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

10 Expertise in Nursing Practice
recognize without benefit of experience. The beginneristhen given rules
for determining actions on the basis of these features, like a computer
following a program. Through instruction, the novice acquires rules for
drawing conclusions or for determining actions based upon facts and
features of the situation that are recognizable without experience in the
skill domain being learned. These elements are either objective ones,
such as instrument readings,or subjectiveones,ofwhichthe novice can
reasonably be expected to have acquired arecognition ability based on
prior experience in other domains. For example, any adult beginning
nursing school can identify a state ofhigh agitation, even though no
formula applied toobjective features such asheart rate can consistently
do this job.
The knowledge impartedto the novice is what we havecalled theoretical
knowledge, yet,even at this first level, it can requirefor its application
assessments, such as that of extreme agitation, that admit of no theoretical
description. We have already, at this initial stage, an example ofthe
superiority of combining theory and experience-taught capabilities.
To make our skill description more accessible, we will illustrate our
distinctions with examples chosen from automobile driving, as almost
all readers have acquired this skill. In later chapters, using actual words
of nurses aswell as descriptions of their behavior, we will follow the
skill-acquisition process as it relates to nursing.
Along with many other rules, the novice driverisgivenaformula for
the safe distance at whichtofollowanother car as a function of objectively
determinedspeed as indicatedbythe speedometer. Of course, the novice
is nottold howto recognize a car as opposedto an elephant (whichprobably
should not befollowed asclosely), since this ability is assumed to
have been already acquired. Interestingly, no strict rules haveeverbeen
found that would allow acomputer, using only objective data such asa
digitized video image, toconsistently and correctly distinguish a member
of theclass of cars from all other objects, demonstrating the inadequacy
of depending upontheory alone. Itseems that our car-recognition ability
comes from experience through a brain-modificationprocess that neurophysiologists
and mathematicians studying artificial neural networks are
beginning to understand in terms of synaptic reinforcement and inhibition
based on outcomes of behaviors. The ability to discriminate between
different sensory inputs and to learn to respond differently to different
classes of input almost certainly doesnotdepend on rules and principles,
evenunconscious ones,ofthe type givennovices during their theoretical
training.