440 ■ III : ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
then reflect on the findings; the findings are evaluated through the lens of an experi-
enced clinician with in- depth analysis by the researcher, at which point the team makes
sense of the findings and determines what can be translated back to the bedside as evi-
dence for practice and further testing. This process is enhanced with reflective inquiry
which allows for use of the clinician’s knowledge from past experiences, critical to the
development of useable patient- centered interventions.
This chapter highlights the importance of clinician knowledge, which should
be recognized by theorists and researchers alike, as valuable and a unique contribu-
tion to science. I agree. Some clinical knowledge is created through reflective prac-
tice. The two primary academic methods of reflection include journaling and group
discussion (Caldwell & Grobbel, 2013), but classroom, case conferences, and other
methods are being utilized. Reflective case studies that focus on the needs of the
patient and the values of the nurse have been shown to have a significant impact on
the advanced practice nursing student’s understanding of his or her role (ter Maten-
Speksnijder, Grypdonock, Pool, & Streumer, 2012). The movement away from crit-
ical thinking and toward clinical reasoning is enhanced through critical reflection
(Raterink, 2016).
The author points out the inevitable merging of traditional research as the gen-
eration of new knowledge with reflective practice, and its contribution to the body
of evolving science for the discipline. This movement has been fully conceptualized
in the newly emerging field of Synthesis Science, that of the language and method-
ology of evidence- based practice. In evidence- based practice models, while random-
ized controlled trials are seen as the gold standard, many other forms of knowledge
are accepted including clinician expertise (which in best practice should derive in part
from reflection) to qualitative findings. Schön (1987), the father of reflective practice,
suggests that an epistemology of practice that traditionally has had a positivist slant,
termed technical rationality, now incorporate the experience of the practitioner, which
is evident in many different models of evidence- based practice. According to Kinsella
(2007), Schön’s position of adding reflective practice to the understanding of a clinical
scenario does not denigrate traditional research knowledge, but instead is additive and
has important ramifications for those applying it to practice. Reflective practice together
with evidence- based practice has been suggested to be the two skills necessary to form
a model of professional thinking (Bannigan & Moores, 2009).
As with any pedagogical strategy, it must be leveled appropriate to the student
population. Just as pharmacology is taught one way and with a specific set of out-
comes to be achieved at the baccalaureate level, it becomes more complex with dif-
ferent outcomes and different teaching strategies at the master’s level. Reflection as
a strategy for mastery differs from every level of nursing practice. Reflection for the
doctoral advanced practice nurse will be at a high level and incorporate several ways
of knowing.
■ REFERENCES
Bannigan, K., & Moores, A. (2009). A model of professional thinking: Integrating reflective practice and
evidence based practice. Canadian Journal of Occupational Therapy, 76 ( 5 ), 342–350.
Caldwell, L., & Grobbel, C. C. (2013). The importance of reflective practice in nursing. International
Journal of Caring Sciences, 6 (3), 319–326.