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Chapter 2   Thoughtful practice

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

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

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

Context of thoughtful nursing and midwifery practice

Reflective practice

Reflection

Critical thinking

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.)