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Christopher Johns is Professor of Nursing at the University of Bedfordshire, Bedfordshire, UK, and Director of the PhD School for reflective practice, performance and narrative. He is also convenor of the International Reflective Practice conferences and Reflective Gatherings.

Acknowledgements xx

1 What is reflective practice? 1

Describing reflection 2

Reflection on experience 2

Mindfulness 3

Prerequisites of reflection 4

Reflexivity 5

Practical wisdom and praxis 5

Contradiction 5

Empowerment 8

Development of voice 9

Silence 9

Received voice 10

The subjective voice 10

The procedural voice 11

The constructed voice 11

Whole brain stuff 12

Knowing reflection 13

Bimadisiwin 14

Critical reflection 14

Transgression 15

Being in place 15

The significance of reflective practices for professional practice 16

Expertise 18

The six dialogical movements 19

The hermeneutic circle 19

Dialogue 20

Evaluating reflection 21

Journal entry 23

Conclusion 23

Notes 24

2 Writing self: the first dialogical movement 25

Mimesis 25

Creative writing 26

Bringing the mind home 27

Dividing the page 28

Commentary 30

Writing rather than telling 30

Tapping the tacit 31

Opening the reflective space through the humanities 32

The therapeutic benefit of writing 33

Notes 34

3 Engaging the reflective spiral: the second dialogical movement 35

Models of reflection 36

Guarding against a prescriptive legacy 36

The model for structured reflection (MSR) 37

What issues are significant to pay attention to? 42

How were others feeling and what made them feel that way? 42

How was I feeling and what made me feel that way? 43

What was I trying to achieve and did I respond effectively? 45

What are the broader consequences of my actions on the patient, others and myself? 46

What knowledge did or might have informed me? 47

To what extent did I act for the best and in tune with my values and beliefs? 47

How does this situation connect with previous experiences? 50

What assumptions govern my practice and what factors influence the way I feel, think and respond within the particular experience? 51

Warshield 53

Stress, anxiety, and coping with work 54

Feeling fluffy–feeling drained scale 54

Water butt theory of stress 56

The risk of burnout 57

The looking forward cues 57

Janet writes 57

How might I respond more effectively given this situation again? 59

What would be the consequences of alternative actions for the patient, others and myself? 60

