critical reflection case study

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Article Contents

Introduction, barriers to hearing children’s voices, the impacts of neoliberalism and managerialism on practice with children and families, the ecv research project, methodology, l.m.’s critical incident (pre-test data), l.m.’s critical incident (post-test data), analysis and further reflection, discussion and conclusion, acknowledgements.

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How Can Critical Reflection Improve Social Work Practice with Children and Families?

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Christine Morley, Lee Marshall, Chez Leggatt-Cook, How Can Critical Reflection Improve Social Work Practice with Children and Families?, The British Journal of Social Work , Volume 53, Issue 6, September 2023, Pages 3181–3199, https://doi.org/10.1093/bjsw/bcad088

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The impacts of neoliberal managerialism mean that practitioners working in child protection programmes are often challenged to balance social work values, with formal compliance activities to reduce risk. Within this context, what are the possibilities for practitioners to creatively navigate complex practice environments to achieve better outcomes for children and families? And how might transformative research empower practitioners to improve practice by reconnecting their work with the emancipatory values of the profession? This article seeks to address these questions by showcasing key findings of a state-wide study focused on empowering children’s voices, through the presentation and analysis of a case study. The research used a pre-test/post-test design with critical reflection as a methodology to transform the practice of front line workers and managers who work with children and families in an Australian-based non-government organisation. The case study illustrates the conceptual and practical processes involved in achieving change in a way that can be replicated by others and transferred to other contexts. The findings of the research suggest that critical reflection can be effective to enable practitioners to improve practice with children and families. The article concludes by highlighting implications for organisations in supporting critically reflective practitioners.

The impacts of neoliberal managerialism on social work practice and organisations have now been well documented (e.g. see Hendrix et al. , 2021 ). Practitioners working in statutory child protection programmes often report feeling powerless in risk-averse and busy contexts and struggle to balance social work values with formal compliance activities designed to reduce risk (e.g. see Cree et al. , 2016 ). A key challenge for practitioners is to find ways to navigate these complex practice environments to achieve better outcomes for families and children.

This article discusses key findings of the final stage of a three-part Australian study: ‘Empowering Children’s Voices’ (ECVs), spanning from 2018 to 2022. This research used critical reflection as an educational methodology to transform practice with children and families in a Queensland-based, Non-Government Organisation (UnitingCare). The second author (L.M.), a participant in the research, presents her analysis of a case study from her practice to demonstrate the conceptual and practical processes involved in using critical reflection to achieve change. The first author (C.M.) was the Chief Investigator on the project and facilitator of the critical reflection workshops. The third author (C.L.-C.) is a research and evaluation advisor within UnitingCare and worked in partnership with C.M. to design and implement the research.

Despite an obligation and intention for practitioners to incorporate children’s insights into professional practice (e.g. see McCafferty, 2017 ; Stafford et al. , 2021a ; Toros, 2021 ), there are barriers to achieving genuine child-inclusive practice (e.g. see Harkin et al. , 2020 ; Morley et al. , 2021 ; Stafford et al. , 2021a , b ; Toros, 2021 ). These include: practitioners holding adult-centric perspectives ( McCafferty, 2017 ); a lack of expertise and confidence on the part of practitioners to work effectively with children ( McCafferty, 2017 ; Toros, 2021 ); protectionist discourses that position children as incapable and/or vulnerable ( van Bijleveld et al. , 2015 ; McCafferty, 2017 ; Harkin et al. , 2020 ; Toros, 2021 ) and a proclivity for child protection over child rights ( Rogowski, 2015 ; Holt, 2016 ; Toros, 2021 ).

Research suggests that children have ‘limited opportunities to participate in the decision-making process’ ( van Bijleveld et al. , 2015 , p. 133; see also Munro, 2011 ; Bastian, 2020 ; Stafford et al. , 2021b ) and ‘are infrequently being seen and heard’ ( Stafford et al. , 2021b , p. 12; see also Holt, 2016 ; Harkin et al. , 2020 ; Morley et al. , 2021 ; Stafford et al. , 2021a ; Toros, 2021 ). On the rare occasions when children are consulted, they report having ‘insufficient or inconsistent opportunity to express their views on matters affecting them while in care’ ( van Bijleveld et al. , 2015 , p. 133). Moreover, when asked, children can recall times when they were ‘excluded from decision-making and planning and were able to articulate how it felt when adults didn’t listen or act on what they had to say’ ( Morley and Leggatt-Cook, 2022 , p. 139); resulting in ‘a sense of being ignored or overlooked’ ( van Bijleveld et al. , 2015 , p. 133).

Neoliberalism and managerialism have become increasingly embedded in human service organisations over the last four decades (e.g. see Spolander et al. , 2014 ). Designed to increased management power and control through cost-cutting, standardisation of work risk management and the imposition of extensive accountability mechanisms for staff, managerialism diminishes professional autonomy and undermines relationship-based practice ( Weinberg and Taylor, 2014 ; Braithwaite, 2021 ). Directly affecting practice, managerialism has resulted in families affected by structural disadvantage (including experiencing problems that manifest as substance abuse, domestic violence, poverty, homelessness, mental health, etc.) being targeted ‘for pre-emptive action’ ( Braithwaite, 2021 , p. 56), leading to the caseloads of child safety workers ballooning.

Invariably, higher workloads and the move from professional practice (conceptualised as ethical practice to support a public good) to technical and proceduralised ways of working that emphasise ‘risk minimisation and performance management’ ( Hitchcock et al. , 2021 , p. 2362) have resulted in reducing social work ‘to a narrower, truncated role of rationing ever scarcer resources, assessing/managing risk and changing the behaviour and life styles of children and families often in punitive ways’ ( Rogowski, 2015 , p. 94; see also Bastian, 2020 ; Rogowski, 2021 ).

Robinson and Macfarlane (2021 , p. 444) argue that neoliberal managerialism renders practitioners ‘paralysed… concerned for our jobs, concerned for our professional integrity… and at a loss as to how to proceed.’ Greenslade et al. (2015 , p. 427) similarly describe the ‘current focus on risk management and compliance’ as undermining practitioners’ ‘ability to do their job’, whilst ‘excessive caseloads, insufficient resources, increased documentation requirements… seriously impaired their ability to practise’ effectively ( Greenslade et al. , 2015 , p. 427). Fenton (2014) likewise found that the less individually responsive, more risk-averse and less social justice value-friendly the organisation, the more neoliberal practice became and the more ethical distress (and powerlessness) practitioners experienced as a result.

Despite the current context, however, Rogowski (2015 , p. 107) argues a ‘more humane practice’ is needed. Elsewhere, he advocates ‘for a different child protection narrative; one that acknowledges the impact of poverty and inequality on children and families, and which interrogates the causes and consequences of deprivation’, noting the clear intersections between poverty/disadvantage and the ‘rates by which children being taken into care’ ( Rogowski, 2018 , p. 79). Rogowski (2015 , p. 107) also argues for ‘a genuine emphasis on family support as opposed to “intervention” which censures parents’.

UnitingCare is a non-government organisation operating in Queensland, Australia. UnitingCare’s ECV project arose from an identified need for children’s experiences to inform programmes that aimed to support their safety and well-being. Several factors prompted initiation of the project. First, in line with the shift towards earlier intervention with vulnerable families in other Western industrial countries (e.g. see Parton, 2006 ; Featherstone et al. , 2014 ), the (then) Queensland Government Department of Child Safety, Youth and Women had recently established a new early intervention programme. Intensive Family Support Services (IFSS) were designed to respond to families where children were deemed at risk of involvement in the statutory child protection system. IFSS supplemented the existing Family Intervention Service (FIS), which provided more intensive intervention and monitoring due to safety concerns, including assisting in reunifying children in out-of-home care with their families.

By 2017, cases were emerging across Queensland of children being harmed whilst their family was engaged with an intervention programme. In some cases, it seemed that a failure to involve children may have contributed to the harm that occurred. Further, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (2017) was encouraging renewed scrutiny of systems designed to protect children’s rights. The National Principles for Child Safe Organisations confirmed that children’s voices could be a powerful protector against harm (see Principle 2, Australian Human Rights Commission, 2018 , p. 6).

The ECV project commenced in 2018 with the aim of hearing from children and practitioners in UnitingCare’s eight FIS and five IFSS programmes about what needed to change:

In Stage 1, WorldCafé workshops with practitioners revealed that child-inclusive practice was occurring in pockets, but overall, intentional engagement with children was not consistent in family intervention practice ( Stafford et al. , 2021a ).

In Stage 2, participatory interviews conducted with children aged 6–17 years (whose families were current or recent clients of UnitingCare’s IFSS or FIS programmes) confirmed that they were largely excluded from decision-making and support planning ( Stafford et al. , 2021b ).

Stage 3 of the project was designed to support the development of new practice strategies for engaging children.

Given the findings of Stages 1 and 2, it was apparent that expanding child-inclusive practice would require thinking beyond existing practice approaches to envision other ways of working with children and families. Interpreting the findings of Stages 1 and 2 within a critical analysis of the impacts of neoliberal managerialism led the research team to understand that meaningful and sustainable change ‘would not be achieved by rolling out a new tool or training package or creating a child-friendly feedback process. Instead, the research demonstrated an overarching paradigm shift was required’ ( Morley and Leggatt-Cook, 2022 , p. 139). This recognition informed the development of Stage 3, which aimed ‘to build on and translate the research findings from Stages 1 and 2 into practice by devising new strategies to empower children’s voices’ ( Morley et al. , 2021 , p. 6).

Given the difficulties that practitioners’ identified, critical reflection was strategically employed to overcome barriers that practitioners face in seeking to meaningfully involve children in their practice. As a qualitative methodology, critical reflection strengthens the connections between theory and practice by recruiting research participants as co-researchers to determine new practice outcomes (e.g. see Morley, 2012 ; Allen, 2013 ; Hickson, 2016 ; Fox, 2021 ). Critical reflection is a transformative methodology that sits within critical and constructivist paradigms and shares similarities with participatory and co-operative inquiry approaches ( Morley, 2008 ; Fox, 2021 ). In this research, the aim was to address the gap between practitioners’ intentions to include children and their actual participation, and to contribute to an evidence base that supports practitioners to genuinely empower children’s voices and participation in practice.

Stage 3 of the ECV research project involved a pre-test/post-test design to measure the impact of the research intervention: that is, critical reflection workshops (3 days total involving 2 × 1.5 days of facilitated learning and reflection). Participants were required to submit a description of a critical incident from their practice to the research team, prior to participating in the workshops. These narratives about practice provided baseline data to understand a practitioner’s level of child-inclusive practice at the time, which was later compared with their post workshop reflections.

Beyond gathering narratives about the barriers to implementing child-inclusive practice, the critical reflection workshops aim to assist practitioners to reimagine their practice in ways that align with the espoused social justice value base of social work. The first half of the workshops involved participants learning about Fook’s (2016) model of critical reflection and presenting their own critical incidents, which were then subject to deconstruction. This involves identification of implicit (often hegemonic) assumptions, values and their unintended implications for practice. Having deconstructed unhelpful assumptions by reinterpreting practice situations within a critical theory framework, the second half of the workshops aimed to reconstruct practice; generating new possibilities for child-inclusive practice (e.g. see Fook, 2016 ).

Following completion of the workshops, participants were invited to share their overarching reflections in a focus group. These discussions, in which participants shared their learning gained from the workshops, and articulated shifts in their thinking and practice that had occurred as part of participating in the research, were recorded and transcribed. These data were also subject to critical analysis (e.g. see Morley, 2012 ; Fook, 2016 ). Formal ethics approval to undertake the research was gained through both QUT Human Research Ethics Committee and UnitingCare. All participants in the study gave written consent.

The first four deconstruction workshops occurred in 2020, with a maximum of twelve participants in each group. Whilst follow-up reconstruction workshops were planned to occur four to six weeks later, as recommended by Fook and Gardner (2007) , COVID-19 resulted in the reconstruction workshops being postponed for more than 12 months. By this time, only eight out of thirty-eight participants were able to continue their participation, following the lengthy break, which is a clear methodological limitation. However, the time in between workshops also provided an opportunity to more fully capture the changes. L.M. was one of the research participants who participated fully (prior to becoming a co-author when UnitingCare seconded her to specifically work on the ECV research). What follows is a presentation and analysis of her pre-test critical incident description, post-test critical reflection and the relevant contributions she made to the focus group discussion. C.M.’s analysis has also been included to transparently demonstrate the methodological process that enabled L.M.’s practice to become more child and family-focused.

Background/contextual information

This practice example is a family with three small children—eighteen months, six and seven years of age .

The family were a blended family with the two eldest daughters having a different father. The family had a significant child protection history including the mother having been a child in care with the experience of twenty-six separate placements in her childhood. The father had experienced a difficult upbringing, reporting being sexually abused as a child and tensions at home due to his parents being intoxicated and frequently fighting.

The current situation was characterised by domestic violence between the parents, substance abuse by both parents, with the father reporting using Ice—however this was not current (self-reported). There were also concerns about poor parenting and the mother being emotionally and physically abusive towards her children—poor attachment was observed and whilst the mother presented as being focused on parenting there had been limited opportunity to observe parenting interactions with the children.

The family had been a current case within the programme for over twelve months and whilst there had been some observable progress in addressing the goals (the house was cleaner and tidier, the older children were attending school regularly and the family were engaging with the service), the intervention felt controlled. The family seemed to be making progress because they felt they needed to change rather than really wanting to.

Critical incident

Recently one of the girls was severely injured by tipping a hot cup of noodles on her lap. This required two weeks in hospital where she received skin grafts. The incident occurred at the paternal grandparent’s home, despite a direction from Child Safety that the girls not be in the care of this grandmother (due to past injuries as a result of lack of supervision). In conversations with the mother about the incident, she did not appear concerned, was happy that the father (ex-partner) ‘was dealing with it’ and despite offers of support, refused to visit her daughter in hospital and preferred to have Facetime with her. In working with the mother, we discussed wound care for her daughter when she returned home and how this would work with transport home from the hospital. The mother had no engagement with the hospital and became aggressive when asked why she had not visited. There had been ongoing discussions about wound care, however the mother was adamant that this had not occurred and there had been no discussion about follow-up appointments. Concerns had been raised with Child Safety given the mother’s lack of attachment and her ability to meet the child’s high-level care needs upon discharge from hospital.

Initial reflection

I chose this scenario because I felt somewhat stuck in working with this family and worried that they may disengage from the programme as a result of my engagement around the most recent injury. There had been a lot of work done with both parents; however, there had been minimal opportunity to involve the children in direct observations and guidance. This was due to the parents’ refusal to have visits when the girls were at home after school. I felt that the children were not the focus of my intervention and I wanted to explore how I could engage them better—given the parent’s refusal to allow visits after school.

This case is important to me as I feel like the change that I have seen in the family has not impacted on the children—whilst they continued to benefit from a cleaner home and more support in attending school, there has been minimal change in the mother’s parenting and her connection/attachment to the children. I believe that both parents have learnt so much from FIS intervention and are now able to articulate their responses during discussions; however, they have limited ability/desire to translate these into practice.

I continue to be worried about the parent’s engagement and the impact of my engagement and work with the family. I hope to learn better techniques/strategies to engage parents to allow their children’s voices to come through. How can I capture their voices, engage and build rapport with children when we have parents that are not willing for this to happen?

C.M.’s initial reflections

Whilst there was nothing wrong or problematic about this practice, it became a critical incident for L.M. because she was feeling ‘stuck’ in working with this family and had developed a sense of frustration in relation to perceived blockages—especially those exhibited by mum. This led to a sense of disconnection from the children and a heightened sense of risk.

