Ethan Grech
Psychiatric Nurse,
Cardiff,UK.
Citation:
Grech, E. (2004)
Hegel’s dialectic and
reflective practice – a short essay.
International Journal of Psychosocial
Rehabilitation. 8, 71-73.
Abstract
Cotton describes current
reflective practice in nursing as an
essentially disempowering and devaluing experience. Gilbert draws on a
Foucauldian framework to argue that reflective practice imposes a
degree of
surveillance on healthcare professionals and refers to Johns’ (1995)
model of
guided reflection as one of the postmodern ‘technologies of power’.
This paper
will attempt to provide a brief critique of Johns’ model from a broad
Hegelian
perspective. Central
to Johns’ idea of
reflective practice is the goal of accessing, understanding and
learning
through lived experience. It is this that enables the practitioner to
take
“congruent action towards developing increased effectiveness within the
context
of what is understood as desirable practice.” Johns’ model
offers, I believe,
a robust guide for reflective practice. It enables the practitioner to
analyse
an experience by promoting the cognition of the contradictory parts
that come
together to make up that experience.
Introduction
For
the postmodern
philosophers Michel Foucault, Jean Baudrillard and Jean-François
Lyotard, there
is little relationship between thought and reality (Rees 1998,
p.295-297). Each
exists in separate compartments. The recurring danger in human history
is that
people should come to believe that their ideas can result in a better
world
(Lyotard 1989, p.8-9). However, within nursing, postmodernism has been
celebrated as a liberating philosophy that enables the practitioner to
take
responsibility for his or her actions (Stevenson 2001).
The ‘hegemonic
discourse’
of reflective practice in nursing has been challenged from a postmodern
perspective by such writers as Cotton (2001) and Gilbert (2001).
Calling for
“new conceptualisations” of reflection and whilst citing little
empirical
evidence, Cotton describes current reflective practice in nursing as an
essentially disempowering and devaluing experience. Gilbert draws on a
Foucauldian framework to argue that reflective practice imposes a
degree of
surveillance on healthcare professionals and refers to Johns’ (1995)
model of
guided reflection as one of the postmodern ‘technologies of power’.
This paper
will attempt to provide a brief critique of Johns’ model from a broad
Hegelian
perspective.
The Hegelian
dialectic and Johns’ model of reflection
G.
W. F. Hegel (1770 – 1831)
described how contradiction lies at the root of all change (Miller
1969,
online). His theories have been developed and enriched to explain the
course of
social change throughout history (Marx and Engels 1967, p.79; Marx
1976,
p.102-103). This dialectical approach suggests that change and movement
are
inevitable and inherent in all living things. Whilst a detailed
discussion of
Hegelian dialectics is beyond the scope of this paper, it should be
noted that
totality, change and mediation are underlying themes in Hegel’s
writings. These
themes can provide an antidote to the reductionism of the empirical
method so
common in contemporary nursing theory. Rees describes how “any two
elements in
contradiction cannot be dissolved into one another but only overcome by
the
creation of a synthesis that is not reducible to either of its
constituent
elements” (Rees 1998, p.7).
In contrast to empiricism,
reflective practice suggests that when a structured and analytical
methodology
is used to reflect on experience, new knowledge and theory can be
generated
(White, 1997). In the empiricist system, the part is seen as a
pre-exiting unit
with little relationship to others. Parts may superficially affect each
other
but not change their fundamental nature. Reality is analysed using
static
concepts and individuals are held to be the building blocks of social
theory.
Thus, this methodology lends itself well to the neoliberal economics of
present
day health service reform. In a dialectical system, the relationship of
the
parts to each other and thus to the whole is fundamental (Rees 1998,
p.5). Not
only is the whole more than a sum of its parts, but the part becomes
more than
it is individually by being part of the whole.
Central to Johns’ idea of
reflective practice is the goal of accessing, understanding and
learning
through lived experience. It is this that enables the practitioner to
take
“congruent action towards developing increased effectiveness within the
context
of what is understood as desirable practice.” Appendix A provides
Johns’
framework for applying Carper’s four patterns of knowing. This enables
the
practitioner to interpret his or her experience within the empirical,
ethical,
personal and aesthetic spheres of knowledge (Carper 1978, cited in
Johns 1995).
