Advancing Practice in Critical Care: a Model of Knowledge Integration Dr Martin Christensen Assistant Professor Alice Lee Centre for Nursing Studies National University of Singapore Singapore
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Advancing Practice in Critical Care: a Model of Knowledge Integration
Dr Martin Christensen Assistant Professor
Alice Lee Centre for Nursing Studies National University of Singapore
Singapore
Advanced Practice
…a registered nurse who has acquired the expert knowledge base, complex decision making skills and clinical competencies for expanded practice.
…advanced practitioners have an eclectic knowledge base, are grounded in practice and support education and research.
…advanced nursing practice is a state of professional maturity, one in which practitioners are pioneering innovators and developers of health care.
Advancing Practice
The essence of advancing practice centres on the continual acquisition of ‘new knowledge’ and skills to enhance and complement previous theoretical and practical knowing.
Identifying Nursing Knowledge
Carper’s (1972): “Ways of Knowing”
Benner’s (1984): “Novice to Expert”
Jacobs-Kramer & Chinn (1988): “Perspectives of Knowing”
Liaschenko & Fisher (1999): “Case, Patient & Person Knowledge”
Presenter
Presentation Notes
Liaschenko & Fisher (1999) suggested that the work of nursing is encapsulated within case, patient and person knowledge. However, their original conception for this model came from the work of Strauss et al (1997) where work involves a sequence of expected tasks, either routinised or unexpected. When compared with critical care nursing practice the sequence of nursing work was aimed at managing outcome focused illness trajectories. What Liaschenko & Fisher (1999, p32) suggested is that the work of nursing (case, patient & person) describes processes and not the accomplishment of outcomes and therefore legitimises nursing work because it “links the actions of nursing to the knowledge used in the conduct of those actions”.
Typology of Nursing Knowledge (Rolfe 1998 & Ryle 2000)
Knowing-How & Knowing-That
Scientific Personal Experiential
Practical Knowledge Theoretical Knowledge
Making the Link
Practical Knowledge (knowing-how)
Theoretical Knowledge (knowing-that)
Reflection/Reflexivity?????
Pragmatic Epistemology & Advancing Practice
…is about practical knowledge which incorporates all forms of knowing – it is the utilisation of knowledge within a practice setting: the value of knowledge for practice and the value of knowledge generated from practice. (Fulbrook, 2003, p.301)
Knowing-How & Knowing-That
Knowing-That
The choice of action determined by the practitioners understanding
of the situation
Knowing-How
Knowing-What – Knowing-Why – Knowing-How
Pattern Recognition
Theoretical &
Empirical Knowledge
Practical &
Experiential Knowledge
Presenter
Presentation Notes
The how (knowing-how as the practical and experiential knowledge) is more focused on task, procedure and description at a behavioural level and is demonstrable by a practitioners’ ability to perform the practice and generate its products as opposed to an understanding of process
Defining Advancing Practice
“The ongoing procedural development of problem-solving, analytical and synthesis skills which allow practitioners to integrate practical knowing-how, theoretical knowing-why and experiential knowing-what into a pragmatic knowing-that knowledge to improve patient care.”
(Christensen 2008)
Advancing Practice is Thinking & Doing
Advancing practice is the integration of the different types of knowing and the understanding associated with this
Thinking Doing
Advancing Practice Model of Development
General Nursing Practice
Advancement Expansion
Specialisation
Advanced Practice
Advancing Critical Care Nursing Practice
Specialisation
Expansion
Advancement
Concentrates on one specific field of nursing practice
The acquisition of new knowledge and skills results in the expansion of the existing knowledge and skills base.
Includes both elements of specialisation and expansion, advancement is further characterised by the integration of postgraduate education which amalgamates experiential–practical knowledge together with theoretical and research-based knowledge
Work-Based Learning
Reflexive Practice Clinical Supervision
Action Learning Groups
Experiential/Theoretical Knowledge
Individual Advancement
of Critical Care
Practice
Reflection Critical Reflection
Advancing Practice Advancing Practice Knowledge Integration Model
Knowing-How & Advancing Practice
Knowing-How
Knowing-What – Knowing-Why – Knowing-How
Advancing Practice
Work-Based Learning
ALG Clinical Supervision
Reflexive Practice
In Conclusion
Advancing practice is more than simply identifying different sources of knowledge either for practice or from practice; it is how this knowledge is used and integrated into clinical practice that contributes to advancing practice.
This model attempts to support this process of development, building on and enhancing the quality of the reflective experience, and therefore shifts the practitioner’s level of understanding and knowledge towards knowing-that.
Thank you for listening
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