Nursing Knowledge

Ways of Knowing/ Historical Perspective of Nursing:

>Silent Knowledge:

• Recognition of formal training of nurses

• Most schools were under the control of hospital

• Managed by hospital administrators and physicians

• Education and practice were based on apprenticeship, form of education.

• Rapid growth in the number of hospital bees training programs for nurses

• Focus was on acquisition of technical skills.

• Theory was taught by physicians and practice was taught by experienced nurses

• Emphasis was on carrying out physicians, orders

• Nurses largely adhered to the medical model, which views body and mind separately and focuses on cure and treatment of pathologic problems

• Nurses were seen as inexpensively, or were thought to be submissive and obedient, and they learned to fulfill their responsibilities to physicians without questions

>Received Knowledge:

• Serious nursing shortages at 1940s into the 1950s

• Nursing education at universities was recommended as opposed to the hospital base training

• Professional organizations for nurses were restructured and begin to grow

• The American nurses association started programs for nursing education

• State licensure testing for registration was started

• Books on research method and explicit theories of nursing begin to appear.

• Doctoral programs in nursing started originating

• The journal nursing research was first published.

• Slow but steady increase in graduate nursing education programs

>Subjective Knowledge:

• Nurse role as leader emerge

• Number of nurse theorists emerge in late 1950s to 1960s

• Provided independent conceptual framework for nourishing education and practice

• Approaches to theory development, were direct observation of practice insights from existing theories and other literature, sources and insights derived from explicit philosophical perspective about nursing and the nature of health and human experience

• Early theories worked at their garage by a functional view of nursing and health. They attempted to define what nursing is, describe the social purpose of nursing service, explain how nurses function to realize these purpose, and identify parameters and variables that influence illness and health

• Their descriptions of nursing and nursing models evolved from their personal professional and educational experience and reflected their perception of ideal nursing practice

>Procedural Knowledge:
• Nursing profession was started to be viewed as scientific discipline, evolving towards a theory based practice.

• Several nursing theory conference were held

• National league for nursing implemented a requirement of conceptual frameworks for nursing curricula led to publication of many nursing theorists beliefs and ideas about nursing and some developed conceptual models

• Nurses debate, whether there should be one conceptual model for nursing or several models to describe the relationships among the nurse, client environment and health

• Books were written for nurses. On how to critique, develop and apply nursing theories • Graduate schools develop courses on analysis and application of theory and researchers identified nursing theories as conceptual frameworks for their studies

• Theories moved to characterizing nursing's roles from "what nurses do" to "what nurses is" this changed nursing from a context-dependent, reactive position to a context- independent proactive arena.

>Constructed Knowledge

• Scholars begin to concentrate on theories that provide a meaningful foundation of nursing practice.

• There was a call to develop substance in theory and to focus on nursing concepts, grounded in practice and linked to research

• Attention shifted from grand theories to middle-range theories, as well as the application of theory in research and practice.

• The idea of evidence-based practice (EBP) was introduced and addressed to the gap in research and practice

• Graduation education in nursing continued to grow and introduced programs of Advanced Practice Nurses(APN) and Doctor of Nursing Practice (DNP)

• DNP was based on recognition of the need for expanded competencies due to the increasing complexity of clinical practice, enhanced knowledge to improve nursing practice and outcomes, and promotion of leadership skills.

• This saw an increasing emphasis on philosophy and philosophy of science in nursing

>Integrated Knowledge

• In the second decade of the 21st century, there has been significant attention to the need to direct nursing knowledge development towards clinical relevance to fill "relevance gap."

• It has been observed that a significant portion of research supports practice imperfectly, infrequently, and often insignificantly, the primary goal of nursing research is to produce knowledge that supports practice

• In the current stage of knowledge development, considerable focus is on EBP and translational research.

Historical era of nursing knowledge

>Curriculum era

Major question: What curriculum content should student nurses study to be nurses?
Emphasis: Courses included in nursing programs
Outcomes: Standardized curricula for diploma programs
Emerging goal: Develop specialized knowledge and higher education

>Research era

Major question: What is the focus for nursing research?
Emphasis: Role of nurses and what to research
Outcomes: Problem studies and studies of nurses
Emerging goal: Isolated studies do not yield unified knowledge

>Graduate education era

Major question: What knowledge is needed for the practice of nursing?
Emphasis: Craving out an advanced role and basis for nursing practice
Outcomes: Nurses have an important role in health care
Emerging goal: Focus graduate education on knowledge development

>Theory era

Major question: How do these frameworks guide research and practice?
Emphasis: There are many ways do to think about nursing
Outcomes: Nursing theoretical works shift the focus to the patient
Emerging goal: Theories guide nursing research and practice

>Theory utilization era

Major question: What new theories are needed to produce evidence of quality care?
Emphasis: Nursing theory guides research, practice, education, and administration
Outcomes: Middle-range theory may be from quantitative or qualitative approaches
Emerging goal: Nursing frameworks produce knowledge (evidence) for quality care