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

Introduction xxiii
Carnegie Foundation for Advancement of Teaching National Nursing
Education study that demonstrates, from the education side, that nurses
are currently undereducated for the complex, responsible, risk-laden
work that they do. These nurse’s stories bring home the point of what
can be accomplished and what is at stake when nurses perform at high
levels of skilled know-how. This work provides a road map for developing
more effective school-to-work transition programs. It also demonstrates
the need for such programs to be utilized by newly graduated nurses
as well as program offerings for the competent to proficient nurse as
well as the disengaged nurse. In chapter 6, Jane Rubin explains how
the misunderstanding of nursing’s ends can lead nurses to imagine
that clinical judgment is just a matter of simple rational calculations
between well-defined options and attributes this misunderstanding,
in part, to a too narrow education in rational technical strategies.
These narrow educational approaches to clinical reasoning overlook
the skill of involvement and the relational nature of discerning and
interpreting patients’ clinical problems as well as their distress over those
problems.
Christine Tanner, a long-standing advocate of reform in nursing
education, also sees the importance and timeliness of this work in
the development of a new education system in Oregon—the Oregon
Consortium for Nursing Education (OCNE) (Gubrud-Howe et al., 2003;
OCNE, 2008; Tanner et al., 2008). OCNE is a collaboration among several
community colleges and the Oregon Health and Science University
School of Nursing, committed to expanding capacity in nursing education,
transforming curriculum to be more responsive to emerging health
care needs, using pedagogies appropriate for a practice discipline drawing
on this research on skill acquisition in nursing practice and advances
in the science of learning, and reforming clinical education to reflect the
realities of today’s practice. The OCNE project has provided a wonderful
opportunity to work with nursing faculty throughout the state, extending
this study to the development and field testing of new pedagogies.
Like From Novice to Expert, this is both a study of skill acquisition
and a research-based articulation of the nature of clinical nursing
knowledge. This work has proven itself relevant for other practice disciplines,
such as medicine, social work, teaching, occupational therapy,
physical therapy, and others. And although all the examples center
on nursing, the progression from principle-based practice guided by
science, technology, and ethics to response-based practice guided by
practical knowledge accumulated through engaged reasoning will be