The Theory of Wisdom-in-Action for Clinical Nursing

The current ANS featured article is titled “Development of a Theory of Wisdom-in-Action for Clinical Nursing” authored by Susan A. Matney, PhD, RN; Kay Avant, PhD, RN; Lauren Clark, PhD, RN; and Nancy Staggers, PhD, RN. You can download this article at no cost while it is featured!  Here is a message from Dr. Matney about this work:

Susan A. Matney

The article presented in Advances in Nursing Science describes the emerging Theory of Wisdom-in-Action (WIA) for clinical nursing. The theory was developed in three phases, In Phase 1, a preliminary theory was developed deductively using derivation and synthesis, based on theories and models from psychology, education, and nursing. Pertinent concepts were identified and nursing-specific definitions created. In Phase 2, a constructivist grounded theory approach inductively captured the experience of wisdom in nursing practice, based on wisdom narratives from 30 emergency department nurses. The resulting grounded theory focused on two processes, technical and affective, juxtaposed on a foundation of expertise. In the final Phase 3, the two theories were synthesized into the Theory of WIA for Clinical Nursing. The theory describes two antecedent dimensions, person-related and setting-related factors, and two types of wisdom processes. General wisdom processes apply to patient care and describe the actions nurses take during a stressful or uncertain situation. Personal wisdom develops afterwards, as a feedback loop with reflection, discovery of meaning, and learning, followed by increased knowledge and confidence.

The theory illustrates how wise nurses practice using their head, their heart, and their gut. The following fictional story demonstrates WIA:

Jane Everywoman was practicing in the emergency room when she received a 42-year-old female patient into the trauma room with a head injury sustained during a bike accident. Jane has 10 years of experience and is the charge nurse for this patient. The patient was non-responsive and had been resuscitated. Jane called the trauma team and they began advanced trauma life support measures. Synchronously, Jane calls the family and notifies them that their wife and mother is in the hospital. The distraught family comes to the hospital and Jane puts them in a private room and visits them routinely to empathically give them updates. During the resuscitation, Jane gets the feeling that she should bring the family into the room, which she finally does. The family was only there for a short time when the doctor tells the nurse to remove them from the room. The patient ends up dying. Weeks later, the patient’s husband finds Jane in the emergency room and thanked her for doing everything they could to save his wife, communicating with him, and bringing the family into the trauma room. He said it was the hardest and best thing she could have ever done because it showed him that everything was being done to save his wife and helped him start the grief process.

The theory of WIA for clinical nursing general wisdom attributes include expertise, a technical nursing process, and affective processes, influenced by insight and intuition. Jane had expertise and was performing the technical skills needed to resuscitate the patient (head). At the same time, she used emotional intelligence to communicate with the family (heart). She also listened to her gut and brought the patient’s family into the trauma room during the resuscitation.

Wisdom is critical for all areas of nursing practice. The nascent Theory of Wisdom-in-Action for Clinical Nursing provides a working framework for translating wisdom in clinical nursing practice into theoretical and practical terms, depicting both the science and the art of nursing. This novel theory displays how nurses practice with wisdom during stressful and uncertain situation. The theory still needs refinement and testing but we feel it reveals that wisdom in action requires clinical skills, experience, knowledge, and affective proficiency.