘walking the walk’ and cri-tiqued the way narratives had come to be seen as fullyequivalent to demonstrations of expertise in practice(Nelson & McGillion, 2004). Reviewing Benner’swork and her many imitators, we critiqued the col-lapse of the distinction between saying and doing, ortalking the talk versus walking the walk, in the devel-opment of practice narratives and the formulation ofthe case for expertise on the basis of those formulaicnarratives.

Suzanne Gordon and I further explored the ques-tion of contested knowledge in nursing (Gordon &Nelson, 2005, 2006) where we argued that nursingdiscourse, and most particularly nursing pedagogy, isalmost entirely focused on the subjective and rela-tional dimensions of practice. Notwithstanding theimportance of empathy and a high level of socialskills, we argued that skilled nursing is not the same associal work practice or pastoral care. Nursing knowl-edge includes biomedical knowledge, pharmacology,psychology, math, anthropology, and so forth. Wepoint to the deafening silence in nursing with respectto the scientific knowledge required for competence,versus the wide recognition and public pride in thehumane and caring aspects of nursing. This populardiscourse on nursing we termed nursing’s ‘virtuescript’ and agued that paradoxically it worked to over-shadow the skilled and knowledgeable dimensions tonursing work, reinforcing nursing as good workundertaken by good, for the most part, women. In so

doing the virtue script actually contributed to the sys-temic undervaluing of nursing knowledge and skill,mislead the public on the nature of nursing work andfunctioned to the detriment of patient care (Gordon& Nelson, 2005).

The second strand of my explorations of reflectionhas not been in the regulatory domain but in theassessment of expertise or competence. In that strandI looked at the place of narrative in the assessment ofcompetence in delineation of expertise in PatriciaBenner’s work. I examined her theoretical constructsconcerning the field – most notably the neoArtis-tolean conceptualization of virtue and knowledge.There are a number of traces from that work that Iintend to pick up here as the scope of my interest inreflection continues to expand. Specifically, Bennerarticulates expertise as a form of ethical competenceand highlights the role of emotion in authenticatingthe reading of the situation (Benner et al., 1999). Ihave critiqued this formulation of practice as roman-tic and idealistic, and expressed concern at the con-struction of what I argue to be a totalizing frameworkthat conflates ethical and clinical competence in theindividual expert nurse (Nelson, 2004).

Building on past work in this paper my goal is tomove to the historicization of the genesis of thesenormative concerns (namely professional ethos,narrative competence, virtue script, and authenticemotion) that have effectively dominated andexcluded other forms of assessment in continuingcompetence, supplanted other forms of competenceassessment with narrative and self-assessment forpractice review in nursing.

Finally, my interest in reflection has been given afurther boost by two developments: first, colleagues inmedicine have in the past few years begun to publishinteresting empirical work that raises serious con-cerns over the validity of self-assessment in compe-tence assessment. Of particular note are a number ofself-assessment evaluation studies from the WilsonCentre for the Study of Health Professional Educa-tion, University of Toronto (Hodges et al., 2001), aswell as a systematic review conducted by Dave Davisof the Association of American Medical Colleges andcolleagues (Davis et al., 2006). These researchersbring evidence to bear that seriously challenges the

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empirical basis of self-assessment and thus raise ques-tions as to the ‘validity’ of reflection in competenceassessment per se.

Second, there is a major push, for multiple reasons,that has put continued competency on the mapfor both governments and the health professionsthroughout the world. The patient safety movementhas been one such global driver, as has the implemen-tation of mobility agreements across Canada, theUSA, within the EU and elsewhere which haveincreased the pressure on regulated professions todevelop processes that both fulfil their mandate toprotect the public, and honour trade agreements thatallow for the free movement of labour and goodsacross jurisdictions. Mechanisms to ensure compe-tency to practice are thus under the spotlight by policymakers and regulators alike, making a theoreticalreview of the field timely.

So let us turn now to the practice of reflection andits genesis in the late 19th century with the work ofthe American philosopher John Dewey (1859–1952)who in a paper published in the Psychological Review

in 1896 provided a critique of the dominant theoreti-cal understanding of learning of the time, the‘stimulus-response relation’ (Dewey, 1896). Deweyargued that, contrary to the accepted view of learningas a simple binary, stimulus-response mechanism,learning in fact took place through an arc. So, insteadof a mechanistic linear action–reaction, learning wasmediated by other factors. Critically, he described thisarc as actually dependent upon, both the context ofthe event and the learner’s previous experience ofsimilar such events.

