Chinese Nursing Research 3 (2016) 97e100

Contents lists available at ScienceDirect

Chinese Nursing Research

j o u r n a l h o m e p a g e : http://www.journals.elsevier.com/chinese-nursing-research

Review Article

The concept and characteristics of clinical practice ability in Master

Degree of Nursing (specialty)*
Jing Zeng a, Jing-Ci Zhu b, *, Xiao-Yu Zhao a
a
Chengdu Medical College, Chengdu, Sichuan 610083, China
b
School of Nursing, Third Military Medical University, China

a r t i c l e i n f o a b s t r a c t

Article history: The concepts of ability, practice ability, and professional practice ability were analyzed using a theoretical
Received 29 June 2015 research method. Based on the results of the analysis, the concept of clinical practice ability for Master
Received in revised form Degree of Nursing (specialty) students was defined, and the characteristics were interpreted to provide
14 December 2015
references for future in-depth studies.
Accepted 17 June 2016
Available online 14 September 2016
© 2016 Shanxi Medical Periodical Press. Publishing services by Elsevier B.V. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords:
Nursing science
Master Degree of Nursing (specialty)
Clinical practice ability
Concept
Characteristics

1. Introduction performed an in-depth theoretical analysis on clinical practice

ability in MNS students and defined the concept and characteristics
The transformation of the medical model has led to changes in of this ability to provide references for future in-depth studies.
the working model for nursing. Simply executing doctor's orders is
no longer a functional nursing model. The nursing model has
2. The concepts related to clinical practice ability in MNS
transformed into a holistic model that is people centered, and
students
clinical care recipients have expanded from patients to families,
groups of individuals, and the overall population. When the
2.1. Ability
working tasks and environment of nurses change, the clinical
practice ability required for nurses changes accordingly. China has
Ability is a concept with multiple dimensions, which may be
recently added the training level of Master Degree of Nursing
interpreted differently. Studies on ability first originated from
(specialty) (MNS). Nurse managers and researchers need to define
psychology. The field of psychology usually defines ability as per-
the clinical practice ability that is required for MNS students to be
sonal psychological characteristics that individuals possess to suc-
competent for clinical job requirements. Several studies on the
cessfully complete certain activities. Ability and activity are closely
clinical practice ability of MNS students have recently been per-
linked. Ability forms, develops, and is present in activities. In
formed in China; however, the concept of clinical practice ability in
addition, ability is the premise of undertaking all activities.1 The
nursing has different interpretations, and the characteristics of
psychological characteristics of ability are associated with direct
clinical practice ability are unclear. The lack of a well-defined the-
stable regulation and control functions during the selection of ac-
ory usually results in confusion in practice. Therefore, we
tivities.2 Researchers suggest that if individuals want to solve
problems or complete activities, having certain psychological
characteristics is not enough. Ability requires both psychological
*
This project was supported by planning project of “12th Five-Year” in
characteristics and specific physiological behaviors to accomplish
philosophy and social sciences of Sichuan province (No. SC13B081).
* Corresponding author.
an activity.3 The field of philosophy defines ability as the skills used
E-mail address: 664619460@qq.com (J.-C. Zhu). and the energy expended during actions, which can correctly
Peer review under responsibility of Shanxi Medical Periodical Press. control certain activities. Ability is an effective method for the

