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

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The Relationship of Theory and
Practice in the Acquisition of Skill
HUBERT L. DREYFUS AND STUART E. DREYFUS
The theory of nursing, as we shall use this phrase, encompassesboth the
medical and nursing scientific knowledge that has been imparted to the
trainee, mostly in nursing school, and the rules of thumb that are largely
acquired during on-the-job training and experience. The term medical
scientific knowledge is rather self-explanatory. Such knowledge draws
primarily on the sciences of chemistry and biology and predicts, among
other things, changes inchemical concentrations and biological events
that various invasive actions will produce. Typical rules of thumb are of
theform if you observethefollowing phenomenon,thenyoushould take
the following action. These are rules of good nursing practice that have
been developed over time and based on experience yet generally deal
with whole situations too complex for analysis in purely scientific terms.
The practice of nursing refers to the actual on-the-job behavior of
experienced nurses consideredto beexperts by their peers and supervisors.
Is this skilled coping behaviorthe result of the application of theory?
Or, is what is taught by experience something more than an increasingly
refined and subtle theory? Ifso, what is it? How does itcome about?
How can it be encouraged and rewarded? These are the issues that this
book will address.
Briefly summarized, we shall argue that while practice without theory
cannot alone produce fully skilled behavior incomplex coping domains
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