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‘Reflective’ writing on practice:professional support for the dying?Brenda Landgrebe a & Richard Winter aa Anglia Polytechnic University , United KingdomPublished online: 09 Jun 2011.
To cite this article: Brenda Landgrebe & Richard Winter (1994) ‘Reflective’ writing onpractice: professional support for the dying?, Educational Action Research, 2:1, 83-94, DOI:10.1080/09650799400200001
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‘Reflective’ Writing on Practice:professional support for the dying?
BRENDA LANDGREBE & RICHARD WINTERAnglia Polytechnic University, United Kingdom
ABSTRACT In the context of a course on reflective writing for professionalpractitioners, Brenda Landgrebe presented two pieces of work which show thatdying patients are not simply supported by carers but that patients can teachtheir carers about the qualities required for an acceptance of death. RichardWinter, the course tutor, suggests some of the general implications of thesepieces concerning the role of writing in action research, namely: the value of thestory format, and the function of writing both as a way of coming to terms withexperience and as providing the confidence with which to challenge acceptedtheories and to envisage agendas for further learning.
Background
Action research depends on a developmental spiral between practice andreflection, but this provokes a crucial question as to what the process of‘reflection’ should consist of, in order to be ‘developmental’, rather than, say,simply self-justificatory. In order to explore this issue, a ten-week coursecalled ‘Reflective Writing for Professional Practitioners’ has been establishedin the Faculty of Health and Social Work at Anglia Polytechnic University, inthe course of which Brenda Landgrebe wrote (among other things) the twopieces presented here. As yet the reflective writing course, being a single‘module’ has no necessary link with practice innovation, and it thereforeexplores only one aspect of the total action research process, namely theprocess of reflecting retrospectively upon one’s experience, as opposed towhat Donald Schön’s work describes: the quasi-experimental activityinvolved in reflecting within one’s practical decision-making (Schön, 1983,pp. 145).
The course consists of ten more-or-less weekly sessions in whichpractitioners write about their experiences and share their writing through aworkshop process. After the first two introductory sessions, the participantsset their own agenda: they write a number of different pieces in the course ofthe term, which can be either fiction or non-fiction. The final piece of workneeds to fulfil the following criteria, derived from the general assessmentcriteria for the faculty BSc programme:
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(a) Careful detailed observation of events and situations;(b) Empathising with the standpoint of other people, especiallyclients, so that one does not use one’s professional or culturalauthority to impose one’s interpretations on others;(c) Noticing the various emotional dimensions of events andsituations;(d) Analysing the complexities of issues, events and situations;(e) Linking the specific details of events and situations with thedetail of other contexts and/or general principles derived from arange of professional knowledge;(f) Learning (developing one’s understanding) in response toprofessional experience.
In Brenda Landgrebe’s case one of these pieces was the (fictional) storyBrave and the final piece of work was the (non-fictional) reflective narrativeAshiko. The two pieces were written without any individual tutorial guidanceand are published here almost exactly as they were originally presented
BRAVEA story by Brenda Landgrebe
“Now I want you to be very brave” said Mum. “Doctor Brown thinks it’staking you a bit longer than usual to get over your sore throat so he wantsyou to go to hospital for some TESTS (Billy just knew that word had bigletters by the way Mum said it). You probably won’t like it, but I’ll be withyou and I’ll help you because I love you”.
Mum had looked worried and Billy had seen her eyes go swimmy likewhen someone is going to cry so he had not said anything and had beenbrave about going to hospital for TESTS and when his own eyes wentswimmy too he waited until Mum went downstairs before he let the tearsspill over and run down his face.
“Now I want you to be very brave” said Dad the next day at thehospital. “The doctors want to do some more TESTS, just to make sure ofsome things. It will mean more needles and you won’t like it much but I’ll behere and I’ll help you, because I love you”. Funny, Dad’s eyes had lookedswimmy too so Billy had been brave, well quite brave anyway. He saidnothing and waited until Dad had gone to telephone Mum after the extraTESTS before he let the tears fall down his face.
