EXPLICATION OF THE MEANING OF CLINICAL JUDGMENT IN NURSING PRACTICE USING RICOEUREAN HERMENEUTICS (HERMENEUTICS).
Contributors: Adelphi University.
Published: 1991
Number of pages: 217
Subjects: Health Sciences, Nursing.; Language, Linguistics.
Description: This dissertation sought to explicate the meaning of the phrase, clinical judgment in nursing practice. A review of nursing literature revealed this phrase was surrounded in a double opacity in that its meaning had not been made explicit, and it had multiple implicit meanings. A search of research paradigms, that would be congruent with meaning explication, led to the selection of Paul Ricoeur's hermeneutic philosophy. Following an excursus of Ricoeur's philosophy a method of textual interpretation was designed for use in this research. This method consisted of using the multiple dialectics, characteristic of Ricoeur's hermeneutics which include: distanciation/appropriation, guessing/validation, and explanation/understanding.

For the purpose of this study a text was created by transcribing four dialogical sessions with an expert nurse. The created text served as the linguistic data for the interpretive project.

Clinical judgment in nursing practice was found to be not merely the acquisition of clinical knowledge, but an evolutionary process of practical reasoning, much like the process of hermeneutics itself. This hermeneutic knowing derives from a synthesis of theoretical knowledge and practical knowledge gained from years of clinical nursing practice. Clinical judgment was found to be a dialectic of phronesis and praxis, in that phronesis, as practical reasoning, serves to inform the action of the nurse, and this action in turn serves to inform further practical reasoning and future action.

Textual interpretation also revealed the difference between clinical judgment and decision making. This finding is of particular significance because prior to this study these terms were assumed to be synonymous. Clinical judgment is distinguished by phronesis, a temporal and ontological component, as well as by rule-transcending and creative action behavior.

It was concluded that clinical judgment is a symbol of the culture of nursing, in that this construct serves to signify a particular way of knowing, being and becoming in nursing practice.

Study findings suggest that different rationalities exist in nursing practice which need to be recognized and valued. Significant implications for nursing relate to staffing practices, expected terminal competencies of undergraduate students, graduate curricula enrichment, staff development, and future research.
Notes: Source: Dissertation Abstracts International, Volume: 52-02, Section: B, page: 0744.

Thesis (PH.D.)--ADELPHI UNIVERSITY, 1991.

School code: 0001.