Exploring nursing expertise: nurses talk nursing

Abstract

It has become increasingly important for practitioners to articulate their expertise in modern healthcare settings that demand high levels of accountability and evidence-based practice. The material presented within this article has been interpreted drawing from discourse analysis1 to help explore the discourses that shape and influence understandings of nursing practice. What we present are extracts from four of the 35 participant nurses who applied to take part in the Royal College of Nursing Institute's Expertise in Practice (pilot) Project (EPP). The material presented is used to provide a starting point for exploring how nurses talk about and construct expertise in nursing practice. The four nurse participants' clinical practice areas cover palliative care, mental health, intensive care and fertility care. The material reveals high levels of intensity in the nurse-patient relationship, 'maverick' nursing practices and ongoing reflexivity. All of these aspects appear to capitalize on expertise as a 'catalyst' that alters treatment pathways and maximizes patient-centred outcomes. Exploring a discourse of nursing expertise exposes the tacit situated nature of professional practice that is heterogeneous and most difficult to articulate and explain. It is proposed that expertise tends to be understood from traditional and dominant discourses of medicine, management and technology. Explaining expertise in practice exposes non-conventional practice that in itself can be isolating and challenging to the status quo of contemporary health-care.

Within the web: the family–practitioner relationship in the context of chronic childhood illness

“…The type of expertise each participant brings however is different. As other authors have described, doctors bring expertise in regard to the nature of disease and methods of treatment (Freidson, 1988;Sefton, 2001), the nurse saliency, observation, informed risk taking and the ability to integrate care of the family (Hardy, Garbett, Titchen, & Manley, 2002;Titchen, 2001). Allied professionals also bring their speciality knowledge and clinical reasoning, in regard to the treatment of the child within their family (Jackson, 2001;Jensen et al, 2000).…”

“…As described in Chapter two, health professional expertise, especially medical expertise continues to be afforded greater value than that of the child or family. The relationship and role of family/patient expertise receives little attention in contemporary health professional literature (Hardy et al, 2002;Higgs & Titchen, 2001). Despite the professional rhetoric regarding partnership and family centred care we have yet to see in practice family/practitioner interactions that reflect a relationship between experts.…”

Facilitation skills: the catalyst for increased effectiveness in consultant practice and clinical systems leadership

“…New methodological insights and understandings have emerged from this study in relation to the use of EAR and the methods which build on the research team's previous experiences of enabling practitioner-research at the individual level in the development of nursing expertise (Manley et al, 2005;Hardy et al 2009). This insight relates to the degree of involvement in collaborative analysis undertaken by participants.…”

“…Other practice leaders (Binnie & Titchen, 1999) were focussing on the contribution of external facilitation to insider roles. The role of facilitation was a key concept emerging at the time linked to the achievement of professional activities such as: critical companionship and learning in the workplace (Titchen 2000); research implementation and knowledge translation (Harvey et al, 2002); practice development (McCormack et al, 1999;Manley & McCormack 2003;Garbett & McCormack, 2004); and the development of expertise in practice (Manley et al, 2005;Hardy et al, 2009). This latter project also used EAR to provide insights into how to support individual and organisational effectiveness through enabling expert practitioners to become practitioner-researchers and facilitators of others.…”

“…Whilst there are new strengths in how this study has been conducted compared with our previous EAR (Manley et al, 2005;Hardy et al, 2009), there are also limitations, particularly around optimizing the support for participants in the workplace itself.…”