According to Dewey (1896),‘the fact is that stimulusand response are not distinctions of existence, butteleological distinctions, that is, distinctions of func-tion, or part, played with reference to reaching ormaintaining an end’. Using the example of a childreaching for a bright light, Dewey argued that both thestimulus and the response are uncertain as the childmay have at times found something nice to eat and atothers burnt her hand. He questioned the existence ofthe stimulus as a thing in itself, and criticized his col-leagues for confusing the sequencing of events with thetotally of the occurrence. Describing the reflex arc as‘neither physical (or physiological) nor psychological’

but a ‘mixed materialistic-spiritualistic assumption’.Dewey’s model emphasizes the coordination and inte-gration of knowledge first formulated by Plato forwhom ‘sensation was an ambiguous dweller on theborder land of soul and body’ (Dewey 1896, p. 6).

Dewey’s constructivist critique was aimed at func-tionalist psychology and anticipated the debatesover linearity and mechanistic stimulus responseapproaches to learning that were to come with behav-iourists who focused on the subject’s response to theenvironment. For Dewey learning was both morecomplex and more interesting than stimulus response,and as an educationalist, psychologist and pragmatistphilosopher, his intellectual curiosity was broad anddeep. He wanted to know how we learn, how differentlearners learn differently and how the same learnerslearn differently in different contexts. His answernamed a process of reflection that simultaneouslybrought into play the context, experience of thelearner and the goal of the activity.

For Dewey learning encompasses an active self-guided phenomenon where the organism (or learner)interacts with the world and interprets sensory andmotor stimuli. Moreover, unlike the stimulusresponse model, Dewey believed the learning activityto be purposeful, whether or not particular goals wereclear to the learner or teacher at the time. By 1933Dewey had elaborated his view that learning wasneither passive nor linear and, moreover, the mannerin which we come to the activity, and with what expe-rience, has a major bearing on how effective the sub-sequent learning is.

Dewey defined reflective thought as ‘active, persis-tent, and careful consideration of any belief or sup-posed form of knowledge in the light of the groundsthat support it and the further conclusions to which ittends’ (Dewey, 1933, p. 118). He set out five phases oraspects. These states of thinking are as follows:

1. Suggestions, in which the mind leaps forward to apossible solution.2. An intellectualization of the difficulty or perplexitythat has been felt (directly experienced) into aproblem to be solved.3. The use of one suggestion after another as aleading idea, or hypothesis, to initiate and guide



observation and other operations in collection offactual material.4. The mental elaboration of the idea, or suppositionas an idea or supposition (reasoning, in the sense inwhich reasoning is a part, not the whole, of inference).5. Testing the hypothesis by overt, or imaginativeaction (Dewey, 1933, pp. 199–209).

In every case of reflective activity, according toDewey, ‘a person finds himself confronted with agiven, present situation from which he has to arrive at,or conclude to, something that is not present. Thisprocess of arriving at an idea of what is absent on thebasis of what is at hand is inference. What is presentcarries or bears the mind over to the idea and ulti-mately the acceptance of something else’ (Dewey,1933, p. 190).

Dewey’s achievement was that he brought intofocus the iterative and dynamic process of learning.He also made the learner and his or her previousexperience integral to that process and key to theeffectiveness of the learning. Finally, Dewey high-lighted the importance of both the learning contextand the goals of the activity. It is worth underlininghere that reflection emerged as an internalized andindividual phenomenon. It described the activity oflearning in a way that allowed us to better under-stand the multiple contextual elements pertinent tolearning.

Interest in the role of reflection in learning wasenergized some decades later with the work ofDonald Schön, an American philosopher, whose 1955doctoral dissertation examined John Dewey’s theoryof inquiry (Smith, 2001). As both a theoretician and amusician Schön was fascinated by the interactive andgrounded nature of learning and improvisation, mostparticularly ‘thinking on your feet’. His interests werebroad and in addition to his academic career he wasactive in industry and training, serving as director ofthe Institute for Applied Technology in the NationalBureau of Standards at the US Department of Com-merce during the Kennedy administration, andco-founding the Organization for Social and Techno-logical Innovation (Smith, 2001). Later, while at Mas-sachusetts Institute of Technology, he developed ahighly productive collaboration with Chris Argyris, a

management theorist whose work became founda-tional in the development of the concept of ‘LearningOrganizations’. Schön and Argyris published Theory

in Practice: Increasing Professional Effectiveness in1974 and thereby launched a programme of study thatfocused on individual and organizational learning.They were interested in the concept of learningsystems and their work focused on optimizing thosesystems. Building on Dewey’s Reflex Arc they devel-oped their Double Loop Learning model, whichincorporated a mechanism that took into account thetaken-for-granted assumptions (of an organization oflearning context). These assumptions they catego-rized as contextual variables in the Double LoopLearning model, arguing that addressing these vari-ables would lead to sustainable organizational change(Argyris & Schön, 1974).

