Donald Schön’s theory of reflective practice has received unprecedented attention as an approach to professional development in nursing and other health and social care professions. This paper examines technical rationality in Schön’s theory of reflective practice and argues that its critique is a broad and often overlooked epistemological underpinning in this work. This paper suggests that the popularity of Schön’s theory is tied in part to his critique of technical rationality, and to his acknowledgement of the significance of practitioner experience (...) and indeterminate zones of practice in the development of expertise. Schön tapped into a growing disillusionment with technical rationality that coincided with a crisis of knowledge across a range of disciplines. The question is raised as to whether Schön’s critique sets up a dichotomy between technical rationality and experience, or overcomes it. The conclusions suggest that Schön is not discarding research‐based professional knowledge, but rather challenging conflated views of its practical significance. In this way, it is proposed that his critique of technical rationality can be interpreted as an attempt to overcome dualistic thinking as it pertains to professional knowledge. (shrink)

Although typically implicit, clinicians face an inherent conflict between their roles as medical healers and as providers of technical biomedicine (Scott et al. in Philos Ethics Humanit Med 4:11, 2009). This conflict arises from the tension between the physicalist model which still predominates in medical training and practice and the extra-physicalist dimensions of medical practice as epitomised in the concept of patient-centred care. More specifically, the problem is that, as grounded in a "borrowed" physicalist philosophy, the dominant "applied scientist" model (...) exhibits a number of limitations which severely restrict its ability to underwrite the effective practice of care. Moreover, being structural in character, these problems cannot be resolved by piecemeal modifications of the existing model, nor by an appeal to evidence-based medicine (Miles in J Eval Clin Pract 15(6):887-890, 2009; Miles in Folia Med 55(1):5-24, 2013; Miles et al. in J Eval Clin Pract 14(5):621-649, 2008). Hence, the need for medical theorists to "partner with experts in the humanities to build a sui generis philosophy of medicine" (Whatley in J Eval Clin Pract 20(6):961-964, 2014, p. 961). In response, the present paper seeks to vindicate the merits of hermeneutically-informed template in providing the requisite grounding. While capable of correcting for the limitations of the applied scientist model, a hermeneutically-informed template is a "both/and" approach, which seeks to complement rather than exclude the physicalist dimension, and thereby aspires to reconcile technical mastery with patient-centred care, rather than eschew one in favour of the other. As such, it can provide a cogent philosophical template for current best practice, which does justice to the art as well as the science of medical care. (shrink)

This paper proceeds from examining the debate regarding the question of whether a systematic literature review should be undertaken within a qualitative research study to focusing specifically on the role of a literature review in a phenomenological study. Along with pointing to the pertinence of orienting to, articulating and delineating the phenomenon within a review of the literature, the paper presents an appropriate approach for this purpose. How a review of the existing literature should locate the focal phenomenon within a (...) given context is illustrated by excerpts from the first author’s literature review within a descriptive phenomenological study. Also discussed is the important issue of when the researcher should fully enter the attitude of the phenomenological reduction and how this may influence the study. (shrink)

The fact that social welfare professions including social work, youth work and community work deal with the lives and relationships of human beings is far from controversial. What is contentious is that in light of increasing intellectual work on the nature of social practices there is a failure in the human services literature to adequately examine the interdependencies and entanglements between conceptualisations of the stuff that the helping professions deals with and understandings of practice. This article examines the nexus and (...) mediations between the phenomena and practice of social service work. The case is made that human services and the human beings they deal with are often imagined and represented in one-dimensional, unambiguous, calculable and orderable ways that align with neo-liberal inspired and technical approaches to practice. I argue that these accounts are inadequate and I suggest that practices of care and the people engaged in such practices should be constituted as complex, unpredictable, wicked and emergent. A key to good practice in the people professions is acknowledging and attending to this complexity and aporia. (shrink)

Linking specific nursing actions to outcomes in the healthcare setting is challenging. Patient outcomes are varied and influenced by a myriad of factors, and always involve a wider team than any one nurse. It is difficult to control for a single action or set of actions of a particular nurse. Furthermore, practice is seldom about any ‘one’ action, for one thing leads to another, all within a complex interplay of influencing factors. In this article, we outline a research method which (...) combined Dewey's pragmatism with Gadamer's hermeneutics to explore the consequences of the nurse's use of advanced assessment skills in the acute care setting of medical and surgical wards. This pragmatic hermeneutic methodological approach allowed the complex interplay of influences to be revealed in the unfolding story. Reflection of the nurse brought insights that may otherwise have been passed over. The philosophical notions of Dewey drew attention to the play of ‘means’ and ‘ends’. A hermeneutic approach that calls for ‘thinking’ extends understanding and raises insights that can inform education and practice. (shrink)