As with other practitioners who experience obstacles in their practice, critical reflection can be used to uncover alternative discourses that highlight new possibilities for action (e.g. see Alberti, 2000 ; Fox, 2021 ; Morley and O’Bree, 2021 ). It is from within these subjugated (often invisible) constructions/interpretations that new practice possibilities may emerge ( Morley, 2012 ). Such practice possibilities are available to all practitioners who are able to recognise their role in creating the knowledge that they use through the interpretations that they privilege (or dismiss). This process of deconstruction involves the ‘hunting’ of (hegemonic) discourses within one’s assumptions in order to recognise how these influence our thinking and action, so that alternative practice options can be created ( Morley, 2020 ). To facilitate this process, in response to L.M.’s critical incident data, I (C.M.) posed some questions to assist her to critically reflect on: her construction of the family; her use of language to describe family members and her interpretation of their behaviours (particularly the mother), amongst other things, in order to: (1) highlight how some of her assumptions might undermine her espoused intentions for practice and (2) elucidate some other possible interpretations of the situation. This connects with much of the literature that refers specifically to developing and utilising reflective perspectives in practice. A critical postmodern theoretical analysis was used to generate questions in relation to the case study, as it is the theoretical framework that underpins the model of critical reflection being used ( Fook, 2016 ). Critical postmodernism shines a light on the operations of power, as well as showing up the social processes and structures that create inequality, structural disadvantage and injustice ( Fook, 2016 ). Within neoliberal contexts, critical postmodern theory, when activated through critical reflection, is particularly useful for highlighting how practitioners might be complicit in hegemonic thinking that disadvantages families and/or blames them for the difficult circumstances they find themselves in. In this way, critical postmodern theory enacted through critical reflection has been asserted as ‘bolstering critical practices that are more aligned with protecting human rights, equity, democracy, social justice and other emancipatory goals of social work’ ( Morley and Macfarlane, 2014 , p. 338). The questions included:

Why have you chosen to emphasise the family’s ‘significant child protection history’ (rather than some of the recent positive changes that you have observed)?

How might shifting your narrative about the parents to incorporate their strengths (and the positive changes they have made) potentially change the way you see them, the situation (and your practice within it)?

What assumptions did you make about the mother’s behaviour? What other interpretations might be relevant?

What does your use of language to describe the mother’s behaviour indicate about how you perceive her? (i.e. ‘refused’ to visit; ‘mother became aggressive’, etc.). What purpose does the meaning you are imposing serve? Are there other terms that are less adversarial? What are some other interpretations of the ‘facts’ of this case? For example, is it possible that mum just doesn’t like hospitals? (or something else?), rather than ‘lacks attachment’?

If you continue to view the mother exclusively through a risk lens, how might this undermine your capacity to build a relationship with her (and ultimately reduce your opportunities to connect with the children)?

If you were able to build a supportive relationship with mum, how might this potentially reduce the risk—and/or your perception of it?

How might this enable you to reconstruct your practice towards being more child-inclusive?

Following the deconstruction workshop, I provided tailored, written feedback to each participant. Approximately twelve months later, I met with those continuing with the research in one-on-one meetings via zoom to revisit and reconstruct their initial accounts. Extracts from L.M.’s post-test reflection data are presented below.

Whilst the impact of COVID-19 has had a significant impact on the intended outcomes of our study, I feel that allowing the fullness of time to stand back and reflect has been extremely beneficial. At the point of introducing my family scenario, there was a sense of ‘stuckness’ in my practice:

I was making progress with the family—however, I did not move with their changes.

As a former government Child Safety Officer, I found myself still sitting in an investigative role rather than in the therapeutic space of the programme.

When I initially wrote the case scenario, the family were going through some really big changes that only became evident after the scenario was completed.

The father was participating in a men’s behaviour change programme and was struggling with the confronting nature of this perpetrator intervention.

Child Safety had also been in the process of removing the children due to the worries around the parent’s ability to make safe decisions and

There was ongoing domestic violence—however, it was unclear what the severity or frequency of this was.

Upon reflection on the feedback, I became aware that I was not focusing on the family’s strengths and had become stuck in a deficit-focused space where I was worried about safety—rather than looking for partnership.

As a result, I shifted my practice to a more strengths focused approach and started to support the mother by rewarding her for achievements—partnering with her.

Opportunities for one-on-one work became available and I spent some time with her whilst the children were doing after school sports—facilitating contact and spending time with the mother and her children.

Mum began to open up a lot and we started to talk about safe/challenging conversations she could have with dad to challenge his assumptions. This was very successful and mum started having more open conversations with dad—who by now was ready for these conversations after his work with the men’s behaviour change programme.

As mum became more confident, we continued our work on relaxation and self-care branching out to crafts, breathing techniques and delighting in spending time doing fun activities with her children and her partner.

As a result, the relationship really strengthened between the parents—mum became emotionally stronger and was able to manage her emotions better, becoming able to have calm conversations with Dad—who was now also in a space where he could listen to mum and respond calmly. This achieved safety for the first time in their relationship.

As we moved further along in the intervention, mum was able to establish stronger safety for herself and the children and their behaviour began to improve—mum began to connect and strengthen her relationship with her children and as a result became more in tune with their needs.

The family were now able to spend more time together doing fun things.

As I continued to strengthen my relationship with the mother, I was able to challenge her more and really focused on building her self-esteem and confidence as a parent and this was observed in the children.

As we moved towards closure dad became drug free and was able to get a job as a roofer (his trade). This resulted in more funds coming into the home and more time for mum to spend on her own, visiting friends, attending appointments or doing things around the house.

The youngest child started day-care and this improved his speech and development.

Mum became more proactive in her engagement with health professionals for her daughters.

Mum also began to take greater care of her appearance—doing her hair, wearing make-up and nice clothes and dad was no longer worried that she was ‘having an affair’—but rather just looking after herself.

The children had new clothes and the house became a home with mum decorating it was pictures and arts and crafts from the children. The family were able to afford some new furniture and had taken great pride in tidying up and decorating their home and

At closure the family expressed a sense of gratitude for pushing them further than they thought they were capable of—but also for listening to their troubles and challenging and supporting them without judgement.

Some weeks after closure dad flagged me down in the car park of the local supermarket—calling out my name from his car. He was genuinely excited to see me and chatted about how well the family were doing. The kids were in the backseat of the car—saying hello and chatting about school and the fun things they had been doing at home. Dad indicated that he was off the drugs now and still working and they were doing really well. Mum approached the car and said hello and advised that she was really happy and things had been going really well.

When I looked at this family scenario recently, I was able to reflect on my shift in engagement with the family and how this had changed the outcome for the family. I reflected on the thoughts that I had when I first read the feedback and some of the strategies I had used to turn the case around from when I had been stuck. I found this experience far more valuable than I had anticipated.

Through L.M. being prepared to consider alternative constructions of the parents, she developed a more engaged and trusting relationship with them, which enabled her to have far greater engagement with the children. Letting go of the risk-dominant lens and using a strengths-based approach permitted her to manage the risk, form a partnership with the family, whilst simultaneously developing opportunities to connect with the children. The children undoubtedly benefitted from L.M.’s work with the parents, as they became a key focus.

the difference that we made with that case was how we moved away from being focused on risk and started to change that intervention strategy to more partnering with mum .

Why would they give their trust to us if they see us as a statutory system like Child Safety? … We have to be mindful [when] walking into their homes … if you [the family] picked up that they [the practitioners] were judgmental about how you lived your life, about how you keep your home, about whether you’re drinking too much alcohol, or whether you’ve got a mental health diagnosis, it’s that kind of picture that they’re building about you as a bad parent . . I do understand why parents are protective of workers seeing their children. If you don’t feel comfortable with that person, why would you let your children engage with that person? I think that’s actually a strength of a good parent if they’re protective. It depends on the reason behind it, but we want our parents to ask questions about who engages with their children .

In adopting a more holistic and empathic perspective, and examining the complexities of the helping relationship, L.M. changed how she viewed the mother and started to trust her. As she observes: ‘I was focusing on what mum was saying, because she really did know what was going on, and once we strengthened that [our relationship] we were able to get to the bottom of what was happening.’

Shifting my perspective from constantly looking out for… the kids [being] unsafe …to actually, I wonder what mum really is thinking and feeling, and what does she really want here? Shifting that whole idea around… What would be her dream or her goal at the end of this intervention? By constantly listening and then coming back to her, and acknowledging what she said, and moving away from that [concern about], Child Safety jumping up and down on the side—going ‘Oh my God, oh my God, the risk is too high,’ and not getting sucked into that .

This research sought to explore how critical self-reflection on practice might assist practitioners to navigate complex organisational environments, dominated by neoliberal managerialism, to achieve better outcomes for children and families. Critical reflection has been an identified useful strategy for practitioners in this regard in other fields of practice (e.g. see Mueller and Morley, 2020 ; Morley and OBree, 2021; Morley and Stenhouse, 2021 ). It further sought to investigate how transformative research, using critical reflection as an educational methodology, might empower practitioners to improve child-inclusive practice by reconnecting their work with the social justice values of the profession, which have been marginalised by neoliberal managerialism (e.g. see McKendrick and Webb, 2014 ; Weinberg and Taylor, 2014 ).

Prior to collecting our reconstructed post-test data, our findings suggested that critical reflection could theoretically create ‘possibilities for practitioners to conceptualise practice differently and implement changes to practice . . that have potentially major implications for improving child-inclusive practice’ ( Morley et al. , 2021 , p. 14). Now that data collection is finalised, this article has presented one participant’s journey of critical reflection and practice transformation in its entirety. Whilst critically reflective research makes no claims about being generalisable ( Morley, 2012 ), the results of this process demonstrate that through engaging in critical reflection, the practitioner facilitated new opportunities for engagement with the family that resulted in her achieving critical outcomes with and for them.

I’ve learned, for example, from [a practitioner’s] example that she brought to our workshop, I’ve learned that if I ever go on a home visit again, I’m going to have eyes on the child, you know. I’ll never forget that . I will never not have my eyes on a kid. I’ll never not be in their bedroom on never not have a … conversation with them. Because I learned, you know, the importance of that and through other people’s experience and through my own experiences .

The unexpected time delay during the workshops due to Covid-19 and the associated lockdowns has been noted as a significant methodological limitation of this research. This was impactful, particularly for attrition associated with the study. That being said, at the conclusion of the research, more than fifty workers in the organisation, including front line practitioners and managers, as well as members of UnitingCare’s leadership team and others in strategic leadership roles had experientially participated in the critical reflection workshops. As one focus group member commented: ‘Having just had the critical reflections… has had ripple effects across the whole organisation and people have seen the importance… the work that came out of that, from all the practitioners … [was] phenomenal.’

At the time of submitting her pre-test data, L.M. indicated that she was feeling frustrated, concerned and ‘stuck’ due to not being able to form supportive relationships with the parents, and consequently even see the children, let alone engage with them. She was about to terminate her work with the family, as the risk was perceived as too great. This was common amongst research participants, who indicated that they were either considering case closure or had already closed the case at the time of submitting their pre-test data, due to their frustrations and/or concerns about risk within the family (for further case examples, see Morley et al. , 2021 ). This pattern is also acknowledged in the literature, as Bastian (2020 , p. 138) explains: ‘The closure of cases due to competing priorities is a legitimate and organizationally endorsed workload management tool in times of limited resources and high workload demands’. However, the findings of this research suggest that critical reflection can assist practitioners to continue working with the families despite perceived risks, and in doing so, may diminish actual risk for children and foster many positive outcomes that strengthen families (see also Morley et al. , 2021 ). Whilst the unplanned time delay between the deconstruction and reconstruction workshops provides the possibility that change identified in L.M.’s practice may have occurred in any case, she does not hold this view, and conversely sees the delay was an opportunity to demonstrate the full impact of the research intervention, which would not have been evident had the workshops progressed and data been collected in the planned timeframe.

This finding aligns with a Scottish-based project that employed critical reflection as a research strategy ‘to contribute to culture change in the children and families’ departments’ ( Cree et al. , 2016 , p. 548). The project similarly involved critical reflection training for practitioners and managers due to the ‘long-standing evidence show[ing] that these [workshops] provide an opportunity for practitioners to discuss their work in an open, non-blaming atmosphere’ ( Cree et al. , 2016 , p. 549) and the understanding that critical reflection can facilitate ‘improvements in professional practice’ ( Cree et al. , 2016 , p. 521). In documenting their experiences, the researchers similarly heard about the difficulties practitioners endure in responding to ‘the day-to-day impact of managerialism and public service cutbacks … and of a social work profession that felt undermined, undervalued and under attack, from government, the media, service users and the general public’ ( Cree et al. , 2016 , p. 553). They, too, acknowledged that the critical reflection workshops had revealed ‘that children and families’ social work practice … is still procedural, risk-averse and focused more on assessment of problems than on prevention or support’, which as one participant in their study pointed out ‘runs counter to relationship-based social work’ ( Cree et al. , 2016 , p. 552). In other papers, these same researchers concluded that critical reflection may offer some opportunities ‘to destabilise dominant practice orthodoxies and cultures and, in so doing, encourage culture change in organisations’ ( Smith et al. , 2017 , p. 973), as it has done it this study.

Ultimately, L.M.’s critical reflection demonstrates that despite the challenges of contemporary contexts, practitioners can (and do) continue to find opportunities to work in partnership with children and families. Analysis of this reflective case study provides an innovative, hopeful, practice-based research example that contributes evidence for informing ‘a transformative agenda in child protection’ ( Bastian, 2020 , pp. 141–142). L.M.’s practice affirms the importance of critical self-reflection in enhancing her relationship with the family (see also van Bijleveld, 2015 ) and also connecting her with concrete possibilities to challenge neoliberal managerialism by placing, in Rogowski’s words, more emphasis ‘on the caring side of social work, one which is more compatible with social justice and social change’ ( Rogowski, 2018 , p. 80; see also Rogowski, 2016 , 2021 ). This includes moving beyond ‘being competent technicians’ ( Rogowski, 2018 , p. 82) to a more critical understanding of what constitutes professional practice. Further, it is important to acknowledge that responsibility for driving change also sits with organisations, which directly influence practice by providing a collegial organisational culture, quality supervision, peer support and manageable workloads ( Hitchcock et al. , 2021 ; Waugh et al. , 2021 ). Given the findings of this inquiry, perhaps the challenge now is for organisations to expand the opportunities for child-inclusive practice by directly supporting and enabling practitioners to critically reflect on their practice.

Scholarly acknowledgements and thanks to Matthew Harcus and Kate Stewart of Queensland University of Technology who contributed to the library research that informed this article.

This research was funded by UnitingCare and funding for this submission was received as part of an industry grant via consultancy agreement. No grant/award number was issued.

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How to write a reflective practice case study, bob price independent health services training consultant, surrey, england.

As evidence and experience play an important role in underpinning primary healthcare, combining them in a reflective practice case study has significant potential for purposes of publication and revalidation of professional practice.

Reflective practice case studies have the potential to help other nurses in the community re-examine care challenges and the opportunities before them. Nurses writing about a clinical case experience can add to the relevant evidence, as can discussion of the insights and issues that emerge. While research and reflective practice are regularly written about more generally in the press, there remains scope for nurses to combine them in a more analytical and pertinent way.

This article guides the reader through the process of identifying suitable case studies to write about and structuring the work they produce. Clear distinctions are made between case study as research methodology and case study as reflective practice process.

Primary Health Care . 27, 9, 35-42. doi: 10.7748/phc.2017.e1328

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

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Prepare for revalidation: read this CPD article, answer the questionnaire and write a reflective account: rcni.com/reflective-account

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Received: 13 June 2017

Accepted: 22 August 2017

case study - evidence review - reflective practice - revalidation - writing for publication

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Introduction

Hunter shobe, geographer, alma trinidad, social worker, daneen bergland, poet and online instructor, remaining flexible to stay steady: internal challenges to critical reflection, creating an environment for critical reflection: external challenges, connecting and reimagining: how critical reflection is important to general education, works cited, case studies in critical reflection praxis in university studies: the stance and dance.

DANEEN BERGLAND is a writer and a senior instructor in University Studies at Portland State University, where she teaches general education courses for sophomores on the themes of popular culture and American identities, and an online, community-based learning course for juniors. Her interests include online teaching and learning, civic learning and engagement, and media literacy.

HUNTER SHROBE is a cultural and urban geographer and an Associate Professor in the Department of Geography at Portland State University. His research and teaching explores the cultural and political dimensions of how people connect to and create meaning in different places. He is coauthor of Portlandness: A Cultural Atlas .

ALMA M. OUANESISOUK TRINIDAD , PhD, MSW is an associate professor in the School of Social Work at Portland State University (PSU). As a first generation college graduate and professional, born and raised on the island of Molokai, Hawai'i with family roots of Filipino immigration through the sugar and pineapple industries, she describes her voyage of serving the people and community as becoming a Pinay (Filipina) scholar warrior and guardian of kapu aloha (sacred love)/mahalaya (love and freedom). She earned her PhD in social welfare from the University of Washington, Seattle, and her MSW from the University of Michigan, Ann Arbor.

