Technical rationality in Schön's reflective practice: dichotomous or non-dualistic epistemological position

Abstract  Donald Schön's theory of reflective practice has received unprecedented attention as an approach to professional development in nursing and other health and social care professions. This paper examines technical rationality in Schön's theory of reflective practice and argues that its critique is a broad and often overlooked epistemological underpinning in this work. This paper suggests that the popularity of Schön's theory is tied in part to his critique of technical rationality, and to his acknowledgement of the significance of practitioner experience and indeterminate zones of practice in the development of expertise. Schön tapped into a growing disillusionment with technical rationality that coincided with a crisis of knowledge across a range of disciplines. The question is raised as to whether Schön's critique sets up a dichotomy between technical rationality and experience, or overcomes it. The conclusions suggest that Schön is not discarding research-based professional knowledge, but rather challenging conflated views of its practical significance. In this way, it is proposed that his critique of technical rationality can be interpreted as an attempt to overcome dualistic thinking as it pertains to professional knowledge.     

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

This paper historicizes the taken‐for‐granted acceptance of reflection as a fundamental professional practice in nursing. It draws attention to the broad application of reflective practice, from pedagogy to practice to regulation, and explores the epistemological basis upon which the authority of reflective discourse rests. Previous work has provided a series of critiques of the logic and suitability of reflective practice across all domains of nursing. The goal of this paper is to commence a history of nursing's reflective identity. The paper begins with a discussion of Dewey and Schön then focuses on Habermas's Theory of Communicative Action as the epistemological basis of reflective practice's standing as a authoritative discourse in nursing.     

Correlates of Reflective Practice in Medicine

Background: The ability of physicians to critically reflect on their professional practice has been increasingly valued. Previous research brought to light the multidimensional structure of reflective practice in medicine. It comprises at least five sets of behaviours in response to complex medical problems encountered in professional practice. Factors associated to reflective practice among physicians have, as far as we know, not yet been explored by empirical study. Purpose: To study factors correlated to reflective practice among physicians. Methods: A questionnaire exploring characteristics of professional practice and educational experiences was administered to primary health care physicians. Measurements were related to scores on a reflective practice measuring instrument developed previously. Associations between variables were examined by statistical analysis with tests of correlation and analysis of variance. Results: Reflective practice is negatively correlated to physician’s age and number of years of clinical practice. Working mainly in hospitals and attendance to medical residency programmes in some specialties apparently have a positive effect on reflective practice. Conclusion: Reflective practice tends to decrease with experience. Findings are consistent with the literature on medical expertise that shows a decline of analytical reasoning in proportion to the increase in experience. Some specialty programmes seems to enhance concerns with the scientific basis to professional practice, thereby favouring reflective approaches. Local features of primary health care settings probably explain their negative effect on reflective practice. Strategies to develop reflective practice among physicians should be explored by further research.     

Medical and nursing clinical decision making: a comparative epistemological analysis

Abstract The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other hand, others argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skilful conduct of clinical decision making.     

Honesty in critically reflective essays: an analysis of student practice

In health professional education, reflective practice is seen as a potential means for self-improvement from everyday clinical encounters. This study aims to examine the level of student honesty in critical reflection, and barriers and facilitators for students engaging in honest reflection. Third year physiotherapy students, completing summative reflective essays on clinical encounters using the modified Gibbs cycle, were invited to participate in an anonymous online survey. Student knowledge and beliefs about reflective practice, and disclosure of the truthfulness of their reflections, were assessed using a mixed method approach. A total of 34 students, from a maximum possible of 48 (71 %), participated in the study activities. A total of 68 % stated that they were at least 80 % truthful about their experiences. There was general student consensus that reflective practice was important for their growth as a clinician. Students questioned the belief that the reflection needed to be based on a factual experience. Reflective practice can be a valuable addition to the clinical education of health care professionals, although this value can be diminished through dishonest reflections if it is not carefully implemented. Student influences on honest reflection include; (1) the design of any assessment criteria, and (2) student knowledge and competency in applying critical reflection.     

