Developing two Xertes utilising an ABL approach is part of the project aims. The two Xerte resources should both be independent learning units that are accessed by nursing students, following a trigger in their practice relevant to the learning unit’s content. Underpinning the content of the Xerte is a professional artistry approach in addition to the active learning approach. I felt at this point these two aspects were becoming lost in the development in the Xertes. I met with Anne Misselbrook, the learning designer supporting the project, who helped me review the active aspect of the Xerte design. The professional artistry approach needed more consideration.
WHAT IS PROFESSIONAL ARTISTRY? The hospital based nurses in my study explained that end of life care was unpredictable. This was attributed to patient’s life course not following the path predicted by the nurse or the clinical team, the changing clinical situation, the changes to patients plans, the changes to the care resources planning. The nurses explained their lack of end of life knowledge caused them to feel uncertain. Fish and Coles (1998 pg 54) explain than practice is messy, and that practitioners have been misled if they believe messiness can be brought under rational control. Fish and Coles argue it is only when professionals recognise the messiness of their practice and learn to understand and accept it will they learn to manage the uncertainty of their practice.
Fish and Coles argue that professional practice is governed by a technical rational approach which is fundamentally the action which one takes, as opposed to a professional artistry approach, which aims to understand better the principals on which their practice is based. A technical rational view of practice determines a set of routines and behaviours using ‘care delivery’ as part of the process. The practitioner activities are prescribed, and individuals are held to account. The professional artistry view argues practice is not simple and predicable and requires the practitioner to make many complex decisions using professional judgements, intuition and common-sense. These activities are not easy to make visible, measure and to teach or research.
In practice the professional artistry view is that only principals can be pre-determined, and the situation may require the practitioner to go beyond them, or to break the conventions to achieve the effect. Reflection is an important part of an professional artistry approach to practice. The unlike a technical rational approach the activities cannot be pre-specified. For this reason, the professional is morally accountable all of their conduct, not just parts of the act.
The TA view emphasises diagnosis, analysis, protocol, guidelines to determine the rules of care and decision along with the knowledge that is required to understand and utilise these. PA uses framework, interpretation of detail, subjectivity and critical appreciation, the dynamic nature of knowledge and an appreciation of the process rather than the facts. The result with regards to knowledge is technical rational approach to skills formation is important, as are clinical guidelines based on evidence to help inform judgements. The addition or building on of a professional artistry approach using principals, frameworks and reflection may help practitioners recognise and manage the uncertainty of end of life care.
As a consequence the two learning units should aim to help learners to understand the principals behind the topics. To develop the use of frameworks and the application of reflection to guide practitioners when making judgements in practice in relation to the topics covered, and accept the uncertainty of the situation.