Using patients: exploring the ethical dimension of reflective practice in nurse education

Within nurse education there is a growing interest in the use of reflective practice as a vehicle for professional development. Additionally, clinically reflective practice is seen as an ideal way of improving performance and patient care. In this paper it will be argued that whilst this development is potentially valuable to both professionals and clients, there are major ethical issues which need to be addressed. The "how to' literature appears to focus predominately on the practitioners subjective description and interpretation of events. It is usual for these events to include details of clients: but not usual for clients to be aware that information about them is being used in this way. Within a deontological ethical framework the use of people as means rather than ends is considered to be morally wrong. However, clients have probably always been used by professionals to some extent: Things such as case conferences and clinical trials are legitimated by the intention to improve training and practice, and are regulated by various professional codes and committees. It would appear, however, that reflective practice is quantitatively and qualitatively different from the above, and thus may cross a moral boundary. Reflective practice is not simply re-examining someone's case: it involves personal interpretation and judgement. The reflector may be recording incidents, verbally or in written form, which would not otherwise be recorded, and may be controversial. This raises questions about the nature and ownership of knowledge, and the responsibilities of people who have such knowledge. Systematic and continued reflection may be akin to action research and, as such, considerations of rigour, authenticity and informed consent need to be addressed. Thus whilst reflective practice may prove to be a good thing, it cannot be seen in isolation from wider ethical concerns.