218 ■ II: ROLES FOR DOCTORAL ADVANCED NURSING PRACTICE
Boyer (1990) inspired most disciplines to engage in robust dialogues about the
meaning of scholarship in modern times. Various nurse scholars have shared opinions
on what a scholar and clinical scholarship means. In writing about clinical scholarship,
Diers (1995) argued that while clinical research in nursing is an accepted form of schol-
arly activity, clinical research and clinical scholarship are not the same. According to
Diers, clinical scholarship offers an alternative way of extending knowledge about nurs-
ing practice. She conceptualized clinical scholarship in a practice profession as an intel-
lectual activity that creates a new understanding for the practice. Clinical scholarship
examines the practice itself and offers rich descriptions of the practice. Through clinical
scholarship, the practitioner synthesizes practice knowledge and challenges the theo-
ries and procedures that we have learned and practiced.
Wright and Leahey (2000) argued that clinical scholarship requires an immer-
sion in clinical practice while simultaneously finding ways to articulate, describe, and
analyze what is occurring within clinical practice. Using a framework to describe the
fundamental building blocks of clinical scholarship, they differentiated perceptual,
conceptual, and executive skills related to the nursing of families. According to Wright
and Leahey (2000), perceptual skills focus on what the nurse observes, and conceptual
skills involve how the nurse makes sense of what is observed, relying on his or her
conceptual grounding and personal experience. In addition, there are executive skills
that include what the nurse does. Specifically, how the nurse responds (communication
skills) is based on how he or she conceptually makes sense of what is happening within
the individual, family, and larger systems, as well as between himself or herself and
these systems. Clinical scholarship is refined through many hours of observation and
participation in therapeutic conversations between nurse clinicians and families using
written documentation that requires analysis of these conversations. Clinical scholar-
ship requires intellectual maturity that comes from expertise and repeated experiences,
which is reflected in careful analyses of situations and critical assessment of responses.
The explanations and reflections offered by the clinical scholar are contextualized in his
or her personal history and are enhanced by his or her well- supported interpretations.
Melanie Dreher (1999) argued that clinical scholarship is a value orientation about
inquiry and implies a willingness to scrutinize nursing practice. Clinical scholarship is
an intellectual process grounded in curiosity about why our clients respond the way
they do and why we, as nurses, do the things that we do. It includes challenging tra-
ditional nursing interventions, testing our ideas, predicting outcomes, and explaining
both patterns and expectations. Clinical scholarship is rooted in observation on ways
in which clients respond to their problems and to their treatments. Unfortunately, the
observations nurses typically have documented often have not been for the purpose
of improving patient outcomes, but rather for limiting liability. It is not sufficient to
observe phenomena. Observations must be interpreted by comparing them with similar
phenomena (whether or not those comparisons are drawn from personal clinical expe-
rience). Comparisons can also be accomplished by using what is known based on the
literature. Synthesis builds on the analysis to create an understanding of why these pat-
terns and/ or exceptions exist. Synthesis in clinical scholarship is the process of explain-
ing or attaching meaning to the observations and the use of comparisons in examining
events or situations. Clinical scholars generate an interpretation of their observations
through the process of discussion with colleagues within the nursing community and
with other disciplines. Another example is the review of literature and the conduct of
integrative reviews of nursing research that incorporate the informed and expert clini-
cal knowledge of the clinician (Ganong, 1987). At another level, understanding meta-
analyses of the science literature provides stronger evidence of practice phenomena
under consideration.