Bonner Ann, Walker Annette
School of Nursing, Family and Community Health, University of Western Sydney and Westmead Hospital, Penrith, South DC, Australia.
J Clin Nurs. 2004 Feb;13(2):210-8. doi: 10.1046/j.1365-2702.2003.00858.x.
Expertise in nursing has been widely studied; there have been no previous studies into what constitute expertise in nephrology (renal) nursing. This paper describes a 'real-world' characteristic of expert nephrology nursing practice.
This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept blurring the boundaries.
The study utilized grounded theory methodology and symbolic interactionism.
The study took place in one renal unit in New South Wales. Sampling was purposive then theoretical; the sample consisting of six non-expert and eleven expert nurses. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semi-structured interviews was undertaken.
The study revealed that only expert nephrology nurses 'blurred the boundaries' of professional nursing practice. They did this by moving intermittently and purposefully, for the benefit of particular patients, into medical domains in the areas of prescribing, dispensing and ordering of pathology tests. Non-expert nurses did not cross these professional boundaries.
Blurring the boundaries was a significant feature of expert nursing practice, and this study was the first to describe explicitly nursing boundaries as two distinct entities; that is, formal and informal.
There are some nephrology nurses who have sufficient knowledge and experience to prescribe some medications and to order certain investigations.
护理专业技能已得到广泛研究；此前尚无关于肾科护理专业技能构成要素的研究。本文描述了肾科专家护理实践的“真实世界”特征。
本文摘自一项关于肾科护理专业技能的获取与运用的大型研究，旨在探讨模糊界限的概念。
该研究采用扎根理论方法和符号互动主义。
研究在新南威尔士州的一个肾科病房进行。抽样是有目的的，然后是理论性的；样本包括六名非专家护士和十一名专家护士。采用参与观察、护理文件审查和半结构化访谈的方式同时进行数据收集和分析。
研究表明，只有肾科专家护士会“模糊”专业护理实践的界限。他们通过为特定患者的利益，间歇性且有目的地进入处方、配药和安排病理检查等医疗领域来做到这一点。非专家护士不会跨越这些专业界限。
模糊界限是专家护理实践的一个显著特征，并且本研究首次明确将护理界限描述为两个不同的实体，即正式界限和非正式界限。
有些肾科护士具备足够的知识和经验来开具某些药物处方并安排某些检查。