What factors might stop me from responding differently? 60

How do I NOW feel about this experience? 60

Am I now more able to support myself and others better as a consequence? 61

Conclusion 61

Notes 61

4 Framing insights 62

Single lines 63

Framing insights 64

Carper’s fundamental ways of knowing 64

The framing perspectives 65

Developmental framing: the being available template 65

The being available template (BAT) 66

Conclusion 68

Note 68

5 The dance with Sophia: the third dialogical movement 69

The dance with Sophia 70

Dialogue as creative play 71

Mapping 71

Narratives of health illness 71

Michael’s wife 72

Michael’s wife 72

Passing people by 73

Waiting 74

Loneliness 74

Caring 75

Buddhist influence 75

Lifting 75

As if she might shatter 76

Sylvia 76

Sylvia 77

Lorna 79

Conclusion 79

6 Guiding reflection: the fourth dialogical movement 80

Dialogue 80

Why reflection needs to be guided 81

Co-creation of insights 81

The reality wall 82

Contracting 83

What issues need to be contracted? 83

Finding the path 84

The nature of guidance 84

Remoralisation 86

Pulling free 86

Conclusion 87

7 Weaving and performing narrative: the fifth and sixth dialogical movements 88

Fifth dialogical movement 88

Methodology 88

Narrative form 89

Creativity 90

Fiction 91

Coherence 91

Sixth dialogical movement 92

Change value of narrative 93

Conclusion 94

Note 94

8 The reflective curriculum 95

The community of inquiry 96

Collaboration 96

Peers 96

Potential benefits of a reflective curriculum 97

Potential constraints to the reflective curriculum 98

Theory–practice gap 98

Imagining the shape of a reflective curriculum 99

Guided reflection groups 101

Dialogue 102

The talking stick 102

Skilled guides 103

Storytelling 103

Art workshops 104

Performance 104

Jane’s rap 104

Imagine 105

The rub 105

Journal entry 1 106

Journal entry 2 107

Honour thy mother 107

Journal entry 3 110

Journal entry 4 111

Judging reflective writing 115

Programmes 115

Conclusion 116

Notes 116

9 Reflection on touch and the environment 117

Touch 117

Commentary 120

Environment (Jill) 121

Conclusion 124

10 The emotional cost of caring 125

Simon writes 125

Commentary 129

Note 130

11 Life begins at 40 131

Clare writes 131

Electrocardiographs (ECGs) 131

Insight 135

Reflection 136

12 Balancing the wind or a lot of hot air 138

Jim writes 138

Mary 139

The pain clinic referral 140

Mary’s family 140

Reflection 144

13 A reflective framework for clinical practice 146

The Burford NDU model: caring in practice 146

Vision 146

Valid vision 149

The nature of caring 149

Suffering 150

Nurturing growth 150

Knowing caring 150

The internal environment of practice 152

Social utility 152

From vision to reality 153

A structural view of a refl ective framework for clinical practice 154

A system to ensure the vision is realised within each clinical moment 154

Wavelength theory 156

The Burford NDU reflective cues 157

Tony 158

Who is this person? 159

What meaning does this health event have for the person? 160

How is this person feeling? 160

How has this event affected their usual life pattern and roles? 160

How do I feel about this person? 161

How can I help this person? 161

What is important for this person to make his stay in the hospice comfortable? 162

What support does this person have in life? 162

How does this person view the future? 162

Reflection on being available to Tony 163

A system to ensure effective communication 163

Narrative notes 164

Talk 164

Reflective handover 164

Bedside handover 165

Patient notes 166

Narrative 168

A reflective quality system to ensure effective practice 169

A system to ensure staff are enabled to realise the vision as a lived reality 169

Organisational culture 170

Conclusion 170

Notes 170

14 Reflective leadership 171

A little voice in a big arena 172

Reflection 175

Transformational leadership 178

Power 178

Journal entry – realising our power 179

Journal entry – self-deception 180

Refl ective leadership 181

The learning organisation 182

Vision 184

Vision, what vision? 184

Conclusion 184

Notes 185

15 Teetering on the edge of chaos 186

Lazell writes 187

Newtonian knowing: The machine in parts 187

Complexity learning and knowledge cycles 189

Choice 190

Maps, strange attractors and learning through leadership 192

Conclusions: Where chaos and leadership fuse 193

Commentary 195

Conclusion 196

Notes 196

16 Ensuring quality 197

Reflective approaches 198

Clinical audit 198

Project 199

Model for reflective inquiry (MRI) 199

Debriefing 200

Standards of care 201

Standards group 202

Nutrition 202

Sleep 204

Relatives 204

Confidentiality 206

The value of standards of care 207

Conclusion 209

Note 210

17 Clinical supervision 211

Sustaining practitioners 212

Bumping heads 213

Revealing woozles 213

Four variables of clinical supervision 213

Voluntary or mandatory 214

Group versus individual supervision 214

Single or multi-professional 215

Who should the supervisor be? 215

Peer supervision 217

Contracting 218

Emancipatory or technical supervision 219

John Heron 221

The nine-step model 222

Pragmatics of clinical supervision 223

Karen 224

Trudy 224

Session 1 225

Commentary 226

Session 2 226

Commentary 228

Session 3 228

Commentary 229

Session 4 229

Commentary 231

Session 5 231

Commentary 232

Session 6 232

Commentary 234

A quiet eddy 234

Notes 234

18 Tales of clinical supervision 235

Michelle 235

Commentary 237

Cathy and the GPs 238

Exploring perspectives 240

Hank’s complaint 248

Horizontal violence 251

Conclusion 252

Notes 252

19 Therapeutic journalling for patients 253

Moira Vass 253

My refl ection 253

Therapeutic benefit 257

Facilitating therapeutic writing 258

Conclusion 259

20 Nurse bully and the timid sheep: an adventure in storyboard 260

Conclusion 269

21 Reflective prose poetry 270

Notes 279

22 Through a glass darkly 280

Introduction 280

Performance design 280

Giving voice 280

Through a glass darkly preamble 281

Through a glass darkly 282

The first gate 283

The second gate 284

The third gate 285

The fourth gate 286

The fifth gate 287

The sixth gate 288

Notes 290

Appendix Clinical supervision evaluation tool 293

References 297

Index 311

Praise for previous editions:

"This edition takes into account developments in reflective theory and has more coverage of different approaches, including the use of narrative dialogue and performance, and greater emphasis on the process of writing over the realization of desirable practice. It also has new chapters on ensuring quality and managing conflict." (Book News, December 2009)

'Christopher Johns is an internationally recognised pioneer of reflective practice in nursing and health care. The first edition of this book was an excellent resource and this updated version is equally impressive. This is a superb resource for nurses and all those eager to enhance their knowledge and skills in reflective practice. It is well presented, user-friendly and stimulating.' (Nursing Standard)