If the nurse is aware of an area of waste that can be addressed and does not reflect a legal concern (reusing some things is unlawful) then the nurse can bring this to the attention of the group and a solution can be developed and hopefully acted upon. This is a simple example. A more complex example would be an aspect of patient care that did not reflect the facility's goal to ensure effective home transitions for patients. If a nurse is aware of the fact that an individual patient has met all the healing goals but has no one at home to help them recover and is a party to allowing the individual to leave the facility without intervention, he or she may need to reflect on the overall policy and how he or she could have been involved in making a referral so that the individual patient did not return home without the support they needed, simply as a response to facility demands for beds or cost reduction. Each of these debates, simple or complex can have a serious result in changing policy or applying good policy that has already been supported. The role of the nurse as patient advocate is also seriously invested in this reflective process. Focusing on the ideals of caring and nurturing and looking at discrepancies in personal and/or facility policy and practice could serve as a supportive function for renewed interest in providing the best care possible in the best place possible and with the most reflective policies possible. 3rd Level

Reflection which besides the above incorporates ethical and political concerns: issues of justice, equality and emancipation enter the deliberations over the value of professional goals and practice and the practitioner makes links between the setting of everyday practice and broader social structure and forces." (Bulman & Schutz, 2004, p. 169)

The reflective exercise that would be necessary to help the individual and/or the group of nurses understand the global aspect of care that they provide can be...

The ethic of care with regard to provision and access can create a constant sense of not being able to do enough for enough people. There are many individual nurses who feel the strain of not being able to provide all the care that someone needs as a result of limited resources and most offensively the lack of health insurance. The political and social aspects of providing care can and often do interfere with the work that is done in the medical industry and yet it is also clear that many individuals in the system feel isolated and insolated from the global concerns of care. Global concerns of the ethic of care can be innovate by reflective processes that give the nurse a better understanding of what they or their facility can do to better serve the local and global community, be it to volunteer in the community or advocate for services through personal or facility lobbying. Reflecting on how the medical industry impact the environment and on how access (or lack there of) impacts the community in which one lives is absolutely essential to developing responsive and responsible ethic of care.
Conclusion:

Clearly collaborating these three reflective focuses could make nursing and health care better in many functional and innovative ways. The idea that the system is rather insular has been proposed by many and needs to be looked at reflectively to resolve this feeling and reality in the profession, so nurses and those who work with them are much more aware of their role, individually, locally and globally. This "way of thinking" may greatly influence this goal. Goodman's theory of reflection is clearly a productive theory that could greatly enhance the profession.

References

Bulman, Chris & Schutz, Sue. (2004). Reflective Practice in Nursing (3rd). (New York:

Blackwell Publishing)