“Now I want you to be very brave” said Mum “the doctor says there’ssomething wrong with your blood and you have to have some TREATMENTto put it right. He is going to put a thin tube in here” she touched him “sothat you can have DRUGS without having needles all the time”. (Funny,thought Billy, some words just had to have big letters.) “You won’t like itmuch but I’ll be here to help you because I love you”.
Mum had looked really worried and her eyes were glistening again soBilly had said nothing and he had been brave, well quite brave anyway, and
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waited until Mum had gone home to get tea for Dad and baby Claire beforehe let his own tears spill over and wet his face.
“Now we want you to be very brave” said Dad as he held up the mirror“We thought the TREATMENT might make your hair come out remember?Well now you have to get used to seeing yourself. You probably won’t like itmuch at first but we will be here (he looked at Mum as he spoke) and we willhelp you because we love you”.
Both Mum and Dad had wet eyes and were smiling, only the smileswere tight and thin as though they were hard to make, so Billy said nothingand was very brave, well quite brave anyway, and waited until Mum andDad had left the room before he let the tears spill over from his own eyes andrun down his face.
“Now we want you to be very brave” said Mum. “It’s going to be strangegoing back to school but your teacher thinks it is best if you tell the classand let them ask questions about your TREATMENT and your wig. Itprobably won’t be very nice at first but we will both be here to help you (sheglanced at Dad) because we love you”.
Both Mum and Dad’s eyes had been shining the whole time, his classhad been talking to him and they seemed not to be able to say much so Billyhad been very brave, well quite brave anyway, and he waited until Mum andDad had gone home and he could sneak away to the classrooms, away fromthe curious eyes of his classmates, before he let his own tears spill over andrun down his face.
“We want you to be very brave” said Dad some months later in thehospital. “Your blood has gone wrong again and the TREATMENT has nothelped this time, so we are going to take you home and look after you therewhere we (he held Mum’s hand) and baby Claire can be near you all thetime. You will be in bed or downstairs on the sofa as you are not very strongand you probably won’t like that very much but we will be there to help you,because we love you”.
Billy thought Dad’s voice sounded strange and Mum made a little noisein her throat and turned away. Dad moved to give Mum a hug so Billy couldnot see their eyes but he thought they might be crying so he did not sayanything and he was very brave, well quite brave anyway, and turned hisown head away from them to wipe the tears from his face onto his pillow.
... Billy opened his eyes and looked at them, Mum and Dad werekneeling by the side of his bed and they were crying. Without any sound atall, tears were spilling out of their eyes and running down their faces. Thetop of Mum’s blouse was wet and Dad held a big handkerchief to his chin.
Dad’s other hand and arm was around Mum’s shoulders and she washolding baby Claire who’s little face was screwed up, her lips pushedforward in a pout as she sobbed in sympathy with her parents.
Billy’s own eyes became quite swimmy as he looked at them but thetears did not spill this time.
He did not feel frightened any more just very calm and very grown up.He knew he had something to say at last.
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He held out his hands to his parents and as they leaned closer to him,baby Claire between them, he said. “You probably won’t like this very muchand I wish I could be here to help you because I love you. Now I want you tobe very brave ...”.
ASHIKO: LEARNING FROM A PATIENTA reflective narrative by Brenda Landgrebe
Ashiko was beautiful. She stood quite still by the window of the bedroom as Ientered.
She was wearing a simple shift dress that fell to her knees. Her armswere bare, slightly bronzed and very slim. Her wrists and hands were tiny;her fingers laced together at waist height.
Her legs were slim but shapely and her feet, like her hands, were verysmall and were clad in thonged sandals anchored at a point between eachfirst and second toe.
I looked at her face. Slightly arched, narrow black eyebrowsaccentuated deep, black-lashed, almond shaped eyes. High, roundedcheekbones supported faint shadows which further enhanced theirprominence. A small flat nose, testifying to her antecedents, sat above fullpale lips.
