Governing nursing through reflection: a discourse analysis of reflective practices

Abstract

Aim. This paper is a report of a study analysing reflection as discourse and a technology of confession which produces a certain desirable subjectivity within nursing practice. Background. Reflection and reflective practice are common themes in nursing practices and in the literature on nursing. These practices are often construed as positive and empowering, and more critical analyses of them are needed. Method. A Foucauldian-inspired discourse analysis based on the concepts of governmentality and technologies of the self was conducted. Interview transcripts from 42 managers, supervisors, teachers and participants in an in-service programme to prepare health care assistants to become Licensed Practice Nurses in the elder care sector were analysed. Findings. Reflection as confession operates as a governing technology within the nursing practice analysed. Programme participants are encouraged to reflect and scrutinize themselves about their work as a way to improve their competencies and practice. Through appraisals, they are invited to reflect about themselves as way to achieve their desires. In this way, active, responsible, problem-solving, self-governing practitioners are constructed. Conclusion. Through a Foucauldian reading of reflective practices it is possible to illustrate that reflection is not a neutral or apolitical practice. Instead, it is a governing practice that does something, in discursive terms, to nursing subjectivity -something that can create a space for reflection about what reflection discursively does to subjectivity. Summary statement What is already know about this topic• Reflection and reflective practices are common themes in nursing practices • Literature on reflection and reflective practice in nursing often construe such practices as positive and empowering • Some literature focuses on issues of power in relation to reflection and nursing, and the work of Foucault has been introduced more extensively during the last decade in research on nursing What this paper adds• Reflection operates as a governing technology that shapes an active, responsible, problem-solving, self-governing nursing practitioner. • Reflection on the individual level is constructed as something desirable that makes it possible to work upon oneself to become a desirable nursing practitioner.• Reflection is not a neutral or apolitical practice, but is a governing practice that acts, in discursive terms, to produce a desirable nursing subjectivity.

Framing the implementation process of video conferencing in discharge planning – according to staff experience

“…Time influences all the other factors in certain ways and ought to be seen as an aspect that needs to be consistently present in discussions on the outcomes of the [17] state that organizations that encourage the staff to reflect on their everyday work are more successful when it comes to implementation of new innovations. Reflection as a concept is known to be one of the most valuable elements when it comes to both individual [40] and organizational learning processes [41]. Schön [42] argues that 'reflective practice' can be an important tool in professional learning, where individuals learn from their own professional experiences, which can be seen as the most important source of personal professional development and improvement.…”

Activating the worker in elderly care: a technique and tactics of invitation

“…How workers are identified as objects therefore matters in the kinds of realities that they make possible as job descriptions. Or, as a further examples, the increased demand on formal qualifications for employees, as offered through inservice training programmes, makes it possible to speak about carers as those who participate actively in these programmes, or not (Fejes 2010a), or those who are competent (those who participate) and those who are not (those who do not participate) (Fejes 2008). …”

“…Technologies depend upon such specific techniques and tactics in the shaping of subjectivities. For example, performance appraisal is a technique within a wider confessional technology (Fejes 2008). Here the employee becomes object of knowledge (visible for calculation) and is made subject as a particular kind of employee through a process whereby he or she comes to know and act on the soul (cf.…”

“…For our analysis we focus specifically on the language interactions between a manager and her workers in an elderly-care home, based on records of conversation and notes of observations. An elderly-care worker research project conducted by Fejes (2008;2010a;2010b;Fejes and Nicoll 2010) and focused on workplace learning and the constitution of subjects, allowed for detailed examination of what goes on in attempts in the production of the active subject through language interactions between the manager and her workers. It is thus to the way that language operates in these sort of attempts that our exploration and theorization turns.…”

Competing discourses and the positioning of students in an adult basic education programme

“…a strict discourse analysis, e.g. Dahl (2005) and Fejes (2008) or a combination of discourse analysis and ethnographical studies, e.g. Lehn-Christiansen (2011) and Somerville (2006).…”