The Underlying Assumptions

“Theory is derived from practice”

Citing Kuhn (1970) and Polanyi (1958), philisophers of science, Benner (1984a)emphasizes between “knowing-how”, a practical knowledge that may elude precise abstract formulations, and “knowing that”, which lends itself to theoretical explanations. Knowing that is the way an individual comes to know by establishing casual relationships between events. Clinical situations are always more varied and complicated that theoretical accounts; therefore, clinical practice is an area of inquiry and a source of knowledge development. By studying practice, nurses can uncover new knowledge. Nurses must develop the knowledge base of practice (know how), and, through investigation and observation, begin to record and develop the know-how of clinical expertise. Ideally, practice and theory dialog creates new possiblities. Theory is derived from practice, and practice is extende by theory. (Alligood 2014)

 2"Human wisdom is more than rational calculation”

Human beings can work out precise formal rules and ethical theory, but our intellect capacity to do this does not guarantee that we can trasfer this knowledge into actual ethical comportment. We cannot get beyond experience, and we must not rely on our theories to distance us from skillfull ethical comportment in concrete, specific relationships and local situations. The Platonic quest to get beyond the vagaries of experience was a misguided turn – a heroic quest to put us beyond habits, skills, practice, and experince. We can redeem the turn if we subject our theories to our unedited, concrete moral experince and acknowledge that skillful moral comportment calls us not to be beyond practice but to be tempered and taught by it. The relationship then, between ethical theory and skillful ethical comportment must be a dialogue between partners, each shaping and informing the other. Disengaged reason and rational calculation cannot replace engaged care as a moral source of wisdom. (Benner,Tanner, Chesla 2009)

3  “Theory frames issues and guides the practitioner in where to look and what to ask”

Nursing practice as a human service practice has a specific goal of improving human health, and has to be guided by a system of nursing knowledge that includes various sorts of theory. The role of theory in clinical practice viewed from the perspective of knowledge-use then needs to be considered from what the nature of nursing practice is and how nursing knowledge is structured. (klinisk sygepleje 2012)

4  “Practice is a systematic whole with a notion of excellence”

Intuition is not science but sometimes intuition can stimulate research and lead to greater knowledge and questions to explore. Intuition is related to experience. A student would not likely experience intuition about a patient care situation, but over time, as a nursing expertise is gained, the student may be better able to use intuition, Benner’s (2001) work, From Novice to Expert, suggests that intuition is really the putting together of the whole picture based on scientific knowledge and clinical expertise, not just a hunch, and intuition continues to be an important part of the nursing process (Benner et al., 2008)

5  “Caring is basis of altruism”

Benner argues for nurses to care for patients “as they see fit”. Benner seeks to move away from rules, bounding care towards the individual, autonomous judgement of practitioners inparticular circumstances. The nurse’s good decisions depend upon her ethical stance, which also equips her to perform caring functions. For Benner, caring is not altruism but rather an evolutionary stage in human development (Benner and Wrubel 1989). (Traynor 1999)

6"“Caring is essential requisite for all coping”

Recently much thought and writing has been given to the idea of caring as the essence of nursing. Benner and Wrubel describe nursing as follows:

Caring is the essential requisite for all coping… [It helps a person] to recover, to appropriate meaning, and to maintain or reestablish connection… from the place of care, the person can neither claim complete autonomy nor be the absolute source of meaning, involvement and caring may lead one to experience loss and pain but may also make joy and fulfillment possible. Caring is primary because it sets up the possibility of giving help and receiving help.(Small 1996)

7 “Caring and interdependence are the ultimate goals of adult development”

Caring is ultimately necessary for human survival. Benner and Wrubel (1989) argued that instead of valuing autonomy, caring and interdependence are the ultimate goals of human development. They explained “To care and feel cared promotes personal and societal health” (Benner & Wrubel, 1989, p.368). According to Benner and Wrubel (1989), “a culture that emphasizes independence and individualism cannot survive without a safety net of care and caring practices” (p.399). (Baker-Ohler & Holba 2009)

8“Concern is essential for the nurse to be situated”

9 “No practitioner can practice beyond experience”

The Dreyfus Model Skill of Acquisition (Dreyfus, 1979; Benner, 1984) is based upon determining the level of practice evident in particular situations. Situated practice capacities are described rather than traits or talents of the practitioners. At each stage of experiential learning (novice, advanced beginner, competent, proficient, expert), clinicians can perform at their best. For example, one can be the best advanced beginner possible, typically the first year of practice. However, no practitioner can be beyond experience regardless of the level of skill acquisition in most clinical situations and despite the necessary attempts to make practice as clear and explicit as possible. If the nurse has never encountered a particular clinical situation, experiential learning is required. (Basford & Slevin 2003)