Oral Presentation The 26th International Nursing Philosophy Conference 2023

Perspectives of Schön’s reflective practice on nursing reasoning under uncertainty (#39)

Lara Daniela PhDc Cunha 1 2 , Márcia PhD Pestana-Santos 3 4 , Lurdes PhD Lomba 4 5 , Margarida PhD Reis Santos 6 7 8
  1. ICBAS School of Medicine and Biomedical Sciences, PhD student in Nursing Sciences , Porto, Portugal
  2. Health Sciences Research Unit: Nursing (UICISA: E), Research Fellow, Coimbra, Portugal
  3. Escola Superior de Enfermagem de Coimbra (ESEnfC), Adjunct Professor, Coimbra, Portugal
  4. Health Sciences Research Unit: Nursing (UICISA: E), Researcher, Coimbra, Portugal
  5. Escola Superior de Enfermagem de Coimbra (ESEnfC), Cordinator Professor, Coimbra, Portugal
  6. Escola Superior de Enfermagem do Porto (ESEP), Coordinator Professor, Porto, Portugal
  7. CINTESIS@RISE (Center for Health Technology and Services Research), Researcher, Porto, Portugal
  8. ICBAS School of Medicine and Biomedical Sciences, ., Porto, Portugal

Through technical rationality, healthcare professionals address instrumental problems by applying the theory and technique arising from scientific knowledge. Nevertheless, the divergent situations of practice characterised by uncertainty, instability, and uniqueness place nurses in a positivist epistemological dilemma. Decision-making under uncertainty is a challenge that nurses face daily in clinical practice. Post-anaesthesia nurses anticipate critical events based on the interaction between (un)known factors of clinical reasoning, putting uncertainty tolerance into perspective. With undeniable epistemological relevance, few nursing researchers have addressed this issue. The aim of this paper is to critically reflect on Schön's reflective practice on nursing reasoning under uncertainty. The main philosophical foundations of reflective practice will briefly frame the problematic of nurses’ reasoning under uncertainty.

Reflective practice presupposes attention to practice epistemology that attends to conceptions of tacit professional knowledge generated through reflection for, in and on practice. The active construction of practice reality starts from the awareness of the variety of available structures, resulting in the need to reflect on the previously tacit structures in action. By making implicit structures explicit, nurses become aware of alternative ways of framing the reality of practice. The individual assesses the values and norms to which has prioritised and those which have been set aside. In this way, awareness of tacit structures creates awareness of more possibilities for action. Critical evaluation of one's own behaviour as a means of developing skill in the workplace, in which thought and action are integrated in a dialectical process, is integrally linked to the "dialogue of thinking and doing through which I become more skillful" (Schön, 1987, p.31).

It is considered that greater focus on reflective practice and its implications for nurses' decisions in situations of uncertainty about clinical reasoning in nursing may contribute to the quality of patient care.

  1. Schön D. (1987). Educating the Reflective Practitioner. Jossey-Bass, New York.