The development of clinical nursing capability: an analysis of progression towards individual clinical and role skills in a surgical ward

Abstract

This paper describes a study of the progression of qualified surgical nurses towards capable proficiency in one setting using participant observation within an ethnographic approach. Two distinct methodologies were used: (i) 18 months of participant observation of the social and economic processes that shaped the nursing team, its leadership and a busy surgical practice context, in which qualified nurses and post‐qualifiers learned the ropes of the specialty; and (ii) invited observations of episodes of skilled behaviour followed by knowledge elicitation interviews using heuristic devices as mediating artefacts. These artefacts, digital images and practitioner knowledge maps allowed the individual to explore current and potential representations of their knowledge within a variety of contexts. Distinctions were drawn between the features of fluent and problem‐solving activity, and factors that triggered an interruption in clinical fluency were isolated. Deliberative triggers and outcomes were analysed by the practitioner. Establishing the cadre of local fluent capability within the ward presented the opportunity to explore newcomer progression. The dual methodology provided a unique perspective on: (i) the context of capability and progression towards clinical nursing fluency; (ii) the different role of deliberation in capable and newcomer practice, and (iii) an emergent view of newly promoted senior nurses as they learned to run things in the ward. This view of using management knowledge differs from the type of knowledge use revealed in clinical fluency. This leads to a theoretical analysis of how different kinds of skills are learned and the relationship between individual and social aspects of learning.

Sharing practice: problems and possibilities

“…Describing incidents or telling stories, followed by discussion (Fairburn 2002). Discussing cases and/or problems, real or fictional. Use of mediating artefacts – pictures, case notes, documents, models and diagrams (Fessey 2002a,b). …”

Editorial

“…McKee (2002) describes a range of factors making hospitals a poor environment for the learning of junior doctors, especially those intending to become GPs; while the Stewart, Bregazzi & O’Halloran (2003) study of specialist registrars in Accident and Emergency medicine notes how they focus on formal learning and fail to recognize how much their progress depends on informal learning and attributes this to the assessment system. Fessey (2002b) describes the preponderance of informal learning by newly qualified nurses and how their commitment to the job affects their access to help from their seniors. Finally, an unusual paper by Aarkrog (2006) observes how a placement in a hospital induces trainee rescue officers to become much more reflective about their practice.…”