AbstractsPsychology

As nurses, we seek to gain nursing wisdom and apply it in our daily practice, yet the process of practicing with wisdom has not been well explained for nursing. The purpose of this dissertation was to develop a theory of wisdom in action (WIA) for clinical nursing, beginning with a formal concept analysis. In Phase 1 (Aim 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. The theory included four dimensions: person-related factors, environment-related factors, knowledge, and wisdom. Separately, a constructivist grounded theory approach inductively captured the experience of wisdom in nursing practice (Aim 2), 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. New findings were the importance of affective characteristics such as emotional intelligence and confidence. Finally, the theories were synthesized into the Theory of Wisdom in Action 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 event. Personal wisdom develops afterwards, as a feedback loop with reflection, discovery of meaning, and learning, followed by increased knowledge and confidence. Wisdom is critical for all areas of nursing practice. The 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, and reveals that wisdom in action requires clinical skills, experience, knowledge, and affective proficiency.