A paradigm for the production of practice-based knowledge

A Culture of Inquiry: Practice-Based Knowledge for Nurse Leaders

A culture of inquiry has not traditionally been associated with nursing leadership. As healthcare evolves, leaders must reevaluate barriers to improving healthcare outcomes. One noted barrier has been a need for more inquisitiveness to innovate. Through an American Organization for Nursing Leadership workgroup, the authors advanced the understanding of a "culture of inquiry," applying a practice-based learning approach for knowledge development. Three recommended foundational elements are psychological safety, building connections, and using design thinking at all organizational levels.

Evidentiary and theoretical foundations for virtual simulation in nursing education

Virtual simulation has been used extensively in nursing education since the beginning of the COVID-19 pandemic due to the unavailability of clinical sites. Extant research supports substitution of up to 50% of nursing clinical hours with simulation. However, in many nursing programs virtual simulation is currently substituting more than half of traditional clinical hours, and the knowledge gaps and limitations surrounding virtual simulation exist. The purpose of this paper is to describe the evidentiary and theoretical foundations for virtual simulation. Through examination of adult learning theories, learning styles and Bloom's Revised Taxonomy, recommendations for maximizing the use of virtual simulation in the current clinical learning environment are outlined. Debriefing is a vital component of virtual simulation. Synchronous debriefing with nursing students, faculty, preceptors, and peers provides the opportunity for scaffolding to support students' learning needs and foster reflection and evaluation to mitigate shortcomings of virtual simulation in the current clinical learning environment.

Toward a moral commitment: Exposing the covert mechanisms of racism in the nursing discipline

Recent Canadian and international events have sparked dialogue and action to address racism within the nursing discipline. While the urgency to seek and implement antiracist solutions demands the attention of nurses, we contend that a contemporary analysis of the mechanisms that continue to perpetuate racism within nursing's theoretical foundation is required first. This study reconsiders the perceived functions of racism within the current state of nursing concepts and theories. In particular, we expose the role that covert racism plays by inadvertently sustaining racism through nursing's theoretical foundation, and how this process strengthens white supremacy. We argue that, in the absence of exposing these covert mechanisms, the development of solutions will be futile in dismantling racism. By making visible the covert mechanisms of racism within nursing's theoretical foundation, we attempt to establish an opportunity for the nursing discipline to dismantle its racist foundation and engage in sustained antiracist action. Lastly, this study demonstrates the need to equip the discipline with a moral commitment to antiracism in an effort to emancipate nursing from its racist legacies.

[Science and nursing science: What links, what issues and what future development for the discipline of nursing?]

This article examines the terms science, discipline and knowledge from the perspective of the use and advancement of knowledge in the discipline of nursing. It views the notion of organized knowledge as the foundation of a science as well as considering the use of scientific methods as imperative in any discipline that aims to contribute to the world of ideas by relying on rationality. This paper aims to trace the link between science and nursing science, to clarify scientific issues for nursing, and to begin thinking about understanding the concept of diversity and the effective contribution of doctoral training in nursing as a guarantee of the future evolution of this discipline.

Nursing knowledge: A middle ground exploration

The discipline of nursing has long maintained that is has a unique contribution to make within the health care arena. This assertion of uniqueness lies in great part in the discipline's claim to a distinct body of knowledge. Nursing knowledge is characterized by diverse and multiple forms of knowing and underpins the work of all nurses, regardless of field of practice. Unfortunately, it has been challenging for the discipline to take full ownership of its epistemological diversity, largely due to factors such as competing worldviews, and ideological and binary positioning. A philosophical middle ground stance is proposed as a way for the discipline to contemplate, discuss and develop nursing knowledge; a middle space that provides the freedom to consider competing worldviews while still allowing for the discipline to fully express itself in all of its epistemological diversity. In being able to enact its multiple forms of knowledge in a creative and open space that is open to different ideas and worldviews, not only can nursing take full ownership of its practice and its unique knowledge, it can also demonstrate how best to navigate an increasingly polarized world. In a world that is increasingly fixated on binary solutions and dualistic points of view, it is time for nursing to celebrate its epistemological diversity.

