Nursing Knowledge

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Nursing Knowledge Health Care Practices

• Dr David Lee
• VUT - Sunbury
• 2002

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Nursing Knowledge

• How is nursing knowledge developed?

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Nursing Knowledge

• Kerlinger (1986) identifies methods of ways of
  knowing in nursing
• - tenacity
• - authority
• - a priori

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Nursing Knowledge

• TENACITY-
• the form of knowledge in which the person
  believes that something is true without reason to
  question.

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Nursing Knowledge

• AUTHORITY-
• a belief that something is true because an
  authoritative source or person says it is true.

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Nursing Knowledge

• A PRIORI KNOWING -
• depends on reason and is not necessarily
  consistent with experience

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Nursing Knowledge

• All these types of knowledge should be challenged
• They promote taken-for-granted Practice

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Nursing Knowledge

• Types of knowledge
• 1. Scientific Knowledge (High hard ground)
• 2. Tacit Knowledge (Swampy low land)
• Street, A (1983)

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Nursing Knowledge

• Polanyi (1975) Tacit knowing / intuitive
  judgement
• - experience calling out to the subconscious
• - gut feeling raised to a conscious level
• - being undervalued in Science world as
  invalid, subjective not to be trusted

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Nursing Knowledge

• CARPERS (1978) 4 TYPES OF KNOWING

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Nursing Knowledge

• EMPIRICS the science of nursing
• - factual or scientific knowledge
• - includes physics, chemistry, physiology,
  natural sciences.

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Nursing Knowledge

• - principles for procedures
• - nursing diagnoses

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Nursing Knowledge

• ETHICAL KNOWING moral knowledge in nursing
• - focused on matters of obligation or what ought
  to be done, what is good right, and what is
  responsible.

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Nursing Knowledge

• - tolerance respect for the interests,
  autonomy dignity of individuals.
• - theory, philosophy, principles and guidelines
  on which ethical decisions are made.

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Nursing Knowledge

• AESTHETICS the art of nursing
• - makes possible knowing what to do with the
  moment, instantly without conscious deliberation.
  
• - the nurses perception of meaning is
  reflected in their actions.

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Nursing Knowledge

• PERSONAL KNOWING
• - concerns the inner experience, aware self.
• - through knowing the self that one is able to
  to know another human being as a person.

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Nursing Knowledge

• - realizing personal values beliefs.

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Nursing Theories Health Care Practices

• Theory
• Theoria (Greek) abstract thought
• Theory is used to help explain the world in a
  logical manner rather than use explanations based
  on the supernatural

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Nursing Theories Health Care Practices

• Development of theory
• Observations -gt Patterns -gt hypothesis -gt
• experiments -gt support hypothesis theory
• -gt not support hypothesis back to
  observations

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Nursing Theories Health Care Practices

• Theory is ideally developed from practice and is
  used to inform practice
• thus theory and practice gap can be minimized

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Nursing Theories Health Care Practices

• Nursing is a practice / applied science
• 4 criteria for practice theory development
  (Glaser Strauss, 1967)
• A theory must
• 1. Closely fit the area in which it is to be used

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Nursing Theories Health Care Practices

• 2. Be general enough to cover diverse practical
  situations
• 3. Be understandable to the practitioners using
  it
• 4. Allow control over changing situations

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Nursing Theories Health Care Practices

• Defining terms
• Theory reasons based on facts, validated by
  empirical data, used to explain, predict and
  control
• It is because of this reason, thus this will
  happen, therefore we can do it like that...

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Nursing Theories Health Care Practices

• Concept general idea
• It is generally because of these reasons, thus
  this will probably happen, therefore we can
  possibly do it like that...

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Nursing Theories Health Care Practices

• A conceptual framework / model broad, general
  idea, cannot be subjected to empirical validation
• We can follow these steps 1,2,3,4,5,6.. in order
  to achieve this.

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Nursing Theories Health Care Practices

• Practice process of work

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Nursing Theories Health Care Practices

• Theory is important in nursing practice
• 1. It describes, predicts, controls and explains
  phenomena of interest to nurses
• 2. It validates, enhances and improves nursing
  practices

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Nursing Theories Health Care Practices

• 3. It promotes understanding and gives rise to a
  body of knowledge
• 4. Theory is intrinsic to practice, and practice
  continues to validate theory. Theory and practice
  are integral to each other

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Nursing Theories Nursing Practices

• Florence Nightingale (mid 19th century)
• Concerned with
• personal hygiene and cleanliness
• nutrition
• fresh air / sunlight

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Nursing Theories Nursing Practices

• Hildegard Peplau (1952)
• Partial theory of nursing
• Nursing is a significant, therapeutic,
  interpersonal process

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Nursing Theories Nursing Practices

• Virginia Henderson (1966)
• Concept of nursing
• Henderson identified 14 components that
  constitute basic nursing care
• 1. Breathing normally

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Nursing Theories Nursing Practices

• 2. Eating and drinking adequately
• 3. Eliminating body waste
• 4. Moving and maintaining desirable postures
• 5. Sleeping and resting

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Nursing Theories Nursing Practices

• 6. Selecting suitable clothes
• 7. Maintaining body temperature
• 8. Keeping the body clean / Well groomed / Well
  protected

