Textbook of Medical-Surgical Nursing 3e

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Unit 1 Contemporary concepts in nursing

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

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

THOUGHTFUL PRACTICE

Reflective practice leading to personal learning

Clinical reasoning, judgement and decision making

PERSON

Clinician’s action in response to individual clinical need

Person-centred process of care

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.)