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| Preface | |
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| Uncovering the Knowledge Embedded in Clinical Nursing Practice | |
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| Differences Between Practical and Theoretical Knowledge | |
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| Knowledge Embedded in Expertise | |
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| Extending Practical Knowledge | |
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| Common Meanings | |
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| Assumptions, Expectations, and Sets | |
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| Paradigm Cases and Personal Knowledge | |
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| Maxims | |
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| Unplanned Practices | |
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| Summary and Conclusions | |
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| The Dreyfus Model of Skill Acquisition Applied to Nursing | |
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| Methods | |
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| Interpretation of Data | |
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| Novice | |
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| Advanced Beginner | |
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| Competent | |
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| Proficient | |
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| Expert | |
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| The Meaning of Experience | |
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| An Interpretive Approach to Identifying and Describing Clinical Knowledge | |
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| Performance Measurements | |
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| Identifying Domains and Competencies | |
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| Summary | |
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| Domains of Nursing Practice | |
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| The Helping Role | |
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| The Healing Relationship: Creating a Climate for and Establishing a Commitment to Healing | |
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| Providing Comfort Measures and Preserving Personhood in the Face of Pain and Extreme Breakdown | |
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| Presencing: Being with a Patient | |
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| Maximizing the Patient's Participation and Control in His or Her Own Recovery | |
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| Interpreting Kinds of Pain and Selecting Appropriate Strategies for Pain Management and Control | |
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| Providing Comfort and Communication Through Touch | |
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| Providing Emotional and Informational Support to Patients' Families | |
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| Guiding Patients Through Emotional and Developmental Change | |
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| Summary and Conclusions | |
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| The Teaching-Coaching Function | |
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| Timing: Capturing a Patient's Readiness to Learn | |
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| Assisting Patients to Integrate the Implications of Illness and Recovery into Their Lifestyles | |
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| Eliciting and Understanding the Patient's Interpretation of His Illness | |
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| Providing an Interpretation of the Patient's Condition and Giving a Rationale for Procedures | |
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| The Coaching Function: Making Culturally Avoided Aspects of an Illness Approachable and Understandable | |
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| Summary and Conclusions | |
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| The Diagnostic and Monitoring Function | |
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| Detection and Documentation of Significant Changes in a Patient's Condition | |
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| Providing an Early Warning Signal: Anticipating Breakdown and Deterioration Prior to Explicit Confirming Diagnostic Signs | |
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| Anticipating Problems: Future Think | |
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| Understanding the Particular Demands and Experiences of an Illness: Anticipating Patient Care Needs | |
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| Assessing the Patient's Potential for Wellness and for Responding to Various Treatment Strategies | |
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| Summary and Conclusions | |
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| Effective Management of Rapidly Changing Situations | |
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| Skilled Performance in Extreme Life-Threatening Emergencies: Rapid Grasp of a Problem | |
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| Contingency Management: Rapid Matching of Demands and Resources in Emergency Situations | |
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| Identifying and Managing a Patient Crisis Until Physician Assistance Is Available | |
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| Summary and Conclusions | |
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| Administering and Monitoring Therapeutic Interventions and Regimens | |
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| Starting and Maintaining Intravenous Therapy with Minimal Risk and Complications | |
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| Administering Medications Accurately and Safely | |
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| Combating the Hazards of Immobility | |
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| Creating a Wound-Management Strategy that Fosters Healing, Comfort, and Appropriate Drainage | |
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| Summary and Conclusions | |
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| Monitoring and Ensuring the Quality of Health Care Practices | |
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| Providing a Backup System to Ensure Safe Medical and Nursing Care | |
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| Assessing What Can Be Safely Omitted from or Added to Medical Orders | |
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| Getting Appropriate and Timely Responses from Physicians | |
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| Summary and Conclusions | |
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| Organizational and Work-Role Competencies | |
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| Coordinating, Ordering, and Meeting Multiple Patient Needs and Requests: Setting Priorities | |
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| Building and Maintaining a Therapeutic Team to Provide Optimum Therapy | |
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| Coping with Staff Shortages and High Turnover | |
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| Summary and Conclusions | |
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| Implications for Research and Clinical Practice | |
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| Involvement versus Distance | |
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| Nurse-Patient Relationships | |
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| Early Warning Signals | |
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| Outside the Boundaries of Nursing | |
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| Monitoring and Organizational Skills | |
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| The Phenomenon of Caring | |
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| Implications for Career Development and Education | |
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| Career Development | |
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| Nursing Education | |
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| The Quest for a New Identity and New Entitlement in Nursing | |
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| Meaningful Incentives and Reward Systems | |
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| A Clinical Promotion System | |
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| Increased Collaborative Relationships | |
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| Increased Recognition | |
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| Excellence and Power in Clinical Nursing Practice | |
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| Transformative Power | |
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| Integrative Caring | |
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| Advocacy | |
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| Healing Power | |
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| Participative/Affirmative Power | |
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| Problem Solving | |
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| Epilogue Practical Applications | |
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| Research Application: Identifying the Use and Misuse of Formal Models in Nursing Practice | |
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| Implementation of Staff Nurse III at El Camino Hospital | |
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| Focus on Excellence | |
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| Identification of the Skilled Performance of Masters Prepared Nurses as a Method of Curriculum Planning and Evaluation | |
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| Building Bridges Between Education and Practice | |
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| References | |
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| Glossary | |
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| Appendix | |
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| Index | |