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Nursing Theories Nursing Practices

• 9. Avoiding dangers in the environment
• 10. Communicating with others in expressing
  emotions, needs, fears or opinions

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Nursing Theories Nursing Practices

• 11. Worshipping according to ones faith
• 12. Working with a sense of accomplishment

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Nursing Theories Nursing Practices

• 13. Participating in various forms of recreation,
  learning, discovering or satisfying the curiosity
  that leads to normal development and health
• 14. Using available health facilities

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Nursing Theories Nursing Practices

• Dorothy Johnson (1980)
• Behavioral system model
• A person is a behavior system comprised of 7
  subsystems
• 1. Attachment/afflictive

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Nursing Theories Nursing Practices

• 2. Dependency 6. Aggressive
• 3. Ingestive 7. Achievement
• 4. Eliminative
• 5. sexual

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Nursing Theories Nursing Practices

• Dorothea Orem (1980)
• Nursing theory
• Nursing is a means to assist individuals in the
  maintenance of self-care practices at 3 levels
• 1. Wholly compensatory
• 2. Partly compensatory
• 3. Supportive-educative

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Nursing Theories Nursing Practices

• Imogene King (1971)
• Concept and definition of nursing
• A person is functioning within a social system
  through interpersonal relationships.

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Nursing Theories Nursing Practices

• Persons use their interpersonal relationships,
  which are influenced by perceptions, to maintain
  and define health

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Nursing Theories Nursing Practices

• Nursing is a process of action, reaction,
  interaction and transaction whereby nurses assist
  individuals of any age and socioeconomic group to
  meet their basic needs in performing activities
  of daily living and to cope with health and
  illness at some particular point in the life
  cycle

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Nursing Theories Nursing Practices

• Callista Roy (1976)
• Theory - a person as a biopsychosocial being
  continually adapting to the environment
• The nursing role is to assess the clients
  behavior and to assist the individual to adapt
  successfully to change

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Nursing Theories Nursing Practices

• Martha Rogers (1970)
• The person as a unified whole coexisting with the
  environment
• Holistic approach to nursing - health and illness
  as expressions of the process of life

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REFLECTIVE PRACTICE NURSING

• What is reflection?
• Thinking about
• Evaluate
• Assess...

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REFLECTIVE PRACTICE NURSING

• What is reflective nursing practice?
• Think about / examination of nursing actions

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REFLECTIVE PRACTICE NURSING

• Purposes of reflection
• inform action / practice
• challenge rituals, routine habitualization
  in nursing practice
• develop new ways of thinking about
  understanding of N/P

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REFLECTIVE PRACTICE NURSING

• uncover the historical/traditional constraints
  that shape practice
• identify social, political interests that have
  been served by the maintenance of these practices

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REFLECTIVE PRACTICE NURSING

• Tools for reflection
• Journals
• Discussions (Story telling)
• Critical friends

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REFLECTIVE PRACTICE NURSING

• Types of reflection (Harbermas)
• 1. Technical - the skill, the technique
• 2. Practical - humanistic approach - e.g. timing
  of the action and its effect
• 3. Critical - who benefits

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REFLECTIVE PRACTICE NURSING

• Timing of reflection
• Reflection - in - action (what we are doing at
  the time )
• Reflection - on - action (retrospective, what
  we have done)
• Schons (1983)

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Praxis

• What is Praxis ?
• - the move to a level of critical awareness
• - purposeful reflection action with intent to
  bring about change or transformation
• - practice or action informed by theory

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Praxis

• Praxis is
• reflection action upon the world in order
  to transform it
• (Freire,197228)

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Praxis

• mens (sic) activity consists of action
  reflection as praxis it requires theory
  to illuminate it
• (Freire, 197296)

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Praxis

• through praxis the insight developed enables us
  to unite the things we do (action) with the
  knowledge that we have accumulated from books
  /experience(knowing)

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Praxis

• Freires central theme
• - construction (describe)
• - confrontation (analyze)
• - deconstruction (uncover)
• - reconstruction (transform)

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Evidence-Based Practice

• Evidence-Based Practice is synonymous with
• Research-based practice
• Experience-based care
• Reasoning-based care
• Authority-based care

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Evidence-Based Practice

• Research based practice is
• professional care based on the best research
  evidence available
• critical appraisal of research findings to
  decide whether how to use the findings in care

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Evidence-Based Practice

• guides management treatment actions
• understanding patient familys experience in
  health/illness their behavior

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Evidence-Based Practice

• Experience-based care is
• lt practitioner gives care makes decision
  based on trial/error, the acquired insight,
  intuitive response interpersonal impression

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Evidence-Based Practice

• lt as practitioner relies on past experience
  personal interaction to sort out make sense of
  what is being said, seen sensed during a
  clinical encounter

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Evidence-Based Practice

• Reasoning-based care is
• care based on logical thinking and reasoning
• the care rationale used is based on knowledge
  from biomedical, social and psychological
  behavioural science to understand what is going
  on in a situation

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Evidence-Based Practice

• Authority based care is
• gt another rationale for care is authority
• gt authority comes from the recognition
  recommendation in a reference book or a report
  from experts