Drawing on cognitive continuum theory necessarily leads to consequences which are not addressed in Thompson's paper: namely a need to consider the quality of nursing decisions, and a willingness to consider approaches to decision making which have been neglected or criticised by nurses. These consequences are explored here, and the implications of adopting this approach for nurses are outlined.

No clear fit with any existing theoretical framework was identified. However, nurses in the highest grade banding, in particular, demonstrated practices associated with transformational leadership. Nurses expressed the very clear need to be acknowledged, respected and valued, and that those who provided this support were regarded as good leaders.

In this paper, the author reflects on the new practitioner envisaged by developers of the Project 2000 curriculum in Scotland, and focuses on the need to develop critical thinking ability, in particular in relation to clinical decision making. Two approaches to decision making are outlined: the rationalist perspective and the phenomenological perspective, and a model illustrating each is discussed. The models examined are, respectively, decision analysis and hypothetico-deductive reasoning, and their relevance to nursing outlined. The author concludes by discussing the nursing process model from both perspectives; and by recommending that nurses learn from the work done by other disciplines on professional judgement. The suggested role of the nurse teacher in preparing the new practitioner is outlined.

A rationale for adopting a Bayesian perspective on evidence interpretation is offered: namely the changing context of practice, with the blurring of professional boundaries and the need to articulate judgements, the avoidance of error and the opportunity to identify the appropriate areas for investigation in nursing.

There is scope to develop a more conceptually complex model of anticipatory care, building on this initial exploration, within which all aims, roles, practices and methods of evaluation can be located and clearly visible. This offers the potential to enable practitioners to interpret and apply policy--otherwise change may be limited and result in service gaps.