LECTURE NOTES ON SOURCES OF ACQUIRING KNOWLEDGE
GUIDED GUID ED BY:
PREPARED BY:
Mrs. .Prema.P Principal N.C.O.N Raichur
Ms. Remya Mathews I M.Sc (N) N.C.O.N Raichur
SUBMITTED ON : 10-8-09
METHODS OF ACQUIRING KNOWLEDGE INTRODUCTION
Knowledge is a complex, multifaceted concept. Information sources for for clin clinic ical al prac practi tice ce vary vary in depe depend ndab abil ilit ity y and and vali validi dity ty.. A brie brief f discus dis cussio sion n of some some alter alternat native ive sour sources ces of eviden evidence ce shows shows how resea researc rch h based based infor informa matio tion n is differ different ent.. Nursi Nursing ng has his histor torica ically lly acquir acquired ed
knowl knowledg edge e
throug through h
tradit tradition ions, s,
author authority ity,,
exper experien ience, ce,
borrowing, trial and error, role modelling and mentorship, intuition, reasoning and research.
SOURCES OF ACQUIRING KNOWLEDGE
TRADITION
tradition’ means “ a long established custom “ or “ the − The word ‘ tradition’ passing on of customs or beliefs from generation to generation “
− Many Many ques questi tion ons s are are answ answer ered ed and and prob proble lems ms solv solved ed base based d on inherited customs or traditions
− Traditions include truths on beliefs that are based on customs and past trends
− Tradi Traditions tions can positivel positively y influence influence nursing nursing practice practice because because they were developed from past experiences
− Trad Traditi itions ons can also also narro narrow w and and limi limitt the knowl knowledg edge e sought sought for nursing practice − The nurses on patient care units quickly inform new staff members
about the accepted or traditional behaviour of the unit
Eg: The idea of providing a patient with a clean, safe, well ventilated environment environment originated with Florence Nightingale( 1859 ).
Advantages source − It is efficient as an information source
− Tradition Tradition or custom also facilitates communication communication by providing providing a common foundation of accepted truth
Disadvantages
− Tradition may interfere with the ability to perceive alternatives − There is growing concern that many nursing interventions are based on tradition , customs and “ unit culture” rather than on sound evidence − Traditions are difficult to change because they have existed for long
periods of time and are frequently supported by people with power and authority
− Many traditions have not been evaluated or tested for accuracy or efficiency
− Traditions that have not been supported through research tend to be persist
AUTHORITY authority ‘ means ‘ a person or body with special power ‘ power ‘ − The term ‘ authority ‘ −
An authorit authority y is a person with with expertis expertise e and power who who is able to influence opinion and behaviour
− There are authoritative people who will give decisions in making judgment on an issue by virtue of specialized training or experience where we had no direct experience −
Knowledge acquired from authority is illustrated when one person credits another person as the source of information
− Nurs Nurses es who who publ publis ish h arti articl cles es and and book books s or deve develo lop p theo theori ries es are are frequently considered authorities −
An expert is only an authority when addressing his or her area of expertise
− Authorities in nursing must have both expertise and power
Advantages Authoriti ities es will will give give guidan guidance ce and specia speciali lized zed train training ing in fields fields − Author where we had no direct experience
Disadvantages −
Knowledge obtained from these authorities can be inaccurate
− Knowledge acquired from these authorities has frequently not been validated and although it may be useful , it must be verified through research
EXPERIENCE −
Experience means practical ‘practical involvement in an activity, event etc’. etc’.
− Experience represent represent a familiar and functional source of knowledge − Personal Personal experience involves gaining knowledge by being personally involved in an event , situation or circumstance Eg: Two or three cardiac patients follow similar post operative sleep patterns. This observation may lead to some interesting discoveries with implications for nursing interventions.
Benner
(
1984
)
described
5
levels
of
experience
in
the
developmental of clinical knowledge and expertise i.e.
− Novice − Advanced beginner − Competent − Proficient − Expert Novice nurses have no personal experience in the work that they are to perfor form , but they have pre conceived notions and expectations about clinical practice that are challenged, refined , confir confirmed med or dis discon confir firme med d by person personal al exper experien ience ce in a clini clinical cal settings
The advanced beginner has just enough experience to recognize and intervene in recurrent situations. eg: The advanced beginner nurse is able to recognize and intervene to meet patients mobility needs.
