Open-mindedness
21
is true then individual practitioners are required to be
disposed to form and revise beliefs on the basis of evi-
dence and/or argument.
If I am to say that open-mindedness is a virtue then
those who are not open-minded are failing in some
way. Following Aristotle I will claim that there are
two failures (vices) of open-mindedness.
One failure is easy to identify as narrow- or closed-
mindedness. Often considered to be the opposite of
open-minded, the closed-minded person is one who
will come to, or hold, a firm view despite evidence to
the contrary; it describes someone who is closed to
the possibility that she or he may be wrong.
The other failure is perhaps less obvious and might
be described as a failure of the critical component of
open-mindedness; that is a tendency to form, or
revise, an opinion without the benefit of evidence
or argument. Such a readiness to believe on weak
or insufficient grounds is credulousness.
Thus open-mindedness can be described as a virtue
lying at a mean between closed-mindedness and
credulousness.
While the traditional enemy of open-mindedness is
closed-mindedness I suspect that credulousness is a
more insidious vice. The closed-minded person will
turn away from reasoned argument, will be unpre-
pared to review the evidence, and will resist change
on the basis that their practice has served them well
in the past and will continue to do so.
In contrast the credulous individual will be ever
ready to adopt the latest idea without thinking
through the evidence or argument on which the
proposed change is based or without considering
the implications and/or likely consequences of the
change.
There remain many practices that are ritualistic
and that have successfully resisted change. Tlris con-
tributes to, and perhaps is even explanatory of, the
‘practice-theory’ gap. Students often complain of
the discrepancy between what they are taught in
the classroom and what they see in the real world of
practice. By way of illustration I shall use the example
of manual handling.
It was once the case that nurses were required to
lift patients. Some 20 or 30 years ago an emphasis was
put on lifting techniques that used ergonomic princi-
pies and correct positioning to minimize the potential
for harm to patients and/or staff. Even at that time
there was a marked reluctance in clinical areas to
change the traditional ‘underarm’ lift, despite wide-
spread acceptance of evidence demonstrating the
potential hazards to both patients and staff.
Some of the techniques designed to avoid harm
were adopted during the 1980s only to be subse-
quently discredited by new evidence. In addition,
European directives have led to the introduction of
restrictions on permissible lifting loads that have
effectively outlawed the lifting of adult patients.
Hence, the term manual handling rather than lifting.
There are a number of devices designed to make easy
and effortless the manual handling of patients, many
of which are inexpensive, readily available, and rela-
tively simple to use, yet resistance to the use of these
devices is apparent to any who work in clinical areas,
and worse still discredited lifting techniques, includ-
ing the ‘underarm’ lift, continue.
The United Kingdom Code of Professional
Conduct (Nursing & Midwifery Council, 2002)
requires that nurses act to ‘... promote and protect
the interests and dignity of patients and clients’
(Nursing & Midwifery Council, 2002, pp. 3-4). To
avoid being found guilty of professional misconduct
a nurse must be sure that the procedures and prac-
tices she or he undertakes are compatible with
current best practice. That is, practices that a body of
contemporary professionals would consider to be
consistent with current best practice. It does not need
to be cutting edge but it does need to be practice
based on valid conclusions drawn from the available
evidence, and furthermore each nurse is required to
maintain her or his professional competence.
Measured thus, a nurse who continues to lift rather
than manually handle is failing to practice in a way that
is consistent with current best evidence-based prac-
tice. While it is important to retain an open mind in so
far as it is possible that new evidence may become
available to show that current manual handling tech-
niques are not best practice, it is folly to suggest that
the current evidence implies anything other than
nurses should manually handle rather than lift.
While I am prepared to concede that there are a
number of reasons why some nurses continue to lift
© Blackwell Publishing Ltd 2003 Nursing Philosophy, 4, pp. 17-24
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