Nurse as Expert.

A long, but important quote from Iain McGilchrist’s groundbreaking book ‘The Matter With Things. My review here.

In the world of nursing, Patricia Benner notes that becoming an expert means shifting from abstract principles to seeing intuitively the patient before you in relation to other real-life experiences, and noting similarities and differences. She also emphasises three other features of expertise, each of which can be seen as a shift from left hemisphere to right hemisphere ‘mode’: a change from viewing separate pieces of information to perception of situations as a whole; a ‘fluid, flexible’ performance; and the ‘passage from a detached observer to an involved performer, no longer outside the situation but now actively engaged in participation’.

Benner recognised that nursing was poorly served by theories developed in the academy, and introduced the (nowadays) revolutionary idea that the practice itself could and should inform theory. As a result her ideas are open to criticism from more conventional quarters for not being quantitative, and for using narratives. Remember once again that the left hemisphere is more interested in quantification than qualification, and distrusts narrative – indeed has difficulty understanding and seeing the point of narrative at all. Equally, because her model relies on experience, which partly comes with age, rather than rules which any person (or machine) could follow, it has been argued by some that she represents a step back into tradition and authority in nursing.

Though the left hemisphere’s theory may dictate that each person is effectively the same as and replaceable by any other member of the category, the right hemisphere is aware of individuals as individuals and that learning comes from living. The words ‘tradition and authority’ are here being used as boo words for what is merely common sense – namely that we learn best from those who have more accumulated experience, and have had more time to reflect on it, than we have. Not to recognise that fact is a sort of self-inflicted disability. In fact such clinical skills are inevitably those of a real individual, here the skilled nurse, in relation to another real individual, the patient in question. It is as much about knowing the patient, as it is about knowing facts. And, interestingly, experienced nurses recognise not just the importance of their own intuitions, but the importance of the patients’ own intuitive feelings.

A number of studies have established that intuition in nursing is real and indispensable. Attending to past experience improves nurses’ judgment. It is not mystical or somehow ‘unscientific’. Many nurses in practice feel that they should not be using intuition in reaching decisions and find that it is often denigrated by managers, their own colleagues and doctors. However, a lack of intuition means that patients may receive inappropriate or incomplete care; and, despite formal discouragement, most nurses persist in putting their intuitive knowledge to use.131 What is more, incorporation of intuition into judgment increases with expertise – which is as it should be, since the gut feelings of novices should not be equated with experienced intuition.

Iain McGilchrist — The Matter With Things.

2 responses to “Nurse as Expert.”

  1. I was just saying to a friend that the right brain has a very hard time being heard these days – anything that favors it is helpful, I think. When I was in school for social work about 20 years ago I came across some interesting ideas about counseling that incorporated narratives – and the practitioners were Australian!
    It’s good to see these excerpts, keep them coming!


  2. What a revelation! In latter years I realised that my nursing practice has so often been informed by intuition and it has served me well. Shame I’m now retired….


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