Chapter 2
Thoughtful practice
19
other nurses. Therefore, nurses will be confronted with a
range of situations that require clinical reasoning, judgement
and decision making. In a normal shift, any clinician may be
required to make a decision every minute (Thompson et al.,
2008). Thoughtful practice acknowledges the interconnected-
ness of the process of clinical reasoning and reflection that is
discussed in the following section.
Reflective practice
Reflection (Figure 2-3) can be seen as the final component
of reasoning as it is the component that informs future deci-
sions and actions. The learning that comes from experience
that complements the knowledge acquired through inquiry is
exponential when it is accompanied by reflection, the act of
examining what we have experienced in order to learn from it
and improve what we do. The process of reflection is based on
‘metacognition’ therefore, reflection should occur after actions
are taken and evaluation completed. Reflection is only made
possible through self-awareness (Jack & Smith, 2007).
Self-
awareness
is the conscious process of understanding ourselves,
our beliefs and values, and is developed and nurtured through
reflection. As reflection will always be influenced by the
personal and professional ethics of the person reflecting, the
thoughtful practitioner must have a complete understanding
of professional ethics. The next section considers ethics in
more detail.
Ethics and morality
The terms
ethics
and
morality
are used to describe beliefs
about right and wrong and to suggest appropriate guidelines
for action. In essence, ethics is the formal, systematic study
of moral beliefs, whereas morality is adhering to informal
personal values. However, because the distinction between
the two is slight, and ‘moral’ also has connotations and
assumptions of personal-judging behaviour, they are often used
interchangeably.
Moral agency
Being person-centred applies to the behaviour of the clinician
as an agent, that is the clinician intentionally makes some-
thing happen through a deliberate action (Kalaitzidis, 2009).
Moral agency
is the responsibility of the individual to translate
their own and the profession’s moral principles into action
(Edwards et al., 2011). In a therapeutic relationship, there is a
moral agency that demands that the notion of personhood is
preserved through the actions of the healthcare professional.
In order for clinicians to be person-centred, moral agency
means that they must be reflective. In this way, clinicians can
know themselves, so that their own values, beliefs, biases and
prejudices, and the impact these can have on the care they
deliver is understood. Through examining their own values
and beliefs, reviewing their knowledge base and rectifying any
deficits or omissions, person-centred care can be optimised.
Moral situations
In the complex modern world, and in contemporary nursing,
we are surrounded by ethical issues in all facets of our lives.
Many situations exist in which ethical analysis is needed.
Some are
moral dilemmas
,
situations in which a clear conflict
exists between two or more moral principles or competing
moral claims. Other situations represent
moral problems
,
in
which there may be competing moral claims or principles, but
one claim or principle is clearly dominant. Some situations
result in
moral uncertainty
,
when one cannot accurately
define the moral situation, or the moral principles to apply,
but has a strong feeling that something is not right. Still other
Self-awareness
Critical thinking
Reflective
practice
Context of thoughtful
nursing and
midwifery practice
Reflection
Figure 2-3
The components of reflective practice
(Dempsey, J., Hillege, S. & Hill, R. (2013). Fundamentals of nursing and midwifery: A person-centred approach to care (2nd ed., Figure 13-1). Sydney:
Lippincott Williams & Wilkins.)