Pensamiento estadístico: herramienta para el desarrollo de la enfermería como ciencia

Objetivo: Integrar los hallazgos de la bibliografía científica que informen sobre la importancia del pensamiento estadístico para el desarrollo de la enfermería como ciencia.Síntesis del contenido: Revisión integradora de publicaciones realizadas en revistas indexadas entre los años 1998 y 2017 en las bases de datos lilacs, sage Journals, Wiley Online Library, Scopus, bireme, Scielo, ScienceDirect, PubMed, cuiden® y ProQuest. Se incluyeron 22 publicaciones cuyos hallazgos fueron extraídos, clasificados y reducidos con el uso de códigos descriptores, códigos nominales y temas emergentes. A partir de las búsquedas surgieron seis temas: Enseñanza para el pensamiento estadístico;Pensamiento estadístico para la toma de decisiones en la práctica; Barreras para el desarrollo del pensamiento estadístico; Competencias necesarias para el pensamiento estadístico; La estadística en la generación de conocimiento para la ciencia; y Desafíos para el desarrollo del pensamiento estadístico.Conclusión: En el desarrollo actual de la enfermería como ciencia, el pensamiento estadístico ha sido una herramienta usada principalmente en el campo de la investigación y en la formación de investigadores. Se ha reportado la presencia de obstáculos para el desarrollo del pensamiento estadístico en los profesionales de la práctica, lo que evidencia la necesidad de conectar la estadística con la práctica de enfermería, para lo cual es indispensable elaborar textos y asignaturas de estadística aplicados al contexto de la disciplina y la práctica.Descriptores: Bioestadística; Estadística como Asunto; Estadística; Ciencia;Enfermería (fuente: decs, bireme).

Evolving from a positivist to constructionist epistemology while using grounded theory: reflections of a novice researcher

Specifying epistemology guiding health research provides evidence of a researcher’s worldview and thus the rationale for methodological choices. A challenging quagmire of epistemological options exists for the novice nurse researcher, often difficult to navigate, particularly in the absence of a philosophical grounding. During her doctoral journey, the first author (KW) explored living with overnight mask ventilation for sleep apnoea using a social constructionist grounded theory. Choosing this methodology required that KW reconcile her background in evidence-based nursing practice with the various theoretical legacies underpinning grounded theory. In this paper, the philosophical roots of both evidence-based nursing and grounded theory are explored. The influence that both context and the researcher’s relationship with their participants and data have upon knowledge construction is also considered. Parallels are drawn between a developing awareness of epistemology and the evolution of grounded theory research from positivism to social constructionism. This paper will assist novice researchers to consider assumptions about the origins of knowledge and subsequently be of help when choosing a research methodology.

Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study

BACKGROUND

This paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the accuracy of nursing diagnoses.Knowledge sources can support nurses in deriving diagnoses. A nurse's disposition toward critical thinking and reasoning skills is also thought to influence the accuracy of his or her nursing diagnoses.

METHOD

A randomised factorial design was used in 2008-2009 to determine the effect of knowledge sources. We used the following instruments to assess the influence of ready knowledge, disposition, and reasoning skills on the accuracy of diagnoses: (1) a knowledge inventory, (2) the California Critical Thinking Disposition Inventory, and (3) the Health Science Reasoning Test. Nurses (n = 249) were randomly assigned to one of four factorial groups, and were instructed to derive diagnoses based on an assessment interview with a simulated patient/actor.

RESULTS

The use of a predefined record structure resulted in a significantly higher accuracy of nursing diagnoses. A regression analysis reveals that almost half of the variance in the accuracy of diagnoses is explained by the use of a predefined record structure, a nurse's age and the reasoning skills of `deduction' and `analysis'.

CONCLUSIONS

Improving nurses' dispositions toward critical thinking and reasoning skills, and the use of a predefined record structure, improves accuracy of nursing diagnoses.

Knowing nursing through inquiry: engaging students in knowledge creation

Two nurse educators share a nursing knowledge course, which was created as a forum for questioning and discovery, thereby revealing a process of knowing nursing through inquiry. The process of inquiry in nursing praxis is emphasized, facilitating students' understanding that they are knowledge-users and creators. With students, we explore the construction of praxis, which includes being/becoming (ontology), knowing (epistemology), and doing (actions with consequences). Nursing knowledge is understood to arise from philosophy, world views, nursing theories, patterns of knowing, evidence-based research, and standards of practice. Students are encouraged to critically reflect on and use what is congruent with their praxis and to construct new knowledge. Exemplars from nurse educators and students are presented as evidence of our claim for furthering the science of nursing education.

