The concept and characteristics of clinical practice ability in Master Degree of Nursing(specialty)☆

2016-12-16JingZengJingCiZhuXioYuZho

Frontiers of Nursing 2016年3期

Jing Zeng,Jing-Ci Zhu,Xio-Yu Zho

aChengdu Medical College,Chengdu,Sichuan 610083,China

bSchool of Nursing,Third Military Medical University,China

Review Article

The concept and characteristics of clinical practice ability in Master Degree of Nursing(specialty)☆

Jing Zenga,Jing-Ci Zhub,*,Xiao-Yu Zhaoa

aChengdu Medical College,Chengdu,Sichuan 610083,China

bSchool of Nursing,Third Military Medical University,China

A R T I C L E I N F O

Article history:

Received 29 June 2015

Received in revised form

14 December 2015

Accepted 17 June 2016

Available online 14 September 2016

Nursing science

Master Degree of Nursing(specialty)

Clinical practice ability

Concept

Characteristics

The concepts of ability,practice ability,and professional practice ability were analyzed using a theoretical research method.Based on the results of the analysis,the concept of clinical practice ability for Master Degree of Nursing(specialty)students was defined,and the characteristics were interpreted to provide references for future in-depth studies.

1.Introduction

The transformation of the medical model has led to changes in the working model for nursing.Simply executing doctor's orders is no longer a functional nursing model.The nursing model has transformed into a holistic model that is people centered,and clinical care recipients have expanded from patients to families, groups of individuals,and the overall population.When the working tasks and environment of nurses change,the clinical practice ability required for nurses changes accordingly.China has recently added the training level of Master Degree of Nursing (specialty)(MNS).Nurse managers and researchers need to define the clinical practice ability that is required for MNS students to be competent for clinical job requirements.Several studies on the clinical practice ability of MNS students have recently been performed in China;however,the concept of clinical practice ability in nursing has different interpretations,and the characteristics of clinical practice ability are unclear.The lack of a well-defined theory usually resultsin confusion in practice.Therefore,weperformed an in-depth theoretical analysis on clinical practice ability in MNS students and defined the concept and characteristics of this ability to provide references for future in-depth studies.

2.The concepts related to clinical practice ability in MNS students

2.1.Ability

Ability is a concept with multiple dimensions,which may be interpreted differently.Studies on ability first originated from psychology.The field of psychology usually defines ability as personal psychological characteristics that individuals possess to successfully complete certain activities.Ability and activity are closely linked.Ability forms,develops,and is present in activities.In addition,ability is the premise of undertaking all activities.1The psychological characteristics of ability are associated with direct stable regulation and control functions during the selection of activities.2Researchers suggest that if individuals want to solve problems or complete activities,having certain psychological characteristics is not enough.Ability requires both psychological characteristics and specific physiological behaviors to accomplish an activity.3The field of philosophy defines ability as the skills used and the energy expended during actions,which can correctly control certain activities.Ability is an effective method for therealization of human values and is a positive force in social development and life.According to the field of vocational ability development,three different concepts of ability have emerged in the history of ability-based education,which are general ability,ordinary ability,and integrated ability.The concept of integrated ability has been accepted and recognized by academic fields in various countries.The concept of integrated ability combines both general ability and ordinary ability to provide a more comprehensive definition of ability,which is linked with job position or role.Ability is the integration of knowledge,skills,judgment,attitude,and values required for certain job roles.

2.2.Practice ability

These concepts suggest that ability is closely associated with practice and cannot be separated from talent,knowledge,or skills. Practice ability has been extensively studied;however,the definition of“practice”has been interpreted differently among academic fields.

