Knowledge Conceptualisation in Advanced Practice: Early Finding from a Constructivist Grounded Theory Study

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The swampy lowland of professional practice (Schon, 1983) is an inherently complex environment, in which nurses are continually called upon to process information and make rapid decisions in ambiguous circumstances (Lamond and Thompson, 2000, Ruth-Sahd and Hendy, 2005, Tanner, 2006). The situation is further obfuscated by the emergence of new and innovative nursing roles, which may have traditionally been within the domain of other professionals, and for which the levels of formal education and training are variable (Longley, Magill and Warner, 2004, McKenna et al., 2006, Offredy, 2002). The fact that expert nursing practice is often linked to the use of intuitive decision-making strategies also compounds the situation; the intuitive-phenomenological paradigm dictating that the practitioner draw upon eclectic forms of knowledge -an epistemology derived from a number of sources. The innate complexity of the contemporary clinical environment thus represents a significant challenge to nursing and paramedical staff working at the edge of the practice envelope. New and innovative approaches to professional education are being developed to meet the needs of such practitioners (Barratt, 2010, Currie et al., -yet the expertise embedded within advanced practice remains elusive in terms of quantification, and is particularly difficult to develop within the neophyte. Within this theme paper, the author will present early findings from a Grounded Theory study exploring the forms of knowledge used by advanced practitioners, the processes by which knowledge construction takes place, and the influence that formal Masters level education may exert upon schema construction (Piaget, 1950), and thus the clinician's unique epistemology of practice. Practitioners who have been educationally prepared for an advanced clinical role through two quite distinct pedagogical modes (a conventional Masters programme and Co-operative Inquiry group) form the initial (purposive) sample. A series of 'salient events' provide the thematic substrate from which Critical Incident Analysis (Flanagan, 1954) draws forth and clarifies the sources of knowledge that practitioners utilise in order to arrive at clinical decisions. Emerging concepts & categories are mapped against an existing conceptual framework i.e. Carper's (1978) Ways of Knowing; this provides both a clearer view of the practitioner's cognitive architecture as well as demonstrating the way in which the study refines, challenges, or supersedes current extant concepts (Charmaz, 2006). Although theoretical/conceptual frameworks may be seen as inconsistent with the basic principles of Grounded Theory i.e. the induction of new theories and concepts (Birks and Mills, 2011), Corbin and Strauss (2008) suggest that , as in this case, they may have some practical utility in terms of framing and interpreting findings. Knowledge Conceptualization in Advanced Clinical Practice – Early Findings from a Constructivist Grounded Theory Study. Available from: [accessed Jun 19, 2017].
Original languageEnglish
Publication statusPublished - 2 Sept 2014
EventNET 2014 - Education In Healthcare - Churchill College, Cambridge, United Kingdom
Duration: 1 Sept 20144 Sept 2014


ConferenceNET 2014 - Education In Healthcare
Abbreviated titleNET 2014
Country/TerritoryUnited Kingdom


  • Pedagogic Research
  • advanced nurse practitioners
  • Grounded theory


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