Her hair was blue/black and glossy, parted at the centre of her headand tucked behind her ears to fall straight down her back. When shestepped towards me I could see that it reached almost to the hem of herdress.
She smiled; a small, hesitant, gentle smile which hardly disturbed herserene countenance but which signalled nevertheless untold emotions –timidity, warmth, fear and confusion.
Ashiko was beautiful and she was dying.I had been asked to visit Ashiko in my capacity of Continuing Care
Nurse. As is customary the referring General Practitioner had given me theinformation I needed to make a first visit.
Ashiko was thirty-six years old and had had a recurrence of breastcancer which had been treated initially in the Philippines. She had had amastectomy and chemotherapy. Eighteen months later cancer wasdiagnosed in the remaining breast and it was decided that she would cometo England for further treatment and to be with her husband who wasstudying here.
Although from the Philippines Ashiko was of Japanese origin. Herhusband was also Japanese. Ashiko was going to live in the house of herhusband’s brother and his French wife, whilst receiving treatment.
During our first conversation I discovered that Ashiko had been to thelocal General Hospital and following tests had been told that the cancer waswell advanced and that further curative treatment was not feasible althoughshe would remain under the supervision of the doctors at the hospital.
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She spoke excellent English and there was no doubt that she hadunderstood the significance of the doctor’s remarks. Ashiko did not cry, didnot express any anger but merely told me the facts.
We discussed her present physical condition, spending a short time onthose symptoms which appeared minor (in Ashiko’s perception), such asnausea, and a longer time on those that she considered important, such aspain.
After ensuring that Ashiko understood how and when to take her drugsand leaving her a contact number we came to a joint decision that I wouldvisit once a week for the time being but that Ashiko would telephone if sheneeded to see me sooner.
I told Ashiko that I would speak to her sister-in-law before I left thehouse.
Nicole met me at the foot of the stairs and asked when Ashiko wasgoing to be taken into hospital. We went into the sitting room and Iexplained that Ashiko did not need to be in hospital right then but that shecould go into hospital when this was needed.
The conversation with Nicole was most enlightening. She told me thatshe was not prepared to nurse Ashiko. She had been asked by herhusband’s family to provide a home for Ashiko while her husband was awayat college and while she was receiving treatment.
Her own husband worked long hours and she had a child of five years.Ashiko’s husband would not be coming home during term time and she hadno-one to help her if Ashiko’s condition deteriorated. She felt that Ashikowould be better off in the Philippines where both her own and her husband’sfamily were large and in close proximity and there would be no problemabout nursing her.
She felt that she had been misled by her Japanese in-laws concerningthe seriousness of Ashiko’s condition. She felt, she said, angry that she wasexpected to accept the responsibility. While she had been prepared fordifferences to emerge between her husband’s culture and her own when theymarried she could not and would not accept that she should not beconsulted about such a major event as a stranger dying in her home.
I asked her if she felt that the situation was Ashiko’s fault and shereplied that Ashiko was just doing as she was told. The family made thedecisions; unmarried women and women without children were rarelyconsulted about anything.
I let her talk. It transpired that she had had some problems in hermarriage at first with the in-laws advising their son – “telling him what weshould do” was how she put it – but since the birth of their daughter thingshad not been so bad. She thought the family had accepted that she had amind of her own. “But now this”, she sighed.
Leaving a contact number and promising that I would do all I could tohelp I left the house, feeling sorry for both of the women in it.
During the following weeks I learned more about Ashiko as both sheand Nicole slowly began to trust me.
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Her family were wealthy and each of the children had been welleducated. Ashiko had gone to America to further her education when shewas well into her twenties and had always stayed there longer than wasoriginally planned undertaking various courses but not, as far as I couldascertain, ever having been in paid employment. She had finally beensummoned back to the Philippines when her family had arranged a marriagefor her.
As she told me this Ashiko lowered her eyes. Her sisters she said hadbeen much younger when they were married. Her husband was ten yearsyounger than herself and had returned to England after the wedding tocontinue his studies which “cost a great deal of money”. This lastinformation was imparted only after I asked her directly if studying inEngland was expensive.
