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―the main features of both transference and counter-transference are the intensity of feelings experienced by a person toward a notable other, feelings that are unfitting to the current situation‖ (p.15) Transference is an unconscious process (Jones 2004) and Hawkins and Shohet (2000 p.209) describe it as: ―seeing a present situation / relationship through the emotional lens of a past situation/relationship‖. While they describe counter-transference as: ―the responses of the counsellor or psychotherapist to their patient/client, both conscious and unconscious‖ (ibid p.206). In my Masters‘ research I had proposed transference/counter-transference happened between a nurse and patient in some close relationships where strong emotions, such as anxiety and anger were present. Clearly, there is an emotional aspect to nursing. Nurses often find themselves in difficult situations where patients and significant loved ones experience extreme emotional responses as a consequence of their illnesses. I asked the nurses looking after Mary whether they ever noticed if they experienced the same emotions as their patients might be feeling because I felt this was happening to me. No-one answered this question. So I went back to talk about Mary, how did they feel when they looked after her? The staff nurses said Mary was ―difficult to look after‖ and they felt cross and frustrated because she wouldn‘t wash or make any effort for her husband. Yet the leap to consider why that might be was missing. It was as though they took the diagnosis of depression away from the context of her cancer and terminal illness. Was there a body and mind split here? There did not seem to be a holistic view of Mary. This brought alive the role of empathy in reflecting-in-action for me, that is, getting at the unexpressed feelings in the moment. If I could empathise with Mary then this understanding of her could be translated into decisions and choices about caring for her needs in a more appropriate way. But did my own needs and especially my emotions get in the way of being able to imagine what she might be feeling? 85
A few days later there was a discussion about Mary again at the evening handover with two staff nurses expressing disquiet about her impending discharge. How were Mary and her husband going to get on at home? How would they cope? One nurse said she thought Mary would come back to the ward. We talked about hospice care and how difficult it was to get this and that it was only available just before a patient would die, usually about three days before. This meant it was mostly too late for the patient and family to really benefit from the hospice environment. By this time I had written the poem Neck Cancer and hesitantly shared the poem just before the late shift handover to three staff nurses and an auxiliary nurse. I felt very nervous and told the staff they would probably think I was a bit ‗off the wall‘ for writing poetry. But to my surprise, the quality of the conversation changed and opened up some powerful reflections in the team. I found sharing the poem and my own emotional state allowed a conversation about how best to care for Mary. We talked about the ethical dilemma we faced about creating some boundaries such as a daily wash while respecting her decision to refuse the nasogastric feed. Sharing stories of care rarely happened in the team; because, usually we nurses ‗just got on with it‘ that is, giving care, not reflecting on that care. Of course this could have been because I was an outsider to the normal team (Coghlan & Brannick 2001). Therefore the trust and safety elements required to show uncertainty about caring for others was missing. On this occasion we were able to acknowledge and empathise with each other because we recognised there were no easy, quick fix solutions for Mary. I noticed the difficulties in providing physical care appeared to be discussed more openly at handover perhaps because these are more easily addressed with concrete actions or decisions. It felt like there was a reluctance to debate or acknowledge the more tricky aspects of nursing such as psychological care or differences in our value systems. But the poetry seemed to facilitate a deeper type of conversation about our values and intentions helping us to see we wanted the best for her and providing a team connection. This was unusual because intentions and values 86
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Hopkinson, C. (2010) More than a go
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Abstract Reflection-in-action is a
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Special Thanks Special thanks are d
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Conclusion.........................
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List of Appendices Appendix 1 Infor
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stories and metaphor as ways of ref
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mostly learning happened through pl
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other patients on the unit who need
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The next story I present also had a
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help us process the experience. I d
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emotional and difficult events in t
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In the Classroom I won‘t do this
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through an avoidance of the body/mi
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Action and Stories in Developing Pr
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mattered to them and were relevant
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Clarke et al (1996) suggested refle
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and qualitative approaches have bee
Page 35 and 36: alienated from the thinking and dec
Page 37 and 38: In collaborative inquiry ‗critica
Page 39 and 40: enabling organisational patterns ov
Page 41 and 42: ideas with Bourdieu‘s concepts wh
Page 43 and 44: process 13 which has been central t
Page 45 and 46: encompasses Bourdieu‘s complex co
Page 47 and 48: Gaining Ethical Approval: A Story o
Page 49 and 50: process. Nevertheless, the committe
Page 51 and 52: time. Two practitioners joined the
Page 53 and 54: generation was through sharing prac
Page 55 and 56: from returning to practice and the
Page 57 and 58: conversation in order to deepen our
Page 59 and 60: possibilities and tensions of refle
Page 61 and 62: and gaps in my knowledge so that my
Page 63 and 64: esearcher (and reader) cannot under
Page 65 and 66: Strand 2: Emerging Processes As par
Page 67 and 68: searching and reading published lit
Page 69 and 70: Chapter 3: A Poetic Inquiry Every p
Page 71 and 72: What Does the Healthcare Literature
Page 73 and 74: There are several themes emerging f
Page 75 and 76: Having searched the poetry literatu
Page 77 and 78: objectivity and functionality throu
Page 79 and 80: Qualitative Inquiry journal in thei
Page 81 and 82: ―defamiliarize‖; science freque
Page 83 and 84: that I puzzled over what the powerf
Page 85: I wish I could take this in my stri
Page 89 and 90: Moving towards Co-Inquiry through S
Page 91 and 92: ‗The Wounded Nurse‘ created a d
Page 93 and 94: off for mandatory training sessions
Page 95 and 96: experiential exercise, a lecturer w
Page 97 and 98: Just a Pair of Hands I get my hands
Page 99 and 100: potentially stifles the spontaneity
Page 101 and 102: layered and provide new insights ov
Page 103 and 104: Surprisingly I did not anticipate a
Page 105 and 106: illusionary as the Douglas Adams qu
Page 107 and 108: Reflecting through Diary Writing To
Page 109 and 110: comfortable, positive and relaxed.