Here, the empirical and aesthetic ways of knowing stand in
contradistinction to
each other. In Hegelian terminology, they form a unity of opposites.
Both are
discrete whilst simultaneously processing the ability to
interpenetrate. The
two patterns of knowing exist as parts of a totality, presented as they
are as
components of Johns’ model. Johns makes the important point that
empirical
knowledge is transcended by the process of assimilation into the
practitioners
personal knowledge and thus into practice.
When describing the
relationship between the four ways of knowing, Johns states that the
aesthetic
emerges as the dominant sphere and is informed by the empirical,
personal and
ethical dimensions. In this way, the aesthetic mediates the other areas
of
knowledge. The result is a synthesis that enables the practitioner to
respond
to new situations with a changed perspective. The model facilitates the
process
of self-awareness, description, critical analysis, synthesis and
evaluation
identified by Atkins and Murphy (1993). Within Johns’ system, the
contradictions between the practitioner’s actual and desirable practice
are
significant as they can provide a powerful motivational force for
change. The
practitioner may be in a state of “cognitive dissonance” (Festinger
1957, cited
in Clark 1999) that can be overcome by the use of Johns’ model.
Criticisms
of the model
Heath (1998) points to the
complexity and diversity of practice in the real world. She suggests
that
practitioners need considerable expertise and reflective skill when
using
Johns’ model so as not to see the examination and categorization of
their
knowledge as a mere “academic exercise.” Echoing the postmodernists’
concerns,
she refers to a degree of controversy surrounding the excessive use of
structure in reflection. Similarly, Kitchen (1999) states that any
model of
reflection should not be over prescriptive. Johns’ model is described
as useful
in one-to-one supervised reflection but is considered somewhat
restrictive,
especially for experienced practitioners. In general, practitioners
need to
guard against the dangers of reducing experiences to a series of
questions
without any real reflection.
Conclusion
Johns’
model offers, I believe,
a robust guide for reflective practice. It enables the practitioner to
analyse
an experience by promoting the cognition of the contradictory parts
that come
together to make up that experience. This method bares striking
similarities to
Hegel’s philosophical approach and is considered to be the very essence
of the
materialist dialectic (Lenin 1972, p.359). Over time, this process
enables the
practitioner to avoid the assumptions that might otherwise be made if
based on
a purely empirical understanding of reality. Given that a reductive
process is
needed to fit the practitioners experiences into one of Carper’s four
categories, some of the criticism above is understandable. However,
these
concerns entirely miss the point. By treating knowledge as a rich
totality, the
use of Carper’s four patterns of knowing enables the full examination
of
practice, theory and assumptions and thus enables the individual to
develop as
a reflective practitioner.
References
Atkins S. and Murphy
K. (1993) Reflection: a review of the literature. Journal of
Advanced
Nursing, 18(8); 1188-1192
Clark A.
(1999)
Changing attitudes through persuasive communication. Nursing
Standard,
13(30); 45-47
Cotton
A.H.
Private
thoughts in public spheres: issues in reflection and reflective
practise in
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Gilbert T.
(2001)
Reflective practice and clinical supervision: meticulous rituals of the
confessional. Journal of Advanced Nursing, 36(2); 199-205
Heath H.
(1998)
Reflection and patterns of knowing in nursing. Journal of Advanced
Nursing,
27; 1054-1059
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(1995)
Framing learning through reflection within Carper’s fundamental ways of
knowing
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Kitchen S. (1999) An
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(accessed 5 October 2003)
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S.J.
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Appendix
A - Johns’
model of guided reflection (10th version): source Johns
(1995).
Cue
questions
Aesthetics
What was I
trying to achieve?
Why did I
respond as I did?
What were
the consequences of that for:
the
patient?
others?
myself?
How was the
person feeling? (or these persons?)
How did I
know this?
Personal
How did I
feel in this situation?
What
internal factors were influencing me?
Ethics
How did
my actions match with my beliefs?
What factors
made me act in incongruent ways?
Empirics
What
knowledge did or should have informed me?
Reflexivity
How did this
connect with previous experiences?
Could I
handle this better in similar situations?
What would
be the consequences of alternative action for:
the
patient?
others?
myself?
How do I now
feel about this situation?
Can I
support myself and others better as a consequence?
Has this
changed my ways of knowing?
