Knowledge Development and Nursing Science [TFN]

Approaches to knowledge development have three facets

Ontology, epistemology, and methodology

Development of nursing knowledge reflects the interface between

Nursing science and research

The ultimate purpose of knowledge development is to improve

Nursing practice

Refers to the study of being what is or what exists

Ontology

Refers to the study of knowledge or ways of knowing

Epistemology

Is the means of acquiring knowledge

Methodology

It is the branch of philosophy that studies the nature of reality, existence, and being.

Ontology

Ontology answers the question

What is real? What exist?

The word ontology comes from the Greek words

Ontos meaning being or existence, logos meaning study

Major ontological perspectives

Realism and relativism

Reality exists independently of human perception. There is one objective reality that can be observed and measured.

Realism

A patient's body temperature of 39°C is an objective fact, regardless of how the patient feels.

Realism

Realism is usually associated with

Positivism, quantitative research, experimental studies

Reality is constructed by individuals based on their experiences, culture, beliefs, and social interactions. Therefore, there may be multiple valid realities.

Relativism

Two patients with the same diagnosis of cancer may experience fear, hope, and coping differently because of their unique life experiences.

Relativism

Characteristics of realism

Reality is objective

Facts exist regardless of personal beliefs

Reality can be measured scientifically

Characteristics of relativism

Reality is subjective

People's experiences differ

Context influences understanding

Relativism is usually associated with

Constructivism, phenomenology, and qualitative reasearch

In nursing, it influences how nurses understand patients, health, illness, and care.

Ontology

Nurses assess measurable data such as

Blood pressure, heart rate, oxygen saturation, laboratory results

Nurses also recognize patients personal experiences, such as:

Pain, anxiety, hope, quality of life, and spiritual well-being

Has one objective reality

Realism

Has multiple subjective reality

Relativism

Does early ambulation reduce the length of hospital stay after surgery?

Quantitative study

What is the lived experience of patients recovering from heart surgery?

Qualitative study

It question what is reality?

Ontology

It question how do we know reality?

Epistemology

It question how should we study reality?

Methodology

Is pain an objective phenomenon or a subjective experience?

Ontology

Through measurement, observation, interviews, or experience?

Epistemology

Quantitative, qualitative, or mixed methods?

Methodology

Understanding ontology helps nurses and researchers

Select appropriate research methods.

Understand different views of health and illness.

Respect patients’ unique experiences.

Deliver holistic, patient-centered care.

Interpret research findings appropriately.

Integrate objective evidence with subjective patient experiences.

Is the philosophical study of reality and existence.

Ontology

In nursing, it helps explain what is considered “__” about health and illness.

Real

Nurses recognize that healthcare involves both

Objective realities and subjective realities

Appreciating both perspectives supports , ___, ___, ____ nursing care.

Holistic, evidence-based, person-centered

Is the branch of philosophy that studies knowledge.

Epistemology

Epistemology asks

How do we know what we know?

Epistemology examine

Where knowledge comes from, how knowledge is acquired, what makes knowledge reliable, and what are the limits of knowledge era.

Several basic types of knowledge

Empirics, personal knowledge, intuitive knowledge, somatic knowledge, metaphysical (spiritual) knowledge, esthetics, and moral or ethical knowledge

The scientific form of knowing. Comes from observation, testing, and replication.

Empirics

A prior knowledge. Pertains to knowledge gained from thought alone.

Personal knowledge

Why is personal knowledge important?

It is what gives people their own view and opinion

Includes feelings and hunches. It is not guessing but relies on non-conscious pattern recognition and experience.

Intuitive knowledge

Knowledge of the body in relation to physical movement. It includes experiential use of muscles and balance to perform a physical task.

Somatic knowledge

Somatic or embodied knowing is __ that involves

Experiential knowledge; senses, perceptions, and mind-body action and reaction

Seeking the presence of a higher power. Aspects of spiritual knowing include magic, miracles, psychokinesis, extrasensory perception, and near-death experiences.

Metaphysical (spiritual) knowledge

Example is the study of God versus the Big Bang Theory

Metaphysical (spiritual) knowledge

The definition of metaphysics is a field of philosophy that is generally focused on how __ and the _ began.

Reality; universe

Knowledge related to beauty, harmony, and expression. It incorporates art, creativity, and values.

Esthetics

Aesthetic knowing in nursing is a way of knowing realities that are not __ the deep meanings in a situation.

Empirically observable

As a method of assessment and intervention, aesthetics provides unique means through which clients and nurses can explore __ of aspects of their world and fosters a creative sense of _.