Through the development of this learning modeland the extension of thinking on reflection, Schön andArgyris provided a critique of the dominant technicaland instrumental approach to education where edu-cators approached teaching as a rational and deduc-tive set of operations as follows: first, derive principlesthrough empirical observations; second, teach thoseprinciples; third, have students apply these principlesunder supervision in practice (Argyris & Schön,1974).

Schön (1987) disputed the technical rationality thatunderpinned such professional education, challengingthe linear model of knowledge development and edu-cation where knowledge arises from basic science,flows through to the applied sciences, following whichtechnical skills are developed to enable implementa-tion. Instead, Schön argued that the real world wasuncertain, even unique, and successful implementa-tion of new ideas involves value judgments as much asobjective decision making (Schön, 1987). Accordingto Schön,

when a practitioner makes sense of a situation he perceives

to be unique, he sees it as something already present in his

repertoire. To see this site as that one is not to subsume the

first under a familiar category or rule. It is, rather, to see the

unfamiliar, unique situation as both similar to and different

from the familiar one, without at first being able to say

similar or different with respect to what. The familiar

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situation functions as a precedent, or a metaphor, or . . . an

exemplar for the unfamiliar one. (Schön, 1983, p. 138)

As Argyris and Schön built on Dewey’s reflectiveinsight and advanced approaches to improve organi-zational learning, interest in how practitioners thinkand how adults learn struck a chord. Following thetaskforce commissioned by the US government oncontinuing education, the field of organizationallearning, professional development and life-longlearning burgeoned (International Council of Con-tinuing Education and Training, 2011), which subse-quently generated a new field of training andacademic inquiry in education in the 1970s and 1980s– adult education. David Boud, an Australian aca-demic in the field of adult education collaborated withRosemary Keogh and David Walker to develop anapplied approach to Schön’s work in the enormouslysuccessful Reflection: Turning Experience into Learn-

ing. Boud et al. (1985) operationalized reflection as anactivity that enabled the learner to ‘recapture theirexperience, think about it, mull it over and evaluate it’(p. 19). Explicitly addressing the emotions, theyreworked Dewey’s five aspects into a three-stagemodel:

• Returning to experience – that is to say recalling ordetailing salient events.• Attending to (or connecting with) feelings – this hastwo aspects: using helpful feelings and removing orcontaining obstructive ones.• Evaluating experience – this involves re-examiningexperience in the light of one’s intent and existingknowledge etc. It also involves integrating this newknowledge into one’s conceptual framework. (Boudet al., 1985, p. 26–31)

For Boud and colleagues, the goal was to empowerthe student to be a self-organized learner. Boudargued that tests, assignments and tutorial exercisesmay maximize the amount of cognitive learning asdefined by end of course examinations, but they mayactually inhibit the development of self-organizedlearning (Boud et al, 1985, p. 11).As ‘only learners canlearn and reflect on their own experiences’, what wasrequired was a tool to enable the learner to focus ontheir feelings, as well as cognitively appraise the situ-

ation (Boud et al, 1985, p. 11). The reflective journalbecame central to this enterprise.Their book includeda chapter by Walker, ‘Writing and Reflection’, thatprovided both rationale and the template for thereflective journal (Walker, 1985).

Thus the 1980s brought forth a Renaissance ofDewey that was characterized by a strong critique ofinstrumentalism. It introduced a transformational roleto education,powered by reflective practice,which wasconstituted largely as a literate technology to empowerthe learner,raise consciousness and transform practice(Boud & Walker, 1998; Boud, 2001).

There were other key thinkers that contributed tothis burgeoning movement in education: Paulo Freire,who (like Dewey) critiqued what he called the‘banking’ concept of education – the notion of thelearner as an empty vessel to be filled with deposits ofknowledge (Freire, 1972). Along with Dewey, Freirebelieved education to be a mechanism for socialchange and essential to create the conditions for ahighly engaged form of democracy. For Freire, educa-tion was a political act whose end goal was socialjustice. To achieve such a transformational resultreflection was required and teachers needed to under-stand the fact that race and class are interwoven intothe classroom, and challenge power disparities by fos-tering reciprocity in the teacher-student relationship.He exhorted teachers interested in social justice anddemocracy to humbly ‘re-examine themselves con-stantly’ (Freire, 2004, p. 15). Other influential strandsinclude, Ivan Illych with his scathing critique of thehierarchical nature of schools (Illych, 2000), phenom-enology and humanistic psychology.

