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Chapter 13 Thoughtful practice: Self-awareness and reflection
misused in relationships. This chapter introduces the concept
of empowerment in order for you to commence your consid-
eration of empowerment through reflection; however, a
deeper understanding may only come with experience.
THOUGHTFUL PRACTICE
A thoughtful practitioner, in the context of clinical practice, is
a clinician who is considerate and compassionate, keeping the
person at the centre of all deliberations in order to promote the
humanity and dignity of the person being cared for, while at
the same time preserving respect for the person providing the
care, and examining the situation in order to learn.
A thoughtful practitioner acts as a moral agent. Moral
agency is described in Chapters 1 and 9 as the responsibility
of translating an ethical principle into action. This is the basis
of thoughtful practice. Inherent in thoughtful practice is an
acknowledgement of the influence of power within institu-
tional systems. Thoughtful care seeks to empower individuals
to choose their own health pathway. To achieve this, practical
or essential care is delivered through processes that are holis-
tic and tailored to meet the individual needs of the person.
Care-related decisions are based on sound and systematic
reasoning processes that are evaluated and reviewed through
reflective practice, so that there is continual learning in and
from practice for the benefit of future care encounters.
Although the term ‘thoughtful’ can be applied to clinical
practice, this description does not always apply in reality.
Chapter 9 outlined the rich history of nursing and midwifery.
Over time, many of these work practices have become
enshrined in habit or ritual practice. Research and evidence-
based practice have had an impact on the use of ritual in
practice; the use of evidence as the rationale for decision
making has reduced ritual in many aspects of practice.
However, there are still many areas that have not been
researched where ritual persists. Ritual practice is described
as ‘carrying out a task without thinking it through in a
problem-solving way. The nurse does something because
this is the way it has always been done’ (Walsh & Ford,
1989, p. 9). Not all ritual practice is unwarranted, however;
many researchers have explored both good and bad rituals in
practice (Philpin, 2002). Other researchers refer to ritual
thinking, or ‘habits of the mind’, linking these to individual
attributes of the clinician (Scheffer & Rubenfeld, 2000).
An appreciation of the need to review the ways in which
care is delivered and thought about in order to relinquish
outdated practices has led to the ‘emergence of the new
nurse, the thinking nurse and the reflective practitioner’
(Cotton, 2001, p. 515). Some commentators have concluded
that individuals can improve their practice through reflec-
tion (Paget, 2001), while others have attributed
improvement to critical thinking as a component of clinical
reasoning (Heffer & Rudy, 2008). Thoughtful practice com-
bines the powerful effects of these processes and the
influences they bring to the processes of care, in order to
create person-centred care for the benefit of the person, as
illustrated in Figure U3-1.
Professional context for thoughtful
practice
In Chapter 5, the context of contemporary nursing and mid-
wifery in modern healthcare is discussed. The healthcare
environment is now one of rapid turnover of patients,
shorter hospital stays, alternative patient care settings,
increased technology and medical knowledge, and greater
patient acuity. These changes in the culture, economics and
politics of healthcare have deeply influenced the roles of
nurses and midwives. The practice of all healthcare profes-
sionals is now required to encompass clinical competence as
well as developed reflective skills that enable personal and
professional growth through heightened self-awareness.
These skills complement the clinical reasoning that
enhances sound clinical judgement and decision making
related to patient care. The following section explores this
professional context through the consideration of profes-
sional attributes and how they can be demonstrated in
professional portfolios that capture the individual practi-
tioner’s personal professional journey.
Professional attributes
The ability to reflect and grow through self-awareness has
been recognised as an essential skill for registered nurses
and midwives in Australia and New Zealand. In contempo-
rary practice, the professional registered nurse or midwife is
expected to be able to analyse his or her own practice
through reflection and self-assessment. The Nursing
Council of New Zealand (NCNZ) and the Midwifery
Council of New Zealand (MCNZ) have included reflection
as a key competency for registered nurses. One of the com-
petency domains of the Nursing and Midwifery Board of
Australia (NMBA), which comprise the minimum standards
for practice, also recognises this. The domain of Critical
Thinking and Analysis includes reflective practice as it:
… relates to self-appraisal, professional development and
the value of evidence and research for practice. Reflect-
ing on practice, feelings and beliefs and the consequences
of these for individuals/groups is an important profes-
sional benchmark (Australian Nursing and Midwifery
Council, 2006, p. 4).
Modern professional nurses and midwives are required
to engage in reflection to identify their own needs, to seek
out and use supportive networks to enhance their profes-
sional growth, and to share these experiences with others to
aid in their professional development. These
professional
attributes
are now being recognised as part of the require-
ments for formal authority to practise through professional
registration. There are now national competency frame-
works in use in both countries, which guide registering
authorities in assessing the competence required for both
registration and maintenance of an ongoing standard of pro-
fessional practice. These frameworks outline the process
for nurses and midwives to systematically evaluate their
practice against a set of national competency standards.
