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

18 Expertise in Nursing Practice
reasoned observation of one’s intuitive, practice-based behavior with an
eye tochallenging, and perhaps improving, intuition without replacing it
by the purely theory-based action of the novice, advanced beginner, or
competent performer.
Another exampleofwhere theory interacts with practice occurs when
an expert intuitively feels that a situationisso novelasto preclude intuitive
response. The first reaction of the expert will be to seek the advice of
someoneforwhomthecurrent situationisnotnovel, due to their differing
experiences. If that is impossible, recognizing intuitively the need for
theory, the expert will try to recall the rules and scientific knowledge
he learned asabeginner inorder tocope with the novel situation. Not
only novelmedical conditions can elicit competent,calculatedbehavior,
but they can also cause changes inthe working environment. If a nurse
has been assigned to anew ward or transferred to anew hospital with a
different working culture, it might be bettertocalculateout a competent
response to a familiar situation than to intuitively respond in a way that
was considered expert under previous circumstances.
We have seennowhowtheory interacts with practice in surprisingly
interesting and important ways. Anyone seeing skill as merely theoretical
knowledgeorasonly practicedresponse will miss much of this intriguing
picture. The very rules and principles so highly valued bythe theoretician
almost always, when closely examined, are seen to require fortheir
application facts and features, some ofwhich are recognized thanks to
practice but undefined bytheory. Practice, on theother hand, would
probably beoflittle avail were it notpreceded by training concerning the
relevant features in various situations and some theoretical understanding
of relationships and correlations among these features. With these
learned conceptual and theoretical ideas from whichto start, the learner
can safely begin to take responsibility and acquireexperience.More importantly,
it is quite possibly the brain instantiation of this conceptual
knowledge that experience will eventually override, as these rule-based
proceduresare replacedbythe synaptic modifications that make possible
an intuitive response. Without theory as a starting point, no twoobservers
giventhe sameexperienceswould be likely to see things in remotely similar
ways. A new set of circumstances would likely be responded to by
theseobservers in radically different ways rather than in theconsensually
accepted way evinced by similarly trained experts. Without consensual
agreement concerning good practice, no meaningful after-the-fact discussion
could occur, and little progress in improving theoverall skill level
of the group could transpire.