A further key development in the surging interest inreflective practice in the 1980s was the merger of theideas of Schön, Freire, and others, with those of theFrankfurt School, to form the movement that becameknown as Critical Pedagogy, and the creation of anapproach to research called Action Research or Par-ticipatoryAction Research (Carr & Kemmis,1986).Asa research methodology, Action Research system-atized the reflective cycle developed by Argyris andSchön, but constituted it as a collective and collabora-tive process to test ideas and generate change.

As part of the intellectual tradition of Marxism,with strong influence from feminism and humanism,



the critical pedagogy movement firmly characterizededucation as a mechanism for social change. It wasdriven to create systems or organizations that couldbe learning or transformative, to resist oppressivepower relations in the classroom, and to ensure edu-cation achieved a transformation in the consciousnessof the learner so that a better society can be created.

Of prime importance to the critical pedagogymovement was the thinking of the Institute for SocialResearch University of Frankfurt, aka the FrankfurtSchool. Jurgen Habermas was Director of the Insti-tute of Social Research from 1983 until his retirementin 1993. His work became emblematic of the tensionbetween Marxism’s fundamental ideal of humandeliverance from oppression and injustice and itsaffirmation of the belief in continued human develop-ment versus ideas produced by the postmodern/post-structuralist revolution of the 1960s/1970s in France.The latter, famously typified by Jean-Fancois Lyo-tard’s essay The Postmodern Condition in which hedefined postmodernism as ‘incredulity towards met-anarratives’ (Lyotard, 1984, p. 2).

Habermas, both through his writings and in hisrole as a public intellectual, continues to uphold thegoal of the full realization of the Enlightenment tobe that of the triumph of rationalism and humanemancipation from oppression. The end goal is atransformed public sphere and engaged democracy.The release of one of his most important works,Theory of Communicative Action (Habermas, 1984),coincided with the enormous growth of universityeducation faculties in many parts of the world asformer teacher’s colleges amalgamated with univer-sities in Australia, the USA, UK, and Canada(Harmon, 1986; Harman & Meek, 2002). As anauthoritative text that advances emancipatory socialaction through reflective communication, Habermas’work provided a political turn to the personal devel-opment ideology of reflective practice to make it anintervention for social change.

Habermas’ theory on communication had beenevolving over the preceding decade. In Theory and

Practice, Habermas (1973a) appropriated the Aristo-telean dualism of techne and praxis for critical socialtheory and differentiated between ‘work’ and ‘inter-action’, the former rational and instrumental and the

latter consensual and normative (Bohman & Rehg,2009). Two years later, Habermas (1973b, 1973c) out-lined two forms of critical reflection: the first hedescribed as unmasking self-deception and ideology,the second providing a reflective articulation offormal structures of knowledge (Bohman & Rehg,2009).

Habermas argues that under capitalism theEnlightenment Project had been halted by the pen-etration of perverse dysfunctional communicationinto all areas of social life. In Structural Transforma-

tion of the Public Sphere, Habermas (1989) arguedthat the state, as a welfare state, increasingly inter-vened in people’s lives, assuming their private con-cerns and interests as its own. Interest groups havesprung up and private interests have penetrated thestate and the public sphere, which is meant to be anintermediary between the state and society, hasblurred and in some cases collapsed entirely. InTheory of Communicative Action (1984), Habermaspicked up this thread, arguing that the relationship ofthe individual to the state is one of client or consumerof services, as Nick Crossley and John Roberts put it(Crossley & Roberts, 2008, p. 5). Individuals who aredependent upon the state lose the ability to act asindependent citizens.

In the 1960s, Habermas pointed to the role of themedia, the manipulation of public opinion and‘dumbing down’ of public debate – something hepoints out reverses the nineteenth century trend forpublic debate and engaged citizenry and politicalaccountability (Habermas, 1984).Thus the reinvigora-tion of the public sphere is the first step to emancipa-tory change.The mechanism to achieve this is throughwhat Habermas terms discourse ethics. Reason, in itscommunicative form, can recouple the economic andpolitical systems from the normatively rooted andcommunicatively rational sphere of everyday life, thelife world (Habermas, 1984).

As Nick Crossley explains in Beyond Habermas:

Reason in its communicative form, can recouple the eco-

nomic and political systems with the normatively rooted and

communicatively rational sphere of everyday life – the life

world. Systematically distorted communication is central to

Habermas’ early definition of critical theory. The epistemol-

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ogy of critical theory, he suggests, should be akin to that of

psychoanalysis. And the epistemology of psychoanalysis

centres upon ‘systemically distorted communication’. The

psychoanalyst identifies distortions in the speech of the

analysand, in the form of omissions, slips, defences etc. and

traces them back to their root cause in the history of

the individual, with a view to working through them with

the analysand such that the analysand can master and

overcome them. Critical theory, taking public discourse as

its analysand, he continues can and should do the same’.

