Expertise in nursing practice : caring, clinical judgment - Springer ...

Introduction xxi
parentheses or asides, and captures both forward and retrospective
thinking, because the end of the story is known by the storyteller. Thus,
a narrative can better capture practical clinical reasoning as it occurs
in transition. We have learned that practitioners, through experience
within a socially based practice, build narratives and memories of salient
clinical situations as they move from novice to skillful practitioner.
With experience, concrete situations become coherent and help the
practitioner develop a sense of doing better or worse, of recognizing
similarities and differences, and of participating in common meanings
and practices. Others’ practice narratives allow practitioners to recognize
reoccurring distinctions and common clinical entities and issues.
Readers of this work may make a wrong assumption that first-personexperience-near
narratives of actual events are hopelessly idiosyncratic
and subjective and therefore not transferable or generalizeable. But the
logic of narrative understanding fits practical knowledge and practical
reasoning (Benner, Sutphen, Leonard-Kahn, & Day, in press; Sullivan &
Rosin, 2008) and is of great use for understanding commonly occurring
situations within a socially organized practice. It is similar to the need in
biology to understand the habitat and singular life of a particular animal in
order to understand the usual life course, particularities, habits, and situated
actions in context and styles of the animal. A similar need exists for
any clinical practice to understand commonly occurring clinical situations
as perceived and confronted by fellow clinicians. This level of knowledge
bridges the gap in understanding from the general to particularities,
actions, and exigencies of practical reasoning in local contexts. Formal,
abstract, and general knowledge is necessary but not sufficient for any
professional practice. For example, in order to use the generalizations
available from evidence-based clinical research, the practitioner must be
able to discern how and which evidence is relevant to a particular situation.
Narratives typically exhibit high levels of validity, especially when
the readers of the narratives are knowledgeable in the field that gave rise
to the narrative. While there may be disagreements in the meanings of the
narratives, when groups are instructed to stay within the situated bounds
of the story set up by the narrator, and do not import new unavailable possibilities
or speculations, a high degree of consensus of meanings is possible
and has been demonstrated in clinical promotion programs where
peer reviews are used. The context of nursing practice has changed dramatically
in the 25 years since From Novice to Expert was published. The
caring practices central to nursing were articulated in 1984 in the midst of
nursing shortages and in the budding awareness that caring practices were