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Daneen Bergland , Hunter Shobe , Alma M. Ouanesisouk Trinidad; Case Studies in Critical Reflection Praxis in University Studies: The Stance and Dance. The Journal of General Education 1 July 2018; 67 (3-4): 209–225. doi: https://doi.org/10.5325/jgeneeduc.67.3-4.0209

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This article articulates the experience of three professors from different disciplines, teaching at three levels of University Studies, Portland State University's general education program, for whom the toggling between personal/professional critical practices and use of reflective practices in the classroom has led to transformative learning experiences for them and their students. It describes the specific reflective tools and methods they used for teaching and professional development, and considers the challenges to sustaining critical reflection and how those challenges might be addressed. The authors argue that critical reflection (CR) is an important practice for teachers and students of general education. In particular, CR engages the habits of mind and capacities, such as critical thinking, central to the goals of general education, as well as engaging the practical skills needed to procure jobs and succeed as professionals. As a professional practice for teachers, it contributes to improved and purposeful teaching methods and rationales, and can build rapport, trust, and credibility with students. Because CR takes time and practice, it is important for students to be exposed to many different methods and have opportunities to practice CR methods from a variety of disciplines/backgrounds throughout their general education.

This article articulates the experience of three professors from different disciplines, teaching at three levels of University Studies, Portland State University's general education program, for whom the toggling between personal/professional critical reflective practices and use of reflective practices in the classroom has led to transformative learning experiences for them and their students. It describes the specific reflective tools and methods they used for teaching and professional development, and considers the challenges to sustaining critical reflection and how these challenges might be addressed.

Informed by the work of scholars in teaching and learning, and based on our own experiences, we argue that critical reflection (CR) is an important practice for teachers and students of general education. We found that in particular, CR engages the habits of mind and capacities such as critical thinking, creativity, intercultural knowledge, ethical reasoning, and lifelong learning, central to the goals of general education, as well as engaging the practical skills needed to procure jobs and succeed as professionals. Our experiences illustrated Brookfield's ( 1995 ) findings, detailed later in this article, that as a professional practice CR contributes to improved and purposeful teaching methods and rationales, and can help build rapport, trust, and credibility with students. Because CR takes time and practice, we believe it is important for students to be exposed to many different methods and have opportunities to practice CR methods from a variety of disciplines/backgrounds throughout their general education.

University Studies: Setting the Stage for Critical Reflection

University Studies differs from traditional general education programs in that students are required to take general education courses at all four levels of the undergraduate curriculum. Most of these courses, especially at the freshman and sophomore levels, are theme-based and interdisciplinary, and all share common learning goals of Communication; Inquiry and Critical Thinking; Diversity, Equity, and Social Justice; and Ethics and Social Responsibility. The curriculum is administered by a single program, made up of multidisciplinary faculty, some affiliated solely with the University Studies program, and others in “shared lines,” teaching University Studies courses on permanent or rotating bases from other departments. The Program, where interdisciplinarity is required, and teaching, collaboration, and reflective practices are valued, provides a fertile environment for experimenting with CR.

Defining Reflection, Critical Reflection (CR), and Critical Self-Reflection (CSR)

Reflection is a widely used and contested term in academic settings, though it is generally agreed that reflective practice involves “examining assumptions, […] being self-aware and critically evaluating [one's] own responses to practice situations” and is “part of the process of lifelong learning” (Finlay, 2008 , p. 52). Many of us practice reflection when we review our work and experience in order to revise and update our course materials or curriculum and what Schön ( 1983 ) called “reflection in action” (p. 49). Mezirow ( 1998 ) and others have parsed reflection further, noting that critical self-reflection of assumptions “emphasizes critical analysis of the psychological or cultural assumptions that are the specific reasons for one's conceptual and psychological limitations, the constitutive processes or conditions of formation of one's experience and beliefs” (para. 41). Critical self-reflection (CSR) turns attention both inward to the self, as well as outward to the context of the self, and requires analysis and critique of the values, perspectives, and assumptions harbored in and influenced by those contexts. Brookfield ( 1995 ), in his book Becoming a Critically Reflective Teacher , elaborates that self-reflection for teachers becomes critical when its purpose is “to understand how considerations of power undergird, frame, and distort educational processes and interactions” and “to question assumptions and practices that seem to make teaching easier, but actually work against our own best long-term interests” (p. 8). He posits the concept of critical reflection as a “stance and dance” in which our stance toward our teaching is one of inquiry and openness, and the dance is the “experimentation and risk” that we engage in as we apply new ideas and methods (p. 42). We've used this concept to frame our case studies and discussion.

This section considers lessons learned from teaching both geography courses and a Freshman Inquiry (FRINQ) course on globalization as a nontenure track faculty (NTTF). The experience influenced my thinking on how to improve my teaching and student learning in FRINQ, but also about how to improve in my home discipline courses. Here, I focus on one method of critical self-reflection—journals.

Keeping a Teaching Journal for Critical Self Reflection: A Stance

I taught in University Studies on assignment from the Geography Department from fall 2012 to spring 2016. In the past I had made notes, but not in an organized systematic way, that would allow me to trace the trajectory of my teaching over time. Realizing I was often asking my students to write in order to better reflect on what they learned, I decided to heed the same advice and keep a teaching journal to put my own reflections in writing. I found I enjoyed writing about teaching and academic things without having to use academic jargon and conventions. Reviewing my journals helped me develop my thinking related to teaching different classes and provided an informal account of student feedback to supplement more formal assessments.

Over time I've developed a set of questions that guide my thinking in revising courses each year: How best to help catalyze student engagement with the course content, concepts, and themes? What exercises and assignments best accommodate a range of students with different backgrounds, various preferred styles of learning, and different reasons for being in school? What are the best ways to promote students applying what they learn to their lives? I found these questions easier to address with my teaching journal as a resource—after all the journal is an account of what worked and what did not. The teaching journal was particularly helpful in guiding my reflections on how best to customize assignments for either general studies or geography courses. Perhaps the greatest benefit of the teaching journal was that it helped me see how I could be more flexible as a teacher.

Assigning Critical Reflection, an Evolution to Student Learning Journals: The Dance

Early on teaching FRINQ, I tried having students write down their main ideas and questions related to the topic before diving immediately into discussions. I hoped this would help students analyze what we discussed and read and react from a personal standpoint. Students seemed to benefit from a few minutes to independently process their thoughts before discussion. Years later, I made the writing assignments a formal part of the class in the form of a learning journal, thinking this would promote the importance of reflective writing. A portion of class time was dedicated to writing in journals. This generated a material record of a student's reflections on content, learning, and the university experience, and a self-authored book of thoughts and ideas from his or her first year of college. More than anything the intent of the journal was to engage the students in course themes on a daily basis (Mcguinness, 2009 ). The entries were part of a larger strategy to engage students and introduce them to concepts which they could consider in the context of their own lives. Several students began entries with variations of “I never realized this until now but …,” suggesting the journal provided a useful space for developing new thoughts about class ideas.

Geographers recognize the usefulness of journals in pedagogy (Anderson, 2012 ; Cook, 2000 ; Fouberg, 2000 ; Fuller et al., 2006 ; Haigh, 2001 ; Haigh, et al., 2015 ; Kenna, 2016 ; Mcguinness, 2009 ). Learning journals have many potential benefits starting with their informality—an invitation for students to focus more on their thoughts than on concerns with proper formatting or organization. Journals can play important roles in helping students recognize how they learn as they separate learning from content (Haigh, 2001 , p. 168), and are more likely to “appreciate the relevance of what they have learned” (Park, 2003 , p. 183). Journal writing can catalyze critical thought and prompt students to connect class material to their lives. Fouberg suggests that, “students relate ideas to themselves and use the space of a journal to figure things out” ( 2000 , p. 196). Learning journals allow students to situate themselves and their own position in society as students and researchers in the context of both theoretical and grounded inquiry (Glass, 2014 ), and devolve some ownership of the learning to the students (Fouberg, 2000 , p. 197).

The spirit of Lynda Barry's Syllabus (2014) informed my journal assignment in asking students to “pay attention, be quiet, and see what's there … not agree with, understand, like, JUST SEE” (p. 5), and to use the journaling to “notice what you notice” (p. 60). Barry highlights the value of having students write in class to engender a feeling of “solitary work” done together (p. 9).

Students handed in journals halfway through each term, which allowed me to gauge which questions had been most effective at catalyzing thoughtful responses. During the first term it became clear that writing responses to general questions was more difficult than responding to specific questions.

Students responded favorably to the assignment, identifying the development of critical thinking as the primary benefit. For example, one student commented in an evaluation that the journals were helpful in getting students to think beyond problems and address, “what we think solutions to problems are.” Another student suggested that the assignment could be improved by posing more entries.

After assigning the journals for an entire year in FRINQ, I assigned a learning journal to students in an upper-level geography course, Sense of Place. The journal had similar but different roles in the two classes. In FRINQ, students were often thinking and writing about issues for the first time, and the journal was for many the first opportunity to consciously work out their initial thoughts on the topic. For the Sense of Place class the prompts more often provided students, who were further along in their studies, the opportunity to sort out concepts and analyze previously encountered ideas more deeply.

Maintaining a teaching journal, having the discipline to keep it going, but also gaining insight from putting thoughts on paper, provided me a helpful reminder of some of the potential benefits and challenges my students faced when keeping their journals. It allowed me to reflect specifically on which assignments, lectures, and points of entry worked well in FRINQ, a year-long general education course, and which worked well in geography classes. Critically reflecting on my teaching in general education provided insight on how students will use important concepts from my own discipline in a context other than academic geography. I was better able to reflect on how to find points of entry for topics and concepts that are relevant and resonate with students from across academic disciplines.

This section provides a critical reflection and key lessons learned from teaching a Sophomore Inquiry course (SINQ) on Design Thinking for Social Change as a tenure track professor in a shared line with the School of Social Work and University Studies.

The SINQ Design Thinking theme was first launched by University Studies in fall 2014 and partnered the School of Social Work, Child and Family Studies, and the Business School. Its inaugural team of faculty included professors from business, architecture, computer science, and child and family studies. I was the only woman professor of color (WPOC) from social sciences on this team. We initially agreed that my particular section of the SINQ would be a pilot with intentional readings and assignments with explicit processes of integrating equity and examining power and privilege as a designer. Having worked in community development, social entrepreneurship, and youth mentorship with community-based, culturally responsive programs as a social worker and scholar, I used Critical Indigenous Pedagogy of Place (CIPP), which brings clarity to one's work, roles, and responsibilities as a student and general citizen of society, as the foundation of my teaching, and presumed the stance of a Pinay scholar warrior of kapu aloha and mahalaya.

Teaching as a Pinay Scholar Warrior of Kapu Aloha and Mahalaya Using Critical Indigenous Pedagogy of Place: A Stance

A Pinay warrior is rooted and grounded in Filipino and other Pacific, Indigenous island cultures. A woman warrior is one who fights for ideals and principles important to the community. Historically, Pinay warriors, such as Gabriela Silang, fought alongside Filipino men against the Spanish colonial regime. Their anti-colonial stance perpetuated an identity and position that I embody. It speaks to a social justice framework that embraces Filipino Ilocano indigenous values of barangay or barrio (small, town community), kaili (township), and pamilia (family). It honors womanhood, sisterhood, and feminism in the context of community. Kapu aloha (sacred love) stems from my roots growing up on the rural island of Molokai in Hawai‘i. To aloha is to commit to deeply love and fondly care for one's community or place that has been injured, oppressed, and is in need of healing. Mahalaya (mahal=love, malaya=freedom) derives from the Filipino Tagalog values of self- and collective determination, and being freed from imperialism, capitalism, and feudalism. These values are embodied in a Pinay scholar warrior of kapu aloha and mahalaya stance. For me, it means passionately and steadfastly holding on to the beauty, grace, and fierceness in my work as a scholar —teaching, mentoring, serving, and conducting research for collective empowerment and social change.

Because the academy historically and contemporarily is not designed for my people, I face ongoing challenges and isolation as a WPOC. Especially during my path towards tenure, the voyage has been brutal and continues to present deep contradictions. My stance brings clarity to the purpose of my work, and intention to building relationships with and among people. I stand on the shoulders of my ancestors and the wisdom of my community-based partners engaged in this course. The collective impact is crystallized time and time again by the people, places, and processes rooted in CIPP. It is this reiterative collectivity and desire for community impact that grounds me. This critical reflection serves as a way to highlight such collaboration.

CIPP serves as my foundation of facilitating critical reflexivity among the students and myself, and builds upon the literature on critical pedagogy, the concept of place, and indigenous and ethnic studies. It is a facilitative learning tool to recognize and confront inequities and disparities in a specific geographic community (Trinidad, 2011 ), and embraces indigenous identities and ways of knowing that are rooted in place (Johnston-GoodStar et al., 2010 ). As an educator, I utilize CIPP as a tool to facilitate social change by acknowledging unique histories of oppression and resistance, genealogies, and cultural values perpetuated and expressed in a specific geographic place.

Centering Place and Integrating CIPP with Design Thinking: The Dance

The three major CIPP processes, rooted in geographic place, are: 1) analysis of power and oppressive forces; 2) indigenization; and 3) sociopolitical development through student-community engagement (Trinidad, 2014 ; 2018 ). These processes were deeply integrated in the SINQ course where students, individually and in groups, used critical self-reflection and reflexivity to consider their social positionalities and the power dynamics in a given time, place, and space, while applying the steps of Design Thinking. Because I scaffolded learning experiences that built upon each other, it was my hope that this reiterative process would eventually become second nature.

In the last decade, Design Thinking has become a popular topic, although sometimes controversial and often misunderstood. While there is still no widely accepted definition, most agree about the basic principles: iterative processes of divergent and convergent thinking and testing, discoveries through empathetic contextual explorations, and synthesis through intuition, creativity, and collaboration (Kelley & Kelley, 2013 ). These principles apply well to business, social work, education, and the creation of new things and ideas based on human needs.

Because of my background in macro social work practice, as the faculty for SINQ I intentionally integrated CIPP to bridge the foundations of Design Thinking and its direct application to real world problems and human lived experiences rooted in Portland. Inherent to CIPP is critical reflexivity, where the practitioner (in this case, the faculty) keeps ongoing analysis of one's social locations and positionalities in the facilitation of a process, including teaching, as well as a generative and parallel process among members of a learning community. My specific section of the course focused on social issues related to gentrification, poverty, social sustainability, social justice, and equity. The course aimed to excite and agitate students about the power of Design Thinking through hands-on experiences and equip them with basic skills needed to apply it to their work. Critical reflexivity was facilitated as students grappled with building skills that intersect with diversity, ethics/social responsibility, critical thinking, and communication. Students identified problems they cared about, crafted their design challenge, engaged in field research, synthesized their findings, brainstormed solutions, and presented their concepts, while expanding their personal and professional networks.

Critical reflections, written and oral, done individually and/or collectively, were scaffolded throughout the term. The main assignments included a mix of critical self-reflections of the readings; an interview with a designer, innovator, or entrepreneur; a community-based learning design team project; and a “my designer, innovator, and/or entrepreneur's philosophy for social change and equity” paper. This included critical reflections on how epistemology or knowledge production related to poverty is framed based on their stances. Additionally, during each session, through means of a “postcard,” students were invited to share insights and thoughts on content or process of the session. This allowed a dialog and a feedback loop between students and faculty. In the final week of the course, each student evaluated how the term and how the learning experiences impacted their overall journey.

For my part, I kept weekly notes of how each student was generally progressing in regards to critical awareness. Simultaneously, I noted dynamics in the context of the learning community, including my own internal reactions and insights. Through time, I engaged with student(s) in person or virtually (email or online domain) through dialog and courageous conversations, especially when, as a learning community, we collectively were struggling with the topic area of the week. Critical reflexivity as teaching practice kept me a couple steps forward in creating space to continuously humanize the journey.

This critical reflexivity helped to humanize each step of Design Thinking. The factors of CIPP that strengthened my facilitation to humanize the process among student learning were that: 1) knowledge building and production (epistemology) needed to be deconstructed and indigenized in community (i.e., knowledge is validated with, by, and for the people); 2) knowledge production needed the nested support from informal and formal mentors and community partners in the field; it is not an exercise done alone; 3) knowledge production is sociopolitical; and 4) knowledge production involves emotions. Such engagement with critical reflexivity impacted students' critical awareness of the power and privilege of their social positionalities and how oppressive forces may play out in the process of design thinking. Being aware of such encouraged students to develop approaches that may alleviate those forces and create change.

