Brykczynski K A
University of Texas Medical Branch, School of Nursing, Galveston 77555-1029, USA.
J Nurs Manag. 1998 Nov;6(6):351-9. doi: 10.1046/j.1365-2834.1998.00088.x.
This study was undertaken to identify and describe expert staff nursing practices in a large teaching hospital in south-western USA.
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.
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.
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.
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.
本研究旨在识别并描述美国西南部一家大型教学医院中专业护士的护理实践。
区分护士的技能水平对于确保安全、高质量的护理至关重要。在当前企业裁员、住院时间缩短、交叉培训以及护士人员流动率持续居高不下的环境下，识别并描述专业护理实践的重要贡献，以及根据护士的技能水平进行认可和奖励至关重要。
采用解释现象学研究方法进行临床情境访谈和参与观察。获取叙事性数据并分多个阶段进行系统分析，以识别和描述反复出现的意义、主题、范例和构成模式。
数据分析的最后阶段涉及以本纳（1984年）的“护理实践领域与能力”为框架对叙事文本进行解读。这些能力在本研究中得到验证，并识别出16项新能力。
本项目中描述的专业护士护理实践并非通常在护士绩效考核中被定义为组织期望的行为。这些实践需要纳入职位描述、绩效考核和临床晋升体系中，以认可、培养并承认专业护理实践的重要性。
