Reflections on clinical judgment of nurse practitioners.
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Clinical Competence↗
Biomedical subjects
K A Brykczynski
Publications and source records attributed to K A Brykczynski.
Clinical exemplars describing expert staff nursing practices.
AIM: This study was undertaken to identify and describe expert staff nursing practices in a large teaching hospital in south-western USA. BACKGROUND: Differentiation of the skill level of staff nurses is important for assuring safe, quality care. In the current atmosphere of corporate, downsizing, shortened hospital stays, cross training and continued high staff nurse turnover rates, it is of critical importance to identify and describe the essential contributions of expert nursing practice and to recognize and reward nurses according to their skill level. METHOD: Clinical situation interviews and participant observations were conducted using the interpretative phenomenological research approach. Narrative data were obtained and analysed systematically in multiple stages to identify and describe recurring meanings, themes, exemplars and constitutive patterns. FINDINGS: The final stage of data analysis involved interpretation of the narrative text using Benner's (1984) 'domains and competencies of nursing practice' as a framework. These competencies were validated in this study and 16 new competencies were identified. CONCLUSIONS: Expert staff nursing practices described in this project are not behaviours commonly defined as organizational expectations in performance appraisals for staff nurses. These practices need to be incorporated into position descriptions, performance appraisals and clinical ladders to recognize, foster and acknowledge the significance of expert nursing practice.
Clinical Competence↗
Employing prevention in practice.
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Clinical Protocols↗
Practical knowledge and competencies of the healing role of the nurse practitioner.
This qualitative study describes the practical knowledge and competencies of the healing role of the nurse practitioner. The conceptual framework is based on Benner's (1984) domains of nursing practice and aspects of practical knowledge and Brykczynski's (1985) study of the clinical practice of nurse practitioners. The healing role is described within the context of the healing domain of the National Organization of Nurse Practitioner Faculties' curriculum guidelines (Zimmer et al., 1990) and Benner's aspects of practical knowledge. The study used the interpretive research approach of Heideggerian hermeneutic phenomenology. The findings contribute two maxims that constitute aspects of practical knowledge: "little things mean a lot" and "healing begins with listening," and two additional healing competencies: sensitive humor and risk taking.
Clinical Competence↗
Developing national guidelines for nurse practitioner education: an overview of the product and the process.
In 1988, the National Organization of Nurse Practitioner Faculties appointed an ad hoc education committee (AHEC) to review existing nurse practitioner (NP) education curricula and to formulate national guidelines. An overview of the new NP guidelines are presented along with the philosophy, content, objectives, and competencies that are viewed as the foundation for NP education today. The guidelines are presented within the structure outlined in Brykczynski's (1985) research about NP practice. Thus, as a "product" of the Advanced Nursing Practice: Nurse Practitioner Curriculum Guidelines (NPCG), a new NP graduate for the 1990s could be described as one who demonstrates beginning competencies in primary health care theory and research within the five domains of practice identified by Brykczynski.
Clinical Competence↗
An interpretive study describing the clinical judgment of nurse practitioners.
Devaluation of nursing practice by both practicing nurses and nurse educators is giving way to keen interest in clinical scholarship. A naturalistic study was conducted to provide a contextual account of the actual practice of experienced nurse practitioners. Data collection procedures consisted of clinical situation interviews with nurse practitioner pairs, participant observation of patient visits to nurse practitioners in four hospital-based ambulatory settings, individual interviews with nurse practitioners, and administration of a brief demographic questionnaire. The 199 clinical situations that constituted the resulting text were analyzed using phenomenological and existential perspectives. The clinical judgment of experienced nurse practitioners is described through interpretive analysis of the text according to the dictates of hermeneutical phenomenology. This methodology provides a way of describing and communicating the knowledge that develops among experienced practitioners and their patients. Text interpretation also produced an adaptation of Benner's (1984a) domains and competencies specifically for nurse practitioner practice, which may be useful as a conceptual framework for nurse practitioner practice, education, and research.
Attitude of Health Personnel↗
Qualitative distinctions and similarities in the practice of clinical nurse specialists and nurse practitioners.
Current debate over whether clinical nurse specialist (CNS) and nurse practitioner (NP) roles should be combined or remain separate are largely theoretical. Minimal research has been conducted comparing these roles. Most studies to date consist of graduate follow-up surveys and comparisons of curricula. Interpretive results of Fenton's investigation of the practice of CNSs and Brykczynski's study describing the practice of NPs were compared to highlight the commonalities and distinctions between the two roles. This comparison is significant in that it explores the actual practice of CNSs and NPs. Both studies were modeled after Benner's research exploring the development of clinical expertise and produced adaptations of Benner's domains and competencies of nursing practice specifically for CNSs and NPs. Participant observations and small group interviews were the data-gathering methods used in these interpretive research studies. The interpretive approach is described as a situational, contextual, or narrative research method for understanding the knowledge and meanings in everyday (naturalistic) settings. Comparative analysis of results of the CNS and NP studies showed a shared core of advanced practice competencies as well as distinct differences between the practice roles. These findings have implications for curriculum development in advanced nursing practice.
Clinical Competence↗