Her husband was never at the house when I visited. Nicole told me thathe came sometimes, at the weekend. I said that I would be pleased to seehim and wondered if he would like to see me to talk about Ashiko’s care. Atmy next visit Maria informed me that he was happy for her (Nicole) to tellhim what was happening and that he was busy with his studies and couldnot say when he would be at the house.
Nicole gradually overcame her resentment towards Ashiko and becamethe friend and ally that she needed, accompanying her to the hospital,telephoning me when Ashiko’s symptoms worsened or when a new symptomdeveloped, but she still insisted that she could not nurse Ashiko when shebecame unable to care for herself. Ashiko would have to be admitted tohospital care.
This was said in Ashiko’s presence and she herself agreed that itshould be so.
Throughout the couple of months that I knew Ashiko she did notcomplain of anything. If her pain worsened she waited until I made a regularvisit to her to tell me, or Nicole asked me to visit.
At one point the hospital consultant decided that another course ofchemotherapy might delay the progress of the disease so this was tried.
Ashiko reacted violently to the treatment, vomiting almostcontinuously and unable to eat or drink. She was already losing weight withterrifying speed, was very tired and had gross muscle weakness and despitechanges in her drug regime, when her anti-emetic drugs were eitherincreased or alternatives tried, the vomiting continued. The chemotherapywas discontinued.
During this time Nicole telephoned frequently and I visited often,sometimes alone, at other times with the General Practitioner. At each visitNicole became more voluble, demanding that we “do something”. Usually shecalmed down enough to agree to Ashiko staying at the house for the timebeing but it was obvious to the doctor and myself that if the situationbecame any worse Ashiko would have to be admitted to hospital or a hospiceunit.
She, however, despite the vomiting and the weakness remained calm.She continued to care for herself never wanting to give Nicole any trouble
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and did not stay in bed for any length of time. In fact I never saw her in bedbut always sitting in a chair and always dressed. Only once did she expressher dismay at what was happening to her. I arrived to find her sitting infront of the mirror brushing her beautiful hair. Her expression was very sadand when I asked her what was wrong she held up the brush for me to see.Long black strands were matted in the bristles.
“My hair is coming out” she said. “My husband does not want to see melike this”.
Eventually Ashiko’s condition dictated that she should be admitted tohospital. I went to see her, just once as it turned out, before she died. Everrespectful she apologised for not being able to get out of bed and admittedthat she was “very weary”.
She talked then of her husband and their families, of Nicole, of thedoctors who had tried to help her and of me.
She had not been able to be a ‘good’ wife for her husband she said andshe had disappointed both sets of parents because she had not given them agrandchild. Nicole had given her a home and she had made a lot of extrawork for her. She was sorry for the trouble she had given the doctors andmyself. Everyone had been so kind, given so much, but her body had notbeen strong enough to get better.
Before I left her she held my hand briefly and thanked me again. Shehad never voluntarily touched me during our short time of knowing eachother and this simple gesture was her gift to me. I never saw her again.Ashiko died less than two days later.
No amount of theoretical knowledge can prepare any practitioner tocope with the variety of situations and events with which he/she will bepresented.
Every effort is made to ensure that adequate preparation is given to thepractitioner before he/she practises in specific areas.
Nurses involved with the care of dying individuals may choose fromseveral courses validated by professional or academic bodies, orexperimental workshops; where they can learn about the physical,psychological, social and spiritual problems which may be experienced bythe dying person, and also examine their own feelings and reactions todeath. Such courses are also designed to assist practitioners to improvetheir knowledge and skills in order to help those individuals in aconstructive manner.
Not only had I attended a course aptly named ‘Care of the DyingPatient and the Family’ in which these issues were addressed but I had alsobeen to a series of study days arranged by CRUSE (an organisation foundedby Margaret Torrie, herself a doctor’s widow) where issues surrounding allaspects of loss were examined.