http://dx.doi.org/10.1016/j.cnre.2016.06.009
2095-7718/© 2016 Shanxi Medical Periodical Press. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.
org/licenses/by-nc-nd/4.0/).
98 J. Zeng et al. / Chinese Nursing Research 3 (2016) 97e100
realization of human values and is a positive force in social devel-
opment and life. According to the field of vocational ability devel-
opment, three different concepts of ability have emerged in the
history of ability-based education, which are general ability, ordi-
nary ability, and integrated ability. The concept of integrated ability
has been accepted and recognized by academic fields in various
countries. The concept of integrated ability combines both general
ability and ordinary ability to provide a more comprehensive
definition of ability, which is linked with job position or role. Ability
is the integration of knowledge, skills, judgment, attitude, and
values required for certain job roles.
2.2. Practice ability
These concepts suggest that ability is closely associated with
practice and cannot be separated from talent, knowledge, or skills.
Practice ability has been extensively studied; however, the defini-
tion of “practice” has been interpreted differently among academic
fields.
2.2.1. The concept of practice in philosophy
Marxist philosophy considers practice to be all social objective
material activities that play a dynamic role in reforming and
exploring the real world. Practice ability is the organic whole of all
material factors, including mental factors, intelligence factors, and
non-intelligence factors. Practice ability mainly includes the
following three components: humanity's nature, which is the sum
of human physical and mental powers; an individual's knowledge,
experiences, and skills; and non-intelligence factors, such as
emotion and the will of the individual.4
2.2.2. The concept of practice in psychology
Studies of practice ability in psychology have focused on prac-
tical intelligence. Neisser was one of the scholars that first proposed
the idea of practical intelligence. He suggested that practical in-
telligence corresponded to academic intelligence and regarded
practical intelligence as the cognitive response of a person to
problems outside of the classroom.5 Sternberg, a psychologist in the
United States, performed in-depth studies on practical intelligence
and proposed the successful intelligence theory, which indicated
that successful intelligence mainly included analytical intelligence,
creative intelligence, and practical intelligence. Sternberg particu-
larly emphasized practical intelligence, which he considered the
ability to transform theories into practice and to analyze and solve
practical problems in work and life. Practical intelligence is tacit
knowledge, which is a type of knowledge that cannot be learned
through language and can only be obtained through one's own
experience and comprehension. This type of knowledge usually is
action oriented, which is helpful for individuals to solve problems
and achieve goals.6,7 In addition, Sternberg8 emphasized that these
three types of intelligence are interconnected and that success can
only be obtained when a balance is reached.
2.2.3. The concept of practice in education
Regarding practice ability in education, scholars have proposed
that in addition to the psychological and physiological character-
istics that individuals possess to solve practical problems and
perform activities, these characteristics should be analyzed from
the perspective of knowledge utilization. Therefore, the concept of
knowledge-based practice ability was proposed, which emphasizes
using internalized knowledge and understanding how individuals
relate to the external environment to solve practical problems.
Knowledge utilization is the core connotation of knowledge-based
practice ability. Therefore, during training, the actual utilization of
knowledge is more important than hands-on activities.9 Several
scholars have defined practice ability in education as individual
absorption and integration of supportive education and basic re-
sources by students, adaption to social life, the ability to answer
basic practical questions, participation in social life practices, pro-
motion of self-growth, and an increase in the ability to self-
practice.10
2.2.4. Practical knowledge
Knowledge and ability complement each other. Experts in many
fields have different classifications of practical knowledge, which is
composed of the following aspects: motivation, emotion, attitude,
strategies for solving subject-related problems, rules, techniques,
procedural knowledge, strategies for controlling the thinking pro-
cess, and situational knowledge.11 Practical knowledge is an
important category of knowledge and complements theoretical
knowledge. Practical knowledge develops from understanding and
using theoretical knowledge in individuals. Theoretical knowledge
is mostly based on practical knowledge. Practice ability from the
perspective of practical knowledge is defined as the reasonable
selection and utilization of mastered knowledge and skills in
various actual situations. Individuals use practical knowledge to
solve practical problems.12 Based on these results, practice ability is
defined as follows: (1) the combination of psychological and
physiological characteristics in individuals; (2) the ability to
transform knowledge into practice, and (3) the ability to use
practical knowledge to solve actual problems.
2.3. Professional practice ability
Practice ability is a broad concept that includes the ability to
perform activities in and outside of work. Professional practice
ability is the ability to reasonably use professional knowledge and
skills to independently solve problems and evaluate results. In
addition, professional practice ability is the core skill required for
workers to be competent.13 Several scholars have proposed that
professional practice ability is the ability to use learned profes-
sional knowledge to solve professional practical problems and that
this ability is not isolated but complex and based on various other
abilities.11 Medicine requires a high level of professional practice
ability. Miller14 suggested that professional practice ability, i.e.,
clinical practice ability, in physicians can be evaluated through
knowledge, competence, performance, and action. Additionally,
Miller constructed a pyramidal framework model. The first layer of
the pyramid (Knows) is the relevant theoretical and operational
knowledge required to perform medical professions. The second
layer (Knows How) is knowing how to use the accumulated medical
professional knowledge, which is to understand and master
knowledge. The third layer (Shows How) is using the acquired
knowledge and ability when facing clinical care recipients in a
virtual context. The fourth layer (Does) is the practical action of
students in a specific and practical clinical working environment.
This pyramidal framework redefines the concept of clinical practice
ability and its role in clinical practice. Clinical practice ability is
based on medical knowledge and the effective presentation of be-
haviors. Clinical practice ability is the bridge during the trans-
formation of knowledge into behavior.15 This framework
emphasizes that behavior in a clinical work environment is not
based on knowledge and operation skills. In contrast, clinical
practice ability is the ability to use a combination of theory,
knowledge, and operation skills to provide timely and effective
treatment for complicated disease conditions in clinical practice.
Based on this pyramid, Epstein et al16 proposed the concept of
cultivation of clinical practice ability in medical education, which is
