Expert public health nursing practice : a complex tapestry : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University

Abstract

Patricia Benner's seminal work, From Novice to Expert (1984), can be considered the starting point for ongoing nursing research that has sought to describe and understand expert nursing practice. A review of the nursing literature revealed a gap in the research based knowledge relating to expert nursing practice from a New Zealand and community health nursing perspective. This study used Heideggerian phenomenology, as this methodology has been interpreted and utilised by Benner, to examine the phenomenon of expert public health nursing practice within a particular New Zealand community health setting. Narrative interviews were conducted with eight identified expert practitioners who are currently practising in this specialty area. Data analysis led to the identification and description of themes which are presented as the research findings, supported by paradigm cases and exemplars. Four key themes were identified. These seemed to capture the essence of the phenomenon of expert public health nursing practice as this was revealed in the practice of the research participants. The themes describe the finely tuned recognition and assessment skills demonstrated by these nurses; their ability to form, sustain and close relationships with clients over time; the skilful coaching undertaken with clients; and the way in which they coped with the dark side of their work with integrity and courage. It was recognised that neither the themes nor the various threads described within each theme exist in isolation from each other. Each theme is closely interrelated, and integrated into the complex tapestry of expert public health nursing practice that emerged in this study. Although this research supports and elaborates upon many of the findings from published studies that have explored both expert and public health nursing practice, differences were apparent. This suggests that nurses should be cautious about using models or concepts developed in contexts that are often vastly different to the New Zealand nursing scene, without carefully evaluating their relevance.