4.2 Clinical Scholarship
4.2.4 Communities of Practice Support A Culture of Clinical
Advanced practice nursing practitioners are trained and educated through hands-on activities that focus on understanding the complexities of practice. Understanding these complexities that tackle the intricacies of community development and policy context is important. In addition, the public health’s objective of addressing health inequalities gives advanced practice nursing practitioners a clear goal. Both health care planners and public health experts recognise the importance of community engagement, and that addressing health disparities requires practitioners assurance that previously marginalised communities have a seat at the decision-making table.
Hence, advanced practice nursing practitioners need to interact with community members, including patients/service-users and families in order to engage these key stakeholders in project decisions, and attend community meetings and interact with key stakeholders through site visits.
4.2 Clinical Scholarship
62
According to Wenger (1998) Communities of Practice (CoPs) members’ negotia- tion of meanings in practice leads to the development of three structural elements of CoPs: (i) mutual engagement (how and what people do together as part of practice), (ii) joint enterprise (a set of problems and topics that they care about), and (iii) shared rep- ertoire (the concepts and artefacts that they create). More recent work by Pyrko et al.
(2017) reported that the process of ‘thinking together’ is conceptualised as a key part of meaningful Communities of Practice where academics and practitioners mutually guide each other through their understandings of the same problems in their area of mutual interest, and in this way directly share tacit knowledge. The collaborative learn- ing process of ‘thinking together’, they argue is what essentially brings Communities of Practice to life and not the other way around (Pyrko et al. 2017, p. 389).
The advanced practice nursing practitioner has much to gain engaging within Communities of Practice towards meeting the criteria of clinical scholarship. In this scenario participants from different settings are no longer merely insiders and out- siders but stakeholders working toward shared purposes who can accomplish more together than they might accomplish separately. In this way the spectrum of clinical scholarship (see Fig. 4.1) and its critical elements associated with the characteristics of scholarship of engagement, integration, application, discovery and teaching could be the visionary step in populating elements of the declared legacy map port- folio (see Chap. 6).
Communities of Practice are collectively engaged in the creation of new ideas and innovations and connect scholars across institutions, leveraging collective anal- ysis of a problem to create an innovative solution. Hence, a Community of Practice is defined as a collaborative, informal network that supports professional practitio- ners in their efforts to develop shared understandings and engage in work-relevant knowledge building (Confessore 1997). Participation involves more than network- ing or exchanging data. Junior members can be fostered via legitimate peripheral participation, progressively developing abilities that allow greater contribution over time (Sherbino et al. 2010). This is where those rich social networks discussed by Brown and Duguid come into play. The aforementioned authors argued, it is not the availability of information itself that is key, but active participation in Communities of Practice. “Become a member of a community, engage in its practices, you can acquire and make use of its knowledge and information” (Brown and Duguid 2000, p. 126). From this perspective, the key to demand for pedagogical knowledge- including what is produced by practitioners through the scholarship of teaching and learning-is the expansion of Communities of Practice around teaching and learning itself (Huber 2009, p. 4).
Boyer’s definition of the scholarship of engagement makes reference to out- reach as a communal act. But its uniqueness is that as an activity, outreach is also a communal process (Bruns et al. 2003, p. 7). For outreach to have the largest impact, the partnership between the university and community must be recipro- cal. Outreach is not an end product. It is a part of a circular process by which what is learned is then incorporated into the other aspects of our work, work that subsequently impacts our engagement with the community (Bruns et al. 2003, p. 9). For communities, which have an abundance of opportunities that are
4 The Spectrum of Clinical Scholarship
63
challenging and thought-provoking, the “real value” of engagement appears in discovery through applied research and action research. Hence action research, when conducted in partnership with the community by advanced practice nursing practitioners adds to the knowledge base of the discipline, while at the same time providing the community with valuable research- based information that can help formulate policy decisions that have long-term impact on citizens.
Central to understanding outreach as scholarly expression is respecting it as a complex phenomenon. First, outreach is expressed in many ways, not a one-size-fits all. Second, the very word outreach conveys a distinct epistemological, ontological, and axiological reference point (Fear et al. 2001). “Reaching out is academy- centered (knowledge from) and unidirectional (to those who benefit). Other terms used in the field, such as service and engagement, are challenging for a different reason: the words have diffuse meaning and are open to multiple interpretations.
Who is serving and engaging whom? Why? How? Under what circumstances?
Towards what ends?” (Fear et al. 2001, p. 22).
Thinking of outreach as a complex phenomenon has theoretical and practical value; firstly, it keeps academics from embracing the notion that there is a defin- itive outreach expression or a best form for undertaking it, because with an incredible array of problems, situations, settings, and challenges facing us in the outreach domain, it is impractical and even dangerous to endorse a “one size fits all” way of thinking (Fear et al. 2001, p. 23). Academics need to adjust their research and practice to the realities of the setting as they experience it which necessitates approaching outreach as a form of inquiry. Secondly, Smith (1997) proposed viewing outreach as complex compels academics to keep on the look- out for new expressions and forms, such as participatory action research (PAR).
According to Bryant- Lukosious et al. (2017) the principles of participatory action research (PAR) are relevant to the advanced practice nursing (APN) role development. APN practitioners work collaboratively within interprofessional teams and in established relationships with other stakeholders in the health sys- tem. Stakeholder roles and relationships are influenced by their values, beliefs, experiences, and expectations. These relationships create the conditions that impact the effective delivery of health services and yet can also facilitate or obstruct the implementation of APN roles (Bryant-Lukosious et al. 2017).
The engagement boundary is a place where academics and advanced practice nursing practitioners/aspirants advance in their understanding of outreach as a dynamic and evolving phenomenon. It is in this regard that reflexivity matters, which means turning the investigative lens on self in critically recursive ways as though the self is “the other” and that means seeking to better appreciate and understand our dynamic and evolving scholarly selves (Fear et al. 2001, p. 29). Engaging in reflective practice is one of the norms of engagement. It is among many approaches and practices with “alternative paradigm inquiry”, including qualitative and partici- patory approaches and scholars need to recognise, understand, and respect multiple ways of knowing, interpreting, and practicing (Fear and Sandmann 2001–2002).
Moreover, service-learning is one of the many contemporary examples of scholarly
“boundary crossings” ways that faculty connect—in scholarly ways—the
4.2 Clinical Scholarship
64
traditionally discrete activities of teaching, research and service, and viewed in this way, engagement becomes a connective expression (Fear and Sandmann 2001–
2002). That happens when the preposition “of” (the scholarship of engagement) is replaced with the preposition “in” and when that occurs, engagement becomes a cross- cutting phenomenon—engagement in teaching, in research, and in service—
guided by an engagement ethos (Fear and Sandmann 2001–2002).
Communities of Practice aligned with the scholarship of engagement advocated by Boyer could raise the profile of person-centered care and embrace the deeper meaning of person-centeredness rather than only the adoption of the term person- centered care. In developing person-centeredness and person-centered care, schol- arship comprising research, teaching and service to the community characterised by integrity in the practices of systematic enquiry and discovery; a willingness to cre- ate interprofessional connections across scholarly domains, and evaluate complex interventions, would provide a platform enabling advanced practice nursing practi- tioners produce credible scholarship for the discipline and the people they serve in a variety of complex clinical milieus.