Keynote paper given by Gary Rolfe at the NET Networking for Education in Healthcare Conference, Churchill College Cambridge, 4 September 2013



I wrote a paper in 2001 entitled Reflective practice: where now? in which I argued that reflective practice had lost its way and needed to rediscover its radical origins. I said:

Reflective practice was originally conceived as a radical critique of technical rationality, and was based on the premise that knowledge generated by practitioners reflecting on their own experiences is of at least equal value to knowledge derived by academics from empirical research. However, experiential knowledge from reflection-on-action now finds itself at the bottom of the hierarchy of evidence on which to base practice, and reflection has become just another technical tool. (Rolfe 2002, p.21)

I have seen very little indication that the situation has improved over the past 11 years, and in some ways it has become worse. My prescription for the problem was a return to the roots from which the modern idea of reflective practice originated, in particular the work of John Dewey, Carl Rogers, Paulo Freire and Donald Schön. Now, of course, you might argue that Schön's work in particular was the catalyst for the reflective nursing practice movement and continues to be a huge influence, but I would suggest that it has largely been misunderstood and misapplied. In fact, I would go further and suggest that many of the writers who cite Schön's work have never properly read him. In particular, when Schön writes about what he calls the reflective practitioner, he is not referring to either the idea or the process that has come to be known as reflective practice in nursing and other health care disciplines. 

Schön is not referring to the retrospective contemplation of practice, he is not suggesting that we write about our practice, and he is not advocating models or frameworks to structure our reflection. For Schön, reflective practice is something that we do, not something that we sit down afterwards and think about. Reflective practice means reflection in practice, or what Schön more usually refers to as reflection-in-action. What he calls reflection-on-action, which appears to have seized the imagination of nurses and other health care practitioners, hardly warrants a mention in either of his two seminal books. On one of the few occasions that he does mention it, he acknowledges that: 

Practitioners do reflect on their knowing-in-practice. Sometimes, in the relative tranquillity of a postmortem, they think back on a project they have undertaken, a situation they have lived through, and they explore the understandings they have brought to their handling of the case. They may do this in a mood of idle speculation, or in a deliberate effort to prepare themselves for future cases. (Schön 1983, p.61) 

And of course this is what most nurses understand by reflective practice and what many nurse educators teach students to do. But it is not what Schön meant or understood by reflective practice. At best, reflection-on-action is reflecting about reflection.

The problem for nursing, which I attempted to highlight back in 2002, is that there is nothing in the idea of reflection-on-action that offers a credible challenge to the dominant technical rational paradigm of evidence-based practice. That is to say, if we regard reflection simply as a way of generating knowledge about our practice by thinking about it retrospectively, then that knowledge will always find itself at the very bottom of the hierarchy of evidence alongside personal experience and unsubstantiated belief. So long as the dominant model of health care demands that practice should be determined by research-based evidence, preferably derived from quantitative data, then experiential knowledge will never really count for much. That's not to say that retrospection isn't useful, but if reflective practice and reflective practitioners are to be taken seriously, then we need to be offering something more than simply thinking afterwards about what we have done in an attempt to do it better next time. And simply claiming that reflection is rigorous and scientific because we used a model or framework just isn't good enough.

What I would like to do today is to offer a radical reappraisal of reflection and reflective practice in an attempt to establish it on a firmer footing. As I'm sure many of you will know, the word radical derives from the Latin radix, meaning roots. Taking a radical view of reflection therefore means exploring its origins, and its modern-day use originates in the work of John Dewey back in the early nineteen hundreds. I will therefore briefly look at Dewey's notion of reflection and suggest why, a hundred years on, it is particularly relevant to nursing and health care practice and education in the 21st century. 

If few nurses have read Schön, then probably even fewer have read Dewey. On the face of it, Dewey's ideas appear far from radical. Dewey uses the words 'reflection' and 'thinking' more or less interchangeably, which is perhaps why reflection is often regarded as being no more than thinking about our experiences. Certainly, this is the way that many practitioners have interpreted it. But Dewey was a pragmatist philosopher and a practical educator, and his notion of thinking is intricately connected to doing. For Dewey, reflection is not a case of having an experience and then going home to think about it. On the contrary, thinking is an active process that involves forming hypotheses and trying them out here and now in the real world. Thinking or reflection is therefore a form of experimentation. We can't reflect in an armchair; refection can only take place in practice; reflection, in Dewey's words, involves: 

Doing something overtly to bring about the anticipated result, and   thereby testing the hypothesis. (Dewey 1916, p.115)

It might seem odd to think of reflection as a way of doing rather than as a way of thinking. However, Dewey's description of reflection is more or less identical to what Schön would later refer to as reflection-in-action or simply as reflective practice, which he described as 'a reflective conversation with the situation' (Schön 1983, p.163). And like all conversations, reflective conversations are best conducted face-to-face within the situation itself rather than by sitting in an armchair writing a letter to the situation. In other words, reflective practitioners reflect on-the-spot, in the here-and-now, and the products of their reflections are immediately put into practice in a continuous and spontaneous interplay between thinking and doing, in which ideas are formulated, tested and revised. 

Video of Keynote presentation, NET 2013 Conference, Cambridge, UK

  The university in dissent (2013)

  Cardinal John Henry Newman and ‘the ideal state and purpose of a university (2012)

  Fast food for thought (2012)

  The business of higher education: Interview with Gary Rolfe for Metro USA (2012)
  NET conference paper (2011)

  Second generation professional doctorates in nursing (2009)

  Nursing scholarship and the asymmetrical professor (2007)

  Against excellence (2003)


    contact: praxis@garyrolfe.net