Competent nurses
frequently have been on job from 2 years to 3
years and often their personal experiences enable them to generate and and achi achiev eve e long long rang range e goal goals s and and plan plans. s. Thr Through ough expe experi rien ence ce,, comp compet eten entt nurs nurse e is able able to us use e pers person onal al know knowle ledg dge e to tak take conscious, deliberate actions that are efficient and organized.
Proficient nurse views the patient as a whole and as a member of a family family and
communit community y. The proficie proficient nt nurse recognizes recognizes that each
patient and family respond differently to illness and health.
The expert nurse has an extensive background of experience experience and is able to identify accurately and intervene skillfully in a situation. The dynamics of expert nursing practice need to be clarified through research.
Advantages
− Experience is the foundation and stimulus for learning − Learners actively construct their experience − Learning occurs during personal experience and enables the nurse to cluster ideas in to a meaningful whole nursin ing g pers person onal al exper xperie ienc nce e enab enable les s one one to gain gain skil skills ls and and − In nurs expe expert rtis ise e by prov provid idin ing g care care to pati patien ents ts and and fami famili lies es in clin clinic ical al settings
Disadvantages
− Each individuals experience is fairly restricted −
Another limitation of experience is that the same objective event is usually experienced or perceived differently by two individuals.
BORROWING −
Borrowing in nursing involves appropriation and use of knowledge from other fields or disciplines to guide nursing practice
− Some nursing leaders have described part of nursing knowledge as information borrowed from disciplines such as medicine, sociology, psychology, physiology and education
Nursing has borrowed in to two ways,
1) Some nurses have taken information from other disciplines and
applied it “ directly “ to nursing practice. This information was not integrated within the unique focus of nursing. eg: Some nurses have used the medical model to guide their nursing practice, thus focusing on the diagnosis and treatment of disease.
2) Another Another way of borrow borrowing ing is the integration integration of informat information ion from othe otherr disc discip ipli line nes s with within in the the focu focus s of nurs nursin ing g whic which h is mor more functional in nursing
Advantages
− Borro Borrowi wing ng helps helps nurses nurses use advanc advances es in techno technolog logy y to becom become e highly specialized and focused on the detection and treatment of disease to the exclusion of health promotion and illness prevention.
Disadvantages
− Since disciplines share knowledge , it is sometimes difficult to know where the boundaries exist between nursing knowledge based and that of other disciplines
− Borrowed knowledge has not been adequate for answering many questions generated in nursing practice
TRIAL AND ERROR − In this approach , alternatives are tried successively until a solution to a problem problem is found
− Trial and error is an approach with unknown outcome used in a situ situat atio ion n of unce uncert rtai aint nty y , when when othe otherr sour source ce of know knowle ledg dge e are are unavailable
Eg: May patients dislike the taste of potassium chloride solution. Nurses try to disguise the taste of the medication in various ways until one method meets with the approval of the patient.
