4.2 Clinical Scholarship
4.2.1 Definitions Surrounding the Milieu of Clinical
synthesis of observations of clients and patients, and is a complex activity that has as its purpose the discovery, organisation, analysis, synthesis, and transmission of knowledge resulting from client-oriented nursing practice (Palmer 1986). The
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observation, analysis, and synthesis of the phenomena with which professional nurses deal with in clinical nursing practice provide the matrix for clinical scholar- ship. This is not to imply that theoretical knowledge is excluded. Client-oriented nursing practice is an integration of theoretical and experiential knowledge (Palmer 1986, p. 318).
It is easier to discuss what clinical scholarship is not than what it is, it is not qualitative research, phenomenology or hermeneutics, not mere journalistic report- ing or even the traditional case study (Diers 1995). Simply feeling, intuiting is not scholarship without informed, intelligent, imaginative, and clinically grounded analysis. In research, attention is paid to the numbers or concepts; in scholarship, care with the language is critical. In both cases, the activity is not complete until it is written down- the vital dissemination phase of generating knowledge (Diers 1995, p. 28). These principles are reinforced by Schlotfeldt (1992) who states that it is ‘nursing’s clinical scholarship that must be depended on to generate promising theories for testing that will advance nursing knowledge and ensure nursing’s con- tinued essential service to humankind’ (p. 8).
Although clinical scholarship begins, as does clinical research, with observa- tion, it builds differently (Diers 1995, p. 28). Excellent clinical research and schol- arship share another potential similarity-they turn conventional ways of thinking upside down (Diers 2004, p. 86). Clinical research begins with a curiosity; clinical scholarship with the sense of wonder that we call “marvel”. The satisfaction in clinical research comes with understanding what the data say, the satisfaction in scholarship comes in knowing (Diers 1995, p. 28). Besides, Vistinainer (1986) described two exemplar cases where the nurses observed, acted, and did the correct thing that in itself is not clinical scholarship. But the product of intellectual work that raises the clinical instance to the level of theory is a working draft on an idea about the world (Vistinainer 1986). As a working draft, theory is to be confronted and transformed by encounters with the real world of clinical work. That process is explicit in theory testing empirical research. It can be equally explicit in clinical scholarship. The clinical scholar must have a repertoire of possible explanations as well as the capacity to envision what the present instance is an instance of (Diers 2004, p. 85). Furthermore, clinical scholarship requires a maturity of practice that comes with experience and especially advanced specialist experience. Clinical scholarship is informed by reading, by thinking, by discussing with colleagues, by mentoring, by teaching so as to generate a mental map kit of potential explanations (Diers 2004, p. 87).
By virtue of their education and experience and clinical expertise, advanced practice nursing practitioners have a unique and significant part to play in advancing the development of nursing knowledge. Often believed to be the sole responsibility of academicians, clinical practice in essence is the field for knowledge develop- ment, for it is in the practice arena that nursing’s phenomena of interest are encoun- tered (Benner 1984; Benner et al. 1996). Knowledge development from a unique nursing perspective defines the boundaries of nursing and delineates the nature and application of nursing knowledge that explicates nurses’ unique contribution to the health care team (Rolfe 2007). There is a need to create spaces for nurses to
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consider the nature of clinical scholarship, and how it could be enacted in the clini- cal milieu. In this way a further and vital contribution to the future of the discipline can be made, and a real commitment to excellence in clinical practice can be dem- onstrated (Wilkies et al. 2013).
The term clinical scholarship is one that has been used in nursing discourses over the recent past. Nurse academics have espoused that nursing must build a culture of clinical scholarship (Kitson 2006; Meleis 1992). Assuming an understanding of this form of scholarship without defining it, Mundinger et al. (2009) postulate that the
‘cornerstone of clinical scholarship is the transfer of research to practice’ (p. 73).
Furthermore, in order to translate essential evidence-based knowledge into practice, the doctor of nursing graduate needs additional preparation in and knowledge of change processes, organisational systems, and evaluation methods. Practice change also entails using many skills that flow from practice relationships, communication, and collegial collaboration (Brown and Crabtree 2013, p. 336).
Academic scholarship has dominated the discourse in nursing. However, in order for nursing to develop and impact on health care, clinical scholarship needs to be explored and theorised. Nurse educators, hospital-based researchers and health organisations need to work together with academics to achieve this goal.
