19: ENHANCING THE DOCTORAL ADVANCED PRACTICE NURSING ROLE ■ 435This problem, however, can be addressed through reflective inquiry, which turns
technical rationality on its head by starting with the individual nurse’s experience,
and then unpacking it to discover what can be learned and applied in future situations.
Reflection, therefore, offers an alternative, inductive approach to learning and knowl-
edge generation. It challenges the usual hierarchy of evidence by shifting the emphasis
from the findings of large- scale research studies to the knowledge generated by individ-
ual practitioners from their own practice, thereby promoting practitioners to the status
of researchers and theorists in their own right (Rolfe, Freshwater, & Jasper, 2001).
Central to this process is a specific practice event experienced uniquely by indi-
viduals, from which a number of more abstract generalizations may be derived. It is
consistent with the essence of nursing, where no two clinical situations are ever the
same. Through exploring specific incidents in practice and generating new theoretical
perspectives, other types of knowledge that are essential to you as a doctoral advanced
NP can be utilized and valued. In addition to propositional knowledge (from published
research and textbooks), you use personal knowledge (self- awareness and ethical val-
ues), and practice knowledge (the cumulative wealth of experience from previous clini-
cal situations). All three types of knowing are embedded in the expert nurse’s everyday
practice in order to provide high- quality and holistic patient/ client care, and this com-
bination of different ways of knowing and their application to practice can be termed
praxis (the action component of phronesis).
Praxis or wise action effectively dissolves the traditional theory– practice gap by
making theory and practice mutually dependent upon one another. Nursing praxis is
a bringing together of theory and practice that involves a continual process of hypoth-
esizing and testing out new ideas, and of modifying practice according to the results.
Therefore, I would argue that all practitioners are not only theorists , but also researchers ,
engaged in numerous pieces of action research and the generation of informal theory.
In its everyday use, the phrase “research- based practice” limits the knowledge deemed
acceptable for practice. However, reflective NPs can access other types of knowledge
through the kind of critical inquiry that takes place within nursing praxis, producing
“practice- based evidence.” Practice knowledge created through reflection can be judged
by its own criteria— its relevance and value to care— rather than any external criteria
normally reserved for positivist research. Such research may have a sample of one, and
might not be generalizable beyond that single person. Nevertheless, it is still a valid
research and represents what Rolfe and Gardner (2005) called a nursing science of the
unique, concerned with persons rather than people.
As a consequence, distinctions between research and practice, and between the gen-
eration and application of knowledge merge into one. Theory does not determine practice,
but is generated from practice. In fact, the process is circular with practice- generating the-
ory and theory- modifying practice, which generates new theory and so on. Nursing praxis
is a fusion of knowing and doing, in which research is incorporated into everyday practice,
and in which theory and practice become two sides of the same coin. The doctoral APN
is thus not just a nurse with a lot of experience, but instead a practitioner who can freely
move between different ways of knowing, and who is able to select and transform knowl-
edge appropriate to the situation. Trusting your intuitive personal and practice knowledge
requires courage and conviction, because it requires a shift from reliance on abstract, prop-
ositional thinking to thinking based on clinical reasoning related to concrete experiences.
Do you have the ability to pay attention to and learn from everyday practice with the aim
of realizing the optimal standard of care for your patients? This ethical artistry, in my opin-
ion, is the hallmark of an advanced and expert practitioner, and also denotes doctoral level
practice. The resulting science and art of nursing are then woven into a rich tapestry of
practice, which honors the intuitive and holistic nature of experience.