2.2.1.The concept of practice in philosophy

Marxist philosophy considers practice to be all social objective material activities that play a dynamic role in reforming and exploring the real world.Practice ability is the organic whole of all material factors,including mental factors,intelligence factors,and non-intelligence factors.Practice ability mainly includes the following three components:humanity's nature,which is the sum of human physical and mental powers;an individual's knowledge, experiences,and skills;and non-intelligence factors,such as emotion and the will of the individual.4

2.2.2.The concept of practice in psychology

Studies of practice ability in psychology have focused on practical intelligence.Neisser was one of the scholars that first proposed the idea of practical intelligence.He suggested that practical intelligence corresponded to academic intelligence and regarded practical intelligence as the cognitive response of a person to problems outside of the classroom.5Sternberg,a psychologist in the United States,performed in-depth studies on practical intelligence and proposed the successful intelligence theory,which indicated that successful intelligence mainly included analytical intelligence, creative intelligence,and practical intelligence.Sternberg particularly emphasized practical intelligence,which he considered the ability to transform theories into practice and to analyze and solve practical problems in work and life.Practical intelligence is tacit knowledge,which is a type of knowledge that cannot be learned through language and can only be obtained through one's own experience and comprehension.This type of knowledge usually is action oriented,which is helpful for individuals to solve problems and achieve goals.6,7In addition,Sternberg8emphasized that these three types of intelligence are interconnected and that success can only be obtained when a balance is reached.

2.2.3.The concept of practice in education

Regarding practice ability in education,scholars have proposed that in addition to the psychological and physiological characteristics that individuals possess to solve practical problems and perform activities,these characteristics should be analyzed from the perspective of knowledge utilization.Therefore,the concept of knowledge-based practice ability was proposed,which emphasizes using internalized knowledge and understanding how individuals relate to the external environment to solve practical problems. Knowledge utilization is the core connotation of knowledge-based practice ability.Therefore,during training,the actual utilization of knowledge is more important than hands-on activities.9Several scholars have defined practice ability in education as individual absorption and integration of supportive education and basic resources by students,adaption to social life,the ability to answer basic practical questions,participation in social life practices,promotion of self-growth,and an increase in the ability to selfpractice.10

2.2.4.Practical knowledge

Knowledge and ability complement each other.Experts in many fields have different classifications of practical knowledge,which is composed of the following aspects:motivation,emotion,attitude, strategies for solving subject-related problems,rules,techniques, procedural knowledge,strategies for controlling the thinking process,and situational knowledge.11Practical knowledge is an important category of knowledge and complements theoretical knowledge.Practical knowledge develops from understanding and using theoretical knowledge in individuals.Theoretical knowledge is mostly based on practical knowledge.Practice ability from the perspective of practical knowledge is defined as the reasonable selection and utilization of mastered knowledge and skills in various actual situations.Individuals use practical knowledge to solve practical problems.12Based on these results,practice ability is defined as follows:(1)the combination of psychological and physiological characteristics in individuals;(2)the ability to transform knowledge into practice,and(3)the ability to use practical knowledge to solve actual problems.

2.3.Professional practice ability

Practice ability is a broad concept that includes the ability to perform activities in and outside of work.Professional practice ability is the ability to reasonably use professional knowledge and skills to independently solve problems and evaluate results.In addition,professional practice ability is the core skill required for workers to be competent.13Several scholars have proposed that professional practice ability is the ability to use learned professional knowledge to solve professional practical problems and that this ability is not isolated but complex and based on various other abilities.11Medicine requires a high level of professional practice ability.Miller14suggested that professional practice ability,i.e., clinical practice ability,in physicians can be evaluated through knowledge,competence,performance,and action.Additionally, Miller constructed a pyramidal framework model.The first layer of the pyramid(Knows)is the relevant theoretical and operational knowledge required to perform medical professions.The second layer(KnowsHow)is knowing howtouse the accumulated medical professional knowledge,which is to understand and master knowledge.The third layer(Shows How)is using the acquired knowledge and ability when facing clinical care recipients in a virtual context.The fourth layer(Does)is the practical action of students in a specific and practical clinical working environment. This pyramidal framework redefines the concept of clinical practice ability and its role in clinical practice.Clinical practice ability is based on medical knowledge and the effective presentation of behaviors.Clinical practice ability is the bridge during the transformation ofknowledge into behavior.15This framework emphasizes that behavior in a clinical work environment is not based on knowledge and operation skills.In contrast,clinical practice ability is the ability to use a combination of theory, knowledge,and operation skills to provide timely and effective treatment for complicated disease conditions in clinical practice. Based on this pyramid,Epstein et al16proposed the concept of cultivation of clinical practice ability in medical education,which is the ability to skillfully and reasonably apply communication,professional knowledge,skills,clinical decision-making,professionalethics,and emotion in clinical practice when serving patients and community populations.Their concept of clinical practice ability is mainly composed of the following aspects:professional skills, multidisciplinary medical collaboration,communication,team work,professional ethics,and clinical decision-making.Scholars in China have suggested that clinical practice ability should be defined according to training goals at different stages of medical education. The psychological characteristics of clinical practice ability include clinicaloperation skills,clinicaldecision-making,humanistic concern,and communication skills that are required to complete clinical practice activities.17In addition,researchers have proposed that clinical practice ability is composed of clinical operation skills, which include the coordination of limb movements,and clinical decision-making,which depends on the cognitive activity of the human brain.18