So what exactly is nursing knowledge?

This paper aims to present a discussion about intrinsic nursing knowledge. The paper stems from the author's study of knowledge claims enshrined in nursing journal articles, books and conference speeches. It is argued that claims by academic nurses have largely depended on principles drawn from continental and not Analytic (British-American) philosophy. Thus, claims are credible only insofar as they defer propositional logic. This is problematic inasmuch as nursing is a practice-based activity usually carried out in medical settings. Transpersonal nursing models are particularly criticizable in respect of their unworldly character as are also concepts based on shallow usages of physics or mathematics. I argue that sensible measurements of the 'real world' are possible--without endorsing positivism--and that nursing requires little recourse to logically unsustainable claims. The paper concludes with an analysis of a recent review of nursing knowledge, which analysis indicates the circularity that attends many discussions on the topic.

A model of consensus formation for reconciling nursing's disciplinary matrix

With questions raised as to whether or not nursing knowledge should be developed from extant conceptual/theoretical models or from practice-based environments, this paper utilizes Kuhn's disciplinary matrix and Laudan's model of consensus formation to explore the changing nature of the discipline's structural matrix. Kuhn's notion that a discipline's structural matrix includes symbolic generalizations, models and exemplars, and Laudan's view that a maturing discipline embraces factual, methodological, and axiological (goals and aims) knowledge, and that context and discourse are also involved in advancing a discipline is described as a means for reconciling the source of nursing knowledge. This paper posits that shared axiological goals connect both theorists and practitioners, and resolve potential conflicts as to viable sources of nursing knowledge. Through shared goals that include humanization, meaning, quality of life, caring, consciousness, transcendence, and presence, which bridge both theoretical and practice approaches, nursing's charge to contribute to the good of society is fulfilled.

The research evidence published in high impact nursing journals between 2000 and 2006: a quantitative content analysis

BACKGROUND

Evidence-based practice has become an imperative for efficient, effective and safe practice. Furthermore, evidences emerging from published research are considered as valid knowledge sources to guiding practice.

OBJECTIVES

The aim of this paper is to review all research articles published in the top 10 general nursing journals for the years 2000-2006 to identify the methodologies used, the types of evidence these studies produced and the issues upon which they endeavored.

DESIGN

Quantitative content analysis was implemented to study all published research papers of the top 10 general nursing journals for the years 2000-2006.

METHODS

The top 10 general nursing journals were included in the study. The abstracts of all research articles were analysed with regards the methodologies of enquiry, the types of evidence produced and the issues of study they endeavored upon. Percentages were developed as to enable conclusions to be drawn.

RESULTS

The results for the category methodologies used were 7% experimental, 6% quasi-experimental, 39% non-experimental, 2% ethnographical studies, 7% phenomenological, 4% grounded theory, 1% action research, 1% case study, 15% unspecified, 5.5% other, 0.5% meta-synthesis, 2% meta-analysis, 5% literature reviews and 3% secondary analysis. For the category types of evidence were 4% hypothesis/theory testing, 11% evaluative, 5% comparative, 2% correlational, 46% descriptive, 5% interpretative and 27% exploratory. For the category issues of study were 45% practice/clinical, 8% educational, 11% professional, 3% spiritual/ethical/metaphysical, 26% health promotion and 7% managerial/policy.

CONCLUSIONS

Published studies can provide adequate evidences for practice if nursing journals conceptualise evidence emerging from non-experimental and qualitative studies as relevant types of evidences for practice and develop appropriate mechanisms for assessing their validity. Also, nursing journals need to increase and encourage the publication of studies that implement RCT methodology, systematic reviews, meta-synthesis and meta-analysis methodologies. Finally, nursing journals need to encourage more high quality research evidence that derive from interpretative, theory testing and evaluative types of studies that are practice relevant.

Practitioner as Theorist

This column addresses the idea of practitioner as theorist as it may inspire new paths of theory development in practice for nursing. Historical and philosophical dimensions of theory development are discussed. Extant theory development strategies as well as new approaches for practice-based theory development are proposed.