Skill Acquisition and Clinical Judgement in Nursing Practice

Abstract

This chapter explores expertise and practical wisdom in nursing through an exploration of skill acquisition and clinical judgement in nursing practice. Three studies using the Dreyfus model of skill acquisition were conducted over a period of 21 years. Nurses with a range of experience and reported skilfulness were interviewed. Each study used nurses’ narrative accounts of actual clinical situations. These studies extend the understanding of the Dreyfus model to complex, underdetermined and fast-paced practices. The skill of involvement and the development of moral agency are linked with the development of expertise and practical wisdom, as the practitioner becomes more skilful. Taken together, these studies demonstrate the usefulness of the Dreyfus model for understanding the learning needs and styles of learning at different levels of skill acquisition.