Technology is fundamental to and embedded in the way practice is conceptualized and institutionalized in social service work. Many scholars assume and expect that good practices of care are achieved with the correct application of theory produced by rigorous scientific research. However, there are significant critiques of this viewpoint. We examine the work of Donald Schön and Martin Heidegger and agree with these authors' suggestions that technical rationality and modern technology are not the way to achieve good practice in the (...) human services. At the same time, we are not convinced that the alternatives offered by Schön and Heidegger provide what good practice requires. We draw on Aristotle's account of the intellectual virtues and make the case for phronesis and praxis as other possibilities for inspiring new kinds of social welfare practice in the twenty-first century. (shrink)

The purpose of this paper is to reveal how the thinking of leadership is always in ‘play’ enacting the wisdom of practice. The ‘know how’ of leadership theory (techne) tends to assume that a plan, or a set of skills, can accomplish whatever one sets out to achieve. However, the nature of human and contextual encounter instead draws one into a dynamic relationship where all is in-play. To lead is to recognise the impact and primacy of play and to respond (...) accordingly. For this research study, experienced leaders were interviewed and data was analysed drawing on the philosophical notions of Heidegger and Gadamer, using a phenomenological methodology. The findings indicate that ‘know how’ is not sufficient. Strong leadership requires wisdom that is enacted in the moment. In addition, ‘who’ the leader is matters, for in the dynamic of play leaders can only draw on their own integrity. Being attuned to the play also matters, for discerning mood, possibilities and threats prompt the leader’s next move. Leadership that enables individuals to play with wisdom, foresight and sound judgement can only be learnt through experience. The implications are that emerging leaders need to be exposed to the play of leadership and to be mentored by experienced leaders who can share their wisdom. Indo-Pacific Journal of Phenomenology , Volume 11, Edition 1 May 2011, 47-57. (shrink)

By engaging with multiple narratives of a police killing involving questionable legal procedures, known as a police encounter in India, we attempt to narrate stories of what happens to those who resist organizational wrongdoing by displaying moral anger against unethical actions. The State enables police encounters to occur by arguing that exceptional and alternate methods are required to engage with the crisis of terror and crime that the nation faces. Thus, police encounters are executed in the name of the collective (...) morality of the greater common good. Those who resist police encounters argue from the standpoint of a democratic morality by suggesting that the very efficacy of democratic institutions will be eroded if encounters are normalized. We explore questions of organizational ethics from a temporal perspective while navigating between contending moral positions regarding police encounters. (shrink)

In this paper, we describe the value and philosophy of lifeworld-led care. Our purpose is to give a philosophically coherent foundation for lifeworld-led care and its core value as a humanising force that moderates technological progress. We begin by indicating the timeliness of these concerns within the current context of citizen-oriented, participative approaches to healthcare. We believe that this context is in need of a deepening philosophy if it is not to succumb to the discourses of mere consumerism. We thus (...) revisit the potential of Husserl’s notion of the lifeworld and how lifeworld-led care could provide important ideas and values that are central to the humanisation of healthcare practice. This framework provides a synthesis of the main arguments of the paper and is finally expressed in a model of lifeworld-led care that includes its core value, core perspectives, relevant indicative methodologies and main benefits. The model is offered as a potentially broad-based approach for integrating many existing practices and trends. In the spirit of Husserl’s interest in both commonality and variation, we highlight the central, less contestable foundations of lifeworld-led care, without constraining the possible varieties of confluent practices. (shrink)

In this paper we offer an appreciation and critique of patient-led care as expressed in current policy and practice. We argue that current patient-led approaches hinder a focus on a deeper understanding of what patient-led care could be. Our critique focuses on how the consumerist/citizenship emphasis in current patient-led care obscures attention from a more fundamental challenge to conceptualise an alternative philosophically informed framework from where care can be led. We thus present an alternative interpretation of patient-led care that we (...) call ‘lifeworld-led care’, and argue that such lifeworld-led care is more than the general understanding of patient-led care. Although the philosophical roots of our alternative conceptualisation are not new, we believe that it is timely to re-consider some of the implications of these perspectives within current discourses of patient-centred policies and practice. The conceptualisation of lifeworld-led care that we develop includes an articulation of three dimensions: a philosophy of the person, a view of well-being and not just illness, and a philosophy of care that is consistent with this. We conclude that the existential view of well-being that we offer is pivotal to lifeworld-led care in that it provides a direction for care and practice that is intrinsically and positively health focused in its broadest and most substantial sense. (shrink)

