Developing Practice in Healthcare: The Contribution of Bildung to Negotiating the Tensions among Practical, Professional and Organisational Knowing

Action research provides a framework for developing practice in healthcare. While developing practice typically implies a combination of patient centeredness, quality improvement and change, conflicts arise in how concepts such as patient centredness are defined. Developing practice invites attention to positionality and engagement with policy directives, trends in clinical care, and other disciplines each with their own language stratification reflecting particular sets of values and beliefs. Our process of engagement is value-based, requiring attention to different and often conflicting languages or worldviews. We understand practice development as responding to different calls from the system, our individual disciplines, patients and changing discourses in healthcare, each exerting different pressures at different times. This paper describes an action research project aimed at developing nursing practice through engaging with two conflicting philosophies of care. We illustrate the contribution made by a particular understanding of Bildung to engaging with positionality, different voices in healthcare and the context of care in a complex environment. Bildung, as self-cultivation, invites engagement with other as an underpinning for developing practice beginning with first person inquiry. The idea of Bildung drew attention to the local moral world of nursing and the experience of dual citizenship. Dual citizenship reflected engagement with conflicting care philosophies and notions of evidence.