Assistant Nurses Under Construction : Reflection as a Governing Technology

Reflection and reflective practices are often spoken of as something good which will enhance nursing practice. In this article, such ways of speaking are problematised through a discourse analysis based of interviews with managers, supervisors, teachers and care workers who participated in an inservice training programme at six nursing homes. The analysis is based on the Foucauldian concepts governmentality and technology. I argue that reflection operates as a technology of confession which shapes self-regulated, active nurses who governs themselves. Introduction In recent decades there has been an intense discussion and research conducted on reflection and reflective practices within nursing literature. Many of these publications take reflection as granted, as a ‘real concept, thing, object which will enhance the capacity of nurses within their work practice (e.g. Boud et al. 2006; Johns, 2000). What they to a large extent neglect to point out and make explicit is how power operates in practices of reflection. By arguing for reflection as a solution to certain challenges or problems as done in such publications, certain kinds of subjectivities are shaped and governed. Such processes need to be problematised. Therefore, this paper aims at making such operations of power visible by analysing reflection as discourse and a technology of confession which produces certain subjectivities within nursing practice. Analytical framework In this text, the concepts of governmentality and technologies of the self are used as an analytical framework (for a more elaborated discussion see Fejes & Nicoll, 2008). Governmentality focuses on the way the population and the individual citizen are being governed. The concept covers ‘the whole range of practices that constitute, define, organize, and instrumentalize the strategies that individuals in their freedom can use in dealing with each other’ (Foucault, 2003a, p. 41). Freedom is a prerequisite for government, where those who try to control and limit the freedom of others, are themselves free individuals. More specifically, what is analysed in a governmentality analysis are liberal rationalities of governing. Two important questions to ask in a governmentality analysis are: what is the ‘thing’ to be governed and how is governing to be conducted (Foucault, 1983)? In other words, what kind of nurse is being fabricated and how is such subjectivity being shaped and fostered? In this paper, the how question focuses on the technology of confession (through reflection). Confession was one of the central technologies of the self studied by Foucault and it is closely related to Christianity and the idea that we all must confess ours sins. To be able to disclose one’s self (to show the truth about oneself), one had to renounce oneself. One of these techniques was verbalization. Through the human sciences, verbalization has become even more important. It has been inscribed in different practices so as to constitute a new self, without the need to renounce oneself. Foucault argues that ‘to use these techniques without renouncing oneself constitutes a decisive break’ (Foucault, 2003b, p. 167). Confessional practice today is related to what Foucault (2003d) calls pastoral power. Such power emerged with Christianity, and the aim was to secure individual salvation in the next world. Pastoral power cannot be exercised without knowing the souls and the innermost secrets of each 101 Thinking Beyond Borders: Global Ideas, Global Values Online Proceedings of the Canadian Association for the Study of Adult Education (CASAE) l'Association Canadienne pour l'Etude de l'Education des Adultes (ACEEA). 27th National Conference 2008 at the University of British Columbia, Vancouver, British Columbia. Edited by Janet Groen and Shibao Guo. ISBN 978-0-920056-50-9 individual. The institutionalized form of pastoral power within the church has lost its vitality, while the function of pastoral power has spread throughout the entire social body. Pastoral power of today is focused on salvation in this world in the form of realising ones desires (Foucault, 2003d). A discourse analysis was conducted based on interview transcripts derived from 30 semi-structured interviews with managers, supervisors, teachers and care workers within an in-service training programme at six nursing homes in Sweden. The transcripts have been interpreted as text constituting and constituted by discourse. Thus, my interest is not in analysing what the interview persons ‘really’ meant. Instead, the focus is on the discursive production of meaning, which constructs and is constructed by ideas about what a desirable nurse should be and how such subjectivity should be fostered. Result In this section, the discourse analysis is presented. First, the technology of reflection as a confessional practice will be analyzed, followed by an analysis of what desirable assistant nurse is being fostered. As part of a technology, there are specific techniques operating to shape subjectivity. In the third section, appraisals will be analyzed as such. Reflection as a Confessional Practice in Nursing The texts analysed produce reflection as a desirable activity, which should produce better care work and nursing practice. Reflection is both desirable on a collective and on an individual level. On the collective level, reflection is seen as making it possible to discuss and solve problems faced at work. The idea is that one can learn from each other. I was thinking, that in some way you could – through supervision, through these techniques, through them create those opportunities for the reflection we often lack. With a deeper cultivation of these questions which are problematic – questions that we have here everyday at our nursing home. It is a way of raising the issues...the knowledge which is actually here already. Instead of searching for it outside.