Governing nursing through reflection: a discourse analysis of reflective practices

Abstract

This paper is a report of a study to analyse reflection as discourse and a technology of confession which produces a certain desirable subjectivity within nursing practice. Reflection and reflective practice are common themes in nursing practices and in the literature on nursing. These practices are often construed as positive and empowering, and more critical analyses of them are needed. A Foucauldian-inspired discourse analysis based on the concepts of governmentality and technologies of the self was conducted. Transcripts of interviews conducted in 2006-07 with 42 managers, supervisors, teachers and participants in an in-service programme to prepare healthcare assistants to become Licensed Practice Nurses in the elder care sector were analysed. Reflection as confession operates as a governing technology within the nursing practice analysed. Programme participants are encouraged to reflect and scrutinize themselves about their work as a way to improve their competencies and practice. Through appraisals, they are invited to reflect about themselves as way to achieve their desires. In this way, active, responsible, problem-solving, self-governing practitioners are constructed. Through a Foucauldian reading of reflective practices it is possible to illustrate that reflection is not a neutral or apolitical practice. Instead, it is a governing practice that does something, in discursive terms, to nursing subjectivity - something that can create a space for reflection about what reflection discursively does to subjectivity.