Within the context of health and social care education, attempts to define ‘scholarship’ have increasingly transcended traditional academic conceptions of the term. While acknowledging that many applied disciplines call for a kind of ‘actionable knowledge’ that is also not separate from its ethical dimensions, engagement in the caring professions in particular provides an interesting exemplar that raises questions about the nature and practice of ‘actionable knowledge’: how is such knowledge from different domains integrated and sustained? This paper is theoretical and (...) wishes to outline some philosophical ideas that may be important when considering the characteristics of the kind of scholarship for caring practices that draw on deep resources for creativity and integration. Firstly, there is an attempt to clarify the nature of scholarly practice by drawing on Aristotle’s notion of ‘phronesis’ . Secondly, a more meditative approach to the integration of knowledge, action and ethics is highlighted. Finally, its implications for scholarship are introduced, in which scholarly integration may best be served by more contemplative ways of being and thinking. Drawing on Heidegger and Gendlin, we consider the challenges of contemplative thinking for pursuing scholarly practice. We articulate contemplative thinking as an unspecialized mode of being that is given to human beings as an intimate source of creativity. The sense in which unspecialization can be cultivated and practised is discussed. (shrink)

Addiction is one of the most significant problems facing contemporary society. Consequently many scholars, institutions and clinicians have sought to understand this complex phenomenon, as is evident in the abundance of etiological models of addiction in existence today. A literature review pointed that there is little consensus regarding the nature and etiopathogenesis of addiction, and integrative models have not yet been able to provide the sought-after integration. In addressing this problem, this study offers a theoretical analysis of the paradigmatic and (...) meta-paradigmatic suitability of Integral Theory in the design of an integrated metatheory of addiction. The data consisted of the most prominent etiological theories and models of addiction. The study focused on several essential features constituting the architectonic of any metatheory that attempts to provide conceptual scaffolding for the construction of a comprehensive metatheory of addiction. The criteria for the construction of a metatheory were conceptual integration, ontological span, ontological depth, empirical validity and internal consistency. Integral Theory was critically assessed in terms of each of the abovementioned criteria. The study suggests that Integral Theory is eminently suitable as a philosophical foundation for the development of an integrated metatheory of addiction. (shrink)

This study aimed to investigate the phenomenon of the meaning of mobility for elders living in rural areas. A phenomenological study was undertaken with older people living in rural South West England and Wales. Ten interviews were undertaken in peoples’ homes and focused on the spatial dimensions of what it was like to live in the rural area and the everyday experiences of traversing rural space. Spatial mobility was experienced by our sample as any of the possible ways that achieved (...) personal life activities where the traverse of space was normally relevant. We describe the meaning of mobility sensitised by the terms used in the “continuum of mobilities” : “literal mobility,” “virtual mobility,” “potential mobility,” and “imaginative mobility.” Our phenomenological findings revealed that the transport and mobility needs of older people living in rural areas could not be meaningfully understood without understanding their well-being priorities, the kinds of movement that constituted well-being, and how this related to the phenomenon of “dwelling,” which included their feeling of “at-homeness” in their rural environment. But also what emerged was a second phenomenon that we have called rural living as a portal to well-being in older people. The connection between well-being and rural place was constituted by two interrelated experiences: the importance of dwelling and slowing down in older age, and the importance of a “rich textured locale” for the well-being of rural older people. We conclude by considering how the elders in our study may have something important to remind us: that mobility and sense of place are mutually implicated and that our present culture places an over emphasis on mobility, which may obscure the value of dwelling. (shrink)

While often dubbed “the bible of contemporary psychiatry” and widely hailed as providing “a benchmark” for the profession, on closer inspection the DSM is seen to be shot through with philosophical assumptions that restrict its theoretical cogency and limit it clinical efficacy. Hence, in the interests of enhanced patient-care it is important to think critically about the DSM, with a view to maximising its diagnostic strengths while minimising its weaknesses. The critical analysis undertaken in the present paper underscores the importance (...) of not construing the DSM as a self-contained diagnostic tool but of viewing it, rather, as an indispensable component in a more comprehensive, multidimensional diagnostic process. More specifically, the contention is that the DSM’s diagnostic limitations evoke a biopsychosocial framework of application as their necessary corrective, notwithstanding the entrenched tendency to construe these approaches as oppositional. Further, it is contended that a hermeneutically informed biopsychosocial template has particular advantages as an integrating framework. (shrink)