Practice Experience and Implementation of Evidence

By Roberta Heale @robertaheale @EBNursingBMJ

A few months ago I wrote about wholistic care and the implementation of acupuncture into my practice. I completed the first course in March and, this past weekend, just completed the second. I’ve taken an anatomical acupuncture program, which translates acupuncture from Traditional Chinese Medicine into a western medicine, anatomical perspective.  It has been an intensive and humbling experience.

I have been reminded that evidence based practice not only includes utilization of the best evidence and partnership with the patient, but also integration of the practitioner’s experience.  Patricia Benner, in her seminal work “From Novice to Expert. Excellence and Power in Clinical Nursing Practice” outlines the transition of nurses from the novice level, where everything is ‘parts’ to expert where situations are taken in as a ‘gestalt’.  I reflect upon this now as I take on a new challenge.

I’ve spent many years working as a nurse practitioner in family practice settings; before that as a registered nurse in acute care floors in hospital.  I had simply taken for granted the ‘muscle memory’ for familiar tasks like giving injections or performing examinations. The physical examination skills required to locate appropriate acupuncture points and the skill in ‘needling’ is different enough from my practice to knock me back to a novice state.  It’s been a long time since I was a novice in my practice and, I have to say, it’s frustrating!

I realize also that these are the physical skills related to acupuncture.  I have a long way to go before I have the intuitiveness to know the subtleties…the ‘feel’ of a needle, the reaction of a patient to the treatment…all the things that are now ingrained in my current practice.  It’s an uncomfortable place to be, but has renewed my empathy for student nurses and new grads as well as my appreciation for the process of implementation of research into practice. Implementation of evidence is much more than simply reading research and applying the findings.  The stage of expertise of the health care practitioner plays an important part of the process and influences the entire patient experience.

I’ll have to keep these things in mind as I begin to practice acupuncture.  I’ll try to be patient with myself and to be cognizant of the need for me to practice, practice, practice to move along the spectrum toward the expert level.


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