This section considers the lessons learned from engaging in Critical Self-Reflection (CSR) as part of a professional development retreat series sponsored by University Studies based on the work of Parker Palmer. The reflections during these workshops, focused on the intersections of self and purpose, led to valuable insights about myself as an instructor, but also the value of CSR for learners at all stages of their careers, from general education student to professional.

Teaching (and Learning) from the “Hidden Wholeness”: A Stance

Though I had practiced CSR at different times in my education and career, my experience as part of an ongoing series of faculty development workshops reintroduced and deepened my understanding of it as an important part of my professional and teaching practices.

My CSR allowed me to reexamine the internalized narratives about what it meant to be a teacher and scholar. It helped me further develop the bridge between my students and myself as learners, to “practice” the kind of thinking and reflection I want my students to do, and to do it alongside them, to some extent disrupting power dynamics and humanizing the online classroom. It reinforced my value of teaching, and helped me seek out and collaborate with others interested and engaged in the same kind of reflective work.

I arrived late to academia, returning to pursue an M.A. in poetry writing after a career in social services. Upon graduating, I was hired as a nontenure track (NTTF) faculty member when University Studies was rapidly ramping up online offerings and needed faculty already skilled in online course development and teaching. As a creative writer, not a researcher or scholar, I felt both intimidated and frustrated by academia's emphasis on disciplinary knowledge over teaching ability and expertise. I'd been trained to teach writing; I knew how to create well-organized, engaging online classes, but I wasn't teaching poetry writing, my discipline, in my general education courses. I compartmentalized my identity as a writer, along with my previous career experience, seeing them as separate chapters of my life, and mostly irrelevant to the way I taught. This lack of identity as a scholar was furthered by my fixed-term contracts that stipulated teaching 36 credits a year, with no expectations of research or publication. However, the values of the academy, codified in promotion guidelines, made clear that academic publication and research made someone a “real” professor. This led me to undervalue my experiences and limit my pursuits of development and research opportunities, because I felt I was “just here to teach.”

Switching Positions Between Teacher and Learner: The Dance

In recent years University Studies has offered multiple series of year-long professional development workshops for faculty centered on the work of Parker Palmer and his book The Courage to Teach ( 2007 ). In these quarterly, full-day reflective workshops made up of faculty and administrators associated with University Studies at all levels, participants were guided in reflective writing and exercises, through contemplative, creative, and critically reflective practices.

One of the key concepts central to the workshop was that of teaching from the authentic and integrated self, as teachers who are then able “to weave a complex web of connections among themselves, their subjects, and their students so that students can learn to weave a world for themselves” (Palmer, 2007 , p. 11). Questions that tapped more deeply into teaching, beyond content, assignments, and assessment strategies, were fundamental to self, and asked participants to consider their intellectual, emotional, and spiritual identities and purpose, not just as an instructor or administrator, but as a whole person. Questions such as “When do you feel most alive?” and “What are your gifts and limits?” allowed participants to consider themselves as a whole person, not only a teacher. Exercises that asked participants to tell stories or explore metaphors related to these bigger questions of identity and purpose helped us to explore and connect the experiences and ideas that led to and influenced our teaching and goals, and particularly resonated with my poet-self.

One of the courses I teach is a junior-level, community-based, fully online, general education course. Designed by a team as part of an innovation grant, its intent was to offer more experiential and community-based learning opportunities for University Studies students and to provide an online pathway at the junior level of the program. This has been a challenging course to teach because it is so different from traditional courses, and, like most general education classes, students' experience levels and goals are broad and diverse. During one session of the Art of Teaching workshop, I wrote the following in response to the prompt “Describe a time when you felt most alive in your work/place.”

I'm teaching a course that is new and outside my area of expertise. Because of it not being content-focused (but, rather a service-learning course) and because it is so new, I've been putting most of my “teaching” efforts into modelling and facilitating. My expertise in this class comes from my own experience in service. As a result, I've felt compelled to participate almost like another student, sharing my own stories and feelings, being very open and personal in a way I've never felt comfortable with before. Part of this is because these students are upperclassmen and some of them are my peers in terms of age and life experience. The power dynamics feel different. As I've tried to figure out what to say to them—needing to be helpful, wise, fulfill learning goals, I've found a new vulnerability. Reading their reflections is bringing up stuff I've forgotten or not revisited from twenty years ago. I'm remembering especially mistakes I made. Big ones that sort of haunt me. This, too, contributes to my sense of feeling open, flawed, fallible. In some ways the tenderness seems fertile, like if I am careful with it and don't let myself shut down around it, it could lead to an opening up—it's a place where reflection can happen. I think we're less able or likely to reflect when we're feeling really confident and comfortable. There's no need.

Because this was a series of workshops that occurred over a period of time, I developed my practice beyond the one-day workshops, and I was able to return to some of the murkier, more complicated conflicts and struggles I was having inside and outside my teaching.

The CSR work I've assigned to my students has been a reminder that they are not blank slates either. Their personal histories and future goals are important to provide both context and content of their learning, and that of the learning community. Additionally, sharing my own reflection and risk-taking, being open about different facets of my life, and drawing connections between these, my students, and the topics of the course, while encouraging students to do the same, helped me to humanize the sometimes sterile online learning environment to one that feels more intimate, peopled with specific and complex individuals.

As many authors have noted, and we discovered in our experiences, there are a variety of reasons students may not have the transformative epiphanies we hope to see (Brookfield, 1995 ; Finlay, 2008 ; Fouberg, 2000 ; Park, 2003 ). CR is open-ended and risky for both students and teachers. It's hard to “teach” or explain. It is non-linear. It requires a particularly open mindset that takes time to develop. There are no right answers, and sometimes the “product” doesn't yield much new knowledge. Students may resent it as busy-work, use it to justify or support preconceptions, may be unsettled by findings, or feel disempowered by new revelations. We recognized from our experience that CR can be emotionally taxing and takes patience, flexibility, and careful scaffolding. Because of this, it is important for general education teachers to hold space for it in our curricula, to practice it alongside students and in collaboration with colleagues.

Shobe realized, in his prompts for reflective journal writing, that he had to negotiate a balance between tasks that are, “too trivial or easy” and those that “challenge students with difficult tasks too soon [that] can encourage feelings of helplessness and a desire to avoid the assignment” (Fouberg, 2000 , pp. 198–199): “I found that paying close attention to the specific needs and abilities of students is key to the successful use of learning journals.”

I've struggled to help students who seem unwilling to do more than the bare minimum, or are unable to move past vague, general, or surface level reflection, repeating themselves or landing on clichés and bromides instead of new insights. I have found it important to remember that students, especially in general education courses, represent diverse backgrounds, learning styles, expectations, and levels of experience. As a general educator of undergraduates, sometimes I am harvesting, sometimes I am pruning, sometimes I am fertilizing, and sometimes I am just getting the ground ready for seed.

For some, it was their first time being introduced to such concepts, especially facilitated by a WPOC. I found students of color and from the social sciences and humanities embracing the process—feeling refreshed to reclaim cultural or social identities and positionalities that have been repressed in their lives, and transformed by the critical awareness harnessed through critical reflection. On the other hand, students from the dominant social groups found such processes annoying, distracting, and irrelevant. Particularly, students who majored in the hard sciences, business, and engineering found this process challenging, indicating that in their work, “we need not worry about human experiences.” What helped me reconcile and face this contradiction was a realization that critical awareness was going to take time among such students. It was a systemic condition of schooling—students up to this point in their education had limited opportunities to examine one's power and privilege.

Humanizing the Design Thinking framework presented challenges for me as I engaged with this particular subgroup of students. The blind spots in understanding the human conditions related to poverty needed to be unpacked. In general, as an instructor, I constantly reminded myself that knowledge building and production is transformative and may need time, more so with some. It required me to internalize the fact that it was my responsibility to make space for and validate diverse reactions and behaviors along the way.

Neoliberalism and corporatization of education, as well as the focus on testing and measurable outcomes, have created an environment stifling to creativity and risk-taking, in general. In addition, teaching and learning have taken a backseat in the competitive and pressurized setting of academia focused on publication and prestige within siloed fields rather than on growth and development as teachers. In this environment CR, collaboration, interdisciplinarity, and general education are undervalued. Elevating the scholarship of teaching and learning at an institutional level and seeing general education more holistically would create an environment more conducive to CR. Additionally, faculty development is often focused on techniques, methods, and fixing, whereas CR privileges process, is reiterative, and occurs over time. To foster CR, departments and programs should offer CR-based development opportunities and trainings like those mentioned in this article.

We encourage faculty to learn more by reading any of the excellent books and articles that have been written on CR, to seek out more opportunities to support and practice CR in workshops and trainings, and to engage in CR informally on their own and/or in collaborations with other like-minded faculty or professionals, including those outside one's field or department. As Trinidad notes, collaborating with community partners was important to applying the concepts of CIPP, supporting her in her own CR process, as well sustaining the CR practices in her course. Bergland has further integrated CR into her professional life, meeting quarterly with a professor from another department, to practice CSR about their teaching and goals in dialog with one another and serving on one another's “personal board of directors.” Indeed, the writing of this article provided an opportunity for the three of us to share and critically reflect together as a diverse and interdisciplinary group, a rich learning experience for us as teachers and professionals.

Our job as general educators is to draw connections between concepts and methods across disciplines. Included in the building of this web of knowledge are the perspectives, learning experiences, and goals of the student. Both Palmer ( 2007 ) and Brookfield ( 1995 ) acknowledge the role of teaching as a connective activity “creating connections between educational processes, students' experiences of learning, and what they feel are important concerns in their lives […]” (Brookfield, p. 43). Critical Reflection is a process to reveal these connections.

Fundamental to the goals and purpose of higher education is the ability to break out of one's own “frame of reference” to think for one's self, to examine one's life, thoughts, knowledge, and actions in their political and social contexts; abilities that are, as Mezirow ( 1998 ) points out, “essential in the world of work, in functioning as a citizen in a democracy, and in making responsible moral decisions in fast-changing societies” (para. 35). He further notes that CR involves imagination and “the capacity to seek out alternatives and look at things as they could be otherwise […]” (para. 3). In other words CR combines critical thinking and creativity, two values echoed in the habits of mind and capacities outlined in the VALUE Rubrics of the Association of American Colleges & Universities, and in the University Studies program learning goals. Additionally, as we are preparing students for procuring and succeeding in the workforce, the metacognitive moves of CR that connect experience to knowledge are very practical. It employs the ability to illustrate their skills and distill insights from recalled experiences. In essence, students are flexing the same muscles they are asked to use when writing cover letters, completing work portfolios, preparing for performance reviews, and when being interviewed.

Brookfield ( 1995 ) reminds us that it is important for teachers to engage in CR alongside our students, where we can work from “a position of informed commitment” (p. 23), allowing us to make more clear for ourselves and our students what we are teaching and why, building trust, and establishing credibility. Because teaching and learning are ongoing processes, our methods and rationales must evolve in response to changing contexts. As educators, we must begin with and return to the questions: Who are the people in this class and what do they need from it? It can be easy to slide into and remain in our comfort zones as experts in our fields, teaching the way we were taught and the content we are most familiar with. But we are not just geographers, poets, or social workers; we have much more to bring to the table.

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Critical Reflection

A Critical Reflection (also called a reflective essay) is a process of identifying, questioning, and assessing our deeply-held assumptions – about our knowledge, the way we perceive events and issues, our beliefs, feelings, and actions. When you reflect critically, you use course material (lectures, readings, discussions, etc.) to examine our biases, compare theories with current actions, search for causes and triggers, and identify problems at their core.   Critical reflection is   not   a reading assignment, a summary of an activity, or an emotional outlet.   Rather,   the goal is   to change your thinking about a subject, and thus change your behaviour.

Tip: Critical reflections are common in coursework across all disciplines, but they can take very different forms. Your instructor may ask you to develop a formal essay, produce weekly blog entries, or provide short paragraph answers to a set of questions. Read the assignment guidelines before you begin.

How to Critically Reflect

Writing a critical reflection happens in two phases.

• Analyze:   In the first phase, analyze the issue and your role by asking critical questions. Use free writing as a way to develop good ideas. Don’t worry about organized paragraphs or good grammar at this stage.
• Articulate:   In the second phase, use your analysis to develop a clear argument about what you learned. Organize your ideas so they are clear for your reader.

First phase: Analyze

A popular method for analyzing is the three stage model: What? So What? Now what?

In the  What?  stage, describe the issue, including your role, observations, and reactions. The   what?   stage helps you make initial observations about what you feel and think. At this point, there’s no need to look at your course notes or readings.

Use the questions below to guide your writing during this stage.

• What happened?
• What did you do?
• What did you expect?
• What was different?
• What was your reaction?
• What did you learn?

In the second  So What?   stage, try to understand on a deeper level why the issue is significant or relevant. Use information from your first stage, your course materials (readings, lectures, discussions) -- as well as previous experience and knowledge to help you think through the issue from a variety of perspectives.

Tip:  Since you’ll be using more course resources in this step, review your readings and course notes before you begin writing.

Below are three perspectives you can consider:

• Academic perspective: How did the experience enhance your understanding of a concept/theory/skill? Did the experience confirm your understanding or challenge it? Did you identify strengths or gaps in your knowledge?
• Personal perspective:   Why does the experience matter? What are the consequences? Were your previous expectations/assumptions confirmed or refuted? What surprised you and why?
• Systems perspective:   What were the sources of power and who benefited/who was harmed? What changes would you suggest? How does this experience help you understand the organization or system?

In the third   Now what?   stage, explore how the experience will shape your future thinking and behaviour.

Use the following questions to guide your thinking and writing:

• What are you going to do as a result of your experiences?
• What will you do differently?
• How will you apply what you learned?

Second phase: Articulate

After completing the analysis stage, you probably have a lot of writing, but it is not yet organized into a coherent story. You need to build an organized and clear argument about what you learned and how you changed. To do so,   develop a thesis statement , make an   outline ,   write , and   revise.

Develop a thesis statement

Develop a clear argument to help your reader understand what you learned. This argument should pull together different themes from your analysis into a main idea. You can see an example of a thesis statement in the sample reflection essay at the end of this resource.

Tip: For more help on developing thesis statements, see our   Thesis statements  resource

Make an outline

Once you have a clear thesis statement for your essay, build an outline. Below is a straightforward method to organize your essay.

• Background/Context of reflection
• Thesis statement
• Introduce theme A
• Writer's past position/thinking
• Moment of learning/change
• Writer's current/new position
• Introduce theme B
• Introduce theme C
• Summarize learning
• Discuss significance of learning for self and others
• Discuss future actions/behaviour

Write and revise

Time to get writing! Work from your outline and give yourself enough time for a first draft and revisions.

Even though you are writing about your personal experience and learning, your audience may still be an academic one. Consult the assignment guidelines or ask your instructor to find out whether your writing should be formal or informal.

Sample Critical Reflection

Below are sample annotated paragraphs from one student’s critical reflection for a course on society and privilege.

Introduction

Background/context of reflection : I became aware of privileged positions in society only in recent years. I was lucky enough, privileged enough, to be ignorant of such phenomena, but for some, privilege is a daily lesson of how they do not fit into mainstream culture. In the past, I defined oppression as only that which is obvious and intentional. I never realized the part I played. However, during a class field study to investigate privileged positions in everyday environments, I learned otherwise.   Thesis:   Without meaning to, I caused harm by participating in a system where I gained from others’ subtle oppression. In one of these spaces, the local mall, everything from advertisements to food to products, to the locations of doorways, bathrooms and other public necessities, made clear my privilege as a white, heterosexual male.

Body paragraph

Topic sentence : Peggy McIntosh describes privilege as an invisible knapsack of tools and advantages. This description crystalized for me when I shopped for a greeting card at the stationary store. There, as a white, heterosexual male, I felt comfortable and empowered to roam about the store as I pleased. I freely asked the clerk about a mother’s day card.   Writer’s past position:   Previously, I never considered that a store did anything but sell products. However, when I asked the sales clerk for same sex greeting cards, she paused for a few seconds and gave me a look that made me feel instantly uncomfortable. Some customers stopped to look at me. I felt a heat move over my face. I felt, for a moment, wrong for being in that store.  I quickly clarified that I was only doing a report for school, implying that I was not in fact homosexual.   Writer’s current position:   The clerk’s demeanor changed. I was free to check, she said.  It was the only time during the field study that I had felt the need to explain what I was doing to anyone. I could get out of the situation with a simple clarification. But what if I really was a member of the homosexual community? The looks and the silence taught me that I should be feared.  I realized that, along with its products, the store was selling an image of normal. But my “normality” was another person’s “abnormality.”  After I walked out of the store I felt guilty for having denied being homosexual.

