Becoming a Reflective Practitioner. Группа авторов. Читать онлайн. Newlib. NEWLIB.NET

Автор: Группа авторов
Издательство: John Wiley & Sons Limited
Серия:
Жанр произведения: Медицина
Год издания: 0
isbn: 9781119764762
Скачать книгу
4.3 The Becoming Assertive Action Ladder 8

10 Treading the fine line between pushing and yielding
9 Playing the power game
8 Staying in adult mode
7 Being communicatively skilful
6 ‘Just do it!’ (JDI)
5 Creating the optimum conditions to assert self
4 Making a good argument
3 Authority to assert self
2 Ethically right to assert self
1 Feeing the need to assert self

      Reflection is always concerned with the development of poise – the ability to know and manage feelings. The practitioner has reflected to understand their feelings. This cue now prompts them to consider how they might manage their feelings in order to respond differently. They may need to confront any lurking negative thoughts, fears, or feelings that seem to get in the way. In Buddhism, this scrutiny is called Apramada, what I term the guard at the gate of the senses’ ever watchful for any negative mental events that may influence responding differently (Sangharakshita 1998). It is an aspect of being mindful acting like a diligent censor, keeping the mind alert, and moving towards the vision which the practitioner desires.

      Practitioners often wear metaphoric suits of armour to protect themselves from the anxiety and emotions of caring and the suffering of others. Jade, one of the primary nurses at Burford Hospital said ‘I don’t come to work dressed in protective armour’ (Johns 1993). Dewey (1933, p. 30) observed:

      Unconscious fears also drive us into purely defensive attitudes that operate like coats of armour – not only to shut out new conceptions but even to prevent us from making new observations.

      Dewey believed that anxiety limited the practitioner’s ability to learn through experience. The professional is closed to protect self rather than open to possibility. ‘Armour’ is akin to professional detachment.

      Logstrup noted the radicality of the ethical demand (1997, p. 44):

      The demand asks me to take care of the other person’s life not only when it strengthens me but also when it is very unpleasant because it intrudes disturbingly into my own existence.

      Hence, why we might strive to meet the demand to care for the life of the other, it opens us to our own vulnerability and why we may wear suits of armour to survive.

      Coming to an understanding of one’s vulnerability begins a journey to unlearn defence mechanisms and learn to cope with it more effectively. The practitioner may need to review and develop their support mechanisms within the practice. To be able to say – ‘I’m struggling‘ without being judged incompetent. In my experience, there is little organisational sensitivity to the profound nature of caring work. The lack of recognition of emotional labour (James 1989; Bolton 2000) that somehow emotional work is natural women’s work, and therefore is unskilled doesn’t need to be taught, and is not valued, when emotional work is the greatest gift nurses can offer patients. Taylor (1992, p. 1042) noted a theme within the literature of how nurses have been dispossessed ‘of their essential humanness as human beings and as people, by emphasising their professional roles and responsibilities’. Taylor draws attention to the fact that nurses are human too and, as such, are vulnerable to the same issues that face their patients and families. The lack of recognition of humanness in nursing through a focus on roles and responsibilities has led practitioners to strive to be something they were clearly struggling to cope with. Consequently, they risk becoming alienated from themselves in their efforts to cope with and live with the contradictions in their lives. Jourard (1971) noted that such striving damages ‘the self’ and reinforces the need to cope in a vicious downward spiral of self‐destruction towards burnout and a state of anomie.

      Stewing in our own juices is not healthy. Imagine your body is like a water butt‐ slowly filling with stress. As it fills, we are more tired and more intolerant but contain it, that is until you feel you are drowning and then one of two things happens. Either you blow up inside and have a breakdown, or else you snap and ‘blow your top’. You rage at events or people (Wilkinson 1988; Parker 1990; Pike 1991).

      Pike (1991, p. 351) writes:

      Moral outrage ensues when the nurse’s attempts to operationalize a choice is thwarted by constraints. The outrage intensifies when these constraints not only block action, but also force a course of action that violates the nurse’s moral tenets.

      Then ask yourself:

       What factors contribute to your sense of feeling drained?

       What factors contribute to your sense of feeling light and fluffy?

       What do you need to do to home feeling more fluffy and less drained?

       Use this scale over a period of time to monitor stress patterns and any improvement in your ‘fluffiness’.12

Schematic illustration of the feeling fluffy–feeling drained scale.

      Many practitioners wear this T‐shirt. However, the water butt does have a drainage tap. Through reflection, the practitioner can learn to monitor her stress levels and open her tap. She can then drain and convert the stress into positive energy necessary to take appropriate action to resolve the sources of stress (Hall 1964) just as the gardener draws water from the water butt to water the flowers and nourish their growth. However, the tap might be blocked, requiring help to unblock it – again, the value of guidance. If stress accumulates then the risk of burnout looms large on the horizon. Cherniss (1980) describes burnout as a process in which