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

Chapter 1 The Relationship of Theory and Practice in the Acquisition of Skill 15
of a complex competition. In fact, at the moment of involved intuitive
response, there can be no doubt, since doubt comes only with detached
evaluation of performance.
Notice that we have stressed how the involved, experienced performerseesgoals
and salient facts but nothowhe sees immediately what
to do to achieve these goals. This is because there are far fewer ways of
seeing what is going on than ways of intervening through actions. The
proficient performer simply has notyet had enough experience with the
wide variety of possible actions in each of the situations that hecan now
discriminate to have renderedthe best response automatic.For this reason,
the proficient performer, seeing the goal and the important features
of the situation, still must decide what to do. To do this, he falls back on
detached, rule-based determination of actions.
The proficient driver, approaching a curve on a rainy day, may intuitively
realize, due to brain activity induced by synaptic modifications
produced during prior experiences, that she is going dangerously fast.
She then consciously decides whether to apply the brakes or merely reduce
pressure by some selected amount on the accelerator. Wecall this
driver proficient rather than expert because valuable moments may be
lost while an actionisconsciously chosen,or time pressure may lead to a
less than optimal choice.Yet, this driveriscertainly more likely to safely
negotiate the curve than is the competent driver, who spends additional
time deciding, based onspeed, angleofbank, and felt gravitational forces,
that the car’s speed isexcessive.
STAGE 5: EXPERT
The expert not only knows what needs to be achieved, based on mature
and practiced situational discrimination, but also knows how to achieve
the goal. A more subtle and refined discrimination ability is what distinguishes
theexpert from the proficient performer. This ability allows the
expert to discriminate among situations all seen as similar with respect
to the plan or perspective, distinguishing those situations requiring one
action fromthose demanding another. As with the proficient performer,
synaptic modifications caused byactions, experienced with involvement
account for responses that turn out to be appropriate being reinforced,
while those that do not work out well are inhibited. In short, the expert
not only sees what needs to be achieved but also howto achieve it. When
things are proceeding normally, experts do not solve problems and do