Advancing practice in critical care nursing.

Abstract

This thesis presents a body of publications in the area of critical care nursing, for the consideration of the award Doctor of Philosophy by publication. The publications and their dissemination herein contribute to a new and original body of knowledge within critical care nursing practice. This thesis aims to demonstrate how an original contribution to the advancement of critical care practice has developed through an on-going integration of academic and practice work and has led to the development of a model for advancing practice. Based on the know-that and know-how framework of advanced knowledge, consideration is given how this approach could be better developed to incorporate other dimensions attributed to experiential learning, namely pattern recognition and an exemplar of the knowing-how knowing-that framework is offered. However, it emerged that there are problems with advancing practice because it is considered the work of the advanced practitioner, yet it is contended that there needs to be a process which allows individuals to advance their own practice. Therefore, it was necessary to develop a working definition of advancing practice not only to map professional advancement of critical care nursing practice and how published works illustrate this, but to offer model of knowledge integration based around theoretical, practical, reflective and reflexive practice and supervisory support to enable individual practitioners the framework to advance practice. This thesis is presented in three chapters: Introduction, Body of Work and The Way Forward. In the first chapter, an overview of the origins and trends of advanced nursing practice and the emergence of advancing nursing practice in critical care. The purpose of this first section, however, is not to engage in the politico-professional debate on the meaning of advanced practice, because this is well developed within the literature, but is to set the scene in the context of published work. By using a narrative approach as a journey of personal discovery, a description of how published works illustrate progress in this respect and show the advancing of critical care practice.The second chapter not only comprises publications with regard to critical care nursing practice but also presents a detailed critique of these publications and their contribution to advancing critical care nursing practice and knowledge. Moreover this discussion identifies three themes which are further developed into the classification of knowledge attributable to advancing practice. In the concluding chapter, recommendations for the way forward are discussed with the development of a critical care nursing knowledge integration model. An exemplar of the model demonstrates that advancing practice in critical care is a continual process of development, analysis and practice that advances the knowledge and skill of critical care nursing. More importantly, it is the integration of all these facets that allows for the growth of the individual to become an advanced practitioner. In summary, this thesis represents a portfolio of work that makes an original contribution to critical care nursing knowledge. The product of this thesis is the development of a knowledge integration model as the basis for advancing practice:"