1. Nursing Theories in relation to Clinical Practicum in Nursing Hesook Suzie Kim, PhD, RN Professor, College of Nursing University of Rhode Island

2. A Model of Nursing Practice Philosophy of Care Philosophy of Therapy Scientific Dimension Ethical Dimension Aesthetic Dimension Deliberation Enactment

3. Clinical Practice: As Use of Knowledge & Application of Skills  Engagement in clinical situations as a professional nurse  Engagement in nursing practice processes for patient care  Involvement in the organized system of nursing service

4. Knowledge for Clinical Practice  Declarative (Theoretical) Knowledge – “ Knowing that ”  Procedural (Practical) Knowledge – “ Knowing how ”

5. Private Knowledge for Practice  Declarative Knowledge  Gained through formal and informal learning – Accessed from the Public Knowledge  Abstract in nature  Symbolic Models  Procedural Knowledge  Gained through personal experiences  Situational in nature  Lead to Schemata and Scripts

6. Relationship between Knowledge in the Public & Private Domains Private Knowledge Public Knowledge Assimilation Knowledge Use In Practice Theory Development Research Consensus Development Standard Setting Maxims & Models Other Personal Experiences

7. Processes of Knowledge Use in Clinical Practice Practice Situation: Multiple Phenomena Private Knowledge Practitioner’s Framing of Situation – Problem Definition Selection of Theories & Strategies for Nursing Approach Enactment of Nursing Approaches or Interventions Public Knowledge Step 1 Step 2 Step 3 Step 4 Practitioner’s Perception – Definition of Situation

8. Nursing Theories in Step 1  Nursing Theories for Attaining Practitioner ’ s Perceptions and Definition of the Situation  Inferential – General Nursing Theories or Frameworks – Preference established  Referential – Private Theories of Clinical Schemata

9. Nursing Theories in Step 2  Nursing Theories for Framing the Situation and Problem Definitions  Inferential – Nursing theories of description & explanation (Causal and non-causal theories)  Referential – Declarative referential theories of clinical experiences; Private theories of patterns and scripts  Transformative – Declarative transformative theories for understanding & emancipation  Desiderative – Theories of “ normality ”

10. Nursing Theories in Step 3  Nursing Theories of Alternative Nursing Approaches and Therapeutics  Inferential – Prescriptive & nursing approach theories  Referential – Public & Private descriptive theories of nursing approaches  Transformative – Emancipatory theories of nursing approaches  Desiderative – Normative theories for selection of nursing approaches

11. Nursing Theories for Step 4  Nursing theories for acting in clinical situations  Inferential – Action theories of practice  Referential – Descriptive theories of situated nursing practice; Private practice scripts  Transformative – Emancipatory theories of action  Desiderative – Normative theories of action

12. Nursing theories & Practice  Nursing practice through the synthesis of knowledge (theories and other understandings) – Synthesis means:  Selection of appropriate theories for the situation  Putting together the selected theories at specific steps  Establishing a specific practice model for a given clinical situation

13. Clinical Practicum in Nursing  Situation-specific, person-centered clinical experiences for obtaining practical knowledge – Schemata & scripts (Exemplars)  Exposure to a variety of clinical situations  Progression in experiences from simple to increasingly complex clinical situations  Gaining clinical competency through skill development and broadening and deepening of clinical knowledge

14. Clinical Practicum  Expansion of the Stock of Private Knowledge of Nursing Relevance  Learning how to synthesize knowledge (theories) effectively  Expansion of Clinical Skills  Critical thinking & decision making  Working with Data (Assessment, Analysis, & Evaluation)  Technical skills (Environmental & instrumental controls, Monitoring & Supportive techniques, etc.)  People skills (Interaction, Communication, Empowering, Counseling, Advocating, Teaching, etc.)  Nursing therapeutics

15. Teaching Nursing Theories in Clinical Practicum  What nursing theories exist as the declarative knowledge  What nursing theories exist integrated into the procedural knowledge  Discrimination of what theories are appropriate in specific clinical situations  What nursing theories are lacking in students – How to assimilate nursing theories in the Public Domain

16. Approaches to Teaching in the Clinical Practicum  Reflective Practice – Donald Sch ö n  Critical Reflective Inquiry  Narrative Phase  Narratives through recall of practice for depth-description of patient- care incidences (action, thinking, & feelings)  Reflective Phase  Analytic reflection on theories-in-use and knowledge (theories) use  Critical Phase  Critique of practice vis- à -vis a normative model of practice  Engagement in Emancipatory and educative processes

17. Critical Reflective Inquiry Narrative Phase Reflective PhaseCritical Phase Narrative Writing Actions Thinking Feelings Espoused theories (Scientific, Ethical, Aesthetic) Description of the Context Description of the Intension Description of the Self Self Emancipation Mutual Emancipation Improvement of practice Development of an ideal practice Discovery of Theories-in-use Identification of Nursing Theories Applied in Practice Identification of Ideal Nursing Theories for the Situation