Armed then with knowledge and skills which I deemed more thanadequate to cope with any situation concerning dying people I was confidentthat I could help Ashiko during her last few weeks of life.
However, to have knowledge in theory is not only limiting to bothpractitioners and patient but can be damaging to both.
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Most nurses can quote the ‘psychological stages’ that a dying patientgoes through as described by Elizabeth Kübler-Ross – Denial, Anger,Depression, Acceptance – but the pitfall here might be that the nurseremembers the book and forgets to study the individual. In an attempt to‘stage’ the patient the individual needs of the dying person may well beoverlooked.
My own initial reactions to Ashiko’s situation reflected more accuratelyKübler-Ross stages than did Ashiko’s.
I could not believe (Denial) that so many bad things could happen toone person. An, apparently, loveless marriage, a strange country, an iratekinswoman, a recurrence of cancer, sterility following chemotherapy, andthe prospect of death.
My own inner feelings (Anger) made me want to stop some, if not all, ofthese things from happening to her.
I perceived her to be vulnerable and this made me feel extremely sad(Depression?).
All of these feelings, however, were fleeting. Ashiko’s calm acceptanceof her situation was infectious. From our first meeting to the last herserenity influenced not only my relationship with her but ultimatelyrelationships with patients and others to this day.
I learned from Ashiko what theorists, writers and lecturers could neverteach me. That each individual with whom we have contact as practitionerscan add a new dimension to our lives, even while we believe that we areteaching them.
Ashiko, whilst making use of my knowledge and experience especiallyconcerning the use of drugs to control her distressing symptoms, taught methat no matter what my feelings were about a situation I should in no wayimpose those feelings on another and indeed in Ashiko’s case, her ownattitude towards her circumstances could not be influenced!
In the Meno Socrates is quoted as saying “... we shall be better, braverand more active men if we believe it right to look for what we don’t knowthan if we believe there is no point in looking because what we don’t knowwe can never discover”.
After Ashiko’s death I made a promise to myself that I would, in future,not only resist pre-judging any situation but that I would endeavour to learnsomething new from each patient I met.
Sometimes my acquired piece of learning has been connected with askill that the patient possessed. Perhaps some factual knowledge on asubject important to them. More often I have been privileged to learnsomething of a patient’s beliefs, religion, culture or social structure or havebeen able to study their coping mechanisms when facing overwhelmingproblems.
Ashiko taught me that I still have a lot to learn both professionally andpersonally but most importantly during those last precious weeks of her lifeAshiko, with her acceptance and serenity in adversity taught me that theachievement of inner peace is not only desirable but also possible.
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Commentary: the writing process (by Richard Winter)
After the course, Brenda and I tape-recorded a discussion of her work, whichis the basis for the following observations.
The Accessibility of the ‘Story’ Format
Brenda said that prior to the course she had had little experience oforganising her thoughts through writing: “I’m a great talker: I communicatethrough talking and touch, but I’ve never actually tried to communicatethrough writing; I’m not a great letter writer, or anything like that”.
Brave was written in response to an instruction simply to “write a pieceof fiction or non-fiction about your professional experience”. She said shestarted writing Brave impelled by the memory of many similar cases and bya desire to ‘jolt’ adult carers into an appreciation of the enormous andlargely unrecognised contribution made by dying children to the supportand comfort of their families. When I asked about the process of her writing,she said she simply started writing the first paragraph, and wrote the wholepiece quickly, spontaneously almost, without any conscious plan, initially,that the work would be structured by its remarkable ‘repetition’ format andby its final dramatic ‘reversal’ of the refrain, which would make the centralpoint of the story.