(Crossley, 2004, p. 89)

Thus, taking the method but not the content ofpsychoanalysis, Habermas built on the work of Wit-tgenstein, Austin, and Searle to adapt the construct ofspeech acts, and develop a method of analysis of com-munication and an intervention to enable true com-munication or ‘ideal speech’ to take place.These idealspeech acts access the universal rationality and ethicaltruth that is habitually subverted under capitalismand in so doing enable progress towards emancipa-tion to take place.

Habermas (1984) elucidates categories of speechacts such as institutionally bound speech acts (p. 326)and normatively regulated speech acts (p. 334). Oneof the functions of speech acts as delineated by Hab-ermas is: to manifest experiences – i.e. to representoneself – whereby the speaker takes up a relation tosomething in the subjective world that he has privi-leged access to (p. 308). With respect to truth ofclaims, Habermas (1984) declares that: ‘The speakermakes a claim to truthfulness for a revealed subjec-tive experience’ (p. 302). Moreover, ‘That a speakermeans what he says can be made credible only in theconsistency of what he does and not through provid-ing grounds [for proof]’ (p. 303).

Habermas’s point is that these ways of communi-cation, or relating one’s perspective to, privilege thesubjective as possessing a truth that is absent in thesystematically distorted communication that shapesour life worlds under capitalism. Speech acts, thus,provide a mechanism (potentially) for valid, ethicallysound communication. They reassert rationality,provide new ways to move forward and emancipatethe actors from repressive and irrational ways ofbeing in the world. To be clear, Habermas did not

speak of reflective practice. Rather, Habermas’Theory of Communicative Action provided the nor-mative ballast to a communication-based (verbal andliterary) practice that created the possibility of libera-tion through ‘truth’, as opposed to continued oppres-sion through distorted and irrational modes ofcommunication.

The work of Habermas, the writings from the criti-cal pedagogy movement, and developments in reflec-tive practice from Schön and colleagues, struck achord in the burgeoning teacher’s colleges and edu-cation faculties of the 1980s (Labaree, 2008). StephenKemmis, well-known Australian educator and actionresearch expert (Kemmis & McTaggart, 1990), is anexemplar of the confluence of the ideas of Schön andHabermas that took place in the 1980s in faculties ofeducation. According to Kemmis, ‘Reflection is apolitical act which either hastens or defers the real-ization of a more rational, just and fulfilling society’(Kemmis, 1985). For critical pedagogists, such asKemmis, reflection is more than a tool (Carr &Kemmis, 1986). As a dialectical process that disruptsand liberates, reflective emancipatory power derivesfrom its constitution as an authoritative practice andhigher form of reasoning (Kemmis, 1985). Habermas’work was widely cited in education research in thisperiod, and much of the intellectual energy in thedevelopment of participatory research approachesemanated from education faculty.

As with education, for nursing too the 1980s was aperiod of enormous expansion in university-basednursing programmes in Canada, the UK, Ireland, andAustralia. Moreover, a good many nursing faculty hadearned their graduate degrees in education, wereengaged in Participatory Action Research styleresearch and were committed to a transformationalpolitical curriculum focused on social justice. Cana-dian scholar, Elizabeth Kinsella (2007, 2010) hasargued that Schön’s critique of technical rationalitywas key to his appeal to nursing and the enthusiasticuptake of reflective practice by the profession. In theUK, Janet Hargreaves described it as offering ‘a won-derful, radical antidote to the unquestioning obedi-ence of the past’ (Hargreaves, 2010, p. 91).

For nurses the move to the university sector pro-vided the opportunity for some to articulate an



explicitly radical agenda for nursing education andthe profession of the future. For instance, the DeakinUniversity School of Nursing, in Geelong, Australia,a notable leader in this movement, in the early 1980sdeveloped a pre-licensure degree programme basedon three elements of Habermas’ Knowledge and

Human Interest (1971): technical interest, practicalinterest and emancipatory interest (Holmes, 1989,1996; Taylor, 2004). The direct link between criti-cal pedagogy, Habermas and nursing that tookplace via graduate programmes in education is welldemonstrated in the case of Deakin UniversitySchool of Nursing in the city of Geelong, Victoria,Australia.