Advantages
− Trial and error offer a practical means of securing knowledge −
Due to its uncertainty , nurses must use trial and error in providing nursing care
Disadvantages
− Ther There e is freq freque uent ntly ly no form formal al docu docume ment ntat atio ion n of effe effect ctiv ive e and and ineffective nursing actions
− Using Using this this strate strategy, gy, knowle knowledge dge is gained gained from from exper experien ience ce but it often not shared with others
− The trial and error way of acquiring knowledge can also be time consuming , because multiple interaction might be implanted before one is found to be effective
− Ther There e is also also a risk risk of impl implem emen enti ting ng nurs nursin ing g acti action ons s that that are are detrimental to a patients health
− This This metho method d is haphaz haphazar ard d and the knowle knowledge dge obtain obtained ed is often often unrecorded unrecorded and hence inaccessible in subsequent clinical studies
ROLE MODELLING AND MENTORSHIP −
Role modelling is learning by imitating the behaviour of an exemplar
−
An exemplar or role model is viewed as knowing the appropriate and rewarded roles for a profession and the roles reflect the attitudes and include the standards and name of behaviour for that profession
−
An intense form of role modelling is Mentorship
−
In a ment mentor orsh ship ip,, the the expe expert rt nurs nurse e serv serves es as a teac teache herr sp spon onse serr guide, exemplar exemplar and counselor for the novice nurse
− There is an investment of time and active involvement that results
in a close, personal mentor-mentee relationship. This relationship
promotes promotes a mutual exchange of ideas and aspirations relative to the mentee’s care plans. The mentee assumes the values, attitudes and behavi behaviour our of the mentor mentor while while gainin gaining g intui intuitiv tive e knowle knowledge dge and personal experience
Advantages enables s novice novice nurses nurses to learn learn throug through h intera interacti ction on with with or to − It enable follow examples set by expert nurses
− The mentor – mentee relationship promotes a mutual exchange of ideas and aspirations relative to the mentee’s career plans
− Mentorship is essential for building research research competence in nursing Exam xamples ples
of
role
mode odels:ls:-
Admir dmired ed
teach eacher ers s,
pract ractiioner oners s,
resea researc rcher hers, s, illust illustrio rious us indivi individua duals ls who ins inspir pire e studen students ts throug through h their examples.
Disadvantages
− Both Both the ment entor and and ment entee inves nvestt equa equall tim time and and acti active ve involv involvem ement ent which which resul results ts in a close, close, person personnel nel mento mentorr-ment -mentee ee relationship
INTUITION −
Intuition means ‘ acquiring knowledge by ourselves’ ourselves’
− It is a type of knowledge that cannot be explained on the basis of reasoning reasoning or prior instruction
− Intuition is an insight on understanding of a situation or event as a whole that usually cannot be logically explained
− The knowledge is incorporated so deeply within that it is difficult to bring it consciously to the surface and express it in a logical manner
− Even though intuition is often unexplained, it has some important scientific uses
Advantages −
Intuition is the result of deep knowledge
− A burs burstt of intu intuit itio ion n may may iden identi tify fy a prob proble lem m for for stud study, y, indi indica cate te,, impor portant tant valu alues for for measu easurre or link two two idea deas toge ogether ther in interpreting interpreting the findings
Disadvantages
− Intuition cannot be explained with ease scientifically and people are uncomfortable with it
− Intuition is unexplainable unexplainable − It is difficult to develop policies and practices for nurses on the basis of intuition −
Intuition is generally considered unscientific and unacceptable for use in research
REASONING
Introduction Reasoning is the processing and organizing of ideas in order to reach conclusions. Through reasoning people are able to “make sense” of both their thoughts and experiences. experiences.
Types of reasoning
Reasoning Reasoning is also classified by the discipline of logic into,
− Inductive
Bandman and Bandmann, 1988 , Chin &
− Deductive
Krawmer 1991
Inductive reasoning
− It
is
the
process
observations.
of
developing
generations
from
specific
Eg: The nurse may observe the anxious behaviour of ( specific ) hospit hospitali alized zed childr children en and conclu conclude de that that ( in genera generall ) childr children’ en’s s separation from their parents is stressful
Deductive Reasoning process ss of develo developin ping g specif specific ic predi predicti ctions ons from from genera generall − It is the proce principles Eg. If we assum assume e that that separa separatio tion n anxiet anxiety y occurs occurs in hospit hospitali alized zed chil childr dren en ( in gene genera rall ), then then we migh mightt pred predic ictt that that ( sp spec ecif ific ic ) childr children en in memor memorial ial Hospit Hospital al whose whose parent parents s do not roomroom-in in will will manifest symptoms of stress.
Advantages and Disadvantages Both systems of reasoning are useful as a means of understanding and organizing phenomena and both play a role in nursing research. However reasoning in and of itself is limited because the validity of reasoning depends on the accuracy of the information with which one starts and reasoning may be an insufficient basis for evaluating accuracy.