For Brenda, then, the form of Brave just ‘came naturally’, which Iinitially found very surprising, since the story struck me as being formallyvery ‘contrived’, consciously ‘artful’. However, Egan reminds us of the longoral tradition of composition, including not only folk ballads but Homer’sepics, based precisely upon repetition and the use of refrains (Egan, 1988).What this might suggest, is that embodying a general insight into experiencethrough the aesthetic structuring of a specific ‘story’ is an ancient culturalskill, and therefore more widespread, perhaps, than writing ‘essays’. (This isnot a new thought: most of us, I believe, live our lives steeped in stories,provided by the ‘entertainment’ industry in the form of novels, films, TVdrama and ‘soaps’ (see Winter, 1986, p. 176; Rowland et al, 1990, p. 291).)Walter Benjamin, in his essay ‘The story-teller’ (Benjamin, 1973) argues thatthe crucial popular art of story-telling is dying out. But perhaps it isn’t, andperhaps we could and ought to use it and foster it, as a technique forbeginning the process of reflection. Because although Brave does notrepresent, for Brenda, the development of new ideas (but the attempt toexpress strongly a point she knew she wished to make) it did lead on to thewriting of Ashiko. For example, (a) the two pieces have the same theme – thepatient who teaches and supports the carer, and (b) Brenda commented thatAshiko’s serenity seemed to have some of the “child-like quality” ofoptimistic belief that things “will be all right” which characterised Billy, thehero of Brave.
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Fiction and Reflective Narrative as Contrasting Genres
The two pieces are clearly differentiated in terms of genre. Brave is ‘artfully’contrived as a fiction, using a lot of rhetorical devices (repetition, refrain, adramatic final ‘twist’). Its ‘message’ is clear, but implicit. Ashiko is‘autobiographical’, and its reflective theme is both explicit and linked to atheoretical argument which originally stands outside the writer’s experienceand is drawn into the text as a retrospective commentary. It would beinteresting to know how this difference in genre represents a difference inthe writer’s reflective process. Alternatively it may be more important to notethat the two genres make available different technical resources which cancomplement one another.
Writing as Coming to Terms with an Experience
Brenda said she had frequently thought about Ashiko during the 15 yearswhich had elapsed since the events described. She had felt troubled by thememory of Ashiko, that she had not done enough to help her, that “therewas still unresolved business between us when she died”. Writing about hermade it clear, however, that things had been resolved, since (she nowrealised) they had both learned from each other.
As I was writing, I thought, No, I really think we came to someagreement at the end. Because when you are writing it down, youhave to think much harder about it; you know: what led on to that,and how did that come about? Usually you have a general memoryof it, but you don’t think about one action leading on to another.But writing it down makes you look at it in more depth, and studyit. And I think I’ve now got Ashiko out of my system; this was away of rounding the whole thing off.
Towards the end of Ashiko Brenda writes, “I learned from Ashiko whattheorists, writers and lecturers could never teach me: that each individualwith whom we have contact as practitioners can add a new dimension to ourlives, even while we believe we are teaching them”. Perhaps this insight hassuch a burden of complexity on it that it may need the sustained reflexiveeffort of writing in order to clarify and reinforce its basis, so that it can besecurely established as a professional basis, even though the wordsthemselves do not express a ‘new’ thought.
How New Insights Can Arise through the Writing Process
One of the most intriguing insights in Ashiko is that the conventional stagesof the experience of dying, as formulated by Kübler-Ross (1970) (denial,anger, depression, acceptance) may be more generally applicable to theexperience of the nurse or the carer than that of the patient. I asked Brenda,“When did you have this idea about the Kübler-Ross stages?” She replied,
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I’ll tell you how that came about. I thought, Oh God, I’ve got to putsome references in here, so I looked at Kübler-Ross, and thought,Ashiko didn’t do any of that; that’s rubbish. But then Iremembered thinking, ‘Surely this can’t all be happening to thislovely lady’, and then, ‘Perhaps I’m the one who’s trying to denyit’. So then I looked at the other stages, to see if they described myreactions, and in a way they did. I’d never looked at it like that,because it’s supposed to describe the patients.