Frameworks of scholarship conceptualised by nurse academics are reflected in the findings of a study with emphasis on reading and doing research and translating it into nursing practice which needs to be done in a non-threatening way (Wilkies et al. 2013). As revealed in that study, clinical scholarship develops from learning from other’s research, reading research and putting research findings into practice, conducting systematic reviews, developing the scholar nurse’s own research, developing collaborative research and doing research from the scholar’s own prac- tice base (Wilkies et al. 2013).
In order to develop and nurture clinical scholarship, an enabling research culture within the health care arena and the academy must be developed to capture and sus- tain the creativity of the advanced practice nursing practitioner/aspirant. This culture needs to be categorised by research productivity, positive interprofessional collegial relationships, inclusivity and effective research processes and training. The health care arena must provide a safe environment for clinicians to discuss and theorise about clinical scholarship (Dopson 2007). As well, health care organisations and nurse leaders in these organisations must encourage and build structures such as practice development projects with a focus on improving patient care (Kitson 2006;
McCormack and McCance 2006), by encouraging and assisting clinical nurses to pursue research and its translation back to practice (Wilkies et al. 2013).
Advanced practice nursing practitioners can earn the rites-to-passage towards becoming a scholar-practitioner (see Fig. 4.1). The spectrum [landscape] of clinical scholarship model incorporates five dimensions of scholarship with specific indica- tors identified within each. Some of the indicators within the five dimensions may overlap. The definitions provided by Boyer have been incorporated to inform the indicators within each of the scholarship dimensions; Scholarship of Engagement, Scholarship of Integration, Scholarship of Application, Scholarship of Discovery and Scholarship of Teaching. The three characteristics associated reciprocally with
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scholarship weave through each of the dimensions and are exclusive to each of the dimensions, but yet collectively inform all five dimensions while connecting with and relating to the scholarly activity of the advanced practice nursing practitioner/
scholar practitioner (see Fig. 4.1). Moreover, the three characteristics; critical reflec- tivity, scholarly knowing, and ethic of inquiry and their identifiers act as a platform to construct and transform the scholarly activity of the advanced practice nursing practitioner within the context of engagement, integration, application, discovery and teaching into clinical scholarship.
Scholarship integrationof Doing research
at the boundaries and
make connections
within and between disciplines
altering the contexts
in which people view
knowledge
Scholarship applicationof
Dynamic process:
Applied research, discover new
knowledge and thereby contribute
to the relevant discipline
Scholarship discoveryof
Push back frontiers of the human knowledge Reflect the excitement of a new idea, exhilaration of
a new insight and search for knowledge for
the joy of knowing
Conduct research that addresses
the unique subject matter
of nursing
Scholarship teachingof
Render a public account of the act of teaching via
vision, design, enactment,
outcomes analysis, synthesis and communication Scholarship
engagementof Build bridges
foster and connections
between academia and society,
science and practice,
research and action Co-producer of
knowledge, knowledge
broker
Characteristics associated with scholarship Spectrum of clinical scholarship
Honesty, integrity, courage, open-mindedness,
scepticism, fairness, generosity,
perseverance, intellectual humility
Scholarly knowing Scrutiny by peers,
public, and self
Ethic of inquiry Spirit of curiosity,
desire to know, passion to understand and urge to discover
Advanced practice nursing practitioner/scholar practitioner Advanced practice nursing practitioner/scholar practitioner
Critical reflectivity
Fig. 4.1 Spectrum of clinical scholarship model
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Building a community of scholar-practitioners requires the development of a research culture within organisations that employ nurses and an environment that builds a sense of community. A community of scholar-practitioners in nursing insep- arably linked with the community of patients/service users and families that we serve, is a vision for the future of the nursing profession. Nurses will then be speak- ing for nursing, partnered with patients and focused on health (Ferguson-Pare 2005).
There are some similarities with the philosophy of developing a research culture with the portrayal of establishing a person-centered culture. According to McCormack et al. (2015) establishing a person-centered culture requires a sustained commitment to practice developments, service improvements and ways of working that embrace continuous feedback, reflection and engagement methods that enable all voices to be heard (p. 3). Patient-centred approaches to care are altering the future landscape of healthcare and the role of the advanced practice nursing practitioner/aspirant is cen- tral to sustaining this partnership in practice aligned with a culture that nurtures the structures, processes and outcomes warranted in such a clinical milieu.