Christensen’s (2011) paper is an interesting and thought provoking article on the integration of theoretical and practical knowledge in advanced and advancing nursing practice. The central question for the authors is how can we, as a profession, understand the knowledge necessary for advancing and advanced practice? Christensen (2011) presents a very useful thematic analysis of the literature relating to knowledge integration models in this area and offers an alternative framework for how knowledge advancing practice might be understood. He argues that pattern recognition, first discussed by Benner (1984) in relation to nursing and expert practice, might be a useful way to understand how knowing that becomes the driver or impetus for action in practice.
Advocates of advanced roles have emphasised the importance of retaining care as the core of these roles (Manley 1997, Birch 2001). However, in the UK, increasingly a tension has emerged in the relationship between health care assistants and nurses over delegation of care to the former who are unregulated workers (Allan 2007). This has increased as the NHS has become more target driven (Allan 2010a,b). I would agree that patient benefit and care must remain the aim of both advanced and advancing roles. However, I would qualify that statement by adding that as a profession, we also need to understand two things. First, as Christensen argues here, how nurses integrate theoretical and practical knowledge; and second, how such integration is possible if nurses no longer deliver bedside or essential care in many areas of nursing.
Christensen (2011) is right to point out that we know little about how nurses acquire and then use knowledge practically. We also need to understand the relationship between different types of knowledge – theoretical and practical are a start – and Christensen (2011) argues that pattern recognition may be a useful tool to start this work. I suggest here another framework or tool that might enhance the concept of pattern recognition, which is not given attention in Christensen’s (2011) paper, namely the context where learning takes place for the advanced or advancing practitioner.
Evans et al.’s (2010) model of contextualisation and re-contextualisation of knowledge by students in the workplace has been developed in fields outside nursing, such as aircraft engineering. Evans et al. (2010) suggest that a fresh approach is needed to understand the old concept of transfer of knowledge. They argue that the transfer of knowledge implies that knowledge is ‘given’ in universities or colleges and taken by the student to be used unchanged in the workplace. They argue that knowledge is indeed learnt at university or college but is re-contexualised in the workplace into new knowledge that enables the learner to do the work expected by mentors, assessors and co-workers. This is not a one-off process but occurs during an academic programme at different sites (contexts) of learning.
Evans et al. (2010) explain the theory of re-contextualisation of knowledge in relation to nursing students’ experiences. It seems to me to be a useful way to understand the on-going theory–practice gap in nursing for students (Allan et al. 2011). But, could we also use this theory to understand pattern recognition among registered nurses as they progress to advanced practice? If we accept the argument that advancing practice is a continuing process that might last over an individual’s career (indeed is there an end-point?), then these points of re-contextualisation might occur for the registered nurse as they progress across specialities and between grades acquiring new theoretical and practical knowledge, at the same time, as re-contextualising this knowledge in each workplace or context for advancing practice.