To begin with, this seems like a perfect example of how an ‘academic’requirement to link experience with the theoretical literature (seeassessment criterion e) above) may take the form of a creative criticalchallenge, rather than the invocation of previously given categories. Moregenerally, however, it illustrates how ‘reflecting’ upon a practice situationcan be the basis for theoretical innovation even when ‘theory’ is interpretedin a very conventional sense. Thus, Brenda’s work proposes a clearlyformulated elaboration of the Kübler-Ross thesis, namely that the emotionsof professionals and carers involved with the dying (as well as those of thepatients themselves) will probably undergo the following identifiable stages...This could indeed be the starting point for a general investigation. It alsomakes one wonder whether other theoretical formulations concerningprofessional work could be “turned back upon the practitioner” in a similarway. For example, it might be fruitful to use Piaget’s stages describing thecognitive development of young children (unstructured exploration,conservation of qualities, concrete operations, formal operations etc.) as astarting point for analysing how a teacher comes to ‘know’ a new class ofpupils.
Professional Consequences
The basic insight (that practitioners learn from their patients) wasestablished for Brenda by the events surrounding Ashiko’s death, ratherthan by the act of writing about them. But the writing itself has also haddefinite professional consequences. I asked Brenda, “Is there any way inwhich you feel you might act differently as a practitioner, now that you have‘got Ashiko out of your system’ by writing about her?” She replied,
Yes, I am certainly more aware of cultural differences in attitude toillness and health, definitely, and I’m really intent on studyingBuddhism. I’m really going to try to find out why this girl (Ashiko)was as she was. So I’m going to look at some cultural things, andsome religious factors, because we have a multicultural andmultireligious society, and I know how easily I could have tried toimpose my Western ideas on Ashiko. It could have gone reallybadly, because she didn’t react in the way I expected her to react.Fortunately, it went all right ...
‘REFLECTIVE’ WRITING ON PRACTICE
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Brenda is currently undertaking another course, on the care of the dying.She commented,
For this other course, I’ve had to write a Care Study. But havingwritten about Ashiko, I actually approached this Care Study with avery sociological outlook, rather than a medical approach. Soalready it has changed me, because I’m concerned with trying tofind out how this man (who is dying) is acting in the way he is. Sowhereas most people would do the Care Study just going from themedical and nursing notes, and from what they observe whilstnursing the patient, I actually went to visit him and his wife athome, to talk to them in a situation where I was not really in a‘nursing’ role, to try to find out about his life. And I got quite a lotof social history from him. [RW: So if you hadn’t written aboutAshiko ...] No I wouldn’t have bothered; I would just have looked atthe notes. But I actually wanted to know what made him theindividual that he is. Because we have to let people find their ownway of coping.
Finally, and beyond even this development of her awareness of the culturaldimensions of nursing theory and practice, Brenda makes a further and yetmore general point concerning the effect of her work: “I want to emphasisethe communication aspect: I really do feel that I have been shown (or havediscovered) another way to communicate, and this is of great importance tome”.
Correspondence
Branda Landgrebe, Faculty of Health and Social Work, Anglia PolytechnicUniversity, Southend Hospital, Westcliffe-on-Sea, Essex SS0 0RY, UnitedKingdom; Professor Richard Winter, Faculty of Health & Social Work, AngliaPolytechnic University, Victoria Road South, Chelmsford, Essex CM1 1LL,United Kingdom.
BibliographyBenjamin, W. (1955) The story-teller, in (1973) Illuminations. Glasgow: Fontana.
Egan, K. (1988) The origin of imagination and the curriculum, in K. Egan &D. Nadaner (Eds) Imagination and Education. Milton Keynes: Open UniversityPress.
Kübler-Ross, E. (1970) On Death and Dying. London: Tavistock.
Plato (1956) The Meno. Harmondsworth: Penguin.
Rowland, G., Rowland, S. & Winter, R. (1990) Writing fiction as inquiry intoprofessional practice, Journal of Curriculum Studies, 22, pp. 291-293.
Schon, D. (1983) The Reflective Practitioner. New York: Basic Books.
Winter, R. (1986) Fictional-critical writing, Cambridge Journal of Education, 3,pp. 175-182.
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