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Being and becoming a reflective practitioner, through guided reflection, in the role of a spasticity management nurse specialist

Jarrett, L. (2009). Being and becoming a reflective practitioner, through guided reflection, in the role of a spasticity management nurse specialist. (Unpublished Doctoral thesis, City University London)


This thesis plots my development as a nurse specialist in spasticity management, a relatively new specialism that has not previously been researched. To address this gap in nursing knowledge this thesis demonstrates how guided reflection developed my individual professional knowledge and how this informed knowledge about nursing and caring when working with people with spasticity and complex disabilities.

I utilised a novel narrative methodology which combined my clinical and research practice. As an organising structure to research and gain insight into my practice I used the six layers of dialogue (Johns 2006). Through this process I explored my experiences by constructing story texts, then reflective texts, culminating in a narrative. Creating story text involved exploring my experiences through regularly journaling. Using a reflective model I developed the texts and dialogued with other sources of knowing such as literature and art forms. To further extend the text and reveal aspects of self that were previously unexplored I would share it with my supervisor(s) and others. To construct the narrative text I assimilated 29 reflective texts into a coherent whole, which represents my unfolding journey, of being and becoming a reflective practitioner.

This reflexive journey has changed my perceptions of situations and my practice approach. Significantly I describe that a person with complex disabilities lives in a precarious harmony; a matrix of highly refined strategies, unique to each person and their family, which allows them to effectively function as a family unit. It can be a fragile state, easily disrupted through life events, health and social care practices.

Implications for practice include that appreciating a person's precarious harmony, is vital to working in relation and towards a therapeutic alliance. Equally, not acknowledging and working with a person's precarious harmony will limit the uptake and ongoing use of novel technologies.

I summarise my practice approach, as the need to sculpt the practice space, tune into the other's wavelength to understand, connect with and flow towards maintaining and improving the balance of the person's precarious harmony.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RT Nursing
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Nursing
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