An interpretive study describing the clinical judgment of nurse practitioners

Devaluation of nursing practice by both practicing nurses and nurse educators is giving way to keen interest in clinical scholarship. A naturalistic study was conducted to provide a contextual account of the actual practice of experienced nurse practitioners. Data collection procedures consisted of clinical situation interviews with nurse practitioner pairs, participant observation of patient visits to nurse practitioners in four hospital-based ambulatory settings, individual interviews with nurse practitioners, and administration of a brief demographic questionnaire. The 199 clinical situations that constituted the resulting text were analyzed using phenomenological and existential perspectives. The clinical judgment of experienced nurse practitioners is described through interpretive analysis of the text according to the dictates of hermeneutical phenomenology. This methodology provides a way of describing and communicating the knowledge that develops among experienced practitioners and their patients. Text interpretation also produced an adaptation of Benner's (1984a) domains and competencies specifically for nurse practitioner practice, which may be useful as a conceptual framework for nurse practitioner practice, education, and research.