Summary of learning:   At the mall I realized how much we indirectly shame nonprivileged groups, even in seemingly welcoming spaces. That shame is supported every time I or any other privileged individual fails to question our advantage. And it leads to a different kind of shame carried by privileged individuals, too.   Value for self and others:   All of this, as Brown (2003) documents, is exacerbated by silence. Thus, the next step for me is to not only question privilege internally, but to publicly question covert bias and oppression. If I do, I may very well be shamed for speaking out. But my actions might just encourage other people to speak up as well.

Sample paragraphs adapted from James C. Olsen's Teaching Portfolio from Georgetown University .

The unexpected benefits of reflection: a case study in university-business collaboration

Journal of Work-Applied Management

ISSN : 2205-2062

Article publication date: 12 July 2018

Issue publication date: 17 July 2018

The purpose of this paper is to present an overview of the development process and outcomes from a six-year collaboration between Halifax Bank (part of the Lloyds Banking Group) and Middlesex University between 2010 and 2016 in the UK. The collaboration involved the construction of work-integrated higher education programmes that were, from the outset, predicated on clear return on investment criteria for the Bank. One unexpected outcome from the collaboration was the emergence of critical reflection as a valued business benefit that, it is argued, has the potential for significant cultural change within the organisation.

Design/methodology/approach

This case study discuses how “productive reflection” can lead to an integrated approach to organisational learning. The study is located in the context of Halifax’s specific organisational objectives established following the banking crash of 2008. Quantitative and qualitative evidence is considered to illustrate the extent to which the “return on investment” criteria established by Halifax have been achieved.

The case study indicates that the challenging business context of the financial crash of 2008 provided the impetus for a sustained collaborative development that allowed the potential pitfalls of restricted learning opportunities to be addressed resulting in an integrated approach to organisational learning. In addition to the organisation’s return on investment criteria being met, there is evidence that the work-integrated approach has raised the prospect of productive reflection becoming part of an emerging learning culture.

Originality/value

The scale and sustained period of the university-business collaboration is unique and provides valuable insight into how an organisation’s learning culture can be affected by a work-integrated approach. In demonstrating the perceived business value of productive reflection, the case presented illustrates how learning can start to become considered as a normal aspect of working life.

• Work-integrated learning
• Workforce development
• In-company training
• Productive reflection
• University-business collaboration

Bravenboer, D. (2018), "The unexpected benefits of reflection: a case study in university-business collaboration", Journal of Work-Applied Management , Vol. 10 No. 1, pp. 50-62. https://doi.org/10.1108/JWAM-01-2017-0002

Emerald Publishing Limited

Copyright © 2018, Darryll Bravenboer

Published in the Journal of Work-Applied Management . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

Introduction

Building on the work of White (2012) and Eastman (2014) this case study presents a longitudinal overview of the development process and outcomes from a six-year collaboration between Halifax Bank (part of the Lloyds Banking Group) and Middlesex University that took place between 2010 and 2016 in the UK. In particular, this case study argues that the demonstration of the business benefits of reflective practice can help to sustain effective university-business collaboration and support transformative change. Whilst a case study approach is limited to specific context discussed, it is hoped that it provides a useful illustration of the potential benefits of university-business collaboration that may be more broadly applicable. The collaboration involved the construction of work-integrated higher education programmes that were, from the outset, predicated on clear return on investment criteria for the Bank. One unexpected outcome from the collaboration was the emergence of critical reflection as a valued business benefit that, it is argued, has the potential for significant cultural change within the organisation and perhaps more broadly.

Emphasises the social collective aspects of reflection – people reflecting together in the workplace […] Reflection is seen as an integral component of work, a necessary element in evaluation, sense-making, learning and decision-making processes in the workplace. It is through a focus on reflection, we suggest, that the needs of production can be reconciled with the needs of employees to have satisfying engagement with their work. ( Boud et al ., 2006 , p. 6)

Cressey (2006) also discusses the evolution of “embedded collective reflection” corresponding with a shift away from problem solving within an organisational setting, governed by standardisation and control, towards greater emphasis on innovation and creativity through “reflective participation” in the workplace. Ghaye et al. (2008) further extend the notion of collective participatory reflection to add “appreciative action” as a means of reframing the positive aspects of the present towards future organisational enhancement. Arguably, this approach may be most pertinent and yet also most challenging in the context of perceived organisational crisis, as discussed below.

Elmholdt and Brinkmann (2006) , however, point to the “disciplining” role of self-reflection as a mechanism for internalised self-regulated surveillance operating within discursive practices at work. Lester and Costley (2010) also discuss the self-disciplining nature of a company focussed learning agenda that restricts the potential for critical reflection. Siebert and Costley (2013) discuss how an uncritical approach to organisational norms and values can lead to “game playing” by employees and managers, which inhibits learning. In an earlier case study concerning Halifax Bank, White (2012) describes how organisationally constrained learning can limit opportunities for critical reflection and innovation. Gustavs and Clegg (2005) also discuss how restricting learning to operating within existing organisational goals can impede creativity and critique.

However, Eastman (2014) documents, with specific reference to work with Halifax Bank, how a sustained university collaboration has led to the development of the individual employee reflective capacities and argues that it has contributed to the establishment of the organisation as a “learning society”. Bravenboer (2011) points to the organisational and individual benefits of a more aligned collaborative approach that requires a shift in traditional higher education culture to recognise the expertise, knowledge and skills that exist in the workplace. Indeed such collaboration is often built around existing staff development activity ( Edmonds and Bainbridge, 2011 ; Minton and Fenwick, 2011 ). The development of an in depth understanding of organisational settings can also help to integrate learning with existing working practices whilst extending it beyond specific business contexts ( Drake et al. , 2009 ).

Mainstream management education is still far from producing the adequate profiles of leaders equipped with the human qualities and the adequate leadership competencies required to build the learning oriented organisations. ( Belet, 2007 , p. 472)

In considering the role of reflection in competence frameworks, Nansubuga et al . (2015) examine the gaps that limit employee’s ability to productively navigate the dynamic and complex contemporary context of working in organisations. They conclude that there is a strong alignment between the development of critical reflective capacities and enhanced context-dependent “operant competence”. Similarly, Bravenboer and Lester (2016) argue that it is possible to conceive of an integrated approach to academic learning and professional competence that is “concerned with critical thinking, reflection, evaluation and making judgements aligned with a consideration of professional values” ( Bravenboer and Lester, 2016 , p. 149).

The context surrounding the case study below, whilst challenging for the company, provided the impetus for a sustained collaborative development that allowed the potential pitfalls of restricted learning opportunities to be addressed resulting in an integrated approach to organisational learning.

Merger, crash and crisis—an unexpected context for learning

The global banking crisis that came to its head in 2008 shook the world and brought national economies to the brink of collapse. In the UK this resulted in the government investing public money to underwrite a number of banks and become major shareholders in what had been private businesses. One of the banks the UK Government became a major stakeholder in was Lloyds Banking Group, which was created following a specific sequence of mergers and other events in the run up to the financial market crash (see Monaghan, 2013 ). Between 2001 and 2006 Halifax and Bank of Scotland merged to form Halifax Bank of Scotland (HBOS), the full transfer of assets was completed by 2006. In 2007 Lloyds TSB wrote off £200m as a result of the US sub-prime mortgage crisis and then in 2008 their first-half profits plunged by 70 per cent. This happened at the same time that Lehman Brothers collapsed in the USA, which had a major effect on the projected price of wholesale financing. The recently formed HBOS bank was particularly exposed to the falling mortgage market as a consequence of its over reliance on wholesale finance. On the 16 September 2008 the HBOS share price halved in the first hour of trading as markets were gripped by the crisis. Lloyds TSB, who had themselves also been significantly weakened by the crisis, stepped in to “rescue” HBOS leading to the formation of Lloyds Banking Group. The UK Government then announced that it had taken a 43.4 per cent stake in Lloyds Banking Group by investing £20bn of public funds. Then in 2009, Lloyds Banking Group revealed £11bn of losses at HBOS, which shocked the UK finance market and the Group’s major shareholders leading to Lloyds chairman Sir Victor Blank stepping down.

Halifax Bank, part of the newly formed Lloyds Banking Group, faced a crisis of public confidence in banking, the prospect of radical changes in how banks were to be allowed to operate, major organisational change as group level procedures were applied to established Halifax practices, as well as major management restructuring and staff redundancies. In such a context, many organisations may have sought to retreat into what might be considered essential areas of business operation as a damage limitation response to crisis. Investing in workforce development may be considered by some to be high on the list of “non-essential” aspects of the business. However, the Halifax senior management took the strategic view that workforce development was in fact essential if the bank was to regain the trust of its customers and respond effectively to the context of major organisational change.

A workforce development strategy to rebuild customer trust

In the context of the public debate about how UK banking should be organised, the Halifax focus on personal financial services and products as a retail or “community” bank resulted in a simple but clear strategic aim:

We are absolutely committed to helping restore customer confidence in banking. As the UK’s largest bank, Halifax has a key role to play in that journey. Part of that process is getting the basics absolutely right by delivering a consistently high standard of customer service at each and every customer interaction. ( Kemp, 2011b )

A key aspect of the Halifax strategy to be able to deliver this “consistently high standard of customer service” was to invest in building the skills and behaviours of its managers to bring about tangible business and customer benefits. As a commercial organisation it was also clear from the outset that Halifax would only invest in the workforce development required to build the skills and behaviours of its managers on the basis of a demonstrable return on this investment. Whilst this is not necessarily in conflict with aims to support the personal and professional development and job satisfaction of Halifax staff, the evidence of investment bringing about business benefits was paramount.

The measures identified by the Halifax included a requirement to reduce staff turnover and recruitment costs. Another key measure was the achievement of better customer service satisfaction rates as indicated by Halifax’s “net promoter score” survey. Halifax also sought to measure increased sales and “converted referrals”, i.e. an increase in the rate of converting “potential” to “actual” bank customers purchasing service products. Lastly, given the context of major organisational change, Halifax sought to measure the extent to which workforce development investment would promote more effective management of changes in established business practices. With these return on investment measure in mind, Halifax agreed to invest in the development of around 1,000 of its Branch Managers and Local Area Managers ( Bravenboer, 2011 ) subject to evidence of its return on investment measures being met on an on-going basis.

In addition to these quantifiable measures, Halifax also saw value in professionalising its retail banking management workforce as an investment in human capital that would add value to its brand. However, Halifax wished to move away from traditional professional training approaches towards working with a university to develop bespoke provision that could help to regain the trust of its customers.

The promotion of university-business collaboration

Given the diversity of employers and their needs, HEIs should approach working with employers as a collaborative venture and engage in a dialogue to better understand the nature of their business and the challenges they face. This will, as part of a more integrated and holistic approach to business/employer engagement, help to identify the “right” solution to meet the identified needs. It will require a shift away from the “product push” approach that HEIs have tested in the past by bringing together the HEI’s wider employer offer. ( Kewin et al ., 2011 , pp. 11-12)

Universities are an integral part of the supply chain to business—a supply chain that has the capability to support business growth and therefore economic prosperity. However, a sustainable supply chain is not a simple linear supplier–purchaser model; strength and resilience in such a supply chain is derived from close collaboration and an understanding of each party’s priorities and capabilities. ( Wilson, 2012 , p. 1)

However, the idea that universities should be a “supply chain” for business growth can also be seen as contested with potential implications for universities that represent a commodification of higher education. For example, the idea that universities should be a “supply chain” for business growth could be seen to: undermine the core purposes of universities including its “civilising” role; prioritise profit rather over public good; prioritise the needs of employers rather than individuals; subsume learner autonomy within corporate objectives; prioritise workforce development rather than individual flourishing; constitute a lowering of academic standards and an example of “dumbing down”; constitute “training” rather than “education”; be more concerned with skills and competence than knowledge; or promote a necessarily narrow and instrumentalist conception of the purpose of higher education.

However, such oppositional descriptions can be argued to reflect a foundational perspective that ignores the culturally contingent history of universities and the constructed nature of higher education discourse. It can certainly be argued that universities have many roles but also that these change to reflect a dynamic relationship with diverse cultural, social and economic (amongst other) factors ( Bravenboer, 2009 ; Bravenboer and Workman, 2016b ). As this case study seeks to illustrate, higher education provision that is specifically designed to respond to the needs of employers need not be described in terms of a failed realisation of a foundational perspective or “core purpose”. Indeed it may be the case that university-business collaboration can shed light on some of the ways that universities can operate and open opportunities for higher-level learning that would otherwise remain closed.

Halifax searched the market for a “provider” and Middlesex University were identified as having both the expertise, and organisational commitment to be potential partners […]. A significant factor of Middlesex University is that it recognises that expertise exists in organisational workplaces and that Universities are not the sole owners of knowledge, expertise and skills […]. We did look at other organisations and universities, but the defining factor for us was Middlesex’s partnership approach which is at the heart of its operation. At Middlesex there was a real desire to understand what we wanted to achieve so that they could tailor the learning to suit us individually. ( Kemp, 2011b )

It is perhaps this willingness and capability to formally build on and recognise professional learning that emerges from practice, from the workplace, that distinguishes the work-integrated approach from that of some traditional banking qualifications. Lester et al . (2016) argue that the evidence from the literature indicates that work-integrated approaches are more effective in establishing professional competence than traditional “sequential” or “parallel” approaches. Following the 2008 crash, Halifax recognised the need for transformative change in the professional practice of their workforce and understood that traditional professional qualification approaches would not achieve this.

Professional and work-based learning

Work-based learning has been established at Middlesex as a field of study that University awards can be made in since 1992 ( Gibbs and Garnett, 2007 ). The professional and work-based learning field of study is predicated on a simple idea, that when people work they learn, that this learning can be at higher-levels and can be recognised formally towards the achievement of University qualifications. However, a key difference with a traditional subject discipline-based approach is that professional and work-based learning is transdisciplinary and applicable to any area of professional/work practice. All participants in work-based learning programmes must be engaged in work, as it is an individual’s work/practice that is the source of their learning. This learning can draw on sources of knowledge that include subject discipline-based or other relevant areas of knowledge but the subject of study is a learner’s own work-based learning. A key aspect of identifying this is through the development of reflective practice approaches to work to support individuals’ ability to think about and understand the broader internal and external contexts of the work they do and to develop an understanding of their professional practitioner identity/subjectivity. This includes developing the ability to engage with others that are interested in, or effected by, the work they do through negotiated engagements with communities of practitioners, employers, co-workers, collaborators, stakeholders, clients, academic tutors and others implicated in their specific area of work/practice. Lastly, professional and work-based learning is concerned with developing different and better ways of working. To review and challenge existing practice and to ask intelligent questions about its appropriateness and effectiveness. In doing this, professional and work-based learning programmes are also specifically designed to develop transdisciplinary approaches that support innovation and enhancement of work/practice. A broader discussion concerning the theoretical underpinnings of the transdisciplinary Work Based Learning Curriculum Framework can be found in Bravenboer and Workman (2016a, b) .

Accreditation and the university work-based learning curriculum framework

One of the key mechanisms deployed at Middlesex University to support university-business collaboration is the facility to formally recognise higher-level learning activity that is outside of its validated portfolio of provision through accreditation. Middlesex University accreditation is the process whereby external learning activity is evaluated to ascertain its equivalence to the University’s academic credit framework and to ascribe a number of credit points at an identified academic level. Accreditation operates to quality assure education and training activities delivered by employers and other organisations to enable University credit to be awarded that can count towards the achievement of University qualifications ( Middlesex University, 2016 ). Crucially, accreditation constitutes a formal recognition that high-level knowledge, understanding and skills exist and can be developed outside of the university.

A second key mechanism used in support of university-business collaboration is the facility to construct professional and work-based learning programmes that lead to University qualifications. Middlesex University has established academic level descriptors for professional and work-based learning that identify expected learning achievement at each level. Middlesex University operate a validated work-based learning curriculum framework that includes a broad range of modules that can be combined to construct programmes that lead to a comprehensive range of University qualifications ranging from a small (40 credit) University Certificate at Level 4 (equivalent to first year undergraduate) to a full Masters qualification. Programmes can be constructed wholly from combinations of these modules or through combination with accredited external learning up to a maximum of two-thirds of the total credit of the target qualification. Further detail can be found in Bravenboer and Workman (2016a, b) .

