Beyond reflection : a study of contemporary nursing practice

Using Casebook Ethnography, nine registered Adult Nurses were observed and interviewed to explore the ways in which they undertook their daily work and the place of reflection in that. The participants were employed in one of two units; a surgical breast care and an acute palliative care unit, both of which were in a large National Health Service trust hospital in central England. Data collection was illuminated by the researcher’s reflective journal. The data collected, rather than simply describing reflective practice, led to wider and more broadly focussed findings which, when analysed, generated one central theme - Communication, Interaction and Discourse and three linked associate themes - Being and Caring, Practical Action, and Knowing. These themes were considered in the light of the key literature around nursing practice and reflection. The findings point to a new understanding of contemporary nursing practice, which illustrates ‘what our kind does’, amongst the groups of participants in order to deliver patient-focussed care. This practice was directed towards working with colleagues who shared the same values and understandings, and who used these shared beliefs to adapt their practice to achieve individualised and exquisite care. As they communicated and interacted with one another, the participants went about their work with attention to empathy and caring, articulated as a common humanity with their patients. They prioritised action where patient need was clear, and used a form of knowledge that was negotiated and validated within a community of practice. As they maintained a dialogue in their teams, the participants developed a sense of their professional identity and of who qualified as ‘our kind’. The implications of this study are that a fuller understanding of how nurses work in contemporary practice will inform the preparation and continuing professional development of nurses and the ways in which effective clinical leadership may be implemented.