Hermeneutics and pragmatism offer a way of exploring the consequences of advanced assessment

Linking specific nursing actions to outcomes in the healthcare setting is challenging. Patient outcomes are varied and influenced by a myriad of factors, and always involve a wider team than any one nurse. It is difficult to control for a single action or set of actions of a particular nurse. Furthermore, practice is seldom about any 'one' action, for one thing leads to another, all within a complex interplay of influencing factors. In this article, we outline a research method which combined Dewey's pragmatism with Gadamer's hermeneutics to explore the consequences of the nurse's use of advanced assessment skills in the acute care setting of medical and surgical wards. This pragmatic hermeneutic methodological approach allowed the complex interplay of influences to be revealed in the unfolding story. Reflection of the nurse brought insights that may otherwise have been passed over. The philosophical notions of Dewey drew attention to the play of 'means' and 'ends'. A hermeneutic approach that calls for 'thinking' extends understanding and raises insights that can inform education and practice.