The development of retail banking practice programmes

The first step in establishing a collaborative relationship with Halifax Bank included Middlesex University working closely with the Halifax Learning Development team to produce a proposal for the accreditation of their in-company professional development course “Journey in Practice”. Journey in Practice operated at two levels, Branch Manager and Local Area Manager and the delivery of the course was managed by the Halifax Learning Development team and included a range of on-line learning resources. The engagement resulted in the formal accreditation of Journey in Practice and the recognition that the Branch Manager course attracted 30 credits at Level 6 (Honours level) and the Local Area Manager courses attracted 40 credits at Level 7 (Masters Level). The collaborative working resulted in some amendment to the way that learning was assessed introducing Reflective Learning Statements and Post Implementation Review mechanisms. The process of developing the Journey in Practice courses in preparation for accreditation established the foundations for mutual trust and future collaborative working.

Encouraged by the recognition of their in-company programme, Halifax also sought a means to provide opportunities for their Managers to gain University qualifications that would help to enhance their professional credibility. However, many of Halifax’s Bank Managers and Local Area Managers had not been to university or engaged with learning since school or college. The opportunity to gain a University qualification that was built on the credit gained through successfully completing the in-company programme could both lessen learning anxiety by building from the familiar context or their work and serve to motivate achievement.

Using the University Work Based Learning Curriculum Framework two programmes were constructed each using 60 credit Negotiated Work Based Learning Project (WBL) modules, one at Level 6 (Honours level) and one at Level 7 (Masters Level). The programme at Level 6 was designed for Brach Managers and would lead to the award of an Advanced Diploma in Retail Banking Practice, whilst the programme at Level 7 would lead to a Postgraduate Certificate in Retail Banking Practice. Each programme was constructed by building on the relevant accredited Halifax Journey in Practice course (30 credits at Level 6 or 40 credits at Level 7) to develop further learning from work-based project activity (see Figure 1 ).

All customer advisers now have a structured training process to support their personal development. We adopt a proactive approach to customer feedback and my Customer Manager now spends her core hours in the banking hall. She engages with customers to learn more about our service and feeds this back in the following day’s fire up. All BCs [Banking Consultants] use their FCR [Forward Customer Review] to contact customers post interview to ensure their account is up & running and meeting their initial needs – deepening their relationships. By implementing my business plan we have seen over a 10 point increase in NPS [Net Promoter Score] as well as increased migration and telephony results. My branch has become the training branch for all new to role BCs/colleagues within the area. I now have a more multi-skilled workforce that offer an improved level of service by building strong future relationship with our customers. I implemented three areas of change – colleague training and support, customer feedback and an effective after interview process. ( Halifax Retail Bank, 2013 )

The work-based project activity was supported and assessed by Middlesex University academic staff but admission to the programme is be determined through Halifax led criteria. This included: successful completion of Journey in Practice course (Middlesex University accredited learning); Annual Performance Appraisal at minimum “Good Performer” level; interview with Line Manager.

Participation in the in-company Journey in Practice programme is required by Halifax for all Branch Managers and Local Area Managers but progression to the Middlesex led qualification was on a voluntary basis. However, Halifax engaged in a significant degree of internal promotion of the opportunity to progress, led by their Learning Development Team. Following each programme workshop the Halifax Learning Development Team conducted a comprehensive learner evaluation and feedback to the Middlesex academic team regarding successes and areas for improvement. An excellent relationship has emerged between Halifax and Middlesex teams which has contributed to high achievement and satisfaction rates for the programmes.

Evaluation of business benefits

The quantitative return on investment measures required by Halifax included increased customer satisfaction indicated by the Halifax Net Promoter Score and increased business effectiveness indicated by increased sales and the rate of converted referrals. In 2011, only one year after the programme had been initiated, Halifax conducted a comprehensive review of the performance of their branches where the programme had been implemented benchmarked against non-participating branches, to ascertain if the required return on investment measures were being achieved. They found that branches with managers that had undertaken the programme were performing 9.8 per cent better than others in terms of sales that converted referrals were 10 per cent higher on average and that the “Net Promoter Score” of customer service quality—increased by 40 per cent. Halifax also found that Managers who undertook the programmes improved performance more quickly in the context of a change in working practices. ( Halifax Retail Bank, 2011 ). Given the context of major restructuring and redundancies, this improvement in performance is noteworthy and as a consequence of this clear return on investment, Halifax continued to invest in the development of their Managers.

These qualifications and the learning being generated are highly motivational and are offering colleagues who would otherwise not have the opportunity, the chance to earn a recognised professional qualification. ( Halifax Retail Bank, 2011 )

Completing the study was challenging as I haven’t done anything like that for over 20 years. I got a great sense of satisfaction and revisited theories I had not looked at for years. This has helped me change the way I run my business. More focus is now on developing and leading rather than delivering messages. I am very grateful that the company supported this programme. ( Halifax Retail Bank, 2013 )

The completion of stage 3 has made me look at the company in a different way. I feel I owe the company something in return and I am now much more of an advocate of LBG [Lloyds Banking Group]. ( Halifax Retail Bank, 2013 )

For colleagues, I believe this delivers a qualification that they will truly aspire to achieve. We’ve had terrific feedback that it’s good that the Halifax is investing in its staff […] Our colleagues see this as being of immense personal value and this provides them a sense of personal achievement from studying […] I know that by investing our money in this programme with Middlesex University, if everyone does what we want them to do in our business we will get a return that will repay that investment handsomely. ( Kemp, 2011b )

The reason we have done this (work based learning) is that there are quantitative benefits, but there are also soft benefits. I recently saw 80 of my managers at their university graduation ceremony and the pride they felt was a benefit you don’t see on the balance sheet […]. As businesses we often say our staff are our competitive advantage but many organisations don’t have a plan in place that backs this up. We worry a lot about staff turnover as recruitment costs are huge and we want staff to stay and develop. Emotionally engaging staff with the organisation is a crucial part of what we’re doing […]. Work based learning isn’t about me giving my staff a certificate with my signature on it, this is a degree, a real qualification and that really counts. This is a great opportunity for many organisations. ( Kemp, 2011a )

What good looks like […] the Jewel in the Crown for Lloyds Banking Group in professionalising the retail banking workforce. ( Halifax Retail Bank, 2011 )

The “unexpected” benefits of reflection and lifelong learning

A great success has been the realisation by many of the learners of the great value of reflection in improving performance. Halifax is a very fast paced organisation and typically colleagues struggle to build in time to reflect, often not seeing its value. This programme has opened many learners’ eyes to the benefit of reflection in their work […]. The Reflective Learning Statements which sit at the core of the learning process have transformed the thinking styles of the Halifax colleagues. ( Halifax Retail Bank, 2011 )

At times I have felt I have almost been detached as a manager from my branch. This has helped me see the branch from a different perspective. Through my research I have gained a much greater knowledge of the area and the opportunities and threats to my branch’s growth. ( Halifax Retail Bank, 2011 )

The course gave me the opportunity to thoroughly research my business and community to really understand my thought process in producing a meaningful business plan. I would not have had the skill or resources to do this before the course. ( Halifax Retail Bank, 2015 )

It was easy to get lost in the wealth of interesting research subjects available when I began to look outside of my usual parameters. ( Halifax Retail Bank, 2015 )

Life as a Branch Manager is very hectic and there is often little time for personal development or reflection. By taking on this study gave me the opportunity to spend time looking at the banking sector as a whole as well as how my branch operates and to try and find ways of improving this for both my customers and colleagues. ( Halifax Retail Bank, 2015 )

The course gave me the opportunity to look at my working practices and how they could be improved. The challenge is implementing these in the real world and finding time to continue to improve and reflect. ( Halifax Retail Bank, 2015 )

It has made me try and seek ways to improve and also made me look at other factors outside my own organisation and how they impact on myself and my branch. ( Halifax Retail Bank, 2015 )

I made the decision to go straight into work after college so although I was pleased with the work I have done to pursue a career in banking; I had missed the experience of university level learning. The opportunity to study retail banking practice at Middlesex offered me the challenge of stretching myself and reflecting both personally and professionally. ( Halifax Retail Bank, 2015 )

I felt immense pride that I had been given this opportunity to study and gain an academic qualification which would support me in my role and the work I do every day. Looking back, all the time, effort and commitment that was needed has paid off. I took such pride in having my family members with me at the graduation ceremony to receive my diploma. ( Halifax Retail Bank, 2011 )

I joined Halifax straight from college and to gain a qualification from a university, whilst carrying out my day job, is a fantastic opportunity. The added bonus being it will also prepare me for the year ahead with the Business Plan I will create as a result! ( Halifax Retail Bank, 2011 )

I think it’s wonderful that as an employee, we have an opportunity to gain a qualification with no cost to ourselves. ( Halifax Retail Bank, 2011 )

Discussion and conclusions—towards the expected benefits of work-integrated learning

The traditional model of university education is predicated on the idea that universities have a privileged position with regards to the creation and dissemination of knowledge and expertise. On this model, individuals go to universities to undertake programmes of study that have been primarily designed by academic staff for the purpose of enabling people to have the opportunity to gain university qualifications. Access to the opportunity to undertake such programmes is determined solely by the university. In many (perhaps most) instances this model meets the expectations of those who go to university and delivers learning opportunities in accordance with the aims intended. It is also the case that maintenance of academic standards of any of the qualifications that a university awards in its name must be a non-negotiable aspect of providing higher education. However, in the UK, there is potential to bring about a different kind of relationship between employers and universities. The motivating ideas driving such a change include that employers need to invest more in developing higher-level skills (towards the achievement of enhanced productivity) and that many people in work have the potential to benefit from higher education without the opportunity to do so.

As indicated above, from the outset the Halifax Bank required a return on the investment they made in developing their staff in business benefit terms including better customer satisfaction and performance enhancement outcomes. Halifax Bank did not engage with Middlesex University to transform its work culture to embrace reflective practice and yet, perhaps unexpectedly, this is what seems, to some extent, to have taken place. It seems also that reflection can indeed be viewed as productive ( Boud et al ., 2006 ) by employers and can be celebrated as an integral aspect of the work of a Branch Manager. More than this, it seems that reflection can also be recognised for its key contribution to enhancing performance and as a means to promote practice improvement. The benefit this has also brought to the individual Branch and Area Managers has not been lost on the participants who seem to recognise and value the opportunity for learning and professional practice enhancement.

When most people go to work in the UK they do not have an expectation that they will have an opportunity for the learning gained through their work to count towards a university qualification. Neither do they typically expect that the projects and other work activities they undertake for their work can lead to them gaining academic credit. It may also be the case that many employees do not see it as their role to critically and collaboratively reflect on their practice. Perhaps, we could postulate that if the banking sector had an established and valued culture of critical reflective practice, some of the mistakes that led to the crash of 2008 could have been avoided? Perhaps at least, if employers can see the potential for a return on their investment, they may be more willing to contribute to the long-term culture change required to promote opportunities for higher-level learning for their employees and consequently promoting a culture of critical reflection. A key starting point for such a change is the explicit recognition of the knowledge and skills that exist within the workplace and a corresponding recognition that universities do not have a monopoly on knowledge production. This change also requires a corresponding shift of culture within the higher education sector to proactively promote collaboration between universities, employers and other organisations (such as professional bodies) as equal partners in the promotion of higher level learning opportunities. The facility to flexibly construct programmes that specifically reflect the needs of employers (while fully maintaining academic standards) is also required if universities are to move away from the “product push” model as recommended by Kewin et al . (2011) . Degree apprenticeships are clearly one way in which collaboration between universities and employers can be initiated but even in this policy area, collaboration can be inhibited ( Bravenboer, 2016 ). The collaborative approach adopted with Halifax Bank, has certainly provided opportunities to access higher education that are viewed as transformative by the participants cited. However, perhaps the broader benefit of evidencing the business benefits of critical reflective practice to employers, illustrates how it is possible to think of work-integrated learning is an entirely normal, valuable and expected aspect of working life.

Retail Banking Practice programme structure

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Practice for Wisdom: On the Neglected Role of Case-Based Critical Reflection

• Published: 08 February 2024

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• Jason D. Swartwood   ORCID: orcid.org/0000-0003-2060-4680 1  

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Despite increased philosophical and psychological work on practical wisdom, contemporary interdisciplinary wisdom research provides few specifics about how to develop wisdom (Kristjánsson 2022). This lack of practically useful guidance is due in part to the difficulty of determining how to combine the tools of philosophy and psychology to develop a plausible account of wisdom as a prescriptive ideal. Modeling wisdom on more ordinary forms of expertise is promising, but skill models of wisdom (Annas 2011; De Caro et al. 2018; Swartwood 2013b; Tsai 2023) have been challenged on the grounds that there are important differences between wisdom and expert skills (Hacker-Wright 2015, p. 986; Kristjánsson 2015, pp. 98, 101; Stichter 2015, 2016, 2018). I’ll argue that we can both vindicate the promise of skill models of wisdom and begin to specify practically useful strategies for wisdom development by attending to a reflective process that I call Case-Based Critical Reflection. I begin by demonstrating the process as it arose in a notable example from everyday life, illustrating how the process can be usefully applied to a case study of interest to wisdom scientists, and explaining its philosophical pedigree. After isolating the key features that make it relevant to wisdom development, I argue that attending to the importance of Critical Reflection can defuse prominent objections to skill models of wisdom.

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The kind of reflection Gandhi is recommending thus aims at developing and testing one’s own existing moral beliefs and judgments by taking seriously alternative views in order to yield guidance about the concrete circumstances of one’s own life. So far, then, the process resembles what psychologist Igor Grossmann and colleagues call Perspectival Metacognition (Grossmann et al. 2020 , p. 109). Perspectival Metacognition (PMC) refers to “aspects of metacognition” that “afford greater understanding of and balance between potentially divergent interests on the issue at hand,” including epistemic humility, consideration of diverse perspectives, and balance of viewpoints (ibid). Nevertheless, this process is not sufficient to provide specific and plausible guidance for concrete situations (Kristjánsson et al. 2021 ; Swartwood 2020 ), such as the nuisance monkeys. Metacognitive processes such as epistemic humility and consideration of diverse perspectives are parts of good decision-making about what one ought to do precisely because they are necessary for most intellectual or decision-making challenges humans face. Doctors wouldn’t succeed at diagnosing illnesses if they didn’t attend to the limits of their knowledge or identify and examine competing explanations of clinical data. Yet medical schools surely need to supplement these laudable intellectual habits with discipline-specific reasoning skills if they’re going to produce accomplished diagnosticians.

Cp. Grossmann et al. ( 2020 , p. 109): “On their own, moral aspirations such as fairness, justice, loyalty, or purity are abstract concepts, void of pragmatic nuances necessary to implement moral concerns in a person’s life.”

See, for example, Baehr ( 2022 ), Kotzee et al ( 2021 ), Siegel ( 2018 ).

Critical Reflection thus falls into what Stichter ( 2021 , p. 105) calls the “goal setting” and “reflecting after acting” phases of action, which he argues are the domain of wisdom.

For example, the process requires the addition of strategies for identifying plausible descriptive beliefs about how the world is and works, strategies for obtaining self-knowledge, strategies for reflecting on what is conducive to one’s own well-being (Tiberius 2023 ), strategies for understanding one’s own and others’ behavior and mental states (Hursthouse 2006 ), and so on.

Compare what Kristjánsson et al ( 2021 , pp. 246–47) call the “integrative function” and the “blueprint function” of phronesis.

See also Wright et al ( 2020 , 24), who endorse Russell’s point that “practical wisdom employs the same global understanding of the human good that is relevant to every virtue,”; Kamtekar ( 2004 , p. 460): practical wisdom organizes a person’s “desires, beliefs about the world, and ultimate goals and values” and does so in such a way that a person’s “motivations are organized so that they do not conflict, but support one another”; and Stichter ( 2018 , 378): “The role of practical wisdom is to make value judgments regarding what it is to live well, what constitutive ends make up living well, and what other ends we could pursue consistent with that overall conception of living well.” Stichter argues elsewhere that “wisdom … requires reflection on our values, goals, and practices, not on how to balance existing goals in particular situations (which is going to be the work of other virtuous skills)” ( 2021 , p. 105). This suggests that Stichter sees only what I have called the critical function as essential to wisdom, while the integrative and specificatory functions are the domain of the character virtues. I find other ways of conceptualizing the relationship between wisdom and the virtues more compelling (De Caro et al. 2018 ), but that is not essential for my argument here.