the ability to skillfully and reasonably apply communication, pro-
fessional knowledge, skills, clinical decision-making, professional
 J. Zeng et al. / Chinese Nursing Research 3 (2016) 97e100
ethics, and emotion in clinical practice when serving patients and
community populations. Their concept of clinical practice ability is
mainly composed of the following aspects: professional skills,
multidisciplinary medical collaboration, communication, team
work, professional ethics, and clinical decision-making. Scholars in
China have suggested that clinical practice ability should be defined
according to training goals at different stages of medical education.
The psychological characteristics of clinical practice ability include
clinical operation skills, clinical decision-making, humanistic
concern, and communication skills that are required to complete
clinical practice activities.17 In addition, researchers have proposed
that clinical practice ability is composed of clinical operation skills,
which include the coordination of limb movements, and clinical
decision-making, which depends on the cognitive activity of the
human brain.18
2.4. Clinical practice ability in nursing
Nursing is an important component of medicine. The trans-
formation of medicine has led to changes in nursing, including a
different understanding and definition of clinical practice ability. In
2002, the Nursing and Midwifery Council (NMC) of the United
Kingdom proposed that clinical practice ability in nursing is the
ability to independently, effectively, and safely complete clinical
practice activities without supervision. Many researchers gradually
proposed a new concept of clinical practice ability in nursing. Based
on these studies, in 2010, the NMC defined clinical practice ability
in nursing as the comprehensive ability to perform safe and
effective nursing practices and interventions using skills, knowl-
edge, attitude, and professional values.19 The National League of
Nursing (NLN) in the United States suggested that clinical practice
ability is the ability to use correct judgment and evidence-based
nursing practices to provide clinical care to patients in different
clinical nursing environments.20 Researchers in China proposed
that clinical practice ability in nursing is the transformation of
learned knowledge and skills into physiological and psychological
characteristics that are required to solve clinical practical
problems.21
3. Definition and characteristics of clinical practice ability for
MNS students
3.1. Definition of clinical practice ability in MNS students
Researchers have suggested that professional practice ability is
a combination of the psychological and physiological character-
istics required to use learned knowledge to solve practical pro-
fessional problems. Clinical practice ability in nursing is a type of
professional practice ability. We defined clinical practice ability for
MNS students as the thinking and actions of MNS students, spe-
cifically when they use theoretical and practical medical knowl-
edge to meet the health needs of clinical care recipients, including
individuals, families, and communities. Clinical practice ability in
nursing is the ability to effectively solve complicated nursing
problems and to provide appropriate and high-quality health
services. This ability is the combination of psychological and
physiological characteristics to solve clinical problems and is an
aggregate various abilities. This ability emphasizes the flexible use
of systemic knowledge by students to solve problems in clinical
practice rather than depending on personal perceptual experience
and simple nursing operation skills. This ability focuses on using
comprehensive methods to solve complicated nursing problems
and to provide high-quality nursing services by individuals in a
changing nursing work environment.
99
3.2. The characteristics of clinical practice ability in MNS students
3.2.1. Clinical setting and practice ability in MNS students
Practice relies on the setting. The setting is the place of practice
and, practice is always performed in specific settings. The devel-
opment of clinical practice ability in MNS students depends on the
clinical setting. This setting is dynamic and complicated, is full of
uncertainty, and is unconventional, including sudden emergencies
and conflicts with patients. Clinical practice ability in MNS students
in the clinical setting is not a hard copy of theories and knowledge
and cannot depend on general nursing operation skills or strate-
gies. In contrast, this ability requires students to flexibly and care-
fully perform decision-making to handle clinical nursing issues.
Clinical practice ability is flexible and open rather than rigid and
mechanical. In the clinical setting, students will provide patient
services, undertake different roles and functions, and use corre-
sponding clinical practice ability in different nursing practices.
Therefore, clinical practice ability cannot be separated from specific
patients, the clinical setting, and the functional roles of students.
3.2.2. The dynamics of clinical practice ability in MNS students
Clinical practice ability in MNS students is required to enable
them to become advanced nurse practitioners. This ability is rooted
in specific historical and cultural contexts. In addition, with social
development, the health needs of the population will vary, which
will require changes to the education system. Furthermore,
communication in clinical practice is iterative, and clinical practice
ability will continuously develop over time, allowing “novices” to
develop into “experts”. In addition, this process of continuous
change and knowledge accumulation creates an optimal growth
environment for the development of nursing specialization.
3.2.3. Evaluation of clinical practice ability in MNS students
Clinical practice ability in MNS students requires effective
evaluation to determine the ability requirements for students,
which is important for teaching nursing practices. Therefore, an
evaluation indicator system corresponding to the components of
clinical practice ability in MNS students should be established to
monitor the development of this ability in students and to improve
the methods of clinical practice teaching.
Conflicts of interest
All contributing authors declare no conflicts of interest.
References
1. Ye Y. General Psychology. Shanghai: East China Normal University Press; 2010:
355 (in Chinese).
2. Feng Z. Principles of Structured and Directed Psychology Teaching. Beijing: Beijing
Normal University Press; 1998:146 (in Chinese).
3. Liu L. The outline of developing students' practical capability. Liaoning Norm
Univ. 2007:15e41 (in Chinese).
4. Marx-Engels-Gesamtausgabe. vol. 46 (Part 1). People's Publishing House. 1980:
486 (in Chinese).
5. Sternberg RJ, Wagner RK, Williams WM, Horvath JA. Testing common sense.
Am Psychol. 1995;50:912e927.
6. Liu L, Fu W. Practical ability: concept, structure and cultivation measures. Educ
Sci. 2005;21:1e5 (in Chinese).
7. Jiang J. Review of the studies of Sternberg in practical intelligence. J Xuzhou
Normal Univ Philos Sci Ed. 2009;35:98e102 (in Chinese).
8. Sternberg RJ. Successful intelligence: finding a balance. Trends Cogn Sci. 1999;3:
436e442.
9. Zhang Q. Teaching change-oriented practical ability. Central China Norm Univ.
2011;35 (in Chinese).
10. Wu Z. The study of the development of students' practical ability. Northeast
Norm Univ. 2006:15e16 (in Chinese).
11. Zhang Q. Research on promoting undergraduates' professional practical abili-
ties: a perspective of cognitive apprenticeship: a case study of “PDIMBTS”
100 J. Zeng et al. / Chinese Nursing Research 3 (2016) 97e100

