Philosophical Perspectives on Trustworthiness and Open-mindedness as Professional Virtues for the Practice of Nursing: Implications for he Moral Education of Nurses

By way of a contrast the open-minded nurse will have a number of options in relation to
protocols and will need to exercise professional phronesis in order to choose from a
range of possible courses of action. Thus she or he will need to remain open to a
number of possibilities including: the possibility that the protocol may be wrong; the
possibility that the protocol may be in need of revision; the possibility that she or he
may be wrong to follow the protocol in general; and the possibility that she or he may
be wrong to follow the protocol in any particular instance. For to follow a protocol
when conditions are such that harm rather than good will ensue is not only to pursue a
wilful disregard for appropriate professional conduct but it is also to practice with
insufficient regard for the flourishing of more-than-ordinarily vulnerable persons.

To put this into a practical context, imagine that a patient has a particular type of wound
which is of a kind appropriate for a specific treatment protocol where dressing x is
required to be renewed daily and is the current accepted best practice for that particular
type of wound. It would be reasonable for an individual nurse to start with an
assumption that she or he can be relatively secure in the knowledge that this is indeed
the best evidence-based practice for that wound but no nurse can continue to use that
dressing if other evidence points to a failure of dressing x to aid the healing process in
the wound of a particular individual patient. The nurse must be able to deviate from the
protocol when the occasion requires but in so doing the nurse needs to be sure that there
is sufficient evidence on which to base a decision to deviate. This requires the exercise
of professional phronesis and represents the essence of autonomous and accountable
practice. The nurse is justified in following the established protocol (using dressing x)
provided the protocol remains dynamic (that is, is updated to take account of new and
compelling evidence). Thus the nurse cannot merely rely on the protocol for if the
protocol becomes out of date the nurse who continues to use dressing x in spite of
evidence to indicate that it is no longer best practice will be demonstrating inter alia a
failure of open-mindedness.

In practice, and in order to avoid being found guilty of professional misconduct a nurse
needs to be confident that the evidence and/or argument on which she or he bases
practice satisfies the test of compliance with a body of contemporary professional
opinion. As such there is a sense in which a nurse is right to be wary of using sources of
evidence and/or argument that do not already have legitimacy among fellow
professionals. Given the pervasive influence of the so-called ‘hierarchy of evidence’

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