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Reflective practice and daily ward reality: a covert power game
Stefanos Mantzoukas1, Melanie A Jasper
1Faculty of Health and Human Sciences, Wolfson Institute of Health Sciences, Thames Valley University, London, UK. stefanos.mantzoukas@tvu.ac.uk
Journal of Clinical Nursing
|November 10, 2004
Summary
Reflection in nursing is often hindered by organizational power dynamics, limiting its use to personal time. Recognizing this covert power struggle is key for nurses to implement reflective practices formally.
Area of Science:
- Nursing
- Sociology of Health
- Organizational Behavior
Background:
- Reflection is a key epistemology for practice-based knowledge development in nursing.
- Nursing bodies and service providers mandate reflection for professional practice.
- Implementation challenges and the impact of organizational culture on reflection are under-researched.
Purpose of the Study:
- To explore nurses' views on reflection in their daily practice.
- To examine the relationship between organizational culture and nurses' reflective practices.
- To investigate the implementation of reflective methods in medical wards.
Main Methods:
- Interpretative ethnographical methodology.
- Data collection through observation and interviews with 16 nurses.
- Qualitative content analysis of interviews and written reflective accounts.
Main Results:
- Four themes emerged: nurse-doctor relationships, nurse-manager relationships, nursing practice, and clinical outcome influence.
- Organizational hierarchy and power struggles invalidate reflection.
- Reflection is perceived as abnormal, confined to personal time.
Conclusions:
- Ward hierarchy and power dynamics create an illusionary reality, constraining reflective practice.
- Dominant professional groups maintain power by defining nursing practice.
- Nurses' awareness of power dynamics can initiate formal use of reflective methods.