As part of the national move of Australian nursingeducation from hospital based programmes to formalprogrammes (diploma and eventually degree pro-grammes), schools of nursing were established in themid to late 1980s as nursing education was phased outof the health sector and mainstreamed into the post-secondary sector. One of the flagship schools in thisnew dawn for nursing was at Deakin University,where the first chair in nursing in Australia was estab-lished. The chair was held by the foundation dean,Alan Pearson. Pearson was a high profile recruit tothis new school, coming as he did from his director-ship of the revolutionary Oxford Clinical PracticeUnit in the UK. Pearson’s widely cited works(Pearson, 1983, 1988) laid the foundation of what wasto become known the Practice Development Move-ment, an enormously influential professional develop-ment movement that applied reflective practice andparticipatory action techniques at the unit level tostimulate and guide practice change (Kitson, 2000;McCormack et al., 2004). Although this particular tra-jectory of reflective practice is beyond the scope ofthe current discussion, it is worth noting the genea-logical twist that took place when reflective practicedeveloped momentum in the National Health Servicein the 1990s. But to return to Habermas, as Pearsonput together his model school he recruited facultywho were both philosophically sympathetic andpolitically motivated. The case of Beverly Taylor,former faculty member and one-time director is illus-trative. She described her recruitment to the DeakinSchool in these terms:

Fresh from a master’s of education course, which had been

served with heavy portions of reflective processes a la Schön,

and the emancipatory power of critical approaches a la Hab-

ermas and his contemporaries, I was fired up to set nursing

education at Deakin University alight with hope for taking

fresh looks at power structures and relationships in nursing.

(Taylor, 1992, p. 1)

The story of the Deakin School is a remarkableexemplar of the colliding and contingent forces thatconstitute the discourses which shape social action.While it was undoubtedly a unique manifestation ofcritical pedagogy, Habermasian theory and reflectivepractice that constituted the school as a critical hub,strands of these philosophies,pedagogical training andethos were well disseminated in the nursing academynot only inAustralia but throughout the world over the1980s and 1990s. Interestingly some 4 years after theestablishment of the school, Bev Taylor, then directorargued that despite its reputation as a ‘critical’ school,it was in fact a ‘reflective’ school (Taylor, 1992, p. 5).This uncoupling by Taylor of reflection and criticalpedagogy was symptomatic of a wider phenomenonwhere reflective practice was enthusiastically beingadopted as professional practice, with attentionfocused on the inner state of the nurse, but shed of itscapacity to drive political social action.

Reconstituted as an internal confessional practicefor the individual nurse, as opposed to a politicizingpractice, the Habermasian aim of pure speech becamereduced to a mechanistic exercise produced forreview by external authority (professors, supervisors,or regulators), and required to meet acceptable stan-dards of personal insight and ethical values.

It has been my case in this paper that the wide-spread dissemination of reflection in nursing, itsnatural, self-evident and prestigious standing as anethical practice that allows for the inculcation of dis-ciplinary norms and values (such as the promotion ofsocial justice) owes far more to Habermas than anyother thinker. Furthermore the fact that nursingaligns itself so readily as a moral practice – distinc-tively among the professions – also reinforces thelegitimacy of reflection as a moral technology and ameans to further nursing practice. Finally, its morallegitimacy gains even further impetus as an anti-

Sioban Nelson210


technocratic technology that works to subvert instru-mental and technical rationality.

However, the uncoupling of reflection from itshighly political origins (at least in the case of Haber-mas) has led to what Habermas would certainly con-sider to be irrational manifestations of regulatedspeech acts, such as institutionally governed reflectionand the production of practice narratives for employ-ers or regulators. In such instances reflection as com-petency demands the nurses engages in a particularversion of templated narratives, with little room foropen or critical discourse. Moreover, there are puni-tive consequences for non-compliance or unaccept-able narratives.

There is more than a little irony that institutional-ized forms of reflection, which owe so much to radi-cally inspired innovations of educators in the 1980s,now represent confessional and surveillance style dis-courses that could not be further from Habermas’sideal speech acts. As opposed to its goal as an eman-cipatory strategy, reflection as an institutional dis-course is indicative of the very collapse between thestate and private life world through systematicallydistorted communication that Habermas so laments.

The goal for this paper has been to trouble thenaturalness of reflection in multiple domains and tobuild the case against the domination of reflection inthe assessment of competence in nursing.The paradoxof a practice developed to counter instrumentalismbeing used for promotion,or for student assessment orfor regulatory purposes is striking. This discussion ofthe original Habermasian ideal of emancipatoryaction through communicative practices challengescontemporary nursing to re-examine the political basisof reflection and confront the difficulties of engage-ment in meaningful critical practice in full awarenessof the state and institutional rationalities that pen-etrate our practice and shape our communication.