Importantly, the process of Critical Reflection can be given more principled or more particularist interpretations, depending on which of the two case-based reasoning strategies are emphasized. If we emphasized the strategy of testing analogies, Critical Reflection could be a process that focuses heavily on the context and details of specific situations. If we emphasized the strategy of developing principles, Critical Reflection could be a process that focuses heavily on general principles that apply across a range of situations. For my purposes here, I will assume only that Critical Reflection needs to include some mix of the two strategies.

Compare what Tsai ( 2023 , Chap. 1.1) calls the Species Thesis (“wisdom is a species of skill”) and The Analogy Thesis (“wisdom is analogous to skill”). Tsai argues that “[t]he Analogy Thesis is too modest because it does not provide or imply any ontological status for wisdom” (ibid). Depending on what the analogy is supposed to show, however, Tsai may be underselling the power of the Analogy Thesis to tell us important things about wisdom.

For similar accounts of the logical structure of analogical reasoning in philosophy of religion and philosophy of science, see Ratzsch and Koperski ( 2023 ), and Waters ( 1986 ).

Tsai offers a different reply, arguing that the presence of expertise in low-validity environments casts doubt on the strict necessity of feedback for expertise ( 2023 , Chap. 5.3), and the fact that the goal of living well can be analyzed into a hierarchy of sub-goals shows that it is possible to get adequate feedback on wisdom ( 2023 , Chap. 5.3–5.5). My goal is to show that this reply is more compelling if it is illustrated using a specific reflective process, like Critical Reflection, that can provide specificatory, integrative, and critical feedback on our judgments about how to live well.

De Caro et al ( 2018 ) make a similar point about wisdom and the character virtues.

An earlier version of this argument was presented in an invited webinar hosted by the Aretai Center on Virtues on 14 April 2023. I thank Maria Silvia Vaccarezza for the invitation and Prof. Vaccarezza and the other participants for their thoughtful and generous feedback on my argument. Thanks go to Ian Stoner for characteristically incisive feedback on an earlier draft of the paper and to Avani Shah f or helpful discussion of additional cases where applying the general value of ahimsa can be challenging. I also benefitted from the feedback of two anonymous reviewers.

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Swartwood, J.D. Practice for Wisdom: On the Neglected Role of Case-Based Critical Reflection. Topoi (2024). https://doi.org/10.1007/s11245-023-10000-z

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Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study

Diana tolosa‐merlos.

1 Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona Spain

Antonio R. Moreno‐Poyato

2 Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat Spain

3 IMIM (Hospital del Mar Medical Research Institute), Barcelona Spain

Francesca González‐Palau

4 Hospital Santa Maria, Salut/Gestió de Serveis Sanitaris, Lleida Spain

Alonso Pérez‐Toribio

5 Unitat de Salut Mental de l'Hospitalet, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, L'Hospitalet de Llobregat Spain

Georgina Casanova‐Garrigós

6 Department and Faculty of Nursing, Universitat Rovira i Virgili, Tortosa Spain

Pilar Delgado‐Hito

7 Department of Fundamental Care and Medical‐Surgical Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat Spain

8 GRIN‐IDIBELL (Nursing Research Group‐ Bellvitge Biomedical Research Institute), L'Hospitalet de Llobregat Spain

Associated Data

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Aims and objectives

To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units.

In mental health units, the therapeutic relationship is especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care.

Action and observation stages of a participatory action research project.

Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used.

The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice.

Conclusions

This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse–patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice.

Relevance to clinical practice

These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day‐to‐day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.

What does this paper contribute to the wider global clinical community?

• An in‐depth analysis of nurses' reflections regarding the aspects that underlie the therapeutic relationship in their clinical practice enables the nurses themselves to become aware and to develop strategies for improvement based on their own knowledge.
• Understanding and confirming how the attitudinal component is a key element for nurses in the practice of the therapeutic relationship allows managers to evaluate strategies that promote motivation and facilitate the involvement of nurses to improve their practice with patients.
• The results point to the need for further studies aimed at identifying and implementing strategies that facilitate mental health nurses to incorporate and improve attitudinal skills related to establishing the nurse–patient therapeutic relationship in clinical practice.

1. INTRODUCTION

The nursing discipline is defined as a significant, therapeutic and interpersonal process that acts in conjunction with other human processes that make health possible for individuals (Peplau, 1988 ). The relationship established between nurse and patient is therapeutic, regardless of the setting in which care is provided (Stevenson & Taylor, 2020 ). However, in the mental health unit setting, the therapeutic relationship is especially relevant to increase the effectiveness of any nursing intervention (McAndrew et al., 2014 ). Reflective practice is considered an essential aspect of improving nursing care and generating knowledge (Vaughan, 2017 ). This paper aims to deepen the knowledge of the therapeutic relationship based on the reflections of nurses regarding their practice, in the context of current challenges within the mental health acute care setting.

1.1. Background

Based on Peplau's model of interpersonal relationships by ( 1988 ), which is the most widely held theory in the mental health nursing community, many authors have based their models on person‐centred mental health nursing (Barker & Buchanan‐Barker, 2010 ; O'Brien, 2001 ; Scanlon, 2006 ). All of them identify the therapeutic relationship as the foundation of nursing practice and the pillar upon which mental health nursing has been built (McAllister et al., 2019 ; Moreno‐Poyato et al., 2016 ). The proper establishment of the nurse–patient therapeutic relationship is especially relevant to increase the effectiveness of any nursing intervention in acute psychiatric units (McAndrew et al., 2014 ).

The therapeutic relationship could be defined as a human exchange (Peplau, 1988 ) that is based on effective communication that favours the possibility for a person to help another person to improve their health condition, with the objective that, through such communication, the person will be able to develop interpersonal and problem‐solving skills (Forchuk et al., 1998 ). To this end, concepts such as understanding, interest, availability, individuality, authenticity, warmth, respect and self‐knowledge are basic pillars for the nurse (Moreno‐Poyato et al., 2016 ). The literature points out that mental health nurses seem to be knowledgeable of the importance of the therapeutic relationship in inpatient units; however, the reality of clinical practice leads us to believe that theoretical knowledge is not enough to create a good bond with patients (Moreno‐Poyato et al., 2016 ). In addition, the literature points out that for nurses, the implementation of the therapeutic relationship in the current context of mental health units has suffered a strong impact related to neoliberal policies, with increased management and a risk‐centred approach (Kingston & Greenwood, 2020 ). Thus, today's environments are chaotic, and nurses are committed to therapeutic work, yet they struggle to balance it with the new demands of management (Kingston & Greenwood, 2020 ). In addition, barriers such as lack of time, communication problems (Harris & Panozzo, 2019a ), the physical structures of the units, the ratios or the cultures of care are external factors that limit the therapeutic relationship (Tolosa‐Merlos et al., 2021 ). If nurses are unable to become aware of how they respond to time pressure, frustration or unclear care policies, there is a risk that these barriers will become entrenched, new ones will be created and the patient will perceive their actions as lacking care, presence or involvement (Harris & Panozzo, 2019b ). Thus, although nurses recognise the importance of self‐awareness and knowing how to recognise how their actions can impact the therapeutic relationship and the care provided to patients, they are also aware of the need for self‐awareness (Thomson et al., 2019 ), institutions and, in general, care policies should encourage nurses to be aware of interpersonal influences, as well as the desirability of providing a safe and supportive clinical environment for these relationships (Stevenson & Taylor, 2020 ).

From the patients' point of view, in the complex environment of inpatient units, their interactions with staff are central components to their satisfaction regarding their experience with admission (Molin et al., 2021 ). When staff spend time, engage in daily activities, and recognise patients as individuals, patients seem to find it easier to be physically and emotionally closer to each other and to themselves (Eldal et al., 2019 ; Moreno‐Poyato et al., 2021 ). However, this therapeutic commitment is not always met in practice, and interventions to improve participation are few and far between and ineffective (McAllister et al., 2021 ).

Thanks to the therapeutic relationship, nurses are in a key position to lead the development of customised interventions (Molin et al., 2021 ). However, there is a significant gap in the literature regarding improving the quality of the therapeutic relationship in acute mental health units (Hartley et al., 2020 ). The nursing profession is characterised by its ability to reflect on practice to improve care and provide more person‐centred care, which is why there is a need to increase the use of evidence‐based practice (Vaughan, 2017 ). In fact, reflective practice allows practitioners to learn from their experiences (Bulman & Schutz, 2013 ; Schön, 1987 ). When nurses are given time to reflect through guided reflection questions they are able to gain valuable insight into practice (Bolg et al., 2020 ); therefore, reflective practice helps nurses integrate their emotional response and practical experience into a better understanding of the care they provide, incorporating knowledge and applying theory (Vaughan, 2017 ). Thus, although the nurse–patient therapeutic relationship has been extensively studied, no studies to date provide knowledge on the establishment of the therapeutic relationship and its implications based on the reflection on the nurses' own practice. Consequently, knowing the meaning of the therapeutic relationship together with the elements that facilitate and hinder its implementation in the complex practice of current acute mental health units can be a starting point for both nurses and managers to become aware of the needs and for the design of strategies for improvement, suited to the reality of clinical practice.

In this regard, the aim of this study was to explore the phenomenon of the therapeutic relationship through the reflective practice of nurses in acute mental health units.

2.1. Design

This study is part of a multicentre mixed methods study involving 18 acute mental health units in Catalonia (Spain) (MiRTCIME.CAT). The principal aim of the project is to improve the nurse–patient therapeutic relationship through the implementation of evidence. The project was carried out following a sequential and transformational design. Quantitative methods were used based on a single‐group quasi‐experimental design with baseline and follow‐up measurements in phases I and III of the project. In the second phase, qualitative methodology was used. In its qualitative component, participatory action research (PAR) was proposed, framed within the constructivist paradigm and following the model by Kemmis and Mctaggart ( 2008 ). A two‐cycle process consisting of four stages each was designed to carry out the PAR. Specifically, this work corresponds to the action and observation stages of the first cycle. These stages are basic in the PAR process of change and make it possible to generate relevant knowledge regarding habitual practice (Cusack et al., 2018 ). In fact, it allows nurses to understand their practices as the product of particular circumstances and thus to identify the crucial aspects on which it may be possible to transform the practices they are carrying out (Kemmis & Mctaggart, 2008 ). The study is reported in line with the Consolidated criteria for reporting qualitative research guidelines (COREQ: Tong et al., 2007 ) (File S1 ).

2.2. Participants

All the acute mental health units that were part of the Catalan Mental Health Network ( n  = 21) were informed of the study. The principal investigator presented the research project and its objectives to the management of each centre through informative sessions. Finally, 18 units agreed to participate. A nurse from each unit joined the research team and this researcher was in charge of coordinating the study at their centre and recruiting the nurses from each unit. All nurses employed in the participating units ( n  = 235) were invited to participate in the study. The inclusion criteria for the participating nurses were belonging to the permanent or interim staff and being assigned to the acute unit at the time the intervention began. The following nurses were excluded from the study: nurses who were training to obtain ‘the official qualification of mental health nurse’, staff nurses who were scheduled to be on leave or maternity leave during the intervention. Thus, a convenience sample of 195 nurses agreed to participate in PAR, of which, ultimately 152 nurses completed the action and observation stages of the first part of this study.

2.3. Data collection

During a previous meeting among the entire research team, a guide was agreed upon so that the nurses could self‐observe their clinical practice in relation to the establishment of the therapeutic relationship. The research team sent the self‐observation guide by email to each nurse, along with a reflective diary in which the nurses were asked to record the self‐observation data (File S2 ). The diary was to include the description and reflection of three types of common interactions in their usual clinical practice: (a) a standard situation of welcoming a patient for admission, (b) an interaction in which there was a pre‐agitational state that required verbal de‐escalation and (c) an interaction whereby the patient is approached individually, promoted by the nurse and in the absence of any demand on behalf of the patient. The structure of the diary, together with the instructions for completion, pursued two purposes. First, to enable nurses to reflect on their starting assumptions, to understand their practice, to understand themselves and their patients, and, finally, to understand their profession (Price, 2017 ). Second, to monitor the process of change planned for the PAR, according to the proposals of Kemmis and Mctaggart ( 2008 ). In this sense, for each interaction, the nurses had to record the description of the situation, the type of verbal and nonverbal language they had used, their reflected intervention, their emotions during the interaction and, finally, a reflection on the influence of the environment on the interaction. Once the nurses had completed the diary, they sent it to the research team by e‐mail. The data were collected between April and June 2018.

2.4. Ethical considerations

This study was approved by the Research Ethics Committees of all the participating hospitals. The nurses participated on a voluntary basis, and all participants signed an informed consent form. Nurses did not receive any compensation or incentive for participating in the study. To maintain the confidentiality and anonymity of the data obtained, each nurse received an alphanumeric code that was incorporated into their diary. The diaries were sent to a generic e‐mail of the project that was only accessible to the principal investigator of the project, subsequently, the data were stored on a computer used exclusively for this study.

2.5. Data analysis

The content analysis method was used to analyse the data (Crowe et al., 2015 ). The diaries reached the first author and were coded to preserve the anonymity and confidentiality of the participants. Under their responsibility, the entire coding and categorisation process was carried out in a consensual manner by a collaborative team that formed the backbone of the process of developing a rigorous coding system (Merriam, 2016 ). In the first stage of analysis, the text was fragmented into descriptive codes assigned exclusively according to their semantic content. In a second stage, these initial codes were grouped into more analytical subcategories, which classified the codes according to the meaning of the linguistic units and their combinations. This led to a third hierarchical stage in which, considering the semantic analysis of the previous subcategories, the codes were ranked inductively. The first and second steps were taken iteratively until a more specific understanding of the subcategories was achieved. These steps were carried out primarily by the first author and discussed and reflected upon continuously and critically within the research team. Throughout the process, the QRS NVivo 12 program was used as computer support.

2.6. Rigour

Reflexivity was continuous throughout the process. Most of the researchers were experts in mental health, with training in qualitative methodology and experience in previous similar studies. As this was a multicentre study and a very large research team, neutrality was ensured as team members adopted an open attitude towards sharing, reasoning and discussing the findings as they emerged. In addition, the team became aware of its initial onto‐epistemological positioning, which was reflected in the design of the self‐observation guide for this stage of the process. As the research progressed, team members repeatedly contrasted the experiences identified in the participants' diaries with their own opinions. They asked follow‐up questions for the generation of new knowledge without guiding the participants' responses, so that this initial positioning could not influence the subsequent analysis. Similarly, the credibility and confirmability of the data should be emphasised, given the triangulation of the researchers in the analysis process and the constant auditing of the results by the participants in subsequent groups. In relation to the transferability of the results, in the case of this study, where participation is so high and from so many centres, it ensures that the results are valid for all units.

3. FINDINGS

The diaries of 152 nurses working at 18 centres were collected and analysed. The nurses ranged in age from 22 to 62 years, with a mean age of 33.6 years (SD = 9.4). Over 70% of the nurses were female. Their experience in mental health was a mean of 7.6 years (SD = 7.5). Almost a quarter of them had the official title of mental health nurse specialist and over 25% of the nurses had a doctoral or master's degree. All facility shifts were equally represented in the sample, although 40% of the nurses had rotating shifts or served on an as‐needed basis (Table ​ (Table1 1 ).

Participants' sociodemographic and professional characteristics ( n  = 152)

Data are shown as absolute number (percentage).

Abbreviation: MH, mental health.

The nurses, by describing and reflecting on their interactions with patients, expressed what the therapeutic relationship was for them and how it was carried out in their usual clinical practice. In this sense, three main categories were identified that responded to how they gave meaning to what the therapeutic relationship represented in practice and what limitations they identified in it (Figure ​ (Figure1 1 ).

Nurses' reflections on the practice of the therapeutic relationship in acute mental health units

3.1. Nursing attitude as a core of the therapeutic relationship

After reflecting on their practice, the nurses stated that attitude was a key element in establishing a quality therapeutic relationship with patients in the units. In this regard, they identified different attitudinal components. In the first place, the nurses considered the attitude of openness to the relationship. This meant being open and available, offering time, letting the patient talk and being attentive to the person's needs.

