434 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
EXHIBIT 19.1 Johns’s model of structured reflection, 15th edition.
- Bring the mind home.
- Focus on a description that seems significant in some way.
- What particular issues seem significant to pay attention to?
- How were others feeling and what made them feel that way?
- How was I feeling and what made me feel that way?
- What was I trying to achieve and did I respond effectively?
- What were the consequences of my actions on the patient, others, and on my-
self? - What factors influenced the way I was feeling, thinking, and responding?
- What knowledge did or might have informed me?
- To what extent did I act for the best and in tune with my values?
- How does this situation connect with previous experience?
- How might I respond more effectively given this situation occurs again?
- What would be the consequences of alternative actions for the patient, others,
and on myself? - What factors might constrain me from acting in new ways?
- How do I now feel about this experience?
- Am I more able to support myself and others better as a consequence?
- Am I more able to realize desirable practice?
Reprinted from Johns (2007) with permission from Sage Publications.
■ WHAT ABOUT NURSING KNOWLEDGE?
You may be asking yourself “It’s all very nice being reflective, but what about the de-
velopment of nursing knowledge?” The dominant paradigm for nursing knowledge
over the past few decades has been one of technical rationality , supported by the rise in
research- based practice. The term technical rationality originated with Habermas (1970)
and was employed by Schön (1983) to refer to the dominance of theory over practice
(and hence of theorists over practitioners).
The development of nursing science has been the result of a one- way flow of
information from researchers through academic journals and textbooks, to nursing
practitioners. Grounded in technical rationality (Aristotle’s episteme ), new develop-
ments in nursing practice have been driven by the findings of scientific (usually quanti-
tative) research studies and the writing of theorists (Rolfe, 2006). Hypothetico- deductive
positivist models of research, working from the general to the specific, generate
middle- range or grand theories to be translated into everyday practice. In actual fact, they
produce evidence of or from phenomena, and not evidence for practice, as is usually
assumed. Such assumptions are an act of belief, and give evidence- based practice a spu-
rious respectability. Nursing theory created by academics away from the clinical set-
ting (on the high, hard ground of technical rationality) cannot be easily incorporated into
practice (in the swampy lowlands ), in the same way that oil and water cannot mix. The
incommensurability between these two discourses or worldviews has led to the theory–
practice gap, much discussed and lamented by educationalists and practitioners alike.
Although some nursing theories are developed inductively from practice, the gap still
exists because they are not returned for testing or implementation in their own original
setting (the practice– theory– practice gap).