By David Seedhouse
19/05/2020 05:09 AM 
Our book, USING PERSONAL JUDGEMENT IN NURSING AND HEALTHCARE, clarifies decision-making in nursing and healthcare. It explains that personal judgement is essential in everyday practice, and offers realistic scenarios for personal reflection and group debate.

The book is designed for nursing students and lecturers from first year undergraduate to postgraduate and advanced practitioner, as well as students and lecturers in any other clinical and allied health discipline. It is particularly effective in programmes on critical thinking, decision-making, reflective practice and ethics.

As writers and thinkers, who wish to use our minds and experience to support and improve healthcare education and practice, we were most definitely aware that we faced a massive challenge in writing this book. We’re operating in a rule-based culture that’s advocated by every official body, is promoted in most texts for students, and is comprehensively validated in accredited health professional education. Yet despite its popularity, this culture fails to properly appreciate, or possibly is even afraid of, the free-thinking human factor.

Consequently, we decided that we must engage in an honest exploration of personal judgement, and that this must include pointing out the limitations of the present drive for more and more regulation and uniformity. Personal judgement happens constantly in healthcare. It often conflicts with or is quite different from the rules. But this does not mean that the rules and standards are unimportant, rather they are genuine attempts to encourage health professionals to be the best they can be - it’s just that we feel that to achieve this we need standards AND we need self-awareness, creativity and personal engagement as well.

We’re looking, we suppose, for the best of both worlds. Therefore we encourage readers to research evidence-based practice (EBP), learn and apply the many professional standards if they wish, while reflecting on what they mean to them personally, using examples from experience wherever possible. And we also encourage readers to understand the power of personal judgement, to appreciate how essential to good practice it is, and to use this book’s ideas and concrete examples to boost self-awareness, awareness of others, and awareness of life’s complexities and differences.

There are encouraging signs that both shared standards AND deep personal reflection will increasingly be officially acknowledged, and will therefore form a vital part of future education and practice. For example, in 2019 the NMC began to recommend that:

‘At the point of registration, the registered nurse will be able to:

1.8 demonstrate the knowledge, skills and ability to think critically when applying evidence and drawing on experience to make evidence informed decisions in all situations

1.10 demonstrate resilience and emotional intelligence and be capable of explaining the rationale that influences their judgments and decisions in routine, complex and challenging situations

1.14 provide and promote non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments

1.17 take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop their professional knowledge and skills

1.18 demonstrate the knowledge and confidence to contribute effectively and proactively in an interdisciplinary team’ (21)

While these requirements still lack exact guidance (how do you actually ‘reflect on people’s values and beliefs’? And if you find they are not the same as yours, can you really be ‘non-discriminatory’) we believe that this is as it should be. It would be impossible and pointless to write specific instructions for every set of circumstances, so we applaud these latest official attempts to encourage personal judgement. And we hope very much that our book will help connect these thought-promoting guidelines and attributes with the complexities and unknowables of everyday practice.

We think that critical thinking and careful reflection is needed now more than ever before.
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