Patterns of reasoning
− Patterns of reasoning are used to develop theories and to plan and implement research
− Steven Stevens s identi identifie fied d 4 patter patterns ns of reasoni easoning ng as being being essent essential ial to nursing, i.e, 1) Prob Proble lema mati tic c 2) Oper Operat atio iona nall 3) Dial Dialec ecti tic c 4) Logis ogisti tic c
Problematic Reasoning
Probl Problem emati atic c reaso reasonin ning g involv involves es identi identify fying ing a probl problem em and the factor factors s influencing the problem, selecting solutions to the problems and resolving the problem. For eg: Nurse Nurses s uses uses probl problema ematic tic reaso reasonin ning g in the nursin nursing g proce process ss to identi identify fy nursi nursing ng diagn diagnosi osis s and and to imple impleme ment nt nursin nursing g interv intervent ention ions s to resolve these problems.
− Prob Proble lema mati tic c reaso easoni ning ng is also also evid eviden entt in the the iden identi tifi fica cati tion on of a research problem
Operational Reasoning
− Operational reasoning involves the identification and discrimination betw betwee een n many many alte altern rnat ativ ives es or view view poin points ts.. The The focu focus s is on the the process ( debating alternatives ) rather than on resolution
− Nurses rses
uses us es
oper perati ational nal
reaso easoni nin ng
in
deve devellopin ping
reali ealis stic, tic,
measurable goals with patients and families
− Debating which measurement methods on data analysis technique to use in a study requires operational thoughts
Dialectic Reasoning
− Dialectic reasoning reasoning involves looking at situations in a holistic way − A dialectic thinker believes that the whole is greater that the sum of the parts and that the whole organizes the parts For eg: A nurse using dialectic reasoning would view a patient as a person with strength and weakness who is experiencing illness.
− Dialectic reasoning reasoning also includes examining examining factors that are opposite and making sense of them by merging them in to single unit or idea , which is greater g reater than either alone Eg: Analy Analyzin zing g studie studies s with with confli conflicti cting ng findin findings gs and summar summarizi izing ng thes these e find findin ings gs to dete deterrmine mine the the cur current ent know knowle ledg dge e base base for for a research problem requires dialectic reasoning
Logistic Reasoning
− The aim of logistic is to determine truth or to explain and predict phenomena
− Logistic reasoning reasoning is used to break the whole into parts and that can be carefully examined as can the relationship among the parts −
Logistic reasoning is the opposite of dialectic reasoning
−
A logistic reasoner assumes that the whole is the sum of the parts and the part organize the whole
− Logistic reasoning is uses frequently in research to select a study design design,, plan plan and imple implemen mentt data data collec collectio tion n and select select analys analysis is technique
Eg: Eg: A pati patien entt stat states es that that sh she e is cold cold and and the the nurs nurse e logi logica call lly y examines the following parts and their relationships, 1) Room temp tempera eratur ture e 2) Patient atient temper temperatu ature re 3) Patient atients s cloth clothing ing 4) Patient atient activi activity ty
CONCLUSION
Acquiri Acquiring ng knowledge knowledge through through tradition tradition,, authority, authority, borrowin borrowing, g, trial trial and and err error, or, pers person onne nell expe experi rien ence ce,, roleole-mo mode dell llin ing, g, intu intuit itio ion n and and reasoning is important in nursing. However these ways of acquiring knowledge are inadequate in providing a scientific knowledge base for nursing. Research is needed to generate new, accurate scientific
infor informa matio tion n to direct direct nursin nursing g practi practice. ce. Becaus Because e the knowl knowledg edge e nurses nurses need is not only narr narrow ow and specific specific but also broad broad and holis holistic tic,, a variet variety y of resear esearch ch method methods s are are needed needed to genera generate te nursing knowledge. Thus knowledge is acquired is a variety of ways and is expected to be an accurate reflection of reality.
REFERENCE
−
Denise. Denise. F.Polit .Polit,, Cheryl Cheryl Tatano Beck, Nursing Nursing Research esearch – Principl Principles es and and meth method ods, s, 7th Edition, Edition, Wolters olters Kluwer Kluwer company company publicati publications, ons, page. No. 11-13
−
Nanc Nancy y
Burn Burns, s,
Susa Susan. n.K. K.Gr Groo oove ve,,
Prac Practi tice ce
of
Saunder Elsevier, 5th Edition, Page.no.6-7,10-12 Page.no.6-7,10-12
− www.google.com
Nurs Nursin ing g
Resea esearc rch, h,