About the theoretic, philosophical, epistemological bases of scientific research: the case of nursing

As indicated by the title, this paper discusses the theoretic, philosophical, epistemological basis of scientific research--the case of nursing. The author points out the fundamental questions in nursing--science and art. Nursing is considered both as a social practice and as a profession that encompasses scientific practice and the construction of knowledge. Thus, Nursing is understood as a "science under construction" or as specific knowledge, even if it is imprecise and, therefore, on its way to become scientific due to its evidences. In other words, knowledge that is justified not by total precision, on the contrary, by the need to find answers to the question about raising the epistemological reach of nursing research results--its knowing and knowing what to do. The discussion emphasizes the crucial nature of nursing care.     

Research assisting nursing practice: a philosophical view

The authors of the present article reflect on the difficulties of nursing research and its relation with its practice, which is based on the philosophy of praxis. Initially, there is a discussion on the relationship between theory and praxis from a philosophical perspective. The authors make a resumed review of nursing knowledge in the last century. Finally, they present the dialectic of interactions as a possibility of advancing beyond the territories of the dialectic of work. According to the authors, complex areas of knowledge related to health/illness/care cannot be exclusively studied by formal sciences or exclusively by biological and social sciences. They believe that a consistent epistemological project has to consider a third area that would include the dialectic of reasoning and the dialectic of representations.     

Sources of strain between physicians and social workers: implications for social workers in health care settings

This paper analyzes the sources of strain between the professions of medicine and social work. The two professions are compared in relation to (1) the organization and socialization process of professional training; (2) perspectives on patient care, illness and role of the health care professional; (3) attitudes toward knowledge and data; (4) attitudes toward and preparation for team-work; (5) perspectives on the role of the patient; (6) perceptions of social work's function.     

Knowledge for the good of the individual and society: linking philosophy,disciplinary goals,theory, and practice

Nursing as a profession has a social mandate to contribute to the good of society through knowledge‐based practice. Knowledge is built upon theories, and theories, together with their philosophical bases and disciplinary goals, are the guiding frameworks for practice. This article explores a philosophical perspective of nursing's social mandate, the disciplinary goals for the good of the individual and society, and one approach for translating knowledge into practice through the use of a middle‐range theory. It is anticipated that the integration of the philosophical perspective and model into nursing practice will strengthen the philosophy, disciplinary goal, theory, and practice links and expand knowledge within the discipline. With the focus on humanization, we propose that nursing knowledge for social good will embrace a synthesis of the individual and the common good. This approach converges vital and agency needs described by Hamilton and the primacy of maintaining the heritage of the good within the human species as outlined by Maritain. Further, by embedding knowledge development in a changing social and health care context, nursing focuses on the goals of clinical reasoning and action. McCubbin and Patterson's Double ABCX Model of Family Adaptation was used as an example of a theory that can guide practice at the community and global level. Using the theory‐practice link as a foundation, the Double ABCX model provides practising nurses with one approach to meet the needs of individuals and society. The integration of theory into nursing practice provides a guide to achieve nursing's disciplinary goals of promoting health and preventing illness across the globe. When nursing goals are directed at the synthesis of the good of the individual and society, nursing's social and moral mandate may be achieved.     

Reflection and reflective practice in health professions education: a systematic review

The importance of reflection and reflective practice are frequently noted in the literature; indeed, reflective capacity is regarded by many as an essential characteristic for professional competence. Educators assert that the emergence of reflective practice is part of a change that acknowledges the need for students to act and to think professionally as an integral part of learning throughout their courses of study, integrating theory and practice from the outset. Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education, and across a variety of health professions. The evidence to support and inform these curricular interventions and innovations remains largely theoretical. Further, the literature is dispersed across several fields, and it is unclear which approaches may have efficacy or impact. We, therefore, designed a literature review to evaluate the existing evidence about reflection and reflective practice and their utility in health professional education. Our aim was to understand the key variables influencing this educational process, identify gaps in the evidence, and to explore any implications for educational practice and research.