value of utilitarian reasoning may be available but it is likely to take the form of a
selection of those things that fit; it is likely to be anecdotal; and it is likely to cohere
with what we already believe to be the good in any case. In this respect such use of
evidence (however this is to be defined) is the same sort of use of evidence that we see
at work in conspiracy theory, in tragedy and comedy in literature, and in the thinking of
credulous individuals.
Being an open-minded nurse
Being open-minded as a nurse is fraught with difficulty especially as much of what
nurses do is prescribed by contractual obligations, institutional and hierarchical
traditions, codes of practice, and various procedures and protocols. These factors give
rise to tensions between individual and corporate professional responsibilities. Given
these constraints it is clear that there is a need for professional phronesis in order that
each nurse can negotiate her or his way in pursuit of nursing as a MacIntyrean practice.
As both MacIntyre and Potter note there is an additional need for institutional
arrangements to be at the very least sympathetic to the idea of virtuous practice if
individuals are to be enabled to practice in virtuous ways. And an appropriate
institutional stance is one that allows practitioners to exercise discretion.
Many institutions use protocols as a way of attempting to standardise practice but it
should be evident that protocols can only ever account for a finite range of possibilities.
There will always remain a need for professional discretion and judgement; that is,
practical wisdom or what I have termed professional phronesis. The dispositionally
open-minded nurse will exercise this professional phronesis with each new case even
where at first sight a patient would appear to fit into the category the protocol is
designed to serve. The open-minded nurse will not only be open-minded about the
validity and currency of the protocol in general but also about the appropriateness of the
protocol for a given individual patient, that is, open-minded in the particular. Any other
position would seem to undermine the notion of an autonomous and accountable
practitioner. The closed-minded nurse will either ignore the protocol altogether or be
inclined to follow the protocol regardless of its validity and regardless of individual
differences among the patients for whom the protocol is designed. The credulous nurse
may abandon the protocol on spurious, inadequate, or insufficient grounds and in the
process render any attempt at systematic care redundant.
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