Why the rise of reflection now? Perspectives from Nurse Education Chris Bulman School of Health and Social Care Oxford Brookes University

Reflection in Nurse Education Interest since 1980s Process of critically reviewing experience in order to learn from it (Freshwater et al. 2008) Learning from/about practice is fundamental to the education of nurses Promoted in nursing education internationally (Ruth-Sahd 2003, Bulman and Schutz 2008, Freshwater et al. 2008).

Knowledge Tensions in HE Difficulties with integrating professional education into higher education Tensions between university and professionally orientated perspectives on knowledge (Eraut 1994). Universities seek to develop and broaden academic knowledge and consequently to challenge long- established professional practices. Importance and status of propositional knowledge in western society. Difference between propositional knowledge and practical ‘know how’.

Objectivity and ‘Knowing more than we can tell’ Complete objectivity, in science, is a false ideal (Polanyi 1958). Personal knowing influences and enhances the objective. Knowledge is embodied through practical knowing. This kind of knowledge cannot always be articulated in words - ‘we know more than we can tell’ (Polanyi ). So there will be knowledge that may never be expressed. Need to seek out ways to help people to communicate and express themselves as adequately as possible. Reflection has the potential for providing such a route (Bulman 2008).

Legitimising Nursing Knowledge Oppression and disparagement towards practice knowledge and the expression of nurses’ ‘ideals of care’ (Meerabeau 2005) Reflection provides a vehicle through which to communicate and justify the importance of practice and practice knowledge (Johns 1995). Legitimises knowledge derived from the realities of practice rather than from more traditional forms of knowing (Brockbank and McGill 1998). Nurses, along with other professionals, have been interested in reflection and consequently have contributed to the growing body of literature on the concept Consequently, nurse education includes reflection into preparation and CPD. (NMC 2010)

Learning how to learn Zeitgeist in HE - ‘banking’ notion of education challenged by emphasis on enabling learning how to learn (Friere 1972) Developing effective critical thinking skills (Brookfield 1987, Barnett 1997, Moon 1999). Criticism of the technical, rational approach to professional education (Schon 1987). Theory-practice gap Need to educate nurses to learn from their practice, develop their thinking and ultimately make a difference to their patients.

Communicating Practice Nurses need to find ways to critically communicate their stories about practice. Not always achieved through a traditional technical route, nor can be found in conventional nursing textbooks

Nurses need to be educated in ways that develop their autonomy, critical thinking, open-mindedness and ability to be sensitive to others (Freshwater and Stickley 2004). Reflection has the potential to develop these qualities in nurses

EBP doesn’t have all the answers Nursing research and evidence- based practice - akin to a new religion; evidence-based practice linked to status for nurses and the work they do (Hart 2004) Real practical insight and understanding is a complex matter involving the whole soul, so much so that over-theorising and not drawing on these can actually get in the way of vision Nussbaum (1990).

Nursing ‘With Grace’ Nursing work involves working with people in intimate, emotional and often distressing aspects of care (Johns 1993). Professional motivation to learn about, and improve, practice (Johns 2001, Bulman 2009). About wanting to nurse ‘with grace’ Unresolved issues and continuing mistakes matter, to everyone in need of nursing.

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