Open-mindedness
23
follow the protocol in any particular instance. For to
follow a protocol when conditions are such that harm
rather than good is likely to result is a wilful disre-
gard for appropriate professional conduct.
Let me put this into a practical context. Imagine
that a patient has a particular type of wound that fits
nicely into a treatment protocol where dressing X is
required to be renewed daily and is the current
accepted best practice for that particular type of
wound. An individual nurse can be relatively secure
in the knowledge that this is indeed the best evidence-
based practice for that wound but no nurse can con-
tinue to use that dressing if the 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. ILis seems to me to be the
essence of autonomous and accountable practice. Tire
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becomes out of date the nurse who continues to use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 despite evidence to indicate that it is no
longer best practice will be demonstrating a failure of
open-mindedness.
Conclusion
The open-minded nurse is an educational aspiration
and a practical imperative. Hare & McLaughlin’s
(1994) distinction is between on the one hand
those who hold a belief while entertaining the
possibility that they may be in error about that
belief, and on the other those who hold a belief dog-
matically. Their search for a well-defined concept of
open-mindedness is related to their belief that edu-
cation for open-mindedness is an essential compo-
nent of liberal education. They advance a very specific
conception of open-mindedness precisely because of
the need to avoid breeding a generation of sceptics.
Hare & McLaughlin claim that what is required is
that we should educate individuals so as to enable
them to form and revise firm beliefs on the basis
of evidence and/or argument, and that one firm
belief that should remain is the firm belief in
open-mindedness.
BramalI (2000) remains unhappy with this as he
feels it does not address the fundamental limitation
of the rationalist enlightenment underpinnings of
open-mindedness: that is, the dependence on rational
method that prevents Conceptionalization outside of
its own methodological epistemology.
As an alternative, Bramall suggests the need for a
disposition to be not only open-minded in terms of
rational evidence and argument as put forward by
Hare but also to be open-minded about our own
world view. rΓhe essential difference being that not
only will I be ’able and willing to form an opinion, or
revise it, in the light of evidence and argument’ but
that I will also be able and willing to extend the scope
of my evidence and argument by using frames of ref-
erence hitherto alien to my firmly held perspective of
the world. If I understand Bramall correctly he is
asking us to extend our view to take account of evi-
dence and argument that we would normally reject
on rational liberal grounds; that is, evidence and/or
argument that does not meet the usual rational liberal
criteria employed to provide legitimacy. While I can
appreciate that this is indeed consistent with the
notion of open-mindedness, particularly that pro-
posed by Bramall, I remain concerned by the tension
this gives as to how we are to know what is to count
and what is not to count as appropriate evidence
and/or argument. This is a pressing problem if I am to
avoid being accused of credulousness.
In practice, and in order to avoid being found guilty
of professional misconduct, I need to be confident
that the evidence and argument on which I base my
practice satisfies the test of compliance with a body
of contemporary professional opinion. On this analy-
sis such a test is a reactionary force and the uncer-
tainty of the status of information that would
normally be considered to be outside of the bounds
of legitimate evidence is unlikely to convince me that
the potential benefits outweigh the risks. In the mean-
time it will be safer for me to restrict my world view'
to that of the received wisdom but about this I must
remain open-minded.
© Blackwell Publishing Ltd 2003 Nursing Philosophy, 4, pp. 17-24
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