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

8 Expertise in Nursing Practice
through trial-and-errorlearning, in addition,ofcourse, to innate behavior,
without benefit of theoretical knowledgeorreasoning abilities. But a skill
such as nursing is far more complex than foraging for food or avoiding
enemies. Itisprobably impossible to learn toexcel in nursing merely by
drawing exclusively from trial and error and from imitation without acquiring
and using articulatable scientific knowledgeor rules of thumb. As
we develop our explanation of the acquisition of complex skills, we shall
delineate the likely necessary contributions of both theory and practice
to the process.
In developing our description of skill acquisition, we, and various
colleagues, haveobserved, and in somecases experimentally studied, the
learning process not only of nurses—which,ofcourse, is the focus of this
book—but alsoofchess players, airplane pilots, and automobile drivers.
We have, furthermore, unashamedly reliedheavily onthe recollection of
someofour own learning experiences. We urge the reader, while tracking
with us the evolution of skillful coping behavior, to recall his or her own
learning experiences not only in nursing but also in other areas to see if
those experiences fit with our description.
Thecareful study of the skill-acquisitionphenomenon has shown us
that a person usually passes through at least five stages of qualitatively
different perceptions of their task as skill improves. Hence, wecall what
followsafive-stage model of skill acquisition. A closer examination of
someofthese five stageswould probably allowtheir decomposition into
their own stages, soour choice of five should notbe regardedasdefinitive
but only as sufficient for our purposes. As we examine in detail how a
novice, if she possesses innate ability and has theopportunity to acquire
sufficient experience, gradually becomesanexpert, we shall focus onthe
most common kind of skill, sometimes called unstructured. The domains
in which such skills develop admit of apotentially unlimited number of
relevant facts and features. The ways that these elements interrelate to
produce later events is often unclear and not capable ofbeing captured
by precise rules. Nursing is certainly carried oninsuchanenvironment,
although the nursing student, learning facts and procedures, may be unawareofthis.
Managers, teachers, and even economicforecasters live in
such an unstructuredworld. Chess,ontheother hand, is a structureddomain,
with a well-definedset of relevant facts (the position of the pieces
on the board) and of legal moves and their effect on the position. While
it is this structured property of chess that makes itpossible for computers,
using primarily brute-force enumeration of a huge number of
possibilities, tocome very close to the best human performance, human
players, lacking thecomputational speed, accuracy, and memory capacity