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Derek Sellman
despite evidence to show the potential for harm, I use
this illustration as an example of closed-mindedness
in practice. Those who lift know they should not and
the most common reason cited is a lack of time. There
are obstacles, including a lack of readily available
equipment, complicated equipment, lack of training
in use of equipment, and so on, but I am minded to
suggest that these obstacles could be overcome rela-
tively easily. It seems to me that to continue to lift
when there is such a weight of evidence (and I
emphasize there is no controversy about this evi-
dence) is a failure of open-mindedness. As Aristotle
(1953) reminds us in the Nichomachean Ethics, a
virtue is a disposition to act. When I claim that open-
mindedness is a virtue I am claiming something more
than just the forming or revising of beliefs; I am claim-
ing that the open-minded nurse is one who is disposed
to act in a manner consistent with those beliefs.
TTiis example is in sharp contrast to the wholesale
adoption of advocacy as a legitimate part of the role
of the nurse during the 1980s and 1990s with very
little critical debate, and certainly without a generally
accepted definition of the term. Seedhouse (2000) has
reviewed the ways in which advocacy has been inter-
preted by nursing scholars and finds disagreement
and variation together with a lack of any clear analy-
sis of the concept as it relates to practising nurses. This
I take to be a different sort of failure of open-
mindedness; a tendency to form a belief on the basis
of insufficient evidence and/or argument, that is,
credulousness. It is tempting to think that it might be
the case that nurses are able to quickly make up their
minds on the basis of the available evidence (after all
nurses are often required to make clinical decisions
rapidly) but this would be to mistake credulousness
for open-mindedness. Advocacy was adopted as one
of the ‘big ideas’ of its time and it has become part of
the received wisdom of nursing; effectively, case
closed - move on to the next idea.
Open-mindedness and practical
application
For reasons both explicit and implicit in the above
discussion I take it that open-mindedness is an edu-
cational ideal. Its importance in specific practice-
based occupations such as nursing is particularly
apparent where the capacity for harm is inherent in
everyday activity.
The education of nurses is based on a number of
assumptions. One explicit assumption is that each
qualified nurse is required to be an autonomous prac-
titioner accountable for what she or he does or fails
to do within her or his area of influence. Yet despite
this injunction much of what hospital nurses do is pre-
scribed by contractual obligations, institutional and
hierarchical traditions, codes of practice, and various
procedures and protocols. These factors give rise to a
tension between individual and corporate profes-
sional responsibilities.
It is evident that protocols can only cover a finite
range of possibilities, there will always remain a need
for professional discretion and judgement. The dis-
positionally open-minded nurse will approach each
new case with an open-mind even where at first
sight the patient would appear to fit into the category
the protocol is designed to serve. Tlie open-minded
nurse will not only be open-minded about the valid-
ity 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 par-
ticular. Any other position would seem to undermine
the notion of an autonomous and accountable
practitioner.
The closed-minded nurse is most likely 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
is likely to abandon the protocol on spurious,
inadequate or insufficient grounds and in the
process render any attempt at systematic care
redundant.
By way of a contrast the open-minded nurse will
have a number of options in relation to protocols and
will need something like practical wisdom to assist in
choosing 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 pro-
tocol 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
© Blackwell Publishing Ltd 2003 Nursing Philosophy, 4, pp. 17-24
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