Expert Public Health Nursing Practice: A Complex Tapestry
Leonie Gallaher, RGON, MA (Hons) Director of Nursing and Midwifery, Northland Health
The research outlined in this paper used Heideggerian phenomenology, as interpreted and utilised by Benner (1984) to examine the phenomenon of expert public health nursing practice within a New Zealand community health setting. Narrative interviews were conducted with eight identified expert practitioners who are currently practising in this speciality area. Data analysis led to the identification and description of themes which were supported by paradigm cases and exemplars. Four key themes were identified which captured 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 with others, and integrated into the complex tapestry of expert public health nursing practice that emerged in this study. Although the research findings supported much of what is reported in other 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.
Expert, public health nursing, Benner
Following the publication of Benner’s original research in 1984, the concept of expert nursing practice has continued to be debated and critiqued in the literature and within diverse nursing forums. English (1993) for example has denigrated aspects of Benner’s work, making the claim that the expert nurse as presented by Benner is some “blessed practitioner, initiated into the protected knowledge of some secret society” (English, Nursing Praxis in New Zealand Vol. 14 No. 3 1999 Page 17 p.389). In contrast, Darbyshire (1994) strongly supports Benner’s interpretative approach to understanding the complexity of expert nursing practice. Continued