employed by Software College in Jiangxi Normal University. Jiangxi Norm Univ.
2006;21 (in Chinese).
12. Dong Y. Research in university students' practical capability and development.
East China Norm Univ. 2007:28e29 (in Chinese).
13. Zhao H. The connotation of professional practical ability and its cultivating
way. J Wuhan Polytech. 2009;8:60e63 (in Chinese).
14. Miller GE. The assessment of clinical skills/competence/performance. Acad
Med. 1990;65:s63e67.
15. Qi W, Wang F. Teachers' professional practical ability: connotation and char-
acteristics. Educ Res. 2012;2:95e102 (in Chinese).
16. Epstein RM, Hundert EM. Defining and assessing professional competence.
JAMA. 2002;287:226e235.
17. Huang D, He P, Yang M. Exploration and practice of strengthening the clinical
practical ability of medical students. Chin High Med Educ. 2004:48e51
(in Chinese).
18. Du W, Xie S, Li J. Exploration of clinical practical ability cultivation in medical
students. Northwest Med Educ. 2008;16:388e390 (in Chinese).
19. Garside JR, Nhemachena JZ. A concept analysis of competence and its transition
in nursing. Nurse Educ Today. 2013;33:541e545.
20. Valloze J. Competence: a concept analysis. Teach Learn Nurs. 2009;4:115e118.
21. Hou M. Investigation and analysis of clinical practice competence of master's of
nursing using the Delphi method. Shihezi Univ. 2010;2 (in Chinese).
How to cite this article: Zeng J, Zhu J-C, Zhao X-Y. The concept
and characteristics of clinical practice ability in Master Degree of
Nursing (specialty). Chin Nurs Res. 2016;3:97e100. http://
dx.doi.org/10.1016/j.cnre.2016.06.009