Patients are confused when they are first admitted and need the staff to listen to them and spend time with them. I always try to use an empathetic approach and be honest from the very beginning. I think it is very important for the patient to know that they can count on me, I try to convey that I am available if they need me. (01DR101)

However, they also identified that, in order to maintain this attitude, they had to be aware of barriers such as the presence of prejudice, the unavailability of other team members, the belief that the therapeutic relationship is useless, or lying to the patient.

The first contact already gives me the feeling that there may be a personality background, a victimizing attitude, excessively correct at times, totally inadequate at others, in spite of which I stay on track and treat him with the utmost respect. (10DR101). Certain users only perform certain actions to push you to the limit. (13DR103)

Secondly, they referred to the communicative attitude as another basic element in the therapeutic relationship. In this case, the nurses considered that special attention should be paid to both their verbal and nonverbal language when interacting with patients. In this sense, they pointed out the need to establish a dialogue with the patient by means of clear and concrete messages, with an appropriate tone and without shouting, as well as showing interest in the conversation, listening attentively, without showing tiredness or boredom, and adapting their distance and physical contact to each situation.

I try to be aware of my gestures, I avoid being invasive, respecting the safety distance with the patient at all times. Regarding verbal language, I use neutral terms, a friendly and calm tone of voice. (04DR115). In a polite but firm manner, I explain to the patient his situation and the alternatives I can offer him instead of smoking. The language is clear and concise, responding directly to what he asks. Saying NO if necessary, as sometimes vague answers upset the patient even more. (04DR104)

In addition, they considered it extremely important that, as caregivers, they should adapt to the other person, that is individualise the care they provide in the context of the therapeutic relationship. This implies considering the patient's psychopathological and emotional state at any given moment, as well as the patient's age, language or culture. This often meant postponing interviews, adapting language, using sign language to communicate, agreeing on a special type of diet, or even relaxing the rules and letting the patient make a call outside the usual hours.

I try to be flexible and adapt things as much as I can to the patient and his or her characteristics. (03DR109). Sometimes the stigma in mental health appears from the self‐stigma and the treatment that the mental health professional gives to patients. Personality is lost by prioritizing the disorder, people talk about the schizophrenic, the depressive, the BPD… obviating the fact that there is a person behind it all, with a context and a manner of understanding and living their life. (05DR104)

Finally, the nurses emphasised the role of their own emotional experience of caregiving. This meant having self‐confidence, feeling they were able to help the patient and do their job well, feeling satisfied with their work and remaining calm, at ease, and relaxed with the patient during their interventions. Nurses also identified emotions that, conversely, had a negative effect on the therapeutic relationship, such as feeling fear, insecurity, tension, patient rejection, grief, helplessness and frustration when the interventions had not been resolved as expected.

To feel fulfilled in my daily work (18DR101). Calm and confident, well supported by the team. Satisfied to have successfully completed an admission. (16DR112). Then I felt helpless, as I could not find a way to reverse the situation. (12DR111)

3.2. Essential nursing actions for the therapeutic relationship

This category refers to the nurses' reflections on their actions in the context of the therapeutic relationship with patients. In their diaries, the nurses were describing and reflecting on different interventions and activities that were carried out in their usual practice and they detected certain actions that were common to all of them.

First, the nurses pointed out the importance of generating an appropriate environment to build a bond and facilitate the relationship with the patients. A calm, intimate, comfortable, unhurried environment without external stimuli or interruptions.

The room is quiet with the door closed and without any interaction from the environment…A pleasant and silent environment favors the therapeutic relationship between the professional and the patient. (04DR110)

In relation to the establishment of a good therapeutic bond, the nurses agreed that the welcome provided on admission was a fundamental intervention. This was viewed as one of the situations in which the therapeutic relationship took on a greater relevance, since this first contact was considered the key to the success of the subsequent relationship with the patient.

Without welcoming the patient when he or she enters the unit, a better quality of the patient/professional relationship cannot be achieved. (01DR113)

Secondly, the nurses felt that the verbal approach was also a relevant aspect of their practice in the context of the therapeutic relationship. For them, it was an essential step in order to be able to carry out any intervention, such as when welcoming a patient when they are admitted to the unit, the use of verbal de‐escalation techniques to ease the tension with very demanding and uncooperative patients or, on the contrary, to approach isolated patients who hardly interact with the environment, although the use of words is not always as effective as they would like it to be.

Verbal containment is one of the most relevant parts of our work. In a pre‐agitation situation, we may be able to transition a patient from pre‐agitation to calmness or from pre‐agitation to psychomotor agitation. (09DR108)

In this sense, the nurses described that the act of offering the patient their assistance was at the heart of the therapeutic relationship. They stated that this action was carried out in the context of being present, listening or through agreement with the patient by proposing alternatives to the demands and needs that they cannot meet.

As he speaks I give him my support with non‐verbal language. I take his hand and he hugs me. I offer my help. We agree that he will make an effort to eat some solid food at dinner and that I will give him a supplement (he has it prescribed if he needs it). (01DR101)

The nurses also acknowledged that interventions such as mechanical restraint were sometimes the only measure to reduce stimuli or were implemented because of patient aggressiveness, risk of escape or even medical indication. However, the nurses reflected that, although this intervention was performed relatively often, it could be seen as a failure and a deterioration in the therapeutic relationship.

(…) avoid as much as possible the adoption of measures that restrict the mobility of the people under our care, since we are aware that this produces a significant deterioration of the therapeutic relationship, adding to the patient's mistrust and suspicion (…) (07DR105)

Finally, the nurses pointed to therapeutic work as another fundamental aspect of the therapeutic relationship. This meant working with the patient on positive reinforcement and other aspects such as pharmacological adherence, identification of symptoms or awareness of the disease, explaining the objectives of admission and the importance of asking for help, respecting the patient's decisions and involving the person in their care and recovery.

The attitude is one of interest, I keep an eye on her so that she doesn't get distracted and can talk calmly. I ask her what she thinks we can do for her to explore her expectations with the admission. (07DR101)

3.3. Contextual factors affecting the therapeutic relationship

The nurses identified contextual factors that facilitated or, on the contrary, acted as barriers to the therapeutic relationship. Indeed, they described that the type of admission could already condition the therapeutic bond, with voluntary admission being a facilitator. The same is true of other factors such as knowing the patient from previous admissions, and whether the patient remembers having a good experience in those previous admissions. However, the nurses also considered elements that are intrinsic to the patient, such as language, culture or bad experiences of previous admissions, as factors limiting the establishment of the therapeutic relationship.

He is open to help and agrees to the admission (03DR110). I must admit that the fact that I know the user from previous admissions has helped the situation to unfold smoothly. (14DR106)

Similarly, the nurses identified barriers that hindered or prevented the establishment and maintenance of a good therapeutic relationship, related to both the environment and the physical structures of the units. In this sense, the structural barriers were related to the lack of adequate spaces to carry out interventions with patients with the intimacy that the nurses considered necessary. Other environmental factors were noted, such as environmental noise and tension, the unpredictability of some patients, the presence of the family or the multiple interruptions were elements that added to the difficulty of the therapeutic relationship.

That afternoon the environment allowed me to dedicate some time to the patient, since there were no emergencies, other admissions, or complicated situations in the unit that required nursing intervention, apart from the "scheduled" or "usual" activities such as the control of vital signs, medication, etc. (03DR105)

Finally, the nurses also expressed how the regulations and care dynamics of the units also conditioned the therapeutic relationship in daily clinical practice. Thus, unit regulations were recurrently brought up by the nurses as a major barrier, due to the numerous limitations and prohibitions.

I explain the rules of the unit: no cell phones, no smoking, no entering other rooms, no belts, no glass objects, etc. and the established schedules… (10DR104)

Nonetheless, the greatest source of difficulties was the care dynamics at the unit, ranging from lack of time, high workload, administrative tasks, staff rotations or the night shift.

Even so, there are barriers that hinder the therapeutic relationship. Sometimes, our language is influenced by the tension in the unit, the lack of time, excessive administrative tasks, etc.… (01DR101)

4. DISCUSSION

This study aimed to explore the phenomenon of the therapeutic relationship from the reflective practice of nurses in acute mental health units. The nurses highlighted that attitude was the core aspect of the therapeutic relationship after reflecting on their practice. Similarly, they also reflected on the actions that were customary in the habitual interventions carried out in the context of the therapeutic relationship, identifying the most common barriers encountered in practice. Finally, the nurses reflected on those aspects of the context of care that conditioned the therapeutic relationship in the clinical practice of acute mental health units.

These findings offer knowledge about relational competence, a competency of professional nursing that is highly relevant in mental health (D'Antonio et al., 2014 ). This competence is directly linked to participation in practice and incorporates not only knowledge and skills, but also attitudes and professionalism that involve applying evidence and learning to practice (Casey et al., 2017 ; Moreno‐Poyato, Casanova‐Garrigos, et al., 2021 ). Specifically, the attitudinal component highlighted in the results and its importance in the context of the nurse–patient therapeutic relationship has been described from a theoretical perspective by authors such as Peplau or Orlando (Forchuk, 1991 ), Travelbee ( 1971 ) and Watson (Turkel et al., 2018 ). Similarly, the empirical literature has collected multiple studies that study the importance of nurses' attitudes towards more general aspects of mental health, such as stigma (Young & Calloway, 2021 ), recovery (Gyamfi et al., 2020 ), coercion (Doedens et al., 2020 ; Laukkanen et al., 2019 ) or severe mental disorder (Economou et al., 2019 ). However, there is hardly any empirical evidence that explicitly shows the relevance and identifies the specific attitudinal skills of nurses in the context of the practice of the therapeutic relationship. Thus, it is likely that the fact that the nurses were able to reflect on their practice made them more aware of the importance of attitude in the context of the therapeutic relationship (Harris & Panozzo, 2019a ), as they were able to respond to the real challenge of establishing an adequate therapeutic relationship in their day‐to‐day work in the acute mental health units (Choperena et al., 2019 ). Moreover, the attitudinal capacity identified by the nurses encompassed aspects already empirically recognised in the context of the therapeutic relationship, such as availability, communication and individualisation (Delaney & Johnson, 2014 ; Harris & Panozzo, 2019b ; McAllister et al., 2019 ; Moreno‐Poyato et al., 2016 ). However, the nurses also highlighted other aspects that have been less empirically studied, such as the importance of self‐confidence and self‐assurance, both in a positive way in order to be able to establish an appropriate therapeutic relationship, (Roche et al., 2011 ; Van Sant and Patterson, 2013 ) as well as negatively, in the form of limitation (O'Connor & Glover, 2017 ; Van Sant and Patterson, ). These results confirm the relevance of Peplau and Orlando's theoretical approaches and the use of the nurse's awareness as a fundamental part of the nursing relationship (Forchuk, 1991 ; Thomson et al., 2019 ).

The results indicate that by reflecting on their practice, the nurses were able to identify those skills (practices) that are essential for the development of the therapeutic relationship and which were transversal to any intervention. The nurses emphasised the importance of generating an adequate environment for the relationship, considering the environment not only as an element of context typical of many acute care units, but also as an element that is essential for the development of the therapeutic relationship (Kingston & Greenwood, 2020 ), also considering that it was their responsibility to be able to build the space where the relationship could take place (McAllister et al., 2021 ; Raphael et al., 2021 ). As in other studies, nurses also identified skills such as verbal engagement, offering help or working with the patient as basic practices for the development of effective interventions in the context of the relationship with their patients (Harris & Panozzo, 2019a ; McAllister et al., 2019 ; Molin et al., 2018 ). Furthermore, in relation to specific interventions, reflection on practice allowed nurses to identify and become aware of nursing admission assessment and mechanical restraint as two common interventions in mental health units that were particularly influential in the therapeutic relationship with the patients. In this sense, for the nurses, welcoming the patient on admission was considered an essential intervention determining a large part of the success in building the therapeutic relationship with the patients (Forchuk et al., 1998 ; Peplau, 1997 ). However, the use of mechanical restraint compromised the therapeutic relationship and the patient's trust (Kinner et al., 2017 ), although they understood that, even if this measure was undesirable, at times it was necessary (Doedens et al., 2020 ).

In addition, the nurses reflected on the contextual factors that directly affected the therapeutic relationship with the patients. In this sense, the nurses paid attention to patient aspects such as voluntariness or involuntariness regarding admission (Moreno‐Poyato, El Abidi, et al., 2021 ) or being previously acquainted with each other from previous admissions and the experience of the relationship (Van Sant and Patterson, 2013 ). The nurses also emphasised the role of the environmental and structural conditions of the units (Staniszewska et al., 2019 ), as well as the regulations and the dynamics of care that were automatically generated in the intense day‐to‐day routine of the units (Adler, 2020 ; Kingston & Greenwood, 2020 ).

4.1. Strengths and limitations

This study has several strengths and limitations. First, it should be noted that this project faced major challenges from a methodological point of view as well as during its execution. Initially, a research group had to be formed with representation of the institutions to assess the feasibility of the project. Next, a balanced team of researchers, consisting of methodologists and clinicians had to be assembled to ensure that the different stages of the research project could be completed. The team had to be formed in several initial working sessions and, subsequently, there was a process of constant mentoring by the principal investigator to the rest of the team. In addition, a considerable volume of data had to be managed. For management and storage, a secure on‐line space was created, guarded and accessed only by the principal investigator of the project. All data were collected electronically to facilitate the circuit. In relation to the analysis, a team was set up under the responsibility of a researcher. This team had to work in a collaborative and consensual manner. Regarding more specific limitations, it should be mentioned that the nurses' reflections in the diaries could be subject to the Hawthorne effect and their responses may have been biased by social desirability. In this sense, the research team insisted on the importance of honesty in the nurses' responses and on the team's handling of the confidentiality of the data. Secondly, another limitation inherent to the use of diaries is related to memory bias and the stress associated with reflective practice. In relation to this, the team recommended specific instructions, both verbally and through the guide provided to the nurses, to prevent this from occurring. Furthermore, the representativeness of the participating nurses and the number of diaries obtained should be highlighted as strengths of the study. These facts enable the findings of this study to be transferred to similar contexts.

5. CONCLUSIONS

The present study contributes to the understanding of the phenomenon of the therapeutic nurse–patient relationship by reflecting on the actual practice of nurses in acute mental health units. The attitudinal component is at the heart of the therapeutic relationship, and, in this sense, it is fundamental for nurses to believe in themselves and their attitude to communicate, adapt and open up to the relationship with the patient. In addition, there are actions that are essential for nurses to establish a TR in practice such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient. Finally, nurses should consider the patient's conditions, the dynamics of care and regulations of the unit, as well as the structure and environment of the unit, as contextual factors to be able to establish an adequate TR with patients in daily clinical practice.

6. RELEVANCE TO CLINICAL PRACTICE

These findings have important implications. The study findings demonstrate that participatory methods stimulate nurses' reflection, motivation and critical thinking. By learning from the reflection of the nurses themselves about the aspects that underlie the therapeutic relationship in their clinical practice, this enables the nurses themselves to become aware and to develop strategies for improvement based on their own knowledge. Moreover, the individual reflection involved in these first stages of a participatory process provides the nurses with an intrinsic knowledge of how they approach the therapeutic relationship and shows that the attitudinal component is basic for them. In this sense, understanding and confirming how the attitudinal component is a key element for nurses in the practice of the therapeutic relationship allows managers to evaluate strategies that promote motivation and facilitate the involvement of nurses in improving their practice with patients. Moreover, these results point to the need to conduct mixed or qualitative studies aimed at exploring the aspects that facilitate the motivation, empowerment and attitudinal training of nurses in greater depth, rather than studies that only seek improvements in the theoretical knowledge of the therapeutic relationship.

CONFLICT OF INTEREST

No conflict of interest has been declared by the authors.

AUTHOR CONTRIBUTIONS

Study design: ARMP and PDH; Data collection: APT, FGP and GCG; Data analysis team: DTM; Final report draft: DTM, ARMP and PDH; Supervision the process of data collection and analysis and provide support and feedback during all study phases: ARMP; Contribution of the manuscript, and read and approved the final manuscript: All authors.

Supporting information

Acknowledgements.

We would like to acknowledge all the participants of MiRTCIME.CAT project.

Tolosa‐Merlos, D. , Moreno‐Poyato, A. R. , González‐Palau, F. , Pérez‐Toribio, A. , Casanova‐Garrigós, G. , & Delgado‐Hito, P. ; MiRTCIME.CAT Working Group (2023). Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study . Journal of Clinical Nursing , 32 , 253–263. 10.1111/jocn.16223 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

College of Nurses of Barcelona (PR‐218/2017)

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