Advancing nursing practice with a unit-based clinical expert.
OBJECTIVE
To explore patterns in the practice of nursing and patient outcomes.


METHODS
Qualitative field research.


METHODS
Populations were critical care nurses and critically ill adult patients in the 10-bed medical critical care unit of a 900-bed teaching hospital. A convenience-purposive sample of 27 nurses and 31 patients was studied in 1985.


METHODS
Six months of participant observation, unstructured interviews, and the constant comparison method of grounded theory.


RESULTS
Markedly different patterns were found in expert and nonexpert practice. The substantive theory of conversion helped explain how the majority of nonexpert nurses advanced their practice. The metaphor of catalyzed conversion captures how a unit-based expert nurse serves as a catalyst to advance the practice of nonexperts. Presence, defined as the way of being within a given clinical context, differentiated nurses.


CONCLUSIONS
(a) Expert and nonexpert practices are substantively different. (b) Expert and nonexpert practice results in different patient outcomes. (c) Conversion helps explain changes in nonexpert practice.


CONCLUSIONS
A unit-based expert nurse can increase patient-focused care.
Hanneman
S K
SK
University of Texas-Houston, School of Nursing, Houston 77030, USA.
D000328:Adult; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians; D009736:Nursing Process; D009742:Nursing Theory; D010348:Patient Care Team; D016896:Treatment Outcome