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

Chapter 1 The Relationship of Theory and Practice in the Acquisition of Skill 21
structure their worlds. Since meanings are shared, one can also select
and describe typical cases, laying out what matters and what possibilities
are opened and closed in typical situations. Qualitative distinctions can
then be made between more and less successful interventions. One can
also lookatthe stages through which caring skills develop and formulate
maxims to aid beginners. Yet, the nurse, who is an expert in caring, knows
that she cannot be guided by principles or any pseudosciences of the
psyche but must enter into the situation of the patient and be guidedby
participation and intuition.
In this domain, there can be no clinical knowledge, as Plato would
define it, but there can and must be clinical understanding. Thus, in
caring, as in the case ofthe application of medical theory, one finds a
practice requiring involvement for which there can be no theory. However,
there is an important difference between the treatment of disease
and the care ofillness. In thecase ofapplying the general principles of
medicine, the nurse must be involved inthe activity of using the technology
and must learn to read the bodily signs of disease, not,ofcourse,
as cues for the application of rules but as patterns that solicit the appropriate
intuitive response. The nurse, however, is not only involvedinthe
activity of beginning to bear the science and technology of medicine on
aspecific body with a specific disease but is also in caring. In caring, the
nurse must be able to take onthe perspective ofthe patient and make
peace with the situation and its suffering in order to be touched bythe
situation of a fellow human being and have the tacttoenable that person
to surmount the patient’s illness. Only by combining both technological
and existential skills in their unique practice is the nurse able to heal both
the body and the person.
Thus, nursing has an evenmore privileged place among Western skills
than that of providing an outstanding example ofthe essential place of
practice and intuitioninatheoretical discipline. Nursing is also—and this
constitutes its total uniqueness—a domain showing forth clearly that in
some human areas, there is no place at all for abstract,objective, universal
theory nor for analytical rationality. Besides being the perfect model of
a craft (techne), the caring practices of nursing provide a paradigm case
of skills that have no theoretical component at all.
COMMENTARY
The Dreyfus model of clinical and ethical skill acquisition and formation
of an expert is based onthe notion that experiential learning is essential for