Personal perceptions; self-awareness

Knowledge of what is right and wrong. Values and social and cultural norms of behavior are components.

Moral or ethical knowledge

Refers to those standards that impose the reasonable obligations to refrain from rapes, stealing, murder, assault, slander, and fraud.

Ethics

Include those that enjoin virtues of honesty, compassion, and loyalty.

Ethical standards

Has been defined as the study of the origins of nursing knowledge, it's structure and methods, the patterns of knowing of its members, and the criteria for validating it's knowledge claims.

Nursing epistemology

Is the study of how nursing knowledge is acquired, developed, validated, and applied.

Nursing epistemology

Nursing epistemology asks

How do nurses know what they know?

Nursing epistemology examines what counts as a __ and _ nursing knowledge and how nurses can justify their beliefs, decisions, and actions in practice.

Valid, trustworthy

Identified four fundamental patterns for nursing knowledge

Carper (1978)

Four fundamental patterns for nursing knowledge

Empirics, esthetics, personal knowledge, and ethics

The science of nursing

Empirics

The art of nursing

Esthetics

Moral knowledge in nursing

Ethics

Is objective, abstract, generally quantifiable, exemplary, discursivekly formulated, and verifiable.

Empirical knowledge

When empirical knowledge is verified through repeated testing over time, it is formulated into __ that explain and predict.

Scientific generalizations, laws, theories, and principles

Empirical knowledge draws on traditional ideas that can be verified though __ and proved by _.

Observation; hypothesis testing

It tends to be the most emphasized way of knowing in nursing because there is a need to know how knowledge can be organized into laws and theories for the purpose of describing, explaining, and predicting phenomena of concern to nurses.

Empirical knowledge

Is expressive, subjective, unique, and experiential rather than formal or descriptive.

Esthetic knowledge

It includes sensing the meaning of a moment. It is evident through actions, conduct, attitudes, and interactions of the nurse in response to another.

Esthetics

Esthetic knowledge relies on

Perception

Refers to the way in which nurses view themselves and the client.

Personal knowledge

Is subjective and promotes wholeness and integrity in personal encounters.

Personal knowledge

__, rather than detachment, is a component of personal knowledge.

Engagement

Because personal knowledge is difficult to express linguistically, it is largely expressed in

Personality

Refers to the moral code for nursing and is based on obligation to service and respect for human life.

Ethics

Occurs as moral dilemmas arise in situations of ambiguity and uncertainty and when consequences are difficult to predict.

Ethical knowledge

They stress that integration of all patterns of knowing is essential for professional nursing practice and that no one pattern should be used in isolation from others.

Fawcett, Watson, Neuman, Walkers, and Fitzpatrick (2001)

Observed that Carper's work did not incorporate practical knowledge into the ways of knowing in nursing.

Schultz and Meleis (1988)

Three patterns of knowledge

Clinical, conceptual, and empirical

Refers to the individual nurse's personal knowledge. It results from using multiple ways of knowing while solving problems during client provision.

Clinical knowledge

Clinical knowledge is manifested in the acts of practicing nurses and results from combining

Personal knowledge and empirical knowledge

Clinical knowledge also include

Intuitive and subjective knowing

Is abstracted and generalized beyond personal experience. It explication ptterns revealed in multiple client experiences, which occur in multiple situations, and articulates the as models or theories.

Conceptual knowledge

In conceptual knowledge, concepts are drafted and relational statements are formulated. Propositional statements are supported by __ or defended by _.

Empirical or anecdotal evidence; logical reasoning

Results from experimental, historical, or phenomenologic research and is used to justify actions and procedures in practice.

Empirical knowledge

The __ of empirical knowledge rests on the degree to which the researcher has followed procedures accepted by the community of researchers and on the logical, unbiased derivation of conclusions from the evidence.

Credibility

Empirical knowledge is evaluated through __ and _ of published research and _.

Systematic review, critique, conference presentations

Also expanded on Carper's patterns of knowing to include __ what they designate as the _.

Chinn and Kramer (2011); emancipatory knowing; praxis of nursing

Refers to the human’s ability to critically examine the current status quo and to determine why it currently exists.

Emancipatory knowing

State that in nursing, synthesis of theories derived from different sources of knowledge.

Kidd and Morrison (1988)

Synthesis of theories derived from different sources of knowledge will

Encourage the use of different types of knowledge in practice, education, theory development, and research.

Encourage the use of different methodologies in practice and research.

Make nursing education more relevant for nurses with different educational backgrounds.

Accommodate nurses at different levels of clinical competence.

Ultimately promote high-quality client care and client satisfaction.