Page 111 and 112: For Jordon, unless she had a perfor
Page 113 and 114: used time in a contradictory way; s
Page 115 and 116: Alex found being so busy was isolat
Page 117 and 118: go and find the area is actually ok
Page 119 and 120: Does a Busy Environment Affect Refl
Page 121 and 122: Jane: Well staff won‟t…once upo
Page 123 and 124: About a year later, in March 2006,
Page 125 and 126: I started to wonder if the busy syn
Page 127 and 128: My argument is, that if ‗being bu
Page 129 and 130: aspects of nursing may hold more so
Page 131 and 132: was also prevalent and was a way th
Page 133 and 134: Photograph from Davies (1980 p. 7-8
Page 135 and 136: Nightingale was a woman of action a
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and romantic/feminine appeared most
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woman‘. I see this as a gender an
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The kettle‘s boiled Milk and suga
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Whinging Women? Gossip, whinge, nag
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whinge? That‟s interesting, it‟
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Breaking News: You need to stop wri
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The story above highlights the loss
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experience with the ethics committe
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This made me wonder about the compl
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She thought it helped nurses reliev
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I realised through the creative wri
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emotions can become exaggerated in
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she ‗likes‘ all her patients th
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my patient, you answer it‖; somet
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sibling derives. Therefore in medie
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Susan had also received a phone-cal
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So what does Susan learn? To keep h
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Silence and/or Reflection Inaction?
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the usual place for this form of ca
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Conclusion This chapter has questio
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game. This embodied habitus keeps n
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Minnie 45 captured the difficulties
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can transform and widen one‘s per
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drawn to this question. In the last
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Perhaps this was due to nurses not
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combination, or purely a matter of
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mistrust of hierarchy and are not p
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Recently I discovered in Native Ame
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I think I can veer between feeling
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At times you feel you don‟t have
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to gain more resources and to flag
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The rabbit twitches it‘s whiskers
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She talked about the freeze on post
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context in which the person may be
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imagine staff will feel personally
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We discussed how this process would
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exposing the imaginary boundaries a
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unlikely to encourage political or
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Chapter 7: Embodying Reflexivity: D
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cultural and systemic tensions alre
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Rising above the Wall: Getting Angr
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does not permit this kind of action
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At the bottom of the power station
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when the staff nurse who I imagine
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So when I lost it, on the ward, I m
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change it? Thus getting angry could
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y creating a dialogue. Similarly, S
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I‟ve always focused more on pract
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Careful Talk: Naming Emotions and D
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I‟m getting a lot of confidence i
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pavement”. This image came to rep
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Shocking He was chatting Then dead
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to come into work on her day off to
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for incompetence? In describing vul
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They don‟t see that they have got
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esponses‘ and ‗what is yours‘
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Chapter 8: Invisible Learning: More
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206). I have tried to demonstrate s
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I think this misses the point of Bo
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came to embody and experience them
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change can be orchestrated, sustain
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field of feeling unsupported by man
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silent subversion, their felt power
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I suggest a lack of two-way explici
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etween nurses while talking away an
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evident may feel physically tired t
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Embodying reflexivity mostly uses s
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a blanket answer because being over
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power) concentrate on time saving,
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Many of the training needs and chan
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creating an illusion of control and
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possible to learn from stories irre
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interplay between the two positions
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Final Thoughts or Beginnings? Refle
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I was further challenged to conside
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has value. My hope is that this the
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Bleakley, A. (2000b) Writing with I
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Clandinin, D.J. Connelly, F.M. (199
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de Vault, M.L. (1997) Personal Writ
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Ghaye, T., Lillyman, S. (2006) Lear
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Hodkinson, P., Biesta, G., James, D
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Johns, C. Freshwater, D. (1998) Tra
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Midgley, M. (1996) Utopias, Dolphin
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Powell, J. (1989) The reflective pr
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Searle, R., Sheehan, D. (2008) Inno
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Tripp, D. (1998) Critical Incidents
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Appendix 1 Information Sheet for Pa
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sense of the research material. You
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produced. However, at the end of th
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Date.................. I can be con
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Appendix 4 Interview Schedule for S
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many as I would like due to other w
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poems. Claire has used pros (sectio
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Appendix 8 Why Reflect X NHS Trust
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Guidance Notes 1. Description of ex
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