As Foucault said when he elaborated the impor-tance of genealogy and archaeological investigationsinto the origins of knowledge:

Let us give the term ‘genealogy’ to the union of erudite

knowledge and local memories which allows us to establish

a historical knowledge of struggles and to make use of this

knowledge tactically today. (Foucault, 1980, p. 83)

Despite its challenges and limitations – revisitingHabermas may just provide the tactical armouryneeded to guide discussions of social justice in nursingtoday.

References

Argyris M. & Schön D. (1974) Theory in Practice: IncreasingProfessional Effectiveness. Jossey-Bass, San Francisco,CA.

Benner P., Hooper-Kyriakidis P. & Stannard D. (1999) Clini-cal Wisdom and Interventions in Critical Care : AThinking-in-Action Approach. Saunders, Philadelphia,PA.

Bohman J. & Rehg W. (2009) (Summer Edition) JürgenHabermas. The Stanford Encyclopedia of Philosophy(ed. E.N. Zalta). Available at: http://plato.stanford.edu/archives/sum2009/entries/habermas/ [accessed 8 January2012].

Boud D. (2001) Using journal writing to enhance reflectivepractice. Adult and Continuing Education, 2001(90), 9–18.Special Issue: Promoting Journal Writing in Adult Educa-tion. Summer.

Boud D (2010) Relocating reflection in the context of prac-tice. In: Beyond Reflective Practice: New Approaches toProfessional Lifelong Learning (eds H. Bradbury, N.Frost, S. Kilminster & M. Zukas), pp. 25–36. Routledge,Abingdon.

Boud D. & Walker D. (1998) Promoting reflection in profes-sional courses: the challenge of context. Studies in HigherEducation, 23(2), 191–206.

Boud D., Keogh R. & Walker D. (eds) (1985) Reflec-tion. Turning Experience into Learning. Kogan Page,London.

Bradbury H., Frost N., Kilminster S. & Zukus M. (eds)(2010) Beyond Reflective Practice: New Approaches toProfessional Lifelong Learning. Routledge, Abingdon.

Carr W. & Kemmis S. (1986) Becoming Critical: Education,Knowledge, and Action Research. Falmer Press, London.

CNO (2011) Quality assurance. Available at: http://www.cno.org/maintain-your-membership/quality-assurance/[accessed 8 January 2012].

CRNBC (2011) Quality assurance and continued compe-tence. Available at: https://www.crnbc.ca/QA/Pages/Default.aspx [accessed 8 January 2012].

Crossley N. (2004) On systematically distorted communica-tons: Boudieu and the socioanalysis of publics. In: AfterHabermas: New Perspectives in the Public Sphere (eds N.Crossley & J.M. Roberts), pp. 83–112. Editorial Board ofthe Sociological Review, Blackwells, Oxford.

Crossley N. & Roberts J.M. (2004) After Habermas: NewPerspectives in the Public Sphere. Editorial Board of theSociological Review, Blackwells, Oxford.



Davis D.A., Mazmanian P., Fordis M., Harrison R.V.,Thorpe K.E. & Perier L. (2006) Accuracy of physicianself-assessment compared with observed measures ofcompetence: a systematic review. JAMA, 296(9), 1094–1102.

Dewey J. (1896) The reflex arc concept in psychology. Psy-chological Review, 3, 357–370.

Dewey J. (1933) How We Think. D. C. Heath, New York.Foucault M. (1980) Two lectures. In: Power/Knowledge:

Selected Interviews and Writings 1972–77 (eds M. Foucault& C. Gordon), pp. 78–108. Random House Canada,Mississauga.

Freire P. (1972) Pedagogy of the Oppressed. Penguin,Harmondsworth.

Freire P. (2004) Pedagogy of Indignation. Paradigm, Boulder,CO.

Gordon S. & Nelson S. (2005) An end to hearts and angels,from virtue to knowledge. American Journal of Nursing,105(5), 62–69.

Gordon S. & Nelson S. (2006) Moving beyond the virtuescript in nursing: creating a knowledge-based identity fornurses. In: Complexities of Care: Nursing Reconsidered(eds S. Nelson & S. Gordon), pp. 13–29. Cornell UniversityPress, Ithica, NY.

Habermas J. (1971) Knowledge and Human Interests. Phi-losophy of the Social Sciences. (tr. J.J. Shapiro). Beacon,Boston, MA.

Habermas J. (1973a) Theory and Practice. (tr. J. Viertel).Beacon, Boston, MA.

Habermas J. (1973b) Nachwort. Appended to SubsequentEditions of Habermas.

Habermas J. (1973c) A postscript to Knowledge and HumanInterests. Philosophy of the Social Sciences, 3, 157–189.

Habermas J. (1984) The Theory of Communicative Action.(tr. T. McCarthy). Polity, Cambridge.

