1. Teresa D. Welch The University of Alabama Spring 2014

2. Problem: To legitimize the definition of expert nursing practice, further research is need to explore the concepts of intuitive, clinical reasoning (Lyneham, Parkinson, & Denholm, 2008).

3. The purpose of this research is to build upon Patricia Benner’s seminal work in the domain of skill acquisition to explore the personal perceptions of expertise in professional clinical nursing staff.

4. Empirical data that builds upon the current body of knowledge would serve to add rigor to that knowledge. If no one recognizes the value of your work, then the work is of no value. Professional nursing practice adds significant value to the healthcare system Promote the recognition of the value in expert clinical practice and the professional contributions of nursing

5. In a grounded theory study, concepts are generated from empirical data rather than from existing literature. Like a detective who strives to explain what is actually happening, the GT-researcher strives to explain the main concern of participants in a specific situation/area and to find out how they resolve or process this main concern (Hallberg, 2010).

6. The expert is defined in the literature as one who possesses both skill and knowledge where intuitive, highly skilled performance is the result of dedicated practice and years of experience. There are five core concepts that are consistently applied to expertise across disciplines: an intuitive grasp of the salient aspects of a situation, intuitive judgment and action, comprehensive understanding, with the flexibility, fluidity and ability to transfer knowledge from one situation to another, and knowledge gained through experience (Avis & Freshwater, 2006; Benner, 2004; Christensen & Hewitt-Taylor, 2006; Ericsson, Whyte, & Ward, 2007).

7. Capturing the description of expert performance is difficult because the expert clinician works from a deep understanding of the global situation. Salient pieces of the situation are contextually grounded and grasped intuitively as the expert is immersed within and focused on the entirety of the situation. Individual details are lost to conscious thought and difficult to ascertain (Benner, 2001; National Research Council, 2000). Further research into the concepts of intuitive, clinical reasoning would legitimize the definition of expert nursing practice (Benner, 2001; Ericsson, 2007; Lyneham, Parkinson, & Denholm, 2008).

8. It is most suitable for addressing the ’why’ and the ‘how’ questions to explain and understand issues that describe processes or behaviors making grounded theory useful in nursing practice to produce an explanatory theory of human behavior within the social context (Hennink, Hutter, & Bailey, 2011; Wuest, 2012). Descriptive Qualitative Research Grounded Theory

9. Sample Purposful sample Purposeful sampling as data begins to reveal emergent concepts Theoretical sampling as data collection becomes more refined seeking to clarify properties of emerging concepts and their relationships to one another. (Wuest, 2011, p. 234) The process of theoretical sampling will continue until data saturation is achieved, meaning that no new concepts or variations are emerging from the data being analyzed.

10. Sample Selection Voluntary Expertise will be defined and inclusion/ exclusion parameters for participation will be established based upon three factors: Benner’s definition of expertise Five core concepts of expertise as defined within the literature Intuitive judgment Intuitive grasp of salience within a situation Flexibility and transferability Knowledge gained through experience Certified Critical Care Nurses Snowball effect

11. Setting- Certified Critical Care nurses in the Southeastern United States. Contact American Association of Critical Care Nurses (AACN) present the purpose of the dissertation and request contact list for participation Attend/ advertise at the NTI conference hosted by AACN

12. Interview Protocol template Face to face, pre-arranged interviews in a mutually agreeable location Skype Follow semi-structured format Audio recorded Interviews will consist of open-ended questions that focus on the personal perceptions of the expert nurse seeking to discover how they perceive their personal expertise.

13. Data Collection Evolving analysis Researcher must be fully engaged in the data Collection and analysis Interview Protocol

14. Data Analysis Open Coding Generate as many conceptual codes as possible Axial Coding Core themes begin to develop Selective Coding Relationships begin to develop Begins with first interview (inductive). Deductively data drivers further interview questions “closed loop” data collection continues until saturation

15. Ethical Considerations IRB review and approval Informed Consent Self determination Participants have the right to decline Anonymity Confidentiality

16. Under the guidance of the Dissertation Committee June 2014 Prospectus October 2014 Proposal to IRB December 2014 Collect and Analyze Data August 2015 Defense of Dissertation

17. Avis, M., & Freshwater, D. (2006). Evidence for practice, epistemology, and critical reflection. Nursing Philosophy, 7, 216-224. Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative ed.). Upper Saddle River, NJ: Prentice Hall Health. Benner, P. (2004). Using the Dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education. Bulletin of Science Technology & Society, 24 (3), 188-199. http://dx.doi.org/10.1177/0270467604265061 Christensen, M., & Hewitt-Taylor, J. (2006, December). From expert to tasks, expert nursing practice redefined? Issues in Clinical Nursing, 1531-1539. http://dx.doi.org/10.1111/j.1365-2702.2006.01601.xhttp://dx.doi.org/10.1111/j.1365-2702.2006.01601.x Ericsson, K.A., (2007). An expert-performance perspective of research on medical expertise: The study of clinical performance. Medical Education, 41, 1124-1130.

18. Ericsson, K.A., Whyte, J., & Ward, P. (2007, January). Expert performance in nursing: Reviewing research on expertise in nursing within the framework of expert-performance approach. Advances in Nursing Science, 30(1), E58-E71. Hallberg, L.R., (2010). Some thought about the literature review in grounded theory studies. International Journal Qualitative Student Health Well- being, 5, doi: 10.3402/qhw.v5i3.5387 Hennink, M., Hutter, I., & Bailey, A. (2011). Qualitative research methods. Los Angeles, CA: Sage. Lyneham, J., Parkinson, C., & Denholm, C. (2008). Explicating Benner’s concept of expert practice: Intuition in emergency nursing. The Journal of Advanced Nursing, 64 (4), 380-387. http://dx.doi.org/10.1111/j.1365-http://dx.doi.org/10.1111/j.1365- 2648.200804799.x National Research Council. (2000). How people learn: Brain, mind, experience, and school: Expanded edition. Washington DC: National Academy Press. Wuest, J. (2012). Grounded theory: The method. In P. L. Munhall (Ed.), Nursing Research: A Qualitative Perspective (5th ed., pp. 225-256). Sudbury, MA: Jones & Bartlett Learning.