Expert nursing knowledge as an evolutionary process
The introduction of the Framework and Higher Award (ENB 1991b) provides the opportunity for nurses to claim credits for the knowledge they use in practice. The assumption is, that this is accreditable (ENB 1991). This study aims to identify if this is the case by examining the practical knowledge of 35 expert nurses. Expert nurses were chosen as they are the most likely of all nurses to be using knowledge in their practice which is accreditable at diploma and degree levels. The study was carried out in two Health Authorities, using both quantitative and qualitative methods. The later formed the main contribution to the study. Ethnographic and phenomenological approaches were used to guide the workshops, interviews, observation visits and critical incident collection. Modified grounded theory was used for data analysis. As a result of the inductive nature of the study, emphasis changed from identifying knowledge for accreditation purposes, to exploring the types of knowledge and expertise that emerged from the data. Findings challenge much that had been written about nursing knowledge. A number of issues arise. Questions are raised about the definitive way that expertise is presented in the literature. Also, the assumption that the importation of subject matter knowledge will produce practitioners who provide expert care is challenged. Whilst education is seen as important, it is not sufficient. Other factors in the nurses' 'world view' require consideration. The experts exhibited four different 'world views'. These in turn had an evolutionary effect on knowledge development and knowledge use. Four distinct types of expertise were found to have developed. A number of areas are explored in relation to the practical knowledge experts use and include: organisational culture, doctor-nurse, and management-nurse relationships, academic and professional development, empowerment and reflective ability. Issues relating to advocacy, the theory-practice gap, accreditation, and the quality of patient care, are also examined. Implications arise for curriculum builders, managers, nurses and educationalists.