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

20 Expertise in Nursing Practice
understood, preserved, and enhanced by nursing as a caring profession.
As Benner and Wrubel (1989) put it, “Nurses promote healing through
assisting the patient in maintaining the human ties and concerns. And it
is this human connection that gives people the courage to weather their
illness” (p. 87).
Since the human way of being is involved and holistic, there can
be no abstract, analytical theory of it. Caring is what one might call an
existential skill. It is, indeed, what Socrates would have called aknack,
but since, unlike cooking, it is a matter of life and death and involvesthe
whole person, that term hardly seems appropriate. Itshows the power of
a tradition based on the theory of disease that the existential skills have
no traditional name that doeshonorto their importance and uniqueness,
and we seem to have no appropriate word for them inour vocabulary.
The best we can come up with is that caring, as a way of helping people
by entering their world, is a higher kind of knowledge that we can call
understanding.
Psychotherapy, which claims to have atheory of mental disease—
that is, ascientific account of the mind and of its normal and abnormal
functioning—might seem to belie our claim that there can be no theory
of tact. However, if theexistential thinkers arecorrect, and we think
theyare, a psychology such as psychoanalytical theory (modeled onmedical
theory) with its handbook of psychopathology (modeled on bodily
pathology) isadream that can never be realized. It isinteresting in this
connection to note that as psychotherapists gain experience in caring
for patients, despite their intense theoretical disagreements, they come
more and more to resemble each other intheir practice. This suggests
that psychotherapists make less and less useoftheory as they gain expertise.
Nurses,ontheother hand, insofar as their work consists in applying
medical theory, learn and apply more and more theory as theyincrease in
experience and expertise. Their understanding of where theory is appropriate
should help nursesresist any temptationtoformulate the principles
of their existential skills. Thecurrent theories of caring in nursing are typically
interpretive perspectives on care, but this should not undermine
their legitimacy (Benner, 1994a; Morse, Bottorff, Neander, &Solberg,
1991).
This does not mean that there is nothing to be said about the tact
involvedinworld preserving. We have already said a gooddeal. Onecan
describe the general structureofhuman beings and the way careconsists
of mattering, possibilities, and inhabiting a shared world. This is what
Heidegger (1962) calls an existential account of the human being. One
can also describe in detail howspecificcultures,families, and individuals