2.4.Clinical practice ability in nursing

Nursing is an important component of medicine.The transformation of medicine has led to changes in nursing,including a different understanding and definition of clinical practice ability.In 2002,the Nursing and Midwifery Council(NMC)of the United Kingdom proposed that clinical practice ability in nursing is the ability to independently,effectively,and safely complete clinical practice activities without supervision.Many researchers gradually proposed a newconcept of clinical practice ability in nursing.Based on these studies,in 2010,the NMC defined clinical practice ability in nursing as the comprehensive ability to perform safe and effective nursing practices and interventions using skills,knowledge,attitude,and professional values.19The National League of Nursing(NLN)in the United States suggested that clinical practice ability is the ability to use correct judgment and evidence-based nursing practices to provide clinical care to patients in different clinical nursing environments.20Researchers in China proposed that clinical practice ability in nursing is the transformation of learned knowledge and skills into physiological and psychological characteristics that are required to solve clinicalpractical problems.21

3.Definition and characteristics of clinical practice ability for MNS students

3.1.Definition of clinical practice ability in MNS students

Researchers have suggested that professional practice ability is a combination of the psychological and physiological characteristics required to use learned knowledge to solve practical professional problems.Clinical practice ability in nursing is a type of professional practice ability.We defined clinical practice ability for MNS students as the thinking and actions of MNS students,specifically when they use theoretical and practical medical knowledge to meet the health needs of clinical care recipients,including individuals,families,and communities.Clinical practice ability in nursing is the ability to effectively solve complicated nursing problems and to provide appropriate and high-quality health services.This ability is the combination of psychological and physiological characteristics to solve clinical problems and is an aggregate various abilities.This ability emphasizes the flexible use of systemic knowledge by students to solve problems in clinical practice rather than depending on personal perceptual experience and simple nursing operation skills.This ability focuses on using comprehensive methods to solve complicated nursing problems and to provide high-quality nursing services by individuals in a changing nursing work environment.

3.2.The characteristics of clinical practice ability in MNS students

3.2.1.Clinical setting and practice ability in MNS students

Practice relies on the setting.The setting is the place of practice and,practice is always performed in specific settings.The development of clinical practice ability in MNS students depends on the clinical setting.This setting is dynamic and complicated,is full of uncertainty,and is unconventional,including sudden emergencies and conflicts with patients.Clinical practice ability in MNS students in the clinical setting is not a hard copy of theories and knowledge and cannot depend on general nursing operation skills or strategies.In contrast,this ability requires students to flexibly and carefully perform decision-making to handle clinical nursing issues. Clinical practice ability is flexible and open rather than rigid and mechanical.In the clinical setting,students will provide patient services,undertake different roles and functions,and use corresponding clinical practice ability in different nursing practices. Therefore,clinical practice ability cannot be separated from specific patients,the clinical setting,and the functional roles of students.

3.2.2.The dynamics of clinical practice ability in MNS students

Clinical practice ability in MNS students is required to enable them to become advanced nurse practitioners.This ability is rooted in specific historical and cultural contexts.In addition,with social development,the health needs of the population will vary,which will require changes to the education system.Furthermore, communication in clinical practice is iterative,and clinical practice ability will continuously develop over time,allowing“novices”to develop into“experts”.In addition,this process of continuous change and knowledge accumulation creates an optimal growth environment for the development of nursing specialization.

3.2.3.Evaluation of clinical practice ability in MNS students

Clinical practice ability in MNS students requires effective evaluation to determine the ability requirements for students, which is important for teaching nursing practices.Therefore,an evaluation indicator system corresponding to the components of clinical practice ability in MNS students should be established to monitor the development of this ability in students and to improve the methods of clinical practice teaching.

Conflicts of interest

All contributing authors declare no conflicts of interest.

1.Ye Y.General Psychology.Shanghai:East China Normal University Press;2010: 355(in Chinese).

2.Feng Z.Principles of Structured and Directed Psychology Teaching.Beijing:Beijing Normal University Press;1998:146(in Chinese).

3.Liu L.The outline of developing students'practical capability.Liaoning Norm Univ.2007:15-41(in Chinese).

4.Marx-Engels-Gesamtausgabe.vol.46(Part 1).People's Publishing House.1980: 486(in Chinese).

5.Sternberg RJ,Wagner RK,Williams WM,Horvath JA.Testing common sense. Am Psychol.1995;50:912-927.

6.Liu L,Fu W.Practical ability:concept,structure and cultivation measures.Educ Sci.2005;21:1-5(in Chinese).

7.Jiang J.Review of the studies of Sternberg in practical intelligence.J Xuzhou Normal Univ Philos Sci Ed.2009;35:98-102(in Chinese).

8.Sternberg RJ.Successful intelligence:finding a balance.Trends Cogn Sci.1999;3: 436-442.

9.Zhang Q.Teaching change-oriented practical ability.Central China Norm Univ. 2011;35(in Chinese).

10.Wu Z.The study of the development of students'practical ability.Northeast Norm Univ.2006:15-16(in Chinese).

11.Zhang Q.Research on promoting undergraduates'professional practical abilities:a perspective of cognitive apprenticeship:a case study of“PDIMBTS”employed by Software College in Jiangxi Normal University.Jiangxi Norm Univ. 2006;21(in Chinese).

12.Dong Y.Research in university students'practical capability and development. East China Norm Univ.2007:28-29(in Chinese).

13.Zhao H.The connotation of professional practical ability and its cultivating way.J Wuhan Polytech.2009;8:60-63(in Chinese).

14.Miller GE.The assessment of clinical skills/competence/performance.Acad Med.1990;65:s63-67.

15.Qi W,Wang F.Teachers'professional practical ability:connotation and characteristics.Educ Res.2012;2:95-102(in Chinese).

16.Epstein RM,Hundert EM.Defining and assessing professional competence. JAMA.2002;287:226-235.

17.Huang D,He P,Yang M.Exploration and practice of strengthening the clinical practical ability of medical students.Chin High Med Educ.2004:48-51 (in Chinese).

18.Du W,Xie S,Li J.Exploration of clinical practical ability cultivation in medical students.Northwest Med Educ.2008;16:388-390(in Chinese).

19.Garside JR,Nhemachena JZ.A concept analysis of competence and its transition in nursing.Nurse Educ Today.2013;33:541-545.

20.Valloze J.Competence:a concept analysis.Teach Learn Nurs.2009;4:115-118.

21.Hou M.Investigation and analysis of clinical practice competence of master's of nursing using the Delphi method.Shihezi Univ.2010;2(in Chinese).

How to cite this article:Zeng J,Zhu J-C,Zhao X-Y.The concept and characteristics of clinical practice ability in Master Degree of Nursing(specialty).Chin Nurs Res.2016;3:97-100.http:// dx.doi.org/10.1016/j.cnre.2016.06.009

☆This project was supported by planning project of“12th Five-Year”in philosophy and social sciences of Sichuan province(No.SC13B081).

*Corresponding author.

E-mail address:664619460@qq.com(J.-C.Zhu).

Peer review under responsibility of Shanxi Medical Periodical Press.

http://dx.doi.org/10.1016/j.cnre.2016.06.009

Frontiers of Nursing

2016年3期