14
Unit 1
Contemporary concepts in nursing
is integrated with practical clinical skills and affective qualities
such as compassion and caring. Thoughtful practice is illus-
trated in Figure 2-1.
Although the components of thoughtful practice all inter-
relate, they are different but they all operate together to create
thoughtful person-centred care.
Thoughtful practice recognises the complexity of con-
temporary nursing and draws wisdom and explanation from
a number of validated theories. Its theoretical base is a syn-
thesis of the theories that have been recognised as influential
on nursing thinking, beliefs, values and behaviours. From
humanist theory and the principle of holistic care comes the
concept of personhood and person-centred care. The cognitive
processes involved in clinical reasoning draw from theories
related to learning such as constructivism, whereas reflective
practice also draws from critical social theory in addition to
constructivist theory. The theories that explain organisational
behaviour that is influenced by personality, values and atti-
tudes underpin the dimension related to clinicians’ actions.
All these theories are contextualised for nursing as thoughtful
practice draws from Virginia Henderson’s concept of individ-
ualised service for people across their lifespan, from Neuman’s
systems model that describes the interaction between people
and their environment and from Watson’s theory of caring
with its emphasis on interpersonal relations (Marriner Tomey
& Alligood, 2009).
Personal and professional attributes
Thoughtful practice is intensely dependent on the personal
attributes of the professional. At the same time, the highly
complex medical and surgical nursing environment also
requires clinicians who can make sound clinical judgements
and decisions that are grounded in good technical knowl-
edge, practical clinical experience and that are well reasoned
using critical, creative and intuitive thinking. In addition, for
thoughtful practice to occur, the registered nurse must practise
in accordance with the professional domains determined by the
regulating authority. Thoughtful practice must be interpreted
within the professional framework provided by the Nursing
and Midwifery Board of Australia’s National Competency
Standards for the Registered Nurse (NMBA, 2006a), which
articulates the professional attributes of the clinician.
Personhood
The concept of
personhood
relates to our being human, to
being the
person
we are as we interact with each other in
a complex world. Although much has been written about
personhood, there is not one single definition. Essentially the
concept of personhood is an expression of our humanity, our
values and beliefs that find expression through our attitudes
and behaviour. These colour the way we interact with, inter-
pret and give meaning to our world, our experiences, and our
relationships. Each person has a concept of self that responds
to the surroundings and others around them. Personhood has
been described as being in a relationship, being in a social
world and being in a place (McCormack & McCance, 2010).
This sense of being a person can be disrupted by illness or
disability, and when this occurs care should be more than a
focus on the disease process but should also be directed towards
rebuilding this sense of personhood.
Person-centredness and person-centred care
At the same time as respecting the person’s ‘self’ within
relationships, there are ‘others’ considered in the concept.
All people have a social context, ‘others’ are the people who
occupy the social world of the person. This includes family
(with its many permutations) and community in the geo-
graphical and social sense (where and with whom they live).
This attention to the extended family is important for any
culture
but is especially vital because of the special place for
family in Indigenous cultures in Australia and New Zealand
(
wh
a¯
nau
means extended family in Ma¯ori). By knowing the
person, we can understand his or her present world and lived
experience.
Person-centredness
is the demonstration of a
respect for personhood through the words and actions of the
professional. The way a person is described may be determined
Figure 2-1
The thoughtful practice
diagram
(Dempsey, J., Hillege, S. & Hill, R. (2013).
Fundamentals of nursing and midwifery: A person-
centred approach to care (2nd ed., p. 236). Sydney:
Lippincott Williams & Wilkins.)
Reflective practice
leading to
personal learning
Clinical reasoning,
judgement and
decision making
Person-centred
process of care
Clinician’s action
in response to
individual clinical
need
PERSON
THOUGHTFUL PRACTICE