Habermas J. (1989) Structural Transformation of the PublicSphere. (trs T. Burger & F. Lawrence). Polity, Cambridge.

Hargreaves J. (2010) Voices from the past. In: BeyondReflective Practice: New Approaches to Professional Life-long Learning (eds H. Bradbury, N. Frost, S. Kilminster &M. Zukus), pp. 83–95. Routledge, Abingdon.

Harman K.M. & Meek V.L. (2002) Merger revisited: inter-national perspectives on mergers in higher education.Special Issue of Higher Education, 44(1), 1–183.

Harmon G. (1986) Restructuring higher education throughinstitutional mergers. Australian experience, 1981–83.Higher Education, 15(6), 567–586.

Hodges B., Regehr G. & Martin D. (2001) Difficulties inrecognizing one’s own incompetence: doctors who areunskilled and unaware of it. Academic Medicine, 76, S87–S89.

Holmes C. (1989) Alternatives to natural science founda-tions for nursing. International Journal of Nursing Studies,27(3), 187–198.

Holmes C. (1996) Resistance to positivist science in nursing:an assessment of the Australian literature. InternationalJournal of Nursing Practice, 2(4), 172–181.

Hunter I.R. (2008) Talking about my generation. CriticalInquiry, 34(Spring), 583–560.

Illych I. (2000) DeSchooling Society. Marion Boyars,London.

International Council of Continuing Education and Training(2011) Who we are. Available at: http://www.iacet.org/content/about-iacet.html [accessed 8 January 2012].

Kemmis S. (1985) Action research and the politics of reflec-tion. In: Reflection: Turning Experience into Learning (edsD. Boyd, D. Keogh & D. Walker), pp. 139–164. KoganPage, London.

Kemmis S. & McTaggart R. (eds) (1990) The ActionResearch Reader. Deakin University, Geelong, Victoria.

Kinsella E.A. (2007) Technical rationality in Schon’s reflec-tive practice: dichotomous or nondualistic epistemologicalpositions. Nursing Philosophy, 8(2), 102–113.

Kinsella E.A. (2010) Professional knowledge and the epis-temology of reflective practice. Nursing Philosophy, 11(1),3–14.

Kitson A. (2000) Towards evidence based quality improve-ment: perspectives from nursing practice. InternationalJournal for Quality in Healthcare, 12(6), 459–464.

Labaree D.F. (2008) An uneasy relationship: the history ofteacher education in the university. In: Handbook ofResearch on Teacher Education, 3rd edn. (ed. M. Cochran-Smith, S. Feiman-Nemser, D.J. McIntyre et al.), pp. 78–108.Association of Teacher Educators, Routledge, New York.

Lyotard J.F. (1984) The Postmodern Condition: A Report onKnowledge. University of Minnesota Press, Minneapolis,MN.

McCormack B., Manley K. & Garbett R. (eds) (2004)Practice Development in Nursing. Wiley-Blackwell,Oxford.

Nelson S. (2004) The search for the good in nursing? Theburden of ethical expertise. Nursing Philosophy, 5(1),12–22.

Nelson S. & McGillion M. (2004) Expertise or Performance?Calling into question narrative use in nursing. Journal ofAdvanced Nursing, 47, 6.

Nelson S. & Purkis M.E. (2004) Mandatory reflection: thereconstitution of the competent nurse. Nursing Inquiry,11, 4.

Pearson A. (1983) The Clinical Nursing Unit. Butterworth-Heinemann, London.

Pearson A. (ed.) (1988) Primary Nursing : Nursing in theBurford and Oxford Nursing Development Units, London.Croom Helm, Sydney.

Schön D. (1983) The Reflective Practitioner: How Profession-als Think in Action. Temple Smith, London.

Schön D. (1987) Educating the Reflective Practitioner. Jossey-Bass, San Francisco, CA.

Sioban Nelson212


Smith M.K. (2001) Donald Schön: learning, reflection andchange. The encyclopedia of informal education.Availableat: http://www.infed.org/thinkers/et-schon.htm [accessed 8January 2012].

Taylor B. (1992) A matter of affirmation: the value of prac-tice experience for postregistration nursing students. Pre-sented to the 1992 Joint Conference on EducationResearch: Discipline and Diversity, Deakin UniversityGeelong, Victoria, Australia.

Taylor B. (2004) Technical, practical, and emancipatoryreflection for practicing holistically. Journal of HolisticNursing, 22(1), 73–84.

Walker D. (1985) Writing and reflection. In: Reflection.Turning Experience into Learning (eds D. Boud, R. Keogh& D. Walker), pp. 52–68. Kogan Page, London.



the lost path to